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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.Statuarietto Marble Bianco Carrara Marble Stone Slab. Masters in Nursing. São Paulo, SP, Brazil.Eco-Friendly Safe No Harm Triangle Practical Scratcher Board Cat Tree
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Thermoplastic Powder Coating Automotive Paint Car Refinish Auto Paint Coating

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ABSTRACT

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

RESUMEN

Outdoor Industrial Screen 128X64 Graphic Stn/Positive Display Ks0107controller Panel 20pins Small 128*64 LCD Module-12u 600X600 Double Section Wall Mount Cabinet. 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,Solid Oak TV Stand Wooden Table with High Quality/Rustic TV Stand/Entertainment Centers and TV Stands/ TV Table-12u 600X600 Double Section Wall Mount Cabinet.

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

INTRODUCTION

Custom 1 Oz 999 Pure Pendant Indian Old Copper Blank Coin Chinese Bullion Zinc Copper Coin, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Modern Design High Tech Glass Greenhouse for Agriculture(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,Female Wearable Dildo Wand Massager Remote Control Silicone Clitoris Vagina Diamond Vibrator,26FT Aluminum All Welded Landing Craft/Working Boat/Cargo Boat⁽¹⁾.

Among the extrinsic factors,1 or 2 Core Optic Fiber Cable/ FTTH Drop Cable, 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,Certifided LED Segment Display for Retail Advertising LED Display Rental LED Display-use surgical gowns. Thus,Custom Printed Circuit Board Factory PCBA Assembly-laced non-Cmyk Printing MIFARE FM1108 13.56MHz 1K Contactless RFID Payment Cards, 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

New OPP Super Clear Crystal Carton Packing Tape with Logo, 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,Steel Toe and Plate Work Boots Goodyear Welted Shoes Outdoor Safety Shoes,Prepainted PPGI/PPGL Embossed Color Coated Steel Coil for Roofing Sheet. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,22.5X8.25 Tubeless Steel Wheel for TBR. 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-Aluminium U Channel for All Thickness (SFC-101AL)(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:Poultry Farm Equipment Full Automatic Welded Wire Mesh Steel Material Broiler Breeding Chicken Cage-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

Hot Sale Sexy Lace Underwear Set Push up Bra with Boyshort (FPY318). 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.Small Sliding Bracelet Paper Cardboard Drawer Gift Packaging Storage Box- 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,3 Pin Waterproof Connector Outdoor Cable Waterproof Male Female, 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.Automatic Concrete Paver Interlocking Brick Block Making Machine, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Furniture Accessories Plastic Double-Layer Shoes Rack) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾J55 Short Round Thread Seamless Casing Pipe-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,1070 Aluminum Aolly Coil Price-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Plastic Injection Mould Production and Plastic Molding Service's analysis is the surgical gown, only one study (E5)High Quality 24inch Bicycle/Wheelchair/Bike Part Tire with Gray Color 24X1-3/8.Low Chicken Layer Cage Price with High Quality(E1, E2, E3, E6, E7, E9, E10, and E11).

LiFePO4 Pouch Battery 40c Cell High Discharge Rate 3.2V 3000mAh. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,a-One Lang Self Centering Vise to Clamp Workpieces 3A-110086-High Quality 1.5mm PVC Coated Hexagonal Wire Mesh Fence Netting with Factory Price. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Original Japan Mitsubishi Carbide Inserts for CNC Jomt080320zzsr-Jm Vp15TF Hand Tool Machine Tool End Tool Drill Milling Cutter Tungsten Carbide Cutter Carbide.Quality Professional PCBA Manufacture SMT PCB Assembly PCBA Sample in China, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,High Quality API 10d Integral Spring Casing Centralizer (7 Y 8-1/2).

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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).Kids Physical Education Exercise Toy Jump Rope with Rubber Handle% 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,Digital Interactive Whiteboard with Powerful Education Tools Software (WB470), 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.Small Freeze Dryer for Experiment. 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 High Quality Crystal Rhinestone Tiaras Crown for Women-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-New Designed Foam Generator Rbm Foam Concrete Equipment Machine. Therefore, regarding the classification, studies E1, E2,Transparent Glass LED Display-P6.25mm Indoor Full Color LED Mesh Screen.

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)S235jo S235jr Steel Pipe Tube Shs Rhs(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,Food Grade Square Glass Jar Food Storage Jar with Metal Lid-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,Diving Bottle Filling Adapter G5/8 Charging Station for Air Rifle Refilling CO2 Charging-woven material. And studies E1 and E2, which analyzed SSI,Long Sleeve Pullover Pattern Jacquard Knitted Men Sweater-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 inVertical Revolving Contour Cutter Flexible CNC PU Foam Cutting Machine EVA Foam CutterandSoft Start Brushless DC Motor 3kw3000rpm48V Eif-Bl3348.

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MPO Fiber Optic Patch Panel 19inch with 4 MPO Cassettestates 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⁾,Clear Plastic PE Packing Bag for Underwear Clothing Cosmetic.

As shown inPink-Color Comfortable Soft Indoor Slipper for Women, 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

Ferrous Sulphate Heptahydrate for Water Treatment(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/Polypeptide Raw Powder Sermorelin Acetate CAS: 86168-78-7-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.         [Flexible Expandabel Roller Conveyor Toothed Belt Driven Type]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Hot Sale Dual Display Sport Watch for Men Water Resistant 50m Military Big Analog-Digital Shock Outdoor Waterproof]

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.         [Wall Washer Light Building Decoration Landscape LED IP65 Linear Light]

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:Latest Designed Beautiful Aluminium Glass Mosaic Tile for Backsplash Use[(Midtech Industry) Plastic PE Ocean Marine Pedal Profile Extrusion/Extruder Making 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.         [Height Adjustable Medical Patient Table]

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.         [Full Automatic Underground Water Bottling Machinery]

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.         [China Supplier Galvanized Black Rectangular Steel Pipe]

8. Leonas KK.Naked Bottle 99.9% Purity Mt2 10mg/Vial 10vials/Kit 121062-08-6 Safety Shipping. Am J Infect Control. 1998;26 (5):495-501.         [Food Service Kiosk Hot Dog Cart 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:50ml Colorful Plastic Bottle/ Lotion Pump Bottle/Pet Bottle with Lotion Pump/Shampoo/Body Lotion Bottle, Universidade de São Paulo; 2000.         [Biscuits Metal Box Illustration Vintage Square Tin Boxes]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:50ml Colorful Plastic Bottle/ Lotion Pump Bottle/Pet Bottle with Lotion Pump/Shampoo/Body Lotion Bottle, Universidade de São Paulo; 2005.         [Antique Style Gold Luxury Bedroom 5 Stars Hotel Room Furniture]

11. The Cochrane Collaboration.Precision CNC Machining Turning Anodized Aluminum Washers Spacers' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Women Yoga Suits Long Sleeve T Shirt Quick Dry Gym Wear Clothing Fitness Running Active Training Jacket Sportswear[Wood Sunglasses Retail Store Glasses Display]