Cross-infection risk of felt-tipped marker pens in cataract surgery

Abstract

Purpose To assess the potential of bacterial transmission using felt-tipped marker pens on forehead skin before cataract surgery. Methods A total of 64 marker pens taken from clinical stock were tested. Forty-eight new pens were cultured in the laboratory. They were first left to desiccate for 0, 4, and 16 h, then dipped into solutions of 0.5 Macfarlane's concentration of coagulase negative staphylococci (CNS), methicillin-resistant Staphylococcus aureus (MRSA) and coliforms, and transferred onto the culture medium after 5, 10, 30, and 120 min intervals of exposure to air. A further 16 pens were collected after routine clinical use for 5 working days and cultured. Results Positive cultures were observed in 100% of pens at 0 min, and 44.4% at 5 min after the organism was exposed to air. Escherichia coli showed least transmissibility with no growth in all plates after 5 min of exposure. Only MRSA showed heavy growth after 10 min of exposure. No pattern emerged with reference to the length of time; each pen was left to desiccate. No growth was observed in the cultures of all 16 marking pens after clinical use. Conclusions The potential for transmission of bacteria through felt-tipped marker pens has not been explored in cataract surgery. This study demonstrated that a theoretical risk of transmission exists in a laboratory setting, and survival times of the bacteria decreased with time. This suggests that the interval in which patients are marked with the same pen may play a role in bacterial transmission.

Is there a risk for bacterial transmission from surgical marker pens?

“…Another conclusion derived from a laboratory-based study was that the time interval between re-use of permanent markers may decrease the likelihood of bacterial transmission from permanent marker pens [5]. However, based on our presented findings we recommend the single use of surgical markers.…”

“…Some literature sources concluded multiple use of permanent marker pens to be safe from a bacterial transmission point-of-view as long as a sufficiently filled permanent marker containing an equally sufficient amount of any bactericidal ingredient(s) (i.e. 'ink') is used [4,5]. However, bacteria can be detected on human skin even after surgical prepping [6] and, therefore, the multiple use of marker pens bears the potential risk of transferring germs from one individual to another marked with the same marker pen [3].…”

Can Skin Marker Pens, Used Preoperatively to Prevent Wrong-Site Surgeries, Transfer Bacteria?

“…The National Healthy People 2010 goal for annual influenza vaccination coverage of HCWs in long-term care facilities is 60%. 4 The results reported here suggest that VA community living centers have already achieved this goal. Each fall, VA healthcare facilities conduct an extensive influenza vaccination campaign offering influenza vaccines to all patients and HCWs free of charge.…”

“…1 It can cause bacteremia and endocarditis, especially among the elderly or among patients with chronic disease; 2 however, S. gallolyticus infection is considered uncommon among neonates. 3,4 We report a cluster of nosocomial bloodstream infections due to Streptococcus gallolyticus subspecies pasteurianus that involved 5 preterm neonates in a 16-bed neonatal unit of a 1,200-bed university hospital in France.…”

Economies of Intraoperative Drawing: Blood, an Autologous Skin Marker

“…Preoperative drawing can be effectuated in a nonsterile manner and with any skin marker which is not bearing the risk of tattooing. Several authors have underlined the risk of cross-infections of felt-tipped marker pens as well as the limited sterility under ink-marked epidermis [1][2][3] . On the other hand, intraoperative drawing needs special markers where the color does not bear the risk of tattooing; it should not be allergenic or irritating, and it should be sterile.…”