Sterility of the Surgical Site Marking Between the Ink and the Epidermis

Background: To prevent wrong-site surgery, multiple organizations have endorsed the practice of signing the operative site with an indelible marker. Potential contamination of the surgical field and the inability to prepare the area under the ink film raises concerns. The purpose of this study was to determine if the use of preoperative site marking affects the sterility of the surgical field. Study Design: After institutional review board approval, 30 consecutive patients scheduled to undergo elective upper extremity surgery by the same surgeon were included. For each patient, surgical marking according to Joint Commission on Accreditation of Healthcare Organizations guidelines were placed on more than half of the planned incision site, and the other half was left unmarked. The patients then underwent routine surgical preparation. The skin was incised, starting from the unmarked side and continuing to the marked aspect. Cultures were obtained by swabbing the skin edges: one from the unmarked side and one from the marked side. After blood agar plating, cultures were incubated for 72 hours and analyzed by a blinded observer. Results: All cultures were negative, regardless of swab site (unmarked or marked location). Conclusions: The practice of surgical site marking does not increase the risk of operative field contamination. © 2007 American College of Surgeons.