The Operative Sentence

The business case for fluid-management systems runs on a disposal price about a third of the current benchmark median

Rebuilt on retrieved primary inputs, the same published worked example costs about three times what the circulating model says, and the break-even moves with it.

In brief

• The disposal price in the circulating model is $0.28 a pound. In Practice Greenhealth's benchmark tables for collection year 2022 — a self-selected cohort of environmental excellence award applicants, not a census — the median is $1,655 a ton, or about $0.83 a pound. That is an unambiguous difference between two published figures, not an estimate.16
• We could not find $0.28 a pound in the document the model cites for it. The April 2004 trade article footnoted at that point was retrieved in full and contains no such figure.7
• Pouring a canister removes the fluid weight but not the container, and whether the emptied container is still regulated waste is decided state by state. Virginia exempts empty suction canisters by name; North Carolina's rules do not use the word at all.1415
• Annualised on the module's own 7,000-procedure base, its operating-room-time term is several times its disposal and supply terms combined — and it is the term whose citation we could least verify. The best independent benchmark for the price of an OR minute is itself fiscal-year 2014 data from one state, and its authors warn against exactly this use of it.61011
• We think the arithmetic favours manual disposal for low-fluid case mixes and favours an enclosed system for high-irrigation cases, and that the crossover sits in a band rather than at a point. That is our judgment about our own model, not a finding in the literature.

The price the model runs on, and where we could and could not find it

The business case for replacing manual suction-canister disposal is not really contested in the trade literature; it is repeated. The version that circulates is a worked example, and it is legible enough to check. It appears in Practice Greenhealth's Greening the OR implementation module on fluid management, which carries a 2011 copyright line.6

From a waste perspective, in a hospital that performs 7000 surgeries per year, use of solidifiers could be roughly equivalent to $35,280 in RMW disposal costs (estimating three 6-lb suction canisters per surgery being disposed of as RMW at $0.28 per pound each) with an additional supply cost estimated conservatively at $105,000 for the solidifiers themselves (estimated to cost between $5-$30 apiece).

Read the full moduleArchived copy

Every number in that passage reconciles against the module's own stated quantities.6 Seven thousand surgeries at three six-pound canisters is 126,000 pounds; at $0.28 a pound that is $35,280 exactly. Twenty-one thousand solidifier packages at the $5 low end is $105,000 exactly. It is a transparent model, which is why it has lasted.

The superscript at the end of that passage is the module's endnote 9, which reads in full: Safe Options for Suction Canister Waste. OR Manager. Vol.20. No. 4. April 2004. Accessed on March 7, 2011. Available at: http://www.orbusmgt.com/catalog/download/ORMVol20No4SuctionWaste.pdf6 We retrieved that article as the four-page PDF it still serves under, de-tagged it locally and read it. It contains the $5-to-$30 solidifier range, the $500-to-$3,000 exposure-treatment estimate, and the observation that medical waste disposal costs about ten times more than regular solid waste. It does not contain $0.28 a pound. It carries three per-pound figures: a landfill range that "range[s] from 21 cents to $3.65 or more a pound", and, in one sentence about a single named hospital, an on-site system at six cents a pound against an incinerator at twenty-five cents. None of the three is $0.28, and none of the three is a regulated-medical-waste hauling price for the model's scenario.7

The price is also widely attributed to a November 2014 magazine article, The Economics of Fluid Waste Disposal.9 We could not read the passage. The article's original URL now redirects to a successor publisher and returns 404, checked 2026-08-06, and the three Internet Archive captures we found are all truncated by a login wall part-way through the first section. What is visible in those captures is an author's account of one facility's practice; whatever cost figures the article carries are behind the wall, and we do not know what form they take. So we cannot confirm the figure appears there, and we note that the article postdates the module by three years in any case.

This is a statement about the record and not about the world. Twenty-eight cents a pound may well have been an accurate market price somewhere in the middle 2000s. What we can say is that the document the model's own footnote points at does not contain it, and that we could not locate any published document that does.

What the benchmark tables say now

Practice Greenhealth publishes the only public series of hospital waste cost benchmarks we could retrieve. The report PDFs served normally to our client on 2026-08-06 even where the organisation's HTML pages returned 403. Each report carries its own methods statement, and the collection year is not the year in the title.

Data is from the 2022 calendar or fiscal year as reported on the 2023 Environmental Excellence Award applications. Hospitals completed the applications between November 2022 and April 2023.

Read the full report

That sentence is the reason every figure below carries a collection year rather than a report year, and it is the reason two figures from adjacent reports are not a trend. The cohort is award applicants: hospitals that chose to apply for an environmental excellence award and chose to answer that question. It is a self-selected high-performing sample, not a census of American hospitals, and the sample size differs from metric to metric within a single report.1

The stable finding across the series is structural rather than numerical: regulated medical waste is roughly six pounds in every hundred by weight and roughly a third of the waste disposal bill, and the best decile gets the tonnage share down to about three per cent.15 The collection-year 2022 median of $1,655 a ton is $0.8275 a pound. That is 2.96 times $0.28. Read the other way, $0.28 is 34 per cent of it.

The published example, re-priced

The arithmetic below changes exactly one input in the module's own worked example and leaves everything else alone.

What changes is not only the size of the number but which term dominates. At $0.28 a pound the module's solidifier supply cost is three times its disposal cost,6 so a reader following the model would conclude that the consumable, not the hauler, is the thing to attack. At the collection-year 2022 benchmark median the two terms are within one per cent of each other at the low end of the solidifier range, and the disposal term becomes the larger of the two as soon as a facility pays less than about $5 a package.1 In our assessment that is the more consequential half of the correction, because it changes which lever a value-analysis committee is told to pull.

The term everyone forgets is the container

Pouring a canister to a sanitary sewer removes the fluid weight from the regulated waste stream. It does not necessarily remove the container. The module says so itself, in one sentence that almost nobody quotes.

How much weight is at stake is arithmetic the module leaves the reader to do. Three litres of an aqueous fluid weighs about 6.6 pounds before any container is counted. The module's range for a full three-litre canister is six to eight pounds.6 So its six-pound figure describes a canister that is not full, and its eight-pound figure leaves roughly 1.4 pounds for the container and residue. On that 1.4-pound reading, the module's 7,000-procedure hospital is disposing of 29,400 pounds of empty plastic a year: about $24,300 if it stays in the regulated stream at $0.8275 a pound, about $2,100 if it goes out as solid waste at $146 a ton. Both prices are collection-year 2022 medians from the same award-applicant cohort.1 The difference, roughly $22,200 a year, is decided by a state administrative code and not by anything the facility buys.

Virginia answers the question by name, in a list of items that are not regulated medical waste when discarded empty.

The following discarded items when they are empty: urine collection bags and tubing, suction canisters and tubing, IV solution bags and tubing, colostomy bags, ileostomy bags, urostomy bags, plastic fluid containers, enteral feeding containers and tubing, hemovacs, urine bottles, and urine specimen cups, unless the items are subject to regulation under 16VAC25-90-1910.1030 (29 CFR 1910.1030) or a comparable state or federal standard.

Read the full section

Two things in that provision matter to a cost model. The exemption is conditional: it lifts where the item is subject to the federal bloodborne pathogens standard or a comparable one, and the rule does not tell the reader when that is. And the same Virginia section runs the other way for the solidifier route, providing that "Human blood and body fluids solidified by absorbent gel, powder, or similar means are also regulated medical waste."14 In Virginia, solidifying keeps the whole weight in the expensive stream by express text; pouring can remove all of it, container included, subject to that condition.

North Carolina's rules answer nothing of the kind. They set disposal routes for the fluid — sanitary sewer with notification for volumes above 20 millilitres, sewer or landfill permitted below it — and they never reach the container.15

Ohio adds a third pattern, and one that reaches the pouring route rather than the container. Its current rule permits discharge of untreated liquid infectious waste "consisting of exclusively blood, blood products, body fluids, and excreta" into a disposal system unless a permit says otherwise.16 The word "exclusively" is new as of the 2025 renumbering, and a suction canister that also holds irrigation saline raises a question the rule does not answer. We raise it and do not resolve it.

The biggest term in the published case is the one we could least verify

Beside the waste arithmetic, the module puts a second and much larger number: five minutes per case of canister handling, at "an estimated cost of $17/minute", over eight cases a day, giving $680 a day in lost operating-room time.6 That is not the same facility as the waste example: eight cases a day is about 2,000 a year, and the waste example is a 7,000-procedure hospital, so the two cannot be compared as printed. On the waste example's own base, 7,000 procedures at five minutes and $17 a minute is $595,000 a year, against $35,280 of disposal and $105,000 of solidifier.6 Normalised that way, operating-room time is several times the two waste terms combined.

The module footnotes the $17 to a 2004 journal article on the benefits of a dedicated minimally invasive surgery programme.6 We could not obtain that article's full text; it is behind a publisher paywall, and its abstract reports total hospital cost per case and total operating-room time per case, not a cost per operating-room minute.11 So we cannot confirm the figure is in it, and we do not assert that it is absent — we did not read the pages.

What can be read in full is the one study that set out to benchmark the price of an operating-room minute directly, from the annual financial disclosure documents of short-term hospitals in California. Its own limitations paragraph records that "because of an exemption, Kaiser hospitals are not included".10 It reports a mean of $37.45 a minute in the inpatient setting and $36.14 in the ambulatory setting, for fiscal year 2014, and it opens by noting that published values range "from $7 to more than $100 per minute, even within a surgical field or procedure."10 It also decomposes the number: direct expenses are 54.6 per cent of the inpatient total, and wages and benefits are about two thirds of those direct expenses.

That decomposition is why five saved minutes are not worth five times $37.45. The staff are paid whether or not the canister is handled. The paper's own discussion says so more sharply than we would.

Note the awkwardness that follows for anyone rebuilding this model in 2026. The best independent benchmark for the price of an operating-room minute is California-only and drawn from fiscal year 2014, and the paper reports that operating-room expenses over its decade grew faster than the consumer price index while cautioning that the consumer price index is not an appropriate deflator for a single revenue centre.10 The honest position is that we have no current national figure to put in this cell, and we have left it as a range the reader sets.

Break-even, in both directions

The model below is ours. Every input is either a retrieved figure with a citation or an arithmetic step shown in the source line, and every one of them is meant to be overridden.

Take the routes one at a time, per canister, ignoring the canister purchase price because we could not source it and because it falls on both sides except where an enclosed system is canister-less.

Solidify and dispose as regulated waste costs $5 for the package plus eight pounds at $0.8275, which is $11.62 a canister.167 Pour, then discard the container as regulated waste costs 1.4 pounds at $0.8275, which is $1.16 a canister; discard it as solid waste at $0.073 and it is ten cents.1 An enclosed system costs $15 to $20 for a per-case manifold where one is required, plus $3.95 to $7.89 of amortised capital: call it $19 to $28 a case however many canisters the case would otherwise have filled.6

Against the solidifier route, the enclosed system's disposal arithmetic closes at $19 ÷ $11.62, which is 1.6 canisters, and at $28 ÷ $11.62, which is 2.4 canisters. Call it a band of roughly five to seven litres of nominal canister capacity per case. Run the identical model at the module's $0.28 a pound and the per-canister cost falls to $7.24, moving the band to 2.6 to 3.9 canisters, or roughly eight to twelve litres.6 Correcting one price input therefore moves the break-even down by three litres a case at the bottom of the band and about five at the top, which is the difference between an arthroscopy list and a general list.

Against manual pouring, it does not close. At $1.16 a canister the enclosed system would need about sixteen canisters a case, near fifty litres, before the disposal saving alone paid for the manifold and the capital.16 Almost no case mix reaches that. We think this is the single most important thing the arithmetic says, and it says it in both directions: the disposal-cost case for an enclosed system is a case against solidifying, not a case against pouring. Where facilities already pour, the argument has to be made on exposure risk, on staff time, or on measurement, and those are not disposal-cost arguments. Where a state's rules make pouring unavailable or make the emptied container regulated anyway, the same arithmetic moves the other way.

So: for ophthalmic, ENT, podiatry and endoscopy lists, where a case may not fill a single canister, our model puts manual disposal ahead on cost by a wide margin, and it stays ahead under every substitution we tried. For high-irrigation orthopaedic work the model reverses decisively. The published volume figures that would let a reader place their own case mix on that scale — irrigation and collected-fluid volumes reported in the procedure literature, by procedure and with each series' size — are being assembled separately and are not on this site yet.

What the two quantitative comparisons we located contain, and what they do not

We located two quantitative comparisons of enclosed fluid management against canisters in the indexed literature. We are not claiming that is all of them. Both were funded by the manufacturer of one of the compared systems, and we name no product here, so their titles are given in the source list with the system name withheld and their identifiers printed in full so anyone can retrieve them in one click.

The first, a 2023 non-randomised prospective service evaluation across three European hospital sites, reports that device-related treated waste fell 98.5 per cent, from 13.2 kilograms (SD 16.6, n = 41 canister procedures) to 0.2 kilograms (SD 0.7, n = 43), and reports reductions in handling weight and in disposal time.12 Its funding statement reads that funding "was provided by [the manufacturer], which participated in the study design and interpretation of the results," and two authors are disclosed as employees of the funder, one of whom provided editorial support.12 We have replaced the company's name in that quotation with a bracket, because this publication names no fluid-management manufacturer; nothing else in the sentence is altered.

The second is a 2025 life-cycle assessment in a Dutch hospital, and it is the more useful of the two for a reader deciding by case mix, because it varies volume rather than reporting a single comparison. Across seventeen impact categories it finds the enclosed system better on global warming, ozone formation, fossil resource scarcity and water consumption at both high and low volumes, better on several further categories only above five litres, and better on three more only above ten litres. It aggregates those seventeen categories into three endpoints, and the three do not agree. On resources the system is "beneficial for resources in each scenario" — at every volume tested. On ecosystems it "is a the better performing alternative when fluid volume is two Liters and greater" (the doubled article is the source's). On human health "the canisters alternative performs better for the small volume procedures (0.1 to 0.5 L)."13 So one endpoint favours the system throughout and two turn on volume; a reader given only the ecosystems sentence has been shown one of the three. Its competing-interests statement declares none; a separate disclaimer records that the work was supported by the manufacturer, which supplied the equipment and funded the laboratory that performed the assessment.13

Neither paper costs anything out. The life-cycle assessment says so itself: "economic and social factors were not included in this analysis, therefore, life cycle costing (LCC) was not conducted in this study", and it recommends one for later work.13 The service evaluation reports waste mass, time and survey responses and makes no monetary comparison.12 One caution about reading the assessment quickly: its resources endpoint is denominated in "USD 2013", which the paper explains is a way "to express the environmental impact in monetary terms" — a scarcity metric priced in dollars, not a cost to a hospital.13 That is worth stating plainly. The two quantitative comparisons we located are evidence about waste mass, handling and environmental impact. They are not evidence about money, and a business case that cites them as though they were is citing the wrong papers.

The money figure that does circulate comes from a page rather than a paper. Practice Greenhealth's own topic page on fluid management states that these systems "save hospitals an average of $51,000 per year", and carries no citation for it. The page returned 403 to our client on 2026-08-06; we read it from an archived capture dated 2025-08-03, and the sentence stands word for word in a capture dated 2023-03-27 as well, uncited in both.8 We report that as provenance and nothing more. An average annual saving of $51,000 is entirely plausible for a large high-irrigation service; we are recording that we could not find the document behind it.

It is also worth recording where the environmental crossover falls relative to ours. The life-cycle assessment's endpoint crossover is around two litres a case; our disposal-cost crossover against solidifying is around five to seven. The two do not have to agree, and they measure different things, but a facility whose case mix sits between them is being told different answers by the two literatures, and should know that.

What would change this answer

• Your own hauler's invoice. The benchmark median is a median of self-selected award applicants. A facility paying $0.40 a pound and a facility paying $1.20 a pound get different break-evens from the same model, and both are inside the published spread by facility size in the same tables.1
• Whether your state's rule reaches the emptied container. Virginia exempts it by name and taxes the solidifier route by name; North Carolina's rules do not mention it; Ohio's permission for the pouring route now says "exclusively", which a canister holding irrigation saline may not satisfy. That one row of state law is worth about $22,000 a year in the module's own 7,000-procedure example.141516
• A published price for a suction canister. We could not find one. If the enclosed system under consideration is canister-less and the current route is not, the canister purchase price falls entirely on one side and moves the break-even toward the system by an amount we cannot compute.
• A current, national benchmark for the cost of an operating-room minute. The only direct benchmark we could retrieve is California data from fiscal year 2014. This is the genuine open question in the literature, not merely a gap in our sourcing: the paper that produced that benchmark says no benchmark existed before it, and none has replaced it that we could find.10
• The passage behind the login wall. If someone can produce the full text of the November 2014 article, or any document published before 2011 containing $0.28 a pound for regulated medical waste, the provenance section of this page changes and we will say so at Corrections.9

Where this could be wrong

The weakest joint in this page is the 1.4-pound empty-container figure, and it carries a lot of weight. It is not measured; it is eight pounds minus the 6.6 pounds that three litres of an aqueous fluid weighs, and both ends of that subtraction are soft. The eight pounds is the top of a range a 2011 document attributes to unnamed manufacturer estimates, and surgical fluid is not water. If the true figure is half a pound the container term collapses; if it is two and a half pounds the term is nearly double what we printed. We kept it because leaving the container out entirely is the error the whole section exists to correct, and because the sensitivity is stated here rather than buried.

The second weakness is that we have compared per-case marginal costs while amortising capital per case, which is a mixed basis. A facility that already owns the equipment faces a different arithmetic from one buying it, and neither is the arithmetic of a lease, which the module says most vendors offer.6 We have not modelled a lease because we could not retrieve a published lease rate.

The third is the cohort. Every dollar figure above traces to hospitals that applied for an environmental excellence award. It is reasonable to think such hospitals negotiate better waste contracts and segregate better than average, which would push the published median below the true national median and make our re-priced example conservative. It is equally arguable that they are larger, more urban and pay more. We do not know which, and no public census exists to check against. Anyone building a real business case should put their own invoice in the top row of Table 5 and ignore ours.

Finally, we have named no winner and we are not equipped to. Nothing on this page is a recommendation to buy, keep or discontinue anything, and the terms we could not price — canister purchase, cleaning consumables, labour, exposure cost, plumbing works — are large enough that a complete model could land anywhere.