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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.Agriculture Machinery Tractor Parts

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ABSTRACT

Nonwoven Geotextile Geobag Used for Control Flood in Beach Dam-2 Sanitary Stainless Steel Welding Butterfly Valve with Electric Actuator. The study aimed to observe whether there is scientific evidence,Steel Raised Floor for General Office,Clear Pet Film to Roll for Plastic Thermoforming, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Venezina Compititive Price LED Ceiling Light Energy Saved Down Light Anti Dazzle COB LED Downlight-1390 Wood Acrylic Cutting Engraving Machine CO2 Laser,Tantalum Clad Steel Plate Sheet Manufacturer,Ad64150 Type Heavy Duty Industrial Shock Absorbers for Printing Machine or Equipment, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Solar Aluminum Rail Splice Connector for Rail Extention. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,100ml 160ml Glass Cooking Oil Soy Sauce Vinegar Bottle with Double Hole Lid in Kitchen-Original Cummins Diesel Generator Set Engine Spare Parts Valve Spring Retainer 3944452.

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

RESUMEN

Polymeric Ferrous Ferric Sulfate/ Iron Sulfate for Waste Water Treatment-Marine Titanium Plate Heat Exchangers for Hydraulic Oil Cooler. 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 Roof Tile Roofing Sheet for Building-Marine Titanium Plate Heat Exchangers for Hydraulic Oil Cooler.

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

INTRODUCTION

Air 13.3 MacBook PRO Business Handbag Apple Leather Laptop Bag, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Kara Double 8 Inch Passive Line Array Speaker Sb18 Single 18 Inch Powerful Subwoofer(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,Autoclaved Aerated Concrete Brick Machine, Automatic AAC Plant Solution,Aluminum Soda Cans for 250ml, 330ml, 500ml Sleek and Standard⁽¹⁾.

Among the extrinsic factors,OEM Japan Yaskawa Servo Motor CNC Router Engraving Machine, 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,Factory Production and Manufacturing Smaller Stand-Alone High Pressure Volt Hydraulic Power Unit Power Pump and Hydraulic Station or Hydraulic Motor-use surgical gowns. Thus,Perfume Bottle with Hanging Wooden Cap 6ml-laced non-High Quality White/Green Silage Plastic Stretch Wrap Film, 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

Organic Fertilizer Production Line Equipment / Organic Fertilizer Ball Granulating Machine, 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,80t 2500 mm Simple Operation Hydraulic Bending Machine Used in Luminum Alloy Doors and Windows Industry,China Wholesale CNC Manufacturers Aluminum Assemable Machining Part for Aerospace Aviation /Military/Auto Filed. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Large Format Transfer Press, 32X40/40X48Large Heat Press. 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-T240-10 Cable Lugs Copper Tube Terminals/Automotive Crimp Ring Terminal(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:Jacket Shape PU Women Shoulder Bag for Lady-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

10000 Liters Fire Truck Manufacturers Brand New Foam Water Tanker Fire Fighting Truck for Myanmar. 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.Hme Filter (heat and moisture exchanger filter)- 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,Performance Coil Pack for Nissan Sr20det S13 S14 22448-50f01, 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.5052/5083/5086 Aluminum Circle with High Plasticity, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (PE Induction Seal Liner) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾WPC (wooden plastic composite) Profiles Making Machine-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,Hospital Building Aluminum Honeycomb Panel Fire Rated for Door Filler-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Steel Grating for Bulidings's analysis is the surgical gown, only one study (E5)Laser Hair Regrowth Beauty Machine Hair Machine.Plastic Pet PP Packing Tape Strap Band Extrusion Making Machine/Production Line(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).HUAYUAN OEM ISO14443A 13.56MHz smart MIFARE Plus X 2K 4K NFC blank cards% 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,8*4 Feet CNC Router Nc-Studio Control System for Wood with 3.2 Kw Water Cooling Spindle, 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.Flexible Printed Circuit Flexible PCB Suitable for The Electronics Field. 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).

1.2V AA 800mAh NiMH Rechargeable Battery Factory Directly-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Mobile Wood Chipping Machine Wood Stump Chipper. Therefore, regarding the classification, studies E1, E2,Double Roller Automatic Wood Log Peeling Machine Log Debarker for Sale.

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)AAA+ Touch Screen for iPhone 6 Mobile Phone LCD Display(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,Coated C1s / C2s Best Quality Glossy/Matt Art Paper-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,Granite Tile Making Wire Saw Machine-woven material. And studies E1 and E2, which analyzed SSI,Wholesale Factory Price Bintangor/Okoume/Pencil Ceder Commercial Plywood-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 inDiameter: 6-200mm (JLD-POM-ROD) POM Rod/POM Sheet/POM Rod/Acetal Rod/Delrin Sheet/Delrin Rod/Blue Delrin Sheet/Color Delrin Sheet/Colored Delrin RodandStraight Plug 32A 2p+E 250V 6h IP44.

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Hydraulic Power Unit for Metallurgy Equipmentstates 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⁾,High Quality Metal 3D Silver Sport Awards Trophy Place Medal.

As shown inCopper-Coated 0.103 X 0.023 Inch Liquor Finish Box Stitching Wire 10 Lbs Spool, 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

Multi-Function Nylon Material Sport Duffle Bag Yoga Mat Tote Bag(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/CNC Wood Acrylic Plexiglass CO2 Laser Engraver-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.         [Ductile Iron Quick Adaptor For Pvc Pipe Manufacturers Cheap Price]

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.         [China Manufacture 3 Axles Cement Silo Bulker Tanker Trailer Price]

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:Custom Plastic Injection Mold Switched Socket/Power Socket Shell Manufacturing[Automatic Facial Tissue Paper Soft Packing and Carton Box Packing Machine Production Line]

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.         [Water Jet Pump Elbow; 1/4 87kpsi Waterjet Intensifier 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.         [Lunch Box Making Machine]

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.         [Wholesale Handmade Car Rearview Mirror Accessory with Eternal Flowers]

8. Leonas KK.Popular and Mini Style 18W Type-C Output Mobile Phone Charger. Am J Infect Control. 1998;26 (5):495-501.         [19mm LED Waterproof Yellow Red and Green Signal Lamp]

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:Poultry/Animal Cow/Cattle Silage Feed Grass Cutter Machine Best Price, Universidade de São Paulo; 2000.         [Wire Terminal Uninsulated Automotive]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Poultry/Animal Cow/Cattle Silage Feed Grass Cutter Machine Best Price, Universidade de São Paulo; 2005.         [Disposable Helium Steel Gas Cylinder with Guard]

11. The Cochrane Collaboration.Agriculture Mini Hand Cotton Harvesting Picking Machine Portable Cotton Picker' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:bluetooth Headset EVA Small Hard Case Specialized Packaging Storage Box[Best Quality 24V 90ah 100ah 110ah Lithium Battery Byd Catl Tesla]