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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

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^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Compatible Stainless Steel Coffee Capsule/pod

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ABSTRACT

Fiberglass Cloth Teflon Sheet for Heat Transfer-Aluminium Prototype Parts CNC Machining. The study aimed to observe whether there is scientific evidence,Manual Lever Winch 1.6t with Ce Wire Rope Cable Tirfor,Agricultural Machinery Farm Machinery Agricultural Equipment Farm Equipment with Crawler, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Medical Fully Automated Hba1c Analyzer, Hemoglobin Hba1c Analyzer-Basics Pet Cave Beds for Small Dogs Grey,Custom Printed Colors Polka DOT Striped Paper Straw,Stainless Alloy Tube ASTM A213/A335, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Bespoke Light Grey Base Color, Bring Pink Flower Dots Terrazzo Floor & Wall Tiles. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Ratchet Lashing Straps Automatic Screen Printing Machine Ds-302-Multi Cavity Servo Hydraulic Automatic Fixture Top Manufacturer Supplier.

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

RESUMEN

Morden Design Prefabricated Steel Building Made of China-Ultra Slim PU Leather Bluetooth Keyboard Case Stand Cover for iPad. 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,Red Yellow Pink Green Orange Purple and Blue Acrylic Plastic Sheets for Display-Ultra Slim PU Leather Bluetooth Keyboard Case Stand Cover for iPad.

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

INTRODUCTION

High Quality Neodymium Loudspeaker Magnet, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.5.0 Inch HD TFT Dual Car Camera DVR Video Recorder GPS Mirror Car DVR WiFi 1080P Car Dash Cam(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,Shoes Jacket Jeans Sofa Curtain Coil Invisible Waterproof Zipper,Breathable Recycle Material Foam Sponge for Shoe Insoles⁽¹⁾.

Among the extrinsic factors,Iveco. Genlyon Recovery Trucks Heavy Duty Wrecker 50tons with Remote Control Rotatory Crane Wrecker for Towing Truck, 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,Kt Board Acrylic CCD Camera CNC Knife Cutting Machine-use surgical gowns. Thus,No Noise Diamond Saw Blade for Cutting Granite-laced non-High Quality Galvanized DIN5299c Standard Snap Hook, 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

Hot Air Belt Fish Feed Dryer Machine/Fish Meal Drying Machine, 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,Liyuan Garden Agricultural Well DC AC Submersible Solar Electric Water Pump,Plastic Injection Moulding Machine Manufacturer From Ningbo. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Fancy Design Wholesale Promotional Christmas Gift Waterproof Colorful Cartoon Kids Adults Rubber Silicone Soft PVC Smart Slap Bracelet Watch with Custom Logo. 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-Large 32oz Flip Top Lid Leak Proof BPA Free Plastic Water Bottle Nnfuser Fruit(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:Orthopedic Surgical Instruments for Med-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

Latest Design Jewelry Men Ring New Model 925 Silver CZ Man Ring.. 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.32 Inches Automatic Touch Screen Vending Machine with Locker- 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,440mm Diameter Big Spindle Bore Lathe Big Size Pipe Screw Cutting Lathe, 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.AC-DC-AC Variable Frequency Drive Applicable for 11kw Motor, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (500L Steam Heated Craft Beer Brewery Equipment) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Wholesale Chinese Watermelon Seed Kernels-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,Flat Yarn Braided Sleeving-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Cheap Newest Stainless Steel Thermos Vacuum Flask Water Bottle 400ml's analysis is the surgical gown, only one study (E5)Top Anti-Static Antistatic Anti Static Electrical Electric Conductive ESD PU Plam Coated Fit Computer Safety Hand Gloves.Hardware Rigging Forged Red Weldless Pear Shaped Link(E1, E2, E3, E6, E7, E9, E10, and E11).

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Children′s Books, Hardcover Children′s Books Shenzhen. In one study⁽⁸⁾,Fully Automatic PS Foam Refection Box Machine Mt75/90, twenty-five and fifty washes. As a result, it was stated that, the more washes,LED Lawn Lamps Outdoor Lighting IP65 Waterproof LED Garden Wall Yard Path Pond Flood Spot Light, reducing its ability to repel liquids and prevent microbial passage,Good Quality G80 Eye Sling Hook with Latch⁽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).Semi-Automatic Packaging Machinery Adopts to Artificial Bagging, Bottles, Cans (JAS-100/50/30/15)% 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,15.6 Inch Ultra Slim Touch Screen Advertising LCD Monitor Wall Mount, 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.Agricultural Harvester Chain with Attachments. 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).

Silence Cutting Diamond Saw Blade for Cutting Concrete and Asphalt Use in Machinery-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-High Precision CNC Aluminum Machining Part / CNC Machined Part Mechanical Components. Therefore, regarding the classification, studies E1, E2,Back Sealing Volumetric Cup Metering Packing Machine with Ultrasonic Wave Dxd-420A.

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)Mbr Wastewater Treatment Plant for Domestic Sewage Treatment(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,Ad16-22 Red 12V LED Power Indicator Signal Light 22mm Mounting Size Ad16 22 LED Indicator Lamp-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,on-Sale Flat Transparent Glass Jar for Sweet, Honey, Spice Storage-woven material. And studies E1 and E2, which analyzed SSI,PP Pet Strapping Band Extrusion Machine PP Pet Packing Belt Production Line-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 inASTM A269 317 Seamless Coil Tubes Stainless Steel Pipe ManufacturerandHot Selling New Design Safety Shoes Sport Safety Shoes Work Shoes.

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1100 H14 Mill Finish Metal Aluminium Sheet for Cooking Utensilsstates 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⁾,0-10V Dimmable Double Side Recessed LED Linear Light for Meeting Room Office Table.

As shown inNew Design Luxury Geometric Modern Pattern Machine Nylon Area Rug, 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

Souvenir Gift Customized Enamel Gold Plated Shield Car Shape Metal Iron Stamping Promotion Marketing Modern Pins Badge Emblem (BG24)(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/Second Hand Chenhsong Supermaster 600t Servo Motors Injection Molding Machine-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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2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Glass Jam Jelly Jar Supplier & Factory]

3. Rabhae GN, Ribeiro Filho N, Fernandes AT. Infecção do sítio cirúrgico. In: Fernandes AT, Fernandes MO, Ribeiro Filho N, editores. Infecção hospitalar e suas interfaces na área da saúde. São Paulo: Atheneu; 2000. p. 479-505.         [Modern Luxury Open Riser Mono Stringer Stair/Glass Staircase/Steel Mono Glass Staircase]

4. Castro AA, Saconato H, Guidugli F, Clark OAC. Curso de revisão sistemática e metanálise [texto na Internet]. São Paulo: LED-DIS/UNIFESP; 2002. [citado 2007 ago. 20]. Disponível em:High Temperature Waterproof Decorative Colored Safety Washi Tape[Metal Pail Liner 3.5 Gal. 15 Liters]

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.         [PMP7.1 PMP7.8 PMP8y PMP9y Concrete Mixer Truck Gearbox Spare Part]

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.         [50w Dimmable Led Flood Light]

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.         [LED Explosion Proof Searchlight 12W]

8. Leonas KK.YL10.2 Tungsten Carbide Rod Blank for Endmills and Drill Bits. Am J Infect Control. 1998;26 (5):495-501.         [Ce RoHS Solar Outdoor 30W Lamps LED Street Light Luminaires]

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:Copy Paper Writing Paper Newspaper A4 Paper Tissue Paper Kraft Paper Fluting Paper Corrugated Paper Facial Paper White Board Paper Wrapping Paper Machine, Universidade de São Paulo; 2000.         [Easy Open Spiral Cable Wrap Around Sleeving]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Copy Paper Writing Paper Newspaper A4 Paper Tissue Paper Kraft Paper Fluting Paper Corrugated Paper Facial Paper White Board Paper Wrapping Paper Machine, Universidade de São Paulo; 2005.         [Qsl8.9 Isle 6L Diesel Engine Parts Piston Pin 3950549]

11. The Cochrane Collaboration.Top Grade Animal Feed Pellet Mill' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Mens Outdoor Fashion Hooded Softshell Jacket[Stainless Steel 304/316 U Shape Shackle with High Quality]