BLOODBORNE PATHOGEN EXPOSURES
FOR TATTOOISTS AND BODY PIERCERS:
CURRENT AND PROPOSED INTERVENTIONS
Colorado School of Public Health
EHOH 6614, April 2, 2014
• Describe the risk
• Outline current regulations and regulatory
• Use Hierarchy of Controls as a framework for risk
• Describe gaps in prevention solutions
• Suggest further prevention methods
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.
• More than 1.1 million people in the United States are living with HIV
• 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
• 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
• The risk of Hepatitis B infection from being stuck with
a needle is 6%
• There is a vaccine for Hepatitis B, but no cure
• 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
Some recommendations and resources but most regulation is at
state or local level
• 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
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
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
EXAMPLE: BOULDER COUNTY1
Boulder County Public Health is an example of stricter
• Artists are required to successfully complete a bloodborne
• Clients are asked to disclose communicable diseases
• Thorough inspections; public access to results online
o Plastic Needle Tips
o Sharps containers
• Develop exposure control and spill response
• 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
• Provide foot-operated sinks and waste receptacles.
• Provide easily accessible sharps containers.
• 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.
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
• Footwear should also be sturdy enough to protect
against dropped sharps10
GAPS IN SOLUTIONS
• Compliance with infection
control standards, but not
• Variability in state and
• Limited impact of state
and local regulations?
• Lack of data
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.
• 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
More research with body artists!
1Boulder County Public Health (2010. Rules and regulations for body art establishments. Retrieved March 16, 2014 from
2Braverman, S. (2012). One in five US adults now has a tattoo. Retrieved from
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
5Centers for Disease Control and Prevention (2013). HIV in the United States: At a glance. Retrieved from
6Centers for Disease Control and Prevention (n.d.). Viral hepatitis headquarters. Retrieved March 16, 2014 from
7Centers for Disease Control and Prevention (2014). Hepatitis C FAQs for the public. Retrieved March 16, 2014 from
8Chong, S., Smith, C., Bialostocki, A., & McEwan, C. (2007). Do modern spectacles endanger surgeons. Annals of Surgery, 245(3),
9Colorado Department of Public Health and Environment. (2001). Rules and Regulations for Body Art Establishments. Retrieved from
10Darby, D. & Darby, A. (2014). Personal protective equipment: Are you covered? Retrieved March 20, 2014 from
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