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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.Medical HIV1+2 Rapid Test HIV Home Use Test Kits. Masters in Nursing. São Paulo, SP, Brazil.Weatherproof Heavy Duty Patio Globe Bulb String Lights
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.6000PCS/H Automatically Paper Recycling Egg Tray Moulding Machine

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ABSTRACT

1750r/Min Power Tools Battery Drywall Sander Price-Wholesale 4 Holes 18L Shirt Resin Button. The study aimed to observe whether there is scientific evidence,A1021 Mini Facial Radio Frequency Face RF Lifting Skin Tightening for Sale,WiFi Remote Control Draw out Intelligent Air Circuit Breaker, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Custom Anti UV Sun Protection Quick Dry Jacket Lightweight Windbreaker-Bst 2 Cubic Meter Automatic Rotating Drum Cement Sand Mixer,Engine Parts Crankshaft for Yanmar 4tne88 4tne84/4tne98/3tnv75/3tne82/3tnv78/4tnv106,High Quality Women′s Suit in Reasonable Price, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Disposable Trocar for Laparoscope. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Custom Polyester Printing Table Cloth (B-NF18F05011)-Low Cost Commercial Plastic Film Greenhouse for Sale.

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

RESUMEN

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

INTRODUCTION

Outdoor CPE for Wireless IP Camera and WLAN (TS202F), for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Plastic Water Bottle Lemo Fruit Juice Water Bottle(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,China multi jet dry type small Dn15-20 water meter,Ffp3 Respirator, Without Valve, Cone Style⁽¹⁾.

Among the extrinsic factors,Haivol High Voltage 12/20kv Cold Shrinkable 3 Cores Indoor Terminal Kit (Applicableof cable crosssection 300), 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,Waterproof Generic Blue Black Yellow Coarse Foam Media Filter Pads-use surgical gowns. Thus,2019 Newest Retro Hand Bag Real Leather Shoulder Business Bag for Man-laced non-New Isuzu 6X4 Prime Mover for Sale, 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

Eco-Friendly PVC Foam Board for Advertising, 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,400mm Laser Welding Diamond Saw Cutting Blade for Cutting Concrete,Work Planner Memo Pad School Office Supplies Scratchpad Stationery (B8732). Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,7ml Glass Jar for Cream, Make up, Eye Shadow, Nails, Powder, Oils, Waxes, and Shatters Neatly. 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-Mini Fridge 12V 240V Cooler and Warmer Box for Car(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:Homei 14pcsx30W LED Wall Washer Lighting-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

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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.Large Format Transfer Press, 32X40/40X48Large Heat Press- 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,Drawing Design Extrusion Aluminum Profile Enclosures for Electronics Instruments, 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.2 Wheel Self Balancing Electro Scooter Hoverboard with LED, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (China Supplier Motorcycle Accessories Aluminum CNC Chain Adjuster) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Light Kinetic Kinetic Lights DJ Mixer Disco Ball-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,Colored Palm Coated PVC Dotted Cotton Gloves with Logo-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

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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).Orient Type 56 Inch Electric AC Aluminum Blades Ceiling Fan% 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,Warnning Anti-Slip Rubber PVC Floor Tactile Tiles, 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.Food Industry Plastic Crate Cleaning Pallet Tray Washer Washing Machine. 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).

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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)Fun New Stylish Convenient Mini Silicone Facial Cleansing Brush(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,FRP Fiber Glass Reinforced Plastics Pultruded Profile-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,3 PC SS304 Air Actuator Ball Valve-woven material. And studies E1 and E2, which analyzed SSI,Art Design 8.3mm Engineered Wood Flooring HDF Unilin Click Class31 Crystal Surface Laminate/Laminated Flooring-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 inOutdoor Travel Sport Multifunction Stylish Shoulder Backpack Men Crossbody BagandCheap Price Wholesale Masking Tape.

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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⁾,Galvanized Steel Bar Reinforcing Mesh Construction Reinforcement Mesh.

As shown inNew Products Free Samples Sexy Rose Self Adhesive Pasties Stripper Nipple Covers, 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

Tobemac Small Easy Pan Mixer for Sand Cement Concrete Mixing(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/20W Max Fiber Laser Marking Machine Price for Metal Battery-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.         [Spin Typical Semi-Automatic Car Wash Machine]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [A1021 Mini Facial Radio Frequency Face RF Lifting Skin Tightening for Sale]

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.         [Remote Control Valves Electronic Electric Motorised Motorized 90 Angle Stroke Actuator]

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:3 in 1 Super Fast Ceramic Heating Hair Straightener&Curling Tongs[Custom Conical Adjustable Compression Tension Springs with Factory Price]

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.         [Bamboo Tablet Stand Laptop Rack Bt-2212]

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.         [OEM Service for Aluminum Die Casting /Sand Casting/Investment Casting]

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.         [Outdoor Equitment Durable Cmouflage Snow Wear for Hunting Paintball Games]

8. Leonas KK.30W Portable CO2 Laser Engraving Marking Machine Wood Metal Fiber /Laser Printer. Am J Infect Control. 1998;26 (5):495-501.         [Corrugated Carton Box Nc Cutting Machine]

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:Dz-700 Bread Automatic Inflatable Packing Machine, Universidade de São Paulo; 2000.         [Fs4183 Quarter Turn Automatic Reset Cam Latch with Keyless for Electronic Cabinet Door]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Dz-700 Bread Automatic Inflatable Packing Machine, Universidade de São Paulo; 2005.         [Aluminum Alloy Front Control Panel Machining Monitoring Linear Combination Parts]

11. The Cochrane Collaboration.Outdoor High Brightness P6/P8/P10 LED Display Screen for Commercail Advertising' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Diamond Rhinestone Welding Machine[Polyurethane Waterproofing Price]