Linda R. Greene, RN, MPS, CIC, director, infection prevention and control for the Rochester (N.Y.) General Health System and APIC board member, discusses 10 things for organizations to know about surgical waste removal systems, and steps to take to prevent bloodborne pathogen transmission to healthcare workers and physicians and surgical site infections for patients.
1. Closed containers most common waste removal system. The typical approach for waste removal after a surgical case is the use of closed (suctioned) containers to hold and move the waste. These containers are typically emptied into a disposable sewer system, and oftentimes that is performed in a decontamination area.
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"You have large containers full of blood and body fluid and then somebody would empty them," says Ms. Greene. "One of the things you find is it's easy to use and inexpensive. The downside is oftentimes it can put people at risk as there's always the potential for spilling and other issues."
2. Waste solidification effective, but expensive. Another option many organizations use for waste removal is waste solidification. In this process, an enzyme is used to turn liquid waste into solid waste, which is then placed into red bag or regulated waste.
"The positive [to this process] is it's fairly efficient," Ms. Greene says. "The negative for an approach like that is those containers are heavy as you've taken a huge container of liquid and made it into a solid. It becomes heavy. It goes into your red bag trash and you now pay by the poundage (or bag) to have the trash removed."
3. Direct-to-drain units growing in popularity. A third approach organizations can consider for waste removal that is garnering more users is a direct-to-drain unit. This is a closed system that suctions out waste and sends it to a central place where it would, essentially, automatically go down a drain using an organization's pumping system, Ms. Greene says.
"These systems are becoming popular, although the initial investment is somewhat expensive," she says. "The waste goes to the docking system and then it's automatically offloaded into your waste management system. It's almost like a plumbing system, in that kind of a simplistic view."
4. Research waste removal system options. Each of these waste removal options has its pros and cons, and organizations should weigh them before investing in one over another or moving forward with a change in system. Not only should cost and efficiency be considered, but organizations will also want to consider the potential for exposure to bloodborne pathogens when handling waste, Ms. Greene says.
5. Regardless of the system used, personnel need protective equipment and safety education. None of the three systems can ensure staff members will not be exposed to bloodborne pathogens during the waste removal process. It is therefore critical for organizations to educate staff members on the proper way to remove waste using the system in a manner most likely to reduce the potential for exposure and to always have protective equipment available, such as a gown, mask, goggles and gloves, Ms. Greene says.
6. Don't neglect goggle use. Goggle use is particularly important for organizations using the closed container waste removal system. "One of the things we find is oftentimes people fail to wear goggles, but splashing and splattering is likely [with containers]," she says. "[Staff members] need to make sure they're being very careful when opening the containers."
7. Use of drains in patients presents infection risks. After a surgical case, physicians will often use drains to prevent the accumulation of fluid underneath the skin. "After you have surgery, there's going to be bleeding around the area [of the incision(s)] and what you don't want is all of that bleeding to occur underneath the skin — you want to have that removed," Ms. Greene says.
The downside of drains from an infection prevention perspective is they provide a direct pathway to an area that is typically sterile. "My skin is my first layer of protection," she says. "If I have surgery, I have some sutures, so I have a little bit of an open wound that allows bacteria to enter. Now you put in a drain and I have almost a direct pipeline into an area that is normally considered more of a sterile area. This can present a risk of infection."
In addition, Ms. Greene says some of the current literature says drains may increase the need for blood transfusions, and there is literature that says patients who require blood transfusion are at a higher risk of infection. "A lot of things that used to part and parcel of medical care, they're really being reexamined," she says.
8. Prolonged use of drains presents additional challenges. "The longer a drain is left in place, there's much more risk of contamination," says Ms. Greene. "As we look at all of these things which are really related to fluid management from a removal perspective, there are definitely practices needed to address the risk of infection."
9. Drains require proper and careful handling. Considering the potential for infection when using drains, Ms. Greene says care providers must ensure sure they are handling drains aseptically. "One needs to be very sure they washed their hands, that they followed very good technique and that the nurse is looking for signs and symptoms of infection when a patient has a drain," she says.
10. Monitor area following drain removal. Drains are typically removed with 24-48 hours, and it is important from an SSI perspective for that area to be monitored closely. "The area should be covered," Ms. Greene says. "There is some definite literature, particularly pertaining to orthopedics, to say an occlusive dressing, a dressing that covers the area like Saran Wrap, should be used to prevent moisture and may be more effective in preventing infection" than other dressings. Some experts recommend three layers of dressing: a non-adhering layer, an absorptive layer and an occlusive dressing.
Linda R. Greene, RN, MPS, CIC, is author of APIC's Guide to the Elimination of Orthopedic Surgical Site Infections (pdf), which details many of the issues discussed in this article. Learn more about APIC.
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