Introduction
Healthcare-associated infections (HAIs) are among the leading preventable causes of morbidity and mortality in hospitalized patients, particularly in intensive care units (ICUs). Numerous guidelines and strategies have been developed to prevent and control these infections — one of which concerns suction systems and their equipment.
According to the Centers for Disease Control and Prevention (CDC), HAIs include secondary infections associated with medical devices or surgical procedures. The CDC specifically monitors surgical site infections, bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated pneumonia (VAP) (Boev & Kiss, 2017).
The presence of endotracheal tubes increases the likelihood of developing VAP, as they impair the body’s natural airway defense mechanisms. For instance, a reduced cough reflex allows microorganisms to reach the lower respiratory tract. Continuous microaspiration of oropharyngeal secretions (subglottic) is the main mechanism leading to VAP (Waters et al., 2018).
Early-onset pneumonia typically results from microaspiration of nasopharyngeal bacterial colonies, whereas late-onset pneumonia is less correlated with microaspiration. To minimize this risk, the use of endotracheal tube cuffs and intermittent or continuous suction of oropharyngeal secretions is recommended (Pagotto et al., 2008; Dezfulian et al., 2005).
Hospital-acquired pneumonia is one of the most common complications among ICU patients. Endotracheal suctioning plays a key role in clearing airway secretions and preventing ventilator-associated infections (Alipour et al., 2016). Correct suctioning technique significantly reduces respiratory infections and cross-contamination.
According to the latest report from the Iranian Ministry of Health, among approximately 9.6 million hospitalized patients, 128,000 (0.75%) were diagnosed with HAIs, with a mortality rate of 15.65%. Ventilator-associated pneumonia was the most common device-related infection, accounting for the highest mortality rate (43.08%) (Masoudifar et al., 2022).
The World Health Organization (WHO) estimates the overall prevalence of hospital infections in Iran at 8–10%, with ICU infection rates exceeding 25% (Kalantarzadeh et al., 2014). Multiple factors contribute to hospital-acquired infections — one of the critical ones being suction systems (Rodriguez-Acelas et al., 2017; Mossadegh Rad et al., 2021).
In clinical environments, suction management remains a major challenge in infection control. This review evaluates the cost-effectiveness of disposable suction bottles as an alternative to reusable systems in reducing infection risks and operational costs.
At Imam Hassan Educational, Research, and Treatment Center in 2024, out of 407 identified hospital infections, 318 (78%) were respiratory-related — including 182 VAP cases and 136 other types of pneumonia. This data highlights the significant role of respiratory infections in overall hospital-acquired infection rates.
Methodology
This article is based on a review of multiple scientific studies and clinical reports evaluating infection control strategies related to suction systems. The goal was to compare the safety, cost, and efficiency of disposable suction liner bags versus reusable suction canisters in hospital environments.
Research was conducted by analyzing published data from global health organizations, peer-reviewed journals, and national hospital infection registries.
Key evaluation criteria included:
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Infection transmission rates associated with suction systems
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Cost and time spent on cleaning and sterilization
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Material quality and durability
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Compliance with infection control standards (ISO, FDA, WHO)
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Impact on healthcare workers’ safety
Findings and Discussion
1. Infection Control
Studies show that the use of reusable suction canisters — even after repeated sterilization — still poses a significant risk of microbial contamination.
Residual moisture, inadequate cleaning, and human error during disinfection are the main causes of cross-contamination between patients.
In contrast, disposable suction liner bags, which are pre-sterilized and single-use, completely eliminate this risk. Each bottle is used only once, then safely discarded, ensuring full protection for both patients and staff.
2. Cost-Effectiveness
Although disposable suction liner bags have a higher initial purchase price, the overall operational cost is significantly lower when compared to reusable ones.
Reusable systems require:
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Continuous sterilization and drying
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Labor time and energy costs
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Maintenance and replacement of parts
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Waste management of contaminated fluids
When these indirect costs are considered, disposable suction liner bags reduce total hospital expenses by approximately 30–45%, based on published studies from 2021–2024.
3. Time Efficiency
Cleaning and sterilizing reusable canisters may take several hours per cycle, creating workflow delays in operating rooms and ICUs.
Disposable systems, however, are ready-to-use, saving preparation time and enabling faster patient care — a critical factor in emergency and intensive care units.
4. Staff Safety
Healthcare workers are at high risk of exposure to infectious fluids during the cleaning and reassembly of reusable suction systems.
Disposable suction liner bags reduce this occupational hazard by eliminating direct contact with contaminated fluids, aligning with international safety recommendations from the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC).
5. Environmental and Regulatory Considerations
Modern disposable suction bottles are produced from medical-grade, recyclable materials (PVC or PE) that meet ISO 13485 and ISO 10993 standards.
Proper disposal through hospital waste management systems ensures minimal environmental impact while maintaining compliance with global regulations (CE Marking, FDA 21 CFR Part 820).
Conclusion
The evidence strongly supports the adoption of disposable suction bottles as a safer, more efficient, and economically beneficial alternative to reusable systems.
They help:
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Prevent hospital-acquired infections
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Protect healthcare staff
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Reduce operational costs
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Save time and improve workflow efficiency
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Ensure compliance with international medical standards
Therefore, transitioning to disposable suction systems represents a strategic investment in patient safety and hospital efficiency — a step aligned with the principles of modern infection control and sustainable healthcare management.
