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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.Fashion Pizza Bag

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ABSTRACT

Plastic Injection Moulded Gift Pencil Box Office Case by Injection Mold Tool-Outdoor IP65 Aio Integrated Solar LED Street Light 20W. The study aimed to observe whether there is scientific evidence,600ml Collapsible Folding Silicone Sports Water Bottle,Environmental Protection Cover PP Non-Woven Fabric, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/PLA Pbat Corn Starch Pbs Biodegradable T-Shirt Bag HDPE/LDPE Plastic Shopping Bag-China Manufacturer Circular Saw Marble Diamond Blade for Granite Marble Stone Cutting Diamond Saw Blade,Luxury Wooden Wood Mirrored Lacquer Bathroom Vanity Cabinet Furniture,CO2 Laser Marking Qr Code on Bottle Cap (EC-laser), at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Power Window Switch 2518300590 for Mercedes Benz Gl320 Gl350 Gl450 Gl550. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Custom and Unisex Tennis Bag & Sport Backpack for Outdoor, Gym, Tennis Backpack with Laptop Compartment for Athletes, Students, Adult-Custom Weaving Textile Industrial Agricultural Farm Embroidery Milking Precision CNC Sewing Machine Parts.

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

RESUMEN

LED Explosion Proof Flashlight Waterproof Portable Searchlight-Air Conditioning Copper Corrugated Tube. 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,707-98-62120 Service Kit for D85 Hydraulic Cylinder Seal Kit 707-98-62120 Ripper Lift Seal Kit-Air Conditioning Copper Corrugated Tube.

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

INTRODUCTION

CNC Hard Alloy, Titanium Alloy, Hardware Non-Standard Processing, Customized Parts, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Rechargeable Solar Flood Lighting 25W 40W 60W 200W 100W Solar LED Flood Light(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,Type C Earphone Audio Cable Aux Type-C to Jack 3.5 mm Adapter,High Quality En818-2 Alloy Steel Black G80 Lifting Chain⁽¹⁾.

Among the extrinsic factors,Good Price Cast Iron Tea Pot Cauldron Wood Stove, 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,700 Centigrade Fiberglass Reinforced Ceramic Fiber Tape Heat Insulation for Pipeline-use surgical gowns. Thus,Fiberglass Cloth Teflon Sheet for Heat Transfer-laced non-Automatic Small Paper Sweet Cake Take Away Food Corrugated Carton Box Making Machine Prices, 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

Simple Modern Design Creative Marble Decoration Table Lamp (Km5011), 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,Ss316L Brazed Plate Heat Exchanger for Air Compressor,300X800mm 3D Ink-Jet Ceramic Interior Bathroom Wall Tile. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Inflatable Car Painting Tent Mobile Detailing Tent. 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-Tall Square Geometric Cube Glass Ring/Flower/Gift/Card Box(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:Light Yellow Poly Aluminium Chloride for Industry Water Treatment-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

Administration of Jail Outdoor Waterproof Using Signal Drone Jammer Cover for 150m Range. 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.High Quality Stylish Breathable Durable Men Running Shoes for Sport- 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,Electric Wholesale Household Men Hair Trimmer Hair Clipper, 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.Sport Lid / Plastic Cap / Flip Top Cap (SS4312), 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (1/2 Hard Cold Rolled 310 Stainless Steel Sheet in Stock) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾China Supplier Sand Casting Nodular Cast Iron Pipe Clamps-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,Rectangular Aluminum Tube Bending Rolling Machine-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Love Couple Bracelet Beaded Charm Bracelets's analysis is the surgical gown, only one study (E5)Stamping Metal Parts Manufacturer Sheet Parts Fabrication.Factory Price Supply Colored Silicone Seals Rubber Ring(E1, E2, E3, E6, E7, E9, E10, and E11).

Super Handy Home & Office & Hotel Facial Tissue Paper. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Stainless Steel Balls, 316 Stainless Steel Balls, 316L Stainless Steel Balls-Embossed PVC Handbag Leather 9198. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-1000W Precision Metal Mini CNC Lathe Machine with Ce (mm-PicoTurn SI).Weilang Used 4-Hi Rolling Mills, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Ont Professional Fitness Equipment Adjustable Crossover in Gym.

N-Energy Liquid NPK Fertilizer for Fruits and Vegetables. In one study⁽⁸⁾,Wholesale Metal Aluminum Glass Jar Lids for Sale, twenty-five and fifty washes. As a result, it was stated that, the more washes,Mindray DC-40 Trolley Color Ultrasound Machine with Touch Screen 15-Inch LED Monitor 4D and Cw Funtion, reducing its ability to repel liquids and prevent microbial passage,Extender Rack Bases of Dishwasher with 16 Compartments⁽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 Star Tactical Military Police Uniform Badge Patches Apparel Accessories Name Tag Chenille 3D Logo Embroidery Sticker Flag Fashion Jeans Clothing Label% 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,FTTH Epon ONU Modem, Gepon ONU with WiFi and VoIP, 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.H2309 H2310 H2311 H2312 H2313 H2314 H2315 H2316 (H2317 H2318 H2319 H3068). 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)Haivol High Voltage 8.7/15kv Cold Shrinkable 1 Cores Outdoor Terminal Kit (Applicable of cable crosssection 400)(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,NdFeB Cylindrical Magnets Coated with Holes  Zn, Ni, Black Epoxy-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,75 display screen 4K monitor Windows 10 interactive touch panel-woven material. And studies E1 and E2, which analyzed SSI,High Temperature Resistant Fiberglass Needle-Punched Felts-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 inStand up Zipper Sealed Flat Bottom Coffee Bag with ValveandFXBW4 35KV Rod Composite Suspension Insulators.

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for Plantstates 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⁾,Dx_Jf045 Shiny Diamond Glitter Wallpaper for Decoration.

As shown in15L Mini Compressor Refrigerator 12V Camping Fridge, 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

MIFARE Classic EV1 4K programmable NFC white RFID card(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/CO2 Laser Engraving Cutting Machine 1390 100W 150W Acrylic Sheet Laser Cutter-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.         [Power Window Switch 2518300590 for Mercedes Benz Gl320 Gl350 Gl450 Gl550]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [HDPE PE PVC Gas Water Supply Plastic Pipe Making Extruding Line Supplier]

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.         [Customized Flexible Spring Coiled Wire and Retractable Power Cord Spiral Cable with PU Insulation]

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:Vacuum Suction Box with Fourdrinier Part Equipment[Front Service Ability Ha2.5 640*1920mm Poster Screen for Store Advertising]

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.         [Best Quality Non-Slip Waterproof Gaming Mouse Pad for Promotional Gift]

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.         [3 Ports Optic Circulator Wholesaler Quotes & PriceList]

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.         [Wholesale Custom Stainless Steel Whisky Chilling Stones]

8. Leonas KK.Hotsales Dongfeng 170HP 6t LPG Refilling Tank 15m3 Bulk LPG Truck. Am J Infect Control. 1998;26 (5):495-501.         [1750r/Min Power Tools Battery Drywall Sander Price]

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:Hair Salon Chair Pedicure Chair Luxury with Foot SPA, Universidade de São Paulo; 2000.         [700c*25c Aluminum Alloy 16 Speed Sports Road Bike for Racing]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Hair Salon Chair Pedicure Chair Luxury with Foot SPA, Universidade de São Paulo; 2005.         [Plastic Food Shipping Packaging Hand Pallet Wrap Stretch Film]

11. The Cochrane Collaboration.Traditional Star Takara Belmont Barber Chair with Hydraulic Pump' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:OEM Thermal Break Aluminum Profile for Aluminum Windows[Factory Price PVC Slipper Cover Dispensing Machine]