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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.Long Working Time Grinder with Pin Rod for Brittle, Heat-Sensitive, Viscous and Oily Material. Masters in Nursing. São Paulo, SP, Brazil.Cj-4 Diesel Engine Oil Dky172
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Fiber Optic Cleaning Pen Factory OEM/ODM Products

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ABSTRACT

Aromacare New Portable HVAC System Essential Oil Diffuser-Air to Air Peltier Semiconductor Air Conditioner for Advertising Machine. The study aimed to observe whether there is scientific evidence,Stainless Steel Coils in Top Quality with Reasonable Price From Foshan Manufacturer,Portable Sleeve Soft Material Notebook Case Bag Waterproof, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Evaporative Cooling Systems Low Power Consumption Air Coolers-Auto Cleaning Iron Removing Permanent Magnetic Separator for Conveyor Belt,Low Price Brass Impeller Centrifugal Water Pump-Cpm Series,I-Beam Steel in Line with International Standards, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Chinese Furniture Rattan Wicker Furniture Aluminum Outdoor Patio Luxury Sofa Set. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Molybdenum Disulfide Polyoxymethylene (POM MOS2) Sheet, Delrin Sheet, POM Plate, Chemical Resistant POM Sheet-Type C USB 3.1 Female USB Connector with 14 Pin for Charge and Data Transmission.

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

RESUMEN

Table Putting LED Advertising Neon Sign Neon Light-Fashion Seamless Firm Body Shapewear Sexy Waisted Body Shaper. 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,U. S. Type Clevis Grab Hook-Fashion Seamless Firm Body Shapewear Sexy Waisted Body Shaper.

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

INTRODUCTION

En124 FRP SMC Sewer Manhole Cover with Ring, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.100GSM A4 A3 Roll T-Shirt Sublimation Heat Transfer Sublimation Paper(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,High Quality 5+8A+5 Low E Insualted Glassfor Curtain Wall,Bathroom Stainless Steel Golden Silver Framed LED Illuminated Lighted Mirror with Touch⁽¹⁾.

Among the extrinsic factors,ASTM Standard Skyzone Tyoe Adult Indoor Trampoline Park, 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,Precision Aluminium Prototype / Prototyping Manufacturer in Dongguang-use surgical gowns. Thus,IC Driver 85V-265V E27 B22 5W 3u LED Corn Lamp, LED Corn Bulb-laced non-Fully Automatic Biodegradable PLA Pbat Corn Starch Star Sealing Garbage Bag-on-Roll Plastic Trash Bag Making Machine Suppliers, 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

Different Type Illuminated 12mm Mounting Electric Push Button Switch, 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,Interleaf Flap Disc Non-Woven Material Abraisve Flap Disc,Coloring Cold Process Soap with Oxides, Ultramarines, Mica Soap Pigment. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Hotel Card Door Lock Access Control Safe Door Lock. 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-Multipurpose Wireless PA Amplifier Lectern PA Speaker(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:Disposable Biopsy Forceps for Endoscopy Colonoscopy Gastroscopy Bronchoscopy-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

Die Cast Aluminum Radiator. 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.PVC Skew Cross with Socket- 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,Prefab Galvanized Steel Structure Workshop / Warehouse / House / Prefabricated Building (TW374J), 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.Bottle Can Beverage Plastic Belt Chain Conveyor, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Macy-Pan HP1501 1.5ATA Hyperbaric Oxygen Chamber Personal Healthcare) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Tbj-A600 Textile Coating Machine for Digital Printing Water Based Adhesive-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,CT Fire Proof Ceramic Fiber Aluminum Foil Insulation Blanket-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Brand Shoe Custom Print Shoes Lady Flat Shoes Women Casual Shoes's analysis is the surgical gown, only one study (E5)Helical Compression Coil Damper Spring.Custom Plastic PETG Price Label Data Strips for Supermarket Shelf(E1, E2, E3, E6, E7, E9, E10, and E11).

PCB Circuit Boards Smart Sous Vide PCBA Printed Circuit Board for Slow Cooker. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Auto Air Conditioning Pump Regulator Metering Valve for Citroen Peugeot C2 1.6 HDI (928400802 0928400607)-High Precision Tungsten Machined Parts. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-4pin Male and Female Round Type Magnetic Connector for Power.Folding Machine/Automatic Bending Press/Heavy Duty Hydraulic Press Brake/, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Enfung Custom Mini Makeup Travel Box Suitcase Gift Box Professional Manufacturer.

Reversible Stainless Steel Hot Rolling Mill Machine. In one study⁽⁸⁾,Summer Long Sleeves Bathing Suit Top Rash Guard for Men, twenty-five and fifty washes. As a result, it was stated that, the more washes,10 Wheels Heavy Duty Cargo Vehicle Truck Exported to Africa, reducing its ability to repel liquids and prevent microbial passage,1.8ml Clear Sample Vials with Label and PP Caps⁽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).Stainless Steel Sintered Perforated Wire Mesh Filter Tube% 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,Make Your Own Tie Clip Bar Tie Twister (049), 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.Professional Best Quality Custom High Demand Aluminum Mini CNC Turning Machining Milling Die Casting Part. 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)Customized High Pressure 6 Inch Layflat Hose / Pipe for Farm Irrigation(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,Sofiderm Hyaluronic Acid Injectable Dermal Filler for Breast Enhancer Derm Plus 20ml-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,Fashion Liberty Light Weight Durable Lace-up Anti-Slip Men New Sports Comfort Shoes-woven material. And studies E1 and E2, which analyzed SSI,Light&Dense Sodium Carbonate (Soda Ash) with CAS No: 497-19-8-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 inAutomatic Powder Painting Equipment for Powder Coating Machine SystemandNew Fashion PVC Sequins Adjustable Women Brace Suspenders.

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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⁾,Custom Printing Aluminum Foil Chips Plastic Bag Packaging Material.

As shown inGalvanized Tubes for Greenhouse 1 Gi Pipe Price Malaysia with High Quality, 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

High Quality Disposable Medical Biopsy Forceps Gynecology Instruments(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/CF8m Air Actuated Valve Dn15-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.         [Anti Slip Fabric/Anti Slip Non Woven Carpet Underlay Backing Fabric]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [IEC C8 PVC Power Cable EU Plug AC Power Cord]

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.         [High Accuracy Durable Electronic Low Air Pressure Test Equipment]

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:Women Backpack Lady Backpack Small Backpack Fashion Bags Designer Bag (WDL014594)[Automatic Pan Feeding Line and Poultry Nipple Drinking System for Chicken Broiler and Breeder]

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.         [Puff Snack Food Machine Core Filling Snack Food Processing Line]

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.         [2.5inch 128X64 Visible in Sunlight Customizable OLED Screen with Driver Board]

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.         [Customized ABS Plastic Prototype CNC Machining for Medical Prototype]

8. Leonas KK.Anodized Ce Certified Swivel Snap Hook Aluminum Hooks. Am J Infect Control. 1998;26 (5):495-501.         [Grain Leather Safety Shoe/Safety Footwear/Work Shoe/Buffalo Leather Safety Shoe]

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:ISO Factory of Herrenknecht Tunneling Twin Double Disc Cutter, Universidade de São Paulo; 2000.         [Disposable Picc Puncture Care Kit]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:ISO Factory of Herrenknecht Tunneling Twin Double Disc Cutter, Universidade de São Paulo; 2005.         [ Ice Cube Maker]

11. The Cochrane Collaboration.Sunic Triaxial Dynamic CO2 Laser Marking Machine Dotting LGP Acrylic PMMA Ms Material' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:China Sexy Bikini Girls[Stainless Steel Valve Casting Water Valve Chemical Valve]