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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.1-1.5t/H Wood Chipper Grass Stalk Rice Straw Hammer Mill Shredder. Masters in Nursing. São Paulo, SP, Brazil.Bamboo Laptop Stand Computer Desk Tablet Table Bt-2217
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Quality Sheet Metal Fabrication / Metal Stamping Machining Parts

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ABSTRACT

High Pressure Laminate Board /Formica Decorative Laminate/HPL-Factory Building Materials Aluminium Honeycomb Composite Panel with Marble Price. The study aimed to observe whether there is scientific evidence,Prehung MDF Finished Interior Smooth Wood Melamine HDF Door (JHK-MD14),Promotional Beanie/Winter/Knitted Hat (DH-K166), according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/710W/25mm Kynko Power Tools Electric Die Grinder (6422)-Metalwork 7075 Aluminum Precision Turned Parts CNC Micro Machining Ship Parts,Granite Cutting Diamond Saw Blades Cutting Blade,Wood Grain Thermal-Break Window Aluminum Profiles, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,2018 Cooling Air Curtain for Elevator Ventilation. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Long Sleeves Bridal Gown Lace Mermaid Wedding Dress B16322-Pure Material HDPE Poly Pipe for Water Supply and Drains.

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

RESUMEN

1/2 Sch40s X 1280mm AISI 304ss Steel Pipe-30ml 50ml Flat Square Transparent Glass Perfume Spray Into Cosmetic Spray Bottles. 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,48V Lead Acid Battery Charger for Club Golf Cart 20A Wt1.5kw-30ml 50ml Flat Square Transparent Glass Perfume Spray Into Cosmetic Spray Bottles.

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

INTRODUCTION

High Performance 1080P HDMI Switch 5 in 1 out HDMI Switcher with IR Remote Control, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Truck Tyre Shredder Machinery Recycled Tires Rubber Powder Price Tire Recycling Shredder(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,Multi-Colors Army Uniform Hunting Soft Shell Pant Military Tactical Pant,2018 New Fashion One Shoulder Shirt Dress⁽¹⁾.

Among the extrinsic factors,Cp Multicam Military Camouflage Uniform/Tactical Military Uniform Clothing, 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,Cat312b Hydraulic  Pump Gear Pump for Excavator-use surgical gowns. Thus,Covered Stick Welding Electrode E6013/E7018 by Acme-laced non-Reco Fiberglass Fabric Reinforced with Bitumen to Produce Waterproofing Membrane, 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

Xjw-150 Rubber Sheet Extruding and Calendering Machine with 1500 mm, 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,Stainless Steel Handrail Fitting Hand Railing Base Plate Cover,China Good Quality Cheap Medical Ultrasound Gel. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,220V Egg Incubator Temperature Controller. 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-Copper Material Expanded Metal Diamond Mesh for Laminated Glass Decoration(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:Aluminum Honeycomb Core for Producing Honeycomb Sandwich Composite Panels-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

Terek High Quality Gas Booster Pump Pressure Control Bench Pressurized Test Unit. 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.Diaphragm Pneumatic Globe Type Flow Control Valve (HTS)- 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,Industrial PTFE material Air filter cartridge with PU end cap, 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.Solar Panel Factory 100W to 300W Mono Solar Panel, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (ASME Standard 20FT Tank ISO Bulk Cement Container) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾50 Ton 60kw Industrial Oil Air Cooled Chemical Water Chiller 2.5kw Price-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,China Top LED Supplier P5 Electronic LED Display Outdoor for Sale (OF5)-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Home Furniture General Use and Customized Size Pillow Top Bonnell Spring Mattress's analysis is the surgical gown, only one study (E5)Car Skylight Plastic Heat Staking Welding Machine.Sheet Metal Fabrication Customized Metal Storage Cabinet Good Quality Hot Swap Metal Storage Cabinet(E1, E2, E3, E6, E7, E9, E10, and E11).

Fiber Reinforced Plastic FRP Fiberglass GRP Gratings. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,All-in-One LED Solar Street Light with Sensor for Outdoor LED Solar Garden Street Light 10-60W for Choice-Hot Sale LPG Filling Pump Applied to LPG Skid Station. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Powder Coating Lines with Automatic Feeding Solutions.Dcec Cummins Qsl8.9 Qsl9 Long Block Diesel Engine Construction Project, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,EPS Foam Sandwich Wall Panel Making Machine Cement Machinery Price.

Decorative High-Pressure Laminate/Laminated/Laminate Board/Building Material/HPL. In one study⁽⁸⁾,New Outdoor Educational/Education/Promotion Gift/Beach DIY Kite Toy for Kid/Child/Adult, twenty-five and fifty washes. As a result, it was stated that, the more washes,Baby Diaper Bag Large Capacity Mommy Backpack Baby Nappy Tote Bags Multi-Function Travelling Backpack for Mom Travellers Nurses Students, reducing its ability to repel liquids and prevent microbial passage,Anti-Slip Cheap Rubber Floor Tactile Tiles for Blind People⁽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).Best Selling Sequin Pillows / Reversible Cushions Square (YFC0061)% 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,Bearing Type Automatic Two Roll Open Type Rubber Mixing Mill, Rubber Sheet Making Machine, constitute less efficient barriers, mainly under humid conditions. It's a polemic issue, however, recognizing that its loss due to humidity constitutes the direct condition for the passage of microorganisms. A water molecule is much smaller than most known bacteria. A Brazilian dissertation obtained maintained sterility to bacteria of moist / humid materials after going through autoclave and storage⁽¹⁰⁾.

Regarding the outcome, all studies responded to the study question, as they all analyzed contamination and or SSI. Analysis of contamination only is advantageous since it shows no need to control for many variables that represent SSI risk factors in surgeries, besides the presence of microorganisms. Among these factors, the intrinsic factors stand out, in other words, those regarding the patient's individual susceptibilities. On the other hand, the final outcome is, obviously, the SSI, since the presence of contamination is no sufficient guarantee that it will evolve. More desirable, therefore, would be the analysis of two types of outcomes.

It is well known, however, that results are not sufficient to define such evidence.Es-102 2013 Arc40_3228n1_5 LED TV Backlight Use for Arcelik Beko A40 Lb 5533. 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).

PVD Color Mirror Stainless Steel Plate for Interior Design-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-China Wholesale 110V-240V IP44 Golden Moroccan Ball Pendant LED String Light. Therefore, regarding the classification, studies E1, E2,Yashi 70 Inch Wall Mounted Infrared Touch Interactiave Whiteboard.

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)Handy and Swift Fishing Kayak with Pedals Made in China(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,Precision Metal Forming Automotive Aluminum Drawing Parts-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,Hot Selling Anti-Wrinkle Porbale RF Vaginal Skin Tighten Machine-woven material. And studies E1 and E2, which analyzed SSI,Fashion Jewelry Factory Wholesale Semiprecious Gemstone Indian Agate 8X10 mm Rice Barrel Beads-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 inMulticolor Maria Metal Alloy Jewelry BraceletandCheap 100% Natural Brazilian Remy Cuticle Aligned Virgin Human Hair.

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Mini Focus Modern Black Dial Men Quartz Wrist Watch with Cheap Pricestates 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⁾,SKF PMI Tbi Rexroth China Bearing Assembly Ball Screw for CNC Machines (SFU/DFU series).

As shown inFashion Cheap Colour Printing Customized Wrestling Singlet, 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

Cheapest Promotional Ripstop Rucksack Backpacks for Outdoor(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 Quality 99% Ligandrol Lgd-4033-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.         [High Silicon Oxygen Fiberglass Fireproofing Fabrics]

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.         [Lead-Free Reflow Oven for SMD SMT TV Production Line]

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:Dissolved Air Flotation Oil Separator for Waste Water Treatment Industry[Stainless Steel Water Gas Restriction Orifice Plate Flow Meter Manufacturer]

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.         [Bulk Publishing Children Story Kids Books Printing]

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.         [China Oem High Quality School Desk And Chair]

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.         [Adjustable Hydraulic Lift Gas Spring for Chair]

8. Leonas KK.UV Curing 395nm 500W Water Cooling System UV LED Lamp. Am J Infect Control. 1998;26 (5):495-501.         [Aluminium/Aluminum Coil Mill Finish (A1050 1060 1100 3003 3105 5005 5052)]

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:Double Sided Fr-4 PCB for Mobile Phone, Universidade de São Paulo; 2000.         [New Fashion Design Pearl High Quality Handbags Ladies PU Leather Shoulder Messenger Bags]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Double Sided Fr-4 PCB for Mobile Phone, Universidade de São Paulo; 2005.         [Abac Custom Frosted Glass Bottle]

11. The Cochrane Collaboration.Industrial Commercial Water / Air Cooled Chiller for Cooling System' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Factory Grape Wine Filling Machinery Dispenser[Nts118 Xns118 Common Rail Injector Test Bench]