Should you reuse markers after designating site?

Many outpatient surgery providers throw away their markers after designating the surgical site. But could you save money and help the environment by reusing them? One recent study points to that possibility, at least for one brand of markers.

Healthcare facilities in Alberta, Edmonton, Canada, were spending thousands of dollars discarding their one-use markers, costing $2 each, due to infection control concerns. However, the Sharpies brand markers don't spread infection, say researchers Sarah Forgie, MD, FRCPC, associate professor in pediatrics, University of Alberta, along with Catherine Burton, MD, BSc, resident in pediatric infectious diseases. One of the surgeons raised a question about whether wiping the outside of the marker like a stethoscope would kill the bacteria." I said that because its alcohol-based, it shouldn't transmit anything," Forgie said.

Because many of the surgical teams in Edmonton liked Sharpie-brand markers, Forgie and Burton tested that brand with a sterile marker specifically intended for single use in operating rooms. Marker tips were heavily contaminated with four types of bacteria that can cause surgical-site infections; two of the germ types are of particular concern in hospitals since they are antibiotic-resistant, Burton explained. "With our little agar plates, we put way more bacteria on these little nibs than you would ever find on a human, and the alcohol effectively killed them from the Sharpie marker," said Forgie.

After recapping the markers and letting them sit for 24 hours, Burton and Forgie found that the sterile, one-use marker, which has a nonalcohol-base ink, still was contaminated, but the Sharpies were not. The finding led to a policy change within Alberta Health Services.

"As long as surgeons or their designate wipe off the outside of the pens after each use, they don't have to throw them out," said Forgie, "which means there is a cost savings, and, most importantly, the markers are still safe for the patient."

However, not everyone is sold on the idea. "They cultured 24 hours after the first use, so the question remains if it would be safe to use the same marker on the next patient one, two, three, or more hours later," says Marcia R. Patrick, RN, MSN, CIC, director of infection prevention and control at MultiCare Health System in Tacoma, WA. "We use a new one for each patient."

The Association of periOperative Registered Nurses (AORN) also gives a thumbs down to reusing markers. "We wouldn't approve, because you don't know if the alcohol in that Sharpie is no longer effective," says Joan Blanchard, RN, MSS, CNOR, CIC, perioperative nursing specialist at the AORN Center for Nursing Practice. You could be spreading methicillin-resistant S. aureus or C. difficile from patient to patient — or any pathogen, and a host of skin bacteria — so they wouldn't recommend reuse, she says.