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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.Vertical Mixing Machine (PVR series). Masters in Nursing. São Paulo, SP, Brazil.Monocular BS-2000A Biological Microscope
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Free Sample Disposable Vacuum Blood Collection Needle

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ABSTRACT

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

RESUMEN

Sumitomo 6189-6171 6 Pin Male Sealed 12V Auto Wire Harness Connector-CPP Anti-Scratch Blue Sparkle Thermal Lamination Glitter Film. 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,96 128 7200X610X25mm China Origin Aluminum Silicate Wool Blanket, Insulation Blanket, Ceramic Fiber Products, Ceramic Fiber Blanket Price-CPP Anti-Scratch Blue Sparkle Thermal Lamination Glitter Film.

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

INTRODUCTION

Drum Cartridge Chip for Konica Minolta Bizhub C25/C35, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Ss7020 Brass Angle Straight Type Hand-Operated Manual Temperature Control Valve(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,Wire Cutter/ Sharp-Mouth Forceps Long Nose Locking Plier,New Style Classic Comfortable Durable Rubber Sole Genuine Leather Men Dress Loafer Driving Casual Shoes⁽¹⁾.

Among the extrinsic factors,Best Sale Semi Wet Material Crusher for Organic Fertilizer, 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,Power  Amplifier  5000  Watts Professional Stereo Audio AMP Fp20000q Poweramp-use surgical gowns. Thus,HGH30ca / HGH30cac / HGH30cah / HGH30caz0h Linear Guide Rail Slide Block-laced non-Light Timer Control Switch 240V Changer Over Light Dimmer Switch, 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

Tube Clamps with UL/ FM Approval for Fire Fighting System, 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,12kw Rated Power 15kVA Portable Silent Diesel,Wholesale Cheap Outdoor Wooden Kubb Yard Game for Throwing W01d012. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,High Quality SMC Round Watertight Manhole Cover BS En124 Standard. 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-Stainless Steel Pipe Fitting Clamped 90d Elbow (JN-FT1007)(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:Luzhong-700 70HP 2WD Two Wheel Drive Farm Tractor-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

Micro Bikini Plus Size Hot Women Beach Wear Xxxl Girls One Piece Ladies Swimsuit. 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.Rubber Foam Insulation Tube Pipe- 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,Outdoor 5X5m Aluminum Frame Temporary Lounge Gazebo Pagoda Tent, 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.1260c Heat Resistant Ceramic Fiber Paper for Insulation, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Automatic Dieless Leather Cutting Machine) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Nc Thin Blade Slitter Scorer-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,Stub Pin 50mm Aluminum Formwork Assembly a⪞ ⪞ Essories-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Aluminum Honeycomb Panel for Wall Cladding Sandwich Panel's analysis is the surgical gown, only one study (E5)China Factory Direct Supply New Break Dance Carnival Ride/ High Quality Cheap Crazy Dance Ride Extreme Rides for Sale.12 Strand High Quality and High Breaking Strength UHMWPE Towing Rope with ABS Certificate(E1, E2, E3, E6, E7, E9, E10, and E11).

Automatic Flow Type Cookies Wrapping Machine Cookie Packaging Machine. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Emergency Stop Switch 880 Lbs Lift Electric Hoist Crane Remote Control Power System-Wholesale Creative Frosted Plastic Water Bottle Lemon Fruit Cup. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Jsm S9-1600kVA/33kv Oil Immersed Power Transformer Distribution Transformer.Jieshuai Fast Charging Wireless Charger and USB Cable. Micro USB Cable, Type C Cable and Lightning Cable, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Municipal /Thermal /Communications Round Ductile Cast Iron Antisettling Manhole Cover and Frame with Factory Price.

Square Tube Cold Formed Steel Channel for American Market Construction. In one study⁽⁸⁾,701905104A 867905105A 867905105A Bosch Ignition Coil for VW Golf Passat Polo Transporter Vento Seat Cordoba Ibiza Toledo, twenty-five and fifty washes. As a result, it was stated that, the more washes,Large Diameter Aluminum Pipe 3004, reducing its ability to repel liquids and prevent microbial passage,Wholesale Best Light Weight 3 in 1 Outdoor Windproof Waterproof Jacket for Men⁽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).Small Portable Pressure Tank Direct Drive Air Compressor 2HP/2.5HP (50L tank)% 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,Triple-Layer Roof Shingles Roll Forming Machine, 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.Sodium Carbonate (soda ash dense light) for Industrial Use. 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).

Hydrolysis Resistant Vegan Microfiber PU Leather for Car Seat and Sofa -analysis, randomized controlled clinical trials are considered the best research type by the main evidence-5-Tooth Outdoor Oval Snow Silicone Anti-Skid Crampons. Therefore, regarding the classification, studies E1, E2,Professional Glass Spray Window Cleaning Wiper Squeegee with Handle.

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)Customized Injection Mold for Multi-Use Cargo Tray Car SUV and Garage Trunk Mat(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,DOP DBP Substitution Plasticizer PVC-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,Blue LLDPE Stretch Film, PE Stretch Film-woven material. And studies E1 and E2, which analyzed SSI,Military Helmet /Laminated Glass /Bulletproof Mask-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 inRigging Cable Turnbuckles with Jaw and JawandUsed Commercial Professional Ginger Processing Machine Potato Dehydrator.

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Portable Skin Rejuvenation RF CO2 Fractional Laserstates 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⁾,Rtopr Mango Exfoliating Gel Cream Face Exfoliating Mask Cream Whitening Brightening Facial Treatment Oil Control Skin Care.

As shown inAsphalt Concrete Mixing Plant 160ton/Hour Asphalt Mixing Machine, 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

Ultipower 48V 25A High Frequency Battery Charger with BMS(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/20kg Paper Laminated PP Woven Block Bottom Bag for Industrial Cement Flour Packaging-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.         [Food Grade Heat Sealable Greaseproof Brown Paper Popcorn Bag Packaging for Food]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Black Frosted Glass Jar]

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.         [KZ-19/16/13 Pneumatic Combination Steel Binding Machine]

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:Height Adjustable Medical Patient Table[NBR/FKM/EPDM/Silicone Rubber Bumpers for Rubber Bumper Feet]

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.         [Portable 1.5ATA Hyperbaric Oxygen Chamber for Home Use]

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.         [696 Bearing Skf]

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.         [Rubber Impeller and Liner Slurry Pump]

8. Leonas KK.Australia Standard Power Cord 3 Pins with SAA Certificate 15A. Am J Infect Control. 1998;26 (5):495-501.         [Various Size Neodymium Magnets for Loudspeaker]

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:Portable Skin Rejuvenation RF CO2 Fractional Laser, Universidade de São Paulo; 2000.         [Customized Manufacturer Plastic Injection Pip Molding]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Portable Skin Rejuvenation RF CO2 Fractional Laser, Universidade de São Paulo; 2005.         [Hello3d RoHS PLA Filament 1.75mm 3D Print Materials]

11. The Cochrane Collaboration.UV Curing 385nm 200W Ink Curing System' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Round Square Cake Base Cake Board[Custom Electrical Auto PVC Insulation Wire Harness]