Surgical Site Marking Does Not Affect Sterility

Rooney, John; Khoo, Oliver K. S.; Higgs, Andrew; Small, Timothy; Bell, Sydney M.

doi:10.1111/j.1445-2197.2008.04618.x

Cited by 12 publications

(5 citation statements)

References 8 publications

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“…This may be attributed to differences in solution application in accordance with manufacturer guidelines, as povidone-iodine prep involves painting a single layer without scrubbing and chlorhexidine prep involves repeated forward and backward strokes for 30 seconds [ 18 ]. In 2008, Rooney et al performed an experiment where they cultured forearms that had been marked like a simulated surgical site with a multiply used marking pen and found that there was no bacterial growth following site sterilization with a 10% povidone-iodine solution [ 5 ]. Another experiment used cultured marking pens on surgical sites that were prepped with betadine (povidone-iodine) scrub followed by betadine (povidone-iodine) paint.…”

Section: Discussionmentioning

confidence: 99%

“…With this study, we aimed to determine the colonization of surgical marking pens in the plastic surgery population. We hypothesized that reusing marking pens, as long as they are stored in a clean environment and patients are prepped after their use, is a safe practice that does not affect surgical site sterility, as this had been previously reported by Rooney et al in 2008 [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

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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“…reviewed the available evidence and concluded that surgical site marking does not affect the sterility of the surgical field. [78]…”

Section: Discussionmentioning

confidence: 99%

Wrong site surgery! How can we stop it?

et al. 2014

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Introduction:“Primum non nocere” (first do no harm): Hippocrates (c. 460 BC-377 BC). Wrong site surgery is the fourth commonest sentinel event after patient suicide, operative and post-operative complications, and medication errors. Misinterpretation of the clinic letters or radiology reports is the commonest reason for the wrong site being marked before surgery.Materials and Methods:We analyzed 50 cases each of operations carried out on the kidney, ureter, and the testis. The side mentioned on clinic letters, the consent form, and radiology reports lists were also studied. The results were analyzed in detail to determine where the potential pitfalls were likely to arise.Results:A total of 803 clinic letters from 150 cases were reviewed. The side of disease was not documented in 8.71% and five patients had the wrong side mentioned in one of their clinic letters. In the radiology reports, the side was not mentioned in three cases and it was reported wrongly in two patients. No wrong side was ever consented for and no wrong side surgery was performed.Conclusion:The side of surgery was not always indicated in clinic letter, theatre list, or the consent form despite the procedure being carried on a bilateral organ. As misinterpretation is a major cause of wrong side surgery, it is prudent that the side is mentioned every time in every clinic letter, consent form, and on the theatre list. The WHO surgical safety checklist has already been very effective in minimizing the wrong site surgery in the National Health Service.

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“…El marcaje sobre la zona donde se va a realizar la cirugía podría presentar un potencial riesgo de infección y por ello que algunos cirujanos optan por marcar «No» en el lado que no se debe operar 36 , pero posteriormente se ha asegurado que la realización de una marca en lugar de la incisión cutánea no ocasiona un aumento del porcentaje de infección 10 . Generalmente, la marca en el lugar a realizar la incisión se realiza con un rotulador no estéril y que suele utilizarse para varios pacientes, pero se ha demostrado que el marcado del sitio quirúrgico llevado a cabo con un marcador quirúrgico no estéril no contamina el sitio quirúrgico y después de la esterilización con una solución yodada no existe contaminación de esta zona 46,47 . También se ha comprobado que el marcado preoperatorio no atrapa bacterias debajo del lugar de la marca por lo que tampoco contamina la herida quirúrgica 48 .…”

Section: Discussionunclassified

Cirugía del lado erróneo: implicación del paciente y los profesionales. Experiencia en la Cirugía Mayor Ambulatoria de la Unidad del Pie

Márquez

Gutiérrez

Martínez

et al. 2012

Revista Española de Cirugía Ortopédica y Traumatología

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Surgery of the wrong side is a very uncommon complication in orthopaedic surgery, but with serious consequences for the patient, the surgeon and the health institution, having to put all the necessary measures in place to prevent this occurring. We have conducted a prospective study on the introduction of a protocol to prevent surgery of the wrong side in 101 patients operated on for any foot disease in the Major Surgery Ambulatory Unit, performing three independent controls to verify the side: by the patient, by the nurse and by the anaesthetist. We review the information available of the side in the medical records and their correlation with the side operated on. Almost a quarter of the patients, 24.8%, were not informed that they had to make a mark on the foot to be operated on. No mark was made by 18.4% of the patients informed to do so, with no relationship between age, gender, education level, to live alone or previous foot operations. There was a lack of noting the side in the documentation, with this omission being more frequent in the Orthopaedic and Traumatology and Anaesthesiology medical records. Nine cases of inconsistency in the surgical side were detected, all in patients who had previous surgery in any foot. Marking of the side has been incorporated as routine practice in foot surgery, being beneficial for the safety of the patient, and should become normal practice in all surgical areas in the near future.

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Surgical Site Marking Does Not Affect Sterility

Abstract: Surgical site marking carried out with a non-sterile surgical marking pen did not contaminate the surgical site. We recommend the practice of surgical site marking.

Cited by 12 publications

References 8 publications

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

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

Wrong site surgery! How can we stop it?

Cirugía del lado erróneo: implicación del paciente y los profesionales. Experiencia en la Cirugía Mayor Ambulatoria de la Unidad del Pie

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