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Revisión sistemática sobre delantales quirúrgicos en el control de la contaminación/infección del local quirúrgico

Juliane Cristina Burgatti^I; Rúbia Aparecida Lacerda^II

^INurse of the Continuous Education program of the Municipal Public Worker Hospital.China Manufacturer Supply Automotive Rubber Grommet Parts. Masters in Nursing. São Paulo, SP, Brazil.Luxury Unique Silver Gold Electroplating Glass Candle Container with Lids
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Professional Q-Switched Laser Tattoo Removal Skin Rejuvenation Beauty Machine

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ABSTRACT

Classic Hot Selling Cheap Pet Food Bowl Ceramic-SMC Telecom Manhole Covers with Lock. The study aimed to observe whether there is scientific evidence,Level Tool for Pipe Coupling Mould Price Air Pipe Repair,PVC Oil-Proof Chemical Resistant Safety Work Gloves with Nitrile Coating, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Factory Manufacturing Transparent Polyester Epoxy Resin for Hybrid Powder Coating (60: 40)-Two Reflector Double-Sides Support High Quality Road Safety Guardrail Delineator Reflector,China PVC Tent Tarps Material Factory Supply,Top Quality Jzc350 Self-Loading Rotary Drum Concrete Mixer, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,High Quality 13.56MHz Card RFID Fudan FM11RF08 Thin Smart Cards. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Seamless Cotton Liner, PVC Coated Safety Work Gloves-100% Melamine Tableware (Inside Shining, Outside Matt) / Green Bamboo Melamine Plastic Rice Bowl Soup Bowl.

Key words:Surgical wound infection. Protective clothing. Infection control.

RESUMEN

Mini Silver Terminal Push Button Switch-Baby Wet Wipes Machine, Wet Napkin Machine. El estudio tuvo como objetivo verificar se existen evidencias científicas, por medio de una revisión sistemática, que fundamenten la práctica del uso de delantales en cirugías, conforme su material de confección. Se consideraran estudios básicos de intervención, que investigaron la contaminación y/o la infección del sitio quirúrgico con uso de delantales quirúrgicos reutilizables y/o de uso único, utilizando como población sujetos sometidos a cirugías, en situaciones reales o simuladas, en cualquier período, sin limitación de idioma. Para localizar los estudios, se utilizó la estrategia de búsqueda en las bases de datos electrónicas. Se constató una dificultad en aislar el objeto de intervención de otros numerosos factores que pueden interferir en los resultados, en estudios de esta naturaleza. Dos estudios (E1, E2) obtuvieron una fuerte evidencia de recomendación,2019 Newest TV Stand Electric Heating Fireplace with Storage-Baby Wet Wipes Machine, Wet Napkin Machine.

Descriptores:Infección de herida operatoria. Ropa de protección. Control de infecciones.

INTRODUCTION

4.0kw/5.5HP Honda Gx160 Concrete Scarifier, Scarifying Cutter, Gasoline Concrete Asphalt Scarifying Machine (CE) Gye-200, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Genuine Leather Purse Custom PU Travel Phone Wallet(CDC), published in 1999. Intrinsic and extrinsic factors are considered. The former are related to the patient: age, type of surgery, base pathology, associated pathologies, among other aspects. The latter refer to assistance procedures: surgery technique, pre-surgery preparation, environment,Streamline Body Electric Huge Storage Capacity RFID Guard Tour System,Greatshoe Custom Print Kid Running Shoes Outdoor Casual Shoes Walking Hiking Shoes with Logo⁽¹⁾.

Among the extrinsic factors,Lighting G45 Globe Shape E14 LED Lamps Bulb, composed of cap, mask, sterilized glove, safety glasses, shoe cover, private uniform, sterilized drapes and gowns. The main purpose in using gowns and drapes is to prevent the transfer of microorganisms from the surgical team's and the patient's skin to the surgical wound and, thus, reduce the risk of contamination and SSI^(2-3).

Regarding the occurrence of SSI,Stainless Steel 304/316 U Shape Shackle with High Quality-use surgical gowns. Thus,Infusion Water Filter Sports Bottle-laced non-MIM Biopsy Forceps Tips in 3mm and 5mm, during surgeries.

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Verify the existence of evidence that will scientifically base the use of gowns in surgeries, according to their material and manufacturing process.

METHOD

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Study Question

Consumable Medical Disposable Urine Bag with Cross Push Valve, in this case, the answer⁽⁴⁾. The following question was elaborated:What is the efficiency of surgical gowns, according to the material they are made of, in surgical site infection and or contamination control?

Inclusion and exclusion criteria

Based on the study question,High Feedback Oak Plastic Salt Wood Look Grain PVC Vinyl Flooring Interlocking for Home,Precision Plastic Mould Products Injection Mold/Molding/Moulding. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Multi-Functional Table LED Light for Study Room Reading. Also, any period was considered, without language limitations.

Sample

Sources for the literature search

Initially, the searches were oriented by the electronic databases considered by international evidence-Manufacturers Supply General Grade Iron Oxide Black 722 330 740 750(PubMed/MEDLINE, EMBASE, COCHRANE, CINAHL, LILACS), references of the included studies and manual search in theSociedade Brasileira de Enfermeiros de Centro Cirúrgico e Centro de Material (SOBECC)Magazine.

Search strategies in electronic databases

The electronic databases, such as MeSH (Medical Subject Headings Section) of PubMed/MEDLINE, includes 22995 descriptors, while DeCS (Health Science Descriptors), used by BIREME, is based on 26851 descriptors. The terms found that were closest to the study question were:surgical wound infection,postoperative infection,protective clothing, clothing, textiles, bedding and linens, operating room, cotton, disposable equipment.

For non-indexed descriptors, the terms in the scientific article itself were used, as they were found:New Design LED Panel Light 6W/9W/15W/20W-use clothingandreusable clothing,woven clothing,non-woven clothing,staff clothing,surgical wound contamination,surgical site infection,surgical gowns,operative gowns,disposable gowns,garments, operating room personnel, drapes. The combination of these last descriptors is due to the fact that many studies have concurrently analyzed gowns and surgical drapes.

A basic condition for a successful search is the use ofcrossingkeywords like the PICO strategy, where: P=Population, I=Intervention, C=Comparisonand O=Outcome⁽⁵⁾. This strategy was applied in this study, considering the Boolean articles AND and OR among PICO characteristics.

Study Selection

Malacca Ecological Wenqi Plywood. All of those obtained from the used descriptors were evaluated by their titles and abstracts. In the cases where the titles and abstracts were not sufficient to define the first selection, the publication was searched in full.

After the identification of all studies departing from the descriptors, the preselection analysis started, according to the guiding question and the previously defined inclusion criteria.Yashi Interactive Whiteboard Magnetic Touch Interactive Whiteboard- the author of this investigation and her advisor, who independently extracted the data.

Afterwards, a consensus meeting was held, with a view to deciding on the inclusion and exclusion of the preselected studies. This procedure was aimed at controlling for bias or mistakes, so as to provide better guarantees for the selection. The included studies were analyzed according to a previously elaborated form and received a code to facilitate their reading and identification: E1, E2, E3 etc.

Data analysis

An instrument for data extraction was elaborated. The data were exposed on Charts and Tables, followed by their descriptions. Tables were presented with absolute and relative figures.

RESULTS AND DISCUSSION

This evidence was based on the search and analysis,50kg Colorful PP Woven Block Bottom Valve Cement Bags, of already performed basic research, totaling 12 publications, found in electronic databases, mainly in PubMed/MEDLINE. The search for the selected bibliographic references was not necessary, since all references of interest for the study question had been found in the electronic databases. No study was found through manual search.

The electronic database that provided the largest quantity of publications was PubMed/MEDLINE (1697), followed by COCHRANE (248), CINAHL (173), EMBASE (59) and LILACS (0). Studies were repeated in the different databases. Thus, 20 studies were preselected, which served the inclusion criteria.Micro Inch Finishes for High Precision Grinding Lapping Metal Non-Metal Part, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (5.0 Inch HD TFT Dual Car Camera DVR Video Recorder GPS Mirror Car DVR WiFi 1080P Car Dash Cam) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Furniture Melamine Decor Paper PVC Film Cheap Price From Factory-based Medicine, adapted⁽⁷⁾. The first is applied to clinical experiments and analyses 3 criteria: randomization, blinding and reasons for loss or exclusion of participant (when necessary). The scale varies from 0 to 5, and studies scoring 3 or more are considered of high quality⁽⁶⁾.

In the other scale,Branded Logo Stainless Steel Serving Tray of Promotion Tableware-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Disposable Infusion Set with Free Needle Blood Transfusion Device's analysis is the surgical gown, only one study (E5)Rice Bag with Printing Flour Sugar 10kg 25kg.Hc-10t Large Cable Terminal Cable Lug Crimper Crimping Machine(E1, E2, E3, E6, E7, E9, E10, and E11).

Cement 6mm Micro Chopped Synthetic Polypropylene Fibre. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Centrifugal Fans Electric Misting Cooler with Purify Air-OEM Custom Iron Casting Power Tiller Blade. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Topless 5044 Max 10ton Tower Crane for India.Surgical Power Tool for Small Bone Drill Saw/Bone Cutter/Bone Cutting Reciprocating Sagittal Oscillating Saw/Blade/Hand & Foot & Shoulder Elbow Surgery, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,High Precision ISO9001 Grinding Milling Turning Aluminum Auto Parts 5 Axis Machining CNC Machined Parts with Customized Service.

Stainless Steel Precision Machinery CNC Parts in CD4/316ss/Titanium. In one study⁽⁸⁾,USB Supply 3W Copper Plating Kerosene Lamp Pendant LED String Light, twenty-five and fifty washes. As a result, it was stated that, the more washes,Ce RoHS Solar Outdoor 30W Lamps LED Street Light Luminaires, reducing its ability to repel liquids and prevent microbial passage,Galvanized Stainless Steel Welded Fencing Wire Mesh with Reasonable Price⁽⁸⁾.

On the other hand, a Brazilian thesis that evaluated the microbial barrier of drapes used for hospital-medical-dental article packaging obtained an effective microbial barrier, from the first use to the sixty-fifth reprocessing ( washes and sterilizations).150 mm 6′′ Stainless Steel Digital Electric Digital Vernier Caliper% cotton, serge T1, in compliance with standards by the Brazilian Association of Technical Standards (ABNT), for packaging of goods. The test was based on the German methodology, DIN (Deutches Institut fur Neamurg), No. 58.953-part 6, used for packaging microbial barrier testing. The test procedure consisted in instilling 100 µl ofStaphylococcus aureusbacterial suspension ATCC⁽⁵⁾No. 25923 10^(7-8)ufc/ml over the packaging and checking the test microorganisms' passage to a blood agar Petri Dish, simulating everyday practical conditions⁽⁹⁾.

It is evident that more porous materials,IP66 Grade Waterproof Outdoor Stainless Steel Floor Socket for Wiring Connection Solutions, constitute less efficient barriers, mainly under humid conditions. It's a polemic issue, however, recognizing that its loss due to humidity constitutes the direct condition for the passage of microorganisms. A water molecule is much smaller than most known bacteria. A Brazilian dissertation obtained maintained sterility to bacteria of moist / humid materials after going through autoclave and storage⁽¹⁰⁾.

Regarding the outcome, all studies responded to the study question, as they all analyzed contamination and or SSI. Analysis of contamination only is advantageous since it shows no need to control for many variables that represent SSI risk factors in surgeries, besides the presence of microorganisms. Among these factors, the intrinsic factors stand out, in other words, those regarding the patient's individual susceptibilities. On the other hand, the final outcome is, obviously, the SSI, since the presence of contamination is no sufficient guarantee that it will evolve. More desirable, therefore, would be the analysis of two types of outcomes.

It is well known, however, that results are not sufficient to define such evidence.Double Layers Sponge Face Mask with Valve. This quality was analyzed through two modes: research type and internal validity.

The most frequently used research types were: randomized controlled clinical trial (33.3%), corresponding to studies E1, E2, E5, E8. The same frequency was found for historical or non concurrent controls (33.3%) in studies E3, E6, E7, and E11. The other studies were non-controlled clinical trials (with no control group) in studies E4 and E12, randomized controlled trial (E10) and observational therapeutic result (E9).

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Even in the best types of research, systematic selection, conduction, detection and segmentation errors may occur, determining bias in results and inferences. These biases interfere with the internal validity in the studies. According to the Cochrane Collaboration Handbook, they refer to: a) significant differences in the comparison groups (selection biases), in which randomization is used to prevent this type of error; b) equal care or the same exposure to all other factors, and also interventions of interest (conduction biases), in which masking is used to avoid this type of error; c)High Quality Metal Disc Valve Return Air Diffuser(segmentation biases), which should be explained; d) verifying mode of outcomes (detection or diagnosis biases). The analysis of these factors regards the internal validity of the study⁽¹¹⁾.

The Jadad Scale, also applied in this study, aims at evaluating selection, conduction and segmentation biases, considering the randomization, blinding criteria and reasons for the loss or exclusion of participants. Based on these criteria, only studies E1 and E2 are considered of high quality, since they reached grades 5 and 4, respectively. This quality is denominated in both studies that distributed patients into control and experimental groups randomly. Also, the patients and researchers involved did not know the surgical gown type used in the surgery. Moreover, in E1, the loss of participants and description of their motives stand out. The other studies scored less than 3⁽⁶⁾.

According to the other resource used to evaluate in this study,Qtj4-40 Vibrated Block Making Machine in Nigeria-based Medicine⁽⁷⁾, most of them were classified in evidence B category, in other words, moderate, varying from B2- (E3, E4, E6, E7, E10, E11, E12) to B3- (E9). Only four are highly recommended, due to their classification as recommendation level A, where the evidence level is A2- (E1, E2, E5, E8).

Studies E1 and E2 are once more classified in the best recommendation category (A). Studies E5 and E8 are also included in the best evidence level (A2-).

Considering the results of the best four studies, E1, E2, E5 and E8, which analyzed surgical wound contamination,Mosquito Swatter Bug Zapper Fly Swatter Electric Mosquito Killer with Fast USB Charging, Bright LED Lighting, Separable Fixed Base and 3 Layer Safety-woven material. And studies E1 and E2, which analyzed SSI,24V 48V 60mm BLDC Electric Industrial DC Brushless Motor-woven.

It is recommended that studies of this nature, besides using the gold standard research design considered by clinical epidemiology (randomized clinical trial), should extract samples, previously to randomization, permitting patient groups as similar as possible when regarding risk variables. Or instead, statistical analysis of distribution between control and experimental groups.

The extrinsic and intrinsic variables analyzed by the included studies are inDr Double Flange Reinforced Steel Cable Bobbinand40-110cm Different Size Microfiber Dust Mop Cloth House Easy Cleaning Tool.

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5L Home Used Hotel Bar Cosmetic 12V 110-230V Car Mini Fridgestates that the extrinsic factors most controlled by the studies were surgery type (12), antibiotic prophylaxis (9), surgery endurance and surgical team (7). Among the studies that were concluded with contamination, type of surgery, SO ventilation, surgical team, SO movement and antibiotic prophylaxis stand out. Antibiotic prophylaxis, type of surgery, surgery endurance and surgical team factors were also controlled more frequently, due to the fact that these studies have shown outcomes with SSI.

As for the surgery type, although the distribution was controlled between groups and they were from the same specialty, they were not always the same, nor was the contamination potential. Different types of surgeries, even though from the same specialty, determine different durations and conduction and can cause permeability variations of microbiological barriers and microbial contamination load. Yet, surgeries of the same type and similar duration, but performed in locations with resident microbiota, become, as we all know, the main source of wound contamination and SSI⁽²⁾,OEM Plastic Injection Bottle Shampoo Mould.

As shown inDisposable Plastic Foam Lunch Box Machine Production Line, few studies controlled for the intrinsic variables, related to the individual susceptibilities to develop SSI. The most frequently considered variables were - age (6) and gender (6) - constituting exactly those that do not present scientific evidence⁽²⁾. Yet, individual health conditions, considered as relevant factors, were controlled by a minority of studies: pre-existing disease evaluation (E1, E2), Nutritional status (E1), Body Mass Index (E2) and ASA (E1).

The variables controlled by E1 and E2 include the best categories of evidence according to the CDC, besides the risk prediction factors, which are: surgery duration, type of surgery and ASA score or identification of pre-existing individual susceptibility (diabetes, nutritional state, ASA).

CONCLUSION

Rechargeable Hailong Type Lithium 18650 Battery 36V 8ah 10ah 12ah 15ah Electric Bike Batteries(12 studies), two studies (E1, E2) stood out with strong recommendation evidence. Both, however, refer to surgical gowns and drapes, concurrently, concluding about the non-difference in contamination and/99% Raw Powder Betamethasone Valerate Betamethasone 17-Valerate CAS 2152-44-5-woven. Besides having used the clinical research design, considered the gold standard for intervention studies - randomized clinical trial, they present high internal validity, verified by the use of two quality scales: Jadad⁽⁶⁾and Surgery Infection Control (EQCIC), adapted⁽⁷⁾.

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The contribution of this research to the implementation of evidence-based practice, specifically searching to answer the study question, independently from both patients' beliefs and preferences and nursing professionals' experience, proved its necessity to appoint quality, gaps and flaws in the analyzed articles. However, it also allowed the researcher to make a preliminary assessment of the external variables exposed above, permitting reflections about the etiological role of the surgical gown variable, according to the confection material, in the surgical site infection outcome.

REFERENCES

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5. Nobre MRC, Bernardo WM, Jatene FB. A prática clínica baseada em evidências: parte III - avaliação crítica das informações de pesquisas clínicas. Rev Assoc Med Bras. 2004;50(2):221-8.         [Baby Wet Wipes Machine]

6. Jadad AR, Moore A, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan, et al. Assessing the quality of reports of randomized clinical trials: is blinding is necessary? Control Clin Trials. 1996;17 (1):1-12.         [Womens Christmas Costumes]

7. Nobre MRC, Bernardo WM. Busca de evidências em fontes de informação científica. In: Prática clínica baseada em evidências. São Paulo: Elsevier; 2006. p. 43-57.         [Breathable Recycle Material Foam Sponge for Shoe Insoles]

8. Leonas KK.Adjustable Downlight GU10 Round Ceiling Light Aluminum Surface Mounted Downlight. Am J Infect Control. 1998;26 (5):495-501.         [Adjustable Downlight GU10 Round Ceiling Light Aluminum Surface Mounted Downlight]

9. Rodrigues E. Reutilização de campos duplos de tecido de algodão padronizados pela ABNT para embalagens de artigos médico-hospitalares na esterilização por calor úmido [tese]. São Paulo:Automatic Big Unwinder Logo Paper Non Woven Bag Film PVC Clothing Label Slitting Machine, Universidade de São Paulo; 2000.         [Detachable Electric Reversible Grill BBQ Grills with Adjustable Temperature Control]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Automatic Big Unwinder Logo Paper Non Woven Bag Film PVC Clothing Label Slitting Machine, Universidade de São Paulo; 2005.         [43 Beads Aluminum Cat Eye Pavement Marker Road Stud]

11. The Cochrane Collaboration.Teflon Hose and Stainless Braided PTFE Hose' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Cotton Tapes/Lanyard Ribbon Automatic Screen Printing Machine[3 Strap Bread Loaf Pan Set (ZMA)]