Infection Control Today - 08/2004: Clinical Update

No Crying Over Spilt Blood
Managing Fluid Waste Disposal

By Kathy Dix

Its 7 p.m. A surgeon has justcompleted a very bloody procedure. Theres a tremendous amount of blood andother body fluids to dispose of. How can you best rid your facility of thismess, while keeping costs down and your employees safe?

The disposal of liquid waste is just one of many factors thatfalls under the umbrella of patient safety, the current watchword inmedicine. Theres a focus in healthcare right now regarding reducing riskof exposure. Patient safety and employee safety are the key words today, saysAnita Earl, RN, BSN, an infection control consultant based in Illinois.

Obviously, one concern is that you want to minimize risk ofexposure. If its a solidifier and a sanitizer, it can save a facility moneyby converting a bio-hazardous waste to regular waste. It eliminates the potentialexposure to harmful pathogens. Some of these products meet most state regulations forconverting liquid medical waste so it would be suitable for white bag disposal,which saves a healthcare facility a lot of money, she adds. The fact is,you want to reduce the risk of exposure, the risk of a spill, and potentialhealthcare worker exposure to patient body fluids.

What we did at the hospital I worked at was to use asolidifying gel on liquid waste in suction canisters. Other liquid waste (likeurine) was disposed of down the hopper, says Melba Rhodes, BSN, an infectioncontrol consultant in Pineville, La. In general, the solidifying and disinfectant agent ispoured into liquid-containing articles such as suction canisters or chest tubedrainage systems to prevent the red bags from leaking fluid.

Medical waste has to be disposed of in certain ways, Rhodescontinues. Each state has a separate way of handing waste specified in thestate sanitary code. Medical waste is included in the environment of carebecause of the hazard to employee, patient and visitor from improperlydisposed-of waste. Closed container systems have the benefits of ease of use andof not forcing healthcare workers to touch the waste themselves, Rhodesobserves. Theres less chance of an exposure. But, she says, Thedrawback is cost.

Even EPA-registered solidifiers do not disinfect,observes Kelly Ticco, marketing manager for Safetec of America, Inc. Theyonly sanitize, which means they reduce, not eliminate, the number of microbesthat might be in blood or body fluid. When you add a solidifier to the blood orbody fluids, like to a suction canister, its not a treatment. It varies fromstate to state, but some states even allow you to pour [medical waste] down thedrain.

Ticco points out the obvious, which although evident, bearsrepeating: Its important to solidify, because whoever is handling thatcanister the nurse, your infection control specialist at the hospital,whoever is cleaning after the procedure even if its an emergency room andtheres been someone with severe bleeding and youre cleaning up a floorarea, what you dont want is splashing. A solidifier eliminates theaerosolization of potentially infectious blood or body fluid. So youreprotecting your employees.

Ticco offers the following example: Say you have a cart,and you have a surgical procedure that generated containers of blood or body fluids,and you are moving those. You are planning on shipping those containers to adisposal facility off-site. Do you really want your employees pushing a cart ofpotentially infectious fluid waste down the aisle of your hospital or yoursurgical center? And the potential for spilling and splashing and contaminationis huge. By solidifying, you eliminate that possibility.

It is necessary to solidify in many cases; certain Departmentof Transportation regulations require absorbent material such as a solidifier inthe shipment of potentially infectious specimens, such as specimens from ahospital laboratory being shipped to another lab.

When in doubt about what regulations to follow, the APIC(Association for Professionals in Infection Control and Epidemiology) guidelinesare a good starting point, says Deb Kleinfeldt, RN, an infectioncontrol practitioner at Powell Valley Healthcare in Powell, Wyo. They ask,Does the waste have an existing or possible pathogen? And then theydiscuss how to handle this waste in the subsequent pages, she says. In ourOR, we use a powder that absorbs the fluid so when they tear the room down, thesuction canisters have a solid in them rather than a liquid. This powder is alsoavailable in the ER, OB and ICU.

Kleinfeldt does not specify which product to use; any thatare on the market and on your purchasing list would be fine, she explains. Then you have to get education to your employees or theywont use it correctly and you may as well not bother with any of this. Thenwrite your policies to match the process of using this absorbent. In summary,she says,

• Review APIC guidelines, chapter 74 to see if there is anythingextra special your state requires.

• Sort out what is needed and doable at your facility.

• Get samples of this absorbent powder to see which one the staff likes better.

• Price-compare, but this isnt as important unless you . nd one that is very costly. Then try to go with the more economically pricedone.

• Get the samples in and in-service your staff. Let them use it for a couple of weeks and make them chooseone.

• Then put out a policy and procedure with a memo saying, This is in place.

• Bring this topic up at your next infection control committee meeting.

• Do an evaluation of the product to see if there are any glitches in the process and to see if it helped in leaks, etc.

What Are Your Options?

Options for disposing of medical waste vary. Some allow for sanitizing the fluids, enabling the healthcarefacility to dispose of it as normal waste rather than medical waste,saving the hospital or clinic a great deal of money over time.

State regulations differ; obviously, those less-concerned withpublic health allow the potentially pathogenic fluids to be disposed of down anormal drain, not into the sanitary sewer, which is a sewer designed to carryonly domestic sanitary sewage and no storm water.¹

Products

• Bemis Health Care offers a suction canister system thatreduces exposure to splatters, spills and aerosolization of infectious medicalwaste. The Vac-U-Station disposable canisters offer bottom drainage portsthat open with a simple pull of a handle, allowing contents to empty directlyinto the sanitary sewer system. This system does not require the use of solidifiers.

• DiSorb offers SafeSorb, which is strictly a fluid solidifier, not a disinfectant. This product is added to the suction canister before starting a procedure. It does not expand once it comes in contact with the fluidwaste. This product also will continue to work for several days, so additional .uid can solidify later. DiSorb offers a cost-analysis program to help establishwhich method of managing liquid waste is best for your facility.

• Dornoch Medical offers a Safety Station and High Fluid Cart; the Safety Station empties, cleans, and disinfects reusable 1800 or 2800cc suction canisters. The High Fluid Cart collects up to 48 liters of fluid in oneor two reusable reservoirs.

• Omni/ajax offers the BioSet Body Fluid Encapsulant/Solidifier, which is a patented cementatious mixture designed for reducing the risk ofcontamination and exposure. The BioSet works by quickly absorbing fluid, and thecementatious reaction will continue to solidify the mass.

• Metrex offers several products, including the PremiCide®Sanitizer/Solidifier with a special PremiGuard Cap, as well as the Canister Express® Solidifying Beads, a Solidifier Suction Canister Fluid Solidi. cation System, and the Vital1® Biohazardous Spill Clean-Up Beads and Kit.

• Safetec of America, Inc., offers the RED-Z solidi. er for cleanup and removal of body fluids, as well asGREEN-Z and YELLOW-Z. Red Z and Yellow Z offer a deodorizer as well as solidi. erand Green Z offers a deodorant-free incinerator-friendly version.

• Stericycle offers several products for solidifying liquidwaste, including Steri*Safe Solidifier, which comes in powder form. It gelsliquid waste using a super-absorbent polymer granule similar to those used indiapers.

• Stryker Medical Systems offers the Neptune WasteManagement System, which provides both . uid waste management and smokeevacuation. The system collects and disposes of liquid medical waste in itsclosed system and involves little employee exposure.