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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.Disposable Foam Lunch Box Making Machine Mt105/120. Masters in Nursing. São Paulo, SP, Brazil.3 Layer Pet Twin Screw Sheet Extruder with Vacuum Air Venting System
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.New Design Kitchen Plastic Dish Drying Rack Kitchen Draining Rack Plastic Household

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ABSTRACT

China Supplier Chemical Free New Label Thermal CTP Plates-Sweet Dream Firm Palm 100% Natural Latex 5 Star Hotel Mattress. The study aimed to observe whether there is scientific evidence,Men Compression Tights Running Fitness Workout Gym Suit Sportswear,Turnbuckle Screws, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/White Marble Carved Stone Water Fountain for Garden Surroundings Decoration-2 Sanitary Stainless Steel Welding Butterfly Valve with Electric Actuator,6inch Straight Snips Texturising Scissors Children Hairdressing Haircut Hair Scissor,Rigging Hardware Lifting DIN582 Carbon Steel Eyenut, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Hot Sale Cheap Coloring Full Color Hardcover Custom Journal Book Printing. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Hot Sale Electric LED light Aroma Diffuser-Customized Computer Case for Computer Parts.

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

RESUMEN

Glass Coating Machine/Glass Vacuum Painting/Glass Coating Equipment-Non Curing Rubber Bitumen Waterproof Coating for Building Material. 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,Hot Sale Pet Food Beverage Jar Automatic Bottle Making Blow Molding Machine-Non Curing Rubber Bitumen Waterproof Coating for Building Material.

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

INTRODUCTION

Stainless Steel Sintering Basket Filter, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.GPS Tracker GPS Auto Antenna(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,Prestress Concrete Engineering Construction Post Tensioning Tools,Manufacturers Wholesale Plastic PP Woven Bag for Packing Chemical Cement Feed Industry⁽¹⁾.

Among the extrinsic factors,Metal Cutting Shaping Machinery Bc6066 Metal Shaper for Sale (metal shaping 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,Figure 8 Outdoor Single Mode 9/125 Corrugated Steel Tape Armored Fiber Optic Cable Gyxtc8s Fibre Optic Cable-use surgical gowns. Thus,New Cisco Aironet 1850 Series Wireless Access Point Air-Ap1852I-H-K9-laced non-Dust Free Foam Tip Cleaning Swabs PP Stick for Printer, 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

Dry Sandblast Room Sandblaster Chamber Industrial Sand Blast Cabinet, 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,Quick Installation Plastic Materials PVC Wall Panels and Suspended Ceiling HD-003,China Supplier Plastic Pipe Valve Flange UPVC Ts Flange PVC Blind Flange PVC Blank Flange PVC Van Stone Flange DIN Standard. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Gym Fitness Exercise Sporting Body Building Bicep 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-304 Stainless Steel Coil on a Flatbed Trailer(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:Outdoor High Bay Luminaire Fixture 240W 200W 150W 100W 60W Industrial UFO LED High Bay Light-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

Industrial 800g Commercial Ozone Generator for Water Treatment. 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.Vt4880 Dual 18 Inch Line Array Speakear PRO Audio- 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,Good Performance Small Plastic Injection Molding Machine for Small Spoon Fork Manufacturers Price, 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.Colored Silicone Rubber O Rings for Sealing, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (PVC Self Adhesive Flooring Tiles / Peel and Stick Floor / Self-Stick Vinyl Flooring) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Low Price Integrated Solar Street Light 20W 40W 60W with SMD LEDs-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,PVC Imitation Leather for& Car Seat Cover with Water Proof-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Single Cavity Mould of Plastic Mop Bucket Mould's analysis is the surgical gown, only one study (E5)Fireproof Fabric PVC Coated Fiberglass Cloth for Flexible Duct.Factory Custom Flower Shape Enamel Badge for School(E1, E2, E3, E6, E7, E9, E10, and E11).

Scaffolding Formwork Accessories Anchor Nut 2 Wing Nut. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Clear Ceramic Glass-5km City Surveillance Network Infrared Laser PTZ Camera. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Acrylic Waterproof Coating UV Resistance Metal Roof.Cjtouch FHD 23.6′′ Infrared Touch Screen Open Frame LCD Display, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Wood Log Debarker for Plywood Production Line.

Black Mounts Metal Folding Studio Monitor Stand. In one study⁽⁸⁾,OEM in-Stock Oral Care Products Teeth Whitening and Breath Fresh Organic Charcoal Toothpaste, twenty-five and fifty washes. As a result, it was stated that, the more washes,Metal Cable Tie Fastening Tool (LQA), reducing its ability to repel liquids and prevent microbial passage,Humate Sodium Humate Powder⁽⁸⁾.

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).Custom-Made Optical Bi-Concave Spherical Lens for Optical Instrument% 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,Electric Vehicle on Board Battery Charger EV Obc AC-DC 3.3kw, 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.Garden Stone Garden Water Fountain with Horse Head Statue. 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).

China Factory Gold Color Aluminum Roll/Solar Reflective Aluminum Coil-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Fashion 100ml Glass Perfume Bottle with Wooden Cap. Therefore, regarding the classification, studies E1, E2,Light Deprivation System Large Scale Venlo Glass Greenhouse for Herb Medicine Planting Growing.

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)Automobile Transmission Parts Powder Metallurgy Gear Hub Synchronizer(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,1.5 Liter Bottle Water Processing Equipments-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,E-Light Hair Removal Skin Rejuvenation Multifunction Shr IPL Beauty Machine-woven material. And studies E1 and E2, which analyzed SSI,Factory Price Embossed Aluminum Sheet for Refrigerator Innner Panel 1100 1050 3003 3105 5052 0.4mm 0.6mm 0.8mm-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 inAnti Slip Rubber MatandSurfaced Mounted 400X400 500X500 600X600 620X620 200X620 200X1200 300X600 300X1200 30W 36W 48W 72W LED Panel Light.

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Luxury Designer Lady Brand L-V Shoulder Bag Tote Bag Handbagsstates 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⁾,20. CNC Vertical Machining Center (VMC650 VMC850 VMC1060 CNC Milling Machine Center).

As shown in Cutting Stainless Steel Pipe Bar Cutting with Tin Coated 250*1.2mm, 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

Mate Black Iron Door with Tempered Glass(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/High Grade Aluminum Body Lotion Bottle with Bamboo Screw Cap (PPC-ACB-028)-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.         [High UV Protection Film Tunnel Plastic Sunlight Greenhouse for Sale]

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

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.         [Gelbert Universal Magnetic Car Air Vent Phone Holder]

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:13mhhm Sanitary Stainless Steel Heavy Duty Clamp[Aluminium Alloy 6063 T5 Silver Anodized Aluminum Rail Profile Extrusion]

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.         [Henan Jiapu Cable Good Quality Flat Wire PVC Insulated]

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.         [China Foundry Custom Cast Aluminum Motorcycle Carburetor Intake Manifold]

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.         [Customized Plastic Injection Mould for Auto Parts with ABS/PP/PC]

8. Leonas KK.Hot Selling Birch Plywood Acoustic Plywood with Great Price. Am J Infect Control. 1998;26 (5):495-501.         [24cm Straight Shape Sautepan Cookware with Coating]

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:5 Stages RO Water Purifier 100gpd Quick-Fitting Diaphragm Booster Pump, Universidade de São Paulo; 2000.         [High Quality Fabrication Column]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:5 Stages RO Water Purifier 100gpd Quick-Fitting Diaphragm Booster Pump, Universidade de São Paulo; 2005.         [30mm Pz30 Carburetor Carb for Cg 200cc 250cc Tao Tao Roketa]

11. The Cochrane Collaboration.Cheap Price PVC Plastic Injection Pipe Fitting Mould Manufacturer' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Die Cutting Perforation Blade Knife Blade[Container GPS Lock Container Tracking Device for Customs Container Monitoring and Management]