CONTENTS1. Hepatitis The Dangers2. Protocols for Equipment Processing3. Cold Sterilisation4. Ultrasonic Cleaner5. Autoclave6. Sterilisation Room7. The Well Equipped Procedural Room8. The Counter Area9. Gloves10. Implant Materials11. Ethical Information12. Temporary Operators13. Bio hazardous Waste14. Anaesthetics
HepatitisHepatitis C is a viral infection of the liverIt is a global health problem of significant importanceChronic infection with hepatitis C can lead to years of ill health,reduced quality of life, cancer of the liver & liver failure.There is no known cure or vaccineTreatment for hepatitis is very expensive (interferon Ribavirincombination) for treatment.Majority of people in NZ infected with HCV contracted the virusfrom needles or infected blood.HCV can remain dormant in its host for up to 20 years then suddenlyactivate.
HepatitisCan live on a hard surface (eg counter top) for up to 3 months.HCV cannot be killed by disinfectingHCV can survive in boiling water – needs 134c for 4 minutes to killHCV is a bloodborne pathogenMian transmission – sharing needles & Indirect contact19% - 30% Of people with tattoos have tested positive for hep Bin NZ. (hep C focus group)This risk icreases with every new tattoo & peirce.41% Hep C cases from tattooingHepititas goes largely underreported due to the socialstigma connected with this.
Protocols for Equipment ProcessingIsolationMoving contaminated equipment out of general area,Preferably into closed puncture-proof container (not to exceed 12hours)DecontaminationRemoving gross debris from equipment, preferably by ultrasoniccavitation (15min. min minimum)DisinfectionInactivating microbial life (except for endospores) preferably bychemical high-level disinfectant either by soak or saturation *15min.Minimum)Bio-shieldingWrapping, sealing, dating and initialling of equipment in material(s)suited for the sterilisation process to be used, preferably clear-view self seal packaging
Protocols for Equipment Processing (continued…)SterilizationCompletely eliminating all microbial life (including endospores),preferably by super-heated steam under pressure or a gamma ionizingradiation sterilizer.DocumentationEntering into record all items sterilized.StoragePlacing all sterile packaged equipment/supplies within a closed containerspecifically used for sterilized items only. (Not to be stored more thanone month)HandlingOnly touching with gloved hands, watching for tears in bio shielding,keeping away from moisture and only placing on appropriate fields, toavoid compromising sterility.
Cold SterilisationGluteralydhydes 2% Zenacide Aidyl PlusCarcinogenicRequire monitoring of the airPerasafe also other similar brands.No proof of sterility.Compromised during packaging.Used for cleaning endoscopy equipment.
Cold SterilisationPeiercing gunsPiercing gun operators need to have hand wash and dry facilities, cleanseparate area to pierce.Skin cleaning procedure and productSkin marking procedure and productGun cleaning procedure and productNostril piercing equipment (disposable attachment)Plastic Piercing guns melt when autoclavedAutoclaving & soaking in alcohol will damage the spring mechnism
Ultrasonic CleanerWhen the ultrasonic cleaner is in useAlways wear Examination gloves, Heavy rubber gloves Protective gloves, Safety glasses & Face mask Face shield, Disposable apronAlways run in conjunction with expel air fanAlways keep the lid on when in useNever put hot water in ultrasonic cleanerBio-hazardous sink close to ultrasonic cleaner2ft radius of contamination with lid on4ft radius of contamination with lid offCan drive pathogens through examination gloves
AutoclaveThe autoclave must Only be handled with clean gloves Have distilled water only Have records of autoclaved packges(how many, descriptions of items, date processed, by whom) Have spore test monthly Have no contaminated waterThe auto clave needs to be in its own steralisation room because thePotential is there for it to do an incomplete cycle and upon ventingcontaminate a whole room.When packaging is used on an autoclave with no dry packging, the door must be left ajar after the cycle has finished enabling package to dry.(Do not leave sitting in autoclave still wet/damp)A record of serial numbers taken from the autoclave printout wouldbe an advantage.
AutoclaveAn autoclave indicator is unreliable. An integrator will not changeunless the proper sterilisation process has taken place. An indicator will change if stuck on a 100 watt ligth bulb or left out in the sun.Integrator will no change unless all conditions have been achieved eg. Correct temperature Correct steam quality Correct timeMonthly spore tests/Sterilisation log
Sterilisation Room The only safe means of cleaning and sterilisationThis must be a separate roomLockableCompletely enclosed with It’s own lighting Air vent system, (expel air) Sink to rinse contaminated tools (must not be used for hand washing)
Sterilisation Room THE ROOM SHOULD BE DIVIDED INTO TWO HALVESCONTAMINATED SIDE CLEAN SIDEThis half is for Piercing equipment This half is for SterilisingTattoo MachinesHeavy rubber gloves (for ultrasonic) In this area should beSafety glasses or visor mask Printer for autoclaveFace mask Distilled waterDisposable plastic apron Airtight containers Sterilisation logFor packagingAutoclave tubing,Autoclave envelopesScissors,Paper Towels There should be nothingAutoclave tape From the contaminated side here.Date stamp or penSealerAir ventUltrasonic cleanerSink
The well Equipped Procedural Room for Piercing Rooms designated for piercing must be an enclosed room, (Separate from pathogens in reception area)Hand wash facilities – correct taps & sinks etcAntibacterial soapEvery surface must be wipeable (no carpet or porous curtains etc)Signs clearly stating CLEAN areas, BIOHAZARD areasTattoo/piercing table or chair, non porous, disinfected betweenClients or couchroll, gladwrap barriers.Bright lighting without shadowsLidded trash receptacles with foot pedalWipeable drawers for safe storage of equipmentSharps container in designated spotImplement trays to minimise cross contaminationDisposable barriers for hands eg tissue or paper towelsDisposable relish cups, jewellery, skin prep etc
The well Equipped Procedural Room for PiercingLatex gloves, every size for every operater (1 weeks supply)Hard surface disinfectants and disposable wipesMarking pens, toothpicks, gentian violet, Indian inkSupply of sterile packed, needles, forceps, tattoo equipment,made up needlebars etc (1 week supply)
The Counter AreaThis is an area constantly contaminated. Usually by clients touchingtheir piercing then touching the counter area, or by placingContaminated (previously worn) jewellery on the counter top.To keep this area clean use : Relish cups for pre worn jewelery Antibacterial wipes to clean the counter Offer client antibacterial wipes for their handsBoth staff & clients need to refrain from touching their peircing inthe store. This should only be done under controlled conditionsEg. Piercing room with gloves
The Counter Area Aseptic Hand wash Procedure1. 10c coin amount of soap2. Lather in palm of hands3. Fingers between fingers/Palm to palm/back & forth4. Fingers between fingers/palm to back of hand/back & forth5. Fingertips inside fingertips back & front6. Fingertips inside fingertips other hand inside7. Rinse with water/allow water to run off fingertips.
GLOVESAlways wash hands prior to glovingFor the purpose of piercing and tattooing sterile gloves are more expensivethan non sterile and in this environment, quickly compromise.Non sterile examination gloves with plenty of glove changes are a moreworkable option. It must be remembered that non sterile gloves begin toBecome compromised after only 3 minutes.
Implant MaterialsSafe Unsafe316 LVM (stainless steel implant grade Nickel316 L (marine) Nickel silverTi Sterling silverN/B Pure silverTeflon Gold platedTygon Other platedHard woods CopperGlass – PyrexAcrylic – LuciteTusk – IvoryHornCrystals – Stone Poorly fitted jewellery Too Stretched Too large jewellery
MSDS – MILL CERTIFICATEMSDSMaterial safety data sheetMedical term for chemicals & metals to prove they are bio campatable.Mill certificates are used by engineers on all surgical implant to show biocompatability of materials and all raw materials eg. TeflonFor our purposesThese are basically one and the same
ETHICAL INFORMATIONEvery operator should have a current St Johns Training First AidWorkplace certificate or Red Cross equivilant.Every operator should have a Hep A & B vaccination, or have antibodies.First aid kit for emergenciesBloodborne pathogen trainingHygiene training
Temporary OperatorsHave a great potential to infect the masses in a very short time.Can pack up and leave at short noticeWorking under adverse conditionsNeed large stocks of sterile packed jewellery, equipment & needles.Often no hand washing facilities.(Must be able to demonstrate an acceptable alternative)Clientele hazardous, intoxicated or under the influenceClients many underage – hard to check identification.
Bio-Hazardous WasteAll needles and needle groups must be disposed of in a biohazardwaste sharpies containerThese are picked up and delivered by a Biohazardous waste company (no exception)Needles placed in a puncture proof drink bottle and disposed at thetip is not good enough. Ask to see documentation to prove this.In the context of the Body Art Industry paper towels, tissues, swabs & dressings are considered contaminated but not necessarily bio-hazardouswaste.The rule of thumb is when compressed does this waste release anypotentially infectious material.
ANAESTHETICSINJECTED ANAESTHETICSAll injected anaesthetics can only be administered by a qualified doctor,nurse, dentist or anaesthetists. For others this practice is illegal.Possibility of anaphylactic shock ( strong allergic reaction)Once in the bloodstream is irreversible.Distorts the area to be pierced.
ANAESTHETICSTOPICAL ANAESTHETICSTopical cream, gels & spraysTakes up to 3 hours to fully anaesthetise although 60-70% after 1hourThis type of anaesthetic give no garuntee when the skin ispunctured (allergic reaction)Swelling can occur, distorting piercing site.Discolouration usually occurs (red or white)Increased chnace of rejectionFreeze spray is non sterile, not for broken skin, can cause frostbite if used incorrectly.