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Background: Over the past decade, wrong-site surgery has been a popular topic of discussion, not only in medical and legal journals but also in the mainstream press. Marking of the surgical site according to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Universal Protocol was implemented at our institution to help reduce the number of wrong-site operations. In this study, we determined whether marking of the site affected the sterility of the surgical field.
Methods: The study included twenty volunteers. The right forearm was used as the experimental (marked) arm and the left forearm, as the control arm. The experimental forearms were marked with a surgical marker as described by the protocol. Both upper extremities were then sterilized from the antecubital fossa to the phalanges with a 7.5% povidone-iodine scrub followed by the application of a 10% povidone-iodine paint. Swabs were used to obtain samples from the experimental and control arms as well as from the marker and were sent for microbiological culture and analysis.
Results: No growth was seen in the cultures of the swabs used on the experimental or control arms or on the marking pens.
Conclusions: Preoperative marking of surgical sites in accordance with the JCAHO Universal Protocol did not affect the sterility of the surgical field, a finding that provides support for the safety of surgical site marking.
Over the past decade, wrong-site surgery has been a popular topic of discussion in medical and legal journals as well as in the mainstream press. The issue has become prominent in the current literature because of profound patient, social, professional, and medicolegal consequences. Although controversial1,2, a report by the Institute of Medicine estimated that 44,000 to 98,000 Americans die each year from preventable medical errors rather than from the admitting diagnosis3. The estimated annual cost to United States taxpayers is approximately $9 billion3. In 1994, the Canadian Orthopaedic Association instituted an educational program intended to prevent wrong-site surgery by recommending that the incision site be marked with an indelible marker. As a result, the number of cases of wrong-site surgery declined from thirteen in 1994 to five in 2000(4). A 2001 poll of 167 randomly selected Canadian orthopaedists showed that 52% of them always marked their surgical site, despite the lack...