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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.Cute Lip Balm Tube

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ABSTRACT

(Midtech Industry) Plastic HDPE/PE Ocean Marine Pedal Profile Board Extrusion/Extruder Making Machine-Grade 9A 10A Full Indian Brazilian Virgin Cuticle Aligned Hair From One Donor. The study aimed to observe whether there is scientific evidence,High Quality Custom Metal Bronze Embossed Logo UAE Dubai Navy Air Force Scout Medal for National Days (201),Customized Made V Slot Extruded Aluminum Channel Profile for Work Table, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/3.0inch Full HD Car DVR Recorder with 1080P Loop Recording Motion Detection G-Sensor WDR-Automatic Non-Woven T-Shirt Bag Making Machine with High Efficient,Lambotec Professional 5800 Chain Saw,Automatic Voltage Regulator for Brushless Diesel Generator, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,High Quality Excavator Hydraulic Vibration Stone Breaker Vibro Ripper Attachment. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Wholesale Cheap Rainbow Color Glass Candle Container for Home Decoration-New Design Fashion Skateboard Hip Hop Hooded Sweatshirt Blank Streetwear Cotton Men′s Custom Crew Neck Sweatshirt.

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

RESUMEN

Over 15 Years Experience Office Zigzag Scissors Factory-Trapezoid Roof Steel Sheet Cold Roll 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,Lever A351 CF8m/Ss316 Grooved Butterfly Valve-Trapezoid Roof Steel Sheet Cold Roll Forming Machine.

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

INTRODUCTION

Blue Color Nonwoven Acquisition Distribution Layer Fabric (ADL) for Sanitary Napkin Raw Materials, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Wholesale Kids Scooter 3 Wheel Kids(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,Stainless Steel Carbon Steel, Aluminium QC12y Hydraulic Shearing Machine for Cutting,Super Slim Electric Crimper/Large Opening Crimping Machine⁽¹⁾.

Among the extrinsic factors,Heat Resistant Reusable Silicone Straight Drinking Straws with Cleaning Brushes, 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,Low Price Portable CNC Plasma Flame Cutter for Metal Cutting China Factory Machinery-use surgical gowns. Thus,Hot Selling 450ml Wholesale Portable Plastic Bottle Creative Unique Gift BPA Free PP Plastic Fruit Infuser Lemon Bottle-laced non-ASTM 316 6.35*0.813mm Soft Annealed Stainless Stel Coil Tube, 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

Ear Nails Female Tassels Titanium Steel Earrings Jewelry, 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,15mm Titanium White Melamine MDF Grooved MDF,Aluminium Machining Parts Turning Service Coffee Machine Milling Machine Spare Parts. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,High Porosity Zirconia Zro2 Foam Filter for Foundry. 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-Hospital Bed Bubble Air Mattress with Pump (SC-BM01+P2000II)(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:Makute Cordless Drill 12V/18V/20V Hand Screwdriver with Li-ion Battery-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

Hospital Equipment Ultrasound Image System Double Screen Trolley Ultrasound Scanner. 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.1 1/2′′ Fire Flow Nozzle Injector Nozzle for Sale- 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,Best Selling Product Electric Car Charging Station, 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.Original Spare Parts Repair Relay Valve Kits for Truck, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Diamond PCD Grinding Cup Wheel for Concrete Floor Polishing) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Special Design of Bathroom Cabinets with LED Light HS-E1107-1000-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,450mm High Quality Circular Diamond Cutting Saw Blade for Marble Stone-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Hq2088 Pressure Transmitter with Universal Industrial 4-20mA Absolute Pressure Sensor's analysis is the surgical gown, only one study (E5)Bronze and Aluminium Girth Gear with Machining for Auto Parts.Hinged Rectangular Christmas Chocolate Tin Box for Metal Gift Packaging(E1, E2, E3, E6, E7, E9, E10, and E11).

Groundnut Strong Aromatic Refined Peanut Butter (European Standard Aflatoxin 4 PPB max). There was no coincidence among the analyzed studies, in other words, there was no use of the same material,CNC Metal Sheet Fiber Laser Cutter Machine for Sale-Outdoor Playground Plastic Slide with Swing and Basketry. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Factory Cheap Price Wholesale Black Nickel Bag O Ring Metal, Professional Custom 43mm Metal O-Ring for Bag.High Quality Nylon Softshell Jacket Military, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Plastic Mould Gift Leatherette Paper Ring Pendant Bracelet Necklace Earring Packaging Jewelry Box.

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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).Ce Approved Spiral Electric Cable Coiled Wire Power Cable% 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,Sand Ice Paper Bowl Machine Double PE (XC-2B70), 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.Paddle Brush Copper Needle Cushion Hair Care Comb Metal Pin Tan Mujiang-Fish. 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)Mold Injection Molding Process Locator Housing(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,Stainless Steel Forged So⪞ Ket Welding Fitting Redu⪞ Ing Tee (1.4550, X&⪞ aret; CrNiNb1810)-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-).

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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 inAlcohol Medical Grade Beauty Cosmetic Cotton Pads Making Machine Facial Puff Organic Circular Make up Remove Cotton Pads for Face Cosmetics Whole MachinesandNylon Travel Duffel Bag Weekender Bag Carry on Luggage with Shoe Pouch.

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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⁾,Automatic Wood Cutting 90 Degree Panel Saw.

As shown in1300X2500mm Wood CNC Router Machine for MDF Wood Engraving Cutting, 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

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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.         [Bar Stool]

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.         [High Concentration Ozone Special Ozone Generator Module Used for Plant Sterilization and Disinfection]

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:304 316 Grade Adjustable Stainless Steel Coated Cable Ties[Super Quality Acrylic Sunglasses Display for Sale]

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.         [26FT Aluminum All Welded Landing Craft/Working Boat/Cargo Boat]

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.         [Hot Dipped Galvanized Steel Pipe]

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.         [ Skillet]

8. Leonas KK.PPGI Steel Role in Different Colors. Am J Infect Control. 1998;26 (5):495-501.         [ N300 Wave Soldering Machine]

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:Digital Depth Gauge with/Without Hook, Universidade de São Paulo; 2000.         [European Quality Tuna Beer Blast Chiller]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Digital Depth Gauge with/Without Hook, Universidade de São Paulo; 2005.         [1.3343 High Speed Vacuum Heat-Treated Hardened Steel Stock]

11. The Cochrane Collaboration.European Style Fashionable Brand Design Sling Bag Genuine Leather Women Purse Ladies Handbags' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Porcelain fused to metal[Long Sleeve Pullover Pattern Jacquard Knitted Men Sweater]