Re-using tourniquets poses patient safety risk, warn researchers

They found that most of the neatly 1,500 tourniquets – one of the most widely used and re-used items in healthcare – that were inspected in their study contained microbes.

“These data reiterate the inherent risks that re-usable tourniquets can pose to patient safety”

Study authors

“Medical devices frequently re-used between procedures in different patients are associated with high contamination rates and multi-resistant micro-organisms,” said the study authors.

Despite this, they highlighted that there were previously no studies that summarised all the available research into tourniquet contamination, and in particular, the types of micro-organisms responsible.

The researchers noted that tourniquets were typically used during peripheral venipuncture, often to make it easier to administer injections, collect blood samples, or perform other procedures.

The study, by Dr Nádia Osório and colleagues at the Polytechnic Institute of Coimbra, looked at bacterial contamination rates found in re-usable tourniquets across a range of clinical studies.

It also attempted to identify the most prevalent contaminant micro-organisms.

The researchers considered potentially relevant studies, both published and unpublished, written in English, French, Spanish and Portuguese up to December 2017 for inclusion in their review.

After a detailed analysis, they were left with 20 clinical studies with a combined total sample size of 1,479 tourniquets.

Contamination rates varied from 10% to 100%, with coagulase-negative staphylococci being the most commonly found microorganism, being present on 441 of the tourniquets analysed.

Coagulase-negative staphylococci can cause a range of infections, including skin and soft tissue infections, noted the researchers.

They also found contamination by other species of bacteria including Escherichia coli, Klebsiella spp, Pseudomonas spp, Acinetobacter baumannii, and Stenotrophomonas maltophilia, with individual contamination rates of up to 10% for each species.

These cause a range of potentially serious illnesses such as pneumonia, representing a particular risk to those with compromised immune systems and long-term health conditions such as cystic fibrosis.

The study authors found that 15 of the studies showed rates of contamination that exceeded 70% of the sampled tourniquets.

“These data reiterate the inherent risks that reusable tourniquets can pose to patient safety and care quality, related to the potential dissemination of micro-organisms between patients through this medical device,” they said.

“More studies should be developed focused on the impact of the introduction of tourniquet decontamination guidelines/programs in clinical settings and professional training,” they said.

They added: “Furthermore, the mandatory introduction of single-use disposable tourniquets in clinical settings should be considered as a potential resolution to our findings.”

The findings were presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam in the Netherlands, which is on during 13-16 April.

  • See attached PDFs below for study abstract and poster