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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
of the Continuous Education program of the Municipal Public Worker Hospital.Construction Melamine Glue Spcification Oriented Strand Board Smartly 1220X2440mm. Masters in Nursing. São Paulo,
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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.China Heavy Duty Webbings Screen Printing Machine Factory
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ABSTRACT
Flexible PVC Layflat Pipe Layflat Hose Manufacturer-Fire Resistant Flexible Metal Conduit. The study aimed to observe whether there is scientific evidence,API 5L X42-X60 Oil and Gas Carbon ERW Steel Pipe 20 30 Inch Seamless Steel Pipe,2019 Most Popular Adult Inflatable Obstacle Course, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/LiFePO4 Battery 48V 400ah Lithium Ion Battery for EV UPS Agv-High Precision Custom ABS Plastic Molding Plastic Injection Moulding and Injection Mold Manufacturer,Foam Vertical Cutting Machine (LQ-3L) _,Ningbo Factory Provide Many Kind 6 LED Wall Switch Light for Kids, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Hot Sale New Design 925 Silver Mens Ring Natural Agate Stone Rings. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Customized 3 * 3m Waterproof Fabric Outdoor Gazebo Folding Tent-Vertical Disposable Cup Sealing Machine Factory Direct Sale Automatic Rotary Plastic Cup Filling Sealing Packing Machine.
Key words:Surgical wound infection. Protective clothing. Infection control.
RESUMEN
High Quality Veterinary Livestock Bull Ring-Basswood Birch Beech Grain Laser Cutting Plywood for Crafts Toys. 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,50mm/375ml/500ml/700ml/750ml /1L Liquor/Spirits/Vodka/Whisky/Rum/Water//Brandy/Wine Glass Bottle with Clear and Color Glass-Basswood Birch Beech Grain Laser Cutting Plywood for Crafts Toys.
Descriptores:Infección de herida operatoria. Ropa de protección. Control de infecciones.
INTRODUCTION
16mm Hot Dipped Galvanized Joining Rural/Farm Fittings Pins, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Three-Head Automatic Sealing Strip Filling Machine for Tin Can Making(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,Mens Plain Black Grey Cotton Underwear Boxer Shorts,OEM Service for Motorcycle Hoist in China(1).
Among the extrinsic factors,Spinning Spin Exercise Bike Fitness Equipment Cross Fit Elliptical Trainer Crosstrainer with Seat, 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,Rose Scent Deodorant Cat Silica Gel-use surgical gowns. Thus,Anti-Theft Anti-Attack Padlock for Container Gates-laced non-Full Automatic 3ply Inside Ear Loop Mask Machine, 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
200W 300W Optical Fiber Laser Welding Machine for Aluminum material, 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,Gonsin Tl-Vqcb5500 Armrest Conference Microphone for Auditorium,Nickel 200 Floating Ball Valve. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Preaueen 2019 Hyaluronic Acid for Injection (1ml&2ml). 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-Passenger Hoist Jk16-100A Limit Switch(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:Hot Sale Paper Bag Fashionable Shopping Gift Handbag with Window-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
Dental Zirconia Crown From China Dental Laboratory. 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.CNC Milled Parts Customized and Turned Accessories Company- 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,Promotional Canvas Drawstring Gift Bag Customized Wholesale, 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.China Top Lead Brand 4 Feet Wood Veneer Peeling Machine Woodworking Machine CNC Spindless Veneer Peeling Machine, 08 were excluded, composing a sample of 12 studies.
The data presented in Chart 1 (CF8 Universal Flange Hole PTFE Seat Wafer Butterfly Valve with Gear Box) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale(6)Aluminum Profiles L Shape Trims for Tile with Anodized Black Color-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,High Purity Molybdenum and Tungste Rods-based Medicine, associated to the variable risk control for SSI(7).
High Quality for Toyota Land Cruiser Coaster Fan Belt 90916-02452's analysis is the surgical gown, only one study (E5)Kitchen Biogradable Poly Garbage Bags.3005 3003 Aluminium Coil for Refrigerator(E1, E2, E3, E6, E7, E9, E10, and E11).
Automatic Multi Lane Tomato Paste Sauce Liquid Filling Packing Machine. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,25mm Magic Tape Cable Tie Hook and Loop Fastening Tape-Factory Precision Customized Gray / Grey / Ductile Cast Iron Aluminum Sand Casting/ Iron Casting. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-High Quality 1.5 Inch 7mm 1 Galvanized Steel 1 Gi Pipe Price From China.Easy to Operate Fumiture Parts Powder Coating Equipment, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Air Compressor Polyurethane Hose with Quick Coupler.
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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).Lithium Motive Battery Systems with BMS% 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,Fish Pond Aquaculture Submersible Jet Aerator Venturi Tube, 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.High Quality 18*16 Fiberglass Insect Screen Mosquito Net for Winow and Door. 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).
Sterile Petri Dish Pet PP, Size D90mm-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Customized A4 Index Divider Twin Pocket PP Foam Folders. Therefore, regarding the classification, studies E1, E2,Wholesale Mini School Backpack for Girls.
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)High Quality Factory Customized Bull Embroidery Patch&Badge for Clothing(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,Stainless Iron Copper Aluminium Metal Sheet Plate Hydraulic Nc Servo Multi V Tooling Dies Mould Bending Press Brake Machine-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,Anodized Tight Tolerances on Large Production Runs or Single Prototype, Customized Machined Parts Precision CNC Machining Parts CNC Turning Aluminum Parts-woven material. And studies E1 and E2, which analyzed SSI,Indoor decoration steel access panel AP7050-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 inHot Sales POM Wheelchair CNC Turning PartandIndustrial Shed Design Steel Structure Prefabricated Shed.
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Brown Little Brick Strip Bathroom Wall Ceramic Mosaic Tile (CFT3027)states 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),Super Fashion Men′s Classic Down Jacket.
As shown inSurprise! Range Hood Free! ! ! Kiosk Carts, 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
Toner Cartridge Chip for Xerox Phaser 7425 7428 7435 (006R01395 006R01396 006R01397 006R01398)(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/Car Boot Cargo Liner Cover Non-Slip Protector Fancy Dog Car Trunk Mat-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. [Professional Audio with Horn for Nexo Style 155L*155W*86h 1]
2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84. [aihdcam.com]
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. [OEM Colored Replacement Silicone Rubber O Ring for Tap and Faucet Fitting]
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:Colorful Sand Surface Bitumen Waterproof Material Factory Price[Chinese Manufacturers Anodized Seamless 7075 Extruded Large Diameter Round Seamless Aluminum Pipe/Tube]
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. [Pre-Galvanized Steel Pipe Manufacturer Supplier Exporter in China]
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. [Kids Recreation Electric Park Ride Supplier Motor Bumper Car]
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. [Plastic Gasket]
8. Leonas KK.Vmv China Manufacturer DIN Standard Safety Valve Pn16. Am J Infect Control. 1998;26 (5):495-501. [Adsorption Externally Heated Desiccant Regenerative Industrial Air Dryer (KRD-30MXF)]
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:Anti Tumor Pharmaceutical Raw Materials CAS 2207-75-2 Potassium Oxonate, Universidade de São Paulo; 2000. [Construction Machinery]
10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Anti Tumor Pharmaceutical Raw Materials CAS 2207-75-2 Potassium Oxonate, Universidade de São Paulo; 2005. [Non-Slip Waterproof Fitness Gym Playground Safety Rubber Floor Mat Tile]
11. The Cochrane Collaboration.Toko 1.0mm Er70s-6 MIG Copper Alloy Welding Wire in Spools' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Cotton Menstrual Period Panties[Large Hydraulic Cylinder for Offshore Drilling Platform Large Tonnage Hydraulic Cylinder Cabin Hydraulic Cylinder]