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

Abstract

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 sev-eral different organisms including coagulase-negative Staphylococcus spp, Staphylococcus aureus, Sphingomonas pau-cimobilis, 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 proce-dures 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 rec-ommend adopting this as a current NICE guideline for control of surgical site infection.

Microbial Colonization of Pneumatic Tourniquets in the Orthopedic Operating Room

“…The use of pneumatic tourniquets in joint arthroplasty is now predominantly part of the standard procedure, as it benefits surgeons by maintaining a bloodless field, improving the visualization of important structures, strengthening the bone cement interface, and expediting the procedure [20]. However, recent studies have shown that reusable tourniquets are indeed contaminated and have postulated their potential role in the development of surgical site infections [8,21-22].…”

Comparison of pain perceived when using pneumatic or silicone ring tourniquets for local anaesthetic procedures in the upper limb

“…It is simple, easy to apply by a single person, and because it acts as an exsanguinator, sterile stockinet, and tourniquet all in one, it reduces the amount of equipment required and improves efficiency. Thompson et al (2011) found in a study of 34 pneumatic tourniquets that 68% were contaminated with bacteria and, thus, could be a source of infection of the surgical site. The sterility of the SRT negates this risk.…”

Evaluation of a new tourniquet for hand surgery: Comparison of 76 carpal tunnel syndrome cases operated using a Hemaclear® Model-F tourniquet versus a pneumatic tourniquet

“…Some authors have shown that pneumatic tourniquets can carry bacterial flora composed mainly of coagulase-negative staphylococci [9,10]. However, this is a low-pathogenic strain and the tourniquet can be sterilized if necessary.…”