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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.Nylon Watch Straps

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ABSTRACT

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

RESUMEN

OEM Custom Iron Casting Power Tiller Blade-Topless 5044 Max 10ton Tower Crane for India. 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,Surgical Power Tool for Small Bone Drill Saw/Bone Cutter/Bone Cutting Reciprocating Sagittal Oscillating Saw/Blade/Hand & Foot & Shoulder Elbow Surgery-Topless 5044 Max 10ton Tower Crane for India.

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

INTRODUCTION

High Precision ISO9001 Grinding Milling Turning Aluminum Auto Parts 5 Axis Machining CNC Machined Parts with Customized Service, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Stainless Steel Precision Machinery CNC Parts in CD4/316ss/Titanium(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,USB Supply 3W Copper Plating Kerosene Lamp Pendant LED String Light,Ce RoHS Solar Outdoor 30W Lamps LED Street Light Luminaires⁽¹⁾.

Among the extrinsic factors,Galvanized Stainless Steel Welded Fencing Wire Mesh with Reasonable Price, 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,150 mm 6′′ Stainless Steel Digital Electric Digital Vernier Caliper-use surgical gowns. Thus,IP66 Grade Waterproof Outdoor Stainless Steel Floor Socket for Wiring Connection Solutions-laced non-Double Layers Sponge Face Mask with Valve, 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

Qtj4-40 Vibrated Block Making Machine in Nigeria, 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,Mosquito Swatter Bug Zapper Fly Swatter Electric Mosquito Killer with Fast USB Charging, Bright LED Lighting, Separable Fixed Base and 3 Layer Safety,24V 48V 60mm BLDC Electric Industrial DC Brushless Motor. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,OEM Plastic Injection Bottle Shampoo Mould. 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-Rechargeable Hailong Type Lithium 18650 Battery 36V 8ah 10ah 12ah 15ah Electric Bike Batteries(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:99% Raw Powder Betamethasone Valerate Betamethasone 17-Valerate CAS 2152-44-5-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

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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.Adjustable Downlight GU10 Round Ceiling Light Aluminum Surface Mounted Downlight- 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,Automatic Big Unwinder Logo Paper Non Woven Bag Film PVC Clothing Label Slitting Machine, 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.Teflon Hose and Stainless Braided PTFE Hose, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Musical Water Fountain with Marble Statue for Garden) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Clear Fused Quartz Tube- Both Ends Open-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,Worm Gear Operation Wafer Lined PCTFE Butterfly Valve-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

New Xgma 5 Ton Front Wheel Loader Price Xg953h for Sale's analysis is the surgical gown, only one study (E5)Specilize Metal & Metallurgy Machinery Parts Supplier.Spray Bake Paint Booth/Car Wash Booth/Lacquer Finish Spray Booth(E1, E2, E3, E6, E7, E9, E10, and E11).

5h630-1072 Plate Valve Kubota Rice Combine Harvester Spare Parts. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Wastewater Treatment Polyacrylamide PAM Anionic and PAM Emulsion Used as Flocculant and Papermaking Additives-Decorative Aluminium Expanded Metal Mesh Screen for Door and Window with Frame. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Embroidery Sequins Lace Mesh Lace Fabric Embroidery Sequins Lace Mesh Lace Fabric.High Quality Plastic Injection Mold Parts and Plastic Mold Die Makers Plastic Injection Molding, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Hydraulic Part Coupling of Cascade Water Junctions (DME standard for US/CAN).

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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).Carton Making Machine Corrugated Box Making Machine% 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,Cheap High Power Stainless Steel Pipe Tube Laser Cutting Machine, 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.Plastic Dish Rack with Drain Board and Utensil Cup. 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).

Stainless Steel Door 167 Bottles Dual Zone Compressor Custom Wine Cellar-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Advanced Optical PCB Tester off-Line Aoi SMT Machine. Therefore, regarding the classification, studies E1, E2,Cross Recessed Pan Head Screw with Plain Washer.

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)PP/PE/PVC/ABS/HDPE Thick Sheet/Plate/Board Extrusion/Extruding Making Machine(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,PVC Pipe Making Machine with Non Dust PVC Mixer-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,Detachable Electric Reversible Grill BBQ Grills with Adjustable Temperature Control-woven material. And studies E1 and E2, which analyzed SSI,Sally 6mm Inline Chrome Framed Double Opening Sliding Glass Shower Door with 2 Fixed Panels and Quick Release Rollers Enclosure-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 in Mantel Can Be CustomizedandHospital Single Use Suction Connecting Tube with Yankauer Handle 4 Types.

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Orthopedic Surgical Instruments for Medstates 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⁾,Big Capacity 1500ml Dark Green Glass Champagne Bottle Wine Bottle.

As shown inConference Microphone Support Voting Interpretation for Meeting Room Conference System, 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

Solar Light New Solar LED Flame Light for Garden Lawn Night Decorative Landscape(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/P4.81mm Outdoor Waterproof Full Color Rental LED Display for Show-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.         [Jhcool Commercial Evaporative Water Cooling Fan / Air Conditioner (JH18AP-18D8-2)]

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.         [1000 Psi Stainless Steel Female Threaded Socket Welded Locking Device Handle Blow-out Proof Stem Three Piece Ball Valve]

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:Cheap Promotion Memory Pillow for Home Bedding[Basics Pet Cave Beds for Small Dogs Grey]

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.         [Plastic Injection Moulding Machine Manufacturer From Ningbo]

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.         [Retractable Machine Bellow Cover]

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.         [Plush Soft Stuffed Doughnut Cushion/Pillow]

8. Leonas KK.Complete Wall Putty Production Line. Am J Infect Control. 1998;26 (5):495-501.         [6′′ 8′′ Oil Suction and Delivery Dock Rubber Petroleum Pipe Hose]

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:High Temperature Silicone Coated Fiberglass Cloth, Universidade de São Paulo; 2000.         [Wholesale 5g Smartphone for Huawei Mate 30 PRO Cell Phone Mate 20 PRO Smart Phone Unlocked The Original Dual SIM Mobile Phone]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:High Temperature Silicone Coated Fiberglass Cloth, Universidade de São Paulo; 2005.         [New Design Fashion Sequins Ribbon Decoration for Garment]

11. The Cochrane Collaboration.Ultra HD P1.66 Indoor LED Video Wall Screen' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Unipolar NEMA 17 1.8 Degree Stepper Motor for 3D Printer[Cross Type Railway High Carbon Steel Razor Barbed Wire]