5 Essential Aspects of Fluid Waste Management in a Surgical Facility
First, the employee must always wear personnel protective equipment during the disposal process, no matter the method used. She says the facility should ideally use a fluid waste management system that protects the employee through a number of safeguards. With a management system, the employee generally takes the canister of fluid to a closed system that engages the equipment to prevent exposure to the staff member. The canister is then emptied, and the employee can rinse it, remove it and place it in regular trash. The fluid is then discarded through the sewer system, in keeping with EPA recommendations.
Here she discusses several important aspects of fluid waste management in a surgical facility, including its impact on accreditation, finances and employee satisfaction.
1. Fluid waste management is essential to limit exposure to infection. Fluid waste management limits employees' exposure to infectious fluid waste, Ms. Clouse says. She says many facilities in the United States are still disposing of fluid waste by dumping it down a hopper or a sink — a process that exposes the employee to dangerous infectious material that could splash back from the sink. She says the process of dumping fluid waste down a sink is also bad for the environment. "We want to keep this stuff out of landfills and put it where it's supposed to go, which is in the sewer system," she says.
She says a fluid waste management system, which protects the employee from infection and then discards the fluid waste into the proper location, is essential for employee safety and satisfaction as well as accreditation.
2. Accrediting bodies are looking more closely at fluid waste management. Unlike federal definitions under RCRA, the Joint Commission considers infectious fluid materials hazardous, and has developed a number of criteria for surgical facilities dealing with fluid waste. The use, handling and disposal of hazardous materials and waste must follow applicable local, state and federal regulations under Joint Commission standards, and hospitals must develop written plans that state exactly how they handle fluid waste. OSHA notes that waste should be placed in containers that are closable; made to contain all contents and prevent leakage of fluids during handling, storage, transport, or shipping; properly labeled; and closed prior to removal to prevent spilling.
"The Joint Commission is definitely looking at fluid waste management more closely, as well as the AAAHC," Ms. Clouse says. She says according to Joint Commission guidelines, hospitals and other surgical facilities must create a written plan that follows state guidelines as to how to identify, evaluate and inventory hazardous materials and used or generated waste. Failing to follow regulatory guidelines can have severe financial consequences for surgical facilities, as a failed survey may necessitate hiring a consultant, revamping programs and re-training employees.
3. Training for fluid waste management programs is limited. Ms. Clouse says training for a fluid waste management system is relatively simple and requires little time on the part of the organization. The training should require a few hours of in-service for employees and should simply cover how to use the new system, who should be in charge and why the change is being made. She says generally, surgical facilities delay implementation because of the time and effort required to get employees accustomed to the new processes.
"Nurses don't like change — and I know, because I've been one for a long time," she says. "Especially with OR procedures, they get stuck in their ways. But once they see that it is for their protection, is environmentally safe and is good for the environment, then it's simple and we usually don't have any resistance."
4. All employees should be trained — regardless of seniority or time spent using the equipment. Ms. Clouse recommends training all employees on a new fluid waste management system, especially in an ambulatory surgery center. "When I do the in-services, I generally teach everybody in the facility, especially in facilities where everybody does every job," she says. "It improves efficiency when everyone knows how to use a system, from the director all the way down."
5. Several options are available on the market. Bemis is not the only manufacturer of fluid waste management systems, and Ms. Clouse recommends trialing a few systems to determine which works best for your facility. Staff may have preferences about ease of setup, disposal and reprocessing, as well as noise level, cost of product and allocation of space in the facility.
Different companies have different methods for handling fluid waste; for example, some products create a dam on the floor to hold back and quietly suction waste fluid, while others are placed inside a suction canister to transform fluid into a solid mass for disposal. The options should fit with your facility's particular fluid needs, which will frequently be driven by the amount of fluid produced due to procedure type and physician technique.
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AORN Recommended Practices for Infection Prevention Open for Comment
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