During the PA-PSRS preventing wrong-site surgery initiative, several inquiries were received regarding the performance and sterility of surgical site marking pens. The majority of surgical site marking pens contain gentian violet ink, which has antifungal properties. Other types of marking pens used by some hospital staff to mark surgical sites are permanent ink markers and, infrequently, ballpoint pens. The surgical site mark should not be easily removed with skin preparation but should not be so permanent as to last weeks or months after the surgical procedure. Three studies describing the performance of pens or markers used to mark surgical sites were reviewed. None was conclusive in determining the best performance of marks on skin when used with skin prep solutions. Also reviewed were three studies that described the sterility of single-use surgical site marking pens and two studies that looked at cross-contamination from surgical site marking pens used on multiple patients. Based on the results of each sterility study, no infection or contamination was observed from single-use pens; however, the potential exists for cross-contamination from pens used on multiple patients. The results of the reviewed studies are not definitive as to the type of surgical site marking pen or the type of skin prep solution to use to obtain the optimal mark at the surgical site. Healthcare facilities may wish to conduct their own studies of surgical site markers and/or skin prep solutions to determine performance between markers and skin prep solutions.
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