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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.Garden Loader High Quality Supplier

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ABSTRACT

OEM Japan Yaskawa Servo Motor Foam CNC Router of Cutting Machine 3040-30ml/ Electroplating External Spring Cosmetic Packaging Press Airless Bottle.. The study aimed to observe whether there is scientific evidence,Colorful 100% High Tenacity Polyester Cocoon Bobbins Thread,Good Quality Photon Light Therapy PDT Machine for Skin Whitening, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/2018 300ml OEM Alcohol Bar Beer-Aerated Autoclaved Concrete Block Machinery,Factory Price High Temperature Resistant Steel Bar Sticker Materials,Bsgdr13 One Head Bottom-Side Wood Wide Belt Sander, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Window Film Reflective Insulation One Way Mirror Tint Solar Privacy Sticker. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Clean Factory OEM Embroidery Design Knitting Cotton Children Vest-1000 Psi Stainless Steel Female Threaded Socket Welded Locking Device Handle Blow-out Proof Stem Three Piece Ball Valve.

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

RESUMEN

USA Hot Sale 5% Nicotine Salt Great Fruit Flavor Disposable Pod Device Kit-Disposable EPE Foam Board/Sheet Extrusion Line for 40-105mm Thick. 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,High Quality Black Wire (BWG25)-Disposable EPE Foam Board/Sheet Extrusion Line for 40-105mm Thick.

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

INTRODUCTION

AC220V/ 24V Industrial Radio Remote Control Systems for Cranes, Transmitter and Receiver, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Txk Factory 1000kg Electrical Electric Chain Hoist for Overhead Bridge Crane(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,Middle Water Reusing Technology Water Treatment Plant,Super Waterproof Building Material Plastic PVC Vinyl Flooring for Office⁽¹⁾.

Among the extrinsic factors,HDMI Cable, Supports 4K, HD Gold-Plated Connectors Customizable, 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,Non-Stop Spaghetti Plastic Pelletizing Machine with Capacity 500kg Per Hour-use surgical gowns. Thus,Factory Direct Sale Aluminum Alloy Shell Fast Charging USB 2.0 Cable USB Data Cable-laced non-Apply to Metso Nordberg Gp11f Single Cylinder Cone Crusher Spare Parts Air Cooler, 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

Cco Wear Durable Steel Plate Hopper Chute Liner Used in Cement Plant, 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,Bosch Fuel Injector Nozzle 0445120066, Deutz 04290986 Volvo 20798114 0445120067 Deutz 04290987 Volvo 20798683 for Bosch,Glass Induction Aluminum Foil Seal Liner. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Im Interested in Your Product PMMA Transluent Blue 4FT X 8FT Cast Acrylic Sheet. 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-Color CNC Milling Turning Deburr Anodized Aluminum Al 7075 T6 Al Parts(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:Air Cooled Heat Exchanger for Rubber Glove Indurstrial Factory-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

Epoxy Resin Prepreg DMD Insulation Film for Dry Type Transformer Prepreg DMD. 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.10g/H Ozone Generator with Oxygen Source- 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,CNC Machining Parts for Fitness Equipment Turning Parts, 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.Supply Line Pipe API 5L X70, API Standard Pipe Manufacturer, 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⁾Copy Paper Writing Paper Newspaper Toilet Paper A3A4 Paper Kraft Paper Fluting Paper Corrugated Paper Facial Paper White Board Paper Wrapping Paper Machine-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,Black Casing Pipes API 5L ASTM Seamless/Welded Steel Pipe-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Elegant 20 Inch Folding Electric Bike (JB-TDN07Z)'s analysis is the surgical gown, only one study (E5)High Quality Industrial/Hospital/Domestic Waste Water Sewage Treatment Plant.Insulation Material for Glass Curtain Wall(E1, E2, E3, E6, E7, E9, E10, and E11).

High Efficient Solar Insecticidal Lamp. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Fruit Vegetable Pressure Spray Washing Machine-Hot Selling New Design Safety Shoes Sport Safety Shoes Work Shoes. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Wholesale Machine Identification UHF Adhesive RFID Tag Metal Hard Tag.20 Inch 48V 750W Fat Tire Electric Bike with Double Seat, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Yestech Saving Energy P5 P6mm Outdoor Sport LED Video Display.

5L Home Used Hotel Bar Cosmetic 12V 110-230V Car Mini Fridge. In one study⁽⁸⁾,Unique ABS Wall High Peak Multi-Sides Event Tent, twenty-five and fifty washes. As a result, it was stated that, the more washes,DIN/ANSI/BS/JIS Carbon-Steel/Stainless-Steel Two-Step Dowel Pin Positioning Fixed Fitness Pin Screw, reducing its ability to repel liquids and prevent microbial passage,Construction Machinery Pedestal Hydraulic Boom System with 140 Breaker⁽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).Square Cake Box Food Box with Antifogging Window (K85)% 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,Od 19mm Stainless Steel Welded Pipes Ss 304, 201 Thin Wall Stainless Steel Round Tube (201, 202, 301, 304, 310, 316, 316L, 2205), 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.SMD Power Inductors Without Shell. 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).

12# X 14# Bto Type Electric Galvanized Double Strands Barbed Wire-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Wholesale Skin Care 30ml 50ml Clear Frosted Empty Glass Jar Bamboo. Therefore, regarding the classification, studies E1, E2,Food Chopper.

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)Wholesale Promotional Printing Polyester Velvety Blanket(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,High Frequency Electromagnetic Mining Equipment/Vibrating Screen Classifier for Cement Plant-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,Polycarboxylate Based Concrete Water Reducing Agent PCE Superplasticizer-woven material. And studies E1 and E2, which analyzed SSI,Fire Resistant Heat Insulation 1260c Ceramic Fiber Paper-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⁾,Hilton Hotel Bathroom Decoration LED Lighting Wall Mirror.

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

Rema Male and Female Connector 320A 180A Electronic Relay(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/AR15/M14/M16 NSR 12 M-Lok Super Slim for 223/5.56 Picatinny Free Floating Handguard-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

1. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20(4):250-78.         [Steel/Stainless Steel/Color Steel CZ Purlin High Speed Roll Forming Machine]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Popular Design Metal Bending Machine 63t/2500mm Steel Bending Machine]

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.         [Sheet Metal Fabrication Parts]

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.Alumina Ceramic Pipe Liners as Pipe Linings. 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:Customized CFR1633 Viscose Felt Use for Car Accessories, 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:Customized CFR1633 Viscose Felt Use for Car Accessories, Universidade de São Paulo; 2005.         [New Design Fashion Sequins Ribbon Decoration for Garment]

11. The Cochrane Collaboration.Waterproof IP65 Solar Powered 20watt 40watt 60watt LED Garden Light' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Silicone Cartoon Schoolbag Shape Coin Purse[Cross Type Railway High Carbon Steel Razor Barbed Wire]