Huff Mallorie L, Jacobs Aaron M, Huang Evanie, Miles Marshall G
Division of Plastic and Reconstructive Surgery, Department of Surgery, Lehigh Valley Health Network, Allentown, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, USA.
Cureus. 2023 Jun 5;15(6):e40007. doi: 10.7759/cureus.40007. eCollection 2023 Jun.
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 (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 . The 10-patient marked and prepped specimens showed eight negative cultures and two with coagulase-negative staphylococci. Although 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.
引言 术前标记是预防包括手术部位错误在内的“绝不允许发生”事件的一项重要安全措施。此外，联合委员会通用协议规定要求对患者进行标记以指明手术部位。标记通常使用笔或记号笔，笔可以是一次性的或可重复使用的。先前的研究表明，耐甲氧西林金黄色葡萄球菌（MRSA）能够在记号笔黑暗、潮湿、加盖的环境中存活，因此很可能成为患者之间传播的源头。联合委员会认定这些标记不会增加术后感染风险。通过本研究，我们旨在确定整形外科患者群体中手术标记笔的菌落定植情况。方法 从一家机构的五名不同的整形外科主治医生处获取两支标记笔，按照标准方式培养需氧菌和厌氧菌生长情况。所有笔均在门诊环境中反复用于给患者做标记。然后用这十支相同的标记笔在模拟患者身上标记切口部位。接着仅以涂擦的方式在皮肤标记处进行标准聚维酮碘消毒准备，之后再次进行培养。对照组由来自手术室的五支无菌笔的培养物组成。每支无菌笔打开、取下笔帽，然后进行擦拭取样。所有二十五份培养物在医院实验室以盲法进行分析。结果 五支对照笔未显示细菌生长。在十支直接笔培养物中，两份样本培养出凝固酶阴性葡萄球菌，一份培养物含有……。十份给患者标记并消毒准备后的样本显示八份培养物为阴性，两份培养出凝固酶阴性葡萄球菌。尽管在标准笔培养中检测到……，但在用聚维酮碘给患者标记并消毒准备后，所有样本中均未出现假单胞菌生长。结论 我们的研究结果再次证实标记笔可能是细菌传播的载体，并且通过描述即使在用聚维酮碘对手术部位进行准备后标记笔上仍存在细菌定植情况，对先前的研究进行了拓展。
