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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.2 Wheel Self Balancing Electro Scooter Hoverboard with LED. Masters in Nursing. São Paulo, SP, Brazil.Industrial Cotton Work Gloves with Single-Side PVC Dots
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.m.sdjtec.com

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ABSTRACT

2018 Hot Selling Beauty Product Fractional CO2 Laser Machine Skin Scar Vagina Tightening-Bamboo Fiber Biodegradable Flower Pot with Saucer. The study aimed to observe whether there is scientific evidence,Black Color and White Color PVC Foam Board /PVC Panel,American Brass High Quality Comp Union Elbow Connector Fitting with Nut, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Adjustable 250V10A Manual/Auto Reset Thermal Protector Ksd301 Thermostat with VDE/Ce/CQC-Perfume Atomizer - 5 Ml Alloy Perfume Refillable Empty Bottle for Your Perfumes,Exclusive Double PE Coated Paper Lunch Box Forming Machine,Decorative Stainless Steel Sheet Pipe PVD Titanium Coating Machine, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Gxq Series Fully Automatic Full Enclosed Dry Cleaning Machine for Laundry Room. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,OEM Sheet Metal Steel Stamping Deep Drawing with Customized Service-Wholesale China Custom Metal Zinc Alloy Doming 3D Shiny Gold Plating Military Pilot Wings Pin Badge.

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

RESUMEN

100W Warehouse High Bay LED Industrial Light with PC Diffuser-New Type High Temperature Non-Stick Teflon Fiberglass Coated PTFE Fabric. 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,Transparent/Clear/Empty/Vegetarian/Vegan/Gel/Halal/Hollow/Pullulan/Gelatin Capsules-New Type High Temperature Non-Stick Teflon Fiberglass Coated PTFE Fabric.

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

INTRODUCTION

Dual Compartment with Gradient Rainbow Gusset PU Shoulder Bag Zxk2193, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Customized Automatic Folding Carton Box Erecting Packing Machine(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,Custom Fashion Waterproof Outdoor Sport Tactical Army Combat Military Uniform,Shenzhen Professional OEM Rigid Flex PCB Flexible Printed Circuit Manufacturer⁽¹⁾.

Among the extrinsic factors,5ton Automatic Diesel Forklift with Tcm Technology, 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,Monofilament Fibrillated Twist Wave Polypropylene Fiber PP Fiber for Concrete-use surgical gowns. Thus,SMC Type Akh Series One Way Flow Control Valve Through Check Valve Pneumatic Fittings Akh04-00-laced non-Fully Automatic Whole Waste Tire Recycling System From Waste Tire to Fine Rubber Powder, 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

Custom Big Book Paper Box Apparel Paper Boxes, 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,Head Lamp Replacement Motorcycle Spare Parts for Suzuki Gsx-R600/750 2011-2017,Tlp Bimetallic Square Washer or Round Washer. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,1390 CO2 Laser Cutting Machine with Oxygen Assist for Metal. 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-Sc200/200 63m/Min Construction Elevator(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:Factory Roof PVC Plastic Roof Tiles Sheet/Roof Designs for Warehouses-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

Customized Malleable Casting Iron Threaded Pipe Fitting Flange Cast Iron Flange. 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.Height Adjustable Reclining Bedside Table (JX-BT011)- 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,Low Price Custom High Quality Precision Aluminium Die Casting, 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.Rotary Adjustable Roller Lever Arm Mini Limit Switch, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Citycoco Scooter with 2018 EEC and Coc Hot Selling) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾China Polypropylene Woven Packaging 50kg Sand Bag-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,12/24V High Torque DC Self-Balanced Motor for Electric Vehicle/Spin Hard Disc Drives-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Alphabet Letter Passion Wholesale Crystal Rhinestone Hot Fix Stones for Iron on Rhinestone Motif's analysis is the surgical gown, only one study (E5)Invt Bd 5kw Hybrid Solar Inverter for Solar Power System Home.Luxury Double Arc Shape Automatic Defrost Cake Display Cabinet(E1, E2, E3, E6, E7, E9, E10, and E11).

Instant Dried Soba Noodle. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Fully Refined Paraffin Wax 58 60 with 50kg Bag-Hot DIP Galvanized Razor Barbed Wire with Factory Price. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-4mm 6mm 8mm Clear Polycarbonate Roof Sheet Transparent Roofing Sheet Polycarbonate Solid Sheet.12 Degree Tapered Cross Bits Bits, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,POF Film L Bar Automatic Hot (heat) Sealer Steam Tunnel.

Cl21 10UF 400V Mef Metallized Polyester Film Capacitor. In one study⁽⁸⁾,Zebra Curtain Indoor Blocking Sunlight Ultraviolet, twenty-five and fifty washes. As a result, it was stated that, the more washes,Frameless Square Hinge Open Shower Enclosure with Stainless Steel Hardware, reducing its ability to repel liquids and prevent microbial passage,Commerical Use Fruit Jam Paste Butter Milling Colloid Mill Machine⁽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).Custom CNC Mill Precision Machining Components H100% 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,Fashion PU Rhombic Style Crossbody Bag Waist Bag for Woman and Man, 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.Managed Optical Ethernet Gigabit IP Service Switch Ws-C3850-24t-E 24 Port Network Switch. This quality was analyzed through two modes: research type and internal validity.

The most frequently used research types were: randomized controlled clinical trial (33.3%), corresponding to studies E1, E2, E5, E8. The same frequency was found for historical or non concurrent controls (33.3%) in studies E3, E6, E7, and E11. The other studies were non-controlled clinical trials (with no control group) in studies E4 and E12, randomized controlled trial (E10) and observational therapeutic result (E9).

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Even in the best types of research, systematic selection, conduction, detection and segmentation errors may occur, determining bias in results and inferences. These biases interfere with the internal validity in the studies. According to the Cochrane Collaboration Handbook, they refer to: a) significant differences in the comparison groups (selection biases), in which randomization is used to prevent this type of error; b) equal care or the same exposure to all other factors, and also interventions of interest (conduction biases), in which masking is used to avoid this type of error; c)HASL&Immersion Tin PCB Circuit Board(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,Add to Compareshare175L Cryogenic Liquid Dewar Cylinder Storage Dewar for Lox/Lin/Lar/Lco2-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,Multi Heads Four/ Six/ Eight Rows/ Randed / Line Wood Drilling / Boring Machine CNC Router Woodworking CNC Machine-woven material. And studies E1 and E2, which analyzed SSI,Motorboat Inspection Service/Quality Control-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 inExcavator Tension/Recoil Spring Zjoc-Sy6 No. A229900004668 for Sany Excavator Sy65andHigh Quaulity and Comfort Pet Sofa (WY161087-1).

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Wholesale Cheap Chinese Healthy Watermelon Kernels Food Ingredientsstates 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⁾,Dongfeng Crane Boom Hydraulic Lorry 10 Ton Knuckle Telescopic Boom Truck Mounted Crane for Sale.

As shown in12 Degree Tapered Cross Bits Bits, 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

Wholesale Cheap Chinese Healthy Watermelon Kernels Food Ingredients(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/Luxury Bag Wholesale Hand Bag Fashion Ladies Handbag Women Canvas Bags-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.         [Radar Transponder]

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.         [ Stylish Home Elevator]

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:Plastic Step Stool Kick Step Stool[Men Genuine Leather Designer Tote Handbags Hard Briefcase Shoulder Bag with Straps (30435)]

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.         [Indoor 36kv High Voltage Sf6 Gas Load Break Switch]

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.         [Anti-Counterfeiting Adhesive Seal Tamper Evident Security Warranty Void Tape]

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.         [Large Size Laptop Desk Bamboo Bed Tray Table Adjustable Foldable Lap Bt-2203]

8. Leonas KK.New LCD Display Arm Digital Blood Pressure Monitor, Arm Sphygmomanometer with Backlight. Am J Infect Control. 1998;26 (5):495-501.         [New American Composite Bag Solid Lady Handbag Messenger Bags Shoulder Bag Women Wallet 6 PCS/Set]

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:Prefabricated Steel Framed Sheds to Metro, Railway Station, Underground Carport, Airport, Universidade de São Paulo; 2000.         [Newest PU Leather Blood Circulation Recliner Vibration Office Massage Sofa Heating Therapy 2D SL Track Ce RoHS Bluetooth Speakers Music Quick Access USB ETL]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Prefabricated Steel Framed Sheds to Metro, Railway Station, Underground Carport, Airport, Universidade de São Paulo; 2005.         [Wd190V High Sensitivity Handheld Metal Detector]

11. The Cochrane Collaboration.Nbm High Quality Auto Part' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Cnc Router 4d Foam[Commercial Hamburger Press Patty Maker Burger Forming Machine]