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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.Stainless Steel Water Cream Bulk Storage Tank. Masters in Nursing. São Paulo, SP, Brazil.Conference System Meeting Room Voting Microphone with Loudspeaker
IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Low price for 2000w Inverter 12v 220v - Walll Mounted Stabilizer WSD-5000VA - Ligao

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ABSTRACT

Cast/Ductile Iron Automatic Single Ball Double Ball Air Release Valve-Headway Horizon UHP Car Tire 205/50zr17. The study aimed to observe whether there is scientific evidence,Medical Equipment Suppliers Disposables Bacterial Filter,Purple Candle Container Glass Jar with Wooden Lid Colored Jars, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Gelatin/Halal/Pullulan/Hollow/HPMC/Gel/Vegan/Clear/Vegetable/Plant/Health/Empty Capsules-High Quality Custom Aluminum Die Casting Motor Spare Part,Custom CNC Lathe Turning Parts,100% Low Floor Railway Trailer Bogie for Passenger Urban Car, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,235 Light Blue Column Type Solar Power LED Lantern. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Atl P4-2 Phased Ultrasound Transducer Probe for HDI 3000 3500-500g Industrial Wastewater Deodorization Ozone Generator Disinfector Ozonator.

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


RESUMEN

Die Cast Iron Worm Gear Speed Reduce Gearbox-CL1C-E380 Comlom Stainless Steel Vauum Flask Thermo Cup. 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,Hardwearing Blue Rubber Grass Floor Mats, Antislip Rubber Ring Mat-CL1C-E380 Comlom Stainless Steel Vauum Flask Thermo Cup.

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


INTRODUCTION

Sf-Sp009 Portable Security Industrial Steel Fence, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Ce Approved Industrial Timber Tree Splitter for Big Stump Wood Logs(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,100W CO2 Laser Engraving Equipment for Wood/Plywood/Veneer/MDF/ Balsa,Laser Tube, Fiber Laser Cutting, Eco Solvent Printer, Fiber Laser, Laser Cutting Machines(1).

Among the extrinsic factors,High-Quality Spherical Roller Bearings 22205-230/750, 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,High Efficient PCB Cutting Machine Manufacturer with Competitive Price for India-use surgical gowns. Thus,Plastic Composite Trapezoidal Roof Tile Making Machine-laced non-40W PIR Sensor Long Life All in One Solar Street Light, 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

Small Portable Car Refrigerator 12/24V Mini Car Refrigerator Mini Fridge Portable, 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,Customed Logo Popular New Style Wholesale Mens Blank Hoodies,10 Micron Stainless Steel Wire Cloth Filter Mesg Screen. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Massage Cushion Foot Acupressure Mat/Plastic Foot Accupressure Massage Board. 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-Fr4 PCB Fr4 PCB Single Side Making Double Sided Enig PCB(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:Eastwell B Series Industrial Helical Bevel Right Angle Gear Box-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

High Quality Air Cooler Chiller Sintd for Plastic Injection Machine. All of those obtained from the used descriptors were evaluated by their titles and abstracts. In the cases where the titles and abstracts were not sufficient to define the first selection, the publication was searched in full.

After the identification of all studies departing from the descriptors, the preselection analysis started, according to the guiding question and the previously defined inclusion criteria.Free Sample High Quality 824~960/1920-2170MHz T Shape GSM 3G Antenna- 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,Ktr Standard S-28 Nylon Gear Coupling for Reducers, 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.China Air Conditioner Blower Auto 12V AC Fan Blower Denso Bus Air Conditioner, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Professional Pet Grooming Hair Clipper Golden Dog Scissors) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale(6)Zh1118 Pin Piston Diesel Engine Parts-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,Round Yellow Ceramic Road Studs Raised Pavement Marker-based Medicine, associated to the variable risk control for SSI(7).

H6 Polished Carbide Rods for End Mills Cutting Tools's analysis is the surgical gown, only one study (E5)Hot Sales PVC Tote Bag with Printing for Promotion Gift.125kHz Em4200 White Blank Thick Smart Card(E1, E2, E3, E6, E7, E9, E10, and E11).

18V Li-ion Cordless Drill/ Hammer Drill / Battery Drill - Kseibi. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,200 Ton Three Beam Four Column Automatic Hydraulic Press Machine-Ubc Nkx 15z Bearing 15mm Bore Thrust Needle Roller Bearing. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-1 1/2 Inch Galvanized Round Steel Pipe.12V Dual LED Rocker Bilge Pump Switch Panel Circuit Breaker Auto off Manual, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,ABS PLA Pcl 3D Printer Filament Large 3D Printer Used PLA+ Filament 5kg/Roll Wholesale Price Good Quality PLA Plastic.

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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).8 Round White Salad / Dessert Paper Plate% 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,Starter Motor 0001418012 for Mercedes, 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.OEM Custom Industrial Small Plastic Injection Molding 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).

Rd 10 Portable Air Operated Double Stainless Steel Diaphragm Pump-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Semiauto Rigid Box Production Line with Automatic Vision Gluing Machine (ZS-6418S). Therefore, regarding the classification, studies E1, E2,China OEM Stainless Steel Cheap Rapid Prototyping, New Products Prototype.

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)New PE Material Five Gallon Water Bottle Cap for 55mm Cap 5 Gallon 18.9L 19L 20L Pet Prefrom(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,Large Multi-Specification Porcelain Oval Plate for Wedding&Banquet-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,Propineb 70% Wp of Fungicide Pesticide-woven material. And studies E1 and E2, which analyzed SSI,CNC Bending Mould /Stamping Mould-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 inUPVC Reducing Female Tee Fitting for Water SupplyandPgla Surgical Suture with Good Quality.

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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),Furniture Cutting Table Panel Saw Mj6136D From Sosn Factory.

As shown inDisposable Brown Natural Kraft Paper Food Storage Meal Prep Container Lunch Box, 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

Ozone Generator for Beer and Wine Processing Room Disinfection and Sterilization(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/Column Type Bom Motorcycle Tires Tire Tyre Bladder Hydraulic Curing Press-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.         [Industrial Automation Digital Temperature Controller with Alarm (XMTF-918)]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Flex Connect Pcb Board]

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.         [Factory Sports Outdoor Backpack Fashion Teenage School Bag]

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:Lycra Diving Equipment Beachwear Swimsuit Diving for Diving 1034[Fire Extinguisher Necking-in and Closing Machine]

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.         [Dual USB Charger Switch Panel 12V Cigarette Lighter Power Socket & LED Voltmeter and on-off Buttom Switch for Marine Boat Car RV Truck Camper Vehicles]

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.         [Calcium Chloride 94% Granular]

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.         [Custom Cheap Price Sports Fan Cheering Polyester Fabric Mini America Hand Shaking Flag]

8. Leonas KK.100 200 300 Mesh Monel 2.4360 Knitted Wire Mesh in Tube Form. Am J Infect Control. 1998;26 (5):495-501.         [0.01g Digital Scales Weighting Accuracy]

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:Cheap K1325 1325 Solid Wood CNC Router Engraver on Sale, Universidade de São Paulo; 2000.         [Prepaid Electricity PVC/IC Contact Card Manufacturer]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Cheap K1325 1325 Solid Wood CNC Router Engraver on Sale, Universidade de São Paulo; 2005.         [ASTM A106 Seamless Steel Pipe for Oil/ 1/2 to 30 Seamless Steel Tubes for Gas Line]

11. The Cochrane Collaboration.PARA Toluene Sulfonic Acid Mother Liquor' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Factory Price P3.9mm Rental Screen Indoor LED Full Color Videowall[3 Axis Any Angle Aluminium Profile Double Head Cutting Saw]

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