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Abstract
Nosocomial infection is a significant problem. Good hand hygiene is the single most effective preventive measure. However, maintaining a clean patient environment is also necessary. Studies have shown that objects found in the clinical area, including blood pressure cuffs, stethoscopes and keyboards, can be contaminated with pathogens, including MRSA.
Aim This pilot study aimed to assess tourniquet practice in a tertiary paediatric hospital and assess the potential for microbial spread on phlebotomy tourniquets.
Method 85 episodes of venepuncture and cannulation were observed by one researcher to determine tourniquet selection in medical/surgical wards and out-patient areas by medical, nursing and auxiliary staff. Thereafter, awareness of potential cross-infection was raised (information sheet and questionnaire) among those responsible for phlebotomy and single-use tourniquets were made widely available. A further 90 episodes were observed to assess if availability of single-use, disposable tourniquets (SUDT) improved practice. To confirm potential for transmission of microbes, 10 elastic tourniquets from medical, nursing and auxiliary staff were swabbed. Samples were applied to MacConkey agar and blood agar plates, incubated for 48 h and assessed for bacterial growth.
Results Prior to the introduction of SUDTs, 85 procedures were observed: 52% used elastic tourniquets; 39% human tourniquets (applying pressure manually with/without assistant); 8% plastic, wipable tourniquets and gauze was used once (1%). Following the introduction of SUDTs, 53% of 90 observed procedures used elastic tourniquets, 20% human tourniquets and 27% SUDTs. Mixed skin organisms were cultured from all 10 tourniquets: predominantly coagulase negative staphylococci and micrococci, but also β-haemolytic streptococci and coliform colonies. Methicillin sensitive Staphylococcus aureus was isolated from three tourniquets and one yielded a mixed growth of faecal organisms (figure 1).
Mixed faecal flora on agar plate cultured from elastic tourniquet.
Conclusion Phlebotomy tourniquets are potential vectors for bacterial pathogens. This pilot study is the first to document the culture of faecal flora from elastic tourniquets. Despite risk of cross infection, most staff preferred elastic tourniquets, even when SUDTs were available. Clinical settings should provide SUDTs and promote good infection control practice through education and meticulous hand hygiene to reduce the risk of microbial spread. However, staff motivation and compliance with single-use alternatives pose significant obstacles to reducing cross-infection.