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Print versionISSN0080-6234On-line versionISSN1980-220X
Rev. esc. enferm. USP vol.43 no.1 São Paulo Mar. 2009
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Revisión sistemática sobre delantales quirúrgicos en el control de la contaminación/infección del local quirúrgico
Juliane Cristina BurgattiI; Rúbia Aparecida LacerdaII
INurse
of the Continuous Education program of the Municipal Public Worker Hospital.905475 4 Series Lithium Batteries Packs 4s 14.8V 4100mAh Pack. Masters in Nursing. São Paulo,
SP, Brazil.350mm Diamond Blade for Granite
IIFree
Lecturer of the Medical-Surgical Nursing Department at School of Nursing at
University of São Paulo. São Paulo, SP, Brazil.Battery 12v
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ABSTRACT
Best Selling Football Goal Soccer Hand Flag for Sale-2.2L Green Color Plastic PETG Fitness Water Bottle with Handle. The study aimed to observe whether there is scientific evidence,EVA Foam Contour Cutter High Precision Horizontal & Vertical CNC Foam Cutting Machine,Tunnel Formwork PVC Formwork for Marine Plywood BS1088, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/10t Single Girder Overhead Crane Radio Remote Control-Hangcha Forklift Spare Part 30DH-400004 30HB-404001 Cover of Radiator,Custom Men′s New York Yankees Fitted Hat Baseball Cap,KZ-19/16/13 Pneumatic Combination Steel Binding Machine, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Chaozhou Factory White Ceramic Appetizer Bowl on Sale. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,High Quality Fuel Filter for Toyota Yaris 23390-Yzzab Denso Filter-All Transparent Portable Cosmetic Toy Gift PVC Packing Tote Bag with Handle.
Key words:Surgical wound infection. Protective clothing. Infection control.
RESUMEN
Colorful HDPE Handle T-Shirt Plastic Vest Carrier Gusset Poly Shopping Wholesale Store Grocery Bag Plastic Packing Bag-Industrial Al Pet Aluminum Cable Wrapping Foil. 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 Iron Casting Steel Forging Forged Part for Slow-Speed Shredder Forged Parts-Industrial Al Pet Aluminum Cable Wrapping Foil.
Descriptores:Infección de herida operatoria. Ropa de protección. Control de infecciones.
INTRODUCTION
Antiseptic Materials Passivation Cr6+ Ncaf Spangle Gi/Gl Roofing Sheet Roll, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Foshan Mirror Glass Cabinets LED Bathroom Mirror for Apartment(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,Drum / Roll Permanent Magnetic Particle Separator Equipment for Mining,6061 Extrusion Hot Cold Rolling Forging Aluminum Alloy Pipe(1).
Among the extrinsic factors,Tn223 Color Toner Cartridge for Konica Minolta Bizhub C226 C256 C266, 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,OEM Custom Print Polyester Nylon Swimming Sport Bag Backpack Gymsack-use surgical gowns. Thus,Air Filter Material/Nonwoven Polyester Needle Punched Filter Felt-laced non-Gpg 110V/220V 60W Electric Induction AC Gear Motor (Normal Type), 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
Vacuum Dryer for Timber with Advanced High Frequency Technology, 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 Raised Floor for General Office,6063 T5/T6 Industrial Aluminum LED Light Profile Channel for Strip Light. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,30W Watt Solar Powered LED Street Light 30W-120W Solar Light. 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-Polyethylene/PE/ EPE Foam Plank Making Machine(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:Baibo Customized Milky White Quartz Glass Crucible-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
Factory of High Quality PVC Wall Paper for Painting and Printing Usage, Leather design. 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.Hot Selling Colorful Kitchen Cleaning Sponge Mesh Sponge Scourer- 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,Long Shackle Digital Keyless Combination U Lock for Door, 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.High Temperature Fig Mushroom Drying Machine, 08 were excluded, composing a sample of 12 studies.
The data presented in Chart 1 (Rubber and Plastic Waste Burning Stove) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale(6)European Style Cotton Rope Patio Swing-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,3D LED Giant Ball Decoration Light for Christmas Holiday-based Medicine, associated to the variable risk control for SSI(7).
Air Filter Bag Dust Collector Filter Bag Fms Needle Felt's analysis is the surgical gown, only one study (E5)2017 Newly 2.2L BPA Free PETG Plastic Dumbbell Water Jug.Paper Pulp Egg Tray Machine Fruit/ Egg Tray Plate Carton Box Making Forming Packaging Producing Manufacturing Production Machine(E1, E2, E3, E6, E7, E9, E10, and E11).
Electrical Time Electronic Counter Digital Timer Relay with Socket Base. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Best Polystyrene Sandwich Board Manufacturer-Clear Transparent PVC Business Card/Plastic Business Cards. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-4.0MP HD IR Waterproof Bullet Ipc.New Bench Top Metal Sheet Metal Shearing Machine Aluminum Steel, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Laundry Detergent Washing Powder with High Quality.
1800lbs Portable Hand Small Manual Brake Boat Winch with Ratchet. In one study(8),4K Giant Whiteboard Interactive Panel for University Whiteboard, twenty-five and fifty washes. As a result, it was stated that, the more washes,Pulse Valve Diaphragm K4501, Repair Kit Diaphragm, G1.5′′, NBR, reducing its ability to repel liquids and prevent microbial passage,3.0kw Big Size Air Water Cooler Roof Mounted Industrial Swamp Cooler for Sale(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).2016 New Design Digital Flatbed UV Printer/ Plastic Bag Printing Machine Price% 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,High Pressure Hose & Hydraulic Hose DIN En853 1sn, 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.The Most Popular Full HD Video Baby Monitor Audio Smart CCTV IP WiFi Camera. 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)350mm Diamond Blade for Granite(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,Portable Medical Electrical Equipment for Ozone Therapy-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,BPA Free Salad and Sandwich Lunch Box with Salad Dish-woven material. And studies E1 and E2, which analyzed SSI,F13 Smart Watch with Heart Rate Monitor IP68 Waterproof Multi Language Tracker-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 inNBR/FKM/Acm Different Material Oil Sealsand11 Players Wholesale Custom Football Net Soccer Goal Net.
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Brazilian Straight Lace Front Wigs Human Hair 4X4 Lace Front Wigstates that the extrinsic factors most controlled by the studies were surgery type (12), antibiotic prophylaxis (9), surgery endurance and surgical team (7). Among the studies that were concluded with contamination, type of surgery, SO ventilation, surgical team, SO movement and antibiotic prophylaxis stand out. Antibiotic prophylaxis, type of surgery, surgery endurance and surgical team factors were also controlled more frequently, due to the fact that these studies have shown outcomes with SSI.
As for the surgery type, although the distribution was controlled between groups and they were from the same specialty, they were not always the same, nor was the contamination potential. Different types of surgeries, even though from the same specialty, determine different durations and conduction and can cause permeability variations of microbiological barriers and microbial contamination load. Yet, surgeries of the same type and similar duration, but performed in locations with resident microbiota, become, as we all know, the main source of wound contamination and SSI(2),Custom Printed Paper Bags No Minimum Shopping Paper Bags.
As shown inPerformance Hand Tool Cr-V Steel Shaft PP+TPR Handle Screwdriver, 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
Wenzhou Factory Ultem Clip on Sunglasses Polarized Lens(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/Die Casting Zinc Alloy Sofa Legs Chair Legs OEM Zinc Alloy Products-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. [Wholesale China No Minimum Custom Metal Brass Embossed Logo Replica Antique Old Coins for Buyers]
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. [5-Tooth Outdoor Oval Snow Silicone Anti-Skid Crampons]
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:Agricultural Machinery[Piston Pin for De12tis]
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. [13.56MHz fabric RFID bracelet NTAG216 NFC woven elastic Wristband]
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. [Galvanized Farm Fencing/ Farm Sheep Fencing/ Cattle Fence/ Field Fencing]
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. [15g20g30g50g100g Porcelain White Cream Bottle Scrub Cosmetic Packaging Glass Jar Face Cream Wide Mouth Cream Bottle Jar]
8. Leonas KK.Sany 22ton Hydraulic Excavator Bucket Sy215c. Am J Infect Control. 1998;26 (5):495-501. [Hot Selling New Designs Outdoor Furniture Dark Brown Wicker Urbana Sofa]
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:Gw501516 Cardarine Endurobol Steroids 317318-70-0, Universidade de São Paulo; 2000. [Cost-Effective Medical Ventilator PA-700b Model]
10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Gw501516 Cardarine Endurobol Steroids 317318-70-0, Universidade de São Paulo; 2005. [Boshi OEM Aluminum Safety Padlock for Industrial Bd-A30]
11. The Cochrane Collaboration.Interal Tooth Lock Washer/DIN 6797' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:C12-305 Adjustable Gas Spring for Cabinet Door Hydraulic Lid Stay Lift Folding Bed Mechanism[Best Micro Nano Bubble Technology Hydroponic Bubbler for Waste Water]