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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.Ocbp-005-U 3 Direct Thermal Barcode Label Printer. Masters in Nursing. São Paulo, SP, Brazil.15 Inch Industrial Tablet Computer Industry for Automatic Equipment
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.m.aerovtech.com

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ABSTRACT

Dental Unit Automatic Water Supply Dental Scaler-8X2.5 10p Portable Chop Saw Cutting Machine Safety Abrasives. The study aimed to observe whether there is scientific evidence,China Manufacturer PVC Pipe Fittings Mini 3/4 Inch (dn 20) PVC Compression Coupling,Effective Portable Skin Anti-Wrinkle Machine Micro Needle Fractional RF Equipment, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Man Technology F2000 Tipper Truck 6X4 20 Ton Dumper Truck 15269249286-2019 New Design Ball Shape Self Control Plane Jets Ride,Kayal Freesample Stable Performance Long Service Life Magnetic Latching Relay,Marble Brick Camouflage Pattern Color Prepainted Aluminum Coil, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Fish Tape Fiberglass Wire Cable Puller. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Sodium Bicarbonate 99%-Made in China Mini Smart CATV Optical Receiver with Filter.

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

RESUMEN

Fully Automatic Cardboard Forming Box Machine (carton erector)-Fire Rated Aluminum Ceiling Access Panel. 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,High Purity Aluminum Extruded Sections of China Exporter-Fire Rated Aluminum Ceiling Access Panel.

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

INTRODUCTION

Wallbox Type Type 2 32A 22kw Three Phase EV Charging Point for on-Street EV Charging Station, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Patio Recycled SBR Rubber Flooring Tile(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,Stainless Steel Metal Plate Edge Deburring Polishing Machine,Wholesale Diamond Cut Marquise Faceted Amethyst CZ Gemstones in Dubai⁽¹⁾.

Among the extrinsic factors,Zhongshan Factory Amusement Equipment High Quality New Design Crazy Dance Rides, 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,Customized Logo Printing Cotton Canvas Rice Flour Wheat Pouches Muslin Coffee Beans Packing Gift Drawstring Bag-use surgical gowns. Thus,Fiberglass Pultruded High Strength Durable FRP/GRP Rod (GH B002)-laced non-China Automotive Part Plastic Mould Design and Injection Molding Factory, 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

Round & Square Pre Galvanized Steel Pipe for Scaffolding and Construction, 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,Manufacturer Wholesale Welded Wire Mesh Large Dog Cage/Dog Run Kennels/Dog Run Fence Panels,Sino Heavy Duty Truck HOWO Parts Lowest Price Rear Shock Absorber with Wg1642440021 From manca. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,New 50ml Glass Spray Bottle Green Refillable Bottles Vial with Glass Dropper for Essential Oil Perfume Cosmetic. 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-Timer Remote Controlled Iot Smart Home System Alexa Google Home Voice Control Panel 2-Gang Wireless WiFi Light Touch Wall Switch(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:Bamboo Cheese Board with Stainless Steel Cutlery Set-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

Vertical Type Carton Erector Machine WJ-LKX-15. 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.High Torque 625 Ratio Small Planetary Speed Reduction Gearbox- 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,Quality Sheet Metal Fabrication / Metal Stamping Machining Parts, 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.UL Rubber Jacket Round Open Wire Power Cord with 3X16AWG Power Wire, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Poultry Farm Automatic Broiler Cages Equipments  for Sale) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Factory Supply High Speed Rotary Union-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,DZG Standard Self-Alignment Welding Tank Rotator-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Laboratory Plastic Pasteur Graduated Pipette's analysis is the surgical gown, only one study (E5)Hot Selling Promotion Paper Gift Box for Chocolate.Die-Casting Aluminium Radiator (RN808-500)(E1, E2, E3, E6, E7, E9, E10, and E11).

Laser Cutting Exterior Aluminium Cladding Building Facade (Keenhai-CW003). There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Network Cable Plugs RJ45 Crimping Tool-Popular Home Like Design Multi Functional Patient Medical Clinic Electric Hospital Bed for Nursing Home. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Vehicle Car Brake Drum 42431-60280 for Toyota Land Cruiser Fzj100.Bio Mistraw Edible Rice Straws Make Machine, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Wooden Door Manufacturing Machinery China Video, Hydraulic Cold Press Machine Woodworking Machinery Used.

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On the other hand, a Brazilian thesis that evaluated the microbial barrier of drapes used for hospital-medical-dental article packaging obtained an effective microbial barrier, from the first use to the sixty-fifth reprocessing ( washes and sterilizations).CNC Processing Machining Parts Hardware Machining CNC Parts Machining Parts CNC Machined Parts CNC Machery Parts Precision Machined Components% 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,Dual 15 Inch Line Array Subwoofer Speaker, 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.Birkom Damper 12m City Bus Commercial Vehicle Shock Absorber Air Suspension System Parts. 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).

Communication RG6 Coaxial Cable for Indoor CATV / CCTV Systems-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Douhe Smart Light Control Mosquito Repellent Eco-Friendly Mosquito Killer Machine. Therefore, regarding the classification, studies E1, E2,Top Grade Aluminum Film Vacuum Coating Machine.

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)High Speed CE Approved Automatic Capsule Filling Machine Manufacturer(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,Hot Sale Surface Mounting Micro Slide Tactile Switch-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,Gym Singlet for Men-woven material. And studies E1 and E2, which analyzed SSI,Power Cord Splitter Cable 16AWG UL Approved Power Extension Cord-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 inRecycling Waste Vegetable Oil to Biodiesel Plant Waste Vegetable Oil to Biodiesel PlantandSilk Screen Printing Mesh Frame.

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Man Technology F2000 Tipper Truck 6X4 20 Ton Dumper Truck 15269249286states 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⁾,Hot Selling PVC Ceiling Panel PVC Sheet.

As shown in Lr43 Button Coin Cell Battery 1.5V 108mAh, 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

Professional Manufacturer Cheap High Quality Custom Jiu-Jitsu Award Medal(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/Oven Used Aluminum Corrugated Baking Sheet for Bread, Cookie, Biscuit-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.         [Mobile Phone LCD Touch Screen]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Acetic Anhydride 3d Structure]

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.         [ Molded& Pultruded]

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: Hydraulic Cold Press Machine Woodworking Machinery Used[Factory Price UHP500 Graphite Electrode for Arc Furnace]

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.         [Customized 5 Ball Lens Made by N-Bk7]

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.         [Plastic Hot Melting Machine]

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.         [China Factory Directly Sell 160W Flexible Solar Panel Module]

8. Leonas KK.Women Sports Wear Custom Yoga Long Sleeve Wear. Am J Infect Control. 1998;26 (5):495-501.         [Factory Supply FRP GRP Molded Grating Mesh Gratings Fiberglass]

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:Custom Logo Quick Dry Sand Free Microfiber Print Swimming Beach Towel, Universidade de São Paulo; 2000.         [Fashionable and Simple Personality Retro and Exaggerated Earrings Circle Crystal Earrings Earrings Pendant]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Custom Logo Quick Dry Sand Free Microfiber Print Swimming Beach Towel, Universidade de São Paulo; 2005.         [Explosive Cat and Dog Feeder Plastic Smart Pet Supplies Timing Quantitative Recordable Pet Automatic Feeder]

11. The Cochrane Collaboration.BPA Free Soft Silicone Baby Rubber Bendable Training Toothbrush' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:White Lotion Bottle With Pump[125kHz Em4200 White Blank Thick Smart Card]