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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.Best Price Polyurethane High Pressure Foam Machine

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ABSTRACT

Factory Price 304 316 Stainless U Steel Channel Price for Sale-ESD Acrylic Sheet for Testing Fixtures. The study aimed to observe whether there is scientific evidence,High Quality Fabrication Column,Ductile Iron Simple Lever Micro Single Ball Automatic Air Vent Release Valve, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/OEM Ignition Coil Pack for Audi Skoda VW Golf Bora 036905715 036905715f 036905100A/B/C-Rexroth Excavator Parts Metering Pump A2vk107  Pump,High Speed 4 6 Color Roll to Roll Flexographic/Flexo Printing Machine for Paper, Film, Plastic Bag,Lxp-120 Glass Disc Insulator in High Voltage Power Transformer, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Table Stainless Steel Meat Grinder for Food Processing Machine. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Prefab Galvanized Steel Structure Workshop / Warehouse / House / Prefabricated Building (TW374J)-925 Sterling Silver Jewelry Pearl Love Pendant Necklace Platinum Plated.

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

RESUMEN

50ml Pet E Liquid Dropper Bottle Plastic Bottle-New Big Wheel 1000W City Coco Electric Scooter with Double Removeable Battery. 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,Continuous Rim Tile Saw Blade-New Big Wheel 1000W City Coco Electric Scooter with Double Removeable Battery.

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

INTRODUCTION

125kHz RFID Card 13.56MHz Proximity Card Blank Thin Card, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Pesticide Residue Testing in Food, Fruit and Vegetables(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,BV, ISO, SGS Certificated Razor Barbed Wire,Emboss Sheet Aluminum Checkered Plate⁽¹⁾.

Among the extrinsic factors,Movable Wireless GPS Mobile Controlled Solar Power LED Traffic Light, 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,Full Automatic Extrusion Nutrition Artificial Rice Making Machinery-use surgical gowns. Thus,Printed Polyester Fans Sponsors Swirler Handle Bar Flag-laced non-Cheap Small Airtight Nutrition Vitamin Pill Container, 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

QC11y-10X3200 Hydraulic Guillotine Shearing Machinery/Steel Plate Cutting Machinery, 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,Deshedding Hand Massage Glove, Pet Grooming Glove,Galvanized Steel C Channel/Strut Channel/Unistrut Channel. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Grouting, Micropile and Harbour Hole Drilling Symmetric/Symmetrix Overburden Drilling Equipment. 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-New Fashion Girls Leather Backpack Bags(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:Galvanized Sheet Metal Steel Strips for Sale-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

Displayed Hook & Loop for Verlcro Wire/ Cable Tie. 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.Wholesale Cheap Iron on Sublimation Printing Woven Label Patches- 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,Drum Roll Permanent Magnetic Separator Equipment, 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.Plastic Color Masterbatch for Shopping Bags Vest Bags, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Economical 6 Zones Hot Air Reflow Ovens Soldering SMT Machine) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾HSS 3 Flutes 75 Degree Chamfer End Mill for Processing Conical Surface-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,Dog Backpack Travel Camping Hiking Pack Canvas Saddle Bag Rucksack for Medium & Large Dog-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Customized Clamshell Cards ID Clamshell Cards for Access Control (CS)'s analysis is the surgical gown, only one study (E5)CT Shape 14.8mm-32mm Thermal Barrier Polyamide Profile.Dual Frequency RFID Cards with Multi-Function Em and UHF(E1, E2, E3, E6, E7, E9, E10, and E11).

Ms Gi Pipe Dn15~Dn400 Gi Pipe List. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,3D CNC DIY Laser Engraver Marking Metal/ Plastic/ Rubber/ ABS/ PVC Engraving-3D Printing Service for Plastic Injection Molding Mould. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Industrial Grade TiO2 Price Rutile Titanium Dioxide for Ceramics.Small Concrete Manual Interlocking Block Brick Making Machine, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Sintered Tungsten Carbide Rod for Aluminum Drilling and Cutting.

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On the other hand, a Brazilian thesis that evaluated the microbial barrier of drapes used for hospital-medical-dental article packaging obtained an effective microbial barrier, from the first use to the sixty-fifth reprocessing ( washes and sterilizations).High Quality Water Bottle Usage Plastic Pull Push Cap From China Manufacture% 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,Costa Rica Digital Smart Full HD ISDB-T TV Transmitter TV Receiver, 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.Custom High Quality Artificial Quartz Stone Single Bowl Kitchen Sink. 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).

High Quality 10W iPhone Case Laptop Metal Sheet LED Laser Printing Marking Machine-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Digital Floating Baby Care Products Frog Bath Design Thermometer. Therefore, regarding the classification, studies E1, E2,Qt40-1 Semi-Automatic Concrete/Cement Block/Brick Machine in Kenya.

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)Full Color Cheap Softcover Book Printing(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,Hotel Tools for Cooking Induction Cooker-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,Aluminum Casting Aluminum Casting Mould Low Pressure Die Casting Lpdc-woven material. And studies E1 and E2, which analyzed SSI,35kw Air Cooled Water Cooled Industrial Water Chiller Machine for Industry Application-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 inOne-Piece Solar Insect Killer Lampand5km City Surveillance Network Infrared Laser PTZ Camera.

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Best Mortar Pump Manufacturer/ Concrete Pumps/ Squeeze Cement Grouting Pumpstates 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⁾,Calcium Fluoride Fluorspar Powder CaF2 90%.

As shown inHex Flange Head Double Thread Self Tapping Screw, 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

Yeezy Boost 350 V2 AAA Quality Designer Sneakers Sport Shoes(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/Electric Fish Tank Water Pump for Waterfalls Garden Fountain Submersible Filter Water Pump-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.         [A4 L Shape Folder Products Made in China]

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.         [Visible Fiberglass Window Screen for Anti-Mosquito]

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:Classic Black Stainless Steel Strap Business Bracelet Round 1.3 Color Screen Single Touch Smart Watch Blood Oxygen Monitor Intelligent Wristwatch[Lanyards Ribbons Automatic Screen Printing Machine Wet-4000s-02]

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.         [98inch IR touch screen monitor smart board with speaker]

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.         [Passenger Round Panoramic Sightseeing Observation Residential Capsule Glass Elevator (G-001)]

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.         [118cm Love Doll Big Breast Silicone Sex Doll]

8. Leonas KK.60W Linear LED High Bay Light 140lm/W for Warehouse Industrial Lighting. Am J Infect Control. 1998;26 (5):495-501.         [Fully Automatic Tri-Dimensional Non Woven Bag Making Machine]

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:Iran Market Crystal Super Clear Packing OPP Tape, Universidade de São Paulo; 2000.         [Hitachi Elevator Push Button (SN-PB310)]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Iran Market Crystal Super Clear Packing OPP Tape, Universidade de São Paulo; 2005.         [Hotel Tools for Cooking Induction Cooker]

11. The Cochrane Collaboration.GMP Certified Lidocaine Hydrochloride Injection Anaesthetic' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Cold Forming Machine For Storage Shelves[Woman Fitness Elastic Strench Sportswear]