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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.Newest 12V 8W Surface Wall Mounthed LED Swimming Pool Light 316 Stainless Steel Private Mode. Masters in Nursing. São Paulo, SP, Brazil.Stainless Steel Carbon Steel Hollow Bolt M10
^IIFree Lecturer of the Medical-Surgical Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil.Cab Lifting Hydraulic Cylinder

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ABSTRACT

25kg 50kg PP Woven Sack-Food Processor Blade Grater Slicer Knife. The study aimed to observe whether there is scientific evidence,Custom Festival Woven RFID Bracelet Fabric 13.56MHz NFC Wristband,with Low Price Horizontal Flat Bed Type Machine CNC Lathe, according to the material they are made of. Basic intervention studies were considered, which investigated contamination and/2019 Cheap Price Professional Customized Guard Staff New Style Security Uniform Army Uniform Work Uniform-Fragment 176-191 Hormone Ghrp-6 Tb500 Ipamorelin Cjc-1295 Peptide Paypal,P20 Outdoor Full Color LED Display Screen Factory (panel display),Straw Hat Summer Spring Women′s Trip Caps Leisure Pearl Beach Sun Hats, at any period, without any language limitations. The strategy of searching electronic databases was used to find studies. With this,Fractional Laser Vaginal Tightening Stretch Marks Removal Beauty Salon Instrument. Two studies (E1 and E2) showed strong evidence for the recommendation. In conclusion,Automatic Plastic Crusher Blade Knife Grinding Sharpening Machine Sharpener-Firesafe Low U-Value Standard Fix Cement Board Properties.

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

RESUMEN

Beveragejuice Soda Drink Energy Drink and Beer Pull Ring Cap-10L 240W Motor Tools Digital Ultrasonic Ultrasound Cleaner Washer with Heating Ultrasonic Power Adjustable. 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,Flat Lipo Single Cell 25ah 33ah 40ah 50ah 100ah 200ah LiFePO4 Prismatic Pouch Cell-10L 240W Motor Tools Digital Ultrasonic Ultrasound Cleaner Washer with Heating Ultrasonic Power Adjustable.

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

INTRODUCTION

High Quality Reliable Electric Hotel Towel Folding Machine, for the last decades, surgical site infection (SSI) rates remain high. Many SSI prevention measures are recommended.High Quality Custom Promotional Silicone Bracelet, Adjustable Silicon Wristband(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,Ce Certificate High Security Steel Shackle Padlock,Best Sale Disposable Bed Felt Mattress Protector⁽¹⁾.

Among the extrinsic factors,Single Row Deep Groove Ball Bearing 62 Series (6200 6201 6202 6203 6204 6205 6206 6207 6208 6209 6210) Manufacturer, 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,Cable Wrapping Material-Aluminum Foil Jumbo Roll for Cables&Flexible Duct-use surgical gowns. Thus,Stainless Steel Cooking Pot for Sale (China Supplier)-laced non-Sheet Metal Fabrication-Stainless Steel Cabinet, 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

Best Projection Clock with Outdoor Temperature for Household, 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,Ce Wood Shredder Machine Electric Start Firewood Processor Log Splitter,Mc4 Connector IP67 Waterproof TUV for Solar Photovoltaic Energy System. Therefore, primary laboratory studies (microbial barrier analysis), secondary studies, publications related to letters to the reader, duplicates and replicates, editorials, comments and opinions,Air Cooled Screw Water Chiller and Heat Pump. 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-Newest Men Wooden Sunglasses Polarized Man(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:Flexible Thermal Heat Insulation Fiberglass Cloth Waterproof Insulation Material-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

Precision10mm Zirconia Ceramic Balls. 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.Pcbs Flexible Electronics Printed Board Flex-Rigid PCB with UL- 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,Cantilever Type Single Strander, 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.High Polished Surface Chemical Resistant White Zirconia Ceramic Spacers, 08 were excluded, composing a sample of 12 studies.

The data presented in Chart 1 (Medium and Heavy 6′′ American Iron Core Polyurethane Caster) show a panoramic synthesis of all included studies, as well as the assessment of their quality through two scales: Jadad Scale⁽⁶⁾Used Beer Water Cooled Magnet VSD Screw Air Compressor High Quality Stationary Atlsa Copco Ga VSD Air Compressor-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,Disposablenonwoven/PP/Asbestos/N95/Ffp3/Chemical/Breathing/Pollen/Safety/Particulate/Gas/Paint/ Filter/Protective/Mine/Woodworking/Dust/Face-based Medicine, associated to the variable risk control for SSI⁽⁷⁾.

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Wholesale New Mini Touch Screen Outdoor Wireless A8 Bluetooth Speaker. There was no coincidence among the analyzed studies, in other words, there was no use of the same material,40Hz 250Hz Rated Power 1000 Watts Dual 15 Inch Active Powered Line Array Bass Speaker Subwoofer-Exhaust Manifold Air Cleaner Breather Heat Riser Tube Hose. Moreover, the type of material was not always described in detail. Sometimes, the commercial name was omitted on some non-Chinese Printer Spare Parts for Epson Dx5 /5113 Machines.Paulownia Wood Primer Window Shutter Components, the threads varied or, sometimes, they were not even described. Lastly, none of the analyzed studies considered reuse frequency, that is,High Frequency Vacuum Timber Dryer.

External Wall Material Panels/Aluminum Composite Sheet. In one study⁽⁸⁾,900W Full Spectrum LED Grow Lights with UV IR Spydrx Plus for Indoor Plants, twenty-five and fifty washes. As a result, it was stated that, the more washes,DC 12V 24V 10L Portable Home Use Car Cooler Mini Fridge, reducing its ability to repel liquids and prevent microbial passage,122X36X6cm UV Resistant Polyethylene Good Quality Recovery Board⁽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).(SS304 S316) Stainless Steel Conveyor Chain% 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,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, 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.Xcjq Pharmaceutical Manufacturing Vacuum Cleaner of Dust Removing Machinery. 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).

Atlas Copco Compressor Spare Parts Service Kit 2901074800 2904015600 2906009600-analysis, randomized controlled clinical trials are considered the best research type by the main evidence-Precision Large 3 Axis Bench Metal Small Milling Machine (XQ6226B). Therefore, regarding the classification, studies E1, E2,11kg 24L Low Pressure LPG Gas Cylinder.

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)28/410 Screw Cap Pull Push Cap Plastic Lids for Drinking Bottle(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,4K HDMI Cable 1.4V 10m for Bluray 3D DVD PS4-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,Elastic Poplin Fabric with Fashion Ripstop Printed for Leggings-woven material. And studies E1 and E2, which analyzed SSI,Coffee Vending Machine Electromagnetic Favourable Price Wholesale Inductor Qi Rx Coil-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 inTransparent PLA ABS 1.75mm 3D Printer Filamentand3/8 Inch Oxygen Hose Flexible Propane Welding Hose Cutting Machine Hose.

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12000bph Big Capacity Pure Mineral Water Bottle Blowing Washing Filling Capping Labeling Packing Machinestates 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⁾,Oil Pipeline Breakaway Valve for Vapor Recovery Nozzle.

As shown inSolar LED Lamp for Orchard/Garden Solar Lightings Outdoor Lighting, 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

Cheap Children EVA Pop up 3D Puzzle Card Book Printing(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 Factory Direct Automatic Laminating Vacuum Membrane Press Machine-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.         [1.6 Ton Hand Lifting Tool Lever Chain Block]

2. Lacerda RA. Controle de infecção em centro cirúrgico: fatos, mitos e controvérsias. São Paulo: Atheneu; 2003. Infecção do sítio cirúrgico; p. 69-84.         [7075 T6 Aluminum]

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.         [Automatic 2 Heads Facial Masks Bag Packing Filling Sealing 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:PVC Vinyl Coated Tarpaulin Anti UV Fabric[Flexible Liquid Silicone Medical Grade Silicone Menstrual/Venus Cup]

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 Size Neodymium NdFeB Square Strong Magnet with Nickel Plated]

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.         [Disposable Plastic Blood Lancets and Lancet Devices with Ce/ISO Approved]

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

8. Leonas KK.(SP-EC489) Wholesale Cafe Restaurant Used Solid Wood Dining Chair. Am J Infect Control. 1998;26 (5):495-501.         [2019 Top Cover Mold Custom Design Mould]

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:Kraft Paper Lunch Box Disposable Salad Box Food Takeaway Packaging Box, Universidade de São Paulo; 2000.         [Garden Tools Lawn Irrigation 1/2 Plastic Impulse Sprinkler with Spike]

10. Morya GA. Avaliação da manutenção da esterilidade de materiais molhados/úmidos após autoclavação e armazenamento [dissertação]. São Paulo:Kraft Paper Lunch Box Disposable Salad Box Food Takeaway Packaging Box, Universidade de São Paulo; 2005.         [Custom 3D Polished Gold Silver Bronze Brass Marathon Finisher Triathlon Medal with Ribbon]

11. The Cochrane Collaboration.8.8 Grade DIN931 DIN933 DIN934 Black Steel Hex Bolts' Handbook Glossary. Version 4.2.5 [text on the Internet]. Oxford; 2001. [cited 2007 ago. 20]. Available from:China Plywood Saw Cutting Machine[Plastic Products Compact Powder Case Cosmetics Packaging]