Contaminated venous tourniquets: is there a better solution for infection control?
Tourniquets are classified as ‘non-critical’ medical devices and are one of the most widely used pieces of medical equipment across a number of settings. This includes spaces such as Emergency Departments (ED) and Intensive Care Units (ICU), theatres, vascular access clinics, pathology, cancer care services, and other routine and everyday areas such as wards.
However, the involvement of tourniquets in invasive procedures — such as blood collection, line insertion and other vascular access routines — as well as their ability to travel, means that a new or adequately cleaned/disinfected tourniquet is paramount for proper infection control procedures. Evidence — both anecdotal and published — suggests that this does not always occur.
Tourniquets are ordinarily mobile, multi-use and made from fabric. As a result, these are difficult and slow to disinfect due to the nature of their material and design, often resulting in inadequate disinfection. A recent review of existing studies found that the majority of published research showed >70% of tourniquets exhibited contamination1. The study also found that there are no standard practices, that tourniquets are shared and reused (sometimes for years) and patient safety may be jeopardised depending on material type and organisms found.
The introduction of disposable or single-use tourniquets can be more expensive and generate greater waste. Anecdotally, user satisfaction tends to be lower due to design and quality, as the item is manufactured for single use. Construction materials for both reusable and single-use tourniquets have been shown to both pick up and transfer microorganisms in a number of settings2.
A third option of single patient tourniquets (where one tourniquet is assigned to a patient) reduces some of the risk, but is reliant on proper hand hygiene and handling, disinfection of surrounding surfaces, as well as disinfection or disposal of the device post-discharge, due to the risk of microbial dissemination. Crucially, a device could still be contaminated and used on a patient multiple times.
In a real-life example, a New Zealand study completed in a secondary-level hospital found various levels of contamination of tourniquets, with the highest levels found on the phlebotomy trolley post-ward round3. The facility disinfects all tourniquets overnight. They suggested a move to cost-comparable disposable tourniquets, but these were not preferred by staff and were found to be less comfortable for patients. Issuing patient specific reusables was cost-prohibitive. How could this example be generalised to larger facilities; to those with known MDRO issues; to those with greater frequency of use of tourniquets?
While there is ongoing research into the risk of bloodstream infections due to tourniquet contamination, the issue of tourniquet contamination itself is known and documented. Conventional tourniquets are routinely subjected to improper processing, if at all — a practice that does not occur with most other medical devices. So why should we settle for less? And what is the solution?
Enter daisygrip — a reusable tourniquet that can be completely disinfected by the user.
The daisygrip is manufactured from a smooth silicone band, which is comfortable for the patient, as well as being documented to pick up less contamination and being easier to disinfect than conventional fabrics4. With daisygrip, you can simply wipe, observe the required time, then use again. The band is coupled with an innovative and unique self-finding magnetic buckle, making closure faster, easier and able to be completed with one hand. Each unit can be reused thousands of times, saving on inventory and replacement. The daisygrip’s patented, Red Dot Award-winning design has a focus on frequency and ease of use, as well as the ability to be completely disinfected in realistic times and places.
Improved infection control practices and hygienic vascular access, all via an easily disinfected, award-winning, reusable medical device. The daisygrip tourniquet — available exclusively through Tristel.
1 “Health professionals’ practices related with tourniquet use during peripheral venipuncture: a scoping review” (de Sousa Salgueiro-Oliviera et al. Rev. Latino-AM. Enfermagem)
2 “Methicillin resistant Staphylococcus aureus contamination of phlebotomy tourniquets and faucets” (Abeywickrama et al. Ceylon Medical Journal)
3 “Quantifying patient bacterial exposure risk from reusable phlebotomy tourniquets in a NZ secondary level hospital” (Schauer and Hammer. Journal of Inf. Prevention)
4 “Reduced bacterial contamination rates detected on silicone tourniquets compared to conventional tourniquets” (Grohamn et al. BMC Infectious Diseases)
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