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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.P4 Outdoor Full Color Media LED Advertising Screen. Masters in Nursing. São Paulo, SP, Brazil.Farm Buckrake and Loader Tines
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Single Face Printed Black Merry Christmas Ribbon

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ABSTRACT

EPDM NBR Viton HNBR FKM SBR FPM NR Rubber O Ring Mechanical Seal for Industrial Equipment Sealing-with 9 Level LED Wireless Bug Detector Spy Camera for Home Detector. The study aimed to observe whether there is scientific evidence,Hot Sale Poultry Feed Pellet Mill,Best Hot 120 Gas Pump Nozzle Fuel Injector Nozzle, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Garden Fence for Security Add Post with SGS-Prepainted Color Coated PPGL/PPGI Steel Coil,Powerful Woodworking Chainsaw Wood Cutting Machine 39.6cc Petrol/Gasoline Chain Saw,Funke Fp80 Fp4 Fp05 Plate Heat Exchanger EPDM Gasket for Marine Engine Oil Water Cooler, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,CNC Hydraulic Press Brake 30t Meter with Minimum Axes Control 1600 mm. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Quality Assured Cotton Canvas Rubber Conveyor Belt Strength 160-800n/mm-Stainless Steel Sea Water Pipe Basket Filter.

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

RESUMEN

IN-G702 Single Channel Cosmetics Micro Infusion Hospital Use Syringe Pump-High CRI 130lm/W Us Stock Street Waterproof Commercial Grade LED Shoebox Lamp. 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,Wholesale Transparent Silver as Airless Bottle Cosmetic Airless Pump Bottle-High CRI 130lm/W Us Stock Street Waterproof Commercial Grade LED Shoebox Lamp.

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

INTRODUCTION

12.5mm Bs5896 PC Strand, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Fashion Real Leather Long Necklace N-1031(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,Tan Leather Wallet Bifold Leather Wallet Leather Wallet Buyers,7W-30W COB LED Down Light⁽¹⁾.

Among the extrinsic factors,Hot Sale High Quality Competitive Price Cheap PVC Flooring Spc Flooring for Decoration, 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,Ce, RoHS, TUV, ETL, Dlc Dimmable 100W 150W 200W LED Ceiling Lights LED Lights Industrial Light Warehouse Meanwell 150W LED High Bay Light LED Light Fixtures-use surgical gowns. Thus,2018 Hot Selling Beauty Product Fractional CO2 Laser Machine Skin Scar Vagina Tightening-laced non-Precision CNC Turning Parts/Aluminum Anodized/OEM CNC Machining Parts, 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

New Style 3D Foam Wall Tile Decor Design PVC 3D Wallpaper 3D Self-Sticking Wall Paper for Hotel Decoration, 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,60mm Double Braided Hawser Nylon Mooring Rope Impa 210736,Outdoor Hotel Project Dining Room Synthetic Fabric Sofa Modular Home Furniture Set. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Factory Directly Sale Chilli Belt Drying Machine Tunnel Equipment. 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-Kenbo 2020 New Arrivals Trendy Rectangle Sunglasses Women Luxury Brand Designer Concave Frame Small Oval Lens Sun Glasses(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:Sample Available Spain Door Handle Antique Classic Zinc Door Handle with Plate-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

En471 Reflective Fabric Tape Cintas Reflectantes De Tela Plateada. 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.Cheaper Promotional Bag Printed Sport Drawstring Backpack Drawstring Bag with Pocket- 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,Round Brush for Blow Drying, Round Hair Brush, Nano Technology Thermal Ceramic Barrel Ionic Anti-Static Blowout Hair Brush with Boar Bristle, for Hair Styling, 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.Automatic Rapid Roller Door, Fast Rolling Shutter Exterior Doors (HF-111), 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Holographic Rear Projection Film/Transparent Film) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾48*31mm Embedded Linear LED Profile, LED Tube with PC Cover-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,CNC Precision Parts Industrial Equipment Parts for Computer-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Waterproof Outdoor Advertising Totem Outdoor Display Kiosk Outdoor Kiosk Totem's analysis is the surgical gown, only one study (E5)W6mo5cr4V2 High Speed Steel Vacuum Heat-Treated Hardened Steel Stock.Distribution Price Air Sleeping Bag/Inflatable Air Sofa/ Inflatable Lazy Bags For Sale(E1, E2, E3, E6, E7, E9, E10, and E11).

Cut out 8.8 IP67 LED Incandescent Neon Home Appliance 12V 24V 125V 230V 400V Red Amber Green Signal Indicator Light. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Factory Wholesale Colorful Glass Empty Bottle-Aluminum 6061/7075/Metal Cold/Hot/Open/Die Forging Parts. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Moulded Plastic Components Injection Moulding Process for Industrial Machinery Parts.Eco Bamboo Fiber Tableware Cup/Mug (BC-C1010), the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Jingda Golden Mosaic Shingles Asphalt Roofing Shingles Fiberglass Roof Tile Philippines for Sales.

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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).Fashion Tablet Case with Stand for Samsung Tab S3% 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,OEM Factory Custom Drawings Metal Iron/Stainless Steel Lost Wax Casting Mounting Bracket for Steel Ropes, 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.Chicken Slaughter Line Machine. 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).

Embroidery 3D Flowers Tulle Nigeria Sequin Lace Fabric for Wedding-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-N & L Simple Design Wooden Wardrobes with Sliding Door. Therefore, regarding the classification, studies E1, E2,Disc Type Flush Bottom Valve for Chemical Plant.

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)Carnival Inflatable Target Toss Football Dart Board Game B6088(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,Carboxymethylcellulose Sodium Food Grade Good Quality-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,High Strength Beam Welded H-Section Steel Building-woven material. And studies E1 and E2, which analyzed SSI,3.3V Low Power Brass Pressure Transducer for Iot Application-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 inCut out 8.8 IP67 LED Incandescent Neon Home Appliance 12V 24V 125V 230V 400V Red Amber Green Signal Indicator Lightand2.0mm Thickness Reinforced PVC Waterproofing Membrane for Plant Roof.

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Industrial Shed Design Prefabricated Building Steel Structure for Warehousestates 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⁾,Fog Smoke Machine 1500W for LED Moving Head Beam Light DMX.

As shown inBMC Manhole Cover Hydraulic Press Machine 250 Ton, 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

EPS PS Foam Thermocol Plate Fast Food Plate Making Machine Disposable Food Box Production Line(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/16620-37011 16620-37030 High Quality Fan Belt Tensioner for Toyota 2014 Corolla-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.         [Mc Series Pluse Filter with Hop-Pocket]

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.         [Q35y Hydraulic Double Head Steel Punching Machine]

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:Aluminum Window Screen/Aluminum Mosquito Net[Professional Speaker Management Digital Processor Dbx260 KTV Processor Digital Audio]

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.         [The Flexible Mesh P37.5 LED Curtain Screen Display for Glass Building]

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.         [Indoor Spc Floor Ecofriendly]

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.         [Factory Price Colorful Low Cost Booklet Printing]

8. Leonas KK.Continuous Transporting Auger Screw Conveyor. Am J Infect Control. 1998;26 (5):495-501.         [CAD/Cam Dental Laboratory Consumable Materials PMMA Blocks]

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 Quality Medical Grade Oxytocin 2mg/Vial Acetate with GMP, Universidade de São Paulo; 2000.         [Die-Casting Aluminum Outdoor IP66 240W LED Street Light]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:High Quality Medical Grade Oxytocin 2mg/Vial Acetate with GMP, Universidade de São Paulo; 2005.         [Reinforced and Waterproof Material Fiberglass Self Adhesive Mesh Tape]

11. The Cochrane Collaboration.Industrial Steel Structure Mezzanine Rack Platform System/Bookshelf' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Premium Matte Sticker Paper Label[Factory Good Quality Coral Fleece Children′s Bathrobes Kids Hooded Bathrobes Wholesale]