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Disposing of liquid and solid medical waste from the operating suite is a task that every healthcare facility must perform with an eye toward efficiency and cost effectiveness while protecting healthcare workers from exposure to pathogenic bacteria and viruses. These workers are often exposed to hepatitis B virus (HBV), human immunodeficiency virus (HIV) and other dangerous bloodborne pathogens on a daily basis. Through the institution of safe work practices and engineering controls, healthcare providers’ exposure can be significantly reduced.
ICT asked members of industry to share their thoughts on key points and best practices to remember regarding the capture and disposal of infectious body fluids to prevent occupational exposure. Our respondents are:
Bill Merkle, president, MD Technologies
Terri Clouse, RN, CNOR, clinical specialist and national sales manager, Bemis Health Care
Russell D’Anna, business development leader for spill control, Multisorb Technologies
Merkle: Key points include:
-- Infection prevention should have highest priority in performing medical procedures.
-- Risk of exposure to infectious fluids increases with each added step in disposal process.
-- Fluid collection and disposal should isolate staff from exposure to infectious fluids.
-- Spilled fluids present a challenge of protecting staff during the collection process.
-- Floor drains and hoppers offer effective, low-cost disposal with low protection.
-- Protective equipment (masks, gloves, gowns, etc. should be used to reduce exposure.
-- Direct fluid disposal affords maximum staff isolation from exposure.
Best practices include:
-- Dispose of fluid as quickly as possible from the surgical field.
-- Dispose of items exposed to fluid to prevent further exposure by staff.
-- Exercise care and use protective equipment when handling potentially infectious fluid.
-- Collect and dispose of spilled fluid as soon as possible
-- Minimize system cost by minimizing necessary system accessories and disposables.
-- Conduct system maintenance diligently to assure satisfactory system performance.
Disposing of fluid directly to drain from the suction field is by far the most cost-effective solution. Such disposal also minimizes possibility of staff or patient contamination due to inadvertent contact with fluid. Closed systems are available to collect and dispose of fluid. These systems collect fluid from the suction field, and dispose of fluid directly down the drain to sanitary sewer. These systems have advantages over systems which require fluid to be transported to a central disposal site because the transport process introduces additional steps where exposure to fluid can occur. Select equipment that meets fluid management needs of the facility and procedures anticipated. A lower-cost system may provide excellent fluid management for all but a few procedures. Organize surgical suites to use higher-cost systems only where fluid management cannot be achieved with lower-cost equipment, and conduct specialty procedures in those areas. Determine feature requirements such as fluid volume totalizing, and select equipment that offers such features. Evaluate space requirements in the procedure/operating room, and select systems compatible with space constraints and traffic patterns in the surgical suite. Collecting spilled fluid from drapes or the floor present important safety considerations in preventing slips and falls as well as minimizing risk of staff exposure. Carefully consider performance of available devices as well as costs when deciding on a solution for your facility. When determining comparative ROI to select a system, consider cost savings over greater than one year to accommodate systems with higher initial capital investment. Some systems require higher initial costs, but later have fewer disposables, offering lower expenses in the long term. Cost payback may be longer than one year for these. In determining relative system expenses, maintenance and costs of protective equipment must be considered.
Clouse: Safe handling of infectious fluid waste should not be taken lightly. One of the greater concerns today regarding disposal of suction canister contents is the high occurrence of bloodborne pathogen exposure for healthcare personnel. This concern has lead to the increased regulations by OSHA, the EPA, and the CDC for disposal of infectious fluids. Keeping the patients and staff safe is the No. 1 priority. Care should be taken when assembling the canisters and connecting to a tandem method. Maintaining equipment will prevent malfunctions and reduce exposure to the fluid. Fluid should never be handled without the proper protection being worn and safety measures in place to prevent spilling. All ports should be capped and lids should be secure on the canisters before transporting. While pouring the contents of a canister down a drain and into the sanitary sewer system is still used by many facilities, it causes aerosolization and splashing can occur exposing the employee to costly treatment. OSHA requires engineering controls such as using PPE when performing this function. Placing used canisters in red bag waste is dangerous and expensive. Canisters can leak or even break, adding increased risk to employees transferring the bags to a pick-up site. Solidifying the canister contents is another option but this adds great cost to the disposal method, does nothing to eliminate the weight issues, and the fluid may not be adequately treated. Fluid waste management systems are becoming very popular in the health care setting but can be costly and often not flexible enough for the entire facility. Most of these systems are considered “closed” which significantly reduces exposure to infectious waste. Some units use canisters and others consist of a large collection tank. Extensive evaluation should be done before committing to a system that may not fulfill all facility requirements. Much can be done to eliminate problems in disposing of fluid waste and preventing exposure. Products must be evaluated for safety, ease of use, and performance. In this economy, hospital management is asking for costs to be cut wherever possible but we must still think of the patient and staff dealing with this dangerous liquid. Every aspect of disposal should be looked at and evaluated for safety. Purchased products should be tracked and put into service only after ensuring user training. Practices for disposing of the waste should be adhered to without deviation. Feedback from employees is important to periodically review the process. Exposures should be reported immediately for evaluation and possible treatment.
D’Anna: There are several key points to remember to prevent occupational exposure when capturing the waste in fluid containment structures like a suction canister unit, sharps container unit, or kick bucket. The medical facility needs to research and follow the regulations that are in place for the proper handling, transport and disposal of bio-waste that is generated. In addition, the medical center should verify with its staff members, landfill operators and medical waste haulers on which treatment and disposal methods are most desired or accepted. An analysis of the volume of waste generated per department needs to be performed to determine what the most suitable and safest cost effective measures will be for preventing cross contamination. This will enhance the reduction of occupational exposure to facility staff members. Another key point to minimize occupational exposure is to adhere to the guidelines that are in place by The Joint Commission. The Joint Commission is an organization that accredits and certifies more than 17,000 health organizations and programs in the United States. This organization performs a review of the medical facility to ensure that proper practices are documented and in place to prevent occupational exposure when infectious body fluids are captured and disposed. One of the best and safest practices that a medical facility can utilize is to treat and solidify their bio-waste with a self-bursting solidifying pouch that contains a super absorbent polymer. The solidifier will kill bacteria inside of the fluid containment unit as it congeals the waste which ensures occupational exposure is greatly reduced. The staff member who handles the waste only needs to insert the product into the container containing the body fluids, and then the self-bursting pouch will do the rest of the work. There is no shaking, tearing or pouring required. A pre-measured packet can be used to handle any size fluid containment unit. It is the safest and most cost effective way to prevent occupational exposure. Other options include wall unit machines which are very expensive. A machine typically needs to be purchased in every department where the waste is generated so that handling, treatment and disposal of the bio-fluid can be adequately achieved. A final option is bottled polymer. However, it is more expensive than the solidifying pouch. It is often difficult to measure bottle degradations when the product is being used. Another concern with bottle polymer is the messy aerosol effect and exposure of the super absorbent polymer to the occupational staff member. All treatment methods should be well documented and labeled within the medical facility to ensure adequate prevention of occupational exposure is achieved.