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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.28 Position Pins Wire to Board Connector for Hybrid Vehicle. Masters in Nursing. São Paulo, SP, Brazil.Lap Joint End / ANSI B16.5 Class 150/300/600/900 Forged Carbon/Stainless Steel Flanges
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Glass Cleaner Liquid

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ABSTRACT

Venlo Type Multi-Span Glass Greenhouse Made in Keda-Copper Hairline Satin Finished Stainless Steel Decorative Sheet Plate. The study aimed to observe whether there is scientific evidence,Steel Structure Building Prefabricated Industrial Warehouse,50W/80W/120W/150W Outdoor IP67 Security LED Lamp Solar Flood Light, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Guangzhou New Style Wall Mounted Sink Bathroom Wall Mount Wash Basin, Artificial Stone Wall Sink-Heavy Wall Aluminum Tubing -Mechanical Tubing, Structural Tubing,Cod Portable Testing Anazlyer,Brush Roller Spray Vegetable Fruit Washing Machine, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Q35y Hydraulic Double Head Steel Punching Machine. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Forged H324 Galvanized Lifting Cable Eye Slip Hook-Sinotruk HOWO Manipulator Wg9725240208 Goood Quality.

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

RESUMEN

Massage Cushion Foot Acupressure Mat/Plastic Foot Accupressure Massage Board-Hydraulic Cylinder Manufacturers for Bending Machine. 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,Flame Resistant BS En559 1/4′′ Twin Welding Hose-Hydraulic Cylinder Manufacturers for Bending Machine.

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

INTRODUCTION

Heated Lunch Box/ Food Insulation Plastic Box/Heat Preservation Plastic Box, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Explosion Proof Lighting LED Explosion Proof Light Fittings for Oil Terminal and Refinery Ports Atex 60W(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,China Efficiency Waste Paper Egg Tray Making Machine,Mercedes Air Suspension Front Shock Absorber⁽¹⁾.

Among the extrinsic factors,High-Performance Resin Platform Trolley with Folding Rail, 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,Tfn Nikotin Nikotina Nikotiini Nicotina for E-Cig-use surgical gowns. Thus,Hot Selling Office School Supplier Custom Logo Notebook Leather Cover Diary A5 Notebook-laced non-Hebei Factory Professional Suspended Ceiling Framing T-Grid, 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

Acetylene Plant Manufactures C2h2 Acetylene Gas Cylinder, 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,Main Product Qy00-5059-H2 Hospital LCD Arm Used in Livingroom,Wholesale Personalized Promotion Items Tyvek Glow in The Dark Silicone Bracelet Factory Custom Fashion Sport Products Elastic Wristband for Promotional Gift. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Fs4395 Double Die-Cast Quarter Turn Cam Latch for Mini Mail Box Toolbox with Cam Lock. 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-Private Hifu Woman Vaginal Treatment Salon Machine(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:Pet Dog Bath Massage Brush, Pet Dog Cat Rubber Bath Brush Hair Fur Grooming Massage-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

Fingerless Type Single Facer Corrugator, Vaccuum Suction Type. 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.Mold Temperature Controller for Injection Molding Machine Sheet Metal Fabrication- 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,Small Batch Production Precision Aircraft CNC Machining/Machined/Machinery 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.1.3207 High Speed Alloy Tool Hardened Steel Stock, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Mercedes Air Suspension Front Shock Absorber) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Print Rigid Custom Paper Drawer Box Gift Packaging-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,Ballscrew Fixed Support Unit Fk12 with High Quality for The Module-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

2MP 2g/3G/4G Smart Home CCTV Security Mini 1080P WiFi Surveillance IP Baby Trigger Monitor Body Camera's analysis is the surgical gown, only one study (E5)Casting Aluminum Outdoor Solar LED Wall Lamp for Garden.Polycarbonate Hollow Sheet UV Protected with 10 Years Warranty(E1, E2, E3, E6, E7, E9, E10, and E11).

High Pressure Bus and Truck Wash Machine. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,High Quality Hydraulic Metal Stainless Aluminum Shearing Machine-Agriculture Assembled Steel Frame Glass Cover Greenhouse. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Boys Basketball Jersey Retro Kids Athletics Suits 2-Piece Sportswear Youth Tank Top and Shorts Clothes.P6 Full Color Front Service Traffic LED Sign, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,10.5mm Diamond Wire Saw for Cutting Reinforce Concrete.

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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).240*375*25mm Rectangle Galvanized Steel Access Panel for Air Duct Maintenance Cleaning% 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,17ami+PTC Manual Reset Thermal Protector, 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.Trampoline Arena for Sales, Kids Indoor Trampoline Park. 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).

CNC Machined Small Batch Plastic Machining Parts-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Patio Garden Furniture Fabric Outdoor Furniture Corner Lounge Sofa Set. Therefore, regarding the classification, studies E1, E2,Stainless Steel Aluminum Custom Precision Sheet Metal Laser Cutting.

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)Steel Pipes Suppliers(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,Hot New Product Hotel Scent Air Machine with Fragrance-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,Stainless Steel Security Window Door Shutter Anti-Theft Mosquito Magnet Insect Mesh-woven material. And studies E1 and E2, which analyzed SSI,Customized Workshop for Industry with H Columns and Beams Steel Structure-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 inWholesale Factory Lithium Ion Battery 48V 100ah 200ah for Solar Battery Energy Storage Systemand4K LED TV Panel Laser Repair Machine Cr-512D Big Size Panel Repairmachine/LCD Screen Repair Machine.

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16620-37011 16620-37030 High Quality Fan Belt Tensioner for Toyota 2014 Corollastates 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⁾,Aluminum Window Screen/Aluminum Mosquito Net.

As shown inPolyimide Heat Resistant Adhesive Tape for Sublimation Printing, 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

PC Blow Mould(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/Capacity 20000cbm One Year MDF Production Line MDF Forming Machine/ MDF Woodwork Machine Continuous Press Line/ MDF Woodwork Machine-woven. Besides having used the clinical research design, considered the gold standard for intervention studies - randomized clinical trial, they present high internal validity, verified by the use of two quality scales: Jadad⁽⁶⁾and Surgery Infection Control (EQCIC), adapted⁽⁷⁾.

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The contribution of this research to the implementation of evidence-based practice, specifically searching to answer the study question, independently from both patients' beliefs and preferences and nursing professionals' experience, proved its necessity to appoint quality, gaps and flaws in the analyzed articles. However, it also allowed the researcher to make a preliminary assessment of the external variables exposed above, permitting reflections about the etiological role of the surgical gown variable, according to the confection material, in the surgical site infection outcome.

REFERENCES

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.         [Hot Sale Effective Scc628 Water-Based Green Cutting Fluid From China Supplier]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Wholesale Scc628 High Efficiency Water-Based Green Cutting Fluid From China Supplier]

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.         [Ipx7 Ipx8 Waterproof Rain Spray Test Instruments]

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:Stainless Steel Forged So⪞ Ket Welding Fitting Redu⪞ Ing Tee (1.4550[20kw Enterprise-Level Multiple Inverter with Solar Wind Diesel Grid]

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.         [Kst-M204h Delegate Unit for Tabletop 3.5 Inch Touch Screen Conference System Microphone]

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.         [Factory Wholesale Best Price Stainless Steel Forged Blind Flange]

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.         [Wenzhou Crop Ring Type Cable End Compression Terminal Lug]

8. Leonas KK.Luxury Cosmetic Top Brand Packaging Paper Box Gift Box. Am J Infect Control. 1998;26 (5):495-501.         [TV Backlight Strip with Lens 32 Inch 6+6 TV Backlight for LG32 Inch LED TV Backlight Strips LG32 Small Lens 6LEDs]

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:750W 8X16 Precision Mini Metal Lathe 3 Jaw 50-2500rpm, Universidade de São Paulo; 2000.         [High Speed Automatic Wave Foam Cutting Machine (HG-B60T)]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:750W 8X16 Precision Mini Metal Lathe 3 Jaw 50-2500rpm, Universidade de São Paulo; 2005.         [Pure Sinewave Solar Inverter Controller Combined with MPPT Controller and AC Charger]

11. The Cochrane Collaboration.Toner Cartridge Chip for Xerox Workcentre 7120 7125 7220 7225 (006R01457 006R01458 006R01459 006R01460)' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:www.mutrade.com[Best Selling Quality Guaranteed PS Food Container Production Line]