Marking Pen Bacterial Contamination During Shoulder Surgery

Magone, Kevin M.; Ristow, Jacob; Root, Kyle T.; Atkinson, Theresa; Sardelli, Matthew

doi:10.1177/23259671211062225

Cited by 1 publication

(1 citation statement)

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“…In another study of ACL reconstruction surgeries, Nakayama et al demonstrated that 6% of patients had positive skin colonization near the incision site and 2% had positive graft colonization with Staphylococcus epidermidis , indicating that a surgical pen could have transmitted S. epidermidis from colonized skin to the graft [ 7 ]. In an experiment culturing pens used in shoulder reconstruction surgery, one of the 43 studied pens demonstrated growth of Propionibacterium acnes [ 8 ]. A literature review of surgical site markers as sources of infection determined that markers can be a source for cross infection with MRSA, other bacteria, fungi, or viruses [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical Marking Pen Contamination: Writing a Postoperative Infection Into Your Preoperative Plan

Huff¹,

Jacobs²,

Huang³

et al. 2023

Cureus

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Introduction Preoperative marking is an essential safety practice to prevent "never" events, including wrong site surgery. Moreover, the Joint Commission regulations of the Universal Protocol require that patients be marked to indicate the operative site. Marking typically occurs with a pen or marker, which may be disposable or reusable. Previous studies have demonstrated that methicillin-resistant Staphylococcus aureus (MRSA) can survive in the dark, moist, capped environment of the marking pen and thus could plausibly be a nidus for transmission from patient to patient. The Joint Commission has established no increased risk of postoperative infection with these markings. With this study, we aimed to determine the colonization of surgical marking pens in the plastic surgery population. Methods Two marking pens from five different attending plastic surgeons at a single institution were cultured in standard fashion for aerobic and anaerobic growth. All pens were used repeatedly in office settings for performing patient markings. Those same ten marking pens were then used to mark incision sites on mock patients. Standard povidone-iodine prepping was then performed in a paint-only fashion over the skin markings, and cultures were again taken. A control group consisted of cultures from five sterile pens from the operating room. Each sterile pen was opened, uncapped, and then swabbed. All twenty-five cultures were analyzed in the hospital laboratory in a blinded fashion. Results The five control pens revealed no bacterial growth. Of the 10 direct pen cultures, two samples grew coagulase-negative staphylococci and one culture contained Pseudomonas aeruginosa . The 10-patient marked and prepped specimens showed eight negative cultures and two with coagulase-negative staphylococci. Although Pseudomonas was detected on standard pen culture, no pseudomonal growth was present in any of the samples after patient marking and prepping with povidone-iodine. Conclusions Our findings reaffirm that marking pens may be vehicles for bacterial transmission and expand upon previous studies by describing the presence of bacterial colonization on marking pens even after surgical site preparation with povidone-iodine.

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Section: Discussionmentioning

confidence: 99%