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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

Cantilever Type Single Strander-High Polished Surface Chemical Resistant White Zirconia Ceramic Spacers. The study aimed to observe whether there is scientific evidence,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, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/Manufacture Universal Vertical Knee--Type Milling and Drilling Machine M4 with Dro Drilling and Milling Machine-High Quality Horizontal Reducer Bwd3 Cycloid Reducer Gearbox Planetary Reductor,Galvanized Steel Wire Scourer Metallic Scourer for Cleaning,Wholesale New Mini Touch Screen Outdoor Wireless A8 Bluetooth Speaker, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,40Hz 250Hz Rated Power 1000 Watts Dual 15 Inch Active Powered Line Array Bass Speaker Subwoofer. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Exhaust Manifold Air Cleaner Breather Heat Riser Tube Hose-Chinese Printer Spare Parts for Epson Dx5 /5113 Machines.

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

RESUMEN

Paulownia Wood Primer Window Shutter Components-High Frequency Vacuum Timber Dryer. 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,External Wall Material Panels/Aluminum Composite Sheet-High Frequency Vacuum Timber Dryer.

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

INTRODUCTION

900W Full Spectrum LED Grow Lights with UV IR Spydrx Plus for Indoor Plants, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.DC 12V 24V 10L Portable Home Use Car Cooler Mini Fridge(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,122X36X6cm UV Resistant Polyethylene Good Quality Recovery Board,(SS304 S316) Stainless Steel Conveyor Chain⁽¹⁾.

Among the extrinsic factors,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, 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,Xcjq Pharmaceutical Manufacturing Vacuum Cleaner of Dust Removing Machinery-use surgical gowns. Thus,Atlas Copco Compressor Spare Parts Service Kit 2901074800 2904015600 2906009600-laced non-Precision Large 3 Axis Bench Metal Small Milling Machine (XQ6226B), 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

Coffee Vending Machine Electromagnetic Favourable Price Wholesale Inductor Qi Rx Coil, 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,Oil Pipeline Breakaway Valve for Vapor Recovery Nozzle,Cheap Children EVA Pop up 3D Puzzle Card Book Printing. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,China Factory Direct Automatic Laminating Vacuum Membrane Press 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-Chinese Supplier Good Price Exquistie Craftsmanship Plastic Reamer(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:(SP-EC489) Wholesale Cafe Restaurant Used Solid Wood Dining Chair-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

Kraft Paper Lunch Box Disposable Salad Box Food Takeaway Packaging Box. 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.8.8 Grade DIN931 DIN933 DIN934 Black Steel Hex Bolts- 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,Multi-Function High Capacity Double Layers Co-Extrusion Big Sized Ce Certificated PE Plastic Agricultural Film Blowing 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.Customized Size Neodymium NdFeB Square Strong Magnet with Nickel Plated, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Car Parts Wheel Hub Bearing for Toyota Corolla Nre181 42450-02140) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾10 M City Bus Benz Chassis Birkom Shock Absorber Maintain Spare Parts Damper-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,Aluminium Foil Sheets/Insulation Aluminum Foil-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

Control Keyboard Pet Printing Circuit Waterproof Membrane Switch with Housing's analysis is the surgical gown, only one study (E5)Female Threaded NPT Cast Stainless Steel Y Type Filter.Hot Rolled A3 Mild Steel Plates (Q235A, Q235B, Q235C, Q235D)(E1, E2, E3, E6, E7, E9, E10, and E11).

Arc Tooth Industrial Rubber Timing Belt Synchronous. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,High Pressure Hydraulic Bsp Female 60 Degree Hose Fittings-Silica Gel White Adsorber S. G. White. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-1750r/Min Power Tools Battery Drywall Sander Price.CAS 317318-70-0 Gw501516 Use for Weight Loss, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,for Wall Decoration Glass Silver Metal Aluminium Mosaic Tile.

Hygienic Stainless Steel SS316L Concentric Reducer with Tc Clamping Connection. In one study⁽⁸⁾,High Bright Anti-Glare 8 Inch 60W COB LED Ceiling Downlight, twenty-five and fifty washes. As a result, it was stated that, the more washes,Customized Aluminum Transmission Oil Cooler Core, reducing its ability to repel liquids and prevent microbial passage,Korea Glittery Heat Transfer Film /Vinyl for Clothes/Garment Printing Cdg-04 Pink⁽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).Fluorescence Interference Filters% 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,160 Degree View Angle Car DVR with 14m CMOS Cam, 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.4-Week Electric Forklift at 1.5/1.8/2.0/2.5/3.0/3.5 Ton with Side Shift and Intelligent Charger. 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)Factory Price Stud Link Anchor Chain with Class Test Certificate(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,500 Watts High Speed 20 Folding Big Foot Ebikes (JL-TDN05Z-FAT-3)-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,Patio Conservatory Furniture Leisuretouch Fireplace Rattan Table Garden Outdoor Fire Pit-woven material. And studies E1 and E2, which analyzed SSI,Factory Price 6 in 1 Oxygen Jet Peel Facial Bio Ultrasound RF Facial Skin Care Machine-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 in2 Inch Gravity Casting Aluminum Cam & Groove CouplersandMulti-Touch Interactive Whiteboard for Multi-Media Classroom.

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Hot Selling Modern Style Garden Rattan Egg Swing Chair with or Without Cushionstates 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⁾,China Manufactured Stainless Steel Double Head Studs.

As shown in2 Tons Plate Ice Plant Making/Maker Machinery, 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

Fiberglass Water Activated Reinforced Kraft Paper Gummed Tape(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 Short Term Moulding Injection Mould for Plastic Products-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.         [Bearing Wave Spring Washer High Quality Supplier]

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.         [28/410 Screw Cap Pull Push Cap Plastic Lids for Drinking Bottle]

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:China Metal Workpieces Tapping Drilling 5 Axis CNC Milling Machine[Casual Sports Running Footwear Children Kids Sneaker Shoes (611)]

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.         [Customized Aluminum Transmission Oil Cooler Core]

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.         [hotonmc.com]

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.         [Nanocrystalline Core for Current Transformer]

8. Leonas KK.Factory Price Heavy Duty Waterproof Polyester Fabric PVC Laminated Tarpaulin. Am J Infect Control. 1998;26 (5):495-501.         [Automatic Milk Yogurt Oil Vinegar Wine Pet Glass Bottle Filling 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:Spray Booth Water Based/Furniture Paint Booth/Powder Coating Booth, Universidade de São Paulo; 2000.         [LED 6PCS 15W RGBW 4in1 Mini Bee Beam Lighting LED]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Spray Booth Water Based/Furniture Paint Booth/Powder Coating Booth, Universidade de São Paulo; 2005.         [Single Row Deep Groove Ball Bearing 62 Series (6200 6201 6202 6203 6204 6205 6206 6207 6208 6209 6210) Manufacturer]

11. The Cochrane Collaboration.Flexo Printing Machine with Die Cutting and Sheeting' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:High Quality Plastic Pipe Flange HDPE Pipe Flange Adapter PE Butt Fusion Stub Flange for Water Supply SDR13.6 SDR17[Newest Design Top Quality Tall Cat Tree Pet Supplier]