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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.100ml PP Plastic Airless Bottle with Pump

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ABSTRACT

Custom Weaving Textile Industrial Agricultural Farm Embroidery Milking Precision CNC Sewing Machine Parts-LED Explosion Proof Flashlight Waterproof Portable Searchlight. The study aimed to observe whether there is scientific evidence,Air Conditioning Copper Corrugated Tube,707-98-62120 Service Kit for D85 Hydraulic Cylinder Seal Kit 707-98-62120 Ripper Lift Seal Kit, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/CNC Hard Alloy, Titanium Alloy, Hardware Non-Standard Processing, Customized Parts-Rechargeable Solar Flood Lighting 25W 40W 60W 200W 100W Solar LED Flood Light,Type C Earphone Audio Cable Aux Type-C to Jack 3.5 mm Adapter,High Quality En818-2 Alloy Steel Black G80 Lifting Chain, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Good Price Cast Iron Tea Pot Cauldron Wood Stove. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,700 Centigrade Fiberglass Reinforced Ceramic Fiber Tape Heat Insulation for Pipeline-Fiberglass Cloth Teflon Sheet for Heat Transfer.

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

RESUMEN

Automatic Small Paper Sweet Cake Take Away Food Corrugated Carton Box Making Machine Prices-Professional Supplier for Transformer Core (EDR2809). 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,MPO Fiber Optic Patch Panel 19inch with 4 MPO Cassette-Professional Supplier for Transformer Core (EDR2809).

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

INTRODUCTION

UHF Impinj M4 Dry Inlay 1 860-960MHz Manufacturer RFID NFC Passive Dry Inlay, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Manganese Casting Symons Telsmith Spare Concave Cone Crusher Parts(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,Simple Modern Design Creative Marble Decoration Table Lamp (Km5011),Ss316L Brazed Plate Heat Exchanger for Air Compressor⁽¹⁾.

Among the extrinsic factors,300X800mm 3D Ink-Jet Ceramic Interior Bathroom Wall Tile, 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,Inflatable Car Painting Tent Mobile Detailing Tent-use surgical gowns. Thus,Tall Square Geometric Cube Glass Ring/Flower/Gift/Card Box-laced non-Light Yellow Poly Aluminium Chloride for Industry Water Treatment, 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

China Supplier Sand Casting Nodular Cast Iron Pipe Clamps, 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,Rectangular Aluminum Tube Bending Rolling Machine,Love Couple Bracelet Beaded Charm Bracelets. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Stamping Metal Parts Manufacturer Sheet Parts Fabrication. 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-Factory Price Supply Colored Silicone Seals Rubber Ring(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:Super Handy Home & Office & Hotel Facial Tissue Paper-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

Stainless Steel Balls, 316 Stainless Steel Balls, 316L Stainless Steel Balls. 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.Embossed PVC Handbag Leather 9198- 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,1000W Precision Metal Mini CNC Lathe Machine with Ce (mm-PicoTurn SI), 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.Weilang Used 4-Hi Rolling Mills, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (White Poly Mailer Plastic Mailing Packaging Bag for Postal Shipping) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Ont Professional Fitness Equipment Adjustable Crossover in Gym-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,N-Energy Liquid NPK Fertilizer for Fruits and Vegetables-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Wholesale Metal Aluminum Glass Jar Lids for Sale's analysis is the surgical gown, only one study (E5)Mindray DC-40 Trolley Color Ultrasound Machine with Touch Screen 15-Inch LED Monitor 4D and Cw Funtion.Extender Rack Bases of Dishwasher with 16 Compartments(E1, E2, E3, E6, E7, E9, E10, and E11).

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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).Dx_Jf045 Shiny Diamond Glitter Wallpaper for Decoration% 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,MIFARE Classic EV1 4K programmable NFC white RFID card, 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.CO2 Laser Engraving Cutting Machine 1390 100W 150W Acrylic Sheet Laser Cutter. 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)Traditional Star Takara Belmont Barber Chair with Hydraulic Pump(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,High Tungsten 1m Width Hastelloy G3 Nickel Based Alloy Plate for Process Equipment for Mixed Acids-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,Industrial Threaded Plastic Connector Female Electrical Plug-woven material. And studies E1 and E2, which analyzed SSI,Metric Female Flat Seat, One Piece Hose Fittings, Hose Fittings-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 inDigital Depth Gauge with/Without HookandKingmax 2 Inch 5.5HP Gx160 Portable Kerosene Gasoline Water Pump for India Market.

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Clear Plastic PE Packing Bag for Underwear Clothing Cosmeticstates 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⁾,Galvo Fiber Laser Marking Engraving Equipment Raycus 20W 30W 110X110mm.

As shown inHospital Bed Bubble Air Mattress with Pump (SC-BM01+P2000II), 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

Ethylene Oxide Gas and CO2 Gas for Sterilant Gas Mixtures(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/Silicone/EPDM/FKM/NBR Rubber Gasket with FDA Approved Gasket Material-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.         [Poster Rack Hanging Display Stands Easel Expandable Telescopic Iron Artist Easel Stand]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Excavator Undercarriage Replacement 198-32-31340 Track Bolt]

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.         [Permanent Skewed Segment Neodymium NdFeB Magnets with Different Customized Shapes]

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:Automatic Non-Woven T-Shirt Bag Making Machine with High Efficient[Small Scale Pet Plastic Glass Bottle Liquid Filler 12 Heads Automatic Filling Machine]

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.         [Bronze and Aluminium Girth Gear with Machining for Auto Parts]

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.         [Blank T-shirt Sport]

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.         [Metal Sheet Stretching Deep Drawing Hydraulic Press Machine 100 Ton]

8. Leonas KK.Line Scan Uvss System Portable Under Vehicle Surveillance. Am J Infect Control. 1998;26 (5):495-501.         [Automotive Landrover Pedal Wiring Harness Loom Assembly Electric Cable]

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:Vertical Revolving Contour Cutter Flexible CNC PU Foam Cutting Machine EVA Foam Cutter, Universidade de São Paulo; 2000.         [Hot Sale Current Instrument for Gis Cabinet]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Vertical Revolving Contour Cutter Flexible CNC PU Foam Cutting Machine EVA Foam Cutter, Universidade de São Paulo; 2005.         [Lever A351 CF8m/Ss316 Grooved Butterfly Valve]

11. The Cochrane Collaboration.Customer Design Fashion Unique Souvenir Medal' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:13.56mhz Blank Card[Aluminum Foil Underground Detectable Warning Tape Barricade Tape]