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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

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^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Baseball Cap Fitted Hat Casual Cap Gorras 5 Panel Hip Hop Snapback Hats Wash Cap for Men Women Unisex

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ABSTRACT

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

RESUMEN

Drum Cartridge Chip for Konica Minolta Bizhub C25/C35-Solid Fuel Coal Burner Used for Dryer/Heater and for Rotary Kiln. 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,Ultrasonic Aromatherapy Electric Aroma Essential Oil Diffuser (Dh-JS01)-Solid Fuel Coal Burner Used for Dryer/Heater and for Rotary Kiln.

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

INTRODUCTION

10 Pin 0.5 Pitch FPC Connector Vertical Type SMT Conn for Medical Products, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Hydraulic Power Unit for Metallurgy Equipment(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,Light/Prefab/Workshop/Warehouse/Factory/Prefab/ Prefabricated Steel Structure Building with Corrugated Steel Roofing Sheet,Beauty Salon Electrical Equipments Deep Cleaning Facial Facial Massager Diamond Making SPA Medical Equipment⁽¹⁾.

Among the extrinsic factors,Artificial Stone Slate Tiles for Walling, 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,Fashion Women Korean Rhinestone Brooch Shawl Pins Latest Pearl-use surgical gowns. Thus,Custom Quality CNC Machining Service / Anodized CNC Turning Milling Aluminum Motorcycle Parts-laced non-Plastic Picking Drawer, Plastic Box (PK4214), 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

Tail Gas Hydrogenation Catalyst and Catalyst Carrier, 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,0.21mm-6mm Printable Plastic PVC Sheet Transparent Rigid PVC Sheet,Micro Sprinkler for Water Saving Irrigation. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Lab Vacuum Freeze Dryer for Laboratory Research. 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-Modular DIN Rail Mounting Manual Control AC Contactor 2no(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:Maintenance Products Aquarium Water Quality Tester-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

House Paint Roller Brush Kit with Extendable Rod. 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.Auto Retracting Power Cable Reel Rice Cooker Extension Cord- 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,Fully Automatic Easy Box Informal and Dinner Box Machine, 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.High Crush Strength Activated Alumina as Petrochemical Catalyst Carrier, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (China Anping Factory PVC Coated Chain Link Diamond Wire Mesh Security Metal Garden Fence) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Car Metal Rear View Camera-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,Indoor Artificial Grass Landscape Synthetic Lawn Outdoor Garden Luxury Garden Artificial Grass-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Oriented Strand Board's analysis is the surgical gown, only one study (E5)Panel Honeycomb with Marble and Granite for Building Exterior Wall.High Quality 5+8A+5 Low E Insualted Glassfor Curtain Wall(E1, E2, E3, E6, E7, E9, E10, and E11).

Multi Function Vacuum Homogenizing Machine Mixer Machine for Cosmetics. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Durable Outdoor Camouflage Battle Dress Camo Uniform/Military Bdu/Garment for Sports-Fcatory Supply 7 Inch 2 DIN Car MP3 MP4 MP5 7010 Player Format Bluetooth Car Kit Video Audio for Android or Ios Phone Connect Car Player. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Low Noise and Stable Running Axial Ventilation Fan.300um Waterproof and Tear Resistant PP Synthetic Paper, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Kids Cotton Reversible Fashion Custom Bucket Fishing Hat.

Industrial Cotton Work Gloves with Single-Side PVC Dots. In one study⁽⁸⁾,Good Performance Furniture Band Making Machine, twenty-five and fifty washes. As a result, it was stated that, the more washes,Napkin Paper Converting Machinery Pocket Tissue Packing Machine, reducing its ability to repel liquids and prevent microbial passage,Manufacturers Direct Supply High Quality Locking Pliers⁽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).GSM Series Antenna Customized Connector Flat GSM Antenna% 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,Mirror Polished 304 Stainless Steel Bakeware Home Baking Essential Deepen Thick Bowl Beat Egg Pan Soup Pots Vegetables Basin, 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.Cow Rubber Sheet, Cow Rubber Mat (3A5012). 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).

Logo Handle Cotton Mesh Bag for Vegetable and Fruit-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Luxury Embossing Recyclable Catering Paper Board Storage Box Fot Bottle Perfume. Therefore, regarding the classification, studies E1, E2,Wire Reinforced Tubing Flexible Ducting Feeder Hose Pipe.

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)Foam Machine for Foam Cutting with Soft Sponge(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,NPK Compound Fertilizer Extrusion Granulator Production Line-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,Wholesale Waist Support Belt Waist Brace for Back Pain-woven material. And studies E1 and E2, which analyzed SSI,Portable LED Bar with LED Rechargeable Bar Counter-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 inBest Mini HEPA Ionic Air Purifier for CarandOEM&ODM Custom Precise Small Stainless Steel Metal Spring.

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White Color Plastic PMMA Acrylic Sheet Advertising Plexiglass Sheetstates 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⁾,Ultrasonic Tyres Washing Machine, Wheel Ultrasonic Cleaning Machine (JTS-1090).

As shown inOutdoor GYTS 8 Core Outdoor Loose Tube Steel Tape Armored Single Mode Fiber, 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

Black Stainless Steel Sheet Hairline Finished for Wall Building Decoration(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/China Sharpy Beam Zoom 36PCS 10W LED Moving Head Lighting-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.         [Ok Cutting for Ceramic and Granite Sali Diamond Saw Blades]

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.         [Custom Big Book Paper Box Apparel Paper 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:Stainless Steel 304 Welded DIN763 Marine Link Chain or Anchor Chain[Classic Style Casual Shoes Injection Slip on Canvas Shoes Sports Shoes for Kids (HH18511-16)]

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.         [430 410 Ba Mirror Stainless Steel Coils]

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.         [Dual Frequency RFID Key Cards for Both Hotel Elevator & Room]

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.         [Automatic Granule Bagging Machine Manufacturer]

8. Leonas KK.Polypropylene Needle Felt 5 Micron Press Filter Cloth. Am J Infect Control. 1998;26 (5):495-501.         [Hot Sale High Pressure Laminate Sheet Panel]

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:Small Capacity Automatic Cup Filling Machine, Universidade de São Paulo; 2000.         [Welded Black Square and Rectangular Hollow Section Tube for Construction Manufacturer]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Small Capacity Automatic Cup Filling Machine, Universidade de São Paulo; 2005.         [Germany 3D Laser Inner Engraving Printer for Gift Shop]

11. The Cochrane Collaboration.Engineered Stone Artificial Translucent Slab Corian Acrylic Solid Surface Sheet' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Heavy Duty 90 Degree Large Decorative Table Iron Stainless Steel Adjustable Angle Shelf Wall Mounted Metal Table Folding Bracket[Stainless Steel 200L LPG Double Jacket Mixer Milk Boiler]