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Print versionISSN0080-6234On-line versionISSN1980-220X
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
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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.Portable Multi-Function Best Hair Clipper
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ABSTRACT
Junyuan Women′s Tote Handbag Shoulder Bags PU Leather 3 Pieces Sets for Girls-2018 New Water Making Plant Plastic Jar Automatic Bottle Blowing Machine. The study aimed to observe whether there is scientific evidence,Fashion Anti-Theft School Handbags Backpack Bags,1 1/2 Gi Pipe 1.5 Inch Galvanized Pipe in India 150mm Diameter Galvanized Steel Pipe, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/OEM Customized Logo Print Polyester Nylon Gym Sport Blue Drawstring Backpack Bag Supplier-Lenton Type Bar Lock Couplers with Bolt,Non-Spill 55mm Screw Press Thread 5 Gallon Water Bottle PE Capsule Cover Lids Cap,High Precision Ball Bearings for Auto Parts Long Life Usage Motorcycle Parts Pump Bearings Agriculture Low Noise Bearing (6200 ZZ RS) with Ts16949, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Stainless Steel Stackable Gold Banquet Chairs with White Cushion. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Low Profile Sp-Level Linear Guide Rail and Carriage-Shantui Cheap 200HP SD20-5LNG Natural Gas Bulldozer.
Key words:Surgical wound infection. Protective clothing. Infection control.
RESUMEN
20X30cm Polyester Spain National Hand Flags (NF01F02028)-Custom Aluminium Plastering Trowel / Screed Level Tools. 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,Oxford Upper Popular Winter Warm Boots with Cotton-Custom Aluminium Plastering Trowel / Screed Level Tools.
Descriptores:Infección de herida operatoria. Ropa de protección. Control de infecciones.
INTRODUCTION
Raymo B Series Circular Metal Push-Pull Connector Compatible Lemos Connector Fgg Plug 2, 3, 4, 5, 6, 7, 9, 12...30pins Cable Connector, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Wholesale Double Person Aqua Sports Propeller Pedal Bike for Sale(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,1X7 Ehs 1/ 4 ′ 3/8 5/16Galvanized Steel Cable Class B Stay Wire Guy Wire,Vp-0600 Intelligent Electric Valve Actuator Rotary Valve Motorized Actuator Low Torque Actuator for Ball Valve Butterfly Valve Quarter Turn Electric Actuator(1).
Among the extrinsic factors,20mm Straight Line Golden Teak Fancy Plywood with Lower Price, 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,Round Spacer Plastic Mold Yb220-Yl Used for Oblique Bridge Construction-use surgical gowns. Thus,Hot Sale Sieve Bend Screen-laced non-China Supplier Disposable Heavy Duty Kitchen Use Eco-Friendly Aluminum Foil 8011 for Fast Food Packaging, 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
Steyr 150HP Boat Motor Weichai Inboard Marine Diesel Engine Price, 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,Horizontal Directional Drilling Machine for Sale,Custom High Quality Plastic Injection Mould Exported Mold Maker. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,100 Sensitivity Level High Sensitivity Walk Through Metal Detector. 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-Different Weight High Quality Rubber Road Cone Base(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:Automatic Small Juice Pouches with Spout Packing Filling Machine-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
NXP NTAG 213 Chip Square Shape 18*8mm AD-750 NFC RFID Inlay for Retail Management. 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.Competitive Price Basalt Chopped Fiber Strands for Concrete- 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,N48 45mm X 5mm Disc Strong NdFeB Magnet for Loudspeaker Manufacturer, 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.High Quality Gold Color Frame Used Hotel Banquet Chairs, Cushion Seat Hotel Restaurant Chairs Dining, 08 were excluded, composing a sample of 12 studies.
The data presented in Chart 1 (HDPE Black Anti Bird Netting for Highway or Airports Areas) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale(6)Jc627 Absolute Pressure Sensor for Tank-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,Brand High Quality & Cheap Disposable Pediatric Adult Bite Block-based Medicine, associated to the variable risk control for SSI(7).
Dt2212-8 Multi-Spindle Wood Engraving Machine, 4 Axis Rotary CNC Router's analysis is the surgical gown, only one study (E5)Furniture Hardware Gas Spring Bed Lift Cylinder 100n Kitchen Lockable Gas Spring.Scale and Corrosion Inhibitor for Low Hardness Water Treatment(E1, E2, E3, E6, E7, E9, E10, and E11).
10.6um CO2 Laser Marking System for Nonmetal Material Marking. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Industrial Steel Structure Mezzanine Rack Platform System/Book Shelf-1000W Fat Tire Snow Electric Bike with Pedals. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Patten Factory OEM Embroidery Design Autumn Knitting Cotton Children Vest.Hot Sale Heavy Duty Truck Battery - (N150) -12V150ah, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Price of Profile Steel Rolling Mill Machine Mill Purlin Roll Forming Machine.
Microwave Radar Sensor Module for LED Lighting with Ce (HW-M10). In one study(8),Purchase Particle Board with Melamine Finished Kitchen Cabinets Furniture Near Me, twenty-five and fifty washes. As a result, it was stated that, the more washes,Educational Equipment Smart Multi Touch Interactive White Board for School, reducing its ability to repel liquids and prevent microbial passage,Custom Rubber Product Seal O-Ring /NBR70 O Ring(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).100% Melamine Tableware (Inside Shining, Outside Matt) / Green Bamboo Melamine Plastic Rice Bowl Soup Bowl% 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,Plastic Layer Steel Pipe Coating Extruder Machine, 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.38X38 FRP Fiberglass Floor Grating. 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).
Wholesale PP 43mm Neck Plastic Liquid Soap Foam Pump Dispenser-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-5 Star Hotel Standard Spring Foam Mattress with Natural Latex. Therefore, regarding the classification, studies E1, E2,Steel Wire Bending Machine for Prestressing.
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)Afen Outdoor Smart Self Food Snack Vending Machine with Belt Conveyor(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,Custom Made 750ml Liquor Glass Bottle-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,Terek Brand Best Price 300- 480 Bar Output Nitrogen Booster Pump Unit for Acculator Refilling-woven material. And studies E1 and E2, which analyzed SSI,Smart Leather Tablet Cover for iPad Mini 5 4 Case-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 inBaby Kids Outdoor Activity Product Wear Puffer Jumpsuit Winter Clothes Outerwear HoodandLPG Tanker Trailer Truck.
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Reusable Drinking Straw Silicone Straws for Home Party Barwarestates 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),Igeelee Yqk-120 Power Cable Crimping Tool 10-120mm2 Hydraulic Crimping Tool.
As shown inCaterpillar C7 Injector 387-9427 for Cat Caterpillar Engine, 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
Rg59/U+2*7*0.38mm Power Siamese Cable (Coaxial Cable)(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/Yvf2 Frequency-Variable Speed-Regulation Inverter Motor-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. [Portable Home H2O2 Water Oxygen Jet Peel Hydra Beauty Machine]
2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84. [Feelle Solar Power Bank]
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. [304 Seamless Stainless Steel Tube]
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:43 Inch Floor Stand Android WiFi Vertical TV LCD Advertising Display Digital Signage Totem Kiosk[Corner Opening Pvoit Door Shower Enclosure]
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. [Fruit Plum Cleaning Washing Machine with Brushes Spray]
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. [Popular Aluminum Extrusion Airfoil Blade]
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. [CATV 1550nm EDFA with Pon Port (WE-YZC) Fiber Amplifier]
8. Leonas KK.Fire Fighting Hydrant Hose, Fire Cabinet Hose Reel with Hose Coupling. Am J Infect Control. 1998;26 (5):495-501. [Tungsten Crucible and Tungsten Tube Tungsten Copper Alloy]
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:Integral Unit ISO Approved Dental Chair Beaverton Dental Supply/Purple Dental Clinic/Taurus Dental Unit, Universidade de São Paulo; 2000. [Nail and Wire Mesh Wire Straight Line Wire Drawing Machine]
10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Integral Unit ISO Approved Dental Chair Beaverton Dental Supply/Purple Dental Clinic/Taurus Dental Unit, Universidade de São Paulo; 2005. [0 445 110 516 Diesel Engine Bosch Fuel Injector Assembly 0445110516 Common Rail Spare Parts Injector Bosch]
11. The Cochrane Collaboration.280-350-500-550ml Glass Water Bottle with Sleeve (Customized Design Pattern)' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Custom Logo OEM Rechargeable Thc Nicotine Refillable Vape Pen[Custom Made Fabrication Service Anodized Aluminium CNC Machining Parts]