The effect of sterile versus non-sterile tourniquets on microbiological colonisation in lower limb surgery.

INTRODUCTION: 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.

Nocturnal orthopaedic operating: can we let sleeping orthopaedic surgeons lie?

A 12-month retrospective study of emergency orthopaedic operations in a district general hospital was performed. There were 962 emergency admissions of whom 272 (17.7%) underwent emergency operation. The largest group consisted of those undergoing operation for femoral neck fractures (37.6% of the total). Despite 58.8% of the patients presenting to the accident and emergency (A&E) department between 0800 and 1700 hours, the majority (66.2%) were operated on 'out-of-hours'. Those patients undergoing emergency operation out-of-hours were allocated to one of three categories (emergency, urgent, or scheduled) depending on the nature and severity of their presenting condition. In the authors' opinion, 81.9% of the patients could have been appropriately classified as scheduled cases and that all out-of-hours operating in this group of patients could have been deferred until the following morning. This would have reduced the number of orthopaedic operations performed out-of-hours from 182 to 33. The operating time at night would have been reduced from 126.9 h to 15.8 h. The implications of this study are important in view of the currently proposed changes in the hours worked by surgical trainees, the CEPOD findings, and the Government's proposals outlined in Achieving a Balance.