Questionnaire - Use of disposable suction canisters and liners
Clinical suction apparatus has been associated with at least one documented outbreak of infection (Suction apparatus and hospital infection due to multiply-resistant Klebsiella aerogenes. Blenkharn JI & Hughes VM. J Hosp Infect 1982; 3: 173-178). In this case, infection occurred when contaminated fluids overflowed from the suction reservoir into the pump mechanism, and from their were pumped in a
fine aerosol to the ward atmosphere. Widespread transfer of infection between patients in different clinical areas was facilitated by inadequate equipment hygiene, and the common practice of sharing equipment between wards and department.
Lessons learned from this widespread and prolonged outbreak of infection, which affected 66 patients over a 10 month period, resulted in several key recommendations:
- clinical equipment must be used according to manufacturer's instruction
- clinical equipment must not be limited in availability, but when it is necessary to share between wards and departments careful and thorough cleansing is essential
- records must be kept of any movement of equipment between wards and departments, to facilitate later epidemiological study and to support future resource allocations
- safety devices, including in-line air filters and overflow protection devices, must be fitted as standard; these must be fitted, used and changed according to manufacturers' recommendation
- suction lines and connecting tubing should have secure fittings with no redundant loops
- care should be taken in disposal of suction fluids, to prevent local contamination of hands and clothing, and of the wider environment
Advances in equipment design and manufacture followed from the work done in the aftermath of this outbreak, with all manufacturers replacing heavy glass suction reservoirs with polycarbonate flaks that in most cases incorporated a moulded handle to facilitate safe handling. In-line air filters were re-styled as sealed capsules to aid safe and easy handling. Although the risks remain, though these advances the probability of a repeat outbreak of infection associated with suction apparatus is now much reduced.
Disposable suction canisters and suction liners were launched in the years following this outbreak, largely in response to concerns regarding the infection control and hygiene impact of re-useable suction containers. It was perhaps a logical development, but largely flawed in concept. Though fitted with a lid, disposable canisters are prone to leakage of their content on disposal, and provide no demonstrable benefit as they cannot and do not address any of the risk issues noted above. They are costly, and have an additional environmental cost in disposal.
Later on, granular gelling agents were developed. These were useful in containing and clearing spillages of fluids in the clinical environment and it was a logical extension that they would then be added to suction reservoirs, to reduce still further the risk of spillage and leakage from discarded canisters. The advantages are obvious, though perhaps minor. Once more, there is an additional cost, and an environmental cost in manufacture and disposal.
Disposable suction canisters may cause difficulties in disposal. Though canister holders have been developed, similar to the wine carriers available from supermarkets, these items do not sit well in clinical waste sacks. If discarded without emptying, their weight and awkward shape may rip of tear the sack, though if these devices are emptied locally, into a sluice or drain, then there is clearly no point at all in having used them in the first place!
Commercial waste disposal systems might be affected by the presence of these suction canisters. Following the large scale public and political move away from incineration of wastes, alternate waste treatments were developed, based on low temperature heating by steam (autoclaves) or microwave. These low cost systems have been particularly successful, but their use for the disposal of suction canisters has been questioned since heat transfer into bulky filled canisters, particularly when the contents have been solidified with gelling granules, may be less than ideal.
To gather more information, studies have been performed to examine heat transfer rates and the safety profile of a range of waste treatment systems. But what about the suction canisters themselves. Are they in widespread use? How much fluid do they contain when they are discarded? Are gelling agents used, and if so, how much is added? Answers might be gained by an audit of the contents of waste bags - no thanks! We can also look at NHS purchasing profiles but the results are likely to be of only limited value and may fail to reflect the realities of suction canister use and disposal.
Fortunately, questionnaires are invaluable in gaining detailed information that can indicate current practice, identify problems and their remedies. We hope that the information obtained from this questionnaire will go some way to identifying the issues involved in the disposal of suction canisters and their contents. Significant findings will be published in an appropriate scientific journal, with care to ensure that the sources of data provided remain anonymous.
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If you would like a copy of the results, in synoptic report form, please email Ian Blenkharn
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