# Metagenomic Analysis of Bacterial Diversity on Reusable Tourniquets in Hospital Environments
## 4 Discussion
### Key Findings and Departmental Variability
It also forms biofilms that enhance its survival on surfaces, adding to the difficulty of complete disinfection. While both _Enterococcus faecalis_ and _Enterococcusecium_ can exhibit resistance to vancomycin (VRE), aminoglycosides, and certain beta-lactams, the vast majority of VRE isolates are _E. ficeium_, which tends to be more antibiotic-resistant than _E. faecalis_[19]. It was also proven that it can withstand a range of pH and temperature conditions, increasing its resilience in healthcare settings [19]. _Stentrophomonas maltophilis_ displays intrinsic resistance to carbapenems, aminoglycosides, beta-lactams, and fluoroquinolones, which limits available treatment options [20]. It is known to form biofilms on various surfaces, complicating elimination. Environmental Adaptability: It is capable of surviving in diverse conditions, including low-oxygen environments, which aids in its persistence on reusable medical equipment. _Staphylococcus aureus_, especially methicillin-resistant strains (MRSA), exhibits resistance to nearly all beta-lactam antibiotics, including penicillin and cephalosporporins, and frequently shows resistance to macrolides, limcosamides, aminoglycososides, fluoroquinolones, and tetracyclines ([PERSON] et al., 2015) [21]. The presence of _S. aureus_, _A. baumanniii_, _P. aeruginosa_, and _E. faecalis_ on reusable tourniquets aligns with previous studies, which have also reported contamination of these devices with potential healthcare-associated pathogens [22; 23]. Such bacteria are known to cause catheter-related bloodstream infections (CRBSI) and peripheral venous catheter-related bloodstream infections (PVCR-BSI), both of which are significant causes of morbidity in hospitalized patients. Lastly, CRBSI and PVCR-BSI are most associated with _S. aureus_ (including MRSA), coagulase-negative _Staphylococci_, _Enterococcus_ spp., _Klebsiella_ spp., and _P. aeruginosa_. The contamination of reusable tourniquets with these microorganisms poses a potential risk for cross-contamination during vascular access procedures. Improper handling of tourniquets may transfer bacteria to the patient's skin or catheter insertion site, increasing the likelihood of infection [24; 25; 26]. These findings underscore the challenges in maintaining sterile conditions with reusable medical devices such as tourniquets, especially given the presence of multidrug-resistant and biofilm-forming pathogens that are difficult to eliminate. These results highlight the necessity for rigorous disinfection protocols or consideration of single-use alternatives to minimize healthcare-associated infection risks. Given these findings, our study reinforces the urgent need for single-use tourniquets or the development of validated disinfection protocols for reusable devices. Current manufacturer guidelines provide inconsistent recommendations regarding tourniquet decontamination, and, in some cases, fail to mention disinfection procedures at all. To reduce the risk of healthcare-associated infections (HAIs), it is critical to establish evidence-based infection control measures that include tourniquets as potential vectors of pathogen transmission. Furthermore, the detection of multidrug-resistant species, including Stenotrophomonas and Acinetobacter, highlights the risk posed by persistent contamination of reusable medical equipment. Future research should evaluate the efficacy of various disinfection methods and assess the long-term microbial burden on reusable tourniquets in different clinical settings. While this study focused on reusable tourniquets as potential reservoirs for pathogens, it is important to acknowledge that other frequently handled medical devices similarly contribute to nosocomial transmission. Medication administration tools--including pillboxes, medication carts, and dispensing systems--have been documented as significant fomites carrying multidrug-resistant organisms.