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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

^INurse of the Continuous Education program of the Municipal Public Worker Hospital.Vmc CNC Milling Machine Xk6330 Full Function. Masters in Nursing. São Paulo, SP, Brazil.Thermo Bonding Wadding Making Machine
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Die Casting Factory

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ABSTRACT

Industrial organic fertilizer granulation machine-Environment Test Machine Hot Air Drying Oven. The study aimed to observe whether there is scientific evidence,Auto Part Front Brake Disc for Fortuner Kun51 2005-2012 43512-0K090,Wall Washer Light Building Decoration Landscape LED IP65 Linear Light, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/High Quality Mk677 / Mk-677 / Nutrobal CAS 159752-10-0-Galvanized Square Nut for Machine Bolt,Single Screw Co-Rotating Companding Pipe PVC PP PE LDPE Plastic Twin Screw Extruder,Hot Selling 500ml Dark Green, Antique Green Grape Wine Glass Bottle, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Portable Travel Cosmetics Accessory 10 PCS Unicorn Makeup Brush Set. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,China Manufacturer Products Air Bubble Washing Machine-Factory Price Stainless Steel Gold Cheap Wedding Banquet Dining Chair.

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

RESUMEN

Contactless Security Card Proximity Keys ID Card for Market (ISO)-10W 20W 30W 50W IP65 2 Years Warranty LED Solar Floodlight with Solar Panel. 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,Beige Color Steel Office 2 Swing Door File Storage Metal Filing Cabinet Cupboard-10W 20W 30W 50W IP65 2 Years Warranty LED Solar Floodlight with Solar Panel.

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

INTRODUCTION

Popular Sponge Brush for Hair Magic Twist Hair Sponge, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.China Cheap Plastic Kayak for Recreational(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,Food Service Kiosk Hot Dog Cart for Sale,Best Price Christmas Rainbow Color Glass Tea Light Candle Holder⁽¹⁾.

Among the extrinsic factors,China Factory Direct Sale Plastic Sport Fruit Infuser Water My Bottle, 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,Large Aluminum Coated Mirror Hang on Wall-use surgical gowns. Thus,Medical Supply 3 Ply Pm 2.5 Filter Paper Face Mask-laced non-High Temperature Resistance Garden Outdoor Cafe for Restaurant Furniture Chair, 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

Low Carbon 10 Inch Seamless Carbon Steel Pipe Schedule 40, 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,3HP Industrial Cooling System Water Cooled Chiller,Holiauma New Single Head Flat Embroidery Machine with Embroidery Area 360*1200mm Using Dahao Newest Control System.. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,New Design Artificial Leather Fabric PVC Leather for Furniture (1008#). 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-RV UPS Power 48V 80ah LiFePO4 Battery Pack(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:Best Selling Sequin Pillows / Reversible Cushions Square (YFC0061)-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

Frosted Glass Shower for Keep Secret. 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.CNC Router CNC Machine for Engraving Cutting EPS Foam, Styrofoam, PU Foam, Polystyrene- 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,High Efficiency 22oz Disposable Paper Cup Making Machine From China, 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.Glass Jar Glass Concentrate Container Small Glass Spice Jars Herb, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Heat Resistant Teflon Coated Fiberglass Adhesive Tape) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾6 Hole Kavo Quick Coupler Connector for Fiber Optic Dental Handpiece-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,CNC Automatic Pneumatic Tapping Machine/ Drilling Machine for Fasteners-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Orfs Male/Orfs Female Hose Fitting's analysis is the surgical gown, only one study (E5)0.7mm 0.13mm Stainless Steel Scourer Wire for Making Scourer.Explosion Proof Motorized Soft Seal Butterfly Valve(E1, E2, E3, E6, E7, E9, E10, and E11).

Safety Kids Playground Rubber Flooring Mat, Kindergarten Rubber Floor/Outdoor Play Area Mats. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,High Quality Low Profit IQF Mixed Vegetable with Corn, Carrots, Green Peas (IQF001)-Bangzhao 1kw 2kw 3kw 4kw 5kw High Frequency Sine Wave Inverter off Grid Hybrid Solar. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Warm Breathable Windproof Waterproof Polyester Taslon Outdoor Jacket for Winter.PE Coated Aluminum Composite Panel Kitchen Cabinet Door Plastic Panels, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Wood Grain Aluminum Profiles for Thermal Break Windows.

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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).Niosh N95 Foldable Face Mask% 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,Metal Bar Furniture Yellow Round PU Seat Stainless Steel Gold Color Bar Stool Chair, 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.Dia. 5.5mm Bonding ND: YAG Laser Rod Lens. 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).

Wholesale Kids 100% Cotton Children Little Boys Girls T Shirt-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Galvanized Trapezoidal Panel Cold Roll Forming Machine. Therefore, regarding the classification, studies E1, E2,Automatic Granule Sugar/Salt/Rice/Snuff Filling Packing Packaging Machine.

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)Durable Shop Furniture Design Garment Store Display Stand Fixtures(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,Affordable Fashion Jewelry 925 Sterling Silver Cubic Zirconia Huggie Hinged Hoop Earrings for Girls-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,High Precision Low Deformation High Density High Pressure Resistance Complex Inner Cavity Smooth Surface Hydraulic Casting-Yhcd4-1.1.2 Filling Valve Body-woven material. And studies E1 and E2, which analyzed SSI,Full Automatic PVC Film Mulch Applicator Vacuum Membrane Press Machine for Wood MDF-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 in50AA-H Crydom SSR Cmx60d20 PCB SSR DC RelayandMass Production CNC Machining Turning Aluminum 6061 Parts Cheap CNC Machining Service Machined Parts.

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Modern Stainless Steel Cafeteria Furniture Restaurant Stacking Dining Chair (JY-S01)states 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⁾,15L Mini Compressor Refrigerator 12V Camping Fridge.

As shown inIndustrial Rear Semi Downdraft Furniture Spray Booths for Woodworking, 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

Prism Silica Sand Glass Hanging Planter Terrarium(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/DMF Model Right Angle Type Pulse Solenoid Valve-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.         [Automatic Paste Ketchup Mayonnaise Chili Sauce Fruit Jam Sachet Packing Machinery]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Jy-602m Used Wooden Theater Meeting Room Chair Folding Concert Chair]

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.         [8mm Craving Waterproof PVC Skirting Board]

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:Commercial Amusement with Ninja Course and Sky Coaster Trampoline Park[Plastic Bowl Producing Machine for Drink Cup]

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.         [Vacuum Plasma PVD Coating Machine for Coating Glass Bottle Nickel Film Plating Equipment]

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.         [350g Cheap Yellow Soap for Laundry/ Clothes Bar Soap]

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.         [Food Grade Heat Sealable Greaseproof Brown Paper Popcorn Bag Packaging for Food]

8. Leonas KK.Precision Planetary Reducer Solar DC Gear Motor. Am J Infect Control. 1998;26 (5):495-501.         [Metal Sheet Fabrication Hexagon Hole Punching with Galvanized Surface]

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:160t 5000 mm Multi Systems Optional (DELEM and ESA and Cybelec) Mvd Electro Hydraulic Synchronous CNC Press Brake, Universidade de São Paulo; 2000.         [Chinese Bird Cage Factory Parrot Cage for Sale]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:160t 5000 mm Multi Systems Optional (DELEM and ESA and Cybelec) Mvd Electro Hydraulic Synchronous CNC Press Brake, Universidade de São Paulo; 2005.         [45 Degree and 90 Degree Cutting Table Sliding Panel Cutter Panel Saw for Furniture Cabinet Making]

11. The Cochrane Collaboration.Custom Made Eco Friendly Feeding Food Plastic Dog Bowl / Luxury Pet Bowls' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:CCTV Rg59 2c Coaxial Cable Rg59 Coaxial Cable with 2 Power Wire[Industrial organic fertilizer granulation machine]