Clean Closure Research Articles

Guidelines in Practice: Sterile Technique.

Sterile technique is the collective actions taken to reduce potential contaminants in the OR and maintain a sterile field during operative or other invasive procedures. Practicing and applying the principles of sterile technique is a cornerstone of perioperative nursing and providing safe patient care. The recently updated AORN "Guideline for sterile technique" provides perioperative nurses with information on the principles of and processes associated with sterile technique. This article provides an overview of the guideline and discusses recommendations for actions to take before preparing the sterile field, while preparing and maintaining the sterile field, for limiting movement, for surgical wound classification, and for quality. It also includes a scenario describing the implementation of isolation technique (ie, clean closure) for colon procedures. Perioperative nurses should review the guideline in its entirety and apply the recommendations when practicing sterile technique.

Adjustments to an Existing Colorectal Surgical Site Infection Prevention Bundle Lead to Fewer Infections

Background: Surgical site infections (SSI) related to colorectal procedures are detrimental to patients and publicly reportable events. Our institution implemented a successful bundle of interventions to decrease SSI rates in 2014. In 2018, compliance started to wane, with a concurrent increase in infections. In an effort to enhance compliance and incorporate up-to-date information, we convened a multidisciplinary team to streamline this process. Methods: Our team evaluated published studies on successful bundle components and updates to professional guidelines for SSI prevention to determine adjustments. Modifications included allowing surgeon preference for (rather than mandating) wound protector use and simplification of clean closure protocol (determined by intraoperative contamination, leading to more efficient closure time). In addition, measures were added to achieve perioperative patient optimization (maintenance of normothermia, prevention of intraoperative hypoxia, tighter glucose control and postoperative bathing). The bundle was implemented in stages starting January 2019. SSI rates were monitored throughout the process using NHSN definitions, and rates were compared using χ2 analysis (Epi Info, CDC). Results: From 2015 to 2017, bundle compliance was 90%, and 8 SSIs (rate, 3.8 per 100 procedures) were detected (Table 1). In 2018, compliance was 82%, with 4 SSIs (rate, 6.6 per 100 procedures). From January through September 2019, SSI rates decreased to a rate of 4.8 per 100 procedures, with notable increase in superficial SSI, with zero cases of deep or organ-space infections. Feedback from operating-room personnel indicated their commitment to bundle compliance and perceived intraoperative time savings. Conclusions: Revamping an existing colorectal SSI bundle, including relaxation of time-intensive and expensive intraoperative measures and increased focus on evidence-based guidelines, resulted in decreased deep-organ space SSI rates, as well as increased satisfaction from procedural team members. Successful implementation of care pathways to prevent infections is an iterative process and requires the engagement of practitioners.Funding: NoneDisclosures: None

General mechanisms for policy-making on environmental remediation at the post-closure nuclear test sites in the USA.

This paper aims to give a condensed introduction to the general mechanisms for policy-making on environmental remediation at the post-closure US contaminated nuclear sites, the accomplishment of "Clean Closure," and the process of setting the goal "Closure in Place." The researches were conducted in three perspectives including overall guidelines, principles of corrective actions, and implementation of practical measures. The results indicated that the round of environmental restoration policies at the post-closure US contaminated nuclear test sites were comprehensive. It was supported by the visions and principles of differentiated and classified governance, demand-driven approach, highlights, unified planning, and progressive implementation in all directions. Meanwhile, it elaborates the diverse policy-making related issues of environmental governance at the polluted US nuclear sites upon closure and presents the preliminary analysis on them respectively to demonstrate valuable reference for the similar researches on the environmental governance of the contaminated nuclear areas as expected.

Remediation Decision‐Making and Behavioral Economics: Results of an Industry Survey

AbstractDecision methods applied in the remediation industry were evaluated using a survey of industry practitioners, in order to assess the relative roles of quantitative decision analysis and gut intuition. Principals from the disciplines of behavioral economics and decision theory were used as a framework to evaluate remediation decision behaviors revealed by the survey. The survey was completed by 118 respondents representing academia, consultants, clients, and others. Survey questions focused on perceptions and experiences related to inputs to decisions and decision processes, as well as remediation goal setting and outcomes. The most common remediation objective cited was short‐term interim measures and the least common was no further action (NFA) with clean closure. NFA was also sparingly achieved: 33% of respondents reported zero NFA closures in their career, and an overall 15% to 20% NFA closure rate was reported among more experienced respondents. Data inputs were ranked most important to decisions, while the decision process itself was ranked lowest. Intuition‐based decision methods such as asking for a trusted opinion, rules of thumb, and meetings were all used at last twice as often as decision analysis such as discounted cash flow or probabilistic analysis. Analysis of survey responses showed that cognitive biases, including overconfidence effect and intuition bias, are present to some extent in remediation decision‐making. Practitioners are advised to be mindful of the decision‐making processes they apply, and to incorporate elements of both intuition and decision analysis, as appropriate to the decisions being made.

Ground-water investigation following a jet fuel release

A tanker truck overturned releasing about 11,350 l of aviation fuel. As two municipal supply wells were within about 396 m of the release, contaminated soil was excavated and an assessment of hydrologic conditions was completed. A recovery well (RW) and five monitoring wells were installed. Ground-water samples were collected periodically from these wells and the municipal supply wells for analysis for volatile organic compounds. Pumping tests were completed on the RW and one municipal supply well. The results of the pumping test on the RWs were used to design a remediation system to remove jet fuel components from the ground water. The pumping tests also demonstrated that there was a ground-water divide separating the spill site from the municipal supply wells. After about 7 months of remediation, samples from the RW and municipal supply wells were clean and the state issued a clean closure.

Risk Assessment Methods for Establishing Clean Closure Levels

Establishment of clean closure concentrations for low levels of hazardous constituents in soils, ground water, and other environmental media by assessing risks to human health and the environment is a tool that is being used with increasing frequency. The four-step process sanctioned by the U.S. Environmental Protection Agency (EPA) includes: 1) hazard identification, 2) exposure assessment, 3) toxicity assessment, and 4) risk characterization. This paper describes the methodology and applies it to the closure of a hazardous waste surface impoundment in Florida. To date, the closure process has taken nearly five years and, pending the EPA's and Florida Department of Environmental Regulation's (FDER's) final approval, will result in clean closure of a small facility that has spent in excess of $450,000 U.S. during this period for removal of 516 cubic metres of sludge and other solids. If clean closure is approved, as is concluded to be protective of human health herein, the facility owner stands to save $275,000 U.S. that is estimated would be required to monitor ground water and to maintain an impermeable cap for the 30-year post closure period currently required under U.S. and Florida regulations. The risk assessment discussed in this paper began when soil samples collected after excavation of 516 cubic metres of sludges, soils, and other solids showed that the preliminary soil closure levels sanctioned by the FDER for chromium and nickel had not been achieved. Continued excavation would have cost a minimum of $50,000 to $100,000 U.S. (in 1988 dollars) and still may not have reached closure levels for these two metals. It is concluded in this paper that the maximum levels of chromium and nickel remaining onsite after remedial excavation (2.1 and 3.7 mg/kg, respectively) do not pose a risk to human health, and that the agency could raise the allowable closure level for these two metals from the current values of 1.1 and 0.70 mg/kg to these maximum values.

Closure of a Hazardous Waste Disposal Facility in an Active Oil Field

State and federal laws and regulations enacted during the past five years have led to closure activities at a large number of hazardous waste disposal facilities. These closures are often lengthy, difficult, and expensive. Closures must adhere to federal regulations promulgated by the U.S. Environmental Protection Agency (EPA) as well as State regulations administered by the Department of Health Services and the Regional Water Quality Control Boards. This exhibit depicts the regulatory framework for closure of a hazardous waste site. It also describes the closure alternatives for a site in the Central Valley which primarily accepted wastes generated from oil field activities. Generally, one of two closure alternatives is followed: (1) sites are closed-in-place with the wastes covered or monitored, or (2) wastes are treated and removed so that no waste or waste residue remains. Regulations issued by the EPA in 1987 made another option available. This option is risk-based clean closure and involves the identification of risk-based cleanup goals. A site-specific risk assessment adhering to federal and state guidelines is required to establish the cleanup goals. Waste constituents present in concentrations below these goals may be left in place without post closure care.

Discharge phenomena on closure of reed contacts

An investigation has been made of the electrical behaviour-on-closure of reed contacts under various loads. The contact coatings observed were carbon-doped gold with ruthenium top layer, electro-deposited ruthenium and sputtered ruthenium. This showed that clean closure is related to pip-and-crater erosion and therefore allowed an understanding of the suitability of coatings at various loads. One conclusion was that switch-on analysis cannot replace life testing.