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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.Automatic Ultrasonic Clean Dry Machine Equipment. Masters in Nursing. São Paulo, SP, Brazil.Expaned PTFE Sheet
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Machine Roomless Passenger

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ABSTRACT

High Frequency Electric Induction Forging Machine Price-Silicone Rubber PVC Key Cover Production Line Dropping Filling Making Machine. The study aimed to observe whether there is scientific evidence,Easy Installation Interior Wall Tiles Aluminum Composit Glass Mosaic,DC1000V Mc4 Male and Female Y- Branch Connector for Photovoltaic System, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Prepainted Steel Coil Color Coated Aluminium Coil for Roofing Sheet-Ventricular Puncture Needle,High Strength Steel Class 8.8 Hex Head Screw Plain DIN933,Outdoor Furniture Garden Patio Wicker / Rattan Sofa Set, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,3-Dimension PU Foam Seal Dispensing Machine. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Rectangular Cheap Plastic Trays for Cookies Packing-CNC Machining Aluminum Pneumatic Inlet 2 Ports Air Quick Exhaust Valve.

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

RESUMEN

2019 New High Power Module Integrated Solar Street LED Lighting-Strong N35 Neodymium Magnets Rare Earth Round Disc Fridge Craft. 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,Halloween Decoration Battery Operated LED Skull Shaped Pendant String Light-Strong N35 Neodymium Magnets Rare Earth Round Disc Fridge Craft.

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

INTRODUCTION

UHP HP RP Graphite Electrode for Eaf/Lf Diameter 200mm-750mm with 4tpi Nipple, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Vintage Black Handcraft Bamboo Frame Classic Wooden Sunglasses 100% UV Protection(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,Hot Selling Bamboo Bathtub Caddy with Towel Holder Extendable Bath Caddy Tray for One Person,Hot Sale Portable Large LCD Screen Ultrasonic Skin Scrubber Beauty Machine Peel Facial SPA Salon Equipment for Men or Female⁽¹⁾.

Among the extrinsic factors,High Quality Outdoor Waterproof P10 LED Video Wall Display Billboards, 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,16mm Agriculture Drip Irrigation Tape for Dripping Irrigation System.-use surgical gowns. Thus,Wholesale Cat Food Filling Packing Machine-laced non-Automatic Pepper/Salt/Ketchup/Tomato Paste/Shampoo/Water/Sugar/Liquid Sachet Packing Machine, 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

Unbreakable Solid Baby Bowl with Sucker for Kindergarten, 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,5 Ounce 150ml Color Painting Air Freshener Glass Diffuser Bottle,High Quality of Adrenaline Hydrochloride Injection. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,12/24V DC Gear Motor 42mm. 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-Stainless Steel Anti-Theft Window Security Screen(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:Tungsten Carbide Flat Wire Drawing Die-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

Cationic Flocculant (cationic polyacrylamide) for Sludge Thickening and Sludge Dewatering. 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.Fully Automatic Disposable PS Foam Plate Food Container Making Machine Mt105/120- 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,Stainless Steel Liquid Storage Tank/Water Tank, Milk Storage Tank, 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.Power Tool Spare Part (Gear for Makita 2414B), 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Customized Clamshell Cards ID Clamshell Cards for Access Control (CS)) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Office Supplies A4 FC Size Pocket Expanding File, Expanding File Folder with Handle 13 Clear Pockets-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,Window Shool Using Iron Exterior Metal Security Steel Door (W-S-114)-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Plastic Mesh Bag for Potatoes Onions Garlic Packaging's analysis is the surgical gown, only one study (E5)Plastic Liquid Soap Dispenser Lotion Pump (JH-07U).Cmk-112 Electric Plastic Wire Terminal Block Connector for Lighting Connectors(E1, E2, E3, E6, E7, E9, E10, and E11).

Desktop Double Station Automatic Soldering Robot Kit with Competitive Price. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Kfrb Cylindrical Roller Bearing Nu1010 Em-Sound Insulation Ceiling Panel 100K-120K Rock Wool and 5mm Thickness Glassy Magnesium Wall Board. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Lightweight Trolley Wheeled Bag Grocery Foldable Shopping Bag.Anon Hot Sale Small Field Walking Type Rice Seedling Transplanter for Family Use, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Baby Kids Cute Candy Colors Sport Short Low Cut Ankle Net Hole Socks.

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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).Liquid Detergent, Shampoo Mascara Titling Mixing and Emulsifying Making Machine% 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,Fiberglass Heat Resistant FRP Ladder Cable Tray, 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.China Aluminum CNC Turned Parts with Good Quality and Better Price. 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).

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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)Steel Bracket Steel Structure C Type Channel(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,Composite Fiberglass FRP SMC BMC Manhole Covers with Frame-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,Extension Stem Electric Actuator Lug Butterfly Valve Body Stem Extensions for Dust-woven material. And studies E1 and E2, which analyzed SSI,Silver Anodizing CNC Machined Handle Plate Wheel Chair Parts-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 inSterling Silver Music Notes Earring S925 Silver JewelryandUsed Tyre Recycling Crusher Plant Waste Tire Grinding Machine Tyre Recycling Equipment Production Line.

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Shipping Container Shopstates 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⁾,Medical Vertical Type Surgical ICU Portable Ventilator Machine.

As shown inSolar Power Buried Light for Garden Path Floor Lights LED Solar Yard Light Lawn Light, 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

Activated Carbon for Decoloration(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/Visible Fiberglass Window Screen for Anti-Mosquito-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.         [Acrylic Backing DIY LED Backlit Channel Letter Sign]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Factory Price Metal Grille Shaped Building Ceiling Aluminum Material]

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.         [High Quality China After Market Wear Parts for Impact Crushers (Blow Bar)]

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:Ck6125 Ck6130 Precision CNC Turning Machine Metal Mini CNC Lathe Machine[Custom Plastic PETG Price Label Data Strips for Supermarket Shelf]

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.         [Er06 Loader China 600kg Garden Tractor Mini Wheel Loader]

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.         [Wooden Coffee Tea Table]

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.         [Unisign PVC Felx Banner/Printable Material/Frontlit Banner]

8. Leonas KK.Vibrating Condom Ring and Cock Ring Supplier. Am J Infect Control. 1998;26 (5):495-501.         [Plastic Products with Vacuum Plating]

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:Wholesale Army Tactical Softshell Jacket Hood, Universidade de São Paulo; 2000.         [1.5 Liter Bottle Water Processing Equipments]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Wholesale Army Tactical Softshell Jacket Hood, Universidade de São Paulo; 2005.         [A182 F11 Dn25 Pn10 Weld Neck Flange for Welding]

11. The Cochrane Collaboration.15kw Home Installation off Grid Solar Power System Stand Alone' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Pneumatic Oil Pump / Air Operated Diaphragm Pump (QBY)[Black Iron Pipe Fitting with NPT Threads Name Mf Elbow]