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November 7, 2008

BehindTheMedspeak: X marks the spot — 'Surgeons could keep a Sharpie marker with them and use it on all of their patients until the ink runs out'

Yiyty8

That's the bottom line (as it were) of the results of a study performed by scientists at the University of Alberta in Edmonton.

Here's Michael Smith's October 23, 2008 MedPage Today report.

    Re-Using Sharpie Pens as Surgical Marker in OR Gets Clean Bill

    When X marks the spot on the skin for surgery, is there a risk that a re-used Sharpie pen could transfer pathogens?

    The answer is no, according to Catherine Burton, M.D., and colleagues at the University of Alberta in Edmonton.

    In fact, commercially available Sharpie pens almost never harbor enough bacteria to show up in a culture because their ink is alcohol-based, Dr. Burton and colleagues said.

    Their Sharpie data are in a study that is to be presented next week at the Interscience Conference on Antimicrobial Agents and Chemotherapy, held here jointly with the Infectious Diseases Society of America meeting.

    On the other hand, pens specifically designed for surgical use — and meant to be used only once — harbored a range of pathogens for several hours, they said.

    The study began when the researchers saw that surgeons at the university hospital were using Sharpie pens to mark patients for surgery — then throwing the pens out after one use for fear of infection.

    At about a dollar a pen, the practice was costly, so the researchers decided to see whether there was any practical danger.

    They took 128 Sharpie-brand markers, with alcohol-based ink, and the same number of Securline brand surgical skin markers, with gentian violet ink.

    The markers were swiped across blood agar plates contaminated with one of four pathogens — methicillin-resistant Staphylococcus aureus, Escherichia coli, vancomycin-resistant Enterococcus faecalis, or Pseudomonas aeruginosa — and then recapped.

    Markers swiped across sterile plates served as controls.

    At eight time points after contamination — zero, five, 15, 30 and 60 minutes, four and 24 hours, and one week — the survival of the organisms was assessed by swiping the markers across clean agar plates, incubating them for 24 hours, and quantifying bacterial growth, the researchers said.

    The researchers found:

    • All the markers produced bacterial growth when they were swiped immediately after contamination.

    • One Sharpie produced vancomycin-resistant E. faecalis 24 hours after contamination, but no other Sharpie produced bacterial growth at any time point.

    • Securline markers produced growth of all organisms up to four hours and growth of P. aeruginosa and E. coli up to 24 hours, but no organism growth at a week.

    The findings imply that surgeons "could keep a Sharpie marker with them and use it on all of their patients until the ink runs out," Dr. Burton said.

    The risk is probably even lower than the findings imply, because the experimental bacterial load was extremely high, said co-author Sarah Forgie, M.D., also of the University of Alberta.

    "We went much further than what would happen in real life," she said.

....................

An abstract of the study, entitled "Can Skin Marker Pens, Used Pre-Operatively to Mark Surgical Sites, Transfer Bacteria?", was presented last week at the Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington, D.C.

More press coverage here, here and here.

November 7, 2008 at 02:01 PM | Permalink


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