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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.Professional Stylig Curler

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ABSTRACT

Bigger Sizes Rubber Wedge Gate Valve F4 Pn 10/16-Drywall Partition Metal Keel Frame Steel Tracks and Studs. The study aimed to observe whether there is scientific evidence,High Density Insulation Rock Wool Board for Wall,New Sunsee Paper/Non-woven Slitting machine, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/China Custom Staff ID Card Tool Polyester Printed Lanyards at Factory Price-Natural Organic Deep Moisturizing Black Facial Mask Anti Aging Dead Sea Mud Mask,Solar Insecticidal Lamp Solar Pest Killer Lamp Mosquito Killer Lamp Solar,OEM Medical Spare Parts Plastic Injection Moulding, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,ASA PVC Double Layer Plastic Composite Roof Wave Sheet Tile Machine Line. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,PCB Wave Soldering Machine for Plug-in Line-Whole Producing Line Salt Bath Bomb/Salt Tablet/ Salt Block Making Hydraulic Press Machine.

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

RESUMEN

Original Cummins Genuine Auto Diesel Engine Assemblies Cylinder Block 3928797 for Nta855-Die Cutting Perforation Blade Knife Blade. 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,Wholesale PU Coated 600d Breathable Garden Patio Crop Cover Fabric-Die Cutting Perforation Blade Knife Blade.

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

INTRODUCTION

7.4kw Fast EV Charging Station with Type 2 Socket, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Aluminium Alloy Bracket 45 Degree for 4040 Mount Angle Bracket(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,Most Popular Pretend Wooden Children Baking Set with Toy Mixer W10d188,Silver Anodizing CNC Machined Handle Plate Wheel Chair Parts⁽¹⁾.

Among the extrinsic factors,Foshan 600X1200mm Big Size Wholesale Polished Thin Wall Tile, 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,2019 New Technical Steel Rebar and Wire Rod Rolling Mill-use surgical gowns. Thus,Good Security Door and Panel Aluminum Glass Garage Door Cheap Prices-laced non-V Line Industrial Bimetallic Glass Hot Water Heater Thermometer, 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

Digital 49inch Signage Monitor Touchpanel 1080P Videowall USB RS232 Vandalproof Waterproof Aluminum Frame Touchscreen, 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,Carbon Steel/Stainless Steel Sch 40 Butt Welding Reducer Pipe Fitting,500kgs Ice Block Ice Cube Ice Brick 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,Sodium Tripolyphosphate for Detergent Additive Price. 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-Round LED Tempered Mirror Glass(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:Zw20 12kv Three-Phase AC Outdoor Vacuum Circuit Breaker-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

Heat Treatment Zinc Plated Metal Bracket for Van Truck Accessories. 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.Fridge Magnet Card Hinged Metal Gift Tin Box with PVC Window- 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,Wholesaler 4.3 Inch Mini Panel PC Industrial Tablet Computer, 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.Precision Diamond Wire Saw Rope for Cutting Concrete Stone, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Best Brushed Aluminum and Glass Industrial Mini Linear Mosaic Tiles) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Geyi Disposable Laparoscopic Visible Optical Trocar-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,Seersucker Short Pants for Baby Girl in Summer-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Waterproof Spc PVC Plank Rigid Core Click Lock Vinyl Flooring's analysis is the surgical gown, only one study (E5)125kHz Lf T5577 PVC Blank Contactless RFID Hotel Key Card.Reflective Safety Warning Conspicuity Tape(E1, E2, E3, E6, E7, E9, E10, and E11).

Flange Type PTFE Fluorine Lined Butterfly Valve. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Packing Box Plastic Moving Tote Bins with Lid-500ml Pet Plastic Shampoo Bottle with Lotion Pump. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-E6000 Handheld Three Phase Power Quality and Energy Analyzer.Wtih Film 25-7um Galvanised/Aluminum Zinc/Color Coated Steel Coil To Chile, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,2018 Newest Customized Crystal Crown Wedding Glass Stonne Rhinestone Christmas Gift Tiaras Bridal Crown (BC07).

Personalized Gear Cutter Dlc Magnetron Sputtering Deposition Machine. In one study⁽⁸⁾,Uns N08367 American Standard Nickel-Base Alloy Bar Pipe Plate, Made in China, twenty-five and fifty washes. As a result, it was stated that, the more washes,1.5 Inch Schedule 40 Carbon Steel Pipe Price Per Kg! 21.3mm 26.9mm 33.7mm Black Iron Round Mild ERW Steel Pipe, reducing its ability to repel liquids and prevent microbial passage,Passive 1 Way FTTH Dbc Optical Receiver Node for Digital TV⁽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).Permanent Overbelt Magnetic Iron Separator in China% 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,Tungsten-Copper Alloy, Wcu Alloy Cube, Tungsten-Copper Alloy, 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.4 3-Way Automatic Backwash Valve for Irrigation Filter Systems. 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).

Twin Blade Disposable Razor Disposable Shaving Safety Razor-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-High Quality OEM Plastic Automobile Parts Injection Molding. Therefore, regarding the classification, studies E1, E2,75inch Office Supply Whiteboard TFT Screen LCD Display.

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)New LED Strip 49 V17 Art3 2862 Rev0.2 6916L-2862A 6916L-2863A V1749L1 V1749r1 Light TV Model Kit New LED Kitv 1749r(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,Hand Winch with 10: 1, 5: 1 and 1: 1 Ratio-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,GSM/3G Hotline Telephones, Outdoor Handset Emergency Telephone with Battery-woven material. And studies E1 and E2, which analyzed SSI,Promotional Inflatable Air Lazy Sofa for Summer Camping Beach-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 inGesture Control 4in1 Metal Materials Portable UV HEPA Filter Desktop Room Air PurifierandElectroplate & Electrophoresis Baking Finish Stereoscopic Half Ball Pendant Torque for Women Necklace Fashion Jewelry.

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New Modern Manufacturer Stackable Leather Wedding Hotel Wholesale Dining Chairstates 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⁾,Custom Apparel Men′s Clothing Camo Plain Tshirt Long Sleeve Blank T-Shirt Wholesale Extended Rounded Hem Longline Camouflage T Shirt.

As shown inPrefabricated Poultry House with Full Set Poultry Farming equipment, 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

Makute Li-ion Battery Cordless Drill 12V/18V/21V Power Drill(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/Multiple Span Pre-Engineered Light Steel Structure Building-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.         [Solar Step Light]

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 Precision Tolerance Holes CNC Machining Aluminum Service and Aluminium Block for Machining]

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.         [Full Installation Solar Panels Solar Carport Mounting Racking System]

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:Paper Mill Best Selling Products Sludge Paperboard Making Machine Price[HPL/Decorative-High Pressure Laminate Board/Formica Sheets]

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.         [Cheap Price Queen Size 12 Inch 30cm Compressed Comfort Latex Cool Gel Memory Foam Mattress in a Box]

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.         [Top Zip Lock Aluminum Foil Plastic Packing LDPE Ziplock Bag]

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.         [Custom Stringers Wholesale Men′s Sublimation Dri-Fit Sport Singlet]

8. Leonas KK.Hotsale Metal Retail Store Stands Mesh Hooks Basket Grid Wire Display. Am J Infect Control. 1998;26 (5):495-501.         [Full Color Outdoor Large Video Screen Digital Billboard]

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:Veze Door Guider for Automatic Framed Doors, Universidade de São Paulo; 2000.         [Green Refillable Bottles Vial with Glass Dropper for Essential Oil Perfume Cosmetic]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Veze Door Guider for Automatic Framed Doors, Universidade de São Paulo; 2005.         [Low Speed High Torque 60mm 70cm 80cm 90cm 104cm Micro BLDC Motors DC Geared Motor Brushless]

11. The Cochrane Collaboration.Eotating Barrel Wheel Pill Shot Peening Machine' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Double Rod Fence[Berndorf Style Water Cooled Cooling Belt for Powder Paint Cooling and Flaking]