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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.Custom Power Bank

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ABSTRACT

High Quality OEM Plastic Automobile Parts Injection Molding-75inch Office Supply Whiteboard TFT Screen LCD Display. The study aimed to observe whether there is scientific evidence,New LED Strip 49 V17 Art3 2862 Rev0.2 6916L-2862A 6916L-2863A V1749L1 V1749r1 Light TV Model Kit New LED Kitv 1749r,Hand Winch with 10: 1, 5: 1 and 1: 1 Ratio, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/GSM/3G Hotline Telephones, Outdoor Handset Emergency Telephone with Battery-Promotional Inflatable Air Lazy Sofa for Summer Camping Beach,Custom Apparel Men′s Clothing Camo Plain Tshirt Long Sleeve Blank T-Shirt Wholesale Extended Rounded Hem Longline Camouflage T Shirt,Makute Li-ion Battery Cordless Drill 12V/18V/21V Power Drill, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Multiple Span Pre-Engineered Light Steel Structure Building. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Disposable Paper Drinking Straws Bulk Wholesale-Hotsale Metal Retail Store Stands Mesh Hooks Basket Grid Wire Display.

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

RESUMEN

Veze Door Guider for Automatic Framed Doors-Eotating Barrel Wheel Pill Shot Peening Machine. 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,Custom Stringers Wholesale Men′s Sublimation Dri-Fit Sport Singlet-Eotating Barrel Wheel Pill Shot Peening Machine.

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

INTRODUCTION

20kv 160kVA 3 Phase Oil Power Voltage High Frequency Distribution Transformer, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Wholesale 500ml Blue Beer Bottle Lead Free Glass Bottle(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,(90degree BSP FEMALE 60degree CONE) Hose Hydraulic Fitting 22691,Hose Manufacture PVC Steel Wire Reinforced Flexible Pipe Hyrubbers Price⁽¹⁾.

Among the extrinsic factors,Wholesale Festival Disposable RFID Woven Fabric Wristband for Events, 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,3kw 24V 310mm Vertical Agv Drive Wheel Assembly-use surgical gowns. Thus,Electric Industrial Silicone Rubber Heat Pad Heating Blanket Silicone Heater-laced non-Super Soft Bed Cheap Throw in Bulk Flannel Fleece Blanket Queen Twin Size Blankets, 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

Pressure Swing Adsorption (PSA) Oxygen Generator, 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,Hot Selling Anti-Wrinkle Porbale RF Vaginal Skin Tighten Machine,Instant Yogurt Cheese Powder for Yogurt Ice Cream. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Good Price Electronic Ignition Coil Pack for Skoda VW Transporter Caddy Seat 867905105b 547905104. 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-Safety Traffic Rubber Roof Support Feet Products(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:Elevator Control PCB Board Flexible PCB Strip GPS Tracking PCB-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

Steel Strip Hydraulic Pressing Machine for Foldable Box Making. 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.Helium Seamless Steel Gas Cylinder- 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,Rechargeable 48V 40ah Lithium Ion LiFePO4 Battery for EV Agv, 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.Lovely Kids Shoes Outdoor Clogs Beach Sandals Shoes EVA, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Digital AC Voltmeter with LED Display) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Men and Women Couples Multi-Function Black Nylon Watch -V116-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,Polypropylene Woven Geotextile Tubes for Marine Environments-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

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China Supplier Masking Paper Tape Adhesive Decorative Washi Tape. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Sludge Dewatering Screw Press Separator Multi-Plate Sludge Dehydrator Treatment-5.1 Home Theater Multimedia Bluetooth Speaker Surround Sound HiFi Speaker with Changeable LED Lights. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Guangdong Air Purifier Factory OEM ODM Manufacturer Air Cleaner.Ultra Slim Credit Card Size Promotion Gift Custom Logo Aluminum 2600mAh Power Bank, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Water Ozone Generator for Fruits Processing Water Treatment.

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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).Upper Arm Automatic Medical Digital Blood Pressure Monitor for Family Use% 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,Zinc Plated Drop in Expansion Anchor Bolts, 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.Wholesale Price Light Frame Structural Steel Construction. 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)Automatic Flow Packaging Machine for Chocolate Cakes and Cookies(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,New Design Big Capacity Pongdang Water Glass Bottles-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,150Mbps WiFi Hotspot Wireless Volte 4G WiFi Router with Voice Call-woven material. And studies E1 and E2, which analyzed SSI,High Marks Ozonizer for City Hospital Sewage Treatment Waste Water/Gas-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 Transparent CNC Machining PartsandAll Sizes Diameter Transparent and Opaque Polished Quartz Screw Glass Ceramic Tube Products.

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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⁾,China New Condition Good Sale Pet Preform Blower Machine.

As shown inSteel Raised Floor for General Office, 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

Custom Bridgestone Logo Epoxy Printing Metal Tyre Valve Cap(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/4K-90 Diesel Rice Wheat Mini Reaper Binder Harvester Machine Factory Supply-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.         [Sanitary Stainless Steel 304/316L Pneumatic Butterfly Valve]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Rebar Stripping Rib Roller Threaded Machines Threading Rolling Machine]

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.         [Safety Reflectors Plastic Traffic Road Signs Warning Reflective Tape]

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:Igeelee HS-06wfl 0.25-6mm2 Insulated Terminals Cable End-Sleeves Crimper Plier AWG 24-10 Capacity[160 Ton Semiclosed High Precision Bending Machine]

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.         [First-class Cotton fiber BALER Machine]

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.         [Face Cleansing 100% Pure Natural Konjac Sponge]

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.         [5X5m Gazebo Party Canopy Pagoda Tent for Outdoor Wedding Event]

8. Leonas KK.Building Material 50mm Extruded Polystyrene Insulation Board. Am J Infect Control. 1998;26 (5):495-501.         [Advanced Optical PCB Tester off-Line SMT Aoi Machine]

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:10′′ Real Nonstick Cast Iron Frying Pan China Factories, Universidade de São Paulo; 2000.         [Paper Packing Box Wholesale Prince for Small Engine Part]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:10′′ Real Nonstick Cast Iron Frying Pan China Factories, Universidade de São Paulo; 2005.         [Eotating Barrel Wheel Pill Shot Peening Machine]

11. The Cochrane Collaboration.10 Ton High Quality Electric Chain Hoist with SGS' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Farm Implement Plough Discs For[1.5 Inch Schedule 40 Carbon Steel Pipe Price Per Kg! 21.3mm 26.9mm 33.7mm Black Iron Round Mild ERW Steel Pipe]