Tourniquets and HAI

We know tourniquets are potential vectors for transmission. Their use in contact with skin results in their being easily contaminated. One study of 200 tourniquets found that on average they were owned for almost 2 years, with 70% of those used by junior doctors and phlebotomists having visible blood stains⁴.

“The high number of tourniquets with visible blood stains should be a cause for concern, and obvious disregard for cleanliness of tourniquets is surprising… Eighteen [of those questioned] had used their tourniquets in countries other than the UK; 12 were in high-risk areas for blood-borne viruses, e.g. Africa and Thailand.⁴”

A report in the Journal of Hospital Infection in 2006 found 28 of 30 tourniquets were contaminated with S. Aureus or MRSA⁵, while a similar report in the American Journal of Infection Control found 34 colonies of S. Aureus on 36 tourniquets, almost half of which were MRSA.⁶

“As a result of our study, we plan to increase the availability of disposable tourniquets in the trust and produce hospital guidelines for their use.⁵”

“Our survey reveals that there is a substantial reservoir of potentially pathogenic bacteria on reusable tourniquets ... This reservoir exists in areas of hospitals in which critically ill, injured, immunocompromised, and postoperative patients are being treated.⁶”

In an effort to reduce the problem, a study reported in the Journal of Hospital Infection tried replacing every tourniquet used by phlebotomists daily, but found that even then 25% of tourniquets became contaminated with MRSA. The authors also found that although improving hand hygiene helped reduce the rate of contamination, it did not eliminate it.⁷

“Each day, the phlebotomists were supplied with a fresh sterile tourniquet, and after use, the tourniquets were swabbed and cultured. The rate of contamination with MRSA was 32 of 131 (25%) tourniquets…. In conclusion, phlebotomy tourniquets may be potential vectors for transferring bacteria, including MRSA.⁷”

A report in the Lancet from 2000 found that 52 of 77 tourniquets had visible blood stains, and grew a wide range of potential pathogens. The authors concluded that “The potential risk of cross-infection is obvious … We recommend the use of disposable tourniquets.”⁸