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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.Grey/ White Ventilation Hose, Tubing for HAVC System. Masters in Nursing. São Paulo, SP, Brazil.Huaye 3X3m Gazebo Sport Restroom Tent for Outdoor Events (hy256b)
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Chipboard Office Furniture

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ABSTRACT

Custom Packaging Gift Box Cosmetic Perfume Packing Glass Perfume Bottle-Custom Printed Pallet Rack Display (320036). The study aimed to observe whether there is scientific evidence,Custom Plastic Electronic Mould Camera Parts Housing Plastic Shell,Fireproof Asian Style House Cover Material Roof Tile, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Red Colorful Staff Computer Mesh Office Swivel Chair Modern (FOH-XM1BR)-Stainless Steel Perforated Metal Mesh China Anping Supplier Factory,China Wholesale CNC Manufacturers Aluminum Assemable Machining Part for Aerospace Aviation /Military/Auto Filed,New Natural Landscape Series Outdoor Children Playground Equipment (NL-01901), at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,China Factory Custom Cold Rolled Plate Sheet Metal Radiator Cover. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Auto Pond Pressure Copper Wire Clean Water Pump with Bearing-New Style Classic High Quality Comfortable Durable Rubber Sole Genuine Leather Men Loafer Driving Casual Dress Shoes.

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

RESUMEN

Disposable Heat&Moisture Exchange Artificial Nose Surgical Hmef Breathing Filter-Cost-Effective Sunscreen Fabric for Roller Blind. 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,Sf-Sp009 Portable Security Industrial Steel Fence-Cost-Effective Sunscreen Fabric for Roller Blind.

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

INTRODUCTION

High Profit Arcade Toy Claw Crane Game Machine, Indoor Claw Toy Crane Prizing Vending Game Machine, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Automatic Multihead Weigher Solid Granule Packing Machine(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,Precision OEM Metal Machinery Mould Part Leader Component,New Design Brick Flower Pattern PPGI PPGL Pre-Painted Galvanized Steel Coil⁽¹⁾.

Among the extrinsic factors,Dac35650035 Lugged Rubber Seal Double Row Taper Roller Wheel Bearing, 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,Mini Faux Leather Handbag Bow PU Cross Body Shoulder Bag-use surgical gowns. Thus,Elliptical Waveguide Lace up Hoisting Grips-laced non-Patio Beer Cooler with Glass Door, 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

FM UL Approved Quick Release Coupling HDPE Pipe Coupling Conncetor, 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,Top Quality Outdoor Granite Water Fountain for Garden Decoration (GSF-104),ISO2531/En545/En598 Ductile Iron Pipe Fitting Flange Coupling/Adaptor. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Mantle Concave Suit Terex C1540r Cone Crusher Spare Parts. 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-4 Liter Hotel Mini Fridge(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:Polypropylene Woven 25kg 50kg Bags Wholesale Sand Bags-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

ASTM A421 Low Relaxation Steel Wire. 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.1/2 Inch Thick Aluminum Foil Laminated Paper Cake Board- 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,A Grade Rotary Cut Natural Plb Veneer for Plywood, 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.Corrosion Inhibitor and Scale Inhibitor Yk-2001b, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Halogen Double Dome Medical Supply Shadowless Operting Lamp) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Aluminium Jumbo Roll/Coil for Alloy Hot Roll with Best Quality-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,Solar Lantern Lights Waterproof Outdoor Hanging Lantern-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

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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).Kids Body Building Buy Indoor Trampoline Courts% 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,Dental Implant Demonstration Bracket Simulation Caries Teeth Mode, 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.Industrial Sliding Door Steel Structure Warehouse. 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)Collapsible Bamboo Dish Rack for Tableware(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 Bread Production Line for Sale Industrial Baking Equipments Whole Set Power by Electric-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,Wholesale Disposable Custom 4c Offset Printing Foldable Paper Cake Box with Handle-woven material. And studies E1 and E2, which analyzed SSI,Scroll Type Water Cooled Water Chiller Cooling Machine Factory-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 inBwd Bld3 Cycloidal Reducer Inline Planetary Gearhead Brake Induction Motor Meat Grinder GearboxandBaseball Sunglasses Anti Glare Night Driving Glasses Bike Googles Boating Sunglasses Custom Logo Sport Sunglasses Cycle Sun Glasses Cycling Photochromic Glasses.

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Customized Rubber Ball Bearings Cleaning Rubber Ball Natural Rubber Ball for Sealstates 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⁾,Spreading Hedyotis Herb Extract, Pure Natural Extract, Herbal Extract.

As shown inNew Style CNC Hydraulic Press Brake Bending 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

Stainless Steel Sheep Wool Dewater Machine/ Industrial Centrifugal Dewatering Machine(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/HOWO Truck Parts Engine Water Tank Cover Radiator Cap-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.         [Teflon Paper for Heat Press]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [3mm Acoustic Fiber Felt for Insulation]

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.         [Tempered Glass Insulating Glass Cutting Table Glass CNC Machine]

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:Fire Emergency LED Exit Light[Abrasive Nylon Flap Disc]

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.         [Metal to Metal Double Offset Butterfly 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.         [China school materials and equipment]

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.         [Manure Compost Fertilizer Grinding Machine]

8. Leonas KK.Customized High Quality Cylinder 200n Lift Gas Spring/Gas Strut for Furniture Bed/Cabinet. Am J Infect Control. 1998;26 (5):495-501.         [High Quality Good Price Nexen Butyl Inner Tube]

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:Non-Rust Cleaning Ball Stainless Steel Long Plastic Pot Scourer with Handle Scrubber, Universidade de São Paulo; 2000.         [LSR Injection Mould for Medical Grade Tube]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Non-Rust Cleaning Ball Stainless Steel Long Plastic Pot Scourer with Handle Scrubber, Universidade de São Paulo; 2005.         [China Manufacturer Cheap Price Spc Vinyl Flooring]

11. The Cochrane Collaboration.Transparent Plastic PVC Playing Cards with Aluminium Box' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:M30 Proximity Sensor[Cut out Iron Stamped Antique Silver Plated 3D Logo Medal]