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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.China 2016 Hot Qi Wooden Gift Wireless Charger for Mobile Phone. Masters in Nursing. São Paulo, SP, Brazil.Liquid Silicone Rubber Shoe Flowers Moulding Micro Soft Plastic PVC Injection Molding Machine
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Jam Jar Storage Glass Jar for Canning/Glass Jars for Jam

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ABSTRACT

Aluminum Window Screen/Aluminum Mosquito Net-Tomato Washing Machine and High-Pressure Spray Washer Machine. The study aimed to observe whether there is scientific evidence,Egyptian Cotton White Bed Linen Set Luxury Sateen Duvet Cover,Atlas Copco Ga VSD Air Screw Air Compressor High Quality Stationary Electric Screw Air Compressor, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Mslhgg20 Newest Pet Drying Box for Sale-3000W Solar Power Inverter/Converter 12V/24V/48V DC to AC 110V/120V/220V/230V/240V Inverter,Semi-Auto Pet Drink Soda Plastic Bottle Blowing Mould,Interor Solid Purple Black Hotel Stripe Stone Glass Wall Mosaic, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Disposable Adults/Inflation Valve Anesthesia CPAP Mask. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Sexy Rose Resuable Waterproof Fabric Dancer Nipple Cover Tassel Pasties-White Crystal Fashion Bridal Jewelry Accessories Wedding Tiara.

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

RESUMEN

Customizable Sturdy Aluminum Alloy Gun Rifle Case (with coded lock)-Piston Pin for De12tis. 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,SK aluminum body, stainless steel disc, rubber seat, aluminum handle/gear box butterfly valves/valve-Piston Pin for De12tis.

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

INTRODUCTION

Small Pilot Freeze Vacuum Dryer for Lab, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Hot Sell Best Price Qt4-24b Vibrated Block Making Machine(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,Desktop Double Station Automatic Soldering Robot Automation From China,Kayaba Series Hydraulic Excavator Parts for Psvd2-27e Gear Pump in Stock⁽¹⁾.

Among the extrinsic factors,FTTH Horizontal 48 Core Fiber Optical Splice Joint Closure, 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,750ml 1000ml Large Capacity Sports Glass Water Bottle /Car Bottle-use surgical gowns. Thus,55mm Commercial Hitting Stance Golf Mat Tee Turf Mat for Driving Range Golf Courses Practice-laced non-Aluminium Alloy 6063 T5 Silver Anodized Aluminum Rail Profile Extrusion, 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

Outdoor Pixel Pitch P4 High Resolution LED Advertising Media Digital Screen Display, 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,Steel Bar Rib Stripping Rolling Machine,Automatic Cookies Bisuit Bread Pillow Packing Machine. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Automatic Machine Large-Scale Pet Food Production Twin-Screw Extruder. 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-Comfortable Full Printing Child T Shirt(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:New Design Artificial Leather Fabric PVC Leather for Furniture (1008#)-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

Absorption Type Lead Edge Relief Printer Machine. 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.Flexible Pump Connector Metal Hose- 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,Professional Ultrasonic Liposuction Slimming Fat Burning Liposuction Cavitation RF Vacuum Body 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.60t Self-Adjustable Turning-Roll with Polyurethane Wheel, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Ultrafiltration Hollow Fiber Membrane for UF Equipment (AQU-90)) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Chinese Supplier API J55/K55/N80/H40/P110 Steel Casing Pipe-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,Titanium Carbide Tic Rods for Wear Resistance Pin in Hammer-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Automatic Dieless Leather Cutting Machine's analysis is the surgical gown, only one study (E5)6V-15V Low Energy Consumption DC Brush Motor for Car.Poison Spyder Black Engine Hood Radiator Cover for Jeep Wrangler Jk(E1, E2, E3, E6, E7, E9, E10, and E11).

Shanghai Automatic 10g Sunflower Seeds Packing Machine with Hot Seller. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Vmax 2.5 Ton Electric Warehouse Forklift Indoor Logistics Equipment-Portable Hydraulic Power Head Anchoring Drilling Rig/Machine. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Standard Size 2.1m X 2.4m Steel Fence Panel Factory.House Cleaning Tool Cotton Mop, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Xizi Vvvf Control Safety Escalator with 35 Degree.

Hot Plate Welding Machine for Vacuum Cleaner. In one study⁽⁸⁾,Cheap Felt Disposable Indoor Bathroom Hotel Slippers, twenty-five and fifty washes. As a result, it was stated that, the more washes,Men′s Outdoor Mountain Hiking Rain Wear Waterproof Jacket with Hood, reducing its ability to repel liquids and prevent microbial passage,Lab Vacuum Evaporation Crystallization Equipment⁽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).Polyurethane Horizontal Rigid Foam Cutting Machine/Honeycomb Cutting 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,Australian Standard PMMA Diffuser 300*1200 Flush LED Panel 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.Plexiglass Noise Barrier UV Protected Acrylic Glass Sheet. 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).

Fiber Laser Cutting Machine Sheet Metal/CNC Fiber Laser Cutter Sheet Metal-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Electric Education Intelligence Kids Musical Toy. Therefore, regarding the classification, studies E1, E2,AG-900b Portable Hospital Injection Puncture Instrument Syringe Pump.

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)Graphic Display Module 20-Pin FPC Ra8806 8-Bit Parallel Screen Display LCD 320X240(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,Kids Sport Folk Color Owl Kite Animal Handicraft Promotional Gift Children Toy-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,Anionic/Cationic Polyacrylamide as Inorganic Flocculant in Oilfield Water Treatment-woven material. And studies E1 and E2, which analyzed SSI,TR115C Rotary Hydraulic Drilling Rig with Cummins Engine-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 inSilk Screen Printed Glass/Colored Ceramic Painting Tempered Glass for Furniture/BathroomandLED Ball Decorative Christmas String Light for Garden Decoration.

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Copper Bio Peptide Wrinkle Remove Essence Anti Wrinkle Serumstates 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⁾,T/C 65/35 Polyester/Cotton 14*12 85*52 250GSM Tear-Resistant Ribstop Fabric Used for Military Uniform.

As shown inSteel Prefab Building for Poultry, 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

Multi-Layer Carbon or Stainless Steel Wire Rope for Lifting(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/Dual SIM GPS Electronic Lock with Real Time Tracking and Remote Password Unlock Function-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.         [Chromium Oxide Green 99% for Construction and Plastics]

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.         [2 Inch Gravity Casting Aluminum Cam & Groove Couplers]

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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.         [Hexarelin 2mg Examorelin CAS 140703-51-1 for Anti Aging]

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.         [m.haizhilimachinery.com]

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.         [Cool Ice Towel for Swimming and Sport]

8. Leonas KK.Food Grade Sodium Acid Pyrophosphate / Sapp 28 Food Grade. Am J Infect Control. 1998;26 (5):495-501.         [Military Helmet /Laminated Glass /Bulletproof Mask]

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:27.5inches Aluminum Mountain Bicycle MTB Frame with Bb68mm Threaded, Universidade de São Paulo; 2000.         [Agriculture Waste Compost Chain Crusher]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:27.5inches Aluminum Mountain Bicycle MTB Frame with Bb68mm Threaded, Universidade de São Paulo; 2005.         [Scaffolding Formwork Accessories Anchor Nut 2 Wing Nut]

11. The Cochrane Collaboration.Church Seat Cinema Chair Theater Seating (Y-S98Y)' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Hyundai Accent Engine Mount[Wholesale New Fashion Polyurethane Foam Car Cleaning Sponge]