Current Practice on Preoperative Correct Site Surgical Marking

Abstract

Performing surgery at an incorrect site has devastating outcomes. The National Patient Safety agency and Royal College of Surgeons England have provided recommendations to promote correct site surgery with emphasis on surgical markings. There is little published data on surgical site marking practices amongst surgeons. A prospective audit on surgical site marking was performed on 500 surgical procedures: 204 inguinal hernias, 35 umbilical hernias, 48 varicose veins, 40 toenail removals, 123 excisions of skin lesions, 10 femoral artery procedures and 40 breast procedures. The results showed that 59% of markings were visible in theatre post sterile draping, 40.4% markings were not visible, and 0.6% (3/500) were not marked. Recommendations suggest the use of an arrow with an indelible marker pen. Our results show the use of an arrow in 64% of patients and this was the most common form of mark used. An appropriate marker pen was used on 88% of patients. There is no evident published data to compare our practice to that of other surgical units, however, to improve correct site surgery markings should be visible, recognisable and understood by all specialties and grades. A universal marking system to improve correct site surgery may be beneficial.

Preoperative site marking in dermatosurgery

“…Skin marking must be visible after disinfection of the surgical field. Masud et al [4] investigated this aspect in a prospective study covering 500 surgeries. The results showed that 59% of markings were visible in theater after sterile draping, 40.4% markings were not visible, and 0.6% (3/500) were not marked.…”

“…To improve correct site surgery, skin markings should be recognizable and understood by all members of the staff in the unit. [4]…”

The Role of Checklists and Human Factors for Improved Patient Safety in Plastic Surgery

“…Masud et al recommended the use of an arrow to mark the correct side. 45 This will avoid wrong interpretations. Indeed, an arrow leaves no doubt about which side has to be operated on, whereas a cross could be interpreted as a "no" (Figs.…”

What interventions are performed in daily practice to prevent surgical site infections in neurosurgical patients? Findings from an explorative survey

“…A preoperative shower (Edmiston et al 2015, Leaper & Ousey 2015), not shaving (Broekman et al 2011, Kose et al 2016), antibiotic prophylaxis (Liu et al 2014), and skin antisepsis (Cowperthwaite & Holm 2015), along with surgical site postoperative care have been recognised as standards of care capable of preventing SSI. Moreover, surgical site marking (Masud et al 2010) has also been included among perioperative standards of care aimed at reducing errors. However, available clinical guidelines are not clear enough when dealing with peculiar neurosurgical patients: for example, (a) the presence of hair can threaten surgical site disinfection and management, (b) subdural or external ventricular drainages can facilitate contamination, and (c) lack of patient compliance with recommendations (eg not touching dressings) due to neurological disorders or postoperative confusion can all increase the risk of SSIs.…”

“…Chlorhexidine gluconate (CHG) at 2% or povidone–iodine (PVP-I) is also recommended for surgical site disinfection (WHO 2016) while the use of antimicrobial- or hydrocolloid-, hydroactive- and silver-containing dressings is not recommended (WHO 2016). Moreover, it is also recommended that the surgeon should mark the surgical site before surgery (Devine et al 2010) with a permanent marker pen (Masud et al 2010) to prevent surgery on the wrong side.…”