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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.Top Supplier Automatic Stainless Steel Jewelry Laser Spot Welding Machine. Masters in Nursing. São Paulo, SP, Brazil. Housing of Electronic Project Instrument
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Customized Precision Metal Stamping Die/Stamping Tooling/ Stamping Mold for Water Heater

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ABSTRACT

Custom Pendant Special Shape National Day Award Medals (133)-Low Cost Hot Sale Agricultural/Commercial Plastic Film Greenhouse Philippines. The study aimed to observe whether there is scientific evidence,Colorful 15-36kgs Child Safety Car Seat with Boost Transform,Automatic Facial Tissue Packing Machinery Napkin Packaging Machine, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Prefabricated House Steel Structure Luxury Modular Container Home-Diamond Multi-Wire for Granite Slab Cutting/Diamond Wire for Granite Squaring,Luxury Series Gas Stove (2/4/6 burners) , ETL Approval,ASTM 304 Welded Stainless Steel Coil Tubing From China Stainless Steel Pipe Supplier, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,4mm Eco-Friendly Waterproof Fireproof Rigid Core Spc Click Safe Flooring. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Large Size Auto Feeding Paper Cutter Composite CNC Digital Oscillation Circular Vibration Cutting Machine 1610 1625-Pipe Threading Machine (Z1T-B2-50, Z3T-B2-50).

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

RESUMEN

Small 10ml Amber Glass Roll on Bottle with Gold and Silver Aluminum Cap-1.5tons Mini Site Dumper SD15. 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,Hero Brand Cake Tray Packaging Machinery Snack Food Price Automatic Ice Lolly Plastic Cup Pillow Packing Machine-1.5tons Mini Site Dumper SD15.

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

INTRODUCTION

Pet Jerry Can Jasu Single Stage Automatic Bottle Blowing Machine, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Quality Luxury Metal Gold Velvet Dining Room Wedding Hotel Banquet Chair(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,Commercial Chest Freezer in Mini, Medium and Large Size,FHD 1080P Wireless 4G Solar Power IP Camera Outdoor Low Power Consumption Surveillance DIY Camera⁽¹⁾.

Among the extrinsic factors,40HP Plastic Molding Cooling Machine Industrial Portable Air Cooled Water Chillers with Scroll Compressor, 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,Hot CNC Lathe Machine Live Tool, Lathe CNC Live Tools, CNC Horizontal Lathe Machine Price EL52L-use surgical gowns. Thus,Super Soft Cotton Bedding Quilt-laced non-Factory Price Small Electric Powder Drying Chamber, 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

Water Treatment Poly Aluminum Chloride as Flocculating, 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,Wholesale Empty Red Black Ice Wine 1000ml 750ml 500ml Glass Wine Bottle,Cheap Price Suitcase Mobile Phone Case Rubber Soft iPhone 6/7/8 Plus Xs Max Cell Phone Case. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Fully Refined Paraffin Wax 64-66 Deg. C. 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-New Lower Price Jewelry Digital Pocket Scale(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:Toporex Fashion OEM Service New Design Transparent Sexy Lingerie-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

Wireless Charge Coil Card Coil Copper Coil Inductor Air Core Coil. 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.Ceiling Filter Synthetic Fiber Filter Pad or Filter Roll- 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,Cable Length 13 Gun Safety Padlock, 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.Gear Box Body for Kubota Harvester, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Industrial LED High Bay Light 200W for Warehouse Projector) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Safety Reflective Underground PVC Warning Tape, Warning Tape-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,Telescopic Spring Cover Spiral Steel Tape Cover for Anti Bcklash Ball-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Wholesale Mini School Backpack for Girls's analysis is the surgical gown, only one study (E5)Zoreya Black Goat Hair High End Makeup Brushes Set Black Private Label Zoreya.IN-G048 Cheap Heine Diagnostic Otoscope Retinoscope Indirect Ophthalmoscope(E1, E2, E3, E6, E7, E9, E10, and E11).

Fiber Glass Mat Battery Separator Electronic Insulation Sheet. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,JIS F 7368 Bronze 10K Rising Stem Type Gate Valves-Global ROM Huawei P30 PRO 8GB 512GB Full Screen Mobile Phone NFC Smartphone Octa Core Android Bar FHD+ Kirin 980 5 Cameras. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-China Zibo Factory Ceramic Fiber Blanket for Furnace Walls, Fire Resistant Blanket, 7200X610X25mm 3600X610X50mm, Size Customized, Temperature 1260c 1350c 1430c.Promotion Wholesale Round Shape Embroidery Patch Hot Sale Customized (039), the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Portable Insulation Bag Student Outdoor Large Capacity Picnic Cooler Bag.

Custom Applique Embroidered Embroidery Patches for Clothing. In one study⁽⁸⁾,CNC Industrial Machinery Part Milling Machining Center, twenty-five and fifty washes. As a result, it was stated that, the more washes,Edible Oil Bottling Machinery Manufacturer, reducing its ability to repel liquids and prevent microbial passage,High Quality FRP Tank Products China⁽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).USB Charging Plastic Mini Wireless Portable Drinking Water Pump% 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,Blood Lancet - Auto Lancet - Safety Lancet, 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.Custom Cheap Replica Engraved Medallions Logo Germany Metal Medal Sport. 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)Aluminium Extrusion Profile for Industry / Aluminium Alloy for Industry(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,Supermarket Indoor 1424mm T8 Vapor Tight LED Linear Trunking System Lighting Fixture IP65-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,PA Horn Speaker Ahuja Design Outdoor Speaker (BC-728T)-woven material. And studies E1 and E2, which analyzed SSI,Chinese 27.5′′ Full Suspension Electric Mountain Bike-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 inShoe Base Glass Railing 21.52mm Sgp Laminated Tempered Safety GlassandTube Screw Conveyor for Flour Mill.

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Machine Tools Accessories with Excellent Endurancestates 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⁾,Industrial Air-Cooled Low Temperature Freezing Water Chiller for Induction Heating System.

As shown inPrecision CNC Turning Parts/Aluminum Anodized/OEM CNC Machining Parts, 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

Hi Graphite Electrode Manufacture/Hi Ge Factory Price(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/Custom Design Pharmaceutical Transparent Vial Labels Packaging-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.         [Pine Wood Gift Box]

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.         [Girls Ladies Fresh Mesh Shawl Dress Dress]

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:Stationary Hydraulic Rockbreaker Booms System[Global ROM Huawei P30 PRO 8GB 512GB Full Screen Mobile Phone NFC Smartphone Octa Core Android Bar FHD+ Kirin 980 5 Cameras]

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.         [Colorful Satin Ribbon for Christmas Gift]

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.         [www.zgnfsjx.com]

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.         [New Arrival Wood Wool Making Machine Wood Shaving Equipment]

8. Leonas KK.Ep2pr Dual Layer Stainless Steel Commercial Electric Pizza Oven of Bakery Equipment. Am J Infect Control. 1998;26 (5):495-501.         [High Precision Auto Parts Injection Mold Manufacturers]

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:Cylinder Bellows Way Covers Protective Rod for CNC Machine, Universidade de São Paulo; 2000.         [12V to 220V 5000W 1000W 1500W 2000W Solar Inverter Power Inverter]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Cylinder Bellows Way Covers Protective Rod for CNC Machine, Universidade de São Paulo; 2005.         [Hot Sale Ultra Thin Dtp743040 3.7V 900mAh Lithium Battery]

11. The Cochrane Collaboration.Protection Higher Temperature Adhesive Hook &Loop Magic Tape' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:www.hyrubbers.com[Agriculture Assembled Steel Frame Glass Cover Greenhouse]