Decision-making regarding an open or a closed fluid waste management system (FWMS) in the planning of thirty operating rooms (ORs) of a new hospital at the CHU de Québec-Université-Laval was an opportunity to explore additional capabilities in health technology assessment (HTA) to support evidence-based planning.

Issues related to FWMSs in ORs were assessed from multiple data sources including: (i) systematic review in indexed databased and grey literature, (ii) waste management laws and regulations, (iii) local registry of reported incidents/accidents, (iv) occupational health and safety database, (v) electronic patient records (EPRs), (vi) field evaluation of two closed FWMSs, (vii) costs, and (viii) survey on FWMSs in ORs of other Quebec hospitals.

Closed FWMSs in ORs could reduce health care professional exposure to blood and body fluids (BBF) according to two low-quality studies. Cases of occupational and patient exposure to BBF with closed FWMSs, some of which had severe issues, were reported to the U.S. Food and Drug Administration. Depending on the volume, discharge of BBF to the sanitary sewer may be authorized upon the approval of the competent municipal authorities. Compared to an open system, a closed FWMS has the potential to reduce manipulation of canisters during the cases because of large canister capacity (24 L). However, local data showed that BBF and irrigation fluid amounts in ORs are <2 L in 84 percent of cases and >2 L in a minority of surgeries, whereas a closed FWMS is associated with higher costs for BBF volumes <12 L. Other issues were observed during field evaluation (e.g., occupational noise). Closed FWMS implementation in other hospitals was very limited in the survey.

Available evidence does not support the widespread use of a closed FWMS. Use of mixed-methods in this particular HTA allowed to assist decision makers on the choice of an FWMS in the OR planning.