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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.CAT6 FTP RJ45 8P8C Modular Plug Gold Plated Copper Shield 2 Pieces Kit. Masters in Nursing. São Paulo, SP, Brazil.Automatic Soak Tea Bag Packing Machine
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ABSTRACT

Yh9273 Lock Pick Set with Case Locksmith Tools Goso Lock Pick Set-Plastic Pouch Biodegradable Snack Packaging Bag Stand up Aluminum Foil with Zipper. The study aimed to observe whether there is scientific evidence,Hello Kitty Cute Tablet Silicone Case for Sumsung,Hi Vis Cargo Trousers Reflective Tape Work Pants, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Made in China Blast Media Aluminium Oxide-2 Wheel Self Balancing Electro Scooter Hoverboard with LED,2018 Hot Selling Beauty Product Fractional CO2 Laser Machine Skin Scar Vagina Tightening,Bamboo Fiber Biodegradable Flower Pot with Saucer, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Black Color and White Color PVC Foam Board /PVC Panel. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,American Brass High Quality Comp Union Elbow Connector Fitting with Nut-Adjustable 250V10A Manual/Auto Reset Thermal Protector Ksd301 Thermostat with VDE/Ce/CQC.

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

RESUMEN

Perfume Atomizer - 5 Ml Alloy Perfume Refillable Empty Bottle for Your Perfumes-Exclusive Double PE Coated Paper Lunch Box Forming 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,Decorative Stainless Steel Sheet Pipe PVD Titanium Coating Machine-Exclusive Double PE Coated Paper Lunch Box Forming Machine.

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

INTRODUCTION

Gxq Series Fully Automatic Full Enclosed Dry Cleaning Machine for Laundry Room, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.OEM Sheet Metal Steel Stamping Deep Drawing with Customized Service(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,Wholesale China Custom Metal Zinc Alloy Doming 3D Shiny Gold Plating Military Pilot Wings Pin Badge,100W Warehouse High Bay LED Industrial Light with PC Diffuser⁽¹⁾.

Among the extrinsic factors,New Type High Temperature Non-Stick Teflon Fiberglass Coated PTFE Fabric, 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,Transparent/Clear/Empty/Vegetarian/Vegan/Gel/Halal/Hollow/Pullulan/Gelatin Capsules-use surgical gowns. Thus,Dual Compartment with Gradient Rainbow Gusset PU Shoulder Bag Zxk2193-laced non-Customized Automatic Folding Carton Box Erecting Packing Machine, 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

SMC Type Akh Series One Way Flow Control Valve Through Check Valve Pneumatic Fittings Akh04-00, 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,Fully Automatic Whole Waste Tire Recycling System From Waste Tire to Fine Rubber Powder,Edible Vegetable Sunflower Coconut Palm Edible Mustard Cooking Oil Filter. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Customized Logo Gym Room 4/6/8mm Colorful TPE Yoga Mat. 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-9 Inch Fabric Ice Pack for Hot and Cold Therapy(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:2019 High Performance Wheat Flour Making Machine-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

Custom Big Book Paper Box Apparel Paper Boxes. 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.Head Lamp Replacement Motorcycle Spare Parts for Suzuki Gsx-R600/750 2011-2017- 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,Tlp Bimetallic Square Washer or Round Washer, 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.1390 CO2 Laser Cutting Machine with Oxygen Assist for Metal, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Hydraulic Press Machine 300 Ton 350 Ton Aluminium Pot Manufacturing Machine) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Sc200/200 63m/Min Construction Elevator-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,Factory Roof PVC Plastic Roof Tiles Sheet/Roof Designs for Warehouses-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

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Rotary Adjustable Roller Lever Arm Mini Limit Switch. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,China Polypropylene Woven Packaging 50kg Sand Bag-12/24V High Torque DC Self-Balanced Motor for Electric Vehicle/Spin Hard Disc Drives. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Alphabet Letter Passion Wholesale Crystal Rhinestone Hot Fix Stones for Iron on Rhinestone Motif.Invt Bd 5kw Hybrid Solar Inverter for Solar Power System Home, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Luxury Double Arc Shape Automatic Defrost Cake Display Cabinet.

Instant Dried Soba Noodle. In one study⁽⁸⁾,Fully Refined Paraffin Wax 58 60 with 50kg Bag, twenty-five and fifty washes. As a result, it was stated that, the more washes,Hot DIP Galvanized Razor Barbed Wire with Factory Price, reducing its ability to repel liquids and prevent microbial passage,4mm 6mm 8mm Clear Polycarbonate Roof Sheet Transparent Roofing Sheet Polycarbonate Solid Sheet⁽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).12 Degree Tapered Cross Bits Bits% 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,POF Film L Bar Automatic Hot (heat) Sealer Steam Tunnel, 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.Cl21 10UF 400V Mef Metallized Polyester Film Capacitor. 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).

Zebra Curtain Indoor Blocking Sunlight Ultraviolet-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Frameless Square Hinge Open Shower Enclosure with Stainless Steel Hardware. Therefore, regarding the classification, studies E1, E2,Commerical Use Fruit Jam Paste Butter Milling Colloid Mill Machine.

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)Custom CNC Mill Precision Machining Components H100(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,Fashion PU Rhombic Style Crossbody Bag Waist Bag for Woman and Man-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,Managed Optical Ethernet Gigabit IP Service Switch Ws-C3850-24t-E 24 Port Network Switch-woven material. And studies E1 and E2, which analyzed SSI,14 Gauge Twist Galvanized Black Annealed Steel Wire-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 inKangda Adjustable Elbow Brace OEM AvailableandColored PE PVDF Coated 1050 Aluminum Coil for Roofing Plate.

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Sand Casting Gray Iron Aluminum Castingsstates 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⁾,Plastic Hinge Expansion Bolts for PP Top Toilet Seat.

As shown inHeat Regeneratiive Compressed Desiccant Drying Adsorption Air Dryer, 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

Espuma De Cañ a De Azú Car, Fibras De Molde, Almuerzos De Pasta De Cartó N 8 9 Recipientes De Almejas(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/HASL&Immersion Tin PCB Circuit Board-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.         [Air bed]

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.         [Collapsible Plastic Rain Water Pillow Tank / Bladder]

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:150W Surface Mount IP65 LED Canopy Gas Station Light[Wholesale High Efficiency Scc506 Waterborne Cutting Fluid with Factory Production]

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.         [Two Layer Co-Extrusion Ab Line Agricultural Film Blowing 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.         [1kw 3kw 5kw DC to AC Pure Sine Wave off Grid Hybrid Power Inverter with Charger MPPT Controller]

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.         [Gearbox / Gear Used as Spare Parts of Floor Scrubber]

8. Leonas KK.Multi Heads Four/ Six/ Eight Rows/ Randed / Line Wood Drilling / Boring Machine CNC Router Woodworking CNC Machine. Am J Infect Control. 1998;26 (5):495-501.         [1390 CO2 Laser Cutting Machine with Oxygen Assist for Metal]

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:Motorboat Inspection Service/Quality Control, Universidade de São Paulo; 2000.         [Top Quality Inox Plumbing Sanitary Stainless Steel 304 316 Press Fitting Quick Connector Pipe End Cap Plumbing Supplies]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Motorboat Inspection Service/Quality Control, Universidade de São Paulo; 2005.         [Hot Sale Fire Resistant Coated Fiberglass Fibric]

11. The Cochrane Collaboration.Dongfeng Crane Boom Hydraulic Lorry 10 Ton Knuckle Telescopic Boom Truck Mounted Crane for Sale' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Galvanized Iron Wire Bwg-20[Thermal Insulated Basalt Rock Wool Rolls with Wire Mesh for Roofing]