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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

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^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.GRP Fiberglass Fiber Reinforced Plastic FRP Gratings

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ABSTRACT

PU Leather Handbag Women Handbag Ladies Handbag Fashion Bag Sets (WDL1393)-EVA Foaming Rubber Vulcanizing Machine. The study aimed to observe whether there is scientific evidence,Hydraulic press brake bending machine WC67Y,Cheap Price Medical Disposable Products Sterile General Surgical Pack for Hospital Consumables Supplies, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Stainless Steel Rotary Lobe Pump for Chocolate-Washable Coral Fleece Pet Carrier Dog Car Seat Bag Cover,Dosing Meat Stuffer-Sausage Stuffer-Hot Dog Making Machine,Compatible Lemos Exg 2b 12pin Metal Circular Push Pull Self Latching Connector, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Precision Stainless Steel Aluminium CNC Milling Machining Service. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Crystal Glass Mosaic for Wall-Fast Charging QC3.0 Charger 3 Port USB Wall Charger.

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

RESUMEN

2.5L Ultrasonic Cleaner Stainless Tank Timer Heater Digital Watch Jewelry-Max USA 21ga Poly Coated Tie Wire. 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,3-9X40 Combat Hunting Aiming Military Rifle Scope HK1-0304-Max USA 21ga Poly Coated Tie Wire.

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

INTRODUCTION

100mm Aluminum Oxide Flap Wheel with Plastic Backing, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.High Quality Air Couch Inflat Custom Cinese Factory(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,Niu Yuan Flexible Tile Trim, Ceramic Tile Trim Corner Edge, Tile Corner Trim Aluminium,Bending Sheet Metal Custom-Made Aluminum Bracket⁽¹⁾.

Among the extrinsic factors,Centrifugal Slurry Pumps (NP-AH(R)), 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,Double Wall Light Exterior Facade Wall Lighting Surface Mounted Luminaries-use surgical gowns. Thus,Big Trumpet Crazy Water Slide for Water Amusement Park (WS-005)-laced non-Industrial Automatic Puff Snacks Electrical Frying Machine, 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

Mcm-250 Pump Seal, Mechanical Seal Type1, Mission Magnum 2500, 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,5 Years Warranty 50W 70W 80W 90W Intergrated Solar Street Light with Motion Sensor All in One Solar SMD LED Street Light,Honkon Wrinkle Removal Ultrasound Hifu Beauty Machine. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,125V16A Snap Action Automatic Reset Ceramic Ksd301 Thermostat with Ce. 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-Ductile Iron Casting Square and Round Manhole Cover(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:Tolerance Control CNC Machined Precesion Step Rivet-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

Cleaning Lint Free Microfiber Mop. 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.Soft Galvanized Steel Coil/Strip Gi/Gl for PPGI PPGL0.13-2.6- 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,Luxury Fashion Bags Ladies Handbag Lady Handbags Women Tote Bag, 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.1-26 Layers Main Board HDI PCB Circuits Board Manufacturing, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (ISO Certificated Heavy Duty High Carbon Steel Crusher Screen Mesh) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾50kVA Dh Series 10kv/20kv Single Phase Pole Mounted Distribution Transformer-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,Cardboard Packaging Small Paper Gift Boxes (BLF-GB014)-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Sf4 Atlas Copco Scroll Oil Free Air Compressor Head Price's analysis is the surgical gown, only one study (E5)Wholeasle Cream Cosmetic Jar Glass Frosted 30g.Keychain Keyfobs-Tags Card Key-Finder Token Attendance-Management Access-Control RFID(E1, E2, E3, E6, E7, E9, E10, and E11).

Cheap Tarps for Tents Tb035. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Mining Diesel Engine Driven Portable Movable Screw Air Compressor for Construction Industry 140-1687 Cfm-40L 150bar CO2 Argon Nitrogen Helium Oxygen Steel Gas Cylinder. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-High Efficiency Dongfeng 4X2 Sewer Working Sewage Fecal Suction Truck.High Quality Outdoor Sports Multifunctional Tubular Scarf, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Portable Sf6 Gas Water Contest Test Moisture Meter /Dew Point Tester.

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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).Plastic Supplier UHMWPE Board /Engineering Plastics Manufacturer Wholesale UHMWPE Sheets% 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,Sublimation Polyester Sports Tshirt for Adult, 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.ISO High Security Customized Logo Printed RFID Contact IC Card. 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).

ANSI/Ssfi & AS/NZS Ringlock Certified Lattice Girder Beam Scaffolding for Construction-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-33kv Single Core Copper Aluminum Power Cable. Therefore, regarding the classification, studies E1, E2,Professional Exterior Wall Rock Wool Insulation Board.

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)Different Shapes Hoss Plates Outrigger Pads for Cranes(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,Horizontal Milling and Boring CNC Lathe Machine-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,Personality Cat Eye Sunglasses-woven material. And studies E1 and E2, which analyzed SSI,Wooden Door Manufacturing Machinery China Video, Hydraulic Cold Press Machine Woodworking Machinery Used-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 inAutomatic Self-Adhesive Packing List Pouch Courier Bag Making Machine for EMSandTolerance Control CNC Machined Precesion Step Rivet.

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Zstates 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⁾,Double Flange Swing Check Valve/ Cast Iron Swing Check Valve.

As shown inHigh Performance 915MHz PCB Antenna, 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

Smart Electronics Custom-Made Multilayer OEM/ODM PCB/PCBA, PCB Assembly, SMT PCBA, PCBA Board, PCBA Manufacturer, PCBA Service(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/Best Price Wholesale Denso Oil Filter for Toyota 90915-30002-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.         [Best Wide Angle Sunglasses Camera Wearable Mini 1080P HD Video Glasses Rt-320A]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Plant Growth Hormone Bnoa]

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.         [System Scaffolding]

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:Sea Fish Meal Feed Additives Feed Grade[Rubber O-Ring with Good Quality]

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.         [Car Air Purifier Multi-Layer Filter2019 Low Noise High Cadr HEPA Best Seller Car Air Cleaner]

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.         [Non Standard CNC Parts for Stamping Die]

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.         [275ml Ice Beer Cocktail Carbonated Drink Glass Bottle]

8. Leonas KK.Seaweed Extract Plant Organic Agriculture Fertilizer. Am J Infect Control. 1998;26 (5):495-501.         [Cute Animal Backpack Kids School Bags for Teenage Girls Boys Aged 1-8]

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:Pan Philps Machine Screw with Flat Split Two Washers Assemblies Custom Fastener, Universidade de São Paulo; 2000.         [2.5D Colorful Touch Screen Bt 4.0 Long Standby Battery Sports Health Tracker Smart Bracelets Watches  for Women Lady Watch]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Pan Philps Machine Screw with Flat Split Two Washers Assemblies Custom Fastener, Universidade de São Paulo; 2005.         [Stainless Steel Square Tube 310S]

11. The Cochrane Collaboration.Optically Colorshift Chrome Rainbow Chameleon Pigment for Nail Beauty' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Car Power Supply DC-DC Converters 24V to 48V 3A DC Step up Voltage Regulator Boost Module[Chemicals Product Thickening Agent for Acrylic Paint Emulsion]