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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.Superthin Continuous Rim Saw Blade for Ceramic Tile Sawing. Masters in Nursing. São Paulo, SP, Brazil.Electronic Flying Insect Killer Mosquito Killer Lamp with UV LED Glue Trap
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Brightness 4W COB LED Jewellery Cabinet Lamp LC7355s

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ABSTRACT

Hot Sale CAS 84380-01-8 Skin Whitening Arbutin Alpha Arbutin High Quality Alpha Arbutin-Johnson Pipe / V Wire Wrap Screen Tube / Wedge Wire Screen. The study aimed to observe whether there is scientific evidence,2019 High Quality Outdoor Double Person Cotton Camping Hammock,Wholesale Wax Dry Herb Tank Container Glass Jar Cbd Thc Tin Can, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Steel Price Arch Pipes Galvanized Steel Pipe Greenhouse Structure Pipe-Makute Electric Blower 600W with Mini Air Fan,Disposable Biopsy Forceps for Endoscopy Colonoscopy Gastroscopy Bronchoscopy,Medical Diagnostic Test Kits HCG Pregnancy Rapid Test Kit, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Silicon Carbide Vinyl Flooring for Transportation Decoration -2.0mm Mj-By2516. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Ningbo Smart High Quality Pll-G Plastic Pneumatic One Touch Fittings-Aluminum/Aluminium Extrusion Alloy Anodized Radiator.

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

RESUMEN

Cheap Electric Bike/Scooter Tyre 3.50-10-Good Price 22.5X8.25 22.5X9.00 Tyre, Demountable Wheel, Demountable Rim. 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,Ce Certification! RF Remote Control Duplicator Garage Door Opener Kl190b-4k-Good Price 22.5X8.25 22.5X9.00 Tyre, Demountable Wheel, Demountable Rim.

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

INTRODUCTION

Bamboo Flip Lid/Cap Bamboo Lotion and Spray Pump, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Custom High Quality Fashion Women Sunglasses with Logo Printing(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,Milling Turning Service CNC Machining Aluminum Parts,2019 Hot Selling Custom Emblem Embroidery Applique Lace Fabric Embroidered Patches (YB-SE-32)⁽¹⁾.

Among the extrinsic factors,Outdoor Indoor Branch Distributor Aluminum Die Casting Housing (XD-A02), 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,Al 6063 6061 7075 Aluminium Metal CNC Machining Part-use surgical gowns. Thus,Straight Dried Instant Chinese Flavor Egg Noodle-laced non-PVC Heat Shrink Sleeve Label for Bottles/Cans, 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

Aluminium Double Head Auto Feeding Any Angle Cutting Machine, 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,Fire Resistant Fiberglass Mosquito Window Screen Mesh,Disposable Foam Plate PS Polystyrene Plastic Food Container Making Machine. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Custom Sheet Metal/Bending Fabrication Service, Stamping Hardware Parts Factory. 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-Berndorf Style Water Cooled Cooling Belt for Powder Paint Cooling and Flaking(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:CNC Stainless Steel Aluminium Sheet Metal Fiber Laser Cutting Machine Price-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

Sinotruk HOWO 6X4 Heavy Duty Tractor Truck 336HP Trailer Head for Sale. 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.Fashion Trolley Bags Case Travel Luggage Bag Suitcase- 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,Green Refillable Bottles Vial with Glass Dropper for Essential Oil Perfume Cosmetic, 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.LED Pixel Beam Bar 7*15W 4in1 LED Moving Head Lighting, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Aluminium Profile/Shell/Housing for T5/T8 LED Tube Light (SQ-H0077)) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Circle-Shaped 316L Stainless Steel Earrings-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,Kraft Paper Laminated Aluminum Foil Food Packaging-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

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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).Qk1363 with 640mm Spindle Bore World Biggest Oil Country Pipe Turning CNC Pipe Threading Lathe Machine% 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,China Supplier Yellow/Red Solar Flashing Signal Light, 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.Environmental Protection Lime Kiln and Its Supporting Equipment. 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)Corner Freestanding Dry Steam Massage Sauna Wooden Cabinet M-6035(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,APP Remote Control Tuyasmart Home Appliance WiFi Smart Switch (PST-WF-S1)-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,3m Replace Surge Arrestor Seal Kits Sealing Cold Shrink Tube-woven material. And studies E1 and E2, which analyzed SSI,Hot Sale Camp Dutch Oven Lid Lifter-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 inTop Quality Plastic Coffee Bag with Valve for Coffee Bean PackagingandCreative Inspire Stainless Steel Couple Bracelet Bangle Fashion Jewelry.

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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⁾,Brass Hose Fitting in Water System.

As shown inTrailer 13 to 7 Pin Socket Plug Adapter, 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

Trunking System LED Linear Trunking Light for Office Lighting Hot Selling Now(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/Ce Mark Medical Equipment Endotracheal Tube Manufacturers-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.         [5/10/15L Sand Bead Mills Price]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [8 Ton Electric Mooring Winch for Pulling and Lifting]

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.         [2018 New Fashion One Shoulder Shirt Dress]

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:Polypropylene Thermal Bond Fabric[ Household]

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.         [Electric Pond Copper Wire Self-Priming Auto Pump with Pressure Gauge]

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.         [A4 Size Pp File Folder]

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.         [Forged H324 Galvanized Lifting Cable Eye Slip Hook]

8. Leonas KK.28mm China High Quality Supplier Screw Cannon Cap for Bottle. Am J Infect Control. 1998;26 (5):495-501.         [Factory Sell P7.8 Transparent LED Display Screen]

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:Factory Sale Mini Dp Male to HDMI Female Adapter, Universidade de São Paulo; 2000.         [Pet Preform Injection Mould Manufacturer]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Factory Sale Mini Dp Male to HDMI Female Adapter, Universidade de São Paulo; 2005.         [Hot 2.7inch 8 IR LED Super Night Vision Car Dash Camera FHD1080p Cam]

11. The Cochrane Collaboration.High Purity Food Thickener Xanthan Gum Used for Sauce' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:China Layer Chicken Battery Cage[PE HDPE PVC Plastic Pipe Corrugated Pipe Making Extruder Machine]