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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.45/400 Polished Anodized Shine Gold/Silver Aluminum Plastic Chrom Lid for Glass Bottle

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ABSTRACT

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

RESUMEN

Wicker Flower Planters-Wear Plate and Cutting Ring for Concrete Pump Parts. 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,PVC Vinyl Coated Tarpaulin Anti UV Fabric-Wear Plate and Cutting Ring for Concrete Pump Parts.

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

INTRODUCTION

Light Building Steel Structure Prefab House Frame, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Stainless Steel Colorful Metal Drinking Straw Bend or Staight Long or Short(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,100X220cm PP Woven Air Dunnage Bag with Fast Valve,Home Seamless Automatic Sock Knitting Machine for Sale Jacquard Socks Knitting Machine Used for Manufacturing Socks Computerized Sock Making Machine⁽¹⁾.

Among the extrinsic factors,Small Roman Umbrella with Canopy Rotating Function Outdoor Umbrella Sun Parasol Beach Umbrella (TGTA-003), 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,Quickclean Single Hyaluronic Acid Intra-Articular Injection to Relief Knee Pain-use surgical gowns. Thus,1.3MP Sony Imx225 Starlight CMOS Board Camera-laced non-Air Cast Air-Stirrup Ankle Brace Support, 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

Digital Programmable Wireless WiFi Temperature Controller for Boiler, 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,2mm Mirror Glass/Coated Glass for LED, LCD, Computer Screen etc,Copper or Aluminium Wire Lug / Terminal Cable Lug. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Gold Supplier Galvanized Corrugated Steel Plate for Roofing Houses. 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-Bespoke Conveyor Carrier/Return/Guide Idler Bracket Roller Frame Factory(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:Fashion Pearl Cat Pendant Fashion 925 Silver Necklace-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

Niu Yuan High Quality Aluminium Corner Profile Tile Wall Edge Trim. 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.55mm Non-Spill Screw Press Thread 5 Gallon Water Bottle PE Cover Lids Cap- 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,Tianrui Design Broiler Chicken Cage for Pakistan Broiler Farm, 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.Satin Finishing Flap Wheel with Pertinax Hub, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Aluminum CNC Motorcycle Drum Brake Hub) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Factory Price Portable 256GB SSD-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,Ultrasonic Non Woven Bag Sealing Machine Price in India-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Rh-Ab201 Hospital Bed Series Air Mattress's analysis is the surgical gown, only one study (E5)Automatic Cake Box Packing Machine (GK-1200G).Rubber Stamp Laser Engraving Machine / Desktop Laser Cutting Machine(E1, E2, E3, E6, E7, E9, E10, and E11).

Multi Heads Weighing Filling Vertical Automatic Granule Snacks Packing Machines. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Sand Casting, Ductile Iron Casting, Cast Iron Casting-Online Nc Computer Controlled Slitter Scorer Machine. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-3D Glass Polarizer Film UV Protection Materials.Promotion Custom Design Cheap Small Hand Flag, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,PVC Foam Board for Modern Furniture and Cabinet.

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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).Ningbo Smart High Quality PA Speed Controller Plastic Pneumatic Fittings% 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,1 Inch 2 Inch Hydraulic Water/ Oil/ Gas Conveying High Pressure Rubber Hose, 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.LED Screen Display Wireless Charging 10000mAh Power Bank. 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).

0.35mm Rigid Translucent Pink Color Plastic Pet Sheet Roll-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Heat Exchanger for Heating The Air Manufactured in China. Therefore, regarding the classification, studies E1, E2,Stn LCD Screen Custom Made LCD Touch Module LCD Panel.

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)Premium Zippered Mattress Encasement - Lab Tested Bed Bug Proof, Dust Mite Proof and Waterproof - Breathable, Noiseless and Vinyl Free Queen Size(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,AC Electric Encapsulated Vertical Vibration Shaker Motor-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,Commercial Supermarket Refrigeration Combined Display Island Deep Freezer-woven material. And studies E1 and E2, which analyzed SSI,2018 New Sock Flyknit Comfort Baby Shoes-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 inGalvanized Trapezoidal Panel Cold Roll Forming MachineandWholesale High Quality Camouflage Canvas Army Tent.

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M8 10.9 Grade High Precission Common Hex Nuts From Chinastates 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⁾,5mm Building Construction Material/Aluminium/Aluminum Plastic Composite Panel.

As shown inExcellent Locating Ring with Die Punch for Auto Parts, 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

Clean Type Air Conditioning Wheel Heat Recovery Heat Exchanger Fresh Air Handling Unit(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/Chancsmac Vacuum Dryer Machine Supplier with Advanced High Frequency Technology-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.         [Drill Brush Attachments Set Scrub Pads & Sponge Power Scrubber Brush]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [8011040380 01208051 88921374 Cheap Price Ignition Coil for Buick Auto Ignition System]

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.         [OEM Stainless Steel Mechanic Parts for Lock Accessories]

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:Complete Large Strawberry Hydropnics Film Multifunctional Agriculture Plastic Film Greenhouse[High Accuracy Grout Aqua Condensate Flow Meter]

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.         [Automatic 2/4/6 Multi-Colors Sticker Label Paper/Plastic Cup Food Straw Film Flexo Printing 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.         [Basin Mixer Faucet]

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.         [Veterinary Hydraulic Grooming Table (GT-1H)]

8. Leonas KK.Good Reputation Manufacturer Product Copper Alloy Paste in China. Am J Infect Control. 1998;26 (5):495-501.         [Line Scan Uvss System Portable Under Vehicle Surveillance]

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:Party Decoration Flying Balloon Heart Shape Helium Balloon for Valentine, Universidade de São Paulo; 2000.         [Reinforced Composite Rubber Seal Strip]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Party Decoration Flying Balloon Heart Shape Helium Balloon for Valentine, Universidade de São Paulo; 2005.         [Wholesale Price Soccer Ball Football Corner Flag]

11. The Cochrane Collaboration.New Kids Bikes / Children Bicycle /Bycicle for 10 Years Old Child with Magnesium Alloy Frame' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:1080P 2MP Sony Imx323 Auto Focus Zoom Lens Camera Module[Plastic flakes granule vertical centrifugal dewatering machine]