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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.Fractional Laser Vaginal Tightening Stretch Marks Removal Beauty Salon Instrument. Masters in Nursing. São Paulo, SP, Brazil.3/8 Inch Oxygen Hose Flexible Propane Welding Hose Cutting Machine Hose
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Good Quality Car Air Filter

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ABSTRACT

Automatic Plastic Crusher Blade Knife Grinding Sharpening Machine Sharpener-Firesafe Low U-Value Standard Fix Cement Board Properties. The study aimed to observe whether there is scientific evidence,Beveragejuice Soda Drink Energy Drink and Beer Pull Ring Cap,10L 240W Motor Tools Digital Ultrasonic Ultrasound Cleaner Washer with Heating Ultrasonic Power Adjustable, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Flat Lipo Single Cell 25ah 33ah 40ah 50ah 100ah 200ah LiFePO4 Prismatic Pouch Cell-High Quality Reliable Electric Hotel Towel Folding Machine,High Quality Custom Promotional Silicone Bracelet, Adjustable Silicon Wristband,Ce Certificate High Security Steel Shackle Padlock, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Best Sale Disposable Bed Felt Mattress Protector. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Single Row Deep Groove Ball Bearing 62 Series (6200 6201 6202 6203 6204 6205 6206 6207 6208 6209 6210) Manufacturer-Cable Wrapping Material-Aluminum Foil Jumbo Roll for Cables&Flexible Duct.

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

RESUMEN

Stainless Steel Cooking Pot for Sale (China Supplier)-Sheet Metal Fabrication-Stainless Steel Cabinet. 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,Hospital Medical Garbage Sterilizer with Microwave Disinfection Disposal Infectious Garbage Treatment 3-Sheet Metal Fabrication-Stainless Steel Cabinet.

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

INTRODUCTION

Hydrogenated C9 Resin for Hot Melt Adhesive with Water Color and Odourless with Reach Certificatation, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.High Speed PVC Extrusion for Insulation Electrical Wire House Wire(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,Custom Best Selling Extruded Silicone Strip,Best Projection Clock with Outdoor Temperature for Household⁽¹⁾.

Among the extrinsic factors,Ce Wood Shredder Machine Electric Start Firewood Processor Log Splitter, 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,Mc4 Connector IP67 Waterproof TUV for Solar Photovoltaic Energy System-use surgical gowns. Thus,Air Cooled Screw Water Chiller and Heat Pump-laced non-Newest Men Wooden Sunglasses Polarized Man, 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

High Polished Surface Chemical Resistant White Zirconia Ceramic Spacers, 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,Used Beer Water Cooled Magnet VSD Screw Air Compressor High Quality Stationary Atlsa Copco Ga VSD Air Compressor,Disposablenonwoven/PP/Asbestos/N95/Ffp3/Chemical/Breathing/Pollen/Safety/Particulate/Gas/Paint/ Filter/Protective/Mine/Woodworking/Dust/Face. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Manufacture Universal Vertical Knee--Type Milling and Drilling Machine M4 with Dro Drilling and Milling Machine. 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-High Quality Horizontal Reducer Bwd3 Cycloid Reducer Gearbox Planetary Reductor(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:Galvanized Steel Wire Scourer Metallic Scourer for Cleaning-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

Wholesale New Mini Touch Screen Outdoor Wireless A8 Bluetooth Speaker. 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.40Hz 250Hz Rated Power 1000 Watts Dual 15 Inch Active Powered Line Array Bass Speaker Subwoofer- 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,Exhaust Manifold Air Cleaner Breather Heat Riser Tube Hose, 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.Chinese Printer Spare Parts for Epson Dx5 /5113 Machines, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (12000bph Big Capacity Pure Mineral Water Bottle Blowing Washing Filling Capping Labeling Packing Machine) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Paulownia Wood Primer Window Shutter Components-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,High Frequency Vacuum Timber Dryer-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

External Wall Material Panels/Aluminum Composite Sheet's analysis is the surgical gown, only one study (E5)900W Full Spectrum LED Grow Lights with UV IR Spydrx Plus for Indoor Plants.DC 12V 24V 10L Portable Home Use Car Cooler Mini Fridge(E1, E2, E3, E6, E7, E9, E10, and E11).

122X36X6cm UV Resistant Polyethylene Good Quality Recovery Board. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,(SS304 S316) Stainless Steel Conveyor Chain-2 Years Warranty 48V 11.6ah Dolphin Down Mounted Lithium Battery Down Tube Li Ion Shark Pack E-Bike Rechargeable Battery USB Charge Port 18650 by 13s4p. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Xcjq Pharmaceutical Manufacturing Vacuum Cleaner of Dust Removing Machinery.Atlas Copco Compressor Spare Parts Service Kit 2901074800 2904015600 2906009600, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Precision Large 3 Axis Bench Metal Small Milling Machine (XQ6226B).

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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).Coffee Vending Machine Electromagnetic Favourable Price Wholesale Inductor Qi Rx Coil% 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,Oil Pipeline Breakaway Valve for Vapor Recovery Nozzle, 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.Cheap Children EVA Pop up 3D Puzzle Card Book Printing. 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).

China Factory Direct Automatic Laminating Vacuum Membrane Press Machine-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Chinese Supplier Good Price Exquistie Craftsmanship Plastic Reamer. Therefore, regarding the classification, studies E1, E2,(SP-EC489) Wholesale Cafe Restaurant Used Solid Wood Dining Chair.

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)Kraft Paper Lunch Box Disposable Salad Box Food Takeaway Packaging Box(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,8.8 Grade DIN931 DIN933 DIN934 Black Steel Hex Bolts-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,Multi-Function High Capacity Double Layers Co-Extrusion Big Sized Ce Certificated PE Plastic Agricultural Film Blowing Machine-woven material. And studies E1 and E2, which analyzed SSI,Customized Size Neodymium NdFeB Square Strong Magnet with Nickel Plated-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 inSolar LED Lamp for Orchard/Garden Solar Lightings Outdoor Lightingand1.6 Ton Hand Lifting Tool Lever Chain Block.

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PVC Vinyl Coated Tarpaulin Anti UV Fabricstates 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⁾,10 M City Bus Benz Chassis Birkom Shock Absorber Maintain Spare Parts Damper.

As shown inFlexible Liquid Silicone Medical Grade Silicone Menstrual/Venus Cup, 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

Aluminium Foil Sheets/Insulation Aluminum Foil(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/Control Keyboard Pet Printing Circuit Waterproof Membrane Switch with Housing-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

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2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Impact Sound Isolation Wall Clip]

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.         [48V off-Grid Solar Pure Sine Wave Inverter 3000W 4000W]

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:2019 Top Cover Mold Custom Design Mould[Garden Tools Lawn Irrigation 1/2 Plastic Impulse Sprinkler with Spike]

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.         [Custom 3D Polished Gold Silver Bronze Brass Marathon Finisher Triathlon Medal with Ribbon]

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.         [Fire Fighting Ductile Iron Grooved Pipe Flange and Fitting]

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.         [Plastic Products Compact Powder Case Cosmetics Packaging]

8. Leonas KK.Hot Rolled A3 Mild Steel Plates (Q235A, Q235B, Q235C, Q235D). Am J Infect Control. 1998;26 (5):495-501.         [Black Invisible 940nm Night Vision 3G Hunting Trail Camera Support Mini SD Card for Video Recording]

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:Arc Tooth Industrial Rubber Timing Belt Synchronous, Universidade de São Paulo; 2000.         [Pattern Stainless Steel Coil]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Arc Tooth Industrial Rubber Timing Belt Synchronous, Universidade de São Paulo; 2005.         [Any Size 50*30mm Custom Engraved Name Soldiers Military Steel Dog Tag Pendant]

11. The Cochrane Collaboration.High Pressure Hydraulic Bsp Female 60 Degree Hose Fittings' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:New Style P5 Mirror LED Video Display Screen for Hotel Wedding[Commercial Hotel Banquet Stacking Wedding Chair for Sale (BR-IM030)]