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Types of tourniquets used
Makeshift tourniquets can be ropes, shoelaces, wire, leather, condoms or plastic bags. Some of these are not elastic enough for quick and easy release and may therefore cause trauma to the skin and veins and may cause infiltration of blood and fluids into surrounding tissues (Strike et al 2013). In addition, these items are often difficult to clean. It is recommended to use a tourniquet that is easy to release using one hand only.
Reuse and sharing of tourniquets
Observational studies have shown that tourniquets can be a potential source of exposition to blood borne pathogens (Crofts et al, 1999; Taylor et al 2004); In Scotland, 60% of the PWID have already shared their tourniquet (Scottish Drugs Forum and Glasgow Involvement Group, 2004). A tourniquet should not be used to stop the bleeding (may put the user at risk).
Risks associated to the sharing of tourniquets
Blood borne virus transmission
The risk associated to syringe sharing is much higher than the risk linked to tourniquet sharing. It is important to bear in mind though that, in hospital settings, Rourke et al (2001) found visible blood stains on 36% of the examined tourniquets; Golder et al (2000) found visible blood stains on half of them.
Other risks
Rourke et al (2001) have found Staphylococcus on 5% of the tourniquets tested in a hospital setting. Golder et al (2000) found abundant cutaneous flora on all samples and bacteria on 22% of the tourniquets.
Recommandations
- Distribute tourniquets that are thin, flexible, easy to remove with a non-porous surface, without limiting the quantities supplied
- Offer a tourniquet with each syringe
- Educate clients about:
- Bacterial and viral infections associated with the use of previously used tourniquets
- Tissue and vein damage, as well as circulatory problems that can be associated with the use of a non-quick-release-tourniquet
- Adequate and individual tourniquet-use
References
Crofts N, Aitken CK, Kaldor JM. (1999) The force of numbers: why hepatitis C is spreading among Australian injecting drug users while HIV is not The hepatitis C virus requires expanded strategies to control its spread. MJA. 170: 220-221
Golder M, Chan CLH, O’Shea S, Corbett K, Chrystie IL, French G. (2000) Potential risk of cross-infection during peripheral-venous access by contamination of tourniquets. The Lancet ;355(9197): 44
Rourke C, Bates C, Reade RC. (2001) Poor hospital infection control practice in venepuncture and use of tourniquets. Journal of Hospital Infection. 49(1):59-61
Scottish Drugs Forum and Glasgow Involvement Group. (2004) Views from the street: needle exchange users in Glasgow.
Strike C, Hopkins S, Watson TM, Gohil H, Leece P, Young S, Buxton J, Challacombe L, Demel G, Heywood D, Lampkin H, Leonard L, Lebounga Vouma J, Lockie L, Millson P, Morissette C, Nielsen D, Petersen D, Tzemis D, Zurba N. (2013) Best Practice Recommendations for Canadian Harm Reduction Programs that Provide Service to People Who Use Drugs and are at Risk for HIV, HCV, and Other Harms: Part 1. Toronto, ON: Working Group on Best Practice for Harm Reduction Programs in Canada.
Taylor A., Fleming A., Rutherford J., and Goldberg, D. (2004) Examining the Injecting Practices of Injecting Drug Users in Scotland. Edinburgh: Scottish Executive
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