Zimmer: What’s living on your tourniquet cuffs

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Recent studies have shown contamination of between 68-100% of non-sterile orthopaedic surgical tourniquets.^1-4 Cultures included MRSA, Pseudomonas spp, coagulase-negative Staphylococcus spp, Bacillus spp. and S. aureus, among others.^1,2 Coagulase-negative Staphylococcus spp. is now the most common cause of joint infection in TKR and a common cause of infection in knee arthroscopy in both surgical site and deep infections.^2,5,6,7

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Methicillin-susceptible coagulase- negative staphylococci are the predominant microbes contaminating tourniquets. While the majority of contaminants isolated are considered normal skin flora, many of these are prevalent offenders in orthopaedic surgical site infections, particularly infections involving prosthetic joints and other hardware. Recent studies have reported an increasing incidence of orthopaedic surgical site infections caused by coagulase-negative staphylococci that have led to delayed diagnosis and increased morbidity.⁸
These cultures, meticillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. Diff), are estimated to cost the NHS £1 billion and contribute to 5,000 deaths/year in the UK.⁹ In recent years, there has been a trend in use toward disposable single- use tourniquet cuffs to help reduce the chance of infection in orthopaedic procedures.
Single-use disposable tourniquet cuffs are generally supplied as sterile products and are intended for disposal after use. The design characteristics and choice of materials for these disposable cuffs are intended to allow them to be applied and used safely and reliably within a sterile surgical field during a single surgical procedure. These various materials and components have been chosen to be sufficiently inexpensive to allow the cuff to be economically discarded after use.¹⁰ Reprocessing of a disposable tourniquet cuff is not recommended and may result in blockages or deformation of the pneumatic  pathway which can be hazardous  for the patient.¹⁰
Zimmer offers a complete range of sterile, single-use tourniquet cuffs which are manufactured in the US. We also distribute sterile single-use contoured cuffs for larger patients and paediatric cuffs for children, manufactured by Delfi Medical.
Contact Zimmer today for more information about cost-effective sterile tourniquets to reduce the incidence of infection in your hospital.

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References

1. Thompson SM et al. 2011, The effect of sterile versus non-sterile tourniquets on microbiological colonisation in lower limb surgery, Ann RColl Surg Engl, 93(8):589-90.


2. Ahmed S, Ahmad R, Case R, Spencer RF, 2009, A study of microbial colonisation of orthopaedic tourniquets, Ann R Coll Surg Engl, 91:131-134.


3. Gottlieb T et al. 2011, Reusable Tourniquets. An underestimated means for patient transfer of multi-resistant bacteria, BMC Proceedings, 5(S6):P38.


4. Walsh EF et al. 2006, Microbial Colonization of tourniquets used in orthopaedic surgery, Orthopaedics, 29(8).


5. Phillips JE, Crane TP, Noy M, Elliott TS, Grimer RJ. The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg Br 2006; 88: 943–8.


6. Fulkerson E, Valle CJ, Wise B, Walsh M, Preston C, Di Cesare PE. Antibiotic susceptibility of bacteria infecting total joint arthroplasty sites. J Bone Joint Surg Am 2006; 88: 1231–7.


7. Babcock HM, Matava MJ, Fraser V. Postarthroscopy surgical site infections:review of the literature. Clin Infect Dis 2002; 34: 65–71.


8. Babcock HM, Matava MJ, Fraser V. Postarthroscopy surgical site infections: review of the literature. Clin Infect Dis. 2002; 34:65-71.


9. Kerstein RL, Fellowes, C 2009. Novel fit for purpose single use tourniquet: best of both worlds. J Med Eng Technol. 33(6):475-80.


10. AORN. 2009. Recommended practices for the use of the pneumatic tourniquet in the perioperative practice setting.

For further information please contact your local Zimmer representative.
Zimmer Pty Ltd • Level 3, 12 Narabang Way Belrose NSW 2085 Australia
Tel: +612 9483 5400 Fax: +612 9986 1453 www.zimmer.com.au