Many hospitals are now purchasing powder treatments designed to turn operating room fluid waste into a semi-solid state, making disposal less of a problem but adding a new layer of costs.
These powders, added to waste fluids, bring out what is generically termed encapsulation decontamination, solidifying and at least partially decontaminating fluids drained off during surgery. Use of these powders has elevated waste disposal costs for hospitals in some states, managers say, but the powders help solve other problems, so hospitals intend to continue using them.
Materials and operating room managers began purchasing the powders for OR in response to state landfill laws requiring infectious waste to be solidified or decontaminated, or both, prior to dumping. OSHA regulations, too, encouraged hospitals to look at waste disposal methods that would reduce staff exposure to blood and body fluids.
Two powder types being used
Hospitals are using Liquid Treatment System LTS, manufactured by Isolyzer, Norcross, Ga., or Red-Z, manufactured by Medzam Limited, North Tonowanda, N.Y., in the operating room. Isolyzer's phenol-derived powder was released for national distribution March 1, 1991. Medzam's chlorine-derived powder has been on the market since 1989.
Both can be purchased in bulk or individual treatment sizes. A 1-oz. packet of Isolyzer's LTS solidifies up to 1,000cc of liquid, and a 0.75-oz. packet of Medzam's Red-Z treats up to 800cc of liquid. Blood and body fluids are treated with the powder after collection in the suction canisters while still in the OR. Additional powder is often used in the disposal bags to insure all waste is solidified before being picked up by housekeeping or environmental services and transported to the incinerator or landfill.
Manufacturers claim that treating the waste also can save some hospitals money by enabling them to pay lower costs for disposal of general waste at landfills rather than pay higher charges for disposal of infectious waste. But materials managers and OR managers say using the solidifying powers is expensive and may not be entirely offset by lower disposal costs. The greatest advantage some managers see in using the powders is increased employee safety.
HCA Wesley Medical Center
HCA Wesley Medical Center, Wichita, Kan., 626 beds, has been using Red-Z in its operating room for two years, but is currently evaluating Isolyzer's LTS as a competing product. Concerns about employee exposure to the chlorine in Red-Z, as well as cost-effectiveness, prompted the evaluation, according to Neil Danielson, director of materials management.
"We want to use the product that poses the least hazard in handling, is sufficient to keep the matter in an encapsulated state and is the most cost-effective," Danielson said.
HCA Wesley wasn't paying any higher costs for dumping liquid infectious waste at the landfill than it pays for dumping treated fluids, so there is simply an added cost to carry out the treatment, that isn't offset by any hard-dollar savings.
"Using these products isn't necessarily cost-effective, but it saves steps and cuts down on labor," he said. "We're avoiding spending a lot of money in employee time on cleanup if a bag of fluid spills, and we are lessening the potential for problems resulting from exposure."
Environmental services staff are trained to transport the treated waste to the appropriate area for disposal. All fluids are treated before they leave the OR.
Hospitals in Kansas that aren't treating infectious waste with these powders, for disposal or incineration, are allowed to add a high concentration of chlorine and flush the OR fluids down the drain. "We chose not to go that route because it takes too much manpower," he said.
Schumpert Medical Center
Schumpert Medical Center, Shreveport, La., began using Isolyzer's LTS four months ago in response to a Texas law prohibiting liquid waste from being dumped in landfills. Larry Culp, director of materials management at the 483-bed hospital, said the landfill regulation addressed fluid vs. solid waste rather than the infectious waste issue.
"The waste is heavier and larger after solidification and costs more to dump," Culp said. He estimated that the implementation of the treatment system will add $48,000 per year to Schumpert's waste disposal costs.
Schumpert uses 2,000 100 ml packets of LTS per month, at a cost of $1.64 a packet. Originally, the hospital purchased LTS in bulk, but switched to packet form to eliminate measuring. Culp said that 61% of all waste going out of the hospital is treated.
"Even though it's costing us a lot, we don't want to indirectly contribute to any kind of contamination," he said.
Univ. of Iowa Hospital and Clinics
University of Iowa Hospital and Clinics, Iowa City, implemented liquid waste solidification for blood and body fluid-tainted liquids two months ago. Victoria Steelman, clinical nursing specialist, said Isolyzer's LTS was chosen because nobody at the hospital wanted to use the chlorine-based products.
"The chlorine-based products produce chlorine gas in the incinerators and soak into the soil in the landfills," she said.
The 879-bed facility began using the treatment out of concern for its employees, Steelman said. "Now there is much less staff exposure to blood and body fluids."
Central sterile transports all treated liquid waste from the operating room to the hospital incinerator. "The work load has shifted from the central sterilization staff to the operating room staff," Steelman said. "Instead of central sterilization disposing of the liquids down the drain, the nurses are putting the treatment into the suction canisters in the operating room."
Too many variables influence whether or not the treatment is cost-effective, so Steelman is unsure whether this effort is paying off for the hospital. But more hospitals are going to find that the treatment meets some important needs, Steelman is convinced.
"It's responsible management of liquid waste, and using these products is certainly cost-effective if considering the potential for a citation from OSHA," she said.
Roanoke Memorial Hospital
Roanoke Memorial Hospital Complex, Roanoke, Va., has been using Isolyzer's LTS in the operating room since January. After the liquids are treated in OR, they are put into a general waste bag and are picked up by housekeeping and transported to the landfill, said Steven Burt, director of environmental services at the 644-bed facility. An estimated 80% of the hospital's waste is sent to the landfill and 20% is incinerated at the hospital or offsite, Burt said.
Roanoke Memorial pays somewhat lower costs at the landfill for the treated waste than it would for liquid infectious waste, Burt said. But the product is still too expensive to be used simply because it will save money on disposal, he added.
"We use it to prevent spills," Burt said. "We always had a problem with the suction canisters dripping." Roanoke Memorial uses a 1-liter bottle of LTS in the operating room. The treatment is squirted into the suction canisters.
Chlorine-based treatments weren't even considered for OR use at Roanoke Memorial, Burt said. "Employees can be sensitive to chlorine. Testing of the phenol-derived powder has proven it to be a solid disinfectant," he said.
UCLA Medical Center
The infection control committee at UCLA Medical Center, Los Angeles, evaluated Isolyzer's LTS in May and decided that the hospital could not afford to use the product. Joyce MacKinnon, operating room manager, said that the committee liked many aspects of the treatment, however.
UCLA wouldn't have been able to generate any disposal savings by using LTS. "The cost of disposal for infectious waste at 50 cents per lb. still applies to treated waste in California," she said.
Suction bottles are capped and transported to the hopper room, located in the OR, and blood and body fluids are then poured down the hopper into the general sewage system.
Johns Hopkins Hospital
The Johns Hopkins Hospital, Baltimore, also is emptying liquid waste from the operating room down the hopper and into the general sewage system. Johns Hopkins intends to continue handling OR liquid waste in this manner.
"We never did a physical evaluation, but were concerned that solidification would make the matter too heavy," said Diane Fecteau, assistant director of nursing of the 1,036-bed facility. Fecteau said that the weight of the solidified matter could break through the hospital's red bags used for infectious waste.
