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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.Cbd Flower Hemp Continuous Drying Machine Dryer. Masters in Nursing. São Paulo, SP, Brazil.Scb10-630 kVA 11kv to 400V 3 Phase Dry Type Transformer
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.High Efficient Commercial Chocolate Ball Mill Machine

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ABSTRACT

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

RESUMEN

SMP-04 AC Mini Submersible Pump for Circulation-Newest Beauty Cosmetic Silicone Sponge Powder Puff Silisponge for Makeup. 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,Pillow Type Vegetable Packing Machine Bread Packing Machine-Newest Beauty Cosmetic Silicone Sponge Powder Puff Silisponge for Makeup.

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

INTRODUCTION

Made in China Hospital Professional Obstetric Instrument Medical Gynecology Equipment, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Infusion Set Non-Vented Drip Chamber Without Filter, 1.25m Tubing, Luer Slip with Needle(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,Ultra Width Aluminum Coil in Grade 1050 3003 5052,Swimming Pool Accessories Stainless Steel Step Pool Ladder⁽¹⁾.

Among the extrinsic factors,2 Handles Smartwave Physical Therapy Eswt Shock Wave Device, 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,Good Price of Mobile Concrete Mixing Plant Construction Machine-use surgical gowns. Thus,CAS 317318-70-0 Gw501516 Use for Weight Loss-laced non-Anatase Titanium Dioxide A100/A101 for Coating, Painting, 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

Factory Price Flex Back Aluminum Hotel Banquet Chair (HM-S19), 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,Type Se Seu Ser Cable with UL Certificate Copper, Aluminum, AA 8000 Conductor XLPE Insulation 6-6-6-6 Service Entrance Cable,NEMA 5-15p Outdoor Extension Cord, 15A, 125V UL ETL. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Diesel Engine High Pressure Cleaning Equipment Industrial Pipe Cleaning Machine. 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-X-Humate High Grade Leonardite Humic Manufacturer Super Potassium Humate Shiny Flake(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:Custom Luxury Printing Cardboard Rigid Gift Box with Magnet-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

High Pressure Laminate Board. 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.Chameleon Spray Paint Powder Kameleon Car Paint Pigment Color Shift Powder for Car- 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,Single Board 3.7V~24VDC Microwave Detector PCB, 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.High- Quality Natural Handmade Organic Health Food 100% Sweet Potato Vermicelli, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Fireproof Fiberglass Woven Roving Cloth 600g) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Ce Certification 13.4L 18bar Helium Gas Cylinder for Balloons-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,Hotbar Reflow Machine for FPC of Camera-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Plastic Bowl Producing Machine for Drink Cup, Jelly Cup, Yogurt Cup with Letters Printing's analysis is the surgical gown, only one study (E5)Qingdao Cattle Beef Tripe Stomach Cleaning Washing Machine.Food Grade Heat Sealable Greaseproof Brown Paper Popcorn Bag Packaging for Food(E1, E2, E3, E6, E7, E9, E10, and E11).

Woman Swimwear Girls Bathing Swimsuit. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Kingmax 2 Inch 5.5HP Gx160 Portable Kerosene Gasoline Water Pump for India Market-Abaya Custom Islamic Party Dress Embroider Bead Muslim Evening Dress for Women. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-P5 Waterproof Outdoor Full Color LED Display Screen for Advertising.Swimming Pool Lighting Unique DMX Outdoor Christmas LED Neon Lights, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Battery Powered Wrapping Machine for Paper Packing.

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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).High Quality of The Hot Blue Film% 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,Singfiller 10ml Hyaluronic Acid Injections to Buy Dermal Filler, 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.Home Appliance LED Light Switch Moulds. 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).

Epimedium P. E.-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Nozzle Tube Valve Thread Body Tube Manufacturer for Piston Cooling. Therefore, regarding the classification, studies E1, E2,Sinotruk HOWO Engine Exhaust Valve (Vg1560050027).

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)Multi Functional Professional Mini Flat Nose Plier(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,Children′s Trolley School Backpack Cartoon Character Set Bag-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,Auto Parts 35003-6401p 444012 Rear Oil Hydraulic Shock Absorber for Toyota-woven material. And studies E1 and E2, which analyzed SSI,Hot Sale Motor Oil Bt-18 Neat Punching and Drawing Oil-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 in Professional Custom 43mm Metal O-Ring for BagandDJ Stage Lighting Disco Club DJ LED Beam Matrix.

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Alcohol Medical Grade Beauty Cosmetic Cotton Pads Making Machine Facial Puff Organic Circular Make up Remove Cotton Pads for Face Cosmetics Whole Machinesstates 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⁾,Cr1000 (3) Common Rail Injector Tester.

As shown inNylon Travel Duffel Bag Weekender Bag Carry on Luggage with Shoe Pouch, 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

Metric Trapezoidal Thread Go and No Go Plug Gauges(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/Emsco Fb-1300 6-1/26-3/4I64hl14/15 Mud Pump Piston for Bomco/Gardnerdenver/Hh/Ideco/Ls/National/Oilwell/Nov/Mudking/Southwest-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

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2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Metro Card]

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.         [ Kindergarten Rubber Floor/Outdoor Play Area Mats]

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:1300X2500mm Wood CNC Router Machine for MDF Wood Engraving Cutting[HD 2.0MP Fisheye Onvif Indoor Mini IP Security system Camera]

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

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.         [White Rectangular Rubber Silicone Tube/Hose/Pipe for LED Lamp/ Light]

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.         [304 316 Grade Adjustable Stainless Steel Coated Cable Ties]

8. Leonas KK.Hot Sale Current Instrument for Gis Cabinet. Am J Infect Control. 1998;26 (5):495-501.         [Super Quality Acrylic Sunglasses Display for Sale]

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:ERW Q195 Q235 Black Welded Steel Pipe for Furniture Pipe Mild Steel Pipes, Universidade de São Paulo; 2000.         [26FT Aluminum All Welded Landing Craft/Working Boat/Cargo Boat]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:ERW Q195 Q235 Black Welded Steel Pipe for Furniture Pipe Mild Steel Pipes, Universidade de São Paulo; 2005.         [ Skillet]

11. The Cochrane Collaboration.PP Foam Soap Pump, Foam Dispenser Pump for Bottles' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Mobile Dvr With Live Video Gps Tracking[ N300 Wave Soldering Machine]