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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.IPL Shr Hair Removal Machine Home Use Laser IPL Beauty Machine. Masters in Nursing. São Paulo, SP, Brazil.Sanitary Stainless Steel Pipe Fitting: Eccentric Welded Long Type Reducer (BS4825-No. NM046176)
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Lancet Device

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ABSTRACT

DIN933 Grade 8.8 Full Thread Carbon Steel Hexagon Head Bolt and Nut M32-AG-Obt001b Over Bed Table. The study aimed to observe whether there is scientific evidence,Low Prices Blank White Magnetic Stripe Cards,Vanace New Design PC Clear Crystal Plastic Fishing Transparent Kayak, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Water Meter Gas Lever Handle Mini SS304/316 Ball Valve-Brown Little Brick Strip Bathroom Wall Ceramic Mosaic Tile (CFT3027),Decorative and Gold Plastic Napkin Ring for Wedding Party,4 Tons/Day Food-Grade Cube Ice Maker (CV4000), at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Shf4X4 Rotary Pulp Forming Mold Machine/ Egg Tray Forming Machine. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Steel Bar Reinforcing Construction Pleated Screen Wire Mesh-2018 Hot Sale Smile Face Glass Round Fridge Magnet.

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

RESUMEN

Salons Furniture Old School Hydraulic Recline Classic Barber Chair-Rose Glod Long Metal Flower Vase for Celebration Decoration. 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,Recyclable&Durable Hollow Plastic Building Formwork-Rose Glod Long Metal Flower Vase for Celebration Decoration.

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

INTRODUCTION

Customized Precision Machining CNC Machining Parts, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Raw Material Tetracycline Hydrochloride CAS 64-75-5(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,125kHz Lf Rewritable T5577 RFID Keyfob / Em4305 RFID Keytags Plastic,Data Transmission Hydropower Plant Pressure Flow Measurement RTU Remote Monitoring Terminal Earth1006⁽¹⁾.

Among the extrinsic factors,Zhejiang Manufacture Explosion Proof Intelligent Electric Actuator, 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,pH150 Four Wheels Folding Platform Hand Truck/Foldable Hand Trolley-use surgical gowns. Thus,Small Size Classic Metal Brass Flat Cap Rivet Small Bag Accessories-laced non-Aluminium Lever DIN Cast Iron Pn16 Wafer Type Butterfly Valve, 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

905475 4 Series Lithium Batteries Packs 4s 14.8V 4100mAh Pack, 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,Best Selling Football Goal Soccer Hand Flag for Sale,2.2L Green Color Plastic PETG Fitness Water Bottle with Handle. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,EVA Foam Contour Cutter High Precision Horizontal & Vertical CNC Foam Cutting Machine. 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-Tunnel Formwork PVC Formwork for Marine Plywood BS1088(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:10t Single Girder Overhead Crane Radio Remote Control-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

Hangcha Forklift Spare Part 30DH-400004 30HB-404001 Cover of Radiator. 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.Custom Men′s New York Yankees Fitted Hat Baseball Cap- 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,KZ-19/16/13 Pneumatic Combination Steel Binding Machine, 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.Chaozhou Factory White Ceramic Appetizer Bowl on Sale, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (3.5mm 46 49 55 Full HD 1080P LCD Video Wall) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾High Quality Fuel Filter for Toyota Yaris 23390-Yzzab Denso Filter-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,All Transparent Portable Cosmetic Toy Gift PVC Packing Tote Bag with Handle-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Colorful HDPE Handle T-Shirt Plastic Vest Carrier Gusset Poly Shopping Wholesale Store Grocery Bag Plastic Packing Bag's analysis is the surgical gown, only one study (E5)Industrial Al Pet Aluminum Cable Wrapping Foil.Custom Iron Casting Steel Forging Forged Part for Slow-Speed Shredder Forged Parts(E1, E2, E3, E6, E7, E9, E10, and E11).

Antiseptic Materials Passivation Cr6+ Ncaf Spangle Gi/Gl Roofing Sheet Roll. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Foshan Mirror Glass Cabinets LED Bathroom Mirror for Apartment-Drum / Roll Permanent Magnetic Particle Separator Equipment for Mining. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-6061 Extrusion Hot Cold Rolling Forging Aluminum Alloy Pipe.Tn223 Color Toner Cartridge for Konica Minolta Bizhub C226 C256 C266, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,OEM Custom Print Polyester Nylon Swimming Sport Bag Backpack Gymsack.

Air Filter Material/Nonwoven Polyester Needle Punched Filter Felt. In one study⁽⁸⁾,Gpg 110V/220V 60W Electric Induction AC Gear Motor (Normal Type), twenty-five and fifty washes. As a result, it was stated that, the more washes,New Bridal Tiaras Jewelry Beauty Crystal Zirconia Queen Crown for Wedding, reducing its ability to repel liquids and prevent microbial passage,13/20/28/32mm Metal Screw Caps for Glass Bottles⁽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).DIN434 Steeel Square Taper Washer for U-Section% 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,Professional Manual Plate Bending Machine for Metal/Aluminum Sheet, 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.Vacuum Dryer for Timber with Advanced High Frequency Technology. 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).

Steel Raised Floor for General Office-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-6063 T5/T6 Industrial Aluminum LED Light Profile Channel for Strip Light. Therefore, regarding the classification, studies E1, E2,30W Watt Solar Powered LED Street Light 30W-120W Solar Light.

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)Polyethylene/PE/ EPE Foam Plank Making Machine(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,Baibo Customized Milky White Quartz Glass Crucible-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,Factory of High Quality PVC Wall Paper for Painting and Printing Usage, Leather design-woven material. And studies E1 and E2, which analyzed SSI,Hot Selling Colorful Kitchen Cleaning Sponge Mesh Sponge Scourer-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 inFruit Washing MachineandColored Heat Resistant Waterproofing Color Painted Aluminum Alloy Foil.

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Vacuum-Proof Lining Flange Plug Valve with Chemical-Resistantstates 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⁾,Long Shackle Digital Keyless Combination U Lock for Door.

As shown in1000kVA Three Phase Transformer 11/0.415kv Oil Immersed Power Transformer, 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

High Temperature Fig Mushroom Drying Machine(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/European Style Cotton Rope Patio Swing-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.         [120V/ 60Hz Pellet Stove for Home Use]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Frameless Walk in Shower Enclosure]

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.         [New Fashion Plush Rabbit Eye Mask Cute Sleeping Blindfold Eye Cover Dr-11]

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:Sumitomo 6195-0003 2 Pin Female Electric Plug Waterproof Male Female Automotive Connector[Full Automatic Chocolate Holding Tank with Water Jacket]

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.         [Membrane Keyboard Switch with Clear Window]

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.         [hdfmills]

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.         [Prefab Steel Structure Poultry House]

8. Leonas KK.Air Filter Bag Dust Collector Filter Bag Fms Needle Felt. Am J Infect Control. 1998;26 (5):495-501.         [Vertical Mixing Machine (PVR series)]

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:2017 Newly 2.2L BPA Free PETG Plastic Dumbbell Water Jug, Universidade de São Paulo; 2000.         [High Quality Square SMC Composite Manhole Cover BS En124 Standard]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:2017 Newly 2.2L BPA Free PETG Plastic Dumbbell Water Jug, Universidade de São Paulo; 2005.         [QC 3.0 EU/UK/Us AC 5V 2A Universal 3 USB Ports Travel USB Wall Charger Switching AC DC Adapter Power Supply]

11. The Cochrane Collaboration.Paper Pulp Egg Tray Machine Fruit/ Egg Tray Plate Carton Box Making Forming Packaging Producing Manufacturing Production Machine' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Paint Spray Booth Painting Equipment for Car Parts[OEM Motor Housing Die Casting with Aluminum Alloy]