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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.UL Rubber Jacket Round Open Wire Power Cord with 3X16AWG Power Wire. Masters in Nursing. São Paulo, SP, Brazil.Stainless Steel 316 Pneumatic Positive Displacement Manufacturers Pump
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Cut To Length Line

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ABSTRACT

Factory Supply High Speed Rotary Union-DZG Standard Self-Alignment Welding Tank Rotator. The study aimed to observe whether there is scientific evidence,Laboratory Plastic Pasteur Graduated Pipette,Hot Selling Promotion Paper Gift Box for Chocolate, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Die-Casting Aluminium Radiator (RN808-500)-Laser Cutting Exterior Aluminium Cladding Building Facade (Keenhai-CW003),Network Cable Plugs RJ45 Crimping Tool,Popular Home Like Design Multi Functional Patient Medical Clinic Electric Hospital Bed for Nursing Home, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Vehicle Car Brake Drum 42431-60280 for Toyota Land Cruiser Fzj100. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Bio Mistraw Edible Rice Straws Make Machine-Wooden Door Manufacturing Machinery China Video, Hydraulic Cold Press Machine Woodworking Machinery Used.

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

RESUMEN

5 Colors Label Ribbons Automatic Screen Printing Machine for Sale-Plastic Pipe Profile Sheet Twin Screw Extruder. 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 White Blank PVC Contactless Polycarbonate ID Cards Forma/Printable Cmyk School ID Card with Chip for Access Control-Plastic Pipe Profile Sheet Twin Screw Extruder.

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

INTRODUCTION

Italian Simple Style Marble Stone Long Coffee Table, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.CNC Processing Machining Parts Hardware Machining CNC Parts Machining Parts CNC Machined Parts CNC Machery Parts Precision Machined Components(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,Dual 15 Inch Line Array Subwoofer Speaker,Birkom Damper 12m City Bus Commercial Vehicle Shock Absorber Air Suspension System Parts⁽¹⁾.

Among the extrinsic factors,Communication RG6 Coaxial Cable for Indoor CATV / CCTV Systems, 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,Douhe Smart Light Control Mosquito Repellent Eco-Friendly Mosquito Killer Machine-use surgical gowns. Thus,Top Grade Aluminum Film Vacuum Coating Machine-laced non-High Speed CE Approved Automatic Capsule Filling Machine Manufacturer, 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

Professional Manufacturer Cheap High Quality Custom Jiu-Jitsu Award Medal, 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,Oven Used Aluminum Corrugated Baking Sheet for Bread, Cookie, Biscuit,Tec-Sieve 358- Prison Mesh/High Security Mesh Fence System. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Women Sports Wear Custom Yoga Long Sleeve Wear. 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-Custom Logo Quick Dry Sand Free Microfiber Print Swimming Beach Towel(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:BPA Free Soft Silicone Baby Rubber Bendable Training Toothbrush-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

Ywf (K) 137-6D75 Mk106-4dk. 14. U Air Compressor Fan Motor for Atlas Copco Fans. 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.Precise Controlled Eif Motor Brushless DC 1kw3000rpm24V- 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,Custom Silicone Wristband RFID Woven Bracelet Tyvek Paper Wrist Band, 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.Food Machine for Making Donut Zs-Np-1, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Black/Galvanised Plain/Banded/Beaded Type Malleable Cast Iron Pipe Fitting) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Hot! Good Quality Vibrating Screen for Mining-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,3 Pin Connector Cable Manufacturer Produce Automotive Engine Nozzle Electronic Wiring Harness-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Mechanical Steel Box Strapping Seal Making Machine with Cheap Price's analysis is the surgical gown, only one study (E5)20W Desktop Mopa Oxided Aluminum Black Laser Marking Machine.Customized 5 Ball Lens Made by N-Bk7(E1, E2, E3, E6, E7, E9, E10, and E11).

CNC Per Squared Milling Machine CNC Pricision Milling Machine CNC Center CNC Machine in Taiwan CNC Used Amada Milling Machine CNC Machinine CNC Mill CNC. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,100% Waterproof Mini Bullet Vibrator Sex Toy, Pussy Massager for Woman-Pgla Surgical Suture with Good Quality. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Metal Tin Fruit Candy Sweets Dessert Snacks Trays Plates.Preseasoned Cast Iron Cookware Round 13cm Frying Pan FDA Approved, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,High Pressure Forged Stainless Steel Rptfe Soft Seat Raise Flange RF End Floating Ball Valve.

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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).Cotton/Polyester 7 Gauge Safety String Knitted Work Glove with PVC Dotted on Both Sides% 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,11kw EV Charger Station Charging Point with Type 2 Cable 20 Feet, 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.Aiyos Android/Windows IR LCD Multi Touchscreen Display for Digital Signage Totem Kiosk. 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).

Polyethylene/PE/ EPE Foam Plank Making Machine-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-3 Channel Cable Tray (S-1130). Therefore, regarding the classification, studies E1, E2,Healthcare Product Compression Wrap Thigh Hip Brace Groin Support Brace.

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)Linear LED Lighting Fixtures 4FT 40W Ugr16 Seamless Connection Use for Workplace, Supermarket, Restaurant, School, Shop Light, No MOQ(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,Kitchenware Cold Rolled Stainless Steel Coil-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,High Quality OEM Aluminum CNC Metal Milling Machine Spare Parts-woven material. And studies E1 and E2, which analyzed SSI,PE Water Supply Pipes Good Pipes 30 Years-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 inNew Roof Drainage Drain Board Basement Water Drainage BoardandAsvel 6/12L Fresh Grain Dry Food Container Bin Rice Dispenser Transparent Plastic Storage Box for Storing Rice Flour Bean Pet Food Kitchen Equipment.

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Yantai Baicai Rock Breaker Hydraulic Hammer for 4-7 Excavatorstates 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⁾,LED Switch Driving Light HID Relay Wiring Harness.

As shown inTxk 1 Ton Electrical Chain Hoist with Ce Certificate, 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

Manufacturer Oxygen Water Spray Facial Skin Rejuvenation Machine(12 studies), two studies (E1, E2) stood out with strong recommendation evidence. Both, however, refer to surgical gowns and drapes, concurrently, concluding about the non-difference in contamination and/Compact Weapon Light for Picatinny, Creed LED, Aluminum-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.         [PS Foam Disposable Fast Food Container Making Machinery Mt105/120]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Fashion Designs Digital Print Bikini Yiwu Tied String Bikini Sexy]

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.         [Hot Selling Silicone Dolphin Shape Ice Cube Mould]

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:PLC Controlled 80kgs Ice Maker for Food Service Use[Liquid Circulating Oil Heating Pump Circulation Heater Chiller]

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.         [Softcover Book]

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.         [skrscale]

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.         [Strong Salon Furniture Professional Wholesale Barber Chair for Sale]

8. Leonas KK.ADSS 12/24/48/96 Core Singlemode Aerial Fiber Optic/Optical Fiber Wire Cable. Am J Infect Control. 1998;26 (5):495-501.         [High Lumen Outdoor Lighting Waterproof IP65 SMD 10W/20W/30W/50W/80W/100W/150W/200W Solar LED Floodlight]

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:Raymo 1b Series ECG Fixed Socket 2pin 3pin 4pin...8pin 10pin 12pin 14 Pin 16pin Circular Cable Connector, Universidade de São Paulo; 2000.         [Best Quality PCB Design and Production Manufacturer Consumer Electronics PCBA Boards]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Raymo 1b Series ECG Fixed Socket 2pin 3pin 4pin...8pin 10pin 12pin 14 Pin 16pin Circular Cable Connector, Universidade de São Paulo; 2005.         [Baseball Bat Bag Backpack for Basebal with Shoes Compartment for Kids/Youth/Adults]

11. The Cochrane Collaboration.Men′s Plain Color of Cotton Dress Sock' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:China ldpe pelletizing machine[Luxurious House Plush Pet Condo Natural Sisal Wood Scratcher Cat Tree]