Reusable tourniquets. An underestimated means for patient transfer of multi-resistant bacteria
KeywordsPublic Health Teaching Hospital Surrogate Marker Hospital Setting Blood Collection
Introduction / objectives
We sought to investigate the use of reusable tourniquets as potential sources of MRO transmission.
100 reusable tourniquets were collected over 10 weeks in a 503-bed Sydney teaching hospital. Tourniquets were incubated overnight in BHI enrichment broth and subcultured.
The colonisation rate was 78% (78/100). Ten grew non multi-resistant Gram- positives - MSSA (1) and Enterococcus species (9), 17 grew commensals. Non multi-resistant Gram-negatives grew in 38 specimens: Pseudomonas species (13) and ‘coliforms’ (26). MROs were found on 25% of tourniquets, including 3 from MRO isolation rooms. An IMP-4 positive E. cloacae and an ESBL E. cloacae were isolated from a single tourniquet each. MRSA was isolated from 14; vanB E. faecium was isolated from 18 and vanA E. faecalis from a single tourniquet. MRSA and VRE were isolated together from nine tourniquets, and 24 tourniquets grew either one. Van B positive E.faecium were typed using DiversiLab rep-PCR system This revealed five clusters without adominant clone. Six of 9 tourniquets from ICU grew at least one MRO. MROs were isolated throughout the 10 week period from a wide variety of locations including general wards, ICU, Burns, theatre anaesthetic bay and the blood collection unit.
Reusable tourniquets are frequently colonised with MROs and may be a potential source of cross-transmission. Using broth enrichment, 24% harboured either MRSA or VRE. Astourniquets are carried from ward to ward by hospital staff and used repeatedly, they may become a ‘sleeper’ mechanism for unrecognised hospital MRO transmission. They are also a surrogate marker for environmental colonisation and deficiencies in hospital cleaning. Continued use of reusable tourniquets may not be justified in the current hospital setting.
Disclosure of interest
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.