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Print versionISSN0080-6234On-line versionISSN1980-220X
Rev. esc. enferm. USP vol.43 no.1 São Paulo Mar. 2009
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Revisión sistemática sobre delantales quirúrgicos en el control de la contaminación/infección del local quirúrgico
Juliane Cristina BurgattiI; Rúbia Aparecida LacerdaII
INurse
of the Continuous Education program of the Municipal Public Worker Hospital.Aluminum Arched Roof Truss System for Event. Masters in Nursing. São Paulo,
SP, Brazil.Fully Refined Paraffin Wax 58 60 with 50kg Bag
IIFree
Lecturer of the Medical-Surgical Nursing Department at School of Nursing at
University of São Paulo. São Paulo, SP, Brazil.Cheap Mushroom Filling Machine/Fungus Plastic Bag Mushroom Spawn Packing Machine/Fungus Compost Grow Stick Bag Bagger
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ABSTRACT
Classic Style Casual Shoes Injection Slip on Canvas Shoes Sports Shoes for Kids (HH18511-16)-Outdoor Plastic Rubber Exhibition Flooring Tile/Eco-Friendly Skidproof Plastic Floor. The study aimed to observe whether there is scientific evidence,Customized Solid Carbide 2 Flutes Center Drill Bit with Side Spiral Angle 30 Degree,Melamine Powder 99.5% Used for Laminate, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Hot Selling Outdoor LED Screen Prices LED Advertising Display-UV Melamine MDF Board/High Gloss UV Board MDF 1220*2440*12 mm,Various Vitamins Feed Grade Food Grade Pharma Grade Feed Additive,Custom Antique Finishing Tennis Sport Medal with Gold Plated (274), at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Kangda Adjustable Elbow Brace OEM Available. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Copy Paper Writing Paper Newspaper Toilet Paper Tissue Paper Kraft Paper A4a3 Paper Corrugated Paper Facial Paper White Board Paper Wrapping Paper Machine-Standard USB Mini Fan for Power Bank and Computer.
Key words:Surgical wound infection. Protective clothing. Infection control.
RESUMEN
Furniture Store Candy/Candy Store Equipment/Candy Store Display-Aluminum Square Tubing. 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,2016 Gentle Cleaning Makeup Remover Wet Wipes-Aluminum Square Tubing.
Descriptores:Infección de herida operatoria. Ropa de protección. Control de infecciones.
INTRODUCTION
Generator Spare Parts Automatic Voltage Regulator AVR GB-100, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Interlocking Flooring Tiles EVA Foam Puzzle Mat for Kids Playground(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,Phosphate Ester Fire Resistant Oil Recycle Unit,CS, Ss Metal Sheet Fiber Laser Cutting Machine with Safety Cover(1).
Among the extrinsic factors,Wooden Road Traffic Signs Safety Cones Children Education Toy, 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,Premium Grade Rubber Cloth Duct Tape for Sealing Pipes-use surgical gowns. Thus,Hot Sale Shopping Mall Retail Shop Clothes Display Shelves-laced non-2mm Paper Cake Board Dongguan Manufacturer Cake Base Board Jordan, 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
Micron Circular Stainless Steel Filter Disc, 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,Top Quality Inox Plumbing Sanitary Stainless Steel 304 316 Press Fitting Quick Connector Pipe End Cap Plumbing Supplies,Yet905 Wireless Keypad Doorbell Kits with Remote Control. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Jingcai Pdlc Smart Tint, Self-Adhesive Pdlc Film, Pdlc Smart Film. 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-Home Appliance Membrane Panels/Lenses with SGS(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:UTP Cat5e Unshielded RJ45 Female Keystone Jack Inline Coupler-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
3X6m Outdoor Full Logo Printing Folding Tent Pop up Canopy for Advertising. 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.Automatic Soak Tea Bag Packing Machine- 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,Factory Custom Printed Children Cardboard Book, Printing Kids Sound Mould Board Book, 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.Outrigger Cylinder Turning Bucket Hydraulic Cylinder Shield Purchase Hydraulic Cylinder Large Hydraulic Cylinder for Offshore Drilling Platform, 08 were excluded, composing a sample of 12 studies.
The data presented in Chart 1 (48kw/60kVA Soundproof Power Silent Diesel Generator for Sri Lanka) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale(6)Women Men Waist Trimmer Back Double Support Waist Trainer-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,High Quality PVC Heat Transfer Vinyl Flex for One Meter to Sale-based Medicine, associated to the variable risk control for SSI(7).
Excellent Quality Micro Plastic Injection Molding Machine's analysis is the surgical gown, only one study (E5)China Prefabricated Metal Steel Strcture Frame Construction Building.New Tech. 220V Home Dhw 60deg. C 5kw 260L, 7kw, 9kw High Efficiency Cop5.32 Save 80% Power Air Heat Pump Hybrid Solar Water Heater(E1, E2, E3, E6, E7, E9, E10, and E11).
Badminton Retrofit UFO Dimmable Industrial LED High Bay Lighting Fixture. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,EPDM/SBR Sponge Rubber Sheet Foam Insulation Matting Blocks Tiles-Customized Hydraulic Basketball Stand Adjustable Basketball Hoop. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Kosher Halal Food Grade 80mesh 200mesh Xanthan Gum.OEM Athletic Pants Sublimation Printing Lycra Yoga Pants, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Gearbox / Gear Used as Spare Parts of Floor Scrubber.
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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).Aluminum Steel Lug Transition Joints Connector% 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,316/316L 304/304L A269 Stainless Steel Welded Pipe Coil Tube, 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.Manufacturing CNC Turning Bike Car Auto Truck Spare Accessories Parts. 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).
Indoor 36kv High Voltage Sf6 Gas Load Break Switch-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Cable Clip for Fixing Solar PV Cable. Therefore, regarding the classification, studies E1, E2,Round Shape Iron-on Woven Patch with Merrow Boarder.
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)Heat Sale Kraft Paper Packing Bags for Milk Tea(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,Male Garment Suit Business Travel Sports Fitness Storage Duffel Duffle Pack Case Bag (CY9910)-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,Special Design PCD Cutting Insert for Carbon CNC Machine Wheel Turning Tools-woven material. And studies E1 and E2, which analyzed SSI,18mm E1 Bintangor Okoume Commercial Plywood-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 inOEM Stainless Steel Parts with Investment CastingandProgrammable P7.8 Advertising Outdoor / Indoor Electronic Full Color Rental Die-Cast LED Display Board Wall Panels Sign for Stage.
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Motorcycle Spare Parts Motorcycle Side Cover for Ybr125/Cg125/Cg150states 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),MB-Z800 12-15t/H Wood Log Debarker 10t/H Automatic Bark Peeler Bark Peeling Machine.
As shown inExposed Roof Waterproofing Membranes Welding-Applied Tpo, 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
DIN580 JIS1168 Eye Bolt for Lifting Products(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/Metal Hardware CNC Turning, Milling, Aluminum Parts, Metal Parts, Tool Parts, Mechanical Parts-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. [Decorative Stainless Steel Sheet Pipe PVD Titanium Coating 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. [Nano Air Bubble Ozone Aerator Pipe for Drinking Water Supply]
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. [Concrete Spare Parts Electrical System Central Distribution Boxes]
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:Hot Sale Conventional Fire Alarm System[Stainless Steel 8 Type Chain with AISI304 and AISI316]
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. [Horizontal Cutting Machine Sponge Cutting Machine EPE Rebond Polyurethane Foam Sheet Cutting Machine]
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. [Custom Women′s Hoodies Pink and White Patch Work Hoodies]
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. [Full Decal Stainless Steel Rim Enamel Steamer Pot]
8. Leonas KK.High Quality Disc Insulators 52-5. Am J Infect Control. 1998;26 (5):495-501. [Ye3 4kw Three-Phase Asynchronous Squirrel-Cage Cast Iron Induction Electric Motor]
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:34 Guage Corrugation Building Material Galvanized Corrugated Steel Roofing Tile, Universidade de São Paulo; 2000. [Made in China Blast Media Aluminium Oxide]
10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:34 Guage Corrugation Building Material Galvanized Corrugated Steel Roofing Tile, Universidade de São Paulo; 2005. [Hydraulic Power Unit for Metallurgy Equipment]
11. The Cochrane Collaboration.Custom and Standard All Kinds of Types NR Rubber Mounts/Bumpers/ Damper/ Buffer for Auto Parts' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:China Korea Aqua Peel Facial Machine[Customized Metal Operation System Shell/Case/Housing]