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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

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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.www.jxmelamine.com

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ABSTRACT

The Factory Provides High Luminescent Glass for Party Glasses Masks to Display Decorative Luminescent Masks-Dental Supply Turbine Handpiece Multi Fution Digital Manometer Air Pressure. The study aimed to observe whether there is scientific evidence,LED Light Dance Costumes Halloween Shows Luminous Prop Dancing Supplies,Schuko Plug Adapter with RoHS Certification Schuko Plug Insert, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Headphone I7 I7s Tws Mini Wireless Bluetooth 5 0 Earphone in-Ear Stereo Earbud Headset Mic Binaural Call for All Bluetooth Phone-IP67 High Power 200 Watt All in One Integrated Solar Outdoor Lighting LED Solar Street Light,Farm & Industry Used Storage Grain Silo,Male Plug Crimp Straight SMA Type Connector for Rg316 Cable, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Plastic Spin Mop Bucket Mold Mop Bucket Mould. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Sterile Filter Pipette Tip in Box Packing 1000UL-Rd 06 on-Stock PVDF Diaphragm Pump.

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

RESUMEN

Rubber Strips Rubber Pads Rubber Belt for Car Luggage Home Appliances-Sounda Printable Vinyl/Car Wrap Vinyl. 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,Classical Furniture PU Foaming Machine/High Pressure PU Machine/PU Dispensing Machine-Sounda Printable Vinyl/Car Wrap Vinyl.

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

INTRODUCTION

4WD 2.0ton Mini Site Dumper, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Mini Dual-Use Portable Infrared Rifle Scope Hunting Night Vision Monocular Thermal Imaging Sight Camera with Multipleadapter Rings(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,Fashion Jewelry 925 Sterling Silver Diamond Jewellery Luxury Ring for Engagement,Worldwild Top 10 Hot Sell Home Dhw 60c 220V 5kw, 7kw, 9kw Super Cop5.32 Save 80% Energy Solar Water Heater with Heat Pump Tankless⁽¹⁾.

Among the extrinsic factors,Tempered Glass for Oven Door, 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,LED Explosion Proof Flashlight Waterproof Portable Searchlight-use surgical gowns. Thus,Packaging Film Usage and POF Material Shrink Film Wrapping Thermal Heating Tunnel-laced non-1500*3000mm 3kw Laser Cutting Machine for Metal Sheet and Metal Tube, 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

Hot Selling Different Thickness Sgch Grade 0.2mm PPGI Galvanized Corrugated Roofing Sheet Workshop, 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,Rectangular Office Wire Box Desktop ABS Plastic Warm White (HC-XH001),Oil Well Screen Tube Machine. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Universal 7010 Multimedia Android System Car Radio 2DIN 7 Inch Touch Screen Bluetooth WiFi MP5 Music Car MP3 MP4 MP5 Car Player. 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-Mattress 3D Border Zipper Stitching Quilting Machine(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:Floor Warning Masking Tape-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

100% Natural Capillary Wormwood Herb Extract. 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.Children Adults Jump Indoor Commercial Trampoline with Park- 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,Electromagnetic Lifter for Steel Scrap, 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.Ceramill Dental Zirconia for Tooth Carving Compatible with Amann Girrbach, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Top Quality Acid Etched Glass for Decoration) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Omron Relay G6ku-2f-Y-Tr DC5 Relay Module G6K-2f-Y 3VDC G6K-2f-Y-Tr-5VDC G6K-2p-DC12 G6ku-2f-Y 12VDC 24VDC in Stock-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,Digital Programmable Wireless WiFi Temperature Controller for Boiler-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

10mm 20mm Width High Strength Stainless Steel Universal Band's analysis is the surgical gown, only one study (E5)Induction Heating Elbow Making Machine with Good Quality.Custom Laser Cutting Parts(E1, E2, E3, E6, E7, E9, E10, and E11).

Pneumatic Jack Hammer Drill Machine Used in Quarry Mining. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Pig Farm Cast Iron Pig Leakage Dung Floor-Factory Price Best Seller Sublimation Luggage Strap. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-2mm-6mm Silver Mirror for Bathroom with Polished Beveled Edge.5kw Home Stand Alone off Grid Solar Power System, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Dish Plate Dryer and Sterilizer 60liter Using UV and Ozone.

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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).Plastic Grid for Road Construction 2020 3030 4040 5050 Bx1100 Bx1200% 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,Stunning 6-7cm Real Touch Flowers for Wedding Home Decor (Not Silk Flowers), 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.Supply Cosmetic Raw Material Sodium Ascorbyl Phosphate / Sap CAS 66170-10-3. 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).

ASTM A213 Cooling Tower Pipe/Heat Exchanger Tube/TP304L-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-PVC Banner Lona / Grey Back PVC Lona / Blockout Banner Flex 440g. Therefore, regarding the classification, studies E1, E2,Cookware Aluminum Circle.

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)Cheap Mini Rechargeable Battery Hand USB Fan N9 Portable Fan DC5V for Students(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,Hydraulic Hose SAE 100 R1AT-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,Professional Disco Lighting 8*12W 4in1 LED Moving Spider Beam-woven material. And studies E1 and E2, which analyzed SSI,Fog Cannon Dust Suppression System-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 in Lighting TrussandWholesale Winter Waterproof USB Battery Heated Vest.

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P0810 Programmable Bus LED Moving Message Sign (front/rear window)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⁾,High Quality High Temperature Powder Coating Oven, Drying Equipment.

As shown inDanfoss / Copeland Scroll Compressor Commercial Ducted Split Air Conditioner, 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

Origin Software Free Download Bioplasm Vector Nls Aura Original Health Scanner(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/Top Supplier Lithium 12V 24V 36V 48V Li Ion Battery for Energy Storage System-woven. Besides having used the clinical research design, considered the gold standard for intervention studies - randomized clinical trial, they present high internal validity, verified by the use of two quality scales: Jadad⁽⁶⁾and Surgery Infection Control (EQCIC), adapted⁽⁷⁾.

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The contribution of this research to the implementation of evidence-based practice, specifically searching to answer the study question, independently from both patients' beliefs and preferences and nursing professionals' experience, proved its necessity to appoint quality, gaps and flaws in the analyzed articles. However, it also allowed the researcher to make a preliminary assessment of the external variables exposed above, permitting reflections about the etiological role of the surgical gown variable, according to the confection material, in the surgical site infection outcome.

REFERENCES

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2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Customize Your Products Faster Various Colors Jeans Buttons and Rivets]

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.         [5mm Thick Heat Resistant Paper 1260 Ceramic Fiber Paper]

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:3 PC SS304 Air Actuator Ball Valve[Acrilic Sheet Acrylic Panel]

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.         [AC Single Phase Home Use 0-100A Voltage Current Power Digital Electric Kwh Energy Meter]

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.         [Ater Stainless Steel Fire Extinguisher]

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.         [Southeast Asia Healthy Soft Integrated Latex Foam Mattress]

8. Leonas KK.PVC Coated Cardboard Lever Arch File Folder. Am J Infect Control. 1998;26 (5):495-501.         [EPS Foam Sandwich Wall Panel Making Machine Cement Machinery Price]

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:Quality Assured Magnetic Building Blocks for Children, Universidade de São Paulo; 2000.         [Samsung 40inch 5LED Universal TV Backlight Strips]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Quality Assured Magnetic Building Blocks for Children, Universidade de São Paulo; 2005.         [3A Ce Pharmacy Clamped Diaphragm Valve with Plastic Handwheel]

11. The Cochrane Collaboration.Kraft Paper Charcoal Packing Bag' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Luxury Silver Wedding Sterling 925 Ring for Set[High Quality Water Resistant Neoprene Portable Children′s Lunch Bag Box Baby Bottle Cooler Bags with Red Color for Mother]