title: The effect of sterile versus non-sterile tourniquets on microbiological colonisation in lower limb surgery.
abstract: BACKGROUND
  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 several different organisms including coagulase-negative Staphylococcus spp, Staphylococcus aureus, Sphingomonas paucimobilis, 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 procedures 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 recommend adopting this as a current NICE guideline for control of surgical site infection.
authors: St Peter's Hospital, Chertsey, UK.
authors: S M
authors: SM
authors: Thompson
authors: M
authors: M
authors: Middleton
authors: M
authors: M
authors: Farook
authors: A
authors: A
authors: Cameron-Smith
authors: S
authors: S
authors: Bone
authors: A
authors: A
authors: Hassan
mesh_terms: D001419:Bacteria / Q000302:isolation & purification; D058491:Bacterial Load; D003428:Cross Infection / Q000517:prevention & control; D004866:Equipment Contamination / Q000517:prevention & control*; D006801:Humans; D007866:Leg / Q000601:surgery*; D019637:Orthopedic Procedures / Q000295:instrumentation*; D011446:Prospective Studies; D013242:Sterilization; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014111:Tourniquets / Q000382:microbiology*