Ridley Taylor J, Rud Christopher T, Krych Aaron J, Macalena Jeffrey A
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
College of Osteopathic Medicine, Marian University, Indianapolis, Indiana, USA.
Orthop J Sports Med. 2018 May 16;6(5):2325967118772043. doi: 10.1177/2325967118772043. eCollection 2018 May.
A sterile surgical marking pen is commonly used during anterior cruciate ligament reconstruction (ACLR) to outline the proposed skin incision and then to mark the graft during preparation. Once in contact with the skin, the pen is a potential source of bacterial transmission and subsequent infections after ACLR.
PURPOSE/HYPOTHESIS: The purpose of this study was to assess whether the skin marking pen is a fomite for contamination during arthroscopic ACLR. We hypothesized that there would be a difference in the rate of culture-positive pens between control pens and the study pens used to delineate the proposed skin incision.
Controlled laboratory study.
Twenty surgical marking pens were collected prospectively from patients undergoing ACLR over a 12-month period. All patients underwent standard preoperative sterile preparation and draping procedures. Proposed incisions were marked with a new sterile pen, and the pen tip was immediately sent for a 5-day inoculation in broth and agar. Negative controls (unopened new pen) and positive controls (used to mark the skin incisions preoperatively) were also cultured. Additionally, blank culture dishes were observed during the growth process. All pens were removed from the surgical field before incision, and new marking pens were used when needed during the procedure.
Three of the 20 study pens (15%) demonstrated positive growth. All 3 pens grew species of . None of the negative controls demonstrated growth, 6 of the 12 positive controls showed growth, and none of the blank dishes exhibited growth.
This study found a 15% rate of surgical marking pen contamination by during ACLR. It is recommended that the skin marking pen not be used for any further steps of the surgical case and be discarded once used.
Infections after ACLR are rare but may result in significant morbidity, and all measures to reduce them should be pursued. Surgeons performing ACLR should dispose of the surgical marking pen after skin marking and before intraoperative use such as graft markup.
在进行前交叉韧带重建术（ACLR）时，常用无菌手术标记笔勾勒出拟行的皮肤切口，然后在准备移植物时标记移植物。一旦与皮肤接触，该笔就可能成为细菌传播的源头，并导致ACLR术后感染。
目的/假设：本研究的目的是评估皮肤标记笔在关节镜下ACLR过程中是否为污染媒介。我们假设，用于勾勒拟行皮肤切口的对照笔和研究笔之间，培养阳性笔的比例会存在差异。
对照实验室研究。
在12个月的时间里，前瞻性地收集了20支接受ACLR患者使用过的手术标记笔。所有患者均接受了标准的术前无菌准备和铺巾程序。用一支新的无菌笔标记拟行切口，然后将笔尖立即送去在肉汤和琼脂中接种5天。同时也对阴性对照（未开封的新笔）和阳性对照（术前用于标记皮肤切口）进行培养。此外，在培养过程中观察空白培养皿。所有笔在切开前均从手术区域移除，手术过程中需要时使用新的标记笔。
20支研究笔中有3支（15%）显示生长阳性。所有3支笔培养出的菌种均为……。阴性对照均未生长，12支阳性对照中有6支显示生长，空白培养皿均未生长。
本研究发现，在ACLR过程中，手术标记笔被……污染的比例为15%。建议手术标记笔在用于手术的任何进一步步骤后，一旦使用即丢弃。
ACLR术后感染虽罕见，但可能导致严重发病，应采取一切措施减少感染。进行ACLR的外科医生应在皮肤标记后、术中使用移植物标记等操作前丢弃手术标记笔。
