10 needle sticks tattoo artists-final


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Information about the risks faced by tattoo artists and body piercers of blood-borne pathogen exposure through needle stick injury.

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10 needle sticks tattoo artists-final

  1. 1. BLOODBORNE PATHOGEN EXPOSURES FOR TATTOOISTS AND BODY PIERCERS: CURRENT AND PROPOSED INTERVENTIONS Colorado School of Public Health EHOH 6614, April 2, 2014 Group 10: Ryan Blair Kathleen Harty Shaina Kumar Danielle Osowski Laura Paulson
  2. 2. LEARNING OBJECTIVES • Describe the risk • Outline current regulations and regulatory agencies • Use Hierarchy of Controls as a framework for risk reduction • Describe gaps in prevention solutions • Suggest further prevention methods
  3. 3. WHO IS AT RISK? Tattooing and body piercing is a growing industry. • In 2012, an estimated 21% of American adults had at least one tattoo (compared to 16% in 2003 and 15% in 2008)2. • A 2004 survey of 500 adults between 18-50 found: 24% had a tattoo; 14% had a piercing outside earlobes; 34% with earlobe piercings13. • Estimated 21,000 tattoo parlors in US16. • High demand increases possible exposure for body artists.
  4. 4. ROUTES OF EXPOSURE: • Needlestick Injuries • Splashes • Cross-contamination
  5. 5. HIV • More than 1.1 million people in the United States are living with HIV infection5 • HIV does not survive long outside the human body (such as on surfaces), and it cannot reproduce • The risk of HIV infection from being stuck with a needle used on an HIV-infected person is less than 1% • Currently there is not a vaccine or cure for HIV.
  6. 6. HEPATITIS B • 1.4 million persons in the U.S. are estimated to be infected with the virus, most of whom are unaware of their infection status6 • Hepatitis B virus can survive outside the body at least 7 days • The risk of Hepatitis B infection from being stuck with a needle is 6% • There is a vaccine for Hepatitis B, but no cure
  7. 7. HEPATITIS C • 3.2 million persons in the United States have chronic Hepatitis C virus infection7 • The Hepatitis C virus can survive outside the body at room temperature, on environmental surfaces, for at least 16 hours but no longer than 4 days • An exposure with an HCV-infected needle would have about a 1.8 percent chance of becoming infected with the virus • There is currently no vaccine for HCV, but there are new medications that can cure the virus
  8. 8. CURRENT REGULATIONS: FEDERAL Some recommendations and resources but most regulation is at state or local level OSHA15 • Outlines bloodborne pathogen standards • Requires each shop to develop an Exposure Control Plan • Requires employers to provide Hep B vaccines at no cost • Recommends each shop maintain a Sharps Incident Log
  9. 9. STATE REGULATION: COLORADO • Colorado Board of Health adopted “Rules and Regulations for Body Art Establishments” in 20019. • Minimum requirements for body artists: o “demonstrate and possess knowledge of Universal Precautions, disinfection and sterilization techniques, procedures for infection and exposure control...and the Infectious Waste Management Plan” o Body artists must obtain Hepatitis B vaccine, or submit written statement of refusal • Other important points: o Clients are not required to disclose infectious diseases o LPHAs may have more stringent requirements
  10. 10. LOCAL REGULATION EXAMPLE: BOULDER COUNTY1 Boulder County Public Health is an example of stricter requirements • Artists are required to successfully complete a bloodborne pathogen course • Clients are asked to disclose communicable diseases • Thorough inspections; public access to results online
  12. 12. POSSIBLE CONTROLS • Elimination? • Substitution o Plastic Needle Tips • Engineering o Retractable needles o Sharps containers
  13. 13. ADMINISTRATIVE CONTROLS • Develop exposure control and spill response programs.17 • Offer Hep B vaccinations to piercers at no cost. • Provide PPE. • Provide separate areas for piercings, cleaning instruments, and sterilization. • Provide adequate lighting. • Provide adequate ventilation and filtered air to piercing areas. • Provide foot-operated sinks and waste receptacles. • Provide easily accessible sharps containers.
  14. 14. BEHAVIORAL CONTROLS • Get Hep B vaccination if not immune.17 • Report needlesticks and spills immediately. • Immediately discard used needles in sharps containers. • Limit the number of customers in piercing area. • Avoid performing piercings and tattoos when fatigued. • Wear PPE.
  15. 15. PERSONAL PROTECTIVE EQUIPMENT • New, clean gloves required for each procedure (per Colorado regulations ) • Hand-washing required before glove use, but some evidence in health-care workers that hand hygiene decreases when gloves are used12 • Face masks and eyewear: not required and risk in body artists has not been studied. However, they could provide some level of protection. o a high incidence of blood splashes has been found on protective eye and face wear of surgeons11; everyday eyewear alone may not be effective8 • Footwear should also be sturdy enough to protect against dropped sharps10
  16. 16. GAPS IN SOLUTIONS • Compliance with infection control standards, but not with administrative controls14 • Variability in state and local regulation • Limited impact of state and local regulations? • Lack of data
  17. 17. RESOURCES FOR WORKERS • Professional Organizations: Association for Professional Piercers Alliance of Professional Tattooists, Inc. • Ways to report concerns? • NIOSH: information about bloodborne pathogens, selecting sharps containers, developing exposure control plans, etc.
  18. 18. CONCLUSION • Encourage increased PPE • Include professional organizations as stakeholders • Increase documentation and reporting of sharps incidents • Increase compliance with exposure control plan • More evaluation of whether bloodborne pathogen standards meet needs of body artists • And... More research with body artists!
  19. 19. REFERENCES 1Boulder County Public Health (2010. Rules and regulations for body art establishments. Retrieved March 16, 2014 from http://www.bouldercounty.org/doc/publichealth/032010bodyartregs.pdf 2Braverman, S. (2012). One in five US adults now has a tattoo. Retrieved from http://www.harrisinteractive.com/vault/Harris%20Poll%2022%20-Tattoos_2.23.12.pdf 3Carlson, V., Lehman, E., & Armstrong, M. (2011). Tattooing regulations in U.S. Journal of Environmental Health, 75(3), 30-37. 4Centers for Disease Control and Prevention(2013). Workplace safety and health topics: Body art. Retrieved March 10, 2014 from http://www.cdc.gov/niosh/topics/body_art/default.html 5Centers for Disease Control and Prevention (2013). HIV in the United States: At a glance. Retrieved from http://www.cdc.gov/hiv/statistics/basics/ataglance.html 6Centers for Disease Control and Prevention (n.d.). Viral hepatitis headquarters. Retrieved March 16, 2014 from http://www.cdcnpin.org/scripts/hepatitis/index.asp#overview 7Centers for Disease Control and Prevention (2014). Hepatitis C FAQs for the public. Retrieved March 16, 2014 from http://www.cdc.gov/hepatitis/c/cfaq.htm 8Chong, S., Smith, C., Bialostocki, A., & McEwan, C. (2007). Do modern spectacles endanger surgeons. Annals of Surgery, 245(3), 495-501. 9Colorado Department of Public Health and Environment. (2001). Rules and Regulations for Body Art Establishments. Retrieved from http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheadername1=Content-Disposition&blobheadername2=Content- Type&blobheadervalue1=inline%3B+filename%3D%22Rules+and+Regulations+for+Body+Art+Establishments.pdf%22&blobheade rvalue2=application%2Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1251807406370&ssbinary=true 10Darby, D. & Darby, A. (2014). Personal protective equipment: Are you covered? Retrieved March 20, 2014 from http://www.cosmetictattoo.org/article/personal-protective-equipment-are-you-covered.html#27
  20. 20. REFERENCES 11Davies, C., Khan, M., Ghauri, A., & Ranaboldo, C. (2007). Blood and body fluid splashes during surgery: The need for eye protection and face masks. Annals of the Royal College of Surgeons of England, 89(8), 770-772. 12Fuller, C., Savage, J., Besser, S., Hayward, A., Cookson, B., Cooper, B., & Stone, S. (2011). The dirty hand in the latex glove: A study of hand hygiene compliance when gloves are worn. Infection Control and Hospital Epidemiology, 32(12), 1194-1199. 13Laumann, A. & Derick, A. (2006). Tattoos and body piercings in the US: A national data set. Journal of the American Academy of Dermatology, 55, 13-421. 14Lehman, E., Huy, J., Levy, E., Viet, S., Mobley, A., & McCleery, T. (2011). Bloodborne pathogen risk reduction activities in the body piercing and tattooing industry. American Journal of Infection Control, 38(2), 130-138. 15Occupational Safety and Health Administration. (2012). Occupation safety and health standards: Bloodborne pathogens (standard number 1910.1030). 16Vanishing Tattoo. Tattoo facts and statistics. Retrieved March 28, 2014 from http://www.vanishingtattoo.com/tattoo_facts.htm 17Weber, M. (2001). Health hazard evaluation report 2000-0013-2830: Body piercing by Bink Tallahassee, Florida. Retrieved from http://www.cdc.gov/niosh/hhe/reports/pdfs/1999-0265-2830.pdf