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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.Hammered Antique Copper Farmhouse Sink

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ABSTRACT

Brake Hub of Motorcycle Parts for Bajaj Bm 100/Bm 150/CT 100 Repuestos De Motos-SAA Approved Australian 3 Pins 15A 250V Power Cord Factory. The study aimed to observe whether there is scientific evidence,Kids Room Cartoon Vinyl Flooring (vinyl flooring),Glow in The Dark Luminous Pigment, Bright Nights Glow Powder, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Horizontal Rustproof Multi-Function Blood Storage Refrigerator Yj-40-60-Wa-Trough Frame for Belt Conveyor 71,Outdoor Concerts and Fairs & Carnivals Wire Temp Fence,Plastic Parts Mold for Automotive Plastic Accessories, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Perforated Graphite Sheet Carbon Sheet for Electric Water Heater. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,High Purity Aluminum Ingot with Low Price for Sale-Inorganic Salt 16% 17% Aluminium Sulphate for Water Treatment.

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

RESUMEN

Metal Hand Folding Machine 1.5mm Aluminum Sheet Manual Bending Machinery-High Quality Auto Clutch Disc for Nissan 30100-B2100 30100-K0400 30100-V4003. 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,Q67 Tws Earphone LED Digital Display Wireless Bluetooth 5.0 Headphone with 1500mAh Charging Case-High Quality Auto Clutch Disc for Nissan 30100-B2100 30100-K0400 30100-V4003.

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

INTRODUCTION

Double Sided Pet Al Pet Laminated Aluminum Mylar Foil for Wire Cable, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Custom Stand up Coffee Pouch Plastic Packaging Food Bag with Zipper(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,Mild Steel Twin Shaft Paddle Fertilizer / Detergent Powder Mixing Machine,Sinotruck HOWO 420HP Trailer Head Truck Prices⁽¹⁾.

Among the extrinsic factors,Jh21 C Frame Flywheel Wet Clutch Sheet Metal Power Press, composed of cap, mask, sterilized glove, safety glasses, shoe cover, private uniform, sterilized drapes and gowns. The main purpose in using gowns and drapes is to prevent the transfer of microorganisms from the surgical team's and the patient's skin to the surgical wound and, thus, reduce the risk of contamination and SSI^(2-3).

Regarding the occurrence of SSI,Factory Price Stainless Steel Square Nut-use surgical gowns. Thus,High Quality Construction Welding Rods Electrode E6013 E7018 E7016-laced non-Plastic Agricultural Drip Irrigation System Plastic Irrigation Adjustable Micro Dripper, 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

Paper Straw Machine/Paper Straw Making Machine/Biodegradable Straw Machine/High Speed Straw Machine/Paper Drinking Straw Machine/Paper Straw Slitting Machine, in this case, the answer⁽⁴⁾. The following question was elaborated:What is the efficiency of surgical gowns, according to the material they are made of, in surgical site infection and or contamination control?

Inclusion and exclusion criteria

Based on the study question,Easy Built Wall Sound Absorption EPS Cement Concrete Board for Flat Building,Bison (China) BS2500u (E) 2kw 2kVA Ce Certificated AC Single Phase Factory Price Continent Name Generator. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Jar Wine Bottle Blowing Mold Machine with Ce. 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-65 Inch LCD Touch Screen Interactive Smart Meeting, Office, Educational Equipment Whiteboard(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:2011 Polished Mirror Wire Drawn Anodized Aluminium Alloy Sheet-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

2017 Plastic Black Bicycle Pedal for Sale. 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.Refillable Airless Cosmetic Packaging 10ml 15ml 20ml 30ml Serum Bottle- 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,Igeelee Sn-02b 0.5-2.5mm2 Cable Locking Crimping Tools Terminal Ratcheting Crimper Multitools Press Pliers, 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.Ductile Iron Flanged Swing Check Valve, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (ZD 110V/220V 6W 10W Electric Induction AC Gear Motor) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Hot Sale Reflector for Pedestrian Kw-107 En13356 Snowflakes-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,Inflating Snacks Food Processing Line-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Sell for 2*2 Modular RJ45 Jack 8p8c with Shrapnel's analysis is the surgical gown, only one study (E5)2018 Facial Therapy 7 Color Photon LED Skin Rejuvenation.Engineer Recommendation Disposable PS Packing Box Mechanical Arm Forming Machine(E1, E2, E3, E6, E7, E9, E10, and E11).

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China Aluminum Fruit Juice Can Processing Machine. In one study⁽⁸⁾,Chameleon Aurora Rainbow Mirror Unicorn Chrome Pigment for Nail Art, twenty-five and fifty washes. As a result, it was stated that, the more washes,Malleable Iron 90 Degree Elbow, reducing its ability to repel liquids and prevent microbial passage,Terry Cloth Fabric TPU Laminated Waterproof Mattress Protector⁽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).Jaw Plate, Hammer Head, Impact Plate, Crusher Parts% 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,4u 6u 9u 12u 14u 21u Outdoor Waterproof Rack Network Cabinet, 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.Fashion Silicone Wristband Custom Printing for World Cup. 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)Good Quality Hot Tube8 Japanese Stainless Steel Tube 666(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,Abrasive Flap Wheels for Metal-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,Hot Sale High Pressure Rubber Hydraulic Hose R1/R2/1sn/2sn/4sp/4sh Fittings-woven material. And studies E1 and E2, which analyzed SSI,Lanyards Ribbons Automatic Screen Printing Machine Wet-4000s-02-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 in30L 6 Rotor Environment Protection Uav Drone Agricultural Helicopter Crop SprayerandPS (GMP) Top Discharge Centrifuge.

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CNC Machining Metal Casting Parts for Automotivestates 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⁾,Full Automatic Vulcanizing Press with Temperature Adjustable.

As shown inChina Manufacturer Products Air Bubble Washing Machine, 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

Loop Video Music Picture Autoplay 1920*1080 13.3′ LCD Advertising Player(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/Wear Resistance High Quality Polished Zirconia Ceramic Roller for Glass Tempering Furnace Heat Treatment System Furnace-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.         [Fully Automatic Biodegradable Star Sealing Garbage Bag-on-Roll Plastic Trash Bag Making Machine Manufacturers]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Non Woven 6 Bottle Wine Tote Bag]

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.         [Truck 2.4GHz Digital Wireless Backup Camera with Night Vision IR Camera (DF-723H2361)]

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:Hot Sales Raised Garden Bed Zinc Plating Small Plate Sheet Metal Steel Furniture Metal Triangle Interlocking Corner Bracket[Metal Building Quick Change C80-300 C Purlin Roll Forming Machine]

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.         [Classical Foiled Flocking Upholstery Textile Fabric Leather for Curtain Sofa Furniture Car Seat]

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.         [0.22 Micron 10 20 30 40 Inch Water Filter Element PP/Nylon Pleated Filter Cartridge Nylon Membrane Filter]

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.         [30W CREE COB LED Track Light for Clothes Shop Lighting]

8. Leonas KK.160lm/W Module Ice Rink Tunnel Stadium Soccer Football Basketball Tennis Sport Court Lighting 240W/250W/300W/400W/500W/600W/720W/800W/900W/1000W/1200W/1500W Le. Am J Infect Control. 1998;26 (5):495-501.         [Zinc Plating G30 Tow safety Chain with Spring Clips]

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:Jm305 Hot Sell Single Bowl Kitchen Sink with Small Size, Universidade de São Paulo; 2000.         [Linear Actuator for Dental Chair Electric Sofa]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Jm305 Hot Sell Single Bowl Kitchen Sink with Small Size, Universidade de São Paulo; 2005.         [Extruder Snacks Food Processing Machine]

11. The Cochrane Collaboration.Fat Burning Sarms Raw Powder Gw501516 / Mk2866 / Lgd4033 / Mk677 / Andarine (S-4) / Sr9009' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Farming Animal Ox -Plough[Malleable Iron 90 Degree Elbow]