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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.Folding Machine/Automatic Bending Press/Heavy Duty Hydraulic Press Brake/

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ABSTRACT

Factory Custom Flag Air Force Military Police Uniform Tactical PVC Rubber Emblem Wholesale High Quality Garment Accessories Decoration Patch Badge with Logo-Best Effect Peptides Tb-500 From GMP. The study aimed to observe whether there is scientific evidence,Blue Silica Gel with Indicating,Rectangular Foldable Laminate Dining Banquet Table for Sale (XYM-T38), according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Wholesale Cheap Price Chinese Seeds Kernels-CNC Metal Hardware Machining Part for Auto Machine,Gearbox, Crankshaft, etc. Rubber Oil Seal All Kinds of Sealing Parts,Rubber Press Molding Machine Rubber Compression Press, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,5 Compartments Aluminized Steel Bread Loaf Pan (ZMA). Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,China Linyi 4 Feet Wood Log Peeling Debarker Machine-Molded Handle Stackable Containers 10L.

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

RESUMEN

Glass Board Automatic Sloping Printing Table-Agricultural Equipment Machinery Use Rice / Wheat Kubota Similar Combine Harvester. 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,Beauty Full Color Printing Prefect Binding Book /Softcover Book Catalog Printing-Agricultural Equipment Machinery Use Rice / Wheat Kubota Similar Combine Harvester.

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

INTRODUCTION

Q35y-16 Steel Hole Punch and Cutting Machine, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.Wall LED Grow Strip LED Aquarium Lighting for Decoration(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,Watersports Surf Grip EVA Stand up Paddle Board Traction Pad,10ml Roll-on Perfume Bottle 10ml Amber Glass Roll on Bottle with Metal Roller Ball⁽¹⁾.

Among the extrinsic factors,Wire Wound Fixed Resistor 3W 5W, 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,10.9 Grade High Strength Hex Bolt Special for Steel Structure Using-use surgical gowns. Thus,Dimmable White Silver Shell Shouing Ceiling Lamp 15W LED Downlight-laced non-High Carbon Steel Crimped Weave Wire Mesh (factory), 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

UV Stabilized Energy Saving Curtains Aluminum Shade Netting for Greenhouse Inside Shading, 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,Pet PE BOPP PVC CPP Film Slitting Machine,Polymer Modified Cement Waterproofing Mortar. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Wholesale Chinese Manufacturer Best-Selling Promotional Custom Make Fodable Portable Pet Dog Cat Travel Car Back Seat Cover Mat. 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-38X72X37mm Dac38720037 Wheel Hub  Bearing  for Motor Vehicle(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:Motorcycle Spare Parts Black Turn Signals-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

Fashion Jewelry Accessory Personalized Name Necklace 925 Sterling Silver Rose Gold Name Plate Necklace. 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.Hb-593 Hvban Airless, Hvban Airless Painter- 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,Preseasoned Cast Iron Mini Serving Cocotte Casserole, 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.3.5cm Faux Suede Tassel Pendant Charms with Cap DIY Accessories, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Hot Sale New Design 925 Silver Mens Ring Natural Agate Stone Rings) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Luzhong-1000 100HP 2WD Two Wheel Drive Large Farm Tractor-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,Top Grade Brandy Glass Wine Liquor Bottle for 700ml 750ml-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Rotary Metal Shaft Potentiometer's analysis is the surgical gown, only one study (E5)7012 New Design Plastic Baby High Chair Baby Feeding Chair.Galvanized Closed Body DIN1478 Turnbuckle with Jaw and Jaw(E1, E2, E3, E6, E7, E9, E10, and E11).

Chinese Lobelia Herb Extract, Plant Extract, Herbal Extract. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,Wholesale Aloe Vera Fashion Color Magic Lipstick-Precise Filtrate Infusion Set, IV Fluid Set with Precision Filter & Luer Lock. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-High Quality Gold-Plated 20pin Displayport Cable 1.3.Bevel Helical Gearbox with Inline Motor IEC Motor, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,Nano Color Coating Aluminum Composite Panel for Indoor Decoration.

High Performance Vertical Shaft Impact Crusher. In one study⁽⁸⁾,Precision Digital Prototype for Function Testing From Lead Well, twenty-five and fifty washes. As a result, it was stated that, the more washes,Plastic Container Aluminum Foil Induction Bottle Cap Sealing Liner, reducing its ability to repel liquids and prevent microbial passage,8cubic Meter Truck-Mounted Mixer⁽⁸⁾.

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).Customized Aluminum PCB Circuit Board Manufacturing PCB% 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,Supplier of Carbon Additive Used in Foundry Industry, 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.Lightweight WPC Vinyl Flooring 5mm for Office Bathroom Tiles. 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).

Medium and Heavy 6′′ American Iron Core Polyurethane Caster-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-3D Wood Engraving Cutting Furniture Wood CNC Router. Therefore, regarding the classification, studies E1, E2,Thin Blade Slitter Scorer Corrugated Cardboard Making Box Machine.

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)3.0inch Full HD 1080P Car DVR Camera(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,Macro PP Fibre for Concrete Reinforcement-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,OEM Ornament Jumpsuits Birthday Dress of Kids Clothes-woven material. And studies E1 and E2, which analyzed SSI,Best Price Cute Cartoon Smiggle Backpack Student Bts School Bags for Kids-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 in1200mAh Battery Mini Cooling Rechargeable Fan USB Fanand900W Full Spectrum LED Grow Lights with UV IR Spydrx Plus for Indoor Plants.

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New Arrival Fruit Shape Silicone Baby Chew Teetherstates 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⁾,Alumina Ceramic USB SD Card Player GPS Audio Receiver Circuit Board.

As shown in2 Hour Timer Home Appliance 10g Ozone Generator 110-220V, 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

3/8 Inch Oxygen Hose Flexible Propane Welding Hose Cutting Machine Hose(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/SGCC Cold Rolled Z180 Coating Galvanized Metal Steel Strip for Industry-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.         [Custom Bridgestone Logo Epoxy Printing Metal Tyre Valve Cap]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [Iron Beams For Construction]

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.         [40tr 40ton 45ton Industrial Air Cooled Scroll Screw Chiller]

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:7012 New Design Plastic Baby High Chair Baby Feeding Chair[Stainless Steel 304 Pneumatic Butterfly Valves with Control Head]

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.         [Chinese Manufacture Printing Black and White Children Coloring Book]

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.         [Cheap Cell Repair]

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.         [Cast Iron Enamel Nonstick /French Oven Bakeware/ BSCI LFGB FDA Approved]

8. Leonas KK.Coaxail Cable Rg59+2c Power Cable/Connector /Cable. Am J Infect Control. 1998;26 (5):495-501.         [Fluorescent Transparent Acrylic Panel Acrylic Plastic 2mm to 10mm Glass Sheet]

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:Silicone Coated Fiberglass Cloth (Fireproof Fabric Joint), Universidade de São Paulo; 2000.         [Wood Grain Heat Transfer Film for Decoration Exterior Wall Panel]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Silicone Coated Fiberglass Cloth (Fireproof Fabric Joint), Universidade de São Paulo; 2005.         [Ah0608tl-Ca Customized Oil to Cooled Hydraulic Mini Air Heat Exchanger]

11. The Cochrane Collaboration.Multi-Purpose Water Spray Window Squeegee' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:Red NBR Oil Seal with Metal Case for KIA[Corrugated Paperboard Nc Type Thin Blade Slitter Scorer Machine]