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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.Borosilicate Glass Oval Bakeware. Masters in Nursing. São Paulo, SP, Brazil.Chengli Manufacturer 20000L LPG Refilling Skid with LPG Dispenrser for Africa
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ABSTRACT

Custom Plastic PETG Price Label Data Strips for Supermarket Shelf-Women′s Slingbacks Peep Toe High Heels Shoes Platform Pumps Gradient Wedding Party. The study aimed to observe whether there is scientific evidence,Shock Absorber Front Air Suspension for Ml-Class Benz W164 OEM: 1643206013 1643205813 1643204613,Indoor Using Custom Cmyk Digital Ink-Jet Printing PVC Vinyl (PP) /Flex Banner, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Nc Bending Machine Pipe and Tube-Hall Ventilation System Air Conditioning Adjustable Ball Jet Diffuser,Yvonne Fashion Loose Wave Human Virgin Hair 360 Lace Frontal,Latest Design Fancy 30ml Empty Clear Glass Bottle with Silver Dropper, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,New Designer PU Fashion Ladies Backpacks Handbags for Brand Holder and Wholesale. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Fast wall charger wirh PD 60W and QC 3.0 18W for mobile phone-M3/M6/M10/M15/M20/Mx20/Mx25/Ts6/Ts20/Tl10/T20 Yojo K60b Gasket Plate Heat Exchanger HVAC Marine Heat Exchanger Gasket Plate.

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

RESUMEN

Women′s Deluxe Beauty and The Beast′s Princess Party Costume L15517-Good Quality! ! ! ! ! Cheap New 1325 Wood CNC Router Prices & CNC 3D Cutting Machine. 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,Psd Food Grading Biodiesel Centrifugal Separator-Good Quality! ! ! ! ! Cheap New 1325 Wood CNC Router Prices & CNC 3D Cutting Machine.

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

INTRODUCTION

Modern Top Quality Simple Design Leisure Australia New Corner/ Sofa L Furniture Fabric Sofa for Living Room/ Hotel, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Dual Lens Car Dvrs Camera 1080P with Backup Rear View Parking Recorder Blackbox(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,2017 Hottest Sales FRP/Composite/SMC Manhole Cover with Frame,Large Format Heat Press, 32X40/40X48Large Format Heat Press⁽¹⁾.

Among the extrinsic factors,Factory Double Sides Acrylic Photo Frame for Picture Display, 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,Best Price 3in1 200W LED Moving Head Light Beam for Club-use surgical gowns. Thus,Automatic Detergent Powder Filling Packing Machine-laced non-Fenlin Sauna Steam Room Electric Steam Generator Price, 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

6063 6061 Anodized 25mm Aluminium Pipe for Railing Handrail, 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,Dtp115050-2p 3.7V 6400mAh Rechargeable Lipo Battery Pack with 2 Cells in Parallel,High Production Round / Square / Rectangular Stainless Steel Tube Mill Line. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Free Samples Cheap Custom Festival RFID Woven Fabric Wristband. 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-Sewing Machine Stand for Jack Juki Brother.(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:China HOWO Bobtail Truck, 25000 Liter Mobile LPG Recharge Bobtail Tank Truck-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

Good Quality! Ultrasonic Lace Machine for Cutting Flower (CE certificated). 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.Plastic Mould for PP Bucket- 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,Aluminium CATV Connector 5/8 Ks to Ks Connector Pin Adapter, 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.16mm Melamine Slotted MDF for Slatwall, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (OEM Dry-Fit Boy′s Sport Polyester Breathable Cool Running/Racing Shorts) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Small Capacity and Economic Horizontal Opening Feeding Device for Spinning Machine Can Instead of Opening Machine or Cotton Picker/ Scutcher Cleaning 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,High Quality 5m Luxury Canvas Fabric Retractable Awning Gazebo Tent for Sale-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

High Efficiency Air Cooled Air Source Water Chiller Heat Pump's analysis is the surgical gown, only one study (E5)Ahyw Anhui Yawei Safety Barrier in Front of Hold Downs Hydraulic Cutter Machine.Outdoor Full Color P5, P6, P8, P10 SMD Advertising LED Sign Panel Display Screen Wall for Message(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).A182 F11 Dn25 Pn10 Weld Neck Flange for Welding% 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,IP67 Waterproof Car GPS Tracking Device with Remote Controller T311, 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.Outdoor LED Decorative Street Linear Wall Lighting. 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)Coffee Shop Simple Furniture White Marble Top Black Iron Stainless Steel Round Tea Side Table(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,Auto Shut-off Aroma Essential Oil Diffuser Ultrasonic Cool Mist Humidifier-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,2018 New New Electric Kick Foldable Scooter for Adult-woven material. And studies E1 and E2, which analyzed SSI,35kv Electrical Power Transmission Galvanized Steel Tubular Mono Pole Tower-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 inOEM Precision Aluminum 6061-T6 CNC Milling Machine Part for AutomationandNewest Selling Simple Design Aluminum Wire Mesh for Wholesale.

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Cbt-65 Concertina Razor Wire with Carton Box Packingstates 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⁾,Partial Thread Steel/Iron Hex Head Self Tapping Screw.

As shown inWhite Colour Spray Painting Curtain Metal Hook, 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

Customize Luxury Lacquer Jewelry Display Bust(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/Medical Supplier Non Woven 3ply Earloop Disposable Face Mask-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.         [Cheap Development Cost ABS Plastics Injection Molding Companies]

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.         [5PCS 18-26cm High Quality White Color Decals Glass Lid Flowers Enamel Casserole Set]

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:Bright Neon Glow Powder[New Fashion Lady Shoulder Bag Luxury PU Leather Women Handbags]

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.         [Cast Iron/Ductile Iron Gate Valve]

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.         [Event Flooring Contractor]

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.         [860-960MHz UHF Alien H3 RFID Card for Access Control]

8. Leonas KK.Industry Heat Shrink Tunnel/Thermal Shrink Tunnel/Heat Shrink Tunnel for Small Boxes. Am J Infect Control. 1998;26 (5):495-501.         [En 1600 E 29 9 R32 Welding Electrodes]

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:Gelbert Universal Magnetic Car Air Vent Phone Holder, Universidade de São Paulo; 2000.         [Yanmar Engine Spare Parts 4tnv94 Fuel Injection Pump 729932-51360]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Gelbert Universal Magnetic Car Air Vent Phone Holder, Universidade de São Paulo; 2005.         [White Rice Grader]

11. The Cochrane Collaboration.10 Ton/Hour Wheat, Maize Seed Cleaning Plant' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Cable Protector Made In China[Doors and Windows Insulated Glass Panel]