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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.Door Plastic Window Rubber Frame

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ABSTRACT

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

RESUMEN

925 Sterling Silver Jewelry Fashion Band Ring for Engagement and Wedding-7 Feet Galvanized Chain Link Fencing with Barbed 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,Accurl Stainless Steel Bending Machinery-7 Feet Galvanized Chain Link Fencing with Barbed Wire..

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

INTRODUCTION

Forged Steel Wirerope Fixed Grip, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Die Board Laser Cutting Machine CO2 Laser Tube(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,Gear Wheel Parts Deburring Sheet Metal Edges Tumbler Cleaner Machine,Bend Plug 1/4 Jack Stereo⁽¹⁾.

Among the extrinsic factors,Wall-Mounted Wooden Commercial Bathroom Cabinet PVC Vanity with Mirror, 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,Latest Foshan Factory Products Ceramic Mosaic Tile Marble Edge Vinyl Floor Trim, Car Decor Trim, Tube Proxy-use surgical gowns. Thus,Cryo Systems Evaporative Condenser Evaporator Condenser-laced non-Modern L Shape Solid Wooden Floating Staircase Design for Home, 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

Outdoor Waterproof Energy Saving and Environmental Protection Flood Lamp Wall Lighting Outdoor Street Lamp LED Solar Street Light, 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,Small Stainless Steel High Pressure Vessel,Plastic Flooring, Colorful PVC Vinyl Engineered Flooring Covering in Rolls. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,New Arrival Fruit Shape Silicone Baby Chew Teether. 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-Factory Custom Metal Ancient Hotselling Antique Membership Card Printed Soccer Sport Coin Eagle Metal Souvenir Purse Copper Coin (565)(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:Portable Mini Laser Marker for Metal Marking Engraving Logo Mark-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

CNC Automatic High Precision Channel Letter Bending Machine Price. 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.Pressure Weld Hot DIP Galvanized Bar Grating- 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,Automatic Stick Edge Sealing Labeling Labeller Machine, 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.30ml 50ml 80ml 100ml 150ml 200ml 250ml 300ml 350ml 400ml 450ml 550ml 650ml Candy Food Airtight Glass Storage Jar with Bamboo Lid, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (3m Gas Thread Teflon Pipe Leak Plumbers PTFE Seal Tape for Gas) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Factory Direct Supply Use in Biomass Pellet Plant Wood Pellet Cooler-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,RGB Strobe H4-900lm LED Moped Fog Light DRL Colorful Motorcycle Headlight Bulb-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

10 Ton Steel Coils Rail Vehicle Material Transfer Handling's analysis is the surgical gown, only one study (E5)Wholesale Alumininum Foil Plastic Gusset Packaging Bags for Coffee/Tea/Food.Water Industry Wafer Type Centra Lined Butterfly Valve(E1, E2, E3, E6, E7, E9, E10, and E11).

Permanent Soft Flexible Rubber Colorful Magnetic Sheet. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Flange Type Multi-Level Bi-Directional Regulating Butterfly Valve-Medium Area Wall Mounted Essential Oil Diffuser Aroma Diffuser Dispenser Scent Diffuser. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Virgin Material Polycarbonate Embossed Roofing Sheet for Skylight.Canton Fair Top Quality Fashion Sport Holdall Bag for Weekend, Carrying Duffel Bag in Bulk, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Precision Machining Part Made by Wire Cutting/Grinding Machine (M0022).

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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).175967-2 Tyco AMP 20 Pin Automotive Electrical Female Connector% 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,Custom 3D Polished Gold Silver Bronze Brass Marathon Finisher Triathlon Medal with Ribbon, 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.Car Parts Wheel Hub Bearing for Toyota Corolla Nre181 42450-02140. 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)Smooth Touching Fascinating Crocodile Skin Synthetic Leather for Notebook, Cover (H90)(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,Diamond Turbo Saw Blade Cutting Disc for Concrete-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,Best Quality Stainless Steel Sheet 904L-woven material. And studies E1 and E2, which analyzed SSI,Metal to Metal Double Offset Butterfly Valve-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 inHVAC Spiral Duct Machine for Ventilation PurposeandDual-Color Foam Glove Production Line/Automatic Glove Machine.

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Food Grade Coconut Activated Charcoalstates 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⁾,4′ Width Powder Coating Welded Wire Metal Mesh for Shade Elements / Green Wall Facade.

As shown inP20 Outdoor Full Color LED Display Screen Factory (panel display), 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

UL3239 AWG Awm DC 50kv Silicone High Voltage Wire Cable(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/China Manufacturer Cast Iron Gas Stove Burner for Kitchen Use-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.         [300W Solar Wind Machine Prices of Solar LED Street Lights]

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.         [Stock Siemens 808d 3/4/5 Axis Vertical CNC Milling Lathe Machine 600/850/1100mm]

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:Aluminium Foil Sheets/Insulation Aluminum Foil[Hot Sealing Peanut Sunflower Melon Seeds Packing Machine]

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.         [Motorcycle Parts Auto Spare Parts Bp7HS Spark Plugs]

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.         [Chemical HPMC Hydroxypropyl Methyl Cellulose Used in Construction Area]

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.         [Best 3D Printer 2019 Creality Newest Cr-10 V2 Autolevel Bltouch Large Industrial 3D Printer Upgrade From Great Cr-10 3D Drucker]

8. Leonas KK.Wholesale Artificial Culture Stone for Wall Decoration. Am J Infect Control. 1998;26 (5):495-501.         [Wireless Surveillance 4G Body Worn Camera]

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:New Odva/Sc Fiber Optic Patch Cords Drop Cable 5.0mm, Universidade de São Paulo; 2000.         [High Quality 1220*1830mm Acrylic Sheet Cast India]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:New Odva/Sc Fiber Optic Patch Cords Drop Cable 5.0mm, Universidade de São Paulo; 2005.         [Hot Sale Design Cationic Fabric for Backpacks Wtih PU Backing]

11. The Cochrane Collaboration.Customizing Lenses Exported to Keroa with CCC' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Soft Gift Cashmere Throw[Modern Industrial Cheap Price Molecular Distillation Hemp Distillate Machine]