UPDATED AFTERCARE BROCHURES
Newly reformatted with additions reflecting new trends and
frequently asked questions from Piercers and Piercees
• Clear concise instructions on cleaning
• "Less is more" message
• More information on jewelry issues
• Facial piercings now covered in Oral Aftercare instructions
• 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.
• 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:
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
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
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
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 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.
• Provides a professional association and peer support
• Publishes a quarterly newsletter dedicated to pierc-
ing-related news, research and information to keep
geographically dispersed individuals current in the
• Standardizes and publicizes industry procedures and
protocols regarding hygiene, quality and education,
and assists piercers in meeting and/or exceeding
• 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
• 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
• 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
• 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.
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-
• Have knowledge of appropriate sterilization and
cross-contamination prevention through Bloodborne
Pathogens Training, required annually for member-
• 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.
• 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
• Must work in a studio which has at least one APP
Business member on current staff.
• 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-
• Must provide a letter of intent;
• Must provide documentation regarding their busi-
ness, including jewelry samples if applicable.
• 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-
tionnaire. For questions please contact us directly at
APP PUBLICATIONS, PROD-
UCTS AND EDUCATIONAL
• Brochures for piercers, educators, consumers, and
healthcare personnel (Available titles listed inside
• 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
° FAQ’s: Piercing and Minors, Pregnancy, Pierc-
ing Guns, Genital Piercings, Oral Piercings, and
° Job Board: free listing of jobs available and those
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
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
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
Virology is the study of viruses, which are submicro-
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-
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
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
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
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
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
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,
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:
• Utilize clean technique
• Understand appropriate sterilization, and
• Practice it at all times.
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
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-
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
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
BREAKING THE CHAIN
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
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
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
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
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
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
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.
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.
HAND SANITIZERS VERSUS
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 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
1. Wash hands prior to donning gloves and immedi-
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
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
• 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
• 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
• 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
• 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
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
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
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.
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
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
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.
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
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 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
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
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
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 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,
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.
No living matter.
needles, etc. in un-
opened, sterile bags,
Only very small
quantities of airborne
just removed from
ments only touched
with freshly gloved
hands, trays or
several weeks in
Only small quantities
of airborne matter.
rubber bands, non-
sterile latex gloves,
swabs, etc. stored in
and only touched with
freshly gloved hands.
Surface of “sterile”
ﬁeld, only touched
with freshly gloved
sterilized jewelry, etc.
after several minutes
in open air, unused.
Surface of skin imme-
diately after aseptic
after correct hand
Normal levels of
corks, rubber bands,
etc.., after extended
exposure to open air
or frequent handling.
isms, nor recently
Unused jewelry prior
fection. Piercing room
High levels of
airborne matter and
possible presence of
light switches, and
other areas that may
have been exposed
directly or indirectly.
High levels of
Bodily ﬂuids, new or
old. Piercings, new
Broken skin of any
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 is the process that physically removes debris
and reduces many of the microorganisms present on
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
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 is the process that kills some but not all
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
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 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
and duration of that exposure was sufﬁcient to achieve
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).
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
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.
What can I use as a disinfecting agent in
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
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.
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.
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.
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
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.
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
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
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
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
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
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
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
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.
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
1. Cleaned in an ultrasonic. (See ultrasonic manu-
facturers’ instructions for optimal solution and cycle
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
TYPES OF TOOLS
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
modified to an
with a slotted,
smooth or ser-
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 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
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
NRTs come in vari-
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.
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
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.
These instruments are used for measuring the
and diameter, or
the distance be-
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
Most American body jewelry
manufacturers have stan-
dardized measurement of
the thickness of their jewelry
wire with the Browne and
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.
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
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
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 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
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
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
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
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
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-
More DR, Seidel JS, Bryan PA.
Department of Emergency Medicine, Harbor-UCLA
Los Angeles, California, USA.
3. Journal of Laryngology and Otology. 2001 Jul; 115(7):
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.
4. International Journal of Pediatric Otorhinolaryngology.
1990 Mar; 19(1): 73-6.
Embedded earrings: a complication of the ear-piercing
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,
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):
Piercing the upper ear: a simple infection, a difﬁcult
Cicchetti S, Skillman J, Gault DT.
Department of Plastic and Reconstructive Surgery,
Mount Vernon Hospital,
8. American Journal of Infection Control. 2001 Aug;
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.
Cohen HA, Nussinovitch M, Straussberg R.
Pediatric Community Clinic, Petach Tikvah, Israel.
10. Scandinavian Journal of Rheumatology. 2001; 30(5):
Does mechanical insult to cartilage trigger relapsing
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
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
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
RECEPTION AND SALES ROOM
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
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 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-
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