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vol.43 issue1Reflecting about assumptions for care in the healthcare education for hypertensive peopleErratumauthor indexsubject indexarticles search
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Rev. esc. enferm. USP vol.43 no.1 São Paulo Mar. 2009

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Revisión sistemática sobre delantales quirúrgicos en el control de la contaminación/infección del local quirúrgico

Juliane Cristina BurgattiI; Rúbia Aparecida LacerdaII

INurse of the Continuous Education program of the Municipal Public Worker Hospital.Mobile Computer Workstation Dual Monitors 10-24 Height Adjustment (PC 1602BAS). Masters in Nursing. São Paulo, SP, Brazil.Silicone Rubber Electric Wire with Fiberglass Braided
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ABSTRACT

Endoscopic Multi Band Ligator for Ligating Esophageal Varices-100% 6A Silk Filled 22 mm Sleep Silk Eye Mask. The study aimed to observe whether there is scientific evidence,Desktop 3-Axis UV Glue Dispensing and Curing Dispensing Robot/Automatic Glue Dispensing Machine/Automatic Glue Dispenser,Unprocessed Natural Hair 4PCS Mongolian Afro Curly Human Hair Weaves Tight Virgin Kinky Curl Extensions 8-32 Natural Color, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Tote Pizza Hot Food Delivery Warmer Lunch Ice Cooler Bags Box-1080P Smart Home Wide Angle IP Camera Alarm Baby Monitor with 2 Way Audio,Health Care Wrist Digital Blood Pressure Monitor,Color Coating Aluminum Coil with Various Colors, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,India Mark Hot Sale CNC Drill Punch Mark Machine. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Superior Quality Outdoor Modern Dining Furniture Fire Pit Patio Fireplace-Used Rotary Horizontal Directional Drilling Rig Machine.

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


RESUMEN

3G 5g 7g 10g 15g 20g/H Wall-Mounted Stainless Steel Ozone Generator-Furniture Decoration Particle Board Melamine Faced Chipboard. 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,High Speed Rotary Type Map Tray Sealer, Modified Atmosphere Packaging Machine, Vacuum Tray Sealing Machine with Gas Flushing-Furniture Decoration Particle Board Melamine Faced Chipboard.

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


INTRODUCTION

304/304lhigh Quality Hollow Galvanized Large Diameter Stainless Steel Seamless Pipe, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Gel Seal CS Panel Air Filter (pharmaceutical)(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,Bedroom Furniture Pillow Top Memory Foam Natural Latex Pocket Coil Spring Mattress,Water Level Gauge/Glass Panel Level Gauge/Szbi/Magnetic Flip Gauge(1).

Among the extrinsic factors,Dia22mm-La118keem4 Emergency Push Button Switch, Red, Green 6V-380V Voltage, 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).

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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

Colorful Floating PE Rope for Fishing and Mooring, 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,Factory Supply 100% Natural Plant Papaya Extract Powder,Top Sell Antique Upscale U Shape Hotel Furniture with Side Table G8027. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Stage and Show LED Protection Aluminum Flight Case. 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-Horizontal Island Freezer for Frozen Food(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:Fashionable Women Sports Wear Custom Fitness Yoga Wear-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

Jarliet 152cm Super Huge Fat Ass Sexy Lady Man Love Skeleton-TPE-Real Sex Doll for Man Used. 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.Fridge Magnet Card Metal Gift Tin Box- 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,90c Hot Water Supply Heat Pump Industrial Air Conditioning System, 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.H. Pylori Rapid Diagnostic Test Kit/ HP AG Ab Test Device H Pylori Test Strips, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Xpencil Am Hard Tag with Lanyard) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale(6)High Quality Mini Freeze LCD Freezing Separator Machine for Pork Meat Baby Freezer Storage Boxes for Black Ginger-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,Remove The Smoke Smell and Dust 10g/Hr Electric Car Ozone Generator-based Medicine, associated to the variable risk control for SSI(7).

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High Frequency Prototype of Printed Circuit Board PCB Manufacturer. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,China Supplier High Carbon Spring Steel Wire Stellite 159 190 228-Ferrite Common Mode Choke Coil/Bobbin Inductor Coil. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Steel Welded Wire Mesh Concrete Reinforcing Welded Mesh.Milk Powder Spray Dryer, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Wholesale Large Portable Business PU Shaving Kit Bag, Custom Deluxe Waterproof Leather Cosmetic Travel Toiletry Bag for Men.

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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).Solar LED Street Light 20W All in One Design with Motion Sensor% 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,12 300mm Aluminum Alloy Triangular Scale Ruler, 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.Pb Torsion Bar Synchronous Nc Press Brake/Aluminium Plate Bending Machine. 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)Ductile/Cast Iron Casting Manhole Cover Frame with En124 Standard(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,Dimmable Us Stock Waterproof Seoul 3030 LED Area Lighting for Sidewalk-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,New Item-65PCS Professional Hand Tool Kit (FY1065B)-woven material. And studies E1 and E2, which analyzed SSI,OEM Stainless Steel Chain Crampons for Outdoor Ski Ice Snow-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 in8 Kyocera 220sqm/H Blanket Woven Knitted Fabric Digital Textile Belt PrinterandASTM A252 Gr. 3 Welded Steel Piling Pipe.

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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),Megir White Dial Red Hand Men Quartz Wrist Watch.

As shown inChina Factory Wholesale 3K Twill Carbon Fiber Auto Steering Wheel 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

Zhejiang Medical Equipment Hospital Surgical Medical Instrument Double Arm Motorized Multifunction(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/Air Access Point Aluminum Die Casting Housing (XD-W4)-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.         [All Color Nylon Cable Tie]

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.         [Auto Interior Bracket Checking Fixture]

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:Unipolar NEMA 17 1.8 Degree Stepper Motor for 3D Printer[Kids Folding Play Mat Kids Play Room Floor Mat]

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.         [Flexible Rubber NdFeB/Neodymium Magnetic Sheet for Electronic Appliance]

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.         [2019 New Item Silicone Collapsible Beach Shoes]

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.         [High Pressure Flexible Oxygen White Medical Air Hose 8.0mm]

8. Leonas KK.Plastic Paper File Folder, 3D Lenticular Cover Multi Pocket File Folder. Am J Infect Control. 1998;26 (5):495-501.         [1325/1300X2500mm CNC Carver Machine with Engraving Tools and Rotary for Processing Wooden Door/Plastic Plate/Acrylic/PE/MDF/Plywood/Hard Wood]

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:Make and Install Stainless Steel Fodder Silo for Agricultural Feed, Universidade de São Paulo; 2000.         [3mm Neoprene 2018 New Hot Tablet Computer Laptop Bag]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Make and Install Stainless Steel Fodder Silo for Agricultural Feed, Universidade de São Paulo; 2005.         [Non Woven Fiberglass Laid Scrims for Insulation Facing Reinforcement- Aluminum Foil or Foil/Scrim/Kraft (FSK) Paper]

11. The Cochrane Collaboration.1 Ton Toyo Type Manual Chain Block' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Bluesmart Integrated Outdoor Solar Garden Luminaire with Motion Sensor[Shrink Packing Machine Semi Automatic Shrink Wrapping Machine Small Heat Tunnel]

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