For clinical leaders on the front lines of healthcare, keeping patients and staff safe is the No. 1 priority.
"Hospitals must foster safe working environments for clinical staff so they can focus on caring for patients," said Cindy Witt, RN, senior consultant of clinical operations at Dublin, Ohio-based Cardinal Health. Ms. Witt has an extensive background in nursing, starting her career as a nurse clinician at Memorial Sloan-Kettering Cancer Center in New York City and serving as first assistant to surgeons at Cleveland Clinic Florida in Weston.
She believes proper waste disposal practices are a crucial part of a safe working environment. However, low personal protective equipment compliance during waste disposal and potential exposure to airborne contaminants, spills and splashes can pose an immediate, yet preventable, risk to staff members' safety. Solidifying infectious liquid waste can help prevent exposure incidents and protect staff during the disposal process.
Ms. Witt spoke with Becker's Hospital Review about how hospitals can improve waste disposal practices and achieve a safer work environment for staff members.
Editor's note: Responses have been lightly edited for length and clarity.
Question: As you work with different hospitals, what perioperative concerns do you most often hear about?
Cindy Witt: Mostly, staff and leadership are concerned with infection prevention and improving safety for both patients and staff members. Clinicians have always been concerned with infection prevention, but given the change in healthcare reimbursement, it has become a critical focus for facilities. Patient outcomes are always the foremost concern, but increasingly the financials of an institution are directly related to infection prevention. In addition, staff safety is directly related to infection prevention. The products and practices that are utilized to support infection prevention are the same products and practices that support the safety of the employee as care is given. If facilities focus on one goal and not the other, they won't realize the desired outcome for patients and healthcare workers. It's critical in today's environment to always address both.
Q: Why are airborne contaminants, spills and splashes such a concern?
CW: Operating room directors and infection control specialists often assume staff members are consistently following their facility's waste disposal protocols. However, low PPE compliance during waste disposal, where a healthcare worker may be exposed to airborne contaminants, spills and splashes, can threaten safety. Most facilities aim to be meticulous about transferring waste and disposing of it safely. But even so, staff can overlook minor procedural details. Not only is this risky and costly, it is inconsistent with recommended best practices from the CDC, U.S. Occupational Safety and Health Administration, Environmental Protection Agency and Department of Transportation.
Every time healthcare workers pour fluid from an open canister into the drain, they can be exposed to airborne contaminants and possible splashback. Paired with improper personal protective equipment, or PPE, workers could be exposed to hazardous pathogens, such as Hepatitis B and HIV. Therefore, hospitals should look at their waste disposal practices and consider making some changes.
Q: What are the clinical and financial consequences of poor waste management practices?
CW: Despite annual training, research shows as many as 17 percent of waste disposal handlers do not follow proper protocols, and up to 24 percent do not wear a gown or facial protection.1 This includes not only clinical staff, but also those in environmental services. Think about it this way: What happens when a toilet flushes? Numerous studies have found aerosolized germs and fecal matter can plume as high as 15 feet from a single flush. These germs can be inhaled, swallowed and spread throughout the room, where they are further transmitted via people's hands. Unfortunately, you don't always know if a patient is infected with a bloodborne pathogen. Since not all patients have been diagnosed, waste handlers should assume that every contact with blood and bodily fluids is a potentially infectious exposure.
In addition to the health risk, fluid waste exposure can be costly. A single exposure incident can cost up to $3,000 to cover treatment, employee time off and follow-up. Hospitals have been fined hundreds of thousands of dollars for improperly managing medical waste. In the long run, the cost and risk of staff exposure during waste disposal far outweigh the cost of prevention.
Q: How can facilities improve waste disposal practices to help avoid these risks and contribute to a safer work environment for staff?
CW: When workers deal with potentially infectious fluids, reducing their exposure to spills, splashback and aerosolized contaminants is critical. To help ensure a safe environment for patients and staff, numerous infection prevention protocols and products are used throughout hospitals. Waste management steps like disconnecting suction equipment, carrying a canister full of liquid to a waste site, and the actual disposal can all be potential hazard points.
A canister of fluid waste that has been solidified helps prevent exposure incidents like spills, splashbacks or the inhalation of airborne contaminants. Liquid waste solidifiers, which have been used in the medical industry for more than 25 years, are the preferred disposal method for many hospitals, surgery centers and labs. Generally, facilities find the use of solidifiers to be an easy-to-implement practice. There are also solidifier products that decontaminate waste as it gels, further reducing the risk of dangerous bloodborne pathogens. Although proper PPE is still important, using a disinfecting product like this can reduce staff safety risk due to infectious waste exposure and allows hospitals to eliminate the questionable practice of pouring contaminated fluid down open drains.
In all but eight states, hospitals can use solidifiers to convert fluid to a noninfectious gel, which allows staff members to dispose canisters in nonregulated white trash bags, instead of the red bags used for regulated medical waste. With average regulated medical waste disposal costing 28 cents per pound, and up to 40 percent of regulated medical waste being from suction canisters, the ability to utilize nonregulated white bag trash can significantly decrease waste disposal expenses.
1. Key Group Research “Fluid Management & Waste Disposal Survey” June 30, 2017.