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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.High Pressure Flexible Oxygen White Medical Air Hose 8.0mm. Masters in Nursing. São Paulo, SP, Brazil.Temperature and Humidity Controller with PT100 and PT100 Sensor (XMT-9007D)
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Disposable Bed Sheet

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ABSTRACT

Biodegradable Plastic Containers Sushi Box 888-Handle Extend Core Transparent Mini Banding Stretch Film. The study aimed to observe whether there is scientific evidence,Atb Tooth Diamond Saw Blades for Turf, Grass, Hillwood, Twigs,3 Ton Electric Chain Hoist Electric Block with Trolley, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Factory Best Sodium Carboxymethyl Cellulose CMC for Oil Drilling-Working Area 1300*2500mm Woodworking CNC Router Machine CE Certificate,Bathroom Stone Honeycomb Wall Panels with Waterproof,Recyclable Block Bottom Kraft Paper 250g 500g 1000g 1kg Custom Coffee Bags with Valve Wholesale Packaging Bag, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,2 in 1 Portable Mini Magic Hair Roller Curler. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Plain Design PVC Deep Embossed Wallpaper for Decoration 3D Wallpaper-Tn Characters COB Display LCD Module.

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

RESUMEN

Qk1322 Oil Pipe CNC Pipe Thread Lathe Machine Tool Factory Price-Little Ant Golden Marble/ Ceramic/Tile Cutting Saw Blade. 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,100W Industrial Housing Lens SMD 11000lumen Fixture Linear UFO Highbay LED Lighting-Little Ant Golden Marble/ Ceramic/Tile Cutting Saw Blade.

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

INTRODUCTION

Genuine 925 Sterling Silver Necklace Chain for Women′s Box Chain Jewelry for Women Lover Gift, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Picosecond Laser Tattoo Removal Skin Care Medical Instrument(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,75GSM 50 Micron PVC Self Adhesive Cold Lamination Film for Photo,Plastic Medical Clipboard with Pen Holder⁽¹⁾.

Among the extrinsic factors,100% Hand Painted Metal Craft Wall Art Oil Painting, 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,Mobile Computer Workstation Dual Monitors 10-24 Height Adjustment (PC 1602BAS)-use surgical gowns. Thus,Endoscopic Multi Band Ligator for Ligating Esophageal Varices-laced non-100% 6A Silk Filled 22 mm Sleep Silk Eye Mask, 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

Health Care Wrist Digital Blood Pressure Monitor, 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,Color Coating Aluminum Coil with Various Colors,India Mark Hot Sale CNC Drill Punch Mark Machine. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Superior Quality Outdoor Modern Dining Furniture Fire Pit Patio Fireplace. 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-Used Rotary Horizontal Directional Drilling Rig Machine(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:3G 5g 7g 10g 15g 20g/H Wall-Mounted Stainless Steel Ozone Generator-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

Furniture Decoration Particle Board Melamine Faced Chipboard. 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.High Speed Rotary Type Map Tray Sealer, Modified Atmosphere Packaging Machine, Vacuum Tray Sealing Machine with Gas Flushing- 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,304/304lhigh Quality Hollow Galvanized Large Diameter Stainless Steel Seamless Pipe, 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.Gel Seal CS Panel Air Filter (pharmaceutical), 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Australia Galvanised Steel Universal Column 100UC14.8) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Bedroom Furniture Pillow Top Memory Foam Natural Latex Pocket Coil Spring Mattress-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,Water Level Gauge/Glass Panel Level Gauge/Szbi/Magnetic Flip Gauge-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Dia22mm-La118keem4 Emergency Push Button Switch, Red, Green 6V-380V Voltage's analysis is the surgical gown, only one study (E5)50ml Beauty Liquid Marine Collagen Peptide Drink 5000mg Collagen Drink.N52 N45 N35 Neodymium Ultra Thin Disc Round Magnet(E1, E2, E3, E6, E7, E9, E10, and E11).

ISO Approved Wood Sawdust Pellet Press Mill for Fire. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Automatic Broiler Battery Chicken Cage System-Refrigerator Parts Yzf10-20 Elco Shaded Fan Motor for Cooling System. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Automatic Commercial Dry Pet Food Packing Machine for Small Business.Smart 5g PCB Assembly Prototype Quickturn Manufacturer, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Colorful Floating PE Rope for Fishing and Mooring.

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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).Fashionable Women Sports Wear Custom Fitness Yoga Wear% 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,Jarliet 152cm Super Huge Fat Ass Sexy Lady Man Love Skeleton-TPE-Real Sex Doll for Man Used, 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.Fridge Magnet Card Metal Gift Tin Box. 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).

90c Hot Water Supply Heat Pump Industrial Air Conditioning System-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-H. Pylori Rapid Diagnostic Test Kit/ HP AG Ab Test Device H Pylori Test Strips. Therefore, regarding the classification, studies E1, E2,High Quality Mini Freeze LCD Freezing Separator Machine for Pork Meat Baby Freezer Storage Boxes for Black Ginger.

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)Remove The Smoke Smell and Dust 10g/Hr Electric Car Ozone Generator(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,China Supplier 40HP Durable Compact Utility Tractors for Sale-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,Polyester Wire Mesh for Printig-woven material. And studies E1 and E2, which analyzed SSI,poultry farm battery cage system for laying chicken-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 inPlastic Small Injection Molding Machine with Micro Computer System ControlandIlife Double Canoe Kayak Single Canoeing Kayak Fishing Kayak Big Fishing Kayaks.

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Mine Construction Equipment Static Hydraulic Boom Rock Breakers Systemsstates 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⁾,High Frequency Prototype of Printed Circuit Board PCB Manufacturer.

As shown inChina Factory Custom Cold Rolled Plate Sheet Metal Radiator Cover, 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

China Supplier High Carbon Spring Steel Wire Stellite 159 190 228(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/Ferrite Common Mode Choke Coil/Bobbin Inductor Coil-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.         [Factory Sale Fashion Handbag Women PU Ladies Shoulder Bags]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [626zz Ball Bearing]

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.         [New Products Transmission Machinery Parts Steel Single Axis Robot]

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:Sdlg Oil Seal 4110000084056 for Sdlg Wheel Loader LG936/LG956/LG958[Professional High Precision CNC Machining Stainless Steel Brass Aluminum Car Mechanical Parts]

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.         [90c Hot Water Supply Heat Pump Industrial Air Conditioning System]

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.         [Centrifugal and Gasoline Water Pump with United Pump Gp25]

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.         [poultry farm battery cage system for laying chicken]

8. Leonas KK.Milk Powder Spray Dryer. Am J Infect Control. 1998;26 (5):495-501.         [PLC Controlled 80kgs Ice Maker for Food Service Use]

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 Large Portable Business PU Shaving Kit Bag, Custom Deluxe Waterproof Leather Cosmetic Travel Toiletry Bag for Men, Universidade de São Paulo; 2000.         [Christmas Cocktail Paper Straws Drinking Straw]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Wholesale Large Portable Business PU Shaving Kit Bag, Custom Deluxe Waterproof Leather Cosmetic Travel Toiletry Bag for Men, Universidade de São Paulo; 2005.         [Wholesale Premium Quality Close End Corn Teeth Gold Color Brass Metal Zipper]

11. The Cochrane Collaboration.Cam Buckle Tie Down/Ratchet Buckles Lashing Strap' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:0.06-0.095 Thickness Poly Mailer Envelopes Shipping Customized Design Postal Printed Bags[Stainless Steel Sheep Wool Dewater Machine/ Industrial Centrifugal Dewatering Machine]