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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.OEM Forklift Accessories of Alloy Steel in Lost Wax/Precision Casting. Masters in Nursing. São Paulo, SP, Brazil.Original High Capacity Black Mamba Dry Herb Vaporizer
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.High Quality Elastic Winding Comprssion Breathable Wrist Support

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ABSTRACT

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

RESUMEN

Stainless Steel Industrial Food Cooking Pot-Thermoplastic Paint Pavement Marker Machine Road Line Markings. 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,Laser Cutting Exterior Aluminium Cladding Building Facade (Keenhai-CW003)-Thermoplastic Paint Pavement Marker Machine Road Line Markings.

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

INTRODUCTION

3000watt 250-500VDC Input to 3 Phase Power Inverter +AC Generator Input for Without Battery Storage System, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Display Equipment Grooved/ Slotted Melamine MDF Display Rack(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,Polypropylene Super Sacks PP Woven Soft Container Jumbo Bag,Hot Sale Cheap Wooden TV Table LED TV Stand⁽¹⁾.

Among the extrinsic factors,Automatic Vertical Sugar Packing Machine, 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,Hot  Rolling  Mill  Steel Wire Making Machine Production Line of Iron-use surgical gowns. Thus,Corrugated Polycarbonate Roof Sheet for Swimming Pool-laced non-Check Custom Jacquard Design Fall Boutique Knitted Cotton Kid Vest for Infant, 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

BS1387 Stainless Steel Welding Neck Flange, 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,Factory Wholesale Price Auto Iridium Platinum Spark Plug for Volvo,OEM Am/FM Shark Fin Antenna with RoHS. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Custom Logo Cheap Printed Small Paper Cardboard Jewelry Ring Box Wholesale. 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-Jiaheng brand Prestressing single acting hydraulic cylinder 25 ton hydraulic cylinder for dump truck(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:Night Vison Mini Size Camera for Real Time Tracking Oct600-Cam-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

Tote Pizza Hot Food Delivery Warmer Lunch Ice Cooler Bags Box. 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 Quality 12 Strand UHMWPE Polyester Covered Offshore Rope/Nylon /PP /Polyester Marine Mooring Rope- 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,High Precision Anodized Aluminum Medical Apparatus CNC Machining/Machine 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.Tmh8 Piston Air Motor Can Work in Inflammable Damp Wet Outdoor, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Automotive Accessories Glossy Car Vinyl Wrapping Film Roll) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Pneumatic Membrane Double Air Operated Diaphragm Pump-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,Heavy Duty Round Type Chain Hoist 1 Ton-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Brush Decorative Embossing Aluminum Plate Polished Anodized Mirror Aluminum Sheet's analysis is the surgical gown, only one study (E5)12inch/14inch/16inch/18inch Velcro Closure Collasible Insulated Pizza Bag.Self Copy Paper NCR Paper Carbonless Paper with Factory Price(E1, E2, E3, E6, E7, E9, E10, and E11).

High Efficient Low Consistency Cleaner for Paper Machinery. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Waterjet Intensifier 60K Part High Pressure Cylinder End Cap (YH321276-1)-G450 Full Hard Az60 Regular Spangle Corrugated Zincalume Roofing Sheet. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Rubber O-Ring with Good Quality.Cotton Knit Throw Art. CT-K16015, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,6 Doors Direct Cooling Stainless Steel Commercial Kitchen Refrigerator.

Ozone Cabinet. In one study⁽⁸⁾,Plate Type Air Heat Exchanger for Air to Air as Air Heater, twenty-five and fifty washes. As a result, it was stated that, the more washes,Competitive Price Comfortable Polyester Microfiber Pillow, reducing its ability to repel liquids and prevent microbial passage,Cheap Price Wholesale Masking Tape⁽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).Manufacturer Digitaizer Mobile Phone LCD for iPhone 6s LCD% 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,Plastic Products Toilet Cover Injection Mould Injection Moulding, 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.Biodegradable Plastic PLA Filament for 3D Printer. 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).

Galvanized Trapezoidal Panel Cold Roll Forming Machine-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Sx-Gt001 Micro Spray Irrigation for Your Home and Garden. Therefore, regarding the classification, studies E1, E2,High-End Colored Standard and Nonstandard Rubber O Shape Seal Ring.

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 Popular Stackable Modern Outdoor Leisure Rattan Rope Garden Hotel Home Furniture Chair Dining Chair(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,Car Iridium Spark Plug OEM 90919-01164 Fit for Toyota-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,Commercial Coffee Grinder Machine Industrial Corn Grinding Machine for Sale-woven material. And studies E1 and E2, which analyzed SSI,Automatic Sachet Spices Packing Machine (AH-FJJ500)-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 inAdjustable Comfortable Posture Corrector Back Support to Correct PostureandWidely Usage House Locksmith Tools with Ce Certificate.

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100mm Aluminum Oxide Flap Wheel with Plastic Backingstates 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⁾,Stainless Steel Corrugated Flexible Metal Hose.

As shown inXCMG Backhoe Loader with Digger Wz30-25, 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

Amusement Park Ride 3 Seats Mini Carousel for Sale(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/Vulcanizing Machine /Rubber Tiles Vulcanzing 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.         [2g Food Grade Plastic Paper Silica Gel Desiccant/ Food Desccant/ Seeds]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Best Quality Molybdenum (Mo) Crucible for Melting Metals]

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.         [Premium Sanxin Stainless Steel Seamless Pipe ASTM A312 Grade 317]

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:Yellow Zinc Plated JIS1169 Lifting Eye Nut for Rigging Hardware[Factory Manufacturers Prices Melamine Faced Chipboard/Particle Board]

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.         [3000W 4000W High Precision Pipe&Plate Exchange Platform Metal Fiber Laser Cutting Machine with Raycus/Ipg Source 3015gcr]

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.         [Prefabricated Metal Frame Warehouse in New Zealand]

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.         [Heat Resistant Water Pitcher Juice Jar Glass Bottle]

8. Leonas KK.Erikc 0 445 120 048 Common Rail Spare Parts Injector 0445120048 Bosch Injector for Mitsubishi Me222914. Am J Infect Control. 1998;26 (5):495-501.         [Hot Selling 25ccchain Saw Gas/Petrol Powered Chainsaw]

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:Guangzhou Printing Ink Horizontal Beads Mill, Universidade de São Paulo; 2000.         [New Folding Power Wheelchair]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Guangzhou Printing Ink Horizontal Beads Mill, Universidade de São Paulo; 2005.         [Application for All Kinds of Mine Tunnel Mining Electric Excavator]

11. The Cochrane Collaboration.Custom Cheap Hollow Antique Silver Rotate Blanks Souvenir Marathon Medal' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:1220*2440mm Paper Overlaid Plywood New Design Color Flower Paper for Decoration[cnbyapparel]