TATTOO
TIPS
CROSS
INFECTION
- GLOVES
MUST WORN AT ALL TIMES WHEN PREPARING YOUR CUSTOMER FOR
TATTOOING AND AT ALL TIMES WHILE TATTOOING AND AFTER TATTOOING
WHILE CLEANING DOWN AND BANDAGING TATTOO.
- GLOVES
MUST BE CHANGED AT ANY TIME YOU TOUCH ANYTHING THAT IS
NOT STERILE . (SUCH AS IF YOU LEAVE THE TATTOO AREA AND
HANDLE MONEY. ETC.)
- IT
IS ADVISABLE TO WEAR GLOVES WHILE CLEANING DOWN TATTOO
AREA BETWEEN CUSTOMER FOR BLOOD CONTAMINATION RISK.
AUTO-CLAVES
- BE
WISE. STERILISE WITH A AUTOCLAVE DON'T PUT YOUR LIFE OR
YOUR CUSTOMERS AT RISK.
- AUTO-
CLAVING HOT PRESSURE STEAM STERILISING IS THE ONLY SURE
WAY TO ENSURE YOUR SAFETY AND YOUR CUSTOMERS.
- AUTO
- CLAVING PROCEDURES CAN BE OBTAINED FROM YOUR LOCAL HEALTH
AUTHORITY AND WILL GIVE YOU THE FULL REQUIREMENTS .
- REMEMBER
THERE ARE MANY PEOPLE IN AUTHORITY WHO ARE AGAINST ANY
TYPE OF TATTOOING AND WILL USE ANY BREACHES OF THE TATTOOING
STERILISING CODE TO BRING DOWN TATTOOING. SO PROTECT YOUR
BUSINESS AND AS WELL AS OURS BY WORKING TO THE REGULATIONS.
- FOR
AUSTRALIAN CUSTOMERS WE HAVE EVERY STATE HEALTH DEPT.
SKIN PENETRATION ACT DOCUMENTS AND CAN BE PURCHASED FROM
US. EVERY KIT SOLD BY US HAS ONE OF THESE DOCUMENTS INCLUDED.
ULTRA
SONIC CLEANERS
- A
MUST IN ANY TATTOO STUDIO OR IN ANY TATTOOING SITUATION
ALL EQUIPMENT MUST BE CLEANED BEFORE AUTO-CLAVING
- THESE
CLEANERS VIBRATE WITH HIGH FREQUENCY TO SHAKE LOSE EVERY
BIT OF BLOOD AND INK FROM YOUR EQUIPMENT .. IT IS RECOMMENDED
THAT YOU RINSE ALL PIECES UNDER COLD RUNNING WATER BEFORE
PUTTING IN TO AUTO-CLAVE.
PERSONAL
HYGIENE
- UTMOST
PERSONAL CLEANLINESS IS ESSENTIAL AT ALL TIMES. WITH CLEAN
AND NEATLY TRIMMED FINGER NAILS AND HANDS WASHED AND STERILISED.
EACH TIME YOU TOUCH UN -STERILE OBJECTS.
- CLEAN
CLOTHES ARE A MUST.
- REMEMBER
A CLEAN BODY AND A CLEAN WORKPLACE IS A SAFE WORK PLACE.
- DON'T
CUT CORNERS!
Successful,
personal service businesses supply their clients with professionally
competent, safe and hygienic services, provided in clean and
congenial premises. Proprietors of these services must become
aware of the possible wider effects of the procedures they
employ. Unsafe or unhygienic procedures can not only affect
the health of the client but also jeopardize the health of
the operator and aid the spread of infectious diseases. More
seriously, where procedures involving penetration of the skin
are not performed correctly, they can be the means of transmitting
organisms that cause diseases like AIDS, Hepatitis B and Hepatitis
C.
It
is essential for proprietors to be fully aware of the potential
dangers
of their procedures and to understand the precautions that
need to be taken
to minimize the likelihood of infection.
1.
The Health (Infectious Diseases) Regulations
1990 set out the following basic principles that must be observed
by people operating in establishments that provide personal
services:
- The
premises must be kept clean and hygienic.
- Any
article to be used for penetrating the skin must be sterile.
- Any
article that has penetrated the skin or is contaminated
with blood must be either disposed of immediately or sterilized
before being used on another person.
- Any
other article to be used on a person must be cleansed
before being used on another person.
- Operators
must keep themselves and their clothing clean and have
no exposed cuts, abrasions or wounds.
The
purpose of this page is to help tattooists and body piercers
to comply with the regulations by explaining how infection
can be associated with procedures they employ and precautions
they should take to protect their clients, themselves and
the community.
2.
How Infections Can Occur
The
potential for serious infection occurs during tattooing and
body piercing. The needles that are used to penetrate the
skin at various sites on the body can become contaminated
by blood or serum.
HIV
(the virus which causes AIDS), Hepatitis B and Hepatitis C
viruses are present in blood and spread by infected blood
entering another person's bloodstream. This can happen during
tattooing or body piercing, when needles used for penetrating
the skin are contaminated with infected blood or serum and
are not sterilized before use on another person.
The
person at risk may be the next client being treated with the
contaminated instrument or you, if you accidentally penetrate
your skin with the contaminated instrument. This is called
a 'needle-stick' injury. Contact with infected blood, serum
or contaminated instruments on open cuts, sores or broken
skin can also lead to infection.
Blood
or serum does not have to be visible on an instrument or needle
for infection to be transmitted. It is important to note:
all instruments that penetrate the skin of a person, including
needles and attachments such as nozzles, needle bars and tubes,
must be sterile.
2.1
Cross-Contamination
Some
of the ways which cross-contamination can occur in tattoo
and body piercing shops are as follows:
- If
one or more operators share the same equipment or materials.
- If
used and clean instruments come into contact with one
another.
- If
clean instruments are placed on unclean surfaces.
- If
strict operator hygiene is not observed.
- If
contaminated dressings, spatulas, disposable gloves are
not disposed of immediately and appropriately after use.
- If
structural facilities, furnishings and fittings of the
premises are not adequately protected, or thoroughly cleaned
between clients.
- If
towels and other articles used on clients are not changed
or thoroughly cleaned between clients.
Operators
should be aware of the potential for unprotected surfaces
and equipment to become contaminated with blood and serum
during tattooing or body piercing. Some examples of how this
can occur are as follows:
- Adjusting
overhead light fittings.
- Adjusting
settings on power packs.
- Answering
telephones.
- Touching
ink bottles or ink trays.
- Touching
curtains, drapes or bin lids.
- Adjusting
furniture and equipment. Clients, operators and the community
can be at risk if cross-contamination occurs.
2.2
Health and Safety in the Workplace
Employers
have a responsibility to provide a safe work environment without
risks to the health of their employees, clients or other persons
who go onto their premises. In the tattoo and body piercing
industry, this safety involves the provision of:
- Adequate
staff training, including hygiene and infection control.
- Properly
maintained facilities and equipment, including the provision
of protective equipment such as gloves.
- A
clean and suitably designed shop, to include the safe
storage of goods such as chemicals to minimize potential
hazards.
2.2.1
Hepatitis B Vaccination
A
safe and effective vaccine for the prevention of Hepatitis
B is available. Vaccination is advised for all tattooists,
body pierces and staff involved in skin penetration procedures
and for staff who may be involved in cleaning skin penetration
instruments and equipment.
A
primary vaccination course usually consists of three injections
over six months. At the end of this time, a blood test can
be done to check that the vaccination has been effective.
It is recommended that booster doses be given five to seven
years after the primary course.
Vaccination
and blood tests can be arranged through a local doctor.
2.2.2
Contact with Blood or Body Fluids
Because
of the risk of blood borne infection, operators and clients
should avoid contact with other peoples' blood and body fluids.
If contact occurs, the following precautions should be taken:
- Wash
the area of contact thoroughly with soap and warm water.
If contact has been with an open wound, broken skin, mucous
membrane (mouth, eyes) or penetrating needle-stick injury.
- Irrigate
the area with water in the case of contact with a mucous
membrane.
- Encourage
bleeding from the wound, and in the case of open wounds
and broken skin wash the area thoroughly with soap and
water.
- Report
the contact to your local doctor who will give you advice.
2.2.3 Bleeding
Should
bleeding occur at any time in the course of a tattooing or
body piercing procedure or accidentally, the following procedures
should be followed:
- Put
on disposable gloves if you are not already wearing them.
- Stop
the bleeding by applying pressure to the wound with a
dry sterile disposable dressing.
- Handle
disposable dressings and contaminated instruments carefully
to avoid contact with blood or serum from the client or
the instrument.
- Dispose
of contaminated instruments into a sharps container or
clean and sterilise the instruments.
- Clean
surfaces such as benches, chairs or floors that have become
contaminated with blood or other body fluids as soon as
possible, using a disposable cloth soaked in diluted bleach
at 1:4 dilution.
- Wash
affected areas with hot water and detergent and dry them
with a clean disposable wipe.
- Disinfect
the surface with diluted bleach and leave for a minimum
of fifteen minutes before wiping dry.
- Dispose
of all cloths used for wiping up blood spills by placing
them in the bin marked 'infectious waste'.
- After
treating wounds, handling contaminated dressings or cleaning
up blood or other body fluids, remove both gloves, dispose
of them in the 'infectious waste' bin and wash hands thoroughly
3.
Tattooing/Body Piercing
3.1
Preparation of Work Area and Setting up of Equipment
It
is very important that you prepare the work area so as to
avoid having to leave the client in the middle of a tattooing
or body piercing procedure to get something which may be needed.
This increases the risk of cross-contaminating surfaces.
- Ensure
that the work area is clean and tidy.
- Make
sure all the items needed are in easy reach and that any
items not required are removed from the immediate area.
- Cover
any work surfaces with disposable coverings or clean linen
(this makes cleaning the work surfaces easier).
- Place
a container labelled 'dirty instruments for sterilising'
in the work area for the collection of these instruments.
Hands
must be washed thoroughly according to the procedure outlined
in section 5 and disposable gloves should be worn. Packages
containing sterile needles should be opened in front of the
client to show that sterile instruments are being used.
To
prevent surfaces from being contaminated in the event that
an item has to be handled or adjusted while tattooing is in
progress:
- Cover
spray-bottles and ink bottles with single-use plastic
bags, so that only the nozzles are exposed.
- Cover
any surfaces which may need to be touched, for example
light fittings and power pack controls, with cling film.
- Place
the required number of single-use, disposable ink caps
into stainless steel ink cap trays and dispense inks into
ink caps. Alternatively, dispense inks onto a single-use,
disposable tray. Any left over ink must be discarded with
the container, after each client.
- Place
water to be used for rinsing between colours in disposable
cups and dispose of the water and cups after each client.
- Tissues
or wipes to be used during tattoo procedures should be
stored where they cannot become contaminated. Enough wipes
to be used on one client should be kept in the working
area and any not used should be immediately discarded
after each client.
- Solder
sterile needles onto the sterile needle bars using a lead
free solder and then clean them to remove any flux residue.
After soldering they must then be re-sterilised in the
autoclave according to prior to being used on a client.
- Wash
hands thoroughly and wear disposable latex gloves.
- Open
autoclave bags containing sterile needles, needle bars
and tubes, and set up the tattoo machine in front of the
client to show that sterile instruments are being used.
Additional
Precautions
- Replace
any sterile instruments accidentally touched by you or
contaminated in any other way, either before or during
a treatment, with another sterile instrument or needle.
- Take
care when inspecting needles for defects such as damaged
or blunt points. They must be cleaned and sterilised prior
to inspection and then re-sterilised before they are used
on a client.
- Needles
must never be tested for sharpness on the operator's skin.
3.2
Skin Preparation
- The
patient's skin should be clean and free from infection.
- If
the area to be tattooed needs to be shaved, a disposable
safety razor should be used.
- After
use, the razor must be immediately disposed of into a
sharps container.
- Prior
to tattooing/body piercing, the skin around the site must
be disinfected. For the area around the eyes the area
should be cleansed with warm water. Skin can be disinfected
using any of the following preparations:
- 70
per cent w/w ethyl alcohol.
- 80
per cent v/v ethyl alcohol.
- 60
per cent v/v isopropyl alcohol.
- Alcoholic
(isopropyl and ethyl) formulations of 0.5 to 4 per
cent w/v chlorhexidine.
- Aqueous
or alcoholic povidone-iodine (1 per cent w/v available
iodine).
These
can be applied to the skin using a spray-bottle or pump pack
and wiping with a clean disposable cloth. Alternatively, skin
disinfectants may be decanted from their original container
into a single-use container. At the end of tattooing/body
piercing each client, any remaining fluid, single-use container
and disposable cloth must be discarded with the container.
Alcohols
in the form of sterile, disposable swabs may also be used
to disinfect the skin. Use-by dates on disinfectants must
be observed. The time between skin preparation and skin penetration
should be at least two minutes but preferably five minutes.
In
tattooing:
- A
detergent-based lotion containing one of the above anti-bacterial
preparations may be used on the skin prior to placement
of a stencil. The application of this lotion on to the
skin should be the same as for anti-bacterial skin cleansers.
Multiple-use deodorants should never be used prior to
the placement of a stencil.
- Because
of the high risk of cross-contamination with blood, it
is important that stencils are not re-used on other clients.
- Before
tattooing, the client's skin may be covered with lubricating
jelly. It is important that the jelly be removed from
the original container using a clean single-use applicator.
If extra jelly is required on the client, a new spatula
should be used each time. Because of the high risk of
cross-contamination of the pump outlet, self-dispensing
pumps for lubricating jelly should be used only to dispense
onto a clean single-use applicator. Under no circumstances
should petroleum jelly be removed from a container using
gloves or bare fingers. Any left-over jelly must not be
returned to the original container and must not be used
on another client.
3.3
Cleaning of Work Area after Tattooing
After
the completion of each tattoo session on a client, the following
procedure should be carried out:
- Dismantle
tubes, needles and needle bars from the tattoo machine
and place them into a puncture resistant autoclavable
container with a lid, immediately after completing the
treatment. This container should be labelled 'dirty instruments
for sterilisation' and be used only for this purpose.
- Apply
anti-bacterial lotions or creams to the treated area of
the skin, if necessary. Remove disposable gloves and dispose
of them into the 'infectious waste bin'. Wash hands thoroughly
- A
suitable anti-bacterial skin cleanser may be used on the
area of the skin where the tattoo has been applied. This
can also be used on the tattoo during the tattooing procedure.
- A
clean sterile dressing should be applied over the completed
tattoo.
- Advice
should be given to each client on how to care for their
tattoo and how to prevent infection from occurring.
- Move
dirty instruments to the cleaning area of your shop and,
as soon as possible, clean and sterilise them
- Remove
disposable needles and re-useable needles that are to
be disposed of from the needle bar and dispose of the
needles immediately into a sharps container.
- Place
other dirty articles which do not require sterilisation
in the cleaning area and clean them as soon as possible.
Note - Do not store instruments or needles in disinfectant
before or after cleaning.
- Dispose
of all used single-use items, (other than sharps), such
as spatulas, ink caps, used tissues and wipes, into the
bin. If any of these items have become contaminated with
blood, dispose of them by placing them into the bin marked
'infectious waste'.
- Any
linen used during a treatment should be placed in a dirty
linen container and washed using the procedure outlined
in this site. Use disposable cloths and protective coverings
on surfaces when a skin penetration procedure is performed
on a client. Additional Precautions
- Remove
the elastic bands from the tattoo machine and dispose
of them into the waste bin.
Clean the tattoo machine by first wiping with a clean
dry swab, and then thoroughly wiping with clean cotton
wool or a pad saturated with 70 per cent w/w ethyl alcohol.
All to dry naturally.
- Clean
containers used for collecting dirty instruments.
- Clean
and sterilise or dispose of ink cap trays.
3.3.1
Cleaning of Work Area after Body Piercing
After
completing body piercing on a client, the following procedure
should be carried out:
- Place
all used disposable instruments into a sharps container
immediately after use.
- Place
all used re-useable instruments into a puncture resistant
container with a lid immediately after completing the
treatment. This container should be labelled 'dirty instruments
for sterilising' and only be used for this purpose.
- Apply
anti-bacterial lotions or creams to the treated area of
the skin, if necessary. Remove your disposable gloves
and dispose of them in the 'infectious waste bin'. Wash
your hands thoroughly as described in this site.
- A
suitable anti-bacterial skin cleanser such as those listed
in this site may be used on the area of the skin where
the piercing has been done.
- Advice
should be given to each client on how to care for their
tattoo/piercing and how to prevent infection from occuring.
- Move
dirty instruments to the cleaning area of your shop and
clean and sterilise them according to the procedure in
this site as soon as possible.
- If
elastic bands are used on clamps, the elastic bands are
to be removed and disposed of before the clamps are cleaned
and sterilised. Place other dirty articles which do not
require sterilisation in the cleaning area and clean them
as soon as possible. They must be kept separate from the
instruments that require sterilisation. Note - Do not
store instruments or needles in disinfectant before or
after cleaning.
- Dispose
of all used disposable items, other than sharps, such
as spatulas, into the bin. If any of these items have
become contaminated with blood, dispose of them by placing
them into the bin marked 'infectious waste'.
- Any
linen used during a treatment should be placed in a dirty
linen container and washed using the procedure outlined
in this site. Use disposable cloths and protective coverings
on surfaces, when a skin penetration procedure is performed
on a client.
3.3.2
Cleaning Work Surfaces
After
use by each client, the surfaces of chairs, couches and the
like, as well as benches, tables and other working surfaces
where there has been contact with the client's skin are to
be:
- washed
with warm water and detergent, and then dried with a clean
disposable wipe; or
- covered
with a clean towel; or
- covered
with disposable paper.
Remove
all protective coverings on surfaces and equipment, taking
care not to contaminate the surfaces which have been protected.
These coverings should be disposed of into the infectious
waste bin. In addition to this, wash these surfaces with warm
water and detergent and dry them with a clean disposable wipe
at the end of each working day and when they become visibly
soiled. If any surfaces have become contaminated with blood
or any other body fluid, they are to be cleaned.
3.4
Cleaning Tattoo/Body Piercing Instruments Prior to Sterilisation
(and Any Instrument Contaminated with Blood or Serum)
As
soon as possible after use, reusable instruments must undergo
cleaning. This is a crucial first step prior to sterilisation.
Cleaning should take place in the cleaning area set aside
for this purpose. New, re-useable needles and instruments
need to be cleaned and sterilised before use, if they are
not purchased pre-sterilised.
Wear
thick, heavy duty rubber gloves when washing contaminated
instruments. This makes handling them safer. Care must be
taken at all times to prevent any penetration of the skin
or splashing of mucous membranes (such as eyes) during the
cleaning process.
Carefully
rinse the item in warm running water. Hot water at this stage
could thicken protein material and make it stick to the instrument.
Cold water will harden fats making cleaning more difficult.
Fully
dismantle the instruments.
Immerse
instruments in hot water and detergent in a sink. While holding
the instruments under the surface of the water, scrub the
instruments with a heat disinfected (see below) clean brush.
This step may be carried out using an ultrasonic cleaner.
Ultrasonic cleaners work by subjecting instruments to high
frequency, high energy sound waves, causing soil to be dislodged
from instruments and dropped to the bottom of the tank or
be sufficiently loosened to be removed during the rinsing
process:
Rinse
cleaned instruments in hot running water.
Carefully
dry instruments with a lint-free, single-use, disposable towel.
Check
the condition of the equipment.
Note:
cleaning materials used for cleaning equipment such as nylon
brushes and pads, should be disinfected by boiling them for
at least five minutes after each cleaning session. When not
in use, they should be stored dry.
Ultrasonic
cleaners must be operated with the lid on to prevent any micro-organisms
present in the cleaning solution from becoming airborne and
contaminating surfaces in the shop. They must be operated
and maintained according to the manufacturer's directions
and must comply with AS 2773.
It
must be stressed that ultrasonic cleaners do not sterilise
or disinfect instruments. However, they do provide a very
safe and effective means of cleaning instruments prior to
sterilisation.
3.5
Sterilising Tattoo/Body Piercing Instruments (and Any Instrument
Contaminated with Blood or Serum)
Tattooing
instruments which must be sterile before use are the tube,
nozzle, needle, needle bar and any other instrument that has
been contaminated with blood or serum. Instruments must be
cleaned and sterilised before they are used on another client,
and forceps used to handle sterile instruments must also be
sterile. Effective sterilisation depends on the following
factors:
Cleanliness
- the articles to be sterilised must be thoroughly pre-cleaned
to allow good contact for all surfaces to be sterilised.
Temperature
- the correct temperature must be maintained throughout the
articles being sterilised.
Time
- the sterilising temperature must be maintained for the correct
period of time. The only method of sterilisation appropriate
is autoclaving. Bench-top autoclaves should conform to Australian
Standards AS 2182. Sterilisation cannot be achieved using
microwave ovens, pressure cookers, ultraviolet cabinets, boiling
water units, ultrasonic cleaners, and similar appliances.
Wiping instruments with disinfectant prior to use does not
sterilise them.
3.6
Cleaning of Other Instruments and Articles
All
instruments and articles that are not intended to penetrate
the skin, but that are used on clients, must be thoroughly
cleaned before and after each use. Containers, including their
lids, used for the storage of items and for the collection
of dirty instruments, must also be thoroughly cleaned before
and after each use. Follow this procedure with instruments
and articles that can be immersed in water:
Rinse
in warm water.
Thoroughly
wash with hot water and soap or detergent using a good scrubbing
action.
Rinse
in hot water (not less than 70¡C) and allow to dry.
Store
instruments in a clean, impervious, and covered container.
Follow this procedure with instruments and articles that would
be damaged if immersed in water, for example, the electrical
handpiece:
Thoroughly
wipe with clean cotton wool or a cotton pad saturated with
70 per cent w/w ethyl alcohol.
Allow
to dry naturally.
Store
clean instruments in a clean, impervious, covered container.
Follow this procedure with garments and other washable fabrics:
Wash
with soap or detergent in hot water (not less than 70¡C).
Rinse
and dry or have commercially laundered.
Store
items in a clean, appropriate area such as a cupboard or drawer.
3.7
Disinfectants - Should They Be Used?
With
the exception of the use of 70 per cent alcohol to cleanse
instruments that would be damaged if immersed in water, all
non skin penetration instruments used in tattooing and body
piercing procedures can be brought to a satisfactory level
of freedom from micro-organisms if they are thoroughly cleansed
in accordance with 'instruments that can be immersed in water'
(section 3.6).
The
routine use of disinfectants, including glutaraldehyde is
no longer recommended. Disinfecting solutions that have been
used by many tattooists and body piercers in the past have
been found to be ineffective, have not been used properly,
or have been found to be inappropriate for use in the tattooing
industry. All tattoo and body piercing instruments must be
thoroughly cleaned and sterilised according to the procedure
in this site.
Note:
Under
no circumstances should instruments be stored in
disinfectants before or after cleaning or sterilising.
3.7.1
Bleach
All
references to 'bleach' throughout this site, relate to household
grade bleach products with a concentration of 40,000 parts
per million available chlorine (ppm avCl) or 4 per cent avCl.
To
dilute bleach for a 1:4 dilution, add 1 cup of bleach (250
ml) to 3 cups of water (750 ml). Only dilute bleach on the
same day it is to be used as its effectiveness deteriorates
rapidly.
To
prevent deterioration, store bleach in dark, cool areas. Use-by
dates on bleach products must be strictly adhered to. Wear
gloves when handling bleach, as it can cause skin irritation.
Take
care to avoid bleach coming into contact with most metals
as they can be easily rusted or corroded.
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