Reduced bacterial contamination rates detected on silicone tourniquets compared to conventional tourniquets in clinical routine.

BACKGROUND: Tourniquets used for peripheral venous vascular access such as blood sampling are regularly contaminated in clinical routine. Although most contaminations are harmless, some pose a possible risk for infection. To improve peripheral venous access infection control standards, tourniquets with no or as few as possible bacterial burden should be used. Conventional tourniquets can be reprocessed by autoclaving or by incubating in disinfectants. However, both methods are time-consuming and not suitable for immediate use between patients. In contrast, silicone tourniquets can be quickly and simply reprocessed with wipe disinfection. In vitro studies from the manufacturer have demonstrated reduced bacterial contamination on silicone tourniquets after usage compared to conventional tourniquets. This study aims to independently investigate the bacterial load on both types of tourniquets in clinical routine. METHODS: In a first trial, new conventional and silicon tourniquets were used for blood sampling in one facility with strict guidelines for reprocessing (after each patient or not at all) for 1 day and tested for bacterial contamination. In a second trial, new tourniquets were used in four facilities while the mode and frequency of tourniquets' reprocessing was defined individually by each facility. The number of treated patients, mode and frequency of reprocessing and other relevant handling measures were documented. RESULTS: Under controlled conditions, with strictly specified reprocessing, slightly fewer bacteria were found on silicone than on conventional tourniquets. In routine clinical practice the reprocessing frequency was not higher for silicone tourniquets in practice. Yet, in all four facilities, there were significantly fewer bacteria found on silicone than on conventional tourniquets. CONCLUSION: Although tourniquets are classified as non-critical medical devices, results show - together with benefits of faster and easier reprocessing - that silicone tourniquets can improve infection control of venous vascular access.

Health professionals' practices related with tourniquet use during peripheral venipuncture: a scoping review. / Práticas relacionadas ao uso do garrote durante a punção venosa periférica: uma revisão de escopo.

OBJECTIVES: during peripheral venipuncture, health professionals are recommended to use a tourniquet above the puncture site in order to potentiate venous distension. Given its characteristics and use in clinical settings, tourniquets may represent a source of microorganism dissemination. However, the results of scientific studies in this area are scattered in the literature. This scoping review aims to map the available evidence on health professionals' practices related with tourniquet use during peripheral venipuncture and associated microbiological contamination. METHODS: scoping review following the Joanna Briggs Institute methodology. Two independent reviewers analyzed the relevance of the studies, extracted and synthesized data. RESULTS: fifteen studies were included in the review. Overall, tourniquets were reused without being subject to recurring decontamination processes. It has been found that practitioners share these devices among themselves and use them successively for periods between two weeks and seven and half years. CONCLUSION: nursing practices related to tourniquet use during peripheral venipuncture are not standard. Reuse of tourniquets may jeopardize the patient's safety if reprocessing (cleaning and disinfection/sterilization) is not adequate, given the type of tourniquet material and microbiota found. New studies are needed to assess the impact of various types of reprocessing practices on tourniquet decontamination and patient safety.

Methicillin resistant Staphylococcus aureus contamination of phlebotomy tourniquets and faucets

Introduction: Methicillin resistant Staphylococcus aureus (MRSA) is transmitted through direct contact or fomites. The most important means of nosocomial spread is by hospital personnel. However, fomites are being increasingly recognized as sources of nosocomial infection. Objectives: Our aim was to describe the MRSA contamination rate of phlebotomy tourniquets and faucets in a tertiary care hospital and to compare the contamination of plastic tourniquets with that of fabric tourniquets. Method: A cross-sectional study was carried out in the general wards of a tertiary care hospital in the Colombo District. Two hundred tourniquets were collected and 100 faucets were swabbed and cultured on CHROMagar™ MRSA medium (CHROMagar Microbiology). Contamination rates of 50 plastic tourniquets and 50 fabric tourniquets were compared. Results: MRSA grew in 26% of tourniquets. Majority were plastic tubes. MRSA contamination of tourniquets did not significantly differ by ward (p>0.4). MRSA was found on 26% of faucets. Contamination rate was highest in the common wards for dermatology, dental, rheumatology, and neurology (55.6%), followed by gynaecology (45.2%), cardiology (33.3%), surgery (18.8%), psychiatry (11.1%), and medicine (5.6%). There was a significant difference in rates of contamination of faucets in the different wards (p<0.01). There was no significant difference in the colony count per surface area of the two types of tourniquets after a single use. Conclusions: MRSA contamination rates of tourniquets and faucets were high. Single-use plastic tourniquets were much less contaminated with MRSA than reused tourniquets.

Microbial colonisation of orthopaedic tourniquets: a potential risk for surgical site infection.

Pneumatic tourniquets have been used in orthopaedic surgery to get avascular fields. Sixteen such tourniquets were analysed for microbial colonisation. Samples were taken from two inner and two outer areas of each tourniquet and cultured on sheep blood agar. Eight of these were wiped with Savlon and the rest with Sterillium solution. Post-treatment samples from the same sites were again cultured. After incubation, colonies from each site were identified and counted. It was observed that the tourniquets were colonised with coagulase-negative staphylococci, Staphylococcus aureus, Bacillus, diphtheroids, Pseudomonas, Acinetobacter, enterococci, enterobacteria, and Candida. On treating with Savlon and Sterillium, there was 92.18% and 95.70% reduction in the colony count, respectively.

Identificação e perfil de sensibilidade de bactérias em garrotes de uso hospitalar / Identification and sensitivity profile of bacteria on tourniquets used in hospitals

Este estudo teve como principais objetivos constatar a presença de bactérias em garrotes hospitalares e identificar o perfil de sensibilidade delas aos antimicrobianos mais conhecidos e utilizados. O cenário da pesquisa foi três hospitais do município de Ubá-MG e posteriormente, o Laboratório de Microbiologia da Faculdade Presidente Antônio Carlos. Foi coletado um garrote em cada setor hospitalar, somando um total de 15 garrotes. Em análise macroscópica, observou a presença de sangue em 26,66%. De todos os garrotes analisados, houve crescimento bacteriano apenas do gênero Staphylococcus, predominando a espécie Staphylococcus aureus em 57,14% sobre a de Staphylococcus Coagulase Negativo 43,86%. Sendo assim, os garrotes podem servir como veiculo de disseminação para contaminação hospitalar, principalmente na forma de transmissão de microrganismos multirresistentes.

The aim of this study was to investigate the presence of bacteria on rubber tourniquets in hospitals and determine their sensitivity profile to the best-known, routinely used antimicrobials. The material was collected from three hospitals in the city of Ubá (MG, Brazil) and analyzed at the Microbiology Laboratory of President Antônio Carlos Faculty in Ubá. We collected one tourniquet from each hospital unit, giving a total of 15. Macroscopic inspection showed the presence of blood on 4 specimens (26,66%). Every tourniquet gave rise to bacterial growth of only one genus, Staphylococcus. The species S. aureus (57,14%) predominated over coagulase-negative staphylococci (43,86%). Consequently, the tourniquets may serve as a vehicle for the spreading of infection in the hospital, especially the transmission of multidrug-resistant microorganisms.

MRSA contaminated venepuncture tourniquets in clinical practice.

INTRODUCTION: Meticillin-resistant Staphylococcus aureus (MRSA) hospital-acquired infection is associated with increased patient mortality. National guidelines state that shared patient equipment must be cleaned after use. The authors sought to identify MRSA contamination in a sample of non-disposable venepuncture tourniquets and audit cleaning habits between patient contacts. MATERIALS AND METHODS: Fifty tourniquets were collected from junior doctors, nursing staff and wards from two district general hospitals in Essex, UK in 2007. A questionnaire was completed at the time of collection for each tourniquet. The tourniquets were cultured using standard microbiology techniques. FINDINGS: 18/50 (36%) tourniquets were positive for S. aureus and of these 6/50 (12%) were MRSA positive. 33/43 (77%) healthcare professionals using non-disposable tourniquets for venepuncture made no attempts at cleaning their tourniquets. 10/43 (23%) staff admitted to cleaning their tourniquets. The tourniquets were used for an average of 14 weeks on approximately three different patients per day. 30/50 (60%) tourniquets were visibly soiled and of these 13 were blood stained and 20/50 (40%) appeared 'clean'. Worn tourniquets when compared with the 'clean' tourniquets were more likely to be contaminated with S. aureus, 15/30 (50%) vs 3/20 (15%), and MRSA 5/30 (17%) vs 1/20 (5%). CONCLUSION: Non-disposable venepuncture tourniquets are contaminated with MRSA and pose a risk to patients. The majority of clinical staff do not clean them between patient contacts as recommended by guidelines. The use of non-disposable venepuncture tourniquets should be abandoned. The introduction of disposable tourniquets to clinical practice should be an adjunct to current measures for MRSA prevention.

The effect of sterile versus non-sterile tourniquets on microbiological colonisation in lower limb surgery.

INTRODUCTION: Surgical tourniquets are commonplace in lower limb surgery. Several studies have shown that tourniquets can be a potential source of microbial contamination but have not compared the use of sterile versus non-sterile tourniquets in the same procedures. METHODS: Patients undergoing elective orthopaedic lower limb surgery were randomised prospectively to use of non-sterile pneumatic tourniquet or sterile elastic exsanguination tourniquet (S-MART™, OHK Medical Devices, haifa, Israel). Samples were taken from the ties of the non-sterile tourniquet prior to surgery and from the sterile tourniquets at the end of the operation in a sterile fashion. These were then sealed in universal containers and immediately analysed by the microbiology department on agar plates, cultured and incubated. RESULTS: Thirty-four non-sterile tourniquets were sampled prior to surgical application, twenty-three of which were contaminated with several different organisms including coagulase-negative Staphylococcus spp, Staphylococcus aureus, Sphingomonas paucimobilis, Bacillus spp, and coliforms. Thirty-six sterile tourniquets were used, with no associated contamination. CONCLUSIONS: There was significant contamination of 68% of orthopaedic surgical tourniquets. These are used regularly in procedures involving the placement of prosthesis and metalwork, and can act as a potential source of infection. We recommend the use of sterile single-use disposable tourniquets where possible. The availability of an alternative should now set the new standard of care and we recommend adopting this as a current NICE guideline for control of surgical site infection.

Reusable venesection tourniquets: a potential source of hospital transmission of multiresistant organisms.

OBJECTIVE: To determine the prevalence of multiresistant organism (MRO) colonisation of reusable venesection tourniquets. DESIGN AND SETTING: A prospective study in a tertiary hospital to collect and analyse reusable venesection tourniquets for the presence of MROs - methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum ß-lactamase and metallo-ß-lactamase-producing Enterobacteriaceae - using a sensitive enrichment method. Tourniquets were collected and tested during a 10-week period between September and November 2010. MAIN OUTCOME MEASURE: Prevalence of MRO colonisation of tourniquets. RESULTS: The overall colonisation rate of 100 tourniquets randomly collected from general wards, ambulatory care areas and critical care areas was 78%. MROs were isolated from 25 tourniquets collected from a variety of hospital locations, including general wards, the intensive care unit, burns unit and anaesthetic bay. MRSA was isolated from 14 tourniquets and VRE from 19; both MRSA and VRE were isolated from nine tourniquets. There were no microorganisms isolated from 22 tourniquets. CONCLUSION: Reusable tourniquets can be colonised with MROs and may be a potential source of transmission of MROs to hospitalised patients.

Acinetobacter baumannii and MRSA contamination on reusable phlebotomy tourniquets.

OBJECTIVE: A study was undertaken to determine the incidence of Acinetobacter baumannii and methicillin resistant Staphylococcus aureus (MRSA) contamination on reusable phlebotomy tourniquets at Wilford Hall Medical Center, Lackland AFB, TX. DESIGN: Reusable tourniquets (n=200) were collected after being used for one day in the outpatient blood collection center (n=100) or during morning blood collection rounds on inpatient wards (n=100). Tourniquets were cultured and growth was screened for A. baumannii and S. aureus. A. baumannii isolates were identified using colonial morphology, oxidase, and GNI+ card on Vitek Legacy. S. aureus isolates were identified and screened for MRSA using colonial morphology, catalase, Staphaurex, and Oxacillin screening agar. RESULTS: Each outpatient tourniquet was used on an average of 33 patients and each inpatient tourniquet was used on an average of 11 patients. The overall contamination rate was 9% (18/200). A. baumannii was isolated from 11% (11/100) of the outpatient tourniquets and 3% (3/100) of the inpatient tourniquets. Methicillin-susceptible S. aureus was isolated from 2% (2/100) of the outpatient tourniquets and 3% (3/100) of the inpatient tourniquets. No MRSA was isolated. One ou'tpatient tourniquet had both A. baumannii and methicillin-susceptible S. aureus. CONCLUSIONS: Reusable tourniquets could serve as a potential reservoir for bacterial pathogens.

Novel fit for purpose single use tourniquet: best of both worlds.

INTRODUCTION: Healthcare associated infections (HAI), such as Meticillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. Diff) are estimated to cost the NHS pound1 billion and contribute to 5000 deaths/year in the UK. To date the main emphasis to reduce HAIs has been on hand hygiene. However environmental microbial load and compliance limits the efficacy of hand washing alone. Cultures from tourniquets have demonstrated contamination by pathogens including MRSA. Consequently, many UK trusts are introducing disposable tourniquets as policy. The use of most disposable tourniquets is still limited, as few are able to maintain patient comfort, ease of use and cost effectiveness. This study compares patient and phlebotomist experiences of the single-use tourniquet, Tournistrip, with currently available disposable and re-usable alternatives. METHODS: The trial was performed in on patients attending two West London teaching hospital outpatient phlebotomy departments, over a four week period. After Tournistrip use, the patients were invited to fill in an anonymous questionnaire, covering comfort and appearance. A separate questionnaire was filled in by the phlebotomists. RESULTS: Ninety five percent of patients found the Tournistrip professional looking, with 54% preferring it to the current re-usable alternatives. One hundred and seventy eight of the 227 patients found Tournistrip comfortable. Overall, 85% of patients found Tournistrip at least as good, if not better than re-usable tourniquets. All of the phlebotomists found the Tournistrip professional looking, and none preferred previously used disposable alternatives. Ninety-five percent found it as easy to use as a re-usable and none found previous disposables better to use. DISCUSSION: The Tournistrip was designed to match the comfort and ease of use of the re-usable tourniquet, whilst maintaining cost efficacy. This clinical trial shows the Tournistrip is viewed as a superior tourniquet to the current generation of disposables and a viable replacement to the re-usable tourniquet in the continuing challenge to reduce HAIs.

Tourniquets and exsanguinators: a potential source of infection in the orthopedic operating theater?

BACKGROUND AND PURPOSE: Fomites are increasingly being recognised as a source of hospital-acquired infection. We have therefore assessed tourniquets and exsanguinators for the presence of bacterial pathogens in 1 elective and 2 trauma orthopedic hospitals. MATERIAL AND METHODS: Swabs were taken prior to and after decontaminating these devices with 1 of 3 different cleaning modalities. These were then assessed for colony counts and organisms identified. RESULTS: Bacteria commonly implicated in surgical site infections such as coagulase-negative staphylococci, Staphylococcus aureus and Proteus spp. were prevalent. We also found a resistant strain of Acinetobacter and Candida. Exsanguinators were the most heavily contaminated devices, and colony counts in the trauma hospitals were up to 400% higher than in the elective hospital. Alcohol- and non-alcohol-based sterile wipes were both highly effective in decontaminating the devices. INTERPRETATION: Infectious organisms reside on the tourniquets and exsanguinators presently used in the orthopedic theater. These fomites may possibly be a source of surgical site infection. We have demonstrated a simple and effective means of decontaminating these devices between cases.

A study of microbial colonisation of orthopaedic tourniquets.

INTRODUCTION: Tourniquets are employed widely in orthopaedic surgery. The use of the same tourniquet on a repetitive basis without a standard protocol for cleaning may be a source of cross-infection. This study examines the contamination of the tourniquets in our institution. MATERIALS AND METHODS: Agar plates were used to take samples from 20 tourniquets employed in orthopaedic procedures. Four sites on each tourniquet were cultured and incubated at 37 degrees C for 48 h. RESULTS: All sampled tourniquets were contaminated with colony counts varying from 9 to > 385. Coagulase-negative Staphylococcus spp. were the most commonly grown organisms from the tourniquets (96%). Some tourniquets had growths of important pathogens including methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas spp., and S. aureus. On cleaning five tourniquets with Clinell (detergent and disinfectant) wipes (GAMA Healthcare Ltd, London, UK), there was a 99.2% reduction in contamination of the tourniquets 5 min after cleaning. CONCLUSIONS: In addition to the manufacturers' guidelines, we recommend the cleaning of tourniquets with a disinfectant wipe before every case.

Poor hospital infection control practice in hand hygiene, glove utilization, and usage of tourniquets.

BACKGROUND: Hospital-acquired infection often occurs because of lapses in accepted standards of practice on the part of health care personnel. The aim of this study is to attract attention on poor hospital infection control practice in venepuncture and use of tourniquets and emphasize the importance of hand hygiene. METHODS: Overall compliance with hygiene during usage of tourniquets and routine patient care before and after implementation of a hospital infection control measures was evaluated. RESULTS: According to the questionnaire, only 26.9% of respondents always washed their hands both before and after venepuncture. In the second step of the study, based on direct observation, hands were washed both before and after venepuncture on only 41 (45.1%) occasions. Failure to remove gloves after patient contact was observed on 23.1% occasions. CONCLUSION: Our survey reveals poor infection control practice in hand hygiene, glove utilization, and usage of tourniquets and the implementation of infection control measures produced a moderate improvement in compliance with them.