A simple Sharpie pen is emerging as an effective tool to prevent surgical errors and infections.
Surgeons typically use marking pens to ensure they operate on the correct part of a patient’s body. But one concern is that the germs from the pen could pose a risk for infection. As a result, many hospitals use sterile pens once and throw them away, a practice that costs thousands of dollars a year.
Infection control experts from the University of Alberta decided to study pens used to mark up surgical patients. They compared a one-use sterile surgical pen to a standard Sharpie — the brand name for a line of no-smudge permanent markers favored by everyone from autograph-writing football stars to President Bush.
In a controlled experiment, the tips of both kinds of pens were heavily contaminated with four types of bacteria that can cause surgical site infections, including two germ types that are resistant to antibiotics. The researchers recapped the markers and allowed them to sit for 24 hours.
Surprisingly, the sterile, one-use marker was still contaminated. But the Sharpies were not. As it turns out, the ink used in a Sharpie pen has an alcohol base, making it an unexpected germ fighter.
The researchers, who will present their findings at an infectious disease conference later this month, noted that they used an unusually large number of germs on the markers to conduct the experiment. That suggests that in the real world, a Sharpie would be highly effective in preventing the spread of germs even after multiple uses.
“We went much further than what would happen in real life,” said Dr. Sarah Forgie, associate professor in the department of pediatrics, in a press release.
Dr. Forgie noted that the pen itself should be cleaned with an alcohol swab between patients, just as is done with stethoscopes. However, she said the marking tip does not pose a risk of bacterial transmission and doesn’t need to be discarded after each use, potentially saving thousands of dollars in annual hospital costs.
Patients undergoing surgery should always make sure that only their surgeon — not a nurse or other surgical staff — draws on the body with a permanent marker to identify the correct surgical site. To learn more about wrong-sided surgery and how to prevent it, read my Well post “When Surgeons Cut the Wrong Body Part.”
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From 1 to 25 of 54 Comments
For my right hip operation last year the nurse had me make the mark, but I thereafter was fully awake when the area was shaved and sterilized, then the lites went out. I assumed thereafter that the side that was shaved would be a sure sign. Operation successful on proper side.
— B ReillyDO NOT REMOVE TESTICLES!
— JewishGuyWhat a great study. Science can be so practical.
— jfx70% alcohol, or 90%? Please check that info and add it to your story. There’s a difference. I’d guess it’s the 70% (really 72%). According to an epidemiology instructor I had who did the research, 90% isn’t as good for killing pathogens.
— julianaA Sharpie can also possibly be used in a “DNR” situation. Rather than rely totally on their procedures, you can write DNR on your chest or arm.
— Look SharpAs a surgeon, I have noticed those pens going into the garbage and I offer them to the patient’s family -they are good for marking packages and golf balls. As I read this article, my first thoughts were that the Sharpie’s always smell of something. Now I’ll have to read this journal article. Hooray for the NY Times Journal of Medicine.
— W ParkWhen I went in for knee surgery about seven years ago, I marked my healthy knee with a big “Do Not Cut” note — using a Sharpie. I half-meant it as a joke, and the surgeon and nurses were amused… but I also wanted to make sure that no one made a last-minute mistake. Better safe than sorry, and yes, they operated on the correct knee.
— BrianPet peeve:
Do not mark directly over the proposed incision site.
— Terry the orthopod.Thanks.
I had a partial knee replacement 5 weeks ago and was given a sedative prior to receiving a femoral nerve block. This was done in a waiting area before I was brought to the operating room. I have no recollection of anything from the time the sedative and nerve block were administered until I was in the recovery room. Once my bandages were removed, I saw my doctor had marked the knee being replaced but I have no memory of it. He definietly didn’t make the mark while I was still actually functioning. Lucky for me it was the correct knee!
And my partial knee replacement has been great. Arthritis pain is gone, although I do have post-surgical pain being dealt with with PT.
FROM TPP — I think this is a good lesson. Before patients are given any form of sedation, they need to meet with the doctor and see that the correct site is marked. It’s such a small thing, but really can prevent tragedy. For those who are not convinced, read the story about wrong-side surgery — it will send chills down your spine. Thanks for sharing your story.
— CarolineMcCain is always mucking about with his Sharpie.
He should have marked Sarah for removal from the ticket.
— Marking his X on Palin.This reminds me of an issue that came up over 30 years ago when I was a medical student. The required dress code for male medical students who were performing clinical service rotations in the 3rd and 4th years of medical school was shirt and tie with the obligatory short white coat—to be differentiated from the longer white coats adorned by house staff and attendings.
My med school buddy and I complained bitterly to each other about this rule. As products of coming of age in the ’60s, we hated wearing ties. He came up with a cogent argument to address this. He postulated that the wearing of ties was a contributing cause of the spread of nosocomial infections in hospitals. Every time we would examine a patient our exposed tie tips would touch some part of a patient’s body. This would occur countless numbers of times over the course of days (or weeks for those of us disinclined or too tired to change ties).
He proposed that we perform a “proof of concept” experient by cutting off the tie tips of all of the house officers and culturing them to see what types of bacteria, if any, would “grow out.” I thought it was a brilliant idea. Unfortunately we never got around to conducting the experiment in med school.
It wasn’t until I was a medical intern in internal medicine, subjected to the same dress code for house officers that I decided once and for all to conduct the “tie tip experiment.” I cut the tie tips off of 6 of my fellow interns’ ties and brought them to the hospital’s clin path lab where I cajoled a tech to culture the tie tips.
Well, let me tell you, so much “junk” grew out in the dishes after 48 hours that I was elated. I submitted my “scientific findings” to the Director of Residency Training. Guess, what? She wasn’t impressed. She faulted the study design, the absence of a control or comparator, the inherent bias in an “open label” study, and the lack of sufficient statistical power to prove anything.
I spent the rest of my internship year trying to find excuses to wear surgical greens instead of the standard dress code.
I wonder if anyone has ever conducted a similar study, and if the dress code policies for house officers has changed. I haven’t conducted a PubMed search, but I’ll bet something along this line has been investigated.
— Barry K. Herman, M.D.Ground breaking research!!!!! I hope that the NIH dedicated millions to this study, rather than fund ADULT stem cell research!!!!
— MikeJust curious…what are your thoughts of Olivia Judson’s editorial/blog today?
— yycHumm, let me think here. Why can’t hospitals begin to use Sharpies!!! Has this not occurred to anyone?
— BertFROM TPP — I think many doctors do use them unofficially, because they prefer them. I think this might be the first study to show a scientific reason for using them.
I had hand surgery 2 weeks ago and I still have the surgeon’s initials on my hand despite many attempts at removal. She wrote with a surgical marker. Will a Sharpie be easier or more difficult to erase from skin? For some surgeries, this may be important. (My doctor has the unfortunate initials of FLY (not kidding) which adds to the desire to get it off!)
FROM TPP — Sharpies take a while to remove too. I have two tips for you. Try nail polish remover or hairspray — I used hairspray the other day for tie-dye that got all over me and it worked great. Let me know if they work. Readers, any other ink-removal tips??
— ErikaI have found over the course of life that more often than not “specialized” items like the one-use surgical pens are either no more effective or less effective than simple “generic” equivalents. Many vendors who serve narrow markets rely upon “specialty items” that are specific to a given industry/profession that only serve the purpose of increased markup. Obviously, there was no actual problem that the one-use pen solved since the Sharpie has proved clearly superior, but they were still able to create a perception of a problem, and an expensive solution to solve it.
Whatever your profession, always look at such expensive specialized items with a skeptical eye. Certainly there are cases where such items are justified or necessary, but as this case shows often times it is no more than a scheme for vendors to increase profit with no added value.
— Othar Hugh ManatiMike@12
At least this research provides useful information. Fighting hospital acquired infections is not a trivial matter.
Investors in the company that makes the purpose-built single-use throw-away marker may wish their money had been used as wisely.
— MTas an orthopedic surgeon doing about 300 arthroscopic knee surgeries a year, i have pateints put black duck tape on the knee NOT to be operated on. It takes a little doing to rip it off to operate on the worng knee, so the results have been good. I think covering up the wrong knee works better than marking the correct knee because you really have to work to operate on the wrong knee by removing the duck tape.
— dr, don rosenLike some stuffed items, just write Do Not Remove Unless By The Consumer on the good side.
— I’m always afraid to remove those labels.I had ACL surgery on my left knee 3 months ago at the Hospital for Special Surgery. While I was waiting for surgery, my assigned Nurse, the Orthopedic Physician’s Assistant, the Anesthesiologist, and finally my Surgeon all came in to my room and asked me “which leg and what operation was being performed”. They all signed off on my charts when I said “my left ACL”, and my surgeon signed his initials on the side of my left knee with a purple marker, which I thought at the time was a Sharpie. The ink came off easily about a week or two after I was permitted to get the area wet. The HHS is the best.
— AliceToothpaste (for skin) and acetone based nail polish remover for WHITE clothes only.
I once got Sharpie on a white shirt and removed the stain with acetone based nail-polish remover. Be careful you don’t get the acetone on anything dyed though.
Rubbing alcohol may also work to remove sharpie from skin.
— KimThe reason a sharpie is better is that before surgery a prep is done, sometimes just lathered on with a film that stays put (duraprep) or a betatine or hibiclens soap. The scrubbing action often washes off regular ink where the sharpie is more permanent. More critical in plastic surgery cases where the patient has many specific marks showing where exactly to cut.
— Susan KodnerGreat advice to take your own Sharpie with you. My mom was “marked” with a purple Sharpie marker just before surgery a few years ago. The doc made his marks, turned to me and offered me the pen. When I refused, he threw it right into the trash and went on his way. Then, when the bill came, Mom was charged $15 for a Sharpie marker!!! Made me wish I’d said thanks and grabbed the thing from him…I could have bought dozens of them for that kind of money!
— 1956okie#15:
Alcohol (ethanol or isopropanol) will remove Sharpie ink from most surfaces including your skin. I’m sure what kind of ink the surgical pens use, but if alcohol doesn’t work you could try acetone, which removes almost anything.
— TMLSharpie removal hint. In the old days I used so-called “sew-up” bicycle tires. The glue was strong enough to hold on the tires at a high speed but got on my legs, hands, whatever. I was glad the glue worked so well. From the smell, the glue had lots of volatile hydrocarbons, So, I tried a non-volatile hydrocarbon, vegetable oil. It worked like a charm. Yes you had to wash off the vegetable oil, but the other stuff was dissolved. And yes, it does work on inks.
— Gruntled and confused