Staphylococcal toxic shock syndrome (TSS) is a rare, life‐threatening systemic bacterial infection, historically associated with the use of superabsorbent tampons. TSS is characterized by high fever, hypotension, rash and multiorgan dysfunction (NHS [131]).

TSS occurs when the bacteria Staphylococcus aureus and Streptococcus pyogenes, which normally live harmlessly on the skin, enter the bloodstream and produce poisonous toxins. These toxins cause severe vasodilation, which in turn causes a large drop in blood pressure (shock), resulting in dizziness and confusion. They also begin to damage tissue, including skin and organs, and can disturb many vital organ functions. If TSS is left untreated, the combination of shock and organ damage can result in death. Symptoms usually occur together and get progressively worse over time. They include:

TSS can also affect men and children, and currently nonmenstrual TSS is more common (Sharma et al. [188]). However, the first reported cases of TSS involved women who were using tampons during menstruation (Eckert and Lentz [56]), and this risk must be taken into account in relation to surgery. Female patients of menstruating age therefore need to be made aware of the dangers of using tampons, which can cause infection leading to TSS. At the time of admission, it is important to ask female patients whether they are menstruating and to highlight the dangers of using tampons during surgery. If tampons are left in situ for longer than 6 hours, infection may develop. Nurses can offer a sanitary pad as an alternative.