THEASSOCIATIONOFPROFESSIONALPIERCERSPROCEDUREMANUALU.S.EDITION
UPDATED AFTERCARE BROCHURES
Newly reformatted with additions reflecting new trends and
frequently asked questions from Pie...
THE ASSOCIATION OF PROFESSIONAL PIERCERS MANUAL
U.S. EDITION CONTENTS
WHAT IS THE APP? ......................................
1
WHAT IS THE APP?
The Association of Professional Piercers (APP) is an
international health and safety organization dedic...
2
• Promotes alliance between the piercing and health-
care industries through cross-attendance at health-
related confere...
3
tionnaire. For questions please contact us directly at
info@safepiercing.org.
APP PUBLICATIONS, PROD-
UCTS AND EDUCATION...
4
5
Although body piercing has historically been considered
a ritual art form, in modern times the practice cannot be
separa...
6
through illness, inadequate nutrition, and other risk
factors. While some organisms cause only temporary
minor discomfor...
7
dictated by the availability of an appropriate Agent, Host
and Environment. Eliminating the route of transmission
to the...
8
9
HANDWASHING
Frequent and conscientious handwashing is the most
important action a piercer can take to reduce the pres-
e...
10
HAND SANITIZERS VERSUS
ANTIMICROBIAL SOAPS
In 2002, the Centers for Disease Control released
guidelines “recommending a...
11
• When moving from “field” to “field”
(from non-sterile to sterile tools, or between
segments of a procedure). To prevent...
12
3. With your now gloved hand, reach into the clean
glove box and remove a second glove.
4. Without touching bare skin t...
13
but may well be worth it depending upon a piercer’s
preferences and circumstances. Contact individual
suppliers for sam...
14
From STERILE to CLEAN to CONTAMINATED
Every piercer should thoroughly grasp how their environment and the tools they us...
15
Cleaning, disinfection and sterilization are all part of
the same process, but they differ significantly in the
number a...
16
as bacteria, fungi, and viruses (like the one caus-
ing Hepatitis B), in addition to the microorganisms
killed at the I...
17
and duration of that exposure was sufficient to achieve
sterilization.
Integrator strips are another method for checking...
18
a long, stable shelf life. Labelling should specifically
state that the product is bactericidal, virucidal, fungicidal
a...
19
DISPOSABLE SUPPLIES
To minimize the risk of cross-contamination and to
ensure that the piercing procedure is as clean a...
20
expiration date should be repackaged and autoclaved,
and marked with a new expiration date.
After a single use, needles...
21
ous lengths, sizes and modifications. They are usu-
ally hollow stainless steel tubes with perfectly smooth
openings, of...
22
that longer, gently sloping tapers (3 inches and up) are
best for stretching, while shorter tapers are used for
jewelry...
23
than lobe tissue and a correspondingly longer healing
time. Therefore infections in this area are more com-
mon and can...
24
4. International Journal of Pediatric Otorhinolaryngology.
1990 Mar; 19(1): 73-6.
Embedded earrings: a complication of ...
25
RECEPTION AND SALES ROOM
Counter
The counter surface should be a nonporous surface
such as glass or metal that can be e...
2005 manual
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2005 manual

  1. 1. THEASSOCIATIONOFPROFESSIONALPIERCERSPROCEDUREMANUALU.S.EDITION
  2. 2. UPDATED AFTERCARE BROCHURES Newly reformatted with additions reflecting new trends and frequently asked questions from Piercers and Piercees alike. NEW AFTERCARE: • Clear concise instructions on cleaning • "Less is more" message • More information on jewelry issues • Facial piercings now covered in Oral Aftercare instructions NEW FORMAT/DESIGNS: • Cohesive appearance of all APP brochures • Eye-catching and aesthetically pleasing • Professional image to support APP standards The new brochures are available for sale on the APP web site (www.safepiercing.org) for $20 per 100, postage paid. Subjects include: • Aftercare Guidelines for Facial and Body Piercing* • Aftercare Guidelines for Oral Piercing* • Picking Your Piercer* • Troubleshooting for You and Your Healthcare Professional (with jewelry removal tips and hints) • Oral Piercing Risks and Safety Measures *Available in Spanish FREE SAMPLES AVAILABLE UPON REQUEST Order by fax or phone (888) 888-1APP or visit our website: www.safepiercing.org MARK YOUR CALENDARS! The annual APP Conference and Exposition takes place every year in beautiful Las Vegas, Nevada. There are classes offered in everything from piercing technique to marketing, current industry legislation to accounting, studio set- up to aftercare. There is something for everyone, from the first time attendee to the long term shop owner, with classes geared specifically for health care professionals. The exposition includes venders from all segments of the body piercing industry from the United States and abroad. Thousands of items are available at the year’s largest gathering of manufactur- ers and distributors directly targeting the body piercing market. For updates about the conference please visit: www.safepiercing.org or call (505) 242-2144 or (888) 888-1APP A PIERCEE'S BILL OF RIGHTS EVERY PERSON BEING PIERCED HAS THE RIGHT: 1. To be pierced in a hygienic environment by a clean, conscientious, sober piercer wearing a fresh pair of dis- posable medical examination gloves. 2. To be pierced with a brand new, completely sterilized single-use needle that is immediately disposed of in a medical Sharps container after use on one piercing. 3. To be touched only with freshly sterilized and appropriate implements,properly used and disposed of or re-ster- ilized (where appropriate) in an autoclave prior to use on anyone else. 4. To know that piercing guns are NEVER appropriate, and are often dangerous when used on anything -- including earlobes. 5. To the peace of mind that comes from knowing that their piercer knows and practices the very highest stan- dards of sterilization and hygiene. 6. To a have a knowledgeable piercer evaluate and discuss appropriate piercings and jewelry for her/his individ- ual anatomy and lifestyle. 7. To be fully informed of all risks and possible complications involved in his/her piercing choice before making any decisions. 8. To seek and receive a second opinion either from another piercer within the studio or from another studio. 9. To have initial piercings fitted with jewelry of appropriate size, material, design, and construction to best pro- mote healing. Gold-plated, gold-filled or sterling silver jewelry is never appropriate for any new or unhealed piercing. 10. To see pictures, be given a tour of the piercing studio, and to have all questions fully and politely answered before making or following through on any decision. 11. To be fully informed about proper aftercare, both verbally and in writing, and to have continuing access to the piercer for assistance throughout the healing process. 12. To be treated with respect, sensitivity and knowledge regardless of gender, sexual orientation, race, religion, ethnicity, ability, health status or piercing choice. 13. To change her/his mind, halt the procedure and leave at any point if the situation seems uncomfortable or improper.
  3. 3. THE ASSOCIATION OF PROFESSIONAL PIERCERS MANUAL U.S. EDITION CONTENTS WHAT IS THE APP? ............................................................................................................................. 1 INTRO TO MICROBIOLOGY FOR THE PIERCER............................................................................... 5 INFECTION CONTROL......................................................................................................................... 9 STERILE CHART ................................................................................................................................ 14 CLEANING, DISINFECTION AND STERILIZATION .......................................................................... 15 EQUIPMENT ....................................................................................................................................... 19 ENVIRONMENT.................................................................................................................................. 25 SKIN PREPARATION ......................................................................................................................... 29 AFTERCARE........................................................................................................................................31 PIERCING HEALING TIMES .............................................................................................................. 35 JEWELRY............................................................................................................................................ 37 ETHICS AND LEGALITIES ................................................................................................................. 43 COMPLIANCE AND TRAINING ..........................................................................................................49 EMERGENCIES.................................................................................................................................. 53 AFTERWARD...................................................................................................................................... 58 GLOSSARY......................................................................................................................................... 59 UNDERSTANDING MSDS.................................................................................................................. 63 APPENDIX A - FULL TEXT OF BLOODBORNE PATHOGENS STANDARD 1910.1030.................. 65 APPENDIX B - HEPATITIS B VACCINE DECLINATION (MANDATORY) ......................................... 77 APPENDIX C - APPLICATIONS FOR MEMBERSHIP........................................................................ 79 This manual was first published in 1998 and was revised in 2002 and 2005. Previous edition credits are extended to: Gahdi Elias, Allen Falkner, Tracy Faraka, Kent Fazekas, Michaela Gray, Drew Lewis, Cheyenne Morrisson, David Vidra, Dr. Jack Ward [Original Edition]; and to: Elayne Angel, Scott Brewer, Steve Joyner, Lisa Lystad, M.D., Patrick McCarthy, Sky Renfro, Bethra Szumski, April Williams-Warner, Dr. Jack Ward [2002 Edition]. Contributors to the 2005 edition include: Elayne Angel, Alicia Cardenas, Luis Garcia, Phish Goldblatt, Schane Gross, April Johnson, Jason King, Paul King, Megg Mass, Christina Shull, Crystal Sims, Bethra Szumski, James Weber, and the intrepid Caitlin McDiarmid. Some cover photos courtesy of Evolution Body Piercing, Inc. Cover design by Paul Romano, www.workhardened.com Copyright © 1998, 2002, 2005. All rights reserved. The goal of the Association of Professional Piercers is to circulate vital health, safety and educational information to the piercing industry, health care workers and the general public. This manual is copyrighted under Federal Law. Any reproduction of its contents is prohibited without prior written permission. For specific reprint permissions, please contact us directly.
  4. 4. 1 WHAT IS THE APP? The Association of Professional Piercers (APP) is an international health and safety organization dedicated to the dissemination of information about body piercing. We are a fully voluntary and nonprofit alliance of indi- viduals and corporations concerned about the safety and standards of the body piercing industry. Governed by an elected Board of Directors, the APP unites piercing professionals who freely share resources to help fellow members, piercers, healthcare professionals, health inspectors, and the public access the most current and accurate information about our art form and its procedures. THE ORIGINS OF THE APP In 1994, representatives from several piercing studios organized a political action group in response to prob- lematic legislation in California (Proposition AB101). The organization quickly grew to accommodate mem- bers nationwide and around the world, becoming the world’s largest body piercing education facilitator and providing invaluable organization and representation for the piercing profession. WHAT IS THE PURPOSE OF THIS MANUAL? This manual is intended as a reference and study aid for all people who care about the promotion and practice of responsible body piercing -- including piercers, health officials, legislators, medical and insurance profes- sionals, and members of the general public. Those in countries other than the US are invited to use this manual as a guide, keeping in mind that regulations, available products and industry standard techniques may vary by location. Please consult with professional piercing associations in your own country. WHAT ARE THE LIMITATIONS OF THIS MANUAL? The following manual is not a training course or a for- mula to make one an instant piercer. This manual is intended to provide a basic overview of the health and safety concerns faced by all body piercers and to offer guidelines that minimize expected risks. This manual is not a substitute for formal training and education. Although this manual is updated periodically, informa- tion in this edition may not be current or appropriate for your individual practice. It is imperative that each piercer seek out and evaluate new health and safety techniques and products with reference to his/her own practice and local circumstances. For recent updates to this information, please see our website. While this manual and its information, suggestions and guidelines are offered for use throughout the world, this version is specifically designated as the “USA Edi- tion.” We recognize that laws vary and not all products, chemical formulas, tools and jewelry types are readily available or desirable everywhere. As a result, we offer the USA Edition as a general foundation and encourage APP members in other areas of the world to update, clarify and edit this version (with permission) to be appropriate to their region. THE APP: • Provides a professional association and peer support for piercers. • Publishes a quarterly newsletter dedicated to pierc- ing-related news, research and information to keep geographically dispersed individuals current in the industry. • Standardizes and publicizes industry procedures and protocols regarding hygiene, quality and education, and assists piercers in meeting and/or exceeding these standards. • Provides support and assistance in implementation of appropriate legislation for the industry. • Provides piercing, business, health and safety educa- tion through annual conferences for piercers, health inspectors, and others related to the industry. • Promotes consumer education and public under- standing of body piercing practices through educa- tional lectures, publications, staffed phone and email lines, a comprehensive website and media relations. (See the inside front cover of this manual for more information.)
  5. 5. 2 • Promotes alliance between the piercing and health- care industries through cross-attendance at health- related conferences and lectures, joint publica- tions and research, resource sharing and ongoing dialogue. • Does not police the piercing industry or piercers. The APP will, however, respond to and resolve complaints against its members and claims of membership which are invalid. • Does not license or certify piercers. Members do receive a certificate of membership which must be renewed annually. Attendees of APP classes receive a certificate of seminar participation. • Does not teach people “how to pierce” or perform piercings at its functions. The APP provides supple- mental education to piercers and has Corporate Members who provide basic piercing education. • Does not dictate the piercing technique(s) or products its members use, what aftercare they suggest, or what specific piercings they may choose to perform, provided they respect local laws and regulations. • Addresses only the practice of body piercing. The APP does not have a position on tattooing, branding, scarification, dermal punching, scalpeling, implants, or other types of body modification where they are allowed by law. MEMBERSHIP The APP has five types of memberships: • Professional Business Member • Professional Business Member-at-Large • Associate Member • Corporate Member • Patron Member Professional Business Members and Pro- fessional Business Members at Large: • Are body piercers; • Uphold a set of safety and hygiene standards that are equal to, or more stringent than those established by state or local governments; • Have at least one year of professional piercing experi- ence; • Have knowledge of appropriate sterilization and cross-contamination prevention through Bloodborne Pathogens Training, required annually for member- ship; • Work in a studio that meets current environmental criteria for hygiene, safety, and ethical practice; • Undergo training and certification in CPR, Blood- borne Pathogens, and First Aid, renewed according to membership requirements; • Must provide monthly spore test results for their studio’s autoclave(s) (sterilizer) • Must sign the APP Health and Safety Agreement and answer an extensive questionnaire to prove knowl- edge of and adherence to current best practice. Associate Members: • Are either piercers with less than one year of profes- sional experience, or non-piercing employees in a piercing studio (owners, counter people); • If beginning piercers, must meet the same standards as our Business Members; • If non-piercers, must work in a studio that meets studio requirements; • Must work in a studio which has at least one APP Business member on current staff. Corporate Members: • Are companies that provide support services to the piercing industry; Some examples of Corporate Members are health and technical educators, medical supply companies, jewelry wholesalers and insur- ance companies; • Must provide a letter of intent; • Must provide documentation regarding their busi- ness, including jewelry samples if applicable. Patron Members: • Are individuals who work outside the piercing industry and who support the APP and its goals. HOW DO I BECOME A MEMBER? A full list of membership requirements, including personal and environmental criteria, is included in the Appendix. This includes the Application for APP Membership, Health and Safety Agreement and Ques-
  6. 6. 3 tionnaire. For questions please contact us directly at info@safepiercing.org. APP PUBLICATIONS, PROD- UCTS AND EDUCATIONAL SERVICES: • Brochures for piercers, educators, consumers, and healthcare personnel (Available titles listed inside front cover) • Health and Safety Procedure Manual • The Point quarterly newsletterThe Point quarterly newsletterThe Point • Public Service Announcements for Radio and Print (available on cd and in written format) • APP T-shirts - New designs every year • APP Annual Conference and Exposition ° Piercing-related, industry-specific classes offered in Techniques, Equipment, Management, Aftercare, Studio Set-Up, Business Documentation, Blood- borne Pathogens, CPR, First Aid and more ° Week-long conference with roundtable discus- sions, social events, and networking ° Largest body jewelry and piercing-related product exposition in the US ° Package and individual class prices available • Website: www.safepiercing.org ° Contact information for current members ° Getting Pierced: Everything you need to know, including how to find a good piercer and Aftercare information ° FAQ’s: Piercing and Minors, Pregnancy, Pierc- ing Guns, Genital Piercings, Oral Piercings, and more... ° Job Board: free listing of jobs available and those seeking positions
  7. 7. 4
  8. 8. 5 Although body piercing has historically been considered a ritual art form, in modern times the practice cannot be separated from our knowledge of biological science. In order to be fully educated in the field, piercers should have a working knowledge of the science behind the art. In particular piercers should understand the ba- sics of Microbiology, Bacteriology, Immunology, and Virology. Scientific facts will provide the professional piercer with the necessary knowledge to carry out appropriate hygiene and safety practices in the work environment and to make informed decisions under changing conditions. DEFINITIONS Cross-contamination is the act of spreading pathogenic (disease-causing) organisms from one item or surface to another. It is the responsibility of the professional piercer to operate at all times with a high regard for the health and safety of their customers, their co-workers, and themselves. Employing appropriate protocols will minimize the risk of cross-contamination with harmful microorganisms such as bacteria and viruses. Microbiology is the study of microscopic organisms. Some microorganisms are beneficial or resident to the individual, but others are detrimental, potentially causing illness or even death. By understanding how microorganisms live and reproduce, the piercer will be able to minimize disease transmission risks. Bacteriology is the study of bacteria.Bacteriology is the study of bacteria.Bacteriology Many varieties of bacteria exist in our environment, some good, some bad. Some bacteria normally live on our bodies (resident) and help protect us from foreign strains (transient), or otherwise work with the body chemistry to optimize health. The type of bacteria in yogurt may aid the digestive tract, while bacteria on teeth can cause tooth decay. Bacteria are of immense importance because of their capacity for rapid growth and reproduction. Bacteria are capable of surviving without a host. Immunology is the study of the ability to resistImmunology is the study of the ability to resistImmunology infection. The immune system treads a fine line between successful defense of the organism and its complete destruction. An underreaction may allow pathogens to gain a foothold and overpower the individual. However, an overreaction can also lead to dire consequences for the individual. Virology is the study of viruses, which are submicro- scopic organisms. Viruses differ from other microorganisms in that they depend on the cells they invade for growth and repro- duction. Some viruses do not kill cells but cause illness, and then seem to disappear. They can remain latent and later cause another, sometimes much more severe form of disease. Viruses cause measles, mumps, polio, herpes, influenza, and the common cold. Some viral infections can be treated with drugs, some cannot. Bacteria are single-celled microorganisms so small that they cannot be seen without the assistance of pow- erful magnification. They have characteristics of both plants and animals. There are hundreds of different types of bacteria, sub- divided into families with common properties. Two very important and relevant classifications of bacteria exist. They are either nonpathogenic (harmless), or they are pathogenic (harmful, with the ability to cause disease). Nonpathogenic bacteria are the most plentiful. Some are actually beneficial and perform important func- tions in our bodies, such as assisting in digestion or protecting the skin from overcolonization by invading organisms. Millions of microscopic organisms inhabit the spaces in which we live and work. Particles of organic matter including bacteria, viruses, fungi, and spores are pres- ent despite the most dedicated efforts to keep things clean. Fortunately, the majority of these organisms are harmless or can be dealt with successfully by the immune system. However, if there is an opening into the body, some of these organisms can enter and cause illness, particu- larly when the body’s own defenses are compromised AN INTRODUCTION TO MICROBIOLOGY FOR THE PROFESSIONAL PIERCER
  9. 9. 6 through illness, inadequate nutrition, and other risk factors. While some organisms cause only temporary minor discomfort, others can result in serious or even fatal diseases. Since microorganisms are omnipres- ent, it is important to understand how to prevent them from gaining access into the body through piercings both during a procedure and afterward. It is also important to help clients understand how hygiene, nutrition, and lifestyle can facilitate or devastate their healing process. The most common forms of bacteria of concern for piercers are Coccus, Bacillus and Spirillum. Coccus (plural Cocci) Cocci are spherical or ovoid in form. One of the most commonly occurring bacteria of concern to piercers is Staphylococcus. This bacterium is present in boils, ab- scesses, and most surface infections. It can enter the body during the piercing or any time during the healing stages while the piercing is an open wound. This risk makes client education and post-piercing care critical in prevention. Some Staph is becoming resistant to antibiotic treatment, making prevention even more es- sential to the health of our clients. Other common types of Cocci are Diplococci (which causes Pneumonia) and Streptococci. Other diseases caused by this family of bacteria are Scarlet Fever and Meningitis. Bacillus (plural Bacilli) This bacteria belongs to the family Bacillaceae. All species are rod-shaped and sometimes occur in chains. Bacillus is the organism that causes dysentery, cholera, and diphtheria. Spirillum (plural Spirilla) This is a genus of spiral-shaped microorganisms belonging to the family Pseudomonadacea. When in flexible form they are called spirochetes. Syphilis is in this group. Pathogenic organisms that cause diseases such as tetanus, tuberculosis and diphtheria are generally beyond our concern when Standard Precautions are observed. To minimize exposure risk: • Focus • Utilize clean technique • Understand appropriate sterilization, and • Practice it at all times. MICROORGANISMS OF THE SKIN There are two types of skin microorganisms: Resident: Those that survive and multiply on theResident: Those that survive and multiply on theResident: skin. Resident flora can be removed with antimicrobial soaps. Some of the normal resident bacteria of the skin include diptheroids (found in outer ear, armpits, and groin/genital areas), micrococci, (Staphylococci epi- dermis found on skin surfaces) and a variety of canes (Propionibacterium canes, Corynebacterium canes found on the face and other skin surfaces). Transient: Those that were acquired through recentTransient: Those that were acquired through recentTransient: exposure. These can survive for a limited amount of time, generally less than 24 hours. Most often they are acquired from others who are infected. Soap is effective for the removal of most transient microorgan- isms. If conditions are conducive, overgrowth of some transient bacteria can occur. Staphylococcus aureus colonization is found in boils, folliculitis and carbuncles. Streptococcus infections can take the form of cellulitis, impetigo and pneumonia. FACTORS THAT INFLUENCE THE SURVIVAL AND GROWTH OF MICROORGANISMS There are three main considerations determining whether or not a microorganism is potentially a problem for you or your clients: 1. Stability of an organism in its physical environ- ment; 2. Availability of the correct transmission medium needed by the organism to spread; 3. Quantity of organisms expelled from the host into the transmission medium. Pathogenicity: The potential of an organism toPathogenicity: The potential of an organism toPathogenicity: cause disease. The factors that influence the patho- genicity of an organism are: 1. Host susceptibility; 2. Organism strength and number; 3. Portal of entry: The organism must have a way into the host. Transmission: The method by which an infectiousTransmission: The method by which an infectiousTransmission: agent is passed. The transmission of an organism is
  10. 10. 7 dictated by the availability of an appropriate Agent, Host and Environment. Eliminating the route of transmission to the portal of entry (a fresh piercing) interrupts this process and is well within the piercer’s control. Routes of transmission are: Direct contact: Person-to-person spread; requires actual physical contact between the existing host and a new portal of entry (e.g. the piercer and a client). A needle stick is a direct contact route of transmission. Indirect contact: Exposure to microorganisms de- posited first on inanimate objects and then transferred to the client. Objects in the environment that are not adequately disinfected or sterilized between clients can result in indirect contact exposure. This is generally referred to as cross-contamination. Using tools first at the counter and then for a piercing procedure without sterilizing would be an example. Touching non-sterile items with gloved hands during a procedure, and then continuing to work on the client without changing gloves would also be considered cross-contamination. Airborne: Pathogenic organisms can also be acquired by inhaling infected droplets that become airborne when an infected person coughs or sneezes. Termed “droplet transmission,” this can easily be avoided with simple precautions, such as covering the mouth and nose when coughing or sneezing (and then wash hands!) Vector-borne: The transmission of organisms by an animal or insect bite, or through exposure to animal blood or other infectious bodily fluids. Zoonosis: Zoonotic diseases are diseases of animals that may be transmitted to humans under natural con- ditions. Once infected, humans can transmit some of these diseases to one another. While no reasonable piercer should be working on animals, it is possible for these diseases to enter the piercing environment by allowing pets or other animals, their droppings or accessories, into the piercing studio. Proper hygiene as well as many local regulations dic- tate that animals never belong in the piercing studio or in any space contiguous with a piercing studio (e.g. an adjoining office). Clean and enclosed fish aquaria may be permissible, however dogs, cats, rodents, reptiles and birds present a potential threat to client and staff safety and should never be admitted. One possible exception would be a guide dog or assistance animal. In this case reasonable alternatives and precautions should be sought to avoid the contamination of the piercing environment while considering the needs of the client. BREAKING THE CHAIN OF INFECTION It is essential that the professional piercer understand how infection occurs, and more importantly, how to prevent this from happening in the work environment. The “Chain of Infection” requires that these elements be present: 1. An Infectious Agent, such as bacteria or virus 2. A Reservoir (existing host) 3. A Portal of Exit from the reservoir (the path out of the existing host) 4. A Vehicle of Transmission for the agent (the path between hosts) 5. A Portal of Entry (the path into a new host) 6. A New Host The single most important thing piercers can do to break this chain is WASH THEIR HANDS. This very simple and basic step has been proven to reduce or eliminate most pathogenic bacteria from the hands. This is the first line of defense in the prevention of disease transmission.
  11. 11. 8
  12. 12. 9 HANDWASHING Frequent and conscientious handwashing is the most important action a piercer can take to reduce the pres- ence and transmission of pathogenic microorganisms. Correct handwashing procedures are easy to follow and are extremely effective when used throughout the day. A studio’s handwashing sink should be used only for hand washing (never tool cleaning) and should have hands-free operation. Hands should not come into contact with faucets or handles. If the sink does not have a foot pedal or motion sensor operated system, an elbow or dry disposable paper towel can be used to operate the water flow. The use of quality liquid soap in a pump or automatic dispenser is strongly encouraged. Bar soaps collect bacteria and other dangerous contaminants from han- dling. Liquid antimicrobial or antibacterial soap has been proven most effective in the inhibiting of bacterial growth and is preferred. Choose a gentle, dye- and fragrance-free anti-micro- bial or antibacterial soap made for healthcare workers and others who wash frequently. Most commercial soaps are not intended for those who wash their hands frequently. They can leave hands chaffed, chapped and irritated and may kill beneficial resident flora. This can actually increase the potential risk of pathogen transmission to the piercer. See the APP website for suggested products (www.safepiercing.org). Single-use paper towels should be dispensed from a stationary, fully covered paper towel dispenser that dispenses only one paper towel at a time. Paper towel rolls run the risk of contamination of the entire roll from handling. Air dryers cut down on paper waste but may blow pathogenic matter around the area. HOW TO WASH HANDS PROPERLY: 1. Wet hands thoroughly with tepid water. 2. Dispense a dime-sized amount of liquid soap into palm and lather. 3. Vigorously scrub all surfaces of both hands up to mid-forearm. 4. Pay special attention to nails, nail beds, between fingers and wrists. 5. Continue for a minimum of thirty seconds. 6. Pat hands dry with a single-use paper towel. A moisturizing lotion can be used to prevent overdry- ing and cracking. Maintaining the health of the hands, skin, nails and nail beds is crucial in the first line of defense against transmission of disease. Several brands of lotion that also seal and protect skin (“invis- ible gloves”) are available through healthcare product suppliers. Lotion must be allowed to dry before don- ning gloves to maintain glove integrity and minimize exposure to glove chemicals. HAND SANITIZERS Waterless hand sanitizer gels have become staples in many piercing shops because they are easy to use and do not require a trip to the sink. Some piercers use them in between glove changes, or keep them at the counter for clients entering the shop. However, careful consideration should be given as to when their use is appropriate. While some studies show these products to be as effective as hand washing in certain situations, other research indicates that they do not significantly reduce overall amounts of bacteria on the hands, and in some cases may even increase it. Most tests proving sanitizers’ germ-killing capacities at up to 99.9% effective were done on inanimate objects, not on living skin. Physiological conditions on human skin may yield far different results. Alcohol-based hand sanitizers work by stripping the outer layer of oil from the skin, thereby killing transient bacteria and delaying regrowth and surfacing of resi- dent bacteria. To use, a dime-sized drop of sanitizer should be pumped onto the skin and rubbed over all surfaces until dry. If hands are dry within 20 seconds, not enough gel was used. Hand sanitizers are not cleaning agents. They do not remove surface dirt or visible soil. Dirt, food, lubricant and other things on your hands will make them less effective. Therefore, in order for hand sanitizers to work properly, hands must first be washed with soap and water before applying. INFECTION CONTROL
  13. 13. 10 HAND SANITIZERS VERSUS ANTIMICROBIAL SOAPS In 2002, the Centers for Disease Control released guidelines “recommending alcohol-based gel as a suitable alternative to hand washing for health-care personnel in health-care settings” (CDC, 2002) when moving between patients. The Food and Drug Admin- istration, on the other hand, says that hand sanitizers may be used as a supplement, but not as a substitute for hand washing. In an FDA comparison study, plain soaps antimicrobial hand soaps, E2-rated hand soaps (a USDA Classifica- tion requiring equivalency to 50 parts per million chlo- rine), and instant hand sanitizers were tested to gauge their relative effectiveness in reducing bacteria on hands. With a 20-second wash procedure, all three types of soap effectively reduced bacteria. E2 soaps were signifi- cantly more effective than the other two soaps. Instant hand sanitizers, on the other hand, showed a significant increase in bacterial numbers on hands. According to most publications, while hand sanitiz- ers are acceptable for use in addition to a thorough handwashing, and are certainly better than no cleaning at all, they are not a substitute for scrubbing with soap and water. Additionally, they are generally advised for healthcare workers, but not for food handlers or the gen- eral public. Since piercers fall squarely into none of these groups, each must come to his/her own conclusion. A final word of caution: While often advertised as being less irritating to hands than regular washing, alcohol-based hand sanitizers can be overdrying, caus- ing cracked skin, contact dermatitis, and accelerating potential latex sensitivities. If you opt to use these products for your staff and/or clientele, choose a brand carefully, consider non-alcohol varieties, and have an alternative available for clients who cannot or will not use these products. GLOVES Gloves are practically, legally and ethically imperative for professional piercers. Finding appropriate gloves and learning how to don them properly will protect the piercer from potential contaminants and reduce the risk of disease transmission between client, piercer and co-workers. It is important to follow the basic rules of glove use: 1. Wash hands prior to donning gloves and immedi- ately afterwards. 2. Keep fingernails trim and smooth, and remove jewelry and watches to prevent accidental tears (per OSHA regulations). 3. Use only disposable gloves. 4. Store gloves properly, away from light, heat and moisture. When should gloves be worn? • During all set-up and cleaning. This prevents cross- contamination and protects hands from exposure to harsh chemical disinfectants. • During sweeping, mopping and trash removal. Any object on the piercing studio floor should be consid- ered contaminated and only touched with gloved hands. • During all disinfection or sterilization procedures. • When working in Biohazard Areas or dealing with contaminated tools or containers. Many piercers double-glove when processing contaminated in- struments. (Check with your glove manufacturer to ensure this will not compromise glove integrity.) • When transporting sterilized implements from the autoclave to designated storage space. Clean gloves should be available in all areas where transport may be initiated. • During contact with a client. A professional piercer should never touch the area of a client’s piercing with ungloved hands. This protects against possible transmission of a client’s resident and transient flora. It also provides a level of professionalism and comfort between the client and piercer. • During a period of contact only, not continuously. When should gloves be changed? • If glove integrity is compromised (gloves become weakened or contaminated). • If a visible weak spot, pinhole or tear is detected or suspected. • When gloves turn yellow or brown. Changes in glove color can take place after prolonged wear. This is normal and occurs from a reaction between traces of copper on sweaty skin and dithiocarbamate, a curing chemical found on the surface of some gloves. Since this reaction can accelerate the breakdown of rubber, gloves should be changed frequently enough to prevent it. Four minutes is the maximum amount of time suggested for using each pair of latex gloves.
  14. 14. 11 • When moving from “field” to “field” (from non-sterile to sterile tools, or between segments of a procedure). To prevent cross- contamination gloves should be changed when moving from a more contaminated area to less contaminated area (see Sterile Chart on page 14). • During a procedure. Many studios develop a written plan concerning glove changes during a procedure. For example, a studio may require at least five pairs of gloves per procedure for: 1. Initial set up of tray and instruments 2. Opening autoclave packages 3. Initial skin prep and marking 4. Piercing procedure 5. Post-procedure clean up Although the number of gloves used in a procedure will vary, setting a minimum number of gloves used can help reduce the likelihood of cross-contamination. The important point is that every piercer understand the concept of cross-contamination, and change gloves as necessary to avoid compromising fields. Many piercers use hand sanitizers and lotions as an additional cleanser or barrier, and to minimize potential contamination through dry, cracked skin. If using latex gloves, be aware that petroleum- or oil-based products must be avoided. Chemicals in petroleum products can penetrate the latex, compromising its barrier integrity. Water-based lotions should be chosen, applied after glove use and washing (post-piercing) and allowed to fully dry before donning new gloves. Anti-inflamma- tory, conditioning and chemical barrier lotions are also available for the healthcare industry and may minimize skin irritation from constant washing and chemical exposure. If a glove becomes hard, brittle or too soft, or loses its elasticity, shape or usual color, it may be degraded and should not be used. As requested by the FDA, glove manufacturers may print expiration dates on glove boxes. Gloves should be used before this date. If the date is unknown, be sure to use glove shipments in the order they were received, and to store all gloves in clean, cool, dry and well-ventilated conditions in their original packaging. Gloves should never be washed, disinfected or autoclaved unless specifically recommended by the manufacturer. As explained by OSHA, “Washing with disinfecting agents may cause deterioration of the glove material and may encourage “wicking” or enhanced penetration of liquids into the glove via undetected pores thereby transporting potentially infectious ma- terials into contact with the hand.” (OSHA instruction CPL 2-2.44C) Whenever you have doubt about the integrity of your gloves, remove the gloves, wash hands and don fresh gloves. Piercers should be aware that sensitization to latex (latex allergies) are becoming increasingly common among both piercers and clients. To protect the health of their staff and clients, many studios are choosing alternative synthetic gloves and eliminating latex from their practices. STERILE GLOVES Some piercers choose to use sterile gloves during piercing procedures; some are required to do so by state law. There are arguments for and against the use of sterile gloves. Where the issue is not dictated by law, a studio should make a research-based deci- sion about whether or not to use sterile gloves in its practice. Sterile gloves are not required by APP standards, though piercers who choose to go beyond the estab- lished minimum guidelines may do so. Donning Sterile Gloves Piercers should use the “open donning” method. The (right-handed) technique is as follows: 1. Pick up the cuff of the right glove with left hand. Slide right hand into the glove until you have a snug fit over the thumb joint and knuckles. Your bare left hand should only touch the folded cuff - the rest of the glove is sterile. Do not use bare hand to adjust fit. 2. Slide right fingertips into the folded cuff of the left glove. Pull out the glove and fit right hand into it. 3. Unfold the cuffs down over wrists. Make sure gloved fingertips do not touch bare forearms or wrists. Donning Clean Gloves 1. With freshly washed hands, remove one glove from the clean glove box by grasping it at the bot- tom edge. Be careful to reach into box as little as possible, and not to touch the fingers of any glove with bare hands. (Discard individual gloves that accidentally contact hands, or that present “fingers first” and cannot be removed by the cuff.) 2. Grasp rolled cuff and slide your hand as far into the glove as possible. DO NOT use your bare hand to adjust fit from the outside.
  15. 15. 12 3. With your now gloved hand, reach into the clean glove box and remove a second glove. 4. Without touching bare skin to the outside of ei- ther glove, slide your other hand into the second glove. 5. Now adjust both gloves for fit. Remember that any portion of glove touched by bare hands should not then be touched with gloved hands. CHOOSING THE RIGHT GLOVE Latex Latex is a polymeric membrane of natural rubber de- rived from the sap of the rubber tree (Hevea Brasilien- sis). It is made heat-stable, resilient, strong and elastic through vulcanization (heating with sulphur) and the addition of accelerators and antioxidants. Non-sterile medical grade latex gloves are used by many piercers for everyday duties within the studio. Latex gloves vary in thickness and texture and should be chosen for durability, comfort and tactile sensitivity. Latex gloves are sometimes powdered to ease don- ning. These powders are usually cornstarch or talc- based and are placed in the glove after manufacturing. Research has shown that glove powder can lead to granulomas in open tissue, and may increase potential for airborne latex proteins and latex sensitivities. Con- sider using non-powdered gloves for all procedures. Many manufacturers are now processing gloves with a polymer coating such as silicone for easy donning without powder. Latex gloves contain protein antigens and curing agents (such as accelerators and antioxidants) that may cause an allergic dermatitis or systematic anaphylaxis (discussed further below). Even those gloves labeled “hypoallergenic” will not always prevent reactions in a highly sensitive person. Those with severe sensitivi- ties may be unable to enter a shop with airborne latex proteins or powders. Latex gloves should never be used on a client who informs you of an allergy to latex, and many shops have chosen to become latex-free for the safety of all clients and staff. If latex is the pri- mary type of glove used in a studio, latex-free gloves should be stocked for clients with latex allergies and a comprehensive latex allergy procedure should be developed. NON-LATEX ALTERNATIVES Many piercers opt for latex-free synthetic alternatives such as Nitrile. While all the options listed below are latex-free, not all synthetic materials are appropriate for all uses. Synthetics also vary widely in price. When bought in bulk from well-chosen manufacturers, many of the best synthetic glove products can be found at reasonable prices. Vinyl Vinyl (PVC) gloves are an easily available alternative to latex. However, they are not as strong as latex and are more easily punctured. They fit loosely, are non-elastic, and may slip, exposing the piercer’s skin or interfering with skilled procedures. Vinyl gloves are the most porous of exam glove op- tions, and may allow penetration by even large mole- cules of blood and fluids over long exposure. The failure rate of stressed vinyl gloves is reported at about 51.3% (compared with 3% for latex and 0% for Nitrile).* Additionally, vinyl gloves do not necessarily eliminate the potential for contact dermatitis because many of the same chemicals used in processing latex gloves are also used in vinyl gloves. Those reacting to additives in latex gloves may need to avoid vinyl as well. For these reasons, vinyl gloves are less than ideal for most procedural applications in the studio. Nitrile Nitrile gloves are a protein-free, low-chemical, synthetic alternative made from nitrile polymer. They are three times more resistant to chemicals and punctures than latex of the same thickness and have a reported stress failure rate of 0%.* While nitrile’s thickness and lack of elasticity require getting used to after thin latex, many piercers find these gloves to be more secure and to allow full dexterity. They are available with textured fingertips for increased grip, and can be had in a range of colors to increase client awareness of glove use. Although slightly more expensive than latex, nitrile gloves are reasonable when bought in bulk and offer an excellent synthetic alternative for those desiring high quality protection and minimal risk of chemical- or allergen-exposure. Test several manufacturers’ products to find an optimum product for your individual needs and budget. Polyurethane and Styrene Co-polymers Other high quality synthetic alternatives such as Tac- tylite and Allergard are available. Some have very little allergy potential and provide a good barrier. Fit, feel and cost vary by material, brand and design. In general these gloves are more expensive than others,
  16. 16. 13 but may well be worth it depending upon a piercer’s preferences and circumstances. Contact individual suppliers for samples. *Adenna, Inc. ©1997-2004. LATEX SENSITIVITIES Since the implementation and recommendation of Uni- versal Precautions by the Centers for Disease Control and Prevention (CDC) and Occupational Safety and Health Administration (OSHA) , latex sensitivities have been on the rise. Estimates suggest 2 - 6% of the gen- eral population is latex sensitive. Among healthcare workers this percentage rises to 8 - 12%. Due to the extensive exposure many people in the healthcare, emergency service, body art and other industries have to latex gloves and protective gear, allergic reactions among these groups are increasingly common and if unchecked can interfere with continued employment. Reactions can range from minor rash to life-threaten- ing respiratory distress. Because latex allergies are actually sensitization reactions from overexposure to latex, and because latex is so pervasive in our home and work environments, prevention through limiting exposure is crucial. Those who come into frequent contact with latex through the skin or inhalation be- come sensitized, and may go on to develop full allergic reactions. These reactions often occur gradually, but can also come on quite suddenly. Those who use gloves at work, have had multiple surgeries, or who have multiple allergic sensitivities or spina bifida are especially at risk. In the piercing studio, many items besides gloves contain latex. Adhesive tape, rubber bands, some autoclave wrap, CPR masks, and even the handles of some tools and covering on ballpoint pens may contain traces of latex. All of these can trigger reac- tions. Piercers should understand the types of latex reaction and how to deal with latex-sensitive clients and coworkers. The three types of latex hypersensitivity reactions that occur are classified in order of severity as Irritant Contact Dermatitis, Type IV Reaction and Type I Reaction. Irritant Contact Dermatitis This type of reaction is actually not an allergy, but rather a surface irritation caused by excessive handwashing, harsh soaps, chemicals, hand sanitizers and/or glove powder. It can appear as overly dry, cracked, sore or flaky skin and rash. To avoid or relieve contact derma- titis, switch to milder products, avoid powdered gloves, and use a soothing hand sealant after washing. Avoid hand sanitizer or products that increase irritation and be aware that cracked skin is open to latex, chemical and pathogenic penetration. Although contact dermatitis is not serious in itself, it can lead to further problems if not cared for. Type IV Reaction: Chemical Protein Hypersensitivity Type IV is a delayed reaction to an allergen that usually appears 48 to 96 hours after contact. Most people with Type IV hypersensitivity experience some form of der- matitis, such as rash, scales, inflammation, or eczema. Reactions may also include conjunctivitis, runny nose or asthma-like symptoms from airborne detritus. It is generally believed that this type of response is due to the chemicals used in manufacturing the rubber and not due to the latex itself. Type I Reaction: Latex Protein Sensitivity This is an immediate and systemic response to latex proteins. People with this type of reaction may have intense burning and irritation at the contact site, hives within 5 to 60 minutes, itchy eyes, swelling of lips and tongue, abdominal pain, asthma, nausea, and in severe cases death from anaphylactic shock. What To Do For their own health and that of their clients, it is im- perative that professional piercers take these health concerns seriously. If you suspect you have a latex sensitivity, consult a doctor or allergist. Because se- vere reactions can develop suddenly and continued exposure increases this risk, cease all contact with latex products. This will often mean making the entire studio latex-free. The use of low-chemical, low-protein, low-endotoxin powder free synthetic gloves (such as nitrile) is recommended in suspected cases of all three types of hypersensitivity. Question all clients regarding latex sensitivity prior to piercing and use only non-latex materials on clients with a history of sensitivity. Hand sealants, non-latex gloves and avoidance of chemical triggers may ease dermatitis and Type IV Reactions. Medications and allergy therapies are available to mini- mize some symptoms of Type I Reactions, but there is no clinically recognized treatment or cure. For more information NIOSH has issued an Alert, Preventing Allergic Reac- tions to Natural Rubber Latex in the Workplace (DHHS [NIOSH] Publication No. 97-135). Free copies are available from the NIOSH Publications Office: 1-800- 35-NIOSH (1-800-356-4674).
  17. 17. 14 From STERILE to CLEAN to CONTAMINATED Every piercer should thoroughly grasp how their environment and the tools they use pass through stages from sterile to clean to contaminated. The chart below should help your understanding. Visualize sterile as white and contaminated as dark red with several shades in between. Always remember that when a lighter colored item comes in contact with a darker one it becomes that color, and can pass it on, until it is disinfected or sterilized. Nothing darker than pale pink should ever come in contact with a piercing, directly or indirectly. Bare hands should avoid red items. If red items are touched, hands should be immediately washed. Dark red items should never be touched with bare hands. WHITE Sterile. No living matter. Autoclaved implements, jewelry, needles, etc. in un- opened, sterile bags, untouched. PALEST PINK Very clean. Only very small quantities of airborne matter. Sterile implements just removed from their bags. Disinfected imple- ments only touched with freshly gloved hands, trays or surfaces immediately after disinfection/ bleaching. Bagged “sterile” implements after several weeks in storage. PALE PINK Clean. Only small quantities of airborne matter. Presterilized corks, rubber bands, non- sterile latex gloves, tissues, cotton swabs, etc. stored in protective containers and only touched with freshly gloved hands. Surface of “sterile” field, only touched with freshly gloved hands. Needles, forceps, sterilized jewelry, etc. after several minutes in open air, unused. Surface of skin imme- diately after aseptic skin prep. Hands immediately after correct hand washing procedure. PINK Not clean. Normal levels of airborne matter. Needles, forceps, corks, rubber bands, etc.., after extended exposure to open air or frequent handling. Clothing, surfaces, implements, neither contaminated with bloodborne organ- isms, nor recently disinfected. Unused jewelry prior to sterilization/disin- fection. Piercing room furniture, etc. RED Dirty. High levels of airborne matter and possible presence of bloodborne matter. Floors, countertops, sinks, doorknobs, light switches, and other areas that may have been exposed to bloodborne contaminants, either directly or indirectly. Unbroken, uncleaned skin. Frequently handled display jewelry. Phones Money DARK RED Contaminated. High levels of airborne/bloodborne matter. Bodily fluids, new or old. Piercings, new or healed. Broken skin of any kind. Used piercing implements, used disposable piercing needles. Previously worn jewelry. STERILE CHART
  18. 18. 15 Cleaning, disinfection and sterilization are all part of the same process, but they differ significantly in the number and types of microorganisms killed. Under- standing the differences enables the piercer to choose the correct way to make contaminated items safe to use. It also determines proper disposal methods for items that cannot be decontaminated and are unsafe for use in the studio. CLEANING Cleaning is the process that physically removes debris and reduces many of the microorganisms present on an object. Cleaning is the first step in the decontamination pro- cess. It is important to clean items prior to disinfecting and/or sterilizing them. There are some items that will not require disinfecting or sterilizing prior to use, and for which only thorough cleaning with an antibacterial or antimicrobial soap is necessary. Washing hands before and after performing pierc- ings, and several times during the day is such a decontamination process. Of course, even the most stringent handwashing does not take the place of wearing gloves. Tools used in piercing procedures must be thoroughly cleaned before sterilization in order to remove gross matter such as body fluids and lubricants. Otherwise the presence of these can keep steam from effectively reaching all surfaces during a sterilization cycle. In order to do this thoroughly without the risks of manual scrubbing, studios should use an ultrasonic cleaner. Ultrasonic Cleaners are a quick and safe way to execute the critical step of removing matter from in- struments and jewelry prior to sterilizing. Ultrasonics do NOT sterilize. Ultrasonics work by using ultrasound energy (wave motion above the level of audible sound). This energy is transmitted to the cleaning solution within the machine where it creates tiny bubbles of vaporized liquid that explode when they reach a high pressure. An extremely thorough cleaning of all surfaces, even inside of tubes and hinges, occurs as shock waves dislodge debris from the contaminated articles placed in the bath. For optimal results the technician must carefully fol- low the manufacturer’s guidelines for use of solution, additives, temperature, baskets, lids and timers. For example, even Stainless Steel forceps may appear cor- roded if the solution is not properly Ph-balanced. With bench-top models, soils removed from components will be suspended in the solution. If all items are not rinsed immediately after the cycle, the soils in the solu- tion will redeposit themselves on tools during drying. All forceps and hinged tools must be run with the jaws open to expose all contaminated surfaces. There is some controversy regarding the risk of aerosolized (airborne) contaminants during the running cycle of an ultrasonic. To be safe, the APP strongly encourages the use of lids during running cycles. Some piercers even enclose the ultrasonic unit or add second- ary barriers to minimize potential risks from airborne aerosolized pathogens. A HEPA filter in the cleaning room is an excellent additional precaution. DISINFECTION Disinfection is the process that kills some but not all disease-causing microorganisms. Some nonpathogenic microorganisms can remain on any item that you have disinfected. What kind and how many of those you might kill depends on what level of disinfection you use. Bacterial spores and the Mycobacterium Tuberculosis var. bovis are difficult-to- kill, laboratory test microorganisms used to classify the strength of a chemical disinfectant as follows. Three Levels of Disinfection 1. Low-Level Disinfection is the least effective pro- cess and is what most of us think of when we talk about “clean.” It does not kill bacterial spores or M.tuberculosis var. bovis. 2. Intermediate-Level Disinfection is a process that kills the tough tuberculosis microorganism. This is important because a process that kills M.tuberculosis var. bovis is also effective against a host of other organisms that are much easier to kill, such those that cause HIV. 3. High-Level Disinfection is a process that will destroy some, but not all bacterial spores, as well CLEANING, DISINFECTION & STERILIZATION
  19. 19. 16 as bacteria, fungi, and viruses (like the one caus- ing Hepatitis B), in addition to the microorganisms killed at the Intermediate Level. According to the CDC, High- Level Disinfection can only be achieved with a chemical solution that can sterilize given appropriate conditions. However, although High- Level Disinfection kills the same types of organ- isms as sterilization, only full autoclave sterilization renders items that have been contaminated with Bloodborne Pathogens safe for reuse. STERILIZATION Sterilization is the process that kills all microbial life. In addition to all bacteria, viruses and fungi, steriliza- tion will also kill bacterial spores, which are resilient and are the most difficult microorganisms to kill. A process able to eliminate bacterial spores will kill other types of microorganisms such as fungi and viruses. Steriliza- tion eliminates the organisms that cause Tuberculosis, Hepatitis B, Hepatitis C and HIV, as well as all other infectious agents. When you have sterilized properly, there will be no microorganisms alive. Any item or product in your shop that may have been exposed to bloodborne pathogen contamination must be sterilized prior to use. This includes reusable items such as tools, forceps and setup trays. If a contami- nated reusable item cannot be sterilized appropriately, it must be discarded. Single-use, disposable items such as piercing needles must also be sterilized prior to use. However, once used disposables must never be sterilized and reused. Many piercing studio operators do not yet under- stand the need to sterilize all jewelry before use in new piercings. Logically, there is no point of using a sterile needle just to follow it with non-sterile jewelry. We can only know how jewelry is handled within our own shops, and must therefore ensure that no poten- tial contaminants from the manufacturers or shipping contact our clients. Regardless of the source of their jewelry, a reputable piercing shop should insert only high quality body piercing jewelry that is sterilized on the premises prior to insertion. It is not a manufacturer’s responsibility to sell only sterilized jewelry. At the same time, manufacturers also must not misrepresent what is being sold by falsely labelling jewelry as “sterile” or “ready for insertion,” or by making other misleading claims. Best practice for any shop is to run new jewelry shipments through an ultrasonic cycle (preferably in a clean ultrasonic reserved for clean jewelry), and to then autoclave all pieces prior to use. Sterilization Procedure Options • Steam under Pressure (Saturated steam/steam autoclave): 220-270 kip pressure at 140 degrees Celsius (284 degrees Fahrenheit) for 15-40 minutes depending on cycle. • Dry Heat (Dry-Clave): Processing at 177 C (350 F) for 1 hour. This is appropriate only for items that cannot withstand steam exposure. • Gas Plasma (ETO gas/chemical autoclave): Re- quires specific site construction for venting of poten- tially toxic fumes and is not practical for piercers. • Gamma Radiation (exposure to specific radioac- tive waves): Highly regulated and costly, requiring specific site construction and disposal criteria. Im- practical for piercers. • Liquid Chemical (cold sterilization): Immersion in an EPA (Environmental Protection Agency) approved and FDA (Food and Drug Administration) controlled chemical agent per manufacturers’ guidelines (com- monly 10-12 hours). Maintaining the sterility of items once removed from the solution is difficult. Problems with disposal and exposure to toxic chemicals make this method impractical for piercers. Sterilization in the Studio Pressurized steam is the only practical and cost-effec- tive method of sterilization in the piercing studio. For our purposes, sterilization requires an autoclave, a piece of medical equipment that employs the steam under pres- sure method of sterilization. Autoclaves can be obtained from a medical supplier and range between $600 and several thousand dollars, depending on size, type and features. Items that have already been cleaned and pro- cessed in an ultrasonic are placed in specially-designed sealable autoclave bags that allow penetration by steam during the sterilization cycle, but protect sterile items from contamination after processing. Until these bags are opened during a piercing procedure, their contents remain sterile unless bag integrity is compromised by puncture, moisture or age. Having a clave on premises is not helpful if it is not in working order. Manufacturer guidelines for main- tenance should be stringently followed. Medical sup- pliers also provide easy in-house methods for studios to check the viability of the sterilization process. Most autoclave bags have indicator strips that change color when exposed to steam, making it easy to distinguish bags that have been processed from those that have not. However, the color change of indicator strips on the autoclave packaging is not a reliable method of determining if an autoclave is working properly. It tests only exposure to steam, not whether the heat, pressure
  20. 20. 17 and duration of that exposure was sufficient to achieve sterilization. Integrator strips are another method for checking clave reliability in house. Integrators are strips or de- vices used in pouches and/or autoclave chambers that prove the conditions for sterilization were met. They are similar to indicators, except that they change color when they have been exposed to the ideal combination of steam, pressure, heat and timing. They should ideally be run and logged daily. Spore tests are the most thorough way of testing autoclave function. They are periodically run through an autoclave cycle, and then sent to an external testing facility for analysis. The testing facility checks to see that there is no subsequent growth of bacterial spores on the medium. Since spores are extremely difficult to kill, the lack of spores on the test medium after autoclaving indicates that more fragile organisms have also been destroyed and the autoclave is functioning properly. Spore tests are absolutely necessary to ensure that items are indeed being sterilized. Failed spore tests require an immediate halt in piercing operations until tools and other items can be reliably resterilized. For this reason some shops keep more than one autoclave on premises. Your studio should have a written policy outlining the procedure that must be followed immedi- ately following notification of a failed spore test. Studios should develop and follow a written steriliza- tion program that includes how and when indicator, integrator and spore tests will be run, recorded and filed. Batch numbers can be included in the log so that a given set of tools can be quickly traced to a particular cycle and double-checked in case a concern regarding a particular piercing or client arise. Some new auto- claves come conveniently equipped with a printer that will provide a sheet documenting the sterilization cycle of each load. This printout is simply a written record and does not take the place of an indicator, integrator or spore test. Logs proving autoclave use and integrity are essential to the conscientious running of a studio, and will be invaluable should post documentation be required for regulatory or legal purposes (e.g. in the event of a lawsuit). Statim Some piercing studios use steam-flushing pressure- pulse autoclaves (such as Statim autoclaves) for sterilization. The sterilization process in this type of autoclave facilitates air removal and steam penetra- tion, and has an extremely short processing time. The steam-flush pressure-pulse autoclave is acceptable for sterilization in the piercing studio as long as certain guidelines are followed: • Due to the high number of cycles run each day, these autoclaves must be spore tested weekly. • Daily, weekly and monthly maintenance of steam, pressure-pulse autoclaves is required. This type of autoclave requires a more rigorous maintenance schedule than traditional autoclaves and a written log of all maintenance should be kept. The Statim has three sterilization cycles, each de- signed to sterilize a specific type of instrument. • Unwrapped cycle - 275 F for 3.5 minutes • Wrapped cycle - 275 F for 10 minutes • Rubber and plastic cycle - 250 F for 15 minutes The following can be sterilized in the Statim 2000: Nylon, polycarbonate (Lexan), polypropylene, PFTE (Teflon), acetal (Delrin) polysulfone (Udel), poly- etherimide (Ultem) silicone rubber, and polyester. The following cannot be sterilized in the Statim 2000 on any cycle: Polyethylene, ABS, styrene, cellulosics, PVC, acrylic (Plexiglas), PPO (Noryl) latex, neoprene, and similar materials. If you are not sure, do not load items until you have checked with the manufacturer. Processing of these ma- terials may lead to instrument or equipment damage. Do not mix instrument types (i.e. plastics and un- wrapped tools) in the same Statim load. DISINFECTING SOLUTIONS What can I use as a disinfecting agent in my shop? What disinfectants you use will depend on the applica- tion and product availability. Appropriate products are marketed under many names and in several categories. All require exposure times of at least 10 minutes in order to effectively disinfect, with the exception of surfaces already considered “clean” (See Sterility Chart on page 14 for explanation). Everything in the immediate piercing environment should be decontaminated with no less than an Inter- mediate Level of disinfection. Note that disinfectants are used only on inanimate surfaces (objects) and antiseptics are used only on animate (living) surfaces. Disinfecting solutions are grouped into families ac- cording to similar characteristics and properties. Choose products proven to be nontoxic, broad spectrum, hospi- tal grade disinfectants, with a narrow efficacy time and
  21. 21. 18 a long, stable shelf life. Labelling should specifically state that the product is bactericidal, virucidal, fungicidal and tuberculocidal. Some may also be described as germicidal or sporicidal as well. Glutaraldehyde - 2% Solutions These are non-biodegradable biohazards and have been classified by the FDA as toxic. These solutions are commonly found in two varieties, the acidic and the al- kaline. The alkaline type will require an activating agent to bring them to the proper Ph levels, thereby making them usable. They generally require a long exposure time in order to be effective. Most, if not all of these that are currently available require special ventilation and vapor monitoring equipment and must be disposed of according to specific local and federal regulations. Once activated, these products have a limited shelf life and are rendered ineffective fairly quickly. Some common products in the alkaline solutions family are Cidex Plus, Procide, and Omnicide. Com- mon acidic Glutaraldehyde products are Sterall and Banicide. The acidic formulations do not require activa- tion, but are only tuberculocidal after about 30 minutes of exposure time. All Glutaraldehyde solutions destroy unlike metals. Using any of these products with mixed metals such as stainless steel tools, brass jaw pliers, and plated pliers will lead to rapid corrosion. Phenolics - 10% Solutions Phenols are surface disinfectants and are not broad spectrum enough to make them useful for most surfaces in the piercing studio. These are sold under such names as Birex, Procide, and Lysol. Iodophores These are iodine-based disinfectants that will stain surfaces and discolor metals. This makes them a poor choice for soaking jewelry or tools. Additionally these disinfectants have been shown to potentially contain high levels of an organism called Pseudomonas, which grows in the solutions when stored for an extended pe- riod of time. Furthermore, many individuals are iodine sensitive or allergic to these products. Biocide, Micro- dyne, and Iodofive are common product names. Chlorine Compounds Sodium hypochlorite, more commonly known as bleach, acts as a protein disintegrator. Most pathogens are protein-based, making this an effective surface disinfec- tant. A solution of 10% bleach to 90% water will destroy most pathogens in less than 10 minutes. For bleach to be effective, the surface area must be aggressively scrubbed first, and the solution allowed to remain on the surface for a full 10 minutes. The diluted mixture has a shelf life of less than 48 hours so it should not be mixed and stored for later use. Many people are highly sensitive to this chemical and some may experience severe allergic reactions to va- pors in a recently cleaned room. Using other chemicals (particularly ammonia-based cleaners) in the same area may produce a toxic reaction and poisonous gas. A bleach solution is incompatible with stainless steel tools or surfaces. Its use in ultrasonic cleaners or au- toclaves will not only void warranties, but will destroy these costly pieces of equipment. Jewelry should never be soaked in even a weak bleach solution. Quaternary Ammonium Compounds Known as “Super-Quats,” these products are sometimes mixed with other chemicals such as alcohol. Although towelette wipes impregnated with Super-Quat solutions are excellent surface cleaners, not all disinfectants in this group will kill Tuberculosis, which is a particularly hardy pathogen. These products should also not be used for soaking jewelry. Common product names are Saniklens, Aseptic-seryl, and Bafix. Synergistic Formulas A synergistic action involves two or more agents co- operating with each other to result in an effect greater than the additive effect of each agent operating by itself. These solutions are non-toxic, biodegradable, broad-spectrum disinfectants that are also non-cor- rosive and nonstaining. Once opened, the stability of these solutions ranges from 6 to 10 months maintain- ing full potency. They do not require special disposal handling. Synergistic solutions are available in spray bottles, liquid pour bottles, foams, and impregnated towelettes. They can be used as hard surface disinfectants and for jewelry soaking. (Note that autoclave sterilization remains the only appropriate way to prepare jewelry for use in a fresh piercing.) Two of the most common products used by professional piercers are the syner- gistic formulas Madacide and Discide. Isopropyl Alcohol Alcohol can be used as a low-level disinfectant only. It is not recommended as a soak or for disinfecting con- taminated environments because it is not a sufficiently effective cleaner.
  22. 22. 19 DISPOSABLE SUPPLIES To minimize the risk of cross-contamination and to ensure that the piercing procedure is as clean as possible, many components of a piercing set-up are disposable. Unless supplies will be sterilized in a Statim autoclave immediately prior to the procedure, all disposables must be individually packaged in autoclave bags, sterilized, and remain in their pouches stored in enclosed, nonporous containers until use. Disposable materials that can and should be autoclaved include piercing needles, corks, rubber bands, cotton swabs, toothpicks, and gauze. When setting up for a piercing or jewelry insertion, the piercer should first select and assemble all materi- als and tools that might be needed for that procedure. In avoiding cross-contamination, it is entirely unac- ceptable to reach into the piercing cabinet or drawers with gloves that have touched a client. Therefore, the piercer should anticipate possible needs and required items before the procedure begins. If additional sup- plies are required, the piercer must don fresh gloves before accessing any items in the piercing cabinet/ drawers, and must change gloves before touching the client or sterile tools. Use of Various Disposables Presterilized Rubber Bands: Because the jaws of forceps should never be locked onto a client during piercing, these are wound around forceps handles to achieve desired tension. Presterilized Cotton Swabs: Excellent for clean- ing and drying in tight spots, and for erasing stray marks. They come in several different lengths and thicknesses. Presterilized Toothpicks: Used with gentian violet for marking placement. Presterilized Wire Snips: Can be used to connect internally threaded jewelry and piercing needles to maintain needle-jewelry connections for smooth jewelry transfers. PIERCING NEEDLES Acceptable piercing needles are hollow and extremely sharp, with a smoothly sloping cutting edge and no scratches or surface flaws that could damage the tis- sue. Most piercing needles are sold as “super sharp,” or double- or triple-bevelled and come in several lengths. Piercers should inspect each needle immediately be- fore use to be sure there are no burrs or irregularities. Should the piercer choose to bend or shorten a needle, great care should be taken to avoid creating such flaws. Some companies are now manufacturing needles in different lengths and bent options. Of course, the true test of needle sharpness and quality will be in use. Since needle quality will affect both the comfort and healing of clients, as well as the smoothness and speed of the piercer’s technique, the use of only high quality needles is encouraged. Piercing needles are available in sizes corresponding to the gauges of jewelry for fresh piercings. Needles are commonly used in 18, 16, 14, 12 and 10 gauge. Most professional piercers agree that needles thinner than 18 gauge or thicker than 8 gauge are inappropri- ate for fresh piercings. Thicker needles may damage tissue, and the excessive weight of metal jewelry thicker than 8 gauge may result in tissue damage or delayed healing. Needle Handling, Storage, and Disposal Piercing needles have an extremely sharp, precision- ground blade, making them both hazardous to ship and handle, and easily damaged. Bulk, unsterilized needles should arrive at the piercing studio in a clearly marked, thick plastic, padded roll tube. Under no cir- cumstances should needles be mailed in a plastic bag, taped to a cardboard square, or rolling around loose in a cardboard box. These methods create the risk of a needlestick, and are certain to dull the fine points of the needles. Most piercing studios perform in-house sterilization of piercing needles. This gives certainty that proper handling has occurred at every stage of the process. Unless needles are autoclaved immediately prior to a piercing procedure in a Statim autoclave, shipments of needles should be immediately packaged and labeled with gauge and date of sterilization. Sterile needles in autoclave packets must be kept in clean, dry enclosed containers until use. Some local regulations and shop policies set expiration dates on sterilized needles and tools, after which the items are no longer considered sterile. Unused sterilized needles stored past their EQUIPMENT
  23. 23. 20 expiration date should be repackaged and autoclaved, and marked with a new expiration date. After a single use, needles must be immediately disposed of into an approved Sharps container. They should never be resterilized after use nor used more than once. Sharps Disposal Untreated, used Sharps disposal containers may not be included with ordinary trash. Sharps containers and waste in red Biohazard liners must be picked up by a Biohazard waste management company or disposed of in a manner that does not violate regulated waste laws. All containers in a studio bearing the Biohazard label must have the contents disposed of according to regulated waste laws. REUSABLE EQUIPMENT Most professionals will use a wide range of tools to speed the procedure and maximize the comfort of the client. Piercing tools come in many styles, qualities and price levels. Piercers are cautioned that while inexpensive tools are abundant, the quality of tools is usually exhibited in their performance and durability. Tools that work well enhance your individual technique, rather than complicate it. High quality piercing tools are made of long-life stainless steel and are designed with piercing applications in mind. Much like surgical imple- ments, initially they will be costly, but they are intended and engineered for repeated use over many years. Following each use, the contaminated tool should be: 1. Cleaned in an ultrasonic. (See ultrasonic manu- facturers’ instructions for optimal solution and cycle length.) 2. Rinsed 3. Dried 4. Bagged and labeled with date (as well as batch number and operator initials if required). To pro- long life of instruments with movable parts, many professionals apply surgical instrument lubrication (and allow it to dry) prior to bagging. 5. Sterilized in an autoclave *Note: Steps 1-4 should be performed only in an area designated as contaminated, and by prop- erly trained personnel wearing personal protective equipment. TYPES OF TOOLS Forceps Forceps come in a variety of shapes and sizes and are used to align and secure tissue, increasing accuracy and speed of the piercing. Properly applied, forceps gently compress the piercing site while causing the piercee minimal discomfort and no additional tissue damage. Some forceps are designed for specific body parts, such as the septum and navel. Others are available modified to an individual pierc- er’s preference, for instance with a slotted, smooth or ser- rated head. Hemostats (“Multipurpose Tools”) These are useful for holding jewelry, beads and needles during procedures. They are available with smooth or serrated jaws, and some are customized with grooves for opening and closing rings as well. The smooth-jawed are less likely to scratch the delicate finish on jewelry. However, either finish of jaw should be wrapped in sterile protective padding, such as plastic surgical tape or a cloth band-aid, for optimum protection. Needle Holders Needle holders are used in surgery for suturing. Their strong jaws with a central groove make them ideal for opening and closing small gauge and small diameter rings. Needle Receiving Tubes (“NRTs”) NRTs are used to support and protect the tissue around piercings when forceps may not be preferred. They are often used for nostrils, septums, Prince Al- berts, vertical clitoral hoods, and some ear cartilage piercings. NRTs come in vari-
  24. 24. 21 ous lengths, sizes and modifications. They are usu- ally hollow stainless steel tubes with perfectly smooth openings, often with one flared or angled end. Some piercers prefer a shatter-resistant, autoclavable, clear Borosilicate glass NRT, which allows full needle vis- ibility during the procedure. Pliers Many kinds of pliers are used in piercing procedures, and are described below. Optimally pliers should be made of stainless steel to withstand repeated autoclav- ing. The obvious exception is smooth brass-jaw pliers, which have the unique advantage of being unlikely to scratch the surface of jewelry due to their brass-coated jaws. Many pliers can be nickel- or chrome-plated to resist rusting, but will eventually break down and become unusable. The corroding metal can damage the delicate components of the autoclave. These tools must be replaced at the first sign of rust. Ring Closing Pliers: Used to narrow the gap on captive rings to create proper tension for holding the bead. Ring Opening (or Expanding) Pliers: Used to remove and insert captive beads and occasionally to widen the gap on captive rings for insertion and removal. Bending Pliers: Used for custom bending nostril screws, fishtail labrets and needles. These are usually jewelers’ pliers and are available with a number of differ- ent head shapes. The most com- monly used are called “double rounds.” Connecting Snips Small pieces of wire used to stabilize the jewelry transfer during the initial piercing when using internally threaded jewelry. Even experienced piercers find the wire connection between the jewelry and needle help- ful in maintaining alignment. When nicely finished and made of titanium or niobium wire in contrasting colors, connecting snips are easily distinguished on the pierc- ing tray and are safe for re-sterilizing. Calipers These instruments are used for measuring the jewelry gauge and diameter, or the distance be- tween markings for piercing place- ment. They are available in both standard inch and metric calibrations, and some offer both units of mea- surement. Though calipers are available in both plastic and metal, few styles can be autoclaved. Usually the fancier and more accurate models cannot be sterilized, so great care should be taken not to contaminate them. There are a few simple styles available in autoclavable stainless steel. Though less accurate and somewhat harder to read, they have an obvious advantage in the piercing studio. Gauge Wheels Most American body jewelry manufacturers have stan- dardized measurement of the thickness of their jewelry wire with the Browne and Sharp/American Standard wire gauge system. In other industries this system has been historically used for measuring gold wire. There are some variances between wholesale companies, so it is always wise to double-check jewelry gauge to the wheel and to the needle before the piercing procedure. Outside the US, manufacturers use metric millimeters for measuring gauge. Insertion Tapers These are tapered pieces of 18g and larger stainless steel or titanium, used to gradually expand an existing piercing channel. Tapers are most often used to stretch a piercing up to the next gauge, to locate/stretch a healed piercing that has shrunk, and to quickly locate the piercing channel if a jewelry transfer is lost during the initial piercing. Reusable tapers are made of auto- clavable materials and are available in many lengths, slopes and styles. In particular, concave tapers are used with non-threaded or larger initial jewelry, and pin-coupling tapers are available for inserting smaller gauge internal jewelry. When using tapers, understand
  25. 25. 22 that longer, gently sloping tapers (3 inches and up) are best for stretching, while shorter tapers are used for jewelry transfers. The longer and more gradual the taper, the more gentle the stretch. Piercing Trays Piercing trays are the basic foundation upon which the piercing set-up and aseptic field is laid. All procedures should be worked from an autoclaved tray set-up or autoclaved tray liner, rather than a countertop or other surface. Trays should be made of autoclavable plastic or stainless steel, and covered with a plastic-backed dental bib or another impenetrable tray liner. Bagged equipment can be laid out upon the liner just prior to a procedure. The actual procedure surface is called an “aseptic field,” and is a sterilized surface that becomes exposed to air contact only at the beginning of the piercing procedure. The aseptic field used by most piercers is the inside surface of a freshly opened sterile forceps pack, or a sterile 3x3 or 4x4 gauze. Once a forceps or gauze pack is opened, sterile tools, needles, jewelry and disposables can be dropped onto the flattened inside surface for use. Needles, jewelry and tools should never be placed on a non-sterile tray or tray liner surface. “Clean” is not sufficient enough for a procedure surface. Procedure surfaces must be sterile. Optimally, piercing trays should fit into the autoclave and should be sterilized at least daily, or immediately if cross-contamination is suspected. Sundry Jars These autoclavable tempered glass and/or stainless steel jars are useful for storing individually packaged sterile items. There are also a few grades of autoclav- able plastic available. Sundry jars should not be used to store bulk sterilized unpackaged items because they are periodically open to air contact, and because bulk sterilized items are only sterile until removed from autoclave packaging. (Again, “clean” items are not clean enough for a piercing procedure.) Sundry jars need to be disinfected daily and sterilized weekly, or immediately if cross-contamination is suspected. THE PIERCING GUN APP members make a commitment to using the best piercing techniques for hygiene, healing and client comfort. These require: piercing instruments that are sterile and/or disposable; jewelry that is sterile, implant grade and anatomy-appropriate; and methods that minimize tissue trauma and scarring. Although pierc- ing gun companies continue to respond innovatively to some of the risks listed below, at the time of this printing the use of an ear stud gun cannot be accepted in the practice of APP members. While piercing guns may seem to be a quick, easy and convenient way of creating holes, they can have major drawbacks in terms of sterility, tissue damage and inappropriate jewelry design. These concerns, which have been documented in the medical literature, are addressed below. Reusable ear piercing guns can put clients in direct contact with the blood and body fluids of previous clients. During a piercing, microspray of body fluid from one client can aerosolize and contaminate the inside of a gun. Even if sterile jewelry packs are used, the next client’s tissue and jewelry may contact contaminated surfaces, potentially transmitting bloodborne pathogens through the reusable ear piercing gun. Although guns may be exposed to bloodborne pathogens dozens of times a day, few, if any, gun piercing establishments possess the expensive equipment (steam autoclave or chemclave) necessary to sterilize them. Considering the dozens of clients who may have di- rect contact with a single gun in one day, pathogens like hepatitis, pseudomonas and common staph constitute a serious public health threat if they are introduced into even one reusable piercing gun. Young children and those with immature or compromised immune systems may be at higher risk. Piercing guns can cause significant tissue damage. Piercing guns use pressure to force a dull metal shaft through the skin. The procedure can cause similar tis- sue damage to a blunt force trauma, such as significant pain, swelling, scarring, and an increased potential for complications. The more serious complications associated with gun piercing increase when stud guns are used on structural tissue such as cartilage. Cartilage has less blood flow
  26. 26. 23 than lobe tissue and a correspondingly longer healing time. Therefore infections in this area are more com- mon and can be much more destructive. The use of non-sterile piercing equipment and insufficient after- care has been associated with increased incidence of auricular chondritis, a severe and disfiguring infection in cartilage tissue. This can result in deformity and col- lapse of structural ear tissue, requiring antibiotic therapy and extensive reconstructive surgery to correct. The length, design and material of traditional gun studs are inappropriate for initial piercings. Traditional ear piercing studs are too short for some earlobes, most cartilage and other body parts. Once they are locked on by the gun mechanism’s pressure, compressed tissue remains constricted and can be- come irritated. Diminished air and blood circulation can lead to prolonged healing, scarring, swelling and possibly impaction. Both piercers and medical per- sonnel have seen stud gun jewelry embedded in ear lobes and cartilage (as well as navels, nostrils and lips), sometimes requiring surgical removal. Jewelry that fits too closely also increases the risk of infection because it does not allow for thorough clean- ing. Body fluids normally discharged during healing can become trapped around the hole by inappropriately designed jewelry. Unless this discharge is thoroughly and frequently removed, it can attract bacteria and becomes an invitation to secondary infection Ear piercing studs made of materials that are not FDA-approved or ASTM-certified as safe for long term implant in the human body should not be used. Even when coated in non-toxic gold plating, materials from underlying alloys can leach into human tissue through corrosion, scratches and surface defects, causing cy- totoxicity and allergic reaction. Since manufacturing a durable corrosion- and defect-free coating for such studs is extremely difficult, medical literature recom- mends only implant grade (ASTM F-138) steel and titanium for piercing stud composition. Studs made of any other materials, including non-implant grade steel (steel not batch-certified as ASTM F-138), should not be used, regardless of the presence of surface plating. Misuse of ear piercing guns is extremely common. Even though many manufacturers’ instructions and local regulations prohibit it, many gun piercers do not stop at piercing only the lobes, and may pierce ear cartilage, nostrils, navels, eyebrows, tongues and other body parts with the ear stud guns. This is absolutely inappropriate and very dangerous. Considering that a large proportion of gun piercers’ clientele are minors or young adults, it is not surpris- ing that few gun piercing complications are reported to medical personnel. Many of the clients may have been pierced without the consent of parents or guardians who provide healthcare access. Therefore, many cases of infection, scarring and minor complications may go unreported and untreated. Because of the ease of acquiring a gun piercing and the lack of awareness of risk, many consumers fail to associate negative experi- ences with the stud gun itself. They believe that, since it is quicker and easier to acquire a gun piercing than a manicure, gun piercing must be inherently risk-free. Legislation has begun to prohibit the use of guns on ear cartilage and non-lobe locations, and New Hampshire has made all non-sterile equipment illegal, but these changes are not yet nationwide. As profes- sional piercers and public health advocates, we have an obligation to provide consumers and legislators with accurate and adequate information to understand the risks and benefits of gun piercing. FURTHER REFERENCES ON EAR PIERCING GUNS 1. Journal of the American Medical Association. 2004 February 25; 291(8): 981. Outbreak of Pseudomonas aeruginosa Infections Caused by Commercial Piercing of Upper Ear Cartilage William E. Keene, PhD, MPH Amy C. Markum, RN, BSN Mansour Samadpour, PhD 2. Pediatric Emergency Care. 1999 Jun15 (3): 189-92. Ear-piercing techniques as a cause of auricular chon- dritis. More DR, Seidel JS, Bryan PA. Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, California, USA. 3. Journal of Laryngology and Otology. 2001 Jul; 115(7): 519-21. Ear deformity in children following high ear-piercing: current practice, consent issues and legislation. Jervis PN, Clifton NJ, Woolford TJ. Department of Otolaryngology, Royal Hallamshire Hospital, Sheffield, UK.
  27. 27. 24 4. International Journal of Pediatric Otorhinolaryngology. 1990 Mar; 19(1): 73-6. Embedded earrings: a complication of the ear-piercing gun. Muntz HR, Pa-C DJ, Asher BF. Department of Pediatric Otolaryngology, St. Louis Children's Hospital, Washington University Medical Center, MO 63110. 5. Plastic and Reconstructive Surgery. 2003 Feb; 111(2): 891-7; discussion 898. Ear reconstruction after auricular chondritis secondary to ear piercing. Margulis A, Bauer BS, Alizadeh K. Northwestern University Medical School, The Chil- dren's Memorial Medical Center, Chicago, Ill 60614, USA. 6. Contact Dermatitis. 1984 Jan; 10(1): 39-41. Nickel release from ear piercing kits and earrings. Fischer T, Fregert S, Gruvberger B, Rystedt I. 7. British Journal of Plastic Surgery. 2002 April; 55(3): 194-7. Piercing the upper ear: a simple infection, a difficult reconstruction. Cicchetti S, Skillman J, Gault DT. Department of Plastic and Reconstructive Surgery, Mount Vernon Hospital, Northwood, UK. 8. American Journal of Infection Control. 2001 Aug; 29(4): 271-4. Body piercing as a risk factor for viral hepatitis: an integrative research review. Hayes MO, Harkness GA. University of New Hampshire, School of Health and Human Services, Durham, USA. 9. Cutis. 1994 Feb; 53(2): 82. Embedded earrings. Cohen HA, Nussinovitch M, Straussberg R. Pediatric Community Clinic, Petach Tikvah, Israel. 10. Scandinavian Journal of Rheumatology. 2001; 30(5): 311. Does mechanical insult to cartilage trigger relapsing polychondritis? Alissa H, Kadanoff R, Adams E. 11. Toxicology In Vitro. 2000 Dec; 14(6): 497-504. Cytotoxicity due to corrosion of ear piercing studs. Rogero SO, Higa OZ, Saiki M, Correa OV, Costa I. Instituto de Pesquisas Energeticas e Nucleares, IPEN, PO Box 11049, CEP 05422-970, SP, Sao Paulo, Brazil. 12. Journal of the American Medical Association. 1974 Mar 11; 227(10): 1165. Ear piercing and hepatitis: Nonsterile instruments for ear piercing and the subsequent onset of viral hepatitis. Johnson CJ, Anderson H, Spearman J, Madson J. 13. Journal of the American Medical Association. 1969 Mar 24; 207(12): 2285. Hepatitis from ear piercing. Van Sciver AE. 14. The Lancet: Infectious Diseases. 2002 December 1; 2(12): 715. Piercing the cartilage and not the lobes leads to ear infections Pam Das
  28. 28. 25 RECEPTION AND SALES ROOM Counter The counter surface should be a nonporous surface such as glass or metal that can be easily disinfected as needed throughout the day. An FDA-approved hard surface disinfectant should be used according to the manufacturer’s instructions for this purpose. Glass cleaner should be used to minimize streaking. Keep disposable relish cups, sealable plastic baggies, dental bibs and tissues at the counter to minimize cross-contamination by customers. Have clients place previously worn jewelry into relish cups or baggies, never on the counter. Even new, unworn jewelry brought in by a client must be handled as if it is contaminated. It very well might have been “just tried on for a second,” which is reason enough to treat it as contaminated. Throw away contaminated disposable items once they have contained a client’s own jewelry, whether they report it was previously worn or not. It is extremely common for customers to touch their jewelry and piercings when they are at the counter, even when they are asked to refrain from such activity. Keep a close watch on your customers and politely but firmly insist that they not handle their own jewelry and/or piercings on the premises. Fully explain your concern for their safety and the reasons behind the rule, and do not tolerate this potential for cross-contamination in the studio. If a client does touch their own jewelry or piercing (whether new or healed), immediately require them to wash their hands or provide germicidal hand wipes for their use to prevent cross-contamination of the studio. Be consistent with requiring hand sanitizing after each and every such contact. A posted sign at the front counter can explain: “For your health and that of others, please do not remove, insert, or handle your jewelry in the store. We will do it for you.” With the possible exception of a welcoming hand- shake, touch pierced clients only with freshly gloved hands. Many piercers feel that wearing gloves for contact of even non-pierced areas establishes a level of professional detachment between the piercer and the client. Dial calipers, gauge wheels, ring expanding pliers, and other tools that are used at the counter should be used for new, unworn jewelry only. Disinfect or sterilize the front counter tools as neces- sary. Should contamination occur, items that cannot be autoclaved must be disposed of. Display Display jewelry should be protected from potential con- tamination. Customers should not be allowed to touch display jewelry to any part of their skin, piercing, or own jewelry. When in doubt, handled items should be autoclaved before being returned to the display case. Sterile jewelry used for initial piercings should not be kept in the display case. If jewelry from the display case is to be used for an initial piercing, the item must meet all criteria for initial piercing jewelry and must be sterilized before use. If display or stock jewelry can- not be autoclaved, contact the manufacturer for proper handling, care and maintenance. Whenever possible, handle display jewelry with gloved hands. THE PIERCING ROOM The piercing room must be a completely separate enclosed room with walls and door(s) made of non- porous material (tile, semigloss paint, sealed brick, vinyl). Unsealed brick, cement, wood and other uneven or porous wall surfaces can trap and harbor disease- causing pathogens. Flooring in the piercing room should be made of linoleum, tile (ceramic, vinyl), sealed wood, or other nonporous material, and should have approximately 4-6 inches of splash guard around the perimeter to protect walls. Floors should be mopped daily with a disinfectant specific to the type of flooring. Lighting in the piercing room must be bright and adjustable. Depending on lighting needs, fixed light- ing can be combined with adjustable lamps. Lamps that are touched or adjusted during procedures must be disinfected at least daily and throughout the day as needed when the potential for cross-contamination ex- ists. Piercers who touch light fixtures during procedures must change gloves before resuming the procedure. To prevent client contact with Biohazard and clean areas of the piercing room, a specific area should be provided and visibly marked for client’s belongings. The Sharps container and contaminated tools should not be located close to sterilized piercing implements ENVIRONMENT

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