Precautions with gentian violet: skin marking made sterile, effective, and economical.

BACKGROUND Surgical site infections have been caused by gentian violet (GV) marking solutions that were contaminated with Mycobaterium chelonae. GV solution is also used in surgery to mark surgical sites. It is commercially available as a solution that may not have been prepared under sterile conditions. OBJECTIVE Our objective is to describe a skin marking method that is sterile, effective, and economical. METHODS GV solution; microcentrifuge tubes; and round, wood toothpicks are used as an alternative to the standard surgical marker. GV (4 drops) is dispensed into a microcentrifuge tube. After capping, the tube is autoclaved. The toothpick is used as the writing instrument and dipped into the GV as needed for intraoperative skin marking. Unlike commercially available skin markers, skin moisture will not cause the writing implement (toothpick) to become ineffective; merely dry the skin before skin marking. RESULTS Autoclaving the commercially available shelved GV solution ensures sterility. The cost of the GV, toothpicks, and microcentrifuge tubes is approximately $0.10 per operation. In contrast, commercially available surgical markers range in cost from $0.79 to $3.89 per pen (manufactured suggested retail price), a 8- to 39- fold difference. CONCLUSION Infectious precautions should be taken with surgical site marking. Marking solutions should be prepared under sterile conditions in a pharmacy. Alternatively, commercially available nonsterile solutions can be autoclaved to ensure sterility.