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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.PP Color Masterbatch for Films and Shooping Bags. Masters in Nursing. São Paulo, SP, Brazil.Stainless Steel Valve Casting Water Valve Chemical Valve
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Class 150 Flange

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ABSTRACT

Sulfur Recovery Catalyst in Oil Refinery Industry with Lowest Price-Plastic Armless DIN Chair Mould Manufacturing. The study aimed to observe whether there is scientific evidence,Wholesale Tumbler Shape Clear 500ml 750ml Wine Glass Bottle with Cork,CF8 Universal Flange Hole PTFE Seat Wafer Butterfly Valve with Gear Box, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Outdoor Telecommunication Equipment 15u Wall Mounted Telecom Battery Cabinet-Disposable Absorbent Surgical Sterile Dental Pack for Factory Supply,5in1 USB Type C Hub HDMI 4K USB C Hub to Ethernet RJ45 LAN Adapter,Chicken Manure Fertilizer Plant Organic Pellets Fertilizer Machine Waste Fertilizer Production Line, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Car Bird View GPS Tracker with Car Rearview Camera for Around Camera Panoramic Safety Car Parking System Driving System and 3D Car DVR Video Recorder HDMI. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Stainless 1 Inch Welded Steel Pipe Sch10 Sch40-Recessed Ceiling LED Linear Trunking Light for Office with 68*80mm Size.

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

RESUMEN

Adult Sea Bike Water Tricycle Bikes for Sale-Pressurized Vessel PVDF UF Membrane Filter Water Treatment Plant. 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,Cheap Wholesale OEM High Precision Aluminum Die Casting Auto Parts-Pressurized Vessel PVDF UF Membrane Filter Water Treatment Plant.

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

INTRODUCTION

Ce TUV IP67 2.5mm2~6.0mm2 Cable Male/Female Mc3 Solar Cable Connector, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Yhzs60 Mobile Concrete Batching Plant, Portable Concrete Mixing Plant, Portable Ready Mix Concrete Batch Plant(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,3000W Fiber Metal Tube Precision Cutting Industry Pipe Laser Cutter Machine,Manual Type Aluminum Window Door Bending Machine for Window Door Making Machine⁽¹⁾.

Among the extrinsic factors,Wire Rope Pulling Tirfor Hoists, 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,HDPE LLDPE LDPE PPR PP PE Gas Water Irrigation Tube Extrusion Plastic Pipe Production Line-use surgical gowns. Thus,Control Keyboard Pet Printing Circuit Waterproof Membrane Switch with Housing-laced non-2X Mc4 Connector Male and Female Mc4 5 Branch Solar Panel Connectors Terminals, 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

Custom Automotive Rubber EPDM Thermoo Rings for Home Electronic Appliance, 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,800/1900MHz CDMA FWT Fixed Wireless Terminal/CDMA FCT Fixed Cellular Terminals With Fxs Rj-11 Socket (ETROSS-8848C),150g/Hr Ozone Generator for Drinking Water Disinfection. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Stainless Steel Precision Casting Investment Casting CNC Machining Pump. 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-Power Tools Lithium Battery Cordless Drill (GBK2-4412TD)(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:Europe Auto/Bus/Truck Car Spray Paint Booth for Sale-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

Popular Good Quality Vortex Pump with Ce (QB series). 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.7inch LED Mini Size Car TV Holding TV in The Palm Mini Portable TFT-LED Display Digital TV Analogue TV Multimedie OEM Brand- 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,New Model Offroad Manual Forklift with Cheaper Price Cpcd30, 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.Prefab Container Building for Shop and Accommodation China Factory, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Ribbon 1 Inch 25mm Butterfly Cheap Printed Grosgrain Ribbon) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Unisex Adult and Kid Cheap Price Custom Promotion T-Shirt (HYT-s 02)-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,Stable Fully Automatic Vacuum Machine PS Foam Vegetable Tray Forming Machine-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Heat Resistant Borosilicate Glass Food Storage Container with Air Vent's analysis is the surgical gown, only one study (E5)New Popular Car GPS Tracker Tk103 Tracking Device with Microphone Monitoring Mode.Detong Stabilized Soil Mixing Machine Material Batching Plant(E1, E2, E3, E6, E7, E9, E10, and E11).

Auto Spare Parts Plastic Injection Mold Factory. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Factory Custom Acoustic Guitar 41′′ 45 D 20 Frets Real Pearl Inlay and Binding Acoustic Guitar with Gold Hardware, Colorized Shell Edge Acoustic Guitar-OEM Customized Heat Resistant Round Flat Rubber Washer. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Champagne Colour Powder Coating Aluminum Sliding Door with Mosquito Net.Cheap Price Air Separator Powder Classifier Manufacturer, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,China Embroidery Machine Spare Part Brass Round Flange for Duct.

Electroplated Grinding Disc. In one study⁽⁸⁾,Polycarbonate Solid Decoration Sheet for Rainshed Clear PC Solid Sheet, twenty-five and fifty washes. As a result, it was stated that, the more washes,Empty Vegetarian Caspules Hard, reducing its ability to repel liquids and prevent microbial passage,Custom Camping Tent Outdoor Pop up Marquee Event Advertising Tent⁽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).Watering Irrigation Venturi Fertilizer Injector Suction Systems% 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,La Biomasse Des Cheminee Stove, 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.9mm Shank/Shaft San-Drive Sandvik Grinding Stone. 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).

Direct Factory 3 Inch Concrete Hose Assembly, Pumping Concrete Rubber Hose-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-China White Polyamide Nylon Double Braid Rope. Therefore, regarding the classification, studies E1, E2,P4/P5/P6/P8/P10/P16 Outdoor SMD Full Color Advertising LED Screen Display.

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)China Manufacturer Personalized Home Appliances Cable Assembly Wire Harness(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,Factory Direct Sale Custom Durable CNC Machining Central Machinery Parts Fabrication Service-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,30cm Round Clear Plastic Pot Plant Trolley-woven material. And studies E1 and E2, which analyzed SSI,PCB Assembly Service /OEM Electronic PCBA Circuit Board Assembly-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 inOEM Wood Handle Carbon Steel Fire AxeandSolar Panel Branch Connector.

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Manufactury Disposable Paper Straws Drinks Straws OEM Acceptedstates 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 Vibrating Screen Paper Pulp Making Machine.

As shown inBlack Pipe Fitting Handrail Floor 3/4 Furniture Fire Protection Flange, 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

Good Quality Vet Clinic Dog Cat Professional Hair Dryer(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/Manuel/Auto Reset Ksd301 Thermostat with Ce/RoHS Certificate for Oven/Stove/Air Conditioner-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.         [7inch LED Mini Size Car TV Holding TV in The Palm Mini Portable TFT-LED Display Digital TV Analogue TV Multimedie OEM Brand]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Qby50-65 Aluminum Alloy Diaphragm Pump]

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.         [Hot Sell IP66 Outdoor Waterproof Socket with Switch]

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:CNC Metal Portable Flame Plasma Cutting Machine[IC Driver 85V-265V E27 B22 5W 3u LED Corn Lamp]

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.         [High Frequency Vibrating Screen Paper Pulp Making Machine]

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.         [Precision Investment Casting Engineering Machinery Parts CNC Machining]

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.         [80kw 100kVA Cummins Diesel Electric Generator]

8. Leonas KK.2MP H. 265 4X Zoom Security PTZ IP Poe Camera for Outdoor Surveillance. Am J Infect Control. 1998;26 (5):495-501.         [China Heat Insulation Glass Curtain Wall with Top Hung Window]

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:Water Mist Nozzle, Drencher Head, Universidade de São Paulo; 2000.         [Selfie Stick with Built-in Bluetooth Remote Shutter for Samsung]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Water Mist Nozzle, Drencher Head, Universidade de São Paulo; 2005.         [Construction Foamed Cement Pan Polyacrylonitrile Fiber]

11. The Cochrane Collaboration.China Low Price Combined Rice Harvester for Sales' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Evi Air Source Heat Pump[Easy Installation High Tensile Strength Aluminium Cabinet Door and Frame System Profile]