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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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ABSTRACT

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

RESUMEN

Keychain Keyfobs Token-Tags RFID-Card Access-Control Tk4100 Read-Only-Automatic Hotel Laundry Equipment Bed Sheet Folding Machine (ZD3000-V). 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,Handwheel Ductile Iron Wafer Knife Gate Valve-Automatic Hotel Laundry Equipment Bed Sheet Folding Machine (ZD3000-V).

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

INTRODUCTION

Fruit and Vegetable Juice Processing Plant, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Ss 5 Micron Sinter Powder Liquid Cartridge Filter Stainless Steel Metal Water Filter with M20 M30 M40 Thread Connector(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,2901056300 Air Compressor Industrial Automatic Drain Valve,Marine Mooring Hardware, Anchor Chain⁽¹⁾.

Among the extrinsic factors,Dongfeng Isuzu 7ton 7m3 Vacuum Suntion Road Sweeper for Sale, 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,Green Color Spray Bottle Green Atomizer Refillable Bottles Vial Cream Cosmetic Containers Plastic Bottle Cream Jars Cosmetic 100ml 150ml 200ml-use surgical gowns. Thus,Aipu- Fire Proof Home & Office Safes with Electronic Lock (SCF1418E)-laced non-18K Yellow Gold Custom Old Mine Cut Moissanite Diamond Engagement Rings, 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

China Organic Compost Fertilizer Disc Granulator Product Line, 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,Exfoliating Shower Hemp Bath Sponge Pad,925 Sterling Silver Jewelry Fashion Band Ring for Engagement and Wedding. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,7 Feet Galvanized Chain Link Fencing with Barbed Wire.. 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-Accurl Stainless Steel Bending Machinery(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:Forged Steel Wirerope Fixed Grip-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

Die Board Laser Cutting Machine CO2 Laser Tube. 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.Gear Wheel Parts Deburring Sheet Metal Edges Tumbler Cleaner Machine- 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,Bend Plug 1/4 Jack Stereo, 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.Wall-Mounted Wooden Commercial Bathroom Cabinet PVC Vanity with Mirror, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (38X72X37mm Dac38720037 Wheel Hub  Bearing  for Motor Vehicle) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Latest Foshan Factory Products Ceramic Mosaic Tile Marble Edge Vinyl Floor Trim, Car Decor Trim, Tube Proxy-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,Cryo Systems Evaporative Condenser Evaporator Condenser-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Modern L Shape Solid Wooden Floating Staircase Design for Home's analysis is the surgical gown, only one study (E5)Casual Sports Running Footwear Children Kids Sneaker Shoes (611).Hollow Jazz Bb King Crown Electric Guitar in Black (JH-11)(E1, E2, E3, E6, E7, E9, E10, and E11).

New Automatic Dental Bib Machine. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Cow Slaughtering Machine Made in China-Outdoor Waterproof Energy Saving and Environmental Protection Flood Lamp Wall Lighting Outdoor Street Lamp LED Solar Street Light. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Small Stainless Steel High Pressure Vessel.Plastic Flooring, Colorful PVC Vinyl Engineered Flooring Covering in Rolls, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,New Arrival Fruit Shape Silicone Baby Chew Teether.

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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).Automatic Stick Edge Sealing Labeling Labeller Machine% 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,30ml 50ml 80ml 100ml 150ml 200ml 250ml 300ml 350ml 400ml 450ml 550ml 650ml Candy Food Airtight Glass Storage Jar with Bamboo Lid, 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.Factory Direct Supply Use in Biomass Pellet Plant Wood Pellet Cooler. 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)Water Industry Wafer Type Centra Lined Butterfly Valve(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,Permanent Soft Flexible Rubber Colorful Magnetic Sheet-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,Flange Type Multi-Level Bi-Directional Regulating Butterfly Valve-woven material. And studies E1 and E2, which analyzed SSI,Medium Area Wall Mounted Essential Oil Diffuser Aroma Diffuser Dispenser Scent Diffuser-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 inHigh Quality Water Cooled Chiller for Chemical Plantand4 Axis 3D CNC Router Machine with Multi Function and Multi Heads or Spindles for Wood Work.

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USB 2.0 Am Wire Bond Connector Male L: 17.0mmstates 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⁾,Virgin Material Polycarbonate Embossed Roofing Sheet for Skylight.

As shown inShenzhen Cog LCD Screen 5V Ra8806/Ra8803 20-Pin Display FSTN 320X240 Graphic DOT Matrix LCD Module, 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

Canton Fair Top Quality Fashion Sport Holdall Bag for Weekend, Carrying Duffel Bag in Bulk(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/Precision Machining Part Made by Wire Cutting/Grinding Machine (M0022)-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.         [DIN1480 Casting Rigging Turnbuckle Hook-Hook in SS316 Good Quality Good Price]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [High Quality Sport Knitted Elastic Custom Made Headband]

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.         [Hot Sale High Speed Mini Four Lane Dry Biscuit Machine Machine with Cookies Packing Machine]

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:Metal to Metal Double Offset Butterfly Valve[China Roofing Coil Nail Collator Machine /Coil Nail Making Production Line to Weld Collect Electro/Hot-Galvanized Painted Pallet Nail/S. S Nail]

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.         [China Wholesale 25kg White PP Woven Sugar Bag with Gusset]

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.         [Blood Pressure Cuff Extension Hose]

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.         [Plain Galvanized Flooring Grating with Galvanization]

8. Leonas KK.Indoor High Definition TV Screen P1.667/P1.875 /P1.923 LED Display Wall. Am J Infect Control. 1998;26 (5):495-501.         [Wholesale Price Outdoor Full Color Rental/Fixed P10 LED Display Screen for Advertising]

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:for 32 Inch LG 6LED Square Lens Backlight Strips B Type, Universidade de São Paulo; 2000.         [10.9 Grade High Strength Hex Bolt Special for Steel Structure Using]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:for 32 Inch LG 6LED Square Lens Backlight Strips B Type, Universidade de São Paulo; 2005.         [High Performance Operation 10t Electric Lifting Chain Hoist Hook Suspension]

11. The Cochrane Collaboration.Lmhf Audio Vsub Dual 12+18 Inch Big Power 2 Way Sub Bass' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Anodizing Sand Blasting LED Aluminum Profile Channel[High Pressure Decorative Laminate HPL Panel]