Introduction: A recent JBJS(Br) article examined skin markers after contamination with a standard MRSA inoculum and cultured on MRSA-indicator nutrient agar. The Penflex™ marker showed no survival after 15 minutes, whereas the Viomedex™ marker produced MRSA cultures for up to three weeks.

Research undertaken at Wrightington has shown that in primary joint replacement coagulase-negative staphylococci account for 67.2% – 76% of contaminants isolated from the ultra clean zone. It is the most prevalent and persistent species on human skin and mucous membranes and accounts for 58% of failures due to deep infection of primary THR.

Further studies of nosocomial infection transmission show bacterial contamination of healthcare workers’ scissors, ballpoint pens, stethoscopes and lab coats with MRSA, VRE and gram-negative bacilli.

Multiuse skin markers may become colonised, possibly with MRSA, MRSE and gram-negative bacilli. This may contaminate patients and cause premature failure of arthroplasty, leading some units to adopt a single use policy.

Our aim was to ascertain bacterial colonisation of multiuse skin markers.

Method: Multiuse indelible skin markers were collected from Orthopaedic staff, wards and Day Surgery Units within the Mid-Yorkshire Hospitals.

Pens identified by a number, brand, location and approximate pen age.

Pen tips were neutralised with 10ml sterile Peptone water and this was used as the inoculum.

Cap interior swabbed with sterile swab (pre-dipped in sterile water).

Both were inoculated into enrichment broth and plated onto Blood and McConkey media.

Incubation at 37°c for 18 hours with plates read at 7 days for colony forming units.

Results: 31 pens. 15 different brands. Age 1 month– 3yrs

No growth on all plates after incubation for 7 days.

Conclusion: These results indicate that multiuse indelible skin markers are safe. There is no evidence to support subsequent cross contamination or the need for sterile single use pens for preoperative marking.