Summary

The surgical skin marking pen is a vector for contamination during arthroscopic ACL reconstructions

Abstract

PROBLEM

Marking pens are commonly used to mark skin incisions, not discarded, and then used to mark graft preparation. To our knowledge, the marking pen as a source of contamination has not been studied.

OBJECTIVES

The purpose of this study was to assess whether the skin marking pen is a vector for contamination during arthroscopic anterior cruciate ligament reconstructions (ACLR). We hypothesized that surgical marking pens used to delineate the proposed skin incision will be culture positive.

Methods

Ten surgical marking pens were collected prospectively from patients undergoing ACLR. All patients received standard preoperative prepping and draping with Duraprep (3M, Maplewood Minnesota) Proposed incisions were marked with a new sterile pen and the pen tip was immediately sent for 5-day inoculation in broth and Agar. Negative controls (unopened new pen) and positive controls (marking of the skin incisions prior to prepping) were also cultured. Additionally, blank culture dishes were followed during the growth process. All pens were removed from the surgical field prior to incision and new marking pens were used when needed during the procedure.

Results

Two of the ten study pens (20%) demonstrated positive growth. Both pens grew species of Staphylococcus. None of the negative controls demonstrated growth, 5 of the 7 positive controls showed growth, and none of the blank dishes exhibited growth. Organisms found were predominantly Staphylococcus but also included Bacillus and Aspergillus.

Conclusion

We found a 20% rate of surgical marking pen contamination by Staphylococcus during ACLR. Infections are rare but may result in significant morbidity, and all measures to reduce these should be sought after. Surgeons performing ACLR should consider disposal of the surgical marking pen following skin marking and prior to intraoperative use such as graft markup. Estimated cost of a new sterile pen is approximately $1.