Tattooing and body piercing guidance Toolkit
Main contents Tattooing and body piercing guidance
ACKNOWLEDGEMENTS Toolkit
Click on text to view FOREWORD ENDORSING ORGANISATIONS INTRODUCTION USING THE GUIDANCE TOOLKIT ACKNOWLEDGEMENTS
Acknowledgements These guidelines are extensively based on the Tattooing and Body Piercing Guidance: Toolkit which was published by the Chartered Institute of Environmental Health (CIEH) London in 2013. We acknowledge the contributions of the original authors and also those who contributed to the production of this Northern Ireland version as set out below:
TATTOOING AND SKIN PIERCING WORKING GROUP MEMBERS
Chartered Institute of Environmental Health Department of Health, Social Services and Public Safety (DHSSPS)
Public Health Agency Health and Safety Liaison Group for Northern Ireland Subgroup of the Chief Environmental Health Officers Group (CEHOG)
January 2014
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FOREWORD 2 Appendix 03 42 Safe use and disposal of sharps ENDORSING ORGANISATIONS 3 Appendix 04 43 Toolkit INTRODUCTION 4 – 5 First Aid following a blood/body fluid exposure USING THE GUIDANCE TOOLKIT 6 Appendix 05 44 Protocol for cleaning up blood or a blood PART A stained body fluid spill Section 01 7 – 12 Appendix 06 45 Legislative background on tattooing and skin piercing activities Principles for good waste handling Section 02a 13 Appenendix 07 Template protocol for environmental cleaning of premises Standard Principles of Infection Control Appendix 08 46 Section 02b 14 – 15 Tattooing/body piercing consent form Principles of Infection Control – Hand hygiene Appendix 09 48 Section 02c 16 – 18 Aftercare follow-up record sheet Principles of Infection Control – Personal protective equipment Appendix 10 49 Decontamination requirements for equipment Section 02d 19 – 21 used in tattooing and skin piercing Principles of Infection Control – Management of sharps and exposure to blood and body fluids Appendix 11 50 Equipment sterilization standard- self Section 02e 22 – 23 assessment and decision making tool for Principles of Infection Control – Safe handling, tattoo and body piercing practitioners storage and disposal of waste materials Appendix 12 51 Section 02f 24 Equipment and body piercing jewellery Principles of Infection Control – Cleaning and sterilization standard for tattooists and body disinfection of the environment piercers Section 02g 25 Appendix 13 52 References Autoclave daily record sheet Section 03 26 – 27 Before and aftercare of a tattoo or body piercing PART C Leaflets to download and print out Section 04 28 – 32 01 Tattoo aftercare 53 Decontamination 02 Ear and face piercing aftercare 54 Section 05 33 – 34 03 Oral piercing aftercare 55 Product quality of tattoo ink 04 Body and surface piercing aftercare 56 Section 06 35 05 Genital piercing (female) aftercare 57 Body piercing jewellery 06 Genital piercing (male) aftercare 58 Section 07 36 – 37 07 Microdermal implants aftercare 59 Governance Poster to download Section 08 38 How to handwash 60 Management of infectious disease incidents relating to tattooing and body piercing PART D Audit Tool to download 61 PART B PART E Appendix 01 40 – 41 Literature review to download 62 Infection, its causes and sprad, including a glossary of infection-related terms Appendix 02 41 Blood borne viruses CONTENTS 3 Tattooing and body piercing guidance
FOREWORD Click Toolkiton text to view FOREWORD ENDORSING ORGANISATIONS INTRODUCTION USING THE GUIDANCE GARY MC FARLANE DR LORRAINE DOHERTY TOOLKIT Director, Chartered Institute of Assistant Director for Health Protection Environmental Health Northern Ireland Public Health Agency Tattooing and body piercing have become The tattooing and body piercing industry has increasingly popular and fashionable. Ensuring seen a period of growth in Northern Ireland in practitioners follow safe working practices is recent years.As such there is now an increased important for protection of both clients and need to ensure that those who are working the practitioners themselves. This toolkit has in this field are supported in delievering safe been developed specifically for Northern parctice.As an interactive document, this toolkit Ireland following the publication of a similar acts as a framework for good infection and resource for England.In doing so we have control practice which enables the user to access collaborated and worked with the relevant NI the sound evidence based guidance and to agencies, notably the Department of Health appropriately manage infection risk. I would Social services and Public Safety (DHSSPS), like to acknowledge the excellent collaborative the Public Health Agency and the Health and working of health protection colleagues from Safety Liaison Group (HSLG), a subgroup of PHA,PHE and CIEH and colleagues from the the Chief Environmental Health Officers Group tattooing industry that has resulted in the (CEHOG). We hope that the resources will prove publication of this invaluable tool. Its my a practical tool for practitioners. pleasure to endorse this guidance toolkit as a key resource for practitioners in the industry PATRICIA ALLEN which can only lead to better health outcomes Assistant Director of Northern Group for service users. Systems Environmental Health NIGEL MC MAHON This guidance toolkit aims to influence tattooing and body piercing practices Chief Environmental Health Officer in Northern Ireland, in particular by the Department of Health, Social Services & promotion of evidence based prevention and Public Safety control measures. It provides easy access Infection prevention and control is a to key guidance and best practice, giving paramount public health concern.The practitioners and others a single authoritative promotion of safe working practices is source of information.By doing so it is hoped important for practitioners, clients and public that standards of safety and hygiene delivered health professionals including environmental across the range of tattooing and body health staff. This reference guide attempts to piercing practices will be consistently high for bring all of the relevant information together Northern Ireland consumers. in one place for the benefit of those involved in the industry, as well as for those that seek to advise and regulate it. The guide has been produced in partnership with a number of organisations and individuals and I would offer my thanks to all those involved. On behalf of the working group, I would also like to record our appreciation of the Chartered Institute of Environmental Health for carrying out the editing, web design and publication of the toolkit online. ➲ Main contents
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ENDORSING ORGANISATIONS Toolkit
Click on text to view FOREWORD CHARTERED INSTITUTE OF PHA is a multi-disciplinary, multi-professional body with a strong regional and local presence. ENDORSING ORGANISATIONS ENVIRONMENTAL HEALTH (CIEH) It has four key functions: INTRODUCTION The CIEH is a registered charity and the USING THE GUIDANCE professional voice for environmental health. • health and social wellbeing improvement; TOOLKIT It sets standards, accredits courses and qualifications for the education of members • health protection; and other environmental health practitioners. • public health support to commissioning It provides information, evidence and policy and policy development ; advice to local and national government and environmental and public health • HSC research and development practitioners in the public and private sectors. As an awarding body, the CIEH provides The PHA also work to create better inter- qualifications, events, and support materials on sectoral working,including enchanced topics relevant to health, wellbeing and safety partnership arrangements with local to develop workplace skills and best practice. government, to tackle the underlying cause of poor health and reduce health inequalities. THE DEPARTMENT OF HEALTH, SOCIAL SERVICES AND PUBLIC NORTHERN IRELAND CHIEF SAFETY (DHSSPS) ENVIRONMENTAL HEALTH OFFICERS GROUP DHSSPS was established by the Departments (NI) Order 1999. It is the Department’s mission The Northern Ireland Chief Environmental to improve the health and social well-being of Officers Group (CEHOG) was formed as a the people of Northern Ireland. liaison body to provide a forum to unite the local government environmental health The Department has three main business service in Northern Ireland and to establish responsibilities: and maintain effective services partnerships with bodies having an influence upon health • Health and Social Care (HSC), which in NI communties. The fundamental remit is includes policy and legislation for to aid the co-ordination and consistency of hospitials, family practitioner services and environmental health services, to assist the community health and personal social development of highly quality services and to services: provide a consultative body with links to other • Public Health which covers policy, agencies and departments to facilitate the legislation and administrative action to passage of advice on relevant policy matters. promote and protect the health and well- Membership of this liaison body includes all being of the population; and twenty six District Chief Environmental Health • Public Safety, which covers policy and Officers, (or equivalent in title and function), legislation for fire and rescue services. the four Group Chief Environmental Health Officers and from outside local government, THE PUBLIC HEALTH AGENCY the Chief Environmental Health Officer, (PHA) DHSSPS and the NI Director of the Chartered Institute of Environmental Health. From its establishment in 2009, Public Health Agency provides a renewed and enchanced focus on public health and wellbeing by bringing together a wide range of public health ➲ Main contents functions under one organisation. 5 Tattooing and body piercing guidance
INTRODUCTION Toolkit
Click on text to view FOREWORD This guidance toolkit has been prepared by a panel of health protection ENDORSING ORGANISATIONS and practitioner representatives. It comprises a consensus of expert advice INTRODUCTION which it is intended will provide an authoritative source of information. USING THE GUIDANCE Its contents are supported by extensive literature reviews (Part E). TOOLKIT The purpose of the guidance toolkit is to support local authority and other regulatory officers in determining their requirements for effective control of risk in these activities and to promote a consistent approach. Similarly, it is intended to be of assistance to practitioners and businesses undertaking these activities to support them in adopting acceptable standards of practice. The use of this guidance toolkit will help to ensure the health and safety of both clients and operators and that tattooing and skin piercing practitioners will be operating in compliance with legal requirements.
BACKGROUND Over the years a variety of legislation has been introduced, mainly for local adoption, Tattooing and body piercing procedures have to encourage and support safe practice. become more popular and fashionable in the Model byelaws have been made available, United Kingdom (UK) as a whole, particularly but have not been accompanied by standard in the last decade. The range of tattooing and requirements for compliance. As a response body piercing procedures has also increased. to on-going concerns, a number of sets of There are no published data on the prevalence local/regional guidelines have been developed of tattoos in the general UK population. There by different agencies, often initiated by are also no comprehensive data for the UK on environmental health or health protection the prevalence of body piercing, but a small specialists (this guidance toolkit draws upon study has estimated that the prevalence of some of the previously published material). body piercing, other than of earlobes, in the However, there have been difficulties previously general adult population in England was 10% in engaging practitioners in the development (Bone A et al, 2008). of such guidelines and in securing adoption There are known and well reported health risks and wider implementation. which can be attributed to these procedures, It is also recognised that there are no nationally as well as associated legal issues. Improper recognised or accredited training courses, and unhygienic practice may result in localised standards for practice, agreed knowledge and skin infections at the site of the tattoo or skills frameworks or arrangements for monitoring piercing. There is also the risk of transmission and reporting of professional competence. of blood-borne viruses, for example Hepatitis The absence of accredited training and B, Hepatitis C, Hepatitis D or HIV, which can competencies for tattooing and body piercing is have more serious and long term health an area that needs to be addressed nationally consequences. It is therefore important that and is outside the scope of this guidance. The practitioners have safe working practices, working group has, however, been greatly and particularly that good infection control assisted in the preparation of this guidance by practices are followed at all times, so that both the Tattoo and Piercing Industry Union who are clients and practitioners are protected. recognised as a professional body for tattoo and body piercing practitioners in the UK. ➲ Main contents
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INTRODUCTION (continued) Toolkit
Click on text to view FOREWORD DEVELOPMENT OF THE GUIDANCE ENDORSING ORGANISATIONS FOR NORTHERN IRELAND INTRODUCTION This guidance was developed in response to USING THE GUIDANCE concerns raised by tattoo and body piercing TOOLKIT practitioners, as well as health protection and environmental health specialists. These concerns were particularly in regard to the lack of robust and consistent guidance on standards of hygiene and safety. This has been leading to inconsistency in advice and variations in standards of practice. A multi-agency steering group was set up comprising representatives from the Chartered Institute of Environmental Health,Department of Health and Social Services and Public Safety (DHSSPS), Public Health Agency (PHA) and the Health and Safety Liaison Group for Northern Ireland (a subgroup of the Chief Environmental Health Officers Group) and also individuals with practical experience of working in this area as expert advisors, practitioners or regulators.
The guidance is supported by extensive documentary evidence of scientific knowledge, reported research and published literature encompassing expert advice and the opinions and experience of practitioners of what works at a practical level.
References Bone A., Ncube F., Nichols T. & Noah ND. (2008) Body piercing in England: a survey of piercing at sites other than earlobe. BMJ; 336; 1426-1428.
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USING THE GUIDANCE TOOLKIT Toolkit
Click on text to view FOREWORD The guidance has been written as a key point of reference for use nationally ENDORSING ORGANISATIONS by tattoo and body piercing practitioners who work in regulated premises, INTRODUCTION local authority officers in their regulatory role and health protection staff USING THE GUIDANCE who are asked to provide expert advice. The guidance does not cover mobile TOOLKIT operators or non-registered practitioners, although the risks encountered THE AUDIT TOOL in relation to their activities will be of equal or greater concern. It does not PROVIDING FEEDBACK address the risks associated with procedures other than those commonly accepted as necessary for tattooing and the insertion of body jewellery, although the procedures recommended for infection control are based upon sound principles of infection control and will have wider application.
The material is arranged so as to be readily No copyright is being claimed for the toolkit or accessible as a web-based toolkit, organised any of the material it contains and the authors in a manner that reflects the tattoo and encourage its wider distribution and use. body piercing setting, and with supportive documentation and literature that can be In offering and using the advice contained in downloaded and saved or printed in the this guidance it must be clearly understood that: manner that users prefer. • Legislation may change over time and the advice given is based on the It is intended that the adoption of the information available at the time this standards recommended in this guidance, toolkit was produced – it is not necessarily particularly those relating to infection control comprehensive and is subject to revision in and decontamination, will help to establish the light of further information. standards for good practice. Governance is promoted by the inclusion of template consent • Only the courts can interpret legislation forms, aftercare advice leaflets and a good with any authority, and practice infection control audit tool. • This advice is not intended to be definitive legal guidance nor is it a substitute for the THE AUDIT TOOL relevant law and independent legal advice should be sought where appropriate. This audit tool can be downloaded and used as individual sections or as a complete tool. PROVIDING FEEDBACK It is intended to be used by tattoo and body piercing practitioners, regulatory officers and We hope you find the guidance useful. It is health protection practitioners to generate intended that the document wiil be revisited evidence of the environment, practice and and updated periodically. To that end feedback procedures in meeting standards and whether on your experience is positively encouraged. practitioners are applying best practice and Feedback can be sent to Gary Mc Farlane, following guidance. The tool can be repeated [email protected] Director of The to see if standards have been maintained or Chartered Institute of Environmental Health improved. Northern Ireland.
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PART A
Toolkit Legislative background on tattooing Section 01 and skin piercing activities Click on text to view SUMMARY SUMMARY General controls Specific controls The use of legislation in this area of activity The primary health and safety legislation in General controls is primarily to ensure that infection control Northern Ireland (NI) is the Health and Safety Determining requirements arrangements are adequate and effectively at Work (Northern Ireland) Order 1978 (HSWO). REGISTRATION AND carried out wherever tattooing and skin It can be used to impose and enforce infection BYELAW REQUIREMENTS IN piercing are carried out. control requirements in relation to all skin piercing NORTHERN IRELAND activities, including peripatetic practitioners who HEALTH AND SAFETY AT The primary means of enforcing infection visit a client’s home. It allows for immediate WORK (NI) ORDER 1978 control arrangements is by use of registration prohibition of persons or activities that pose an General duties and the observance of provisions contained imminent risk to health or safety. Risk assessment in byelaws.The registration and byelaw Control of substances provisions are largely concerned with setting Determining requirements hazardous to health requirements for good standards by requiring It is intended that this guidance will provide an Management of contractors the maintenance of established hygiene additional authoritative source of information Enforcement controls in respect of premises, equipment, to support local authorities in determining AGE LIMITS AND CONSENT procedures and practices. However, there their requirements for effective control of risk Tattooing are additional controls contained in primary in these activities and adopting a consistent Other skin piercing activities legislation that do contain provisions for the approach in the application of the legislation. Acupuncture and electrolysis immediate prohibition of activities or persons Similarly, it will be of assistance to those Consent or for the closure of premises where risk of businesses and practitioners undertaking USE OF LOCAL ANAESTHETIC infection can be demonstrated. these activities to ensure that they are able MEDICATION to operate safely and comply with legal The legislation relating to tattooing and skin requirements. piercing activities,can therefore be broadly split into two main areas: • Specific controls by registration of premises and people carrying out the activities, and associated byelaws, and • General controls of activities through primary legislation that is not specific to particular activities but applies to all of them.
Specific controls Arrangements for registration will differ depending on the particular requirements of the local authority in whose area the business is located or the activity is being carried out. The majority of local authorities have adopted byelaws in respect of the standards for the maintenance of established hygiene controls in respect of premises, equipment, procedures and practices.
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PART A
Toolkit Legislative background on tattooing Section 01 and skin piercing activities (continued) Click on text to view SUMMARY REGISTRATION AND BYELAW Article 15 of the 1985 Order provides for Specific controls REQUIREMENTS IN NORTHERN offences and for non-custodial penalties General controls IRELAND (summary conviction and fine) for trading without council and registration or breaching Determining requirements There are provisions in Part V of the The council byelaws. The court may also order REGISTRATION AND Local Government (Miscellaneous Provisions) suspension of, or cancellation of registration BYELAW REQUIREMENTS IN Northern Ireland Order 1985 (LGMPO) for local NORTHERN IRELAND (whether of a person or premises) on authorities in NI to require the registration conviction. When cancellation of registration HEALTH AND SAFETY AT of persons carrying on the practices of WORK (NI) ORDER 1978 happens, the court may order a fine, increased acupuncture, tattooing, ear piercing or General duties on a daily basis for late surrender of the electrolysis. These powers are adoptive, and Risk assessment cancelled registration certificate. There is also local authorities are able to choose which Control of substances an offence of not displaying a certificate of of these practices would be required to be hazardous to health registration or byelaws (in respect of which a registered in their area The Local Government Management of contractors person is liable on summary conviction to a (Northern Ireland) Order 2005 added semi- Enforcement fine). permanent skin-colouring and cosmetic AGE LIMITS AND CONSENT piercing to this list of activities for which The penalties for offences are fines on the Tattooing registration can be required. Standard Scale of Level 3 (currently £1000) for Other skin piercing activities offences under Article 15(1),Article 15(2), and Acupuncture and electrolysis The Order allows for local authorities to Level 1 (currently £200) for an offence under Consent make byelaws, for the purpose of securing; Article 15(9). USE OF LOCAL ANAESTHETIC the cleanliness and hygiene of premises, MEDICATION practitioners and equipment. These measures There are some exemptions from the are intended to increase health protection and registration requirements. It does not apply to reduce the risk of transmission of blood borne practices carried out by or under the supervision virus infections. of a person who is registered as a medical practitioner (a Doctor registered with the The local authority can request reasonable General Medical Council) or for acupuncture information from applicants for registration. by a dentist, or chartered physiotherapist, or This cannot include details concerning persons a state registered physiotherapist, or a state whom the applicant has given treatments to, registered chiropodist, or to premises under however, it could include evidence of training their supervision. or competency for those being registered. Local authority officers can be authorised to The registration is mandatory in that the enter any premises where they have reason local authority must issue a registration if to believe that an offence under Article 15 the application has been properly made. A is being committed there, but where entry is registration can only be refused where a person refused the authority of a warrant issued by a has previously been convicted of an offence Justice of the Peace has to be obtained. under Article 15 of the 1985 Order and the convicting magistrate suspended or cancelled The Department of Health Social Services and the previous registration. A registration can only Public Safety (DHSSPS) issued guidance on the be cancelled by a magistrate upon conviction legal provisions relating to the regulation of of an offence, and this is instead of or in cosmetic piercing and skin colouring businesses addition to a fine. in 2005. The document also provides model byelaws which local authorities could formally adopt as well as guidance on the procedure for the confirmation of byelaws by the DHSSPS. ➲ Main contents http://www.dhsspsni.gov.uk/bodypiercing- 10 order.pdf Tattooing and body piercing guidance
PART A
Toolkit Legislative background on tattooing Section 01 and skin piercing activities (continued) Click on text to view HEALTH AND SAFETY AT WORK The Management of Health and Safety at Work Regulations (Northern Ireland) 2000 SUMMARY (NI) ORDER 1978 requires all employers and self employed Specific controls The Health & Safety at Work (Northern persons to: General controls Ireland) Order 1978 (HSWO) applies to all Determining requirements persons engaged in tattooing and skin piercing • Undertake a risk assessment of their REGISTRATION AND activities for gain or reward. This includes activities; BYELAW REQUIREMENTS IN peripatetic workers who carry out treatments • Remove, where possible, that risk or; NORTHERN IRELAND in the client’s home, although only the Health • Where residual risk is unavoidable, to HEALTH AND SAFETY AT & Safety Executive for Northern Ireland have WORK (NI) ORDER 1978 provide control measures to reduce it as powers in relation to peripatetic workers. far as possible, including as a last resort, General duties provision of personal protective equipment; Risk assessment It provides means of securing effective Control of substances infection control and the following areas are • Provide training to staff and persons they hazardous to health particularly applicable. use to undertake their business activities Management of contractors (contractors) to ensure they understand the Enforcement General duties risks and the control measures. AGE LIMITS AND CONSENT Under Article 4 of the Order, all employers have One of the risks that must be considered is Tattooing a general duty of care to ensure the health, that of possible complications relating to skin Other skin piercing activities safety and welfare of their employees. Under piercing and tattooing. The practitioner must Acupuncture and electrolysis Article 5, both employers and self-employed make sure that a fully ‘informed consent’ Consent persons have a general duty of care to ensure procedure is adopted. This means gathering USE OF LOCAL ANAESTHETIC their activities do not expose them or the information from the client about their health MEDICATION general public to risks to their health or safety. and suitability for the treatment, and giving the client enough information about the Risk assessment possible complications that could arise from the A risk assessment is the key step in protecting treatment for them to make their own decision. workers and the public, as well as complying with the law. The risk assessment is a careful Control of substances hazardous examination of what work activities could to health cause harm to people and this then guides The Control of Substances Hazardous to decisions about precautions that need to Health Regulations (Northern Ireland) be taken, including infection prevention and 2003 (COSHH) requires that a specific risk control measures. assessment is carried out by employers or self employed persons who work with substances The HSE provides detailed advice on carrying hazardous to health. Substances which are out risk assessments http://www.hse.gov.uk/ hazardous to health include biological agents. risk/risk-assessment.htm, including interactive The hazards in this context are the organisms tools http://www.hse.gov.uk/risk/shop.htm and which can cause communicable diseases other pieces of guidance http://www.hseni.gov. could be transmitted from person to person by uk/..guidance/content-getting-started/content- unhygienic practices. risk-assessment.htm Therefore a specific risk assessment in respect of infection control is necessary for all persons undertaking tattooing and skin piercing activities.
Businesses employing less than 5 people do not have to record the findings of this risk assessment, however they still have to satisfy ➲ Main contents regulatory officers that their risk assessment is suitable and sufficient. 11 Tattooing and body piercing guidance
PART A
Toolkit Legislative background on tattooing Section 01 and skin piercing activities (continued) Click on text to view SUMMARY Management of contractors AGE LIMITS AND CONSENT Specific controls The Management of Health and Safety at The need for limits on age, and requirements General controls Work Regulations (Northern Ireland) 2000 for consent, can be a controversial area Determining requirements (Regulations Sections 11, 12 & 13) because in many circumstances specific REGISTRATION AND contains legal provisions which can be of requirements have not been made in law. BYELAW REQUIREMENTS IN particular importance to the many tattooists Consent is a complex area of law, and one that NORTHERN IRELAND and cosmetic piercers who do not own the is often misunderstood by the general public, HEALTH AND SAFETY AT premises which they operate from and are and also by some skin piercing practitioners. WORK (NI) ORDER 1978 not employed by the person who owns and/ General duties or manages the premises where they work. In Tattooing Risk assessment these cases, they are usually self-employed and The Tattooing of Minors (Northern Ireland) Control of substances have some form of contract, formal or informal, hazardous to health Order 1979 imposes a statutory minimum age with the owner of the shop premises whereby Management of contractors of 18 years for permanent tattooing (except they pay the owner to allow them to work there. Enforcement when carried out for medical reasons by a duly In these circumstances the shop owner can be qualified medical practitioner or by a person AGE LIMITS AND CONSENT said to be contracting out to the practitioner working under their direction). The practitioner Tattooing and in effect ‘endorsing’ their work’. has a defence if they can show that they had Other skin piercing activities good reason to believe that the person was Acupuncture and electrolysis These tattooists and piercers are therefore over 18 years of age. The consent of a client Consent contractors undertaking the activities of the under 18 is not a defence. The Police enforce this USE OF LOCAL ANAESTHETIC business owner for them. This means that MEDICATION the premises owners cannot abdicate their legislation and fines are up to £500. own general duties under the HSWO to the Skin piercing activities individual practitioners. They have a duty to ensure that persons working on their premises There is no statutory age of consent for cosmetic are competent and that they carry out their piercing (cosmetic body piercing and ear work in a safe manner. The only way they piercing). Cosmetic piercing of a minor is lawful can do this satisfactorily is to assess the provided a valid consent is given. Furthermore the practitioners for themselves and monitor their courts have held that a parents right to decide activities to ensure they have carried out their on behalf of his and her child yields to the child’s own risk assessment, as they are required to competence to make a decision, for example if do by law, and that they are following control he or she is capable of understanding the nature measures they have identified. The business of the act to be done (see below). Body piercing owner has the ultimate power to remove the for sexual gratification is unlawful. Children under risk, by stopping particular contractors working the age of 17 are not able to consent lawfully to at their premises. a piercing that would be regarded as indecent assault. Genital or nipple piercing performed on Enforcement someone under the age of 17 might be regarded The requirements of HSWO are enforceable as an indecent assault under sexual offences through improvement and prohibition notices. legislation depending on the facts of the case. Improvement notices give a time limit for Ear piercing and in some cultures nose piercing is compliance with requirements. Prohibition generally considered acceptable when carried out notices can have the effect of immediately on a minor, even below the age of five, provided stopping the operations of a business or the that a parent or legal guardian gives consent and activities of a person where imminent risk is is present whilst the procedure is carried out apparent. Failure to comply with HSWO may ➲ Main contents result in court action.
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PART A
Toolkit Legislative background on tattooing Section 01 and skin piercing activities (continued) Click on text to view SUMMARY Acupuncture and electrolysis Genital Mutilation Act 2003 states that certain procedures in respect of female genitals are Specific controls When carried out properly these do not cause illegal unless carried out for medical reasons. General controls harm to the body, and leave no permanent Determining requirements markings. For this reason they are not likely to The signing of a declaration and providing proof REGISTRATION AND raise any concerns over common assault charges, of age should be a fundamental part of the BYELAW REQUIREMENTS IN although practitioners should be aware of possible client consultation process and practitioners NORTHERN IRELAND indecent assault complications (see below). should always require that the client signs HEALTH AND SAFETY AT Consent should still be obtained before treatment a consent form prior to any work being WORK (NI) ORDER 1978 commenced. However, the consent will only be takes place, and in the case of a minor this should valid if the customer has been fully informed General duties be obtained from the parents or legal guardians. Risk assessment as to the nature of the process, the likely effect Control of substances Other considerations and potential problems involved. An example hazardous to health of a consent form is provided in Appendix 8. Management of contractors Semi-permanent skin-colouring, cosmetic piercing, However, for practitioners own protection, it is Enforcement beading, branding, scarring, cutting and other recommended that any consent forms they use are worded with the advice of a solicitor who is AGE LIMITS AND CONSENT extreme forms of body modification do cause actual harm and generally leave permanent marks familiar with this area of law. Tattooing and can result in disfigurement. They can therefore Other skin piercing activities USE OF LOCAL ANAESTHETIC be considered as assaults to the body, and so Acupuncture and electrolysis MEDICATION Consent potentially subject to the legislation concerning There is a range of topical local anaesthetic USE OF LOCAL ANAESTHETIC assault. This means that the question of age and MEDICATION the client’s informed consent are very important products for surface (skin) anaesthesia available from community pharmacies (Pharmacy only (P) Consent medicines), however none of these products are licensed for local anaesthesia prior to tattoo or In the legal proceedings of R v Brown (1994) body piercing.The client may wish to obtain a 1 AC 212, the House of Lords ruled on appeal topical local anaesthetic preparation prior to the that consent could not be a defence against procedure; however responsibility for purchasing sections 20 and 47 of the Offences Against and application of the product should remain the Person Act 1861 which deals with common with the client. The client should be advised assaults. However, the law also recognises that to read the Patient Information Leaflet which certain activities that give rise to ‘harm’ are accompanies the product and should be aware lawful. This includes surgery, tattooing, ear of the following: piercing and violent sports. The courts have also held that the law allows children under the • Warnings, cautions and contraindications. age of 18 to consent to cosmetic body piercing • Side effects. provided they are sufficiently mature to • That they are using the licensed product for understand the nature of the request. This kind an un-licensed indication. of assessment is clearly a subjective matter for • Recommendations regarding the operator who will need to ensure that the administration and application. client is provided with sufficient information to allow them to proceed in an informed way and Alternatively, a qualified practitioner, without pressure. e.g. doctor, may prescribe a topical local anaesthetic product to be self-administered Under the Sexual Offences (Northern Ireland) by the client, or can prescribe and administer Order 2008, girls and boys under the age of 16 a topical local anaesthetic product, in cannot legally give consent to intimate sexual accordance with legal requirements of their contact under any circumstances, so piercing professional registration. of nipples and genitalia (for girls) or genitalia (for boys) can be regarded as an assault Local anaesthetic injections are prescription-only ➲ Main contents offence. Evidence that such contact was for medicines (POMs) therefore they can only be sexual gratification would be required in order prescribed by a suitably qualified practitioner. 13 to constitute an indecent assault. The Female Local anaesthetic injections are not licensed for Tattooing and body piercing guidance
PART A
Toolkit Legislative background on tattooing Section 01 and skin piercing activities (continued) Click on text to view SUMMARY local anaesthesia prior to tattoo or body piercing. In addition they should not be administered Specific controls parenterally unless adequate resuscitation General controls equipment is available. Information on the Determining requirements supply and administration of injectable medicines REGISTRATION AND outside their licensed medicinal uses is available BYELAW REQUIREMENTS IN from the Medicines and Healthcare Regulatory NORTHERN IRELAND Agency (MHRA)2 and from the Nursing and HEALTH AND SAFETY AT Midwifery Council (NMC). WORK (NI) ORDER 1978 General duties References 1. British National Formulary (BNF) http://www. Risk assessment medicinescomplete.com/mc/bnf/current/PHP8663- Control of substances local-anaesthesia.htm (accessed 22/4/2013) hazardous to health 2. MHRA; Frequently asked questions: Supply and Management of contractors administration of Botox®, Vistabel®, Dysport® and Enforcement other injectable medicines outside their licensed medicinal uses such as in cosmetic procedures http:// AGE LIMITS AND CONSENT www.mhra.gov.uk/Howweregulate/Medicines/ Tattooing Availabilityprescribingsellingandsupplyingof medicines/Frequentlyraisedissues/BotoxVistabel Other skin piercing activities Dysportandotherinjectablemedicines Acupuncture and electrolysis incosmeticprocedures/index.htm (accessed Consent 22/4/2013) USE OF LOCAL ANAESTHETIC 3. NMC; Remote prescribing and injectable cosmetic MEDICATION medicinal products http://www.nmc-uk.org/Nurses- and-midwives/Regulation-in-practice/Regulation-in- Practice-Topics/Remote-prescribing-and-injectable- cosmetic-medicinal-products/ (accessed 22/4/2013) 4.DHSSPSNI; Local Government (Northern Ireland) Order 2005 Regulation of Cosmetic Piercing and Skin-Colouring businesses Guidance on Artilce 31 and Schedule 2 http://www.dhsspsni.gov.uk/ bodypiercing-order.pdf (accessed on 20/08/14)
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PART A
Toolkit Section 02a Infection prevention and control Click on text to view SECTION 02A INTRODUCTION Responsibilities Under the HSWO, all employers should ensure INTRODUCTION Infection, its causes and spread that all their employees are appropriately trained Infection, its causes The causes and methods of spread of and spread and proficient in the procedures necessary for infections that are likely to arise in connection Factors in infection working safely. Employers and their employees with tattooing and skin piercing, are well control practice are also responsible to ensure that any person Responsibilities understood. on the premises is not placed at any avoidable STANDARD PRINCIPLES OF See Appendix 01– Infection, its causes risk, as far as is reasonably practicable. They INFECTION CONTROL and spread also have a responsibility to protect voluntary Appendix 01 – Infection, its workers. Employers are also required by COSHH, causes and spread Unsafe or unhygienic practices by tattooing/ to review every procedure carried out by SECTION 02B body piercing practitioners can lead to the their employees which involves contact with PRINCIPLES OF INFECTION spread of infectious diseases that can affect a substance hazardous to health, including CONTROL – HAND HYGIENE the health of the client as well as jeopardise pathogenic micro-organisms. Specific guidance SECTION 02C the health of the practitioner. Although some is available from the Department of Health bacterial or viral infections may be spread during (Department of Health, 1998). PRINCIPLES OF INFECTION CONTROL – PERSONAL procedures that do not involve skin penetration, PROTECTIVE EQUIPMENT it is the occupational risk of transmission of STANDARD PRINCIPLES OF INFECTION CONTROL SECTION 02D infections such as blood-borne viruses (BBVs), such as hepatitis B, hepatitis C, hepatitis D and PRINCIPLES OF INFECTION This guidance is based upon standard principles HIV, which can arise and which are of primary CONTROL – MANAGEMENT OF which are the basic level of infection control SHARPS AND EXPOSURE TO concern. Precautions to minimise the possibility practice. Compliance with these standard BLOOD AND BODY FLUIDS of exposure to blood from an infected client principles reduces the risk of transmission of SECTION 02E or practitioner should be put in place by the blood-borne and other pathogens. adoption of safe practices and procedures. This PRINCIPLES OF INFECTION CONTROL – SAFE HANDLING, should include immunisation against hepatitis B Everyone providing treatments to clients STORAGE AND DISPOSAL OF (Department of Health, 2010a). should know about and be able to carry WASTE MATERIALS out these standard principles for infection SECTION 02F Factors in infection control practice prevention and control (National Institute for PRINCIPLES OF INFECTION The risk of transmission of infection can be Health and Care Excellence 2012). To that end CONTROL – CLEANING AND minimised by: they should have received training in: DISINFECTION OF THE • Hand hygiene and skin care. ENVIRONMENT • Good cleanliness of the premises where the tattooing and/or body piercing is taking SECTION 02G – REFERENCES • The use of personal protective equipment place, and of the fixtures and fittings. (PPE). • Good personal hygiene of the practitioners. • Sharps management and management of • Correct cleaning and sterilization or exposure to blood and body fluids. disposal of instruments, materials and • Safe handling, storage and disposal of equipment processes in place. waste materials. It is therefore important that the safe • Cleaning and disinfection of the working practices described in this environment. guidance are followed at all times in order to protect both the client and practitioner.
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Toolkit Section 02b Infection prevention and control Click on text to view SECTION 02A PRINCIPLES OF INFECTION As a gold standard for infection control CONTROL – HAND HYGIENE purposes,it recommended that hand wash INTRODUCTION basins should: STANDARD PRINCIPLES OF Hand hygiene is a major component of the INFECTION CONTROL standard principles and one of the most • Have elbow/foot-operated or non-touch mixer taps. SECTION 02B effective methods to prevent transmission of pathogens by reducing the number PRINCIPLES OF INFECTION • Have wall-mounted cartridge soap CONTROL – HAND HYGIENE of microorganisms that may be present. dispensers and paper towels available at The spread of infection from hands is well Hand washing facilities each hand wash basin. When to wash hands recognised and the importance of compliance • Not have a plug or overflow or be capable What to use to wash hands with hand hygiene practices is emphasised in of taking a sink plug. all national and international guidelines. How to carry out hand washing • Not have taps aligned to run directly into Use of hand rubs the drain aperture. Hand care Hand washing facilities Use of hand cream Hand washing facilities should be adequate • Have waterproof splashbacks. Care of broken skin and conveniently located in treatment areas. • Have space allowed at the design stage for Poster – How to handwash Hand washing instructions should be clearly the placement of waste bins next to the SECTION 02C displayed at the hand wash basin, such as in hand wash basin. the form of a poster. PRINCIPLES OF INFECTION When to wash hands CONTROL – PERSONAL See Poster – How to handwash PROTECTIVE EQUIPMENT • Before and after an intervention with each client. SECTION 02D Hand wash basins must be designated for that • After contact with any blood or body fluids. PRINCIPLES OF INFECTION purpose only and have a constant supply of hot CONTROL – MANAGEMENT OF and cold running water, ideally delivered through • Immediately after the removal of gloves. SHARPS AND EXPOSURE TO a mixer tap. Under no circumstances should • After using a tissue or handkerchief. BLOOD AND BODY FLUIDS equipment be washed in hand wash basins. • After smoking. SECTION 02E Liquid soap dispensers with single use • After visiting the toilet. PRINCIPLES OF INFECTION liquid soap cartridges/bottles should be CONTROL – SAFE HANDLING, • Before and after eating. used, ideally wall-mounted, although free STORAGE AND DISPOSAL OF • Immediately after any other activity or WASTE MATERIALS standing dispensers would be considered contact with a client’s surroundings that suitable. Disposable liquid soap cartridges are SECTION 02F could potentially result in hands becoming recommended because they do not permit a PRINCIPLES OF INFECTION contaminated. CONTROL – CLEANING AND topping-up process and this minimizes the risk DISINFECTION OF THE of contamination. What to use for hand washing ENVIRONMENT Wall-mounted disposable paper towels should For an ordinary hygienic hand wash, the SECTION 02G – REFERENCES be next to the hand wash basins, and fully use of liquid soap is sufficient. Preparations stocked at the start of each working day to containing antiseptics that have a residual minimise or reduce the need to fill up within effect on the skin surface are not required for hours during which the premises is operational. use in tattoo and body piercing settings.
A foot-operated pedal bin, of an appropriate size, should be placed next to the hand wash basin for disposal of paper towels.
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Toolkit Section 02b Infection prevention and control Click on text to view SECTION 02A How to carry out hand washing Use of hand rubs
INTRODUCTION There are three distinct and essential stages Hand rubs containing alcohol based products to handwashing (National Institute for Health can enable practitioners to quickly and effectively STANDARD PRINCIPLES OF INFECTION CONTROL and Care Excellence, 2012) clean their hands before and after contact with clients. However, the use of a hand alcohol SECTION 02B 1. Preparation rub/gel is not a substitute for using soap and PRINCIPLES OF INFECTION Before washing hands, all wrist and hand water for hand washing e.g. when undertaking CONTROL – HAND HYGIENE jewellery should be removed. Cuts and tattooing and body piercing procedures (see Hand washing facilities abrasions must be covered with waterproof above), and should not be used when the hands When to wash hands dressings. Fingernails should be kept short, are visibly soiled or potentially contaminated What to use to wash hands clean and free from nail polish. Hands should with body fluids (National Institute for Health How to carry out hand washing be made wet by placing them under tepid and Care Excellence, 2012). Hand rubs should Use of hand rubs running water before applying liquid soap. Hand care conform to the standard BS EN 1500. The hand Use of hand cream rub solution must come into contact with all 2. Washing and rinsing Care of broken skin surfaces of the hand; the hands must be rubbed The hand wash solution must come into Poster – How to handwash together paying particular attention to the tips of contact with all of the surfaces of the the fingers, the thumbs and the areas between SECTION 02C hand. The hands must be rubbed together the fingers, until the solution has evaporated. PRINCIPLES OF INFECTION vigorously for a minimum of 10–15 CONTROL – PERSONAL seconds, paying particular attention to Hand care PROTECTIVE EQUIPMENT the tips of the fingers, the thumbs and the Use of hand cream SECTION 02D areas between the fingers. Hands should A hand cream can be applied regularly to PRINCIPLES OF INFECTION be rinsed thoroughly. CONTROL – MANAGEMENT OF protect skin from the drying effects of regular SHARPS AND EXPOSURE TO hand decontamination (National Institute 3. Drying BLOOD AND BODY FLUIDS for Health and Care Excellence, 2012). Each In a tattooing and body piercing setting, SECTION 02E practitioner should have their own supply and good quality disposable soft paper towels PRINCIPLES OF INFECTION a communal pot should not be used. would be considered the method of choice CONTROL – SAFE HANDLING, Care of broken skin STORAGE AND DISPOSAL OF because communal towels are a source of WASTE MATERIALS cross-contamination. Paper towels should Unbroken skin is the best defence because it SECTION 02F be stored in a wall-mounted dispenser provides the perfect barrier against infection. next to the washbasin and thrown away Small areas of broken or infected skin on PRINCIPLES OF INFECTION exposed parts of the practitioner’s body should CONTROL – CLEANING AND in a pedal operated waste bin. Hands DISINFECTION OF THE should not be used to lift the lid or they will be covered with a waterproof dressing that ENVIRONMENT become re-contaminated. completely covers the affected area. SECTION 02G – REFERENCES
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Toolkit Section 02c Infection prevention and control Click on text to view SECTION 02A PRINCIPLES OF INFECTION Types of protective clothing CONTROL – PERSONAL Work clothing INTRODUCTION PROTECTIVE EQUIPMENT STANDARD PRINCIPLES OF Practitioner clothing should be clean at all INFECTION CONTROL Personal protective equipment (PPE) should be times, and professional in appearance. Work SECTION 02B available to all practitioners and staff who may clothing should be changed daily. Staff clothing be at risk whilst working in the premises. should not impede good hand washing, PRINCIPLES OF INFECTION CONTROL – HAND HYGIENE therefore the wearing of short sleeved tops is Assessment of risk advocated (Department of Health, 2010b). SECTION 02C Regulation 3 of the Management of Health PRINCIPLES OF INFECTION Gloves and Safety at Work Regulations (Northern CONTROL – PERSONAL COSHH requires employers to assess any Ireland) 2000 requires every employer to make PROTECTIVE EQUIPMENT substances hazardous to health, including a suitable and sufficient assessment of: Assessment of risk biohazards within blood and body fluids (such Types of protective clothing a) risks to the health and safety of their as blood-borne viruses) and take steps to Work clothing employees to which they are exposed reduce the risk of exposure. Gloves whilst they are at work; and − Glove choice The use of gloves has two purposes: b) risks to health and safety of persons not in their − Synthetic materials employment arising out of or in connection − Latex gloves 1. To protect the hands from becoming − Sterile gloves with the conduct by them of their undertaking. contaminated with dirt and microorganisms. − Gloves used for cleaning Therefore the selection of protective 2. By changing gloves, to prevent transfer of Aprons equipment must be based on an assessment microbes from one client to another. Eye and face protection of the risk of transmission of infection between SECTION 02D the practitioner and client and vice versa: Gloves must be worn when carrying out invasive PRINCIPLES OF INFECTION procedures, when in contact with sterile sites CONTROL – MANAGEMENT OF Anticipated Wear Wear plastic Wear eye and non-intact skin or mucous membranes, and SHARPS AND EXPOSURE TO level of disposable or fluid and face during all activities that have been assessed BLOOD AND BODY FLUIDS exposure gloves repellent protection as carrying a risk of exposure to blood, body apron SECTION 02E fluids, secretions or excretions, or to sharp or PRINCIPLES OF INFECTION No contaminated instruments (National Institute CONTROL – SAFE HANDLING, exposure for Health and Care Excellence, 2012). to blood/ STORAGE AND DISPOSAL OF body fluids The correct method for wearing and removing WASTE MATERIALS anticipated X X X SECTION 02F gloves can be found on the WHO Save Lives website: (http://www.who.int/gpsc/5may/ PRINCIPLES OF INFECTION CONTROL – CLEANING AND Glove_Use_Information_Leaflet.pdf). Hands DISINFECTION OF THE Exposure must be washed and dried thoroughly before ENVIRONMENT to blood/ putting on disposable gloves. body fluids SECTION 02G – REFERENCES anticipated Gloves can tear or puncture visibly during use, but low risk Yes Yes X of splashing or leakage may occur through microscopic holes. Hands may also become contaminated as gloves are removed. Gloves therefore must Exposure not be seen as a substitute for good hand to blood/ hygiene. Used gloves should be disposed of as body fluids offensive waste (see waste section). anticipated with high Yes Yes Yes risk of ➲ Main contents splashing to the face 18 Tattooing and body piercing guidance
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Toolkit Section 02c Infection prevention and control Click on text to view SECTION 02A Gloves are single-use items (National Institute Nitrile for Health and Care Excellence, 2012). This • Provides an excellent biological barrier, INTRODUCTION means they must be put on immediately resistant to punctures and tears. STANDARD PRINCIPLES OF before an episode of client contact or • Comparable to latex in terms of barrier INFECTION CONTROL procedure and removed as soon as the activity performance. SECTION 02B is completed, or when leaving the client for • Is a good alternative for latex sensitive PRINCIPLES OF INFECTION any reason. Gloves must be changed between CONTROL – HAND HYGIENE different procedural activities for the same individuals. SECTION 02C client and between dealing with different • Can be used where a latex free PRINCIPLES OF INFECTION clients, or removed if they become torn. environment is necessary. CONTROL – PERSONAL Glove choice • Is less elastic than latex but does shape to PROTECTIVE EQUIPMENT the wearer’s hand over time. Assessment of risk Gloves should be made available in a range of sizes for use by different practitioners (National • Can be used for handling certain chemicals Types of protective clothing (Infection Control Nurses Association, 2002). Work clothing Institute of Clinical Excellence, 2012). Gloves However, nitrile contains the same types of All gloves used for direct client care must − Glove choice chemicals as latex in the manufacturing process conform to current EU legislation (CE marked − Synthetic materials and allergic reactions have been reported. as for single use) and should be appropriate − Latex gloves Polyisoprene and Neoprene − Sterile gloves for the task. Only PPE meeting the basic health − Gloves used for cleaning and safety requirements of the EC Personal • Offers effective protection against viral Aprons Protective Equipment Directive requirements is penetration. Eye and face protection entitled to carry a CE mark and be sold for use • Has similar elasticity and physical SECTION 02D in the EC (Health and Safety Executive, 2012a). properties as latex. Practitioners should therefore look for the CE PRINCIPLES OF INFECTION • Is suitable for individuals sensitised to latex mark information on glove packs plus EN 374- CONTROL – MANAGEMENT OF proteins. SHARPS AND EXPOSURE TO 1:2003 or EN 374-2. These markings show the BLOOD AND BODY FLUIDS gloves are protective against chemicals and • Can be used when a latex free environment is necessary (Infection Control Nurses SECTION 02E can resist microorganisms at a performance Association, 2002). PRINCIPLES OF INFECTION level 2 test in penetration tests. Although CONTROL – SAFE HANDLING, this cannot infer protection against viruses, Vinyl STORAGE AND DISPOSAL OF because they are not used in the performance • Is suitable for use in areas where there is a WASTE MATERIALS tests, in practice this is the highest level of low biohazard risk. protection afforded against microorganisms SECTION 02F • Provides a good alternative for use when (Health and Safety Executive, 2012a). PRINCIPLES OF INFECTION staff or clients are sensitised to latex. CONTROL – CLEANING AND Synthetic materials DISINFECTION OF THE • In lab tests shows increased permeability ENVIRONMENT Neoprene and nitrile gloves are synthetic gloves to blood borne viruses than latex. SECTION 02G – REFERENCES which have been shown to have comparable in- • Possesses lower tensile strength than latex use barrier performance to natural rubber latex and breaks down more frequently. gloves in laboratory and clinical studies. • Is prone to leaking. • Is inelastic and can be baggy to wear. • Is inexpensive in comparison to synthetic rubbers (Infection Control Nurses Association, 2002).
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Toolkit Section 02c Infection prevention and control Click on text to view SECTION 02A Overall, vinyl gloves can be used to perform Where latex gloves are in use, monitoring of many tasks, but, depending on the quality clients and staff should be undertaken. Any INTRODUCTION of the glove may not be appropriate when sensitivity shown to natural rubber latex in STANDARD PRINCIPLES OF handling blood/blood-stained fluids (Royal either clients or staff should be documented INFECTION CONTROL College of Nursing, 2012). and action must be taken to remove further SECTION 02B exposure risks. Alternatives to natural rubber Polythene PRINCIPLES OF INFECTION latex gloves therefore must be made available CONTROL – HAND HYGIENE These gloves are not recommended for use (Health and Safety Executive, 2012). Further when undertaking activities involving blood/ SECTION 02C information on latex allergy can be found body fluids exposure and therefore should not PRINCIPLES OF INFECTION on-line at: http://www.hse.gov.uk/skin/employ/ be used in the tattooing and body piercing CONTROL – PERSONAL latex-gloves.htm and detailed information on PROTECTIVE EQUIPMENT setting. They are ill fitting, have heat sealed skin care and dermatitis in the work place can Assessment of risk seams that are predisposed to split and have be found at: http://www.hse.gov.uk/skin/ Types of protective clothing a tendency to tear (Infection Control Nurses Sterile gloves Work clothing Association, 2002). Sterile gloves are used for major surgical Gloves Latex gloves (natural rubber latex) − Glove choice procedures and are not applicable to Latex gloves may be the preferred choice for − Synthetic materials tattooing/body piercing. procedures in tattooing and body piercing − Latex gloves Gloves used for cleaning − Sterile gloves because of latex’s tactile sensitivity, barrier − Gloves used for cleaning property against viruses, good fit and optimal For environmental cleaning purposes or for Aprons elasticity and user familiarity. However, latex manual pre-cleaning of equipment prior to Eye and face protection is a known skin and respiratory sensitiser and disinfection/sterilization, general-purpose SECTION 02D in a small number of people it can cause rubber gloves should be used. The gloves should serious allergy (see below) (Health and Safety be washed with general-purpose detergent PRINCIPLES OF INFECTION CONTROL – MANAGEMENT OF Executive, 2012a). There may also be issues and warm water, and dried between uses. They SHARPS AND EXPOSURE TO when using latex gloves alongside petroleum- should be changed weekly, or more frequently BLOOD AND BODY FLUIDS based lubricants which may affect the glove’s if the gloves become damaged (for example if SECTION 02E integrity and therefore its protection ability. there are signs of peeling, cracking and tears) (National Patient Safety Agency, 2007). PRINCIPLES OF INFECTION Latex allergies are becoming common with CONTROL – SAFE HANDLING, prolonged use of latex gloves (Infection Control STORAGE AND DISPOSAL OF WASTE MATERIALS Nurses Association, 2002). The use of appropriate synthetic gloves is therefore recommended to SECTION 02F avoid becoming sensitised. It is recognised, PRINCIPLES OF INFECTION however, that within certain work environments, CONTROL – CLEANING AND DISINFECTION OF THE latex gloves are still used in large numbers due ENVIRONMENT to their efficacy and low cost. If latex gloves SECTION 02G – REFERENCES are worn, then powder free, low protein content materials must be chosen to help prevent latex allergy (Health and Safety Executive, 2012).
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Toolkit Section 02d Infection prevention and control Click on text to view SECTION 02A Aprons PRINCIPLES OF INFECTION INTRODUCTION A disposable plastic apron must be worn when CONTROL – MANAGEMENT OF STANDARD PRINCIPLES OF there is a risk that clothing may be exposed SHARPS AND EXPOSURE TO BLOOD INFECTION CONTROL to blood, body fluids, secretions or excretions AND BODY FLUIDS SECTION 02B (with the exception of sweat or tears) (National PRINCIPLES OF INFECTION Introduction CONTROL – HAND HYGIENE Institute for Health and Care Excellence, 2012). All body fluids should be regarded as potentially SECTION 02C Plastic aprons should be used as single-use items and changed between clients. They infectious. Blood carries the highest risk of PRINCIPLES OF INFECTION CONTROL – PERSONAL should be discarded and disposed of as transmitting blood borne viruses such as hepatitis PROTECTIVE EQUIPMENT offensive waste after use. B, C , D and human immunodeficiency virus (HIV). SECTION 02D Blood borne viruses may also be transmitted by Eye and face protection PRINCIPLES OF INFECTION other body fluids, especially if contaminated by CONTROL – MANAGEMENT OF Eye protection and face masks must be worn blood (Health Protection Agency, 2009). SHARPS AND EXPOSURE TO BLOOD AND BODY FLUIDS where there is a risk of blood, body fluids, See appendix 02 – Blood borne viruses Introduction secretions or excretions splashing into the eyes Sharps and needles and face (National Institute for Health and Sharps and needles Sterile needles Care Excellence, 2012). A risk assessment of ‘Sharps/needlestick’ injuries The word ‘sharps’ is a generic term that and exposure to blood/ the planned procedure should be undertaken includes needles, scalpels, stitch cutters, glass body fluid spills to help inform decision making (e.g. when ampoules and sharp instruments that may Types of injury/exposure manually cleaning equipment as part of Risks of transmission of blood- become contaminated with blood or body borne viruses following a sharps decontamination processes). fluid. In tattooing/body piercing premises, injury/exposure sharps include equipment such as razors, Management of sharps/ If reusable goggles/protective glasses are needle bars with needles attached and needlestick injuries and exposure used, they should be washed after each client to blood and body fluids cannulae (sometimes used for body piercing). Sharps/’needlestick’ injuries or task using a general purpose detergent, Blood/body fluid spills rinsed and stored dry. Eye protection should be ‘Sharps’ contaminated with blood or other Occupational health for blood compatible with any facemask used. borne virus prevention body fluids should be classified as hazardous waste and handled accordingly. Risk assessment Face masks (such as surgical masks) should Vaccination requirements only be used if there is a risk of splashing of See Section 02e Appendix 02 – Blood borne viruses blood/body fluid droplets into the mouth Appendix 03– Safe use and All ‘sharps’ must be handled and disposed of disposal of sharps or nose. If used, masks should be changed safely and with extreme care. After use they Appendix 04– First Aid following between clients and disposed of immediately should be placed immediately into yellow sharps a sharps/ ’needlestick’ injury and after use. They must not be carried or worn exposure to blood/body fluid boxes/bins with orange lids, compliant with UN around the neck. Appendix 05– Protocol for 3291 and BS7320 standards. This is to reduce cleaning up a blood or a blood the risk of exposure to blood-borne viruses, stained body fluid spill for example through an accidental ‘sharps’ SECTION 02E or ‘needlestick’ injury (National Institute for PRINCIPLES OF INFECTION Health and Care Excellence, 2012). CONTROL – SAFE HANDLING, STORAGE AND DISPOSAL OF See Appendix 03 – Safe use and disposal WASTE MATERIALS of sharps SECTION 02F PRINCIPLES OF INFECTION Sterile needles CONTROL – CLEANING AND Only sterile single-use needles should be DISINFECTION OF THE ENVIRONMENT used for skin piercing or tattooing. Needles Section 02g – References should be examined for imperfections prior to their use and discarded if any are found. ➲ Main contents Needles should either be used directly from the packaging or placed on a sterile surface/tray 21 for immediate use. Tattooing and body piercing guidance
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Toolkit Section 02d Infection prevention and control Click on text to view SECTION 02A ‘Sharps/needlestick’injuries and The risk of infection following a percutaneous INTRODUCTION exposure to blood and body fluids injury, especially deep penetrating injuries STANDARD PRINCIPLES OF Types of injury/exposure involving a hollow-bore needle or a device visibly INFECTION CONTROL contaminated with blood has been estimated at: SECTION 02B A blood/body fluid injury/exposure incident • 1 in 3 when a source patient is infected PRINCIPLES OF INFECTION includes: CONTROL – HAND HYGIENE with HBV and is classed as being highly − Inoculation of blood by a needle or SECTION 02C infectious at the time. other ‘sharps’. PRINCIPLES OF INFECTION • 1 in 30 when the patient is infected with HCV. CONTROL – PERSONAL − Contamination of broken skin with PROTECTIVE EQUIPMENT blood. • 1 in 300 when the patient is infected with HIV SECTION 02D − Blood splashes to mucous membrane, (Health Protection Agency, 2008). PRINCIPLES OF INFECTION CONTROL – MANAGEMENT OF e.g. eyes or mouth. Management of sharps/‘needlestick’ SHARPS AND EXPOSURE TO − Swallowing a person’s blood, e.g. after BLOOD AND BODY FLUIDS injuries and exposure to blood and mouth-to-mouth resuscitation. Introduction body fluids Sharps and needles − Contamination where the individual has Injuries where a person’s broken skin or eyes, Sterile needles an open wound, and clothes have been mouth or other mucous membranes are Sharps/’needlestick’ injuries and exposure to blood/ soaked by blood. exposed to another person’s blood or body body fluid spills − Bites (where the skin is broken). fluids, therefore, may carry a risk of infection Types of injury/exposure with blood borne viruses. Risks of transmission of blood- Risks of transmission of blood-borne borne viruses following a sharps Sharps/’needlestick’ injuries injury/exposure viruses following a significant injury/ Management of sharps/ exposure Prompt first aid and immediate risk assessment is needlestick injuries and exposure to blood and body fluids Transmission of blood borne viruses (BBVs) needed in the event of such incidents to establish ‘Sharps/needlestick’ injuries may result from contamination of mucous the type of exposure sustained and to help Blood/body fluid spills membranes of the eyes or the mouth, or determine what appropriate action is needed. Occupational health for blood of broken skin, with infected blood or other borne virus prevention See Appendix 04 – First Aid following a infectious material. There is no evidence Risk assessment blood/body fluid exposure Vaccination requirements that BBVs can be transmitted by blood Appendix 02 – Blood borne viruses contamination of intact skin, inhalation or by Blood/body fluid spills Appendix 03– Safe use and faecal-oral contamination. Blood and body fluid spills must be dealt with disposal of sharps quickly and effectively. Specialist body fluid Appendix 04– First Aid following The transmission risks after a mucocutaneous a sharps/ ’needlestick’ injury and spill kits are available to purchase. These can exposure to blood/body fluid exposure (splash exposure) are lower than be stored in a safe designated area in the Appendix 05– Protocol for those after a percutaneous exposure (‘sharps’ premises, enabling easy access and timely cleaning up a blood or a blood injury), estimated at 1 in a 1000 for HIV clear up. The expiry dates of products inside stained body fluid spill (Health Protection Agency 2008). There is kits should be regularly checked and out of SECTION 02E currently no evidence on the risk of transmission date items replaced as necessary. Posters and PRINCIPLES OF INFECTION for hepatitis B virus (HBV) and hepatitis C virus CONTROL – SAFE HANDLING, simple training should be provided on the use STORAGE AND DISPOSAL OF (HCV) following mucocutaneous exposure of the body fluid spill kits. WASTE MATERIALS (Health Protection Agency, 2008). SECTION 02F PRINCIPLES OF INFECTION CONTROL – CLEANING AND DISINFECTION OF THE ENVIRONMENT Section 02g – References
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Toolkit Section 02d Infection prevention and control Click on text to view SECTION 02A The body fluid spill kit should contain: Under the HSWO, employers must pay for protective measures such as immunisation. INTRODUCTION • Disposable plastic aprons and synthetic This is usually provided through the company STANDARD PRINCIPLES OF (e.g. nitrile) gloves. INFECTION CONTROL occupational health provider. In the absence of SECTION 02B • Disposable cloths. an occupational health service, the employee PRINCIPLES OF INFECTION • General purpose detergent. could be asked to arrange immunisation CONTROL – HAND HYGIENE • Chlorine granules. through their own GP, but the employer must SECTION 02C make alternative arrangements if this cannot PRINCIPLES OF INFECTION See Appendix 05 – Protocol for cleaning up CONTROL – PERSONAL blood or a blood stained body fluid spill be done, and reimburse any charges made to PROTECTIVE EQUIPMENT the employee for such arrangements. As with SECTION 02D Occupational health for blood all control measures, immunisation needs to be PRINCIPLES OF INFECTION borne virus prevention checked and reviewed and boosters provided, CONTROL – MANAGEMENT OF where necessary. SHARPS AND EXPOSURE TO Risk assessment BLOOD AND BODY FLUIDS Apart from the overall duty to carry It would be considered good practice for Introduction out risk assessment of hazards in the Sharps and needles practitioners to keep copies of their vaccination Sterile needles workplace,COSHH places a pecfic duty on history/antibody level results. If practitioners Sharps/’needlestick’ injuries employers to assess the risks from exposure to refuse to have hepatitis B vaccination, it is and exposure to blood/ hazardous substances, including pathogens body fluid spills advised the employer should consider asking Types of injury/exposure (called biological agents in COSHH), and to the employee to sign a disclaimer form. Risks of transmission of blood- bring into effect the measures necessary to borne viruses following a sharps protect workers and others from those risks as If the response to the hepatitis vaccine is injury/exposure Management of sharps/ far as is reasonably practicable. not sufficient, the GP will need to investigate needlestick injuries and exposure whether there is a specific reason for non- to blood and body fluids In these circumstances the assessment of risks response to the vaccine. It is most important Sharps/’needlestick’ injuries to health should include: Blood/body fluid spills for non-responders to know their status. They Occupational health for blood • How to prevent exposure to biological may need to be protected by other measures borne virus prevention agents. (e.g. Immunoglobulin) following a ‘needlestick/ Risk assessment sharps’ injury. Vaccination requirements • Steps needed to achieve adequate control Appendix 02 – Blood borne viruses of exposure. There is no vaccine against hepatitis C and Appendix 03– Safe use and • Steps needed to avoid accidental ‘needle- disposal of sharps human immunodeficiency virus (HIV). Robust stick/sharps’ injury. Appendix 04 – First Aid following infection control measures should be employed at all times to minimise the risk of exposure to a sharps/ ’needlestick’ injury and Vaccination requirements exposure to blood/body fluid these viruses. Appendix 05 – Protocol for Those at risk of blood/body fluid exposure cleaning up a blood or a blood through sharps or splashes, therefore, should If a practitioner is found to be positive for stained body fluid spill have a full course of hepatitis B vaccine. An a blood borne virus disease, they should be SECTION 02E accelerated course consisting of three doses at assessed and advised by their GP in relation to PRINCIPLES OF INFECTION CONTROL – SAFE HANDLING, zero, one and two months (followed by a fourth working practices. STORAGE AND DISPOSAL OF dose at twelve months after the first dose WASTE MATERIALS for those at continued risk of exposure), and SECTION 02F antibody titres (blood levels) should be checked PRINCIPLES OF INFECTION one to four months after the completion of the CONTROL – CLEANING AND DISINFECTION OF THE primary course of vaccine. It is recommended ENVIRONMENT that those at continued risk of infection Section 02g – References should be offered a once only single booster, approximately five years after completion of the ➲ Main contents primary immunisation course (antibody levels do not need to be checked before or after this 23 booster dose). (Department of Health 2006). Tattooing and body piercing guidance
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Toolkit Section 02e Infection prevention and control Click on text to view SECTION 02A PRINCIPLES OF INFECTION See Appendix 06– Principles for good waste handling INTRODUCTION CONTROL – SAFE HANDLING, STORAGE AND DISPOSAL OF STANDARD PRINCIPLES OF There are a few municipal non-healthcare INFECTION CONTROL WASTE MATERIALS waste streams that are classed to be similar SECTION 02B Good waste management is important to: in nature to healthcare waste and are hence included within the Department of Health’s PRINCIPLES OF INFECTION • Reduce the health and safety risk to staff, waste guidance’s assessment framework. CONTROL – HAND HYGIENE clients and visitors. Waste such as ‘sharps’ and related wastes SECTION 02C • Protect the environment. from tattoo and body piercing practice PRINCIPLES OF INFECTION • Reduce waste disposal costs. is specifically included in this definition CONTROL – PERSONAL (Department of Health 2012). PROTECTIVE EQUIPMENT Responsibility for waste materials SECTION 02D All organisations have a legal responsibility to Soft waste from body-piercing or tattooing PRINCIPLES OF INFECTION dispose of waste safely, ensuring no harm is practice can normally be assumed to present CONTROL – MANAGEMENT OF caused either to staff, members of the public no risk of infection, unless an indication to SHARPS AND EXPOSURE TO the contrary is provided by a healthcare BLOOD AND BODY FLUIDS or the environment. This responsibility begins when waste is generated and ends with its professional (Department of Health 2012). SECTION 02E final disposal. It is essential that persons However, as waste contaminated with non- PRINCIPLES OF INFECTION handling waste fulfil their legal responsibilities infectious body fluids is capable of causing CONTROL – SAFE HANDLING, by taking care to prevent injury or transmission offence, it would be classed as ‘offensive’ STORAGE AND DISPOSAL OF waste (see below) and would require WASTE MATERIALS of infection to themselves or others. appropriate packaging to indicate the bag Responsibility for waste Premises should have a waste policy. The materials contents (Department of Health 2012). Sharps practitioner is responsible for ensuring that National guidance on waste waste would always be considered hazardous management contracts are in place for collection and safe waste and should be disposed of accordingly Offensive waste disposal of offensive/hazardous waste from (see below) (Department of Health 2012). Sharps the premises. It is essential to ensure with the Offensive waste All other waste waste management provider that appropriate Disposal of aerosol cans, glass, documentation is generated when necessary. The guidance from the Department of Health, bottles, broken crockery and dry The manager of the premises is also responsible Social Services and Public Safety states that cell batteries for monitoring the performance of staff and “used gloves and aprons, swabs, small Appendix 06 – Principles for waste contractors, as per agreed contract. dressings, and cotton wool contaminated with good waste handling body fluids arising from cosmetic piercing and SECTION 02F National guidance on waste other body art plus other special treatment PRINCIPLES OF INFECTION management procedures would be considered as offensive/ CONTROL – CLEANING AND In 2013 The Department of Health, Social hygiene waste where it is generated in quantity DISINFECTION OF THE Services and Public Safety published Health (one bag of 7 kg or more in any collection ENVIRONMENT Technical Memorandum HTM 07-01- The interval)”. Offensive waste should be placed Section 02g – References “Safe Management of Healthcare Waste” into a yellow/black bag (“tiger bag”) for (http://www.dhsspsni.gov.uk/htm_07-01_final. disposal so that subsequent holders of the pdf ).This document is to be used as a best waste can handle and dispose of the material practice guide for the safe and effective appropriately. Only where such waste “is handling of waste. The previous clinical waste generated in small quantities (less than 7 kg in classification system using groups A to E can one bag in any collection period) should it be no longer be used, as the groups do not reflect disposed in the black-bag (general waste) the appropriate segregation for transport or stream” (Department of Health 2012). ➲ Main contents disposal.
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Toolkit Section 02e Infection prevention and control Click on text to view SECTION 02A Sharps’ INTRODUCTION ‘Sharps’ should always be handled and disposed of as hazardous waste (see Section 02d). STANDARD PRINCIPLES OF ‘ INFECTION CONTROL In Northern Ireland ‘sharps’ not contaminated with medicinal products (such as those generated SECTION 02B at a body piercing/tattooing premises), should PRINCIPLES OF INFECTION be disposed of in a standards compliant yellow CONTROL – HAND HYGIENE ‘sharps’ bin with an orange lid (Department of SECTION 02C Health, 2012). PRINCIPLES OF INFECTION CONTROL – PERSONAL All other waste PROTECTIVE EQUIPMENT All other non-contaminated waste such as SECTION 02D paper should be placed in black bags, or bags PRINCIPLES OF INFECTION for recycling, within a foot operated pedal bin CONTROL – MANAGEMENT OF and disposed of as normal household waste. SHARPS AND EXPOSURE TO Aerosols, batteries and broken glass should not BLOOD AND BODY FLUIDS be placed in these bags. SECTION 02E Disposal of Aerosol Cans, Glass, Bottles, PRINCIPLES OF INFECTION Broken Crockery and Dry Cell Batteries CONTROL – SAFE HANDLING, STORAGE AND DISPOSAL OF These items should always be placed in a WASTE MATERIALS designated cardboard box, lined with a plastic Responsibility for waste bag so that it is leak-proof. The box should be materials labelled to indicate its contents and method National guidance on waste of disposal. management Offensive waste Sharps All other waste Disposal of aerosol cans, glass, bottles, broken crockery and dry cell batteries Appendix 06 – Principles for good waste handling SECTION 02F PRINCIPLES OF INFECTION CONTROL – CLEANING AND DISINFECTION OF THE ENVIRONMENT Section 02g – References
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25 Tattooing and body piercing guidance
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Toolkit Section 02f Infection prevention and control Click on text to view SECTION 02A PRINCIPLES OF INFECTION Colour-coding for cleaning INTRODUCTION CONTROL – CLEANING AND equipment DISINFECTION OF THE The aim of a colour-coding system for cleaning STANDARD PRINCIPLES OF ENVIRONMENT INFECTION CONTROL equipment is to prevent cross-contamination SECTION 02B Cleaning is the process that physically removes There is a national colour-coding system for PRINCIPLES OF INFECTION contamination with organic material such as the NHS (National Patient Safety Agency, CONTROL – HAND HYGIENE blood and body fluids, along with dirt and 2007b) (e.g. blue for general areas, red for SECTION 02C dust. Cleaning does not necessarily destroy toilet areas/wash hand basins),which could microorganisms from the item that is being be adapted for use in the tattooing and body PRINCIPLES OF INFECTION CONTROL – PERSONAL cleaned. However, providing and maintaining piercing setting. PROTECTIVE EQUIPMENT a clean and readily cleanable environment Use of chemicals SECTION 02D facilitates the prevention and control of infections. PRINCIPLES OF INFECTION Household detergent is adequate for most routine environmental cleaning. For high risk CONTROL – MANAGEMENT OF Equipment for cleaning SHARPS AND EXPOSURE TO environmental surfaces such as treatment BLOOD AND BODY FLUIDS Cleaning equipment that is regularly used surfaces, a hypochlorite solution of 1000 parts SECTION 02E should be fit for purpose, easy-to-use and well- per million (PPM) available chlorine should be PRINCIPLES OF INFECTION maintained (National Patient Safety Agency, used. This solution should be made up for use CONTROL – SAFE HANDLING, 2007a). A clutter-free environment and the on a daily basis, following the manufacturer’s STORAGE AND DISPOSAL OF adoption of local ‘clean as you go’ policies instructions, in a labelled container WASTE MATERIALS will provide the foundation for quality service provided by the commercial manufacturer SECTION 02F provision in a clean, safe place. Good cleaning (using, for example, one tablet of sodium PRINCIPLES OF INFECTION practice includes having: dichloisocyanurate (NaDCC) per litre format). CONTROL – CLEANING AND After twenty-four hours the solution must be • The provision and maintenance of a clean DISINFECTION OF THE discarded. The hypochlorite solution must ENVIRONMENT and appropriate environment by using not be transferred into a trigger spray bottle systems to manage the environment’s Equipment for cleaning but be used directly from the container onto Colour-coding for cleaning cleanliness with a documented cleaning a disposable cloth or paper towels. Surfaces equipment policy and rota plus a regular audit contaminated with blood should be cleaned in Use of chemicals programme. accordance with the guidance on dealing with Appendix 07 – Template • Equipment which is suitable for purpose, blood spillage as a higher concentration of protocol for environmental is able to be kept clean (i.e. impervious cleaning of premises hypochlorite will be required (see Appendix 05 surfaces) and maintained in good physical Section 02g – References – Protocol for cleaning up blood or a blood repair. stained body fluid spill). • Working from the cleanest area towards the dirtiest area to greatly reduce the risk of All chemicals should be handled and stored cross contamination. in accordance with the manufacturer’s instructions/COSHH guidance (Health and • A person in charge who has direct Safety Executive, 2002). Material safety data responsibility for ensuring that cleanliness sheets should be accessible to all staff. All standards are maintained. chemicals used on the premises should be • Single use cloths for cleaning tasks and used and stored in an identified cool, dry and cleaning equipment such as mops and well ventilated place (room/cabinet) that is buckets kept in good order (i.e. cleaned lockable, out of reach of visitors and members daily, renewed regularly and stored safely of the public and in the original containers. (cleaned, dried and stored inverted) in a Expiry dates should be routinely checked. ➲ Main contents designated area after use). See Appendix 07 – Template protocol for 26 environmental cleaning of premises Tattooing and body piercing guidance
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Toolkit Section 02g Infection prevention and control Click on text to view References Health and Safety Executive (2008). Health and SECTION 02A Calderdale Local Authority (2008). Advice and Safety Regulation – a short guide. (http://www.hse. INTRODUCTION safe practice for permanent tattooing plus advice gov.uk/pubns/hsc13.pdf) and safe practice for body piercing. (http://www. STANDARD PRINCIPLES OF Health and Safety Executive (2012a). The use of INFECTION CONTROL calderdale.gov.uk/business/licences/skinpiercing/ index.html) gloves. Blood Borne Viruses Guidance. (http://www. SECTION 02B hse.gov.uk/biosafety/blood-borne-viruses/use-of- Dartford Borough Council (2009). Code of practice gloves.htm) PRINCIPLES OF INFECTION for hygienic piercing. (www.dartford.gov.uk) CONTROL – HAND HYGIENE Health and Safety Executive (2012b). How to deal with an exposure incident. Blood Borne Viruses SECTION 02C Department of Health (1998). UK Health Departments Guidance for Clinical Health Care Guidance. (http://www.hse.gov.uk/biosafety/blood- PRINCIPLES OF INFECTION Workers: Protection Against Infection with borne-viruses/how-deal-exposure-incident.htm) CONTROL – PERSONAL Blood-borne Viruses Recommendations of the Health & Safety at Work etc Act (1974). PROTECTIVE EQUIPMENT Expert Advisory Group on AIDS and the Advisory Group on Hepatitis. HMSO (http://www.dh.gov. (http://www.legislation.gov.uk/ukpga/1974/37) SECTION 02D uk/en/Publicationsandstatistics/Publications/ Infection Control Nurses Association (ICNA) PRINCIPLES OF INFECTION PublicationsPolicyAndGuidance/DH_4002766) (now Infection Prevention Society (IPS)) (2002). A CONTROL – MANAGEMENT OF comprehensive glove choice. Fitwise, England. SHARPS AND EXPOSURE TO The Department of Health, Social Services and Public Safety, Health Technical Memorandum BLOOD AND BODY FLUIDS Management of Health and Safety at Work HTM 07-01- The Safe Management (http://www. Regulations. (www.opsi.gov.uk/si/si1999/19993242. SECTION 02E dhsspsni.gov.uk/htm_07-01_final.pdf) htm) PRINCIPLES OF INFECTION Department of Health (2006). Immunisation CONTROL – SAFE HANDLING, National Institute for Health and Care Excellence against Infectious Disease. (http://www.dh.gov. (2012). Infection control: Prevention and control of STORAGE AND DISPOSAL OF uk/en/Publicationsandstatistics/Publications/ healthcare-associated infections in primary and WASTE MATERIALS PublicationsPolicyAndGuidance/DH_079917) community care (CG139). (http://guidance.nice.org. SECTION 02F Department of Health (2010b). Uniforms and uk/CG139) PRINCIPLES OF INFECTION workwear: guidance on uniform and workwear National Patient Safety Agency (NPSA) (2007a). CONTROL – CLEANING AND policies for NHS employers. (http://www.dh.gov. The national specifications for cleanliness in the DISINFECTION OF THE uk/en/Publicationsandstatistics/Publications/ NHS: a framework for setting and measuring PublicationsPolicyAndGuidance/DH_114751) ENVIRONMENT performance outcomes. (http://www.nrls.npsa.nhs. uk/resources/?EntryId45=59818) Section 02g – References Department of Health (2012). Safe management of healthcare waste V2.0. (http://www.dh.gov. National Patient Safety Agency (NPSA) (2007b). uk/prod_consum_dh/groups/dh_digitalassets/ NHS colour coding hospital cleaning materials documents/digitalasset/dh_133874.pdf) and equipment 15. (http://www.nrls.npsa.nhs.uk/ Department of Health, Social Services and Public resources/?EntryId45=59810) Safety, Health Technical Memorandum HTM 07- National Patient Safety Agency (NPSA) (2009). The 01- The Safe Managemnet of Health Care Waste. Revised Healthcare Cleaning Manual. (http://www. (http://www.dhsspsni.gov.uk/htm_07-01_final.pdf) nrls.npsa.nhs.uk/resources/?EntryId45=61830)
Health Protection Agency (2008). Eye of the Royal College of Nursing (2012). Wipe it out- Needle: UK surveillance of significant exposures to Essential practice for infection prevention BBV in healthcare workers. (www.hpa.org.uk/web/ and control. Guidance for nursing staff. HPAwebFile/HPAweb_C/1227688128096) (http://www.rcn.org.uk/__data/assets/pdf_ Health Protection Agency (2009). Inoculation file/0008/427832/004166.pdf) Injuries and Children in Schools and similar settings: Risk Assessment Guidelines for Health Protection Units. (http://www.hpa.org.uk/webc/HPAwebFile/ HPAweb_C/1259152291335)
Health and Safety Executive (2002). Guidance on Control of Substances Hazardous to Health Regulations.(http://www.hse.gov.uk/coshh/)
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27 Tattooing and body piercing guidance
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Toolkit Section 03 Before and aftercare of a tattoo or body piercing Click on text to view SKIN PREPARATION SKIN PREPARATION In the case of body piercing of minors, they must have a parent or other responsible adult NEED FOR AFTERCARE Where shaving is required, only single-use present when aftercare advice is given. Care of skin after tattooing razors are acceptable. Either a 70% alcohol- Care of skin after piercing impregnated single use swab (typically 70% Good practice is to include on the consent Aftercare leaflets isopropyl alcohol) or a 0.5% chlorhexidine in form a tick box or similar indicator to record WHAT TO DO IF A CLIENT 70% alcohol single use swabs (National Institute that aftercare advice has been explained and RETURNS WITH AN INFECTION for Health and Care Excellence, 2012) can be discussed at the time that the consent form Appendix 08– Tattooing and used for skin disinfection. If the skin is visibly dirty was signed. body piercing consent form then the area should first be cleaned with soap See Appendix 08 – Tattooing/body piercing Appendix 09– Aftercare and water and dried with a paper towel. follow-up record sheet consent form Where it is necessary to mark the skin, a single References Maintaining a good level of hygiene around use toothpick dipped into gentian violet or the treated area is essential during the healing other suitable dye could be used. The dye period. should be dispensed into a single-use pot for each client. Otherwise the entire bottle Care of skin after tattooing should be discarded after each client. As an Good practice is to cover the tattooed area alternative, or where large areas of skin need with sterile non-adhesive gauze which is then to be marked, then a single-use commonly secured with hypo-allergenic tape. Gauze available marker pen could be used, or a permits ventilation and aids healing. suitable single-use alternative. (Dartford Borough Council, 2009) A sterile, non-adhesive dressing may be appropriate for larger areas, at least during Where products such as petroleum jelly are the client’s journey home, but in many cases used for procedures, an appropriate amount of simply keeping the area clean and dry is likely material should be dispensed, using a single- to be the best approach. If plastic film wrap use implement (Calderdale Local Authority, is used for larger areas then it must be clean 2008), into a single-use pot for every client. (taken directly from the pack) and the client Practitioners should not use cream/lotion direct should be advised on when and how to replace from a jar/tube. Roll-on or stick applicators this covering. are not acceptable for use. The practitioner’s hands, even if gloved, should never come into Care of skin after piercing contact with the contents of these jars/tubes. The piercing site should be kept clean and dry NEED FOR AFTERCARE to promote healing. All piercings must be performed using good When checking the pierced site, hands should infection prevention technique and pre- be clean. It is not normally necessary to rotate sterilized equipment to reduce the chance or remove a piece of jewellery however, if the of infection occurring. The aftercare of body client has been advised to do this, it should be piercing sites and tattooed areas is also very handled as little as possible, with clean hands important in order to promote good healing and using a clean tissue and, if possible, to which lowers the risk of infection and reduces touch only the jewellery item. the risk of scarring. Clients should be advised about healing times Practitioners must explain to their clients the as these may be prolonged because of the time known potential complications associated with it takes for the jewellery “tunnel” to become dry the particular procedure they are being asked and then to heal after the initial piercing. ➲ Main contents to carry out. Upon completion of a treatment, 28 they must provide both verbal and written aftercare advice relevant to that treatment. Tattooing and body piercing guidance
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Toolkit Section 03 Before and aftercare of a tattoo or body piercing Click on text to view SKIN PREPARATION Aftercare leaflets WHAT TO DO IF A CLIENT NEED FOR AFTERCARE Lapses in aftercare are common causes of RETURNS WITH AN INFECTION Care of skin after tattooing infection following piercing and clients should be If any of the following signs or symptoms of Care of skin after piercing provided with an appropriate aftercare leaflet an infection develop, urgent medical attention Aftercare leaflets such as those available within this guidance. should be sought: WHAT TO DO IF A CLIENT Click on the aftercare leaflet thumbnail • Redness spreading around the site and RETURNS WITH AN INFECTION below to view the links for downloading extending away from it. Appendix 08 – Tattooing and body piercing consent form • Pus or green/yellow fluid oozing from the site. Appendix 09– Aftercare Tattoo Ear and face • Bleeding that is not controlled by light follow-up record sheet 01 02piercing pressure. References • Pain (rather than discomfort). Tattoo Ear and face piercing Key Advice aftercare Key Advice Hand washing The aftercare of body piercing Hand washing The aftercare following a tattoo is important to promote good Hand washing is the single most important aftercare Hand washing is the single most is important to promote good Signs of infection healing and prevent the risk of method of reducing infection. Hands must Note: Cartilage piercings occasionally form important method of reducing infection. be washed prior to touching the affected lumps commonly known as granulomas. healing and prevent the risk of infection. Hands must be washed prior to touching If appropriate aftercare is not followed area, therefore reducing the risk of infection. This is just trapped fluid and can easily be the affected area, therefore reducing the resolved using the heat and pressure from a infection. infection may occur. The signs of Healing times for piercing will risk of infection. Wash your hands in warm water and liquid warm water compress once a day, replacing • Swelling. infection are: vary with the type and position soap, always dry your hands thoroughly one of your daily cleanings. For the first week or so it is with a clean towel or paper towel. This Wash your hands in warm water and HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh of the piercing and vary from liquid soap, always dry your hands should remove most germs and prevent Expect some swelling and soreness from normal for the area to be red around the wound. person to person. your new piercing. Any knock or bang can thoroughly with a clean towel or paper them being transferred to the affected area. and tender. cause swelling or soreness to flare up again towel. This should remove most germs 6hZkZgZWjgc^c\VcYi]gdWW^c\ For the first few weeks it is A new piercing can be tender, itchy and throughout the healing phase. and prevent them being transferred to sensation round the site. normal for the area to be red, slightly red and can remain so for a As with all body art, infection is the affected area. Do not tender and swollen. few weeks. A pale, odourless fluid may use cotton wool to clean the a risk. To reduce these risks take >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an sometimes discharge from the piercing and piercing as the fibres in the cotton wool Tattoo aftercare painful to touch. form a crust. This should not be confused may get caught in the piercing. • Heat. advice from your practitioner Approximate healing times for the with pus, which would indicate infection. Do not Good practice is to cover the tattooed 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc various piercings are: pick at any discharge and regarding aftercare. not with an offensive smell. move, twist or turn the piercingdo area with non-stick gauze which is then Ear piercing aftercare whilst dry. If any secreted discharge has secured with hypo-allergenic tape. Gauze Ear lobe piercing – 6 to 8 weeks The risk of infection can be HeZV`idndjgegVXi^i^dcZgdghZZ`bZY^XVa Including Lobes/ Tragus/ Anti Tragus/ hardened then turning jewellery may permits ventilation and aids healing. attention immediately if you suffer from Ear cartilage piercing – 6 to 8 weeks Conch/ Helix/ Snug/ Diath/ Industrial/ Rook/ cause the discharge to tear the piercing, greatly reduced by good Cheek piercing – 2 to 3 months Translobal/ Transverse Lobe. allowing bacteria to enter the wound and A tattoo covering a large area may any of the above or have any concerns general hygiene including: prolonging the healing time. need to be covered with a sterile, non- regarding infection in your tattoo or if Eyebrow piercing – 2 to 4 months Facial piercing aftercare there are any signs of an allergic reaction adhesive dressing, at least during your Nose piercing – up to 6 months Including Eyebrow, Bridge, Jestum, Vertical Do not use sunbeds for the first two to any of the products used. • Immobility of, or reluctance to move, a =VcYlVh]^c\WZ[dgZidjX]^c\ journey home. However, simply keeping Labret, Septum/ Nostril. weeks, or if you decide to then cover the the area clean and dry is likely to be the Remember these times are wound area with a breathable plaster the tattoo Soak the piercing for a few minutes by best approach. during tanning. approximate and will depend on submerging the area of skin containing the how healthy you are and whether piercing in a clean jug or bowl containing Do not swim for the first 24 hours @ZZe^c\i]ZiViiddZY A tattoo covering a large area may have following a piercing. plastic film wrap applied, this must be you look after the piercing a warm water solution (1/4 level teaspoon area covered with non-stick of preferably sea salt to an egg cup/shot clean (taken straight from the pack and properly until healed. Signs of infection glass of warm water). Alternatively wet a gauze which is secured with used immediately) and you should be If appropriate aftercare is not followed clean cloth or gauze in the solution and limb/digit/part of the body. infection may occur. The signs of advised when to replace this covering by As with all body art, infection is hypo-allergenic tape. apply as a warm compress. This will soften infection are: your practitioner. a risk. To reduce these risks take any discharge and allow you to clean the HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh advice from your practitioner entry and exit points of the piercing with Any cream that you apply must be used around the wound. regarding aftercare. a cotton bud or gauze. Once the discharge from an appropriate pot/tube at home is removed or softened then jewellery can 6hZkZgZWjgc^c\VcYi]gdWW^c\ and you should wash your hands before The risk of infection can be be gently moved so as to work a little warm sensation round the site. application. Cream can be purchased greatly reduced by good general water through the piercing. When cleaning >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an from your practitioner or a pharmacist. always tighten the ball on any bars by painful to touch. hygiene including: screwing the ball to the right. Antibiotic creams should not be used 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc except if infection has occurred and under =VcYlVh]^c\WZ[dgZidjX]^c\ Do this twice each day, preferably after with an offensive smell. Where the client informs the practitioner supervision of your Doctor. the piercing. washing or bathing. Speak to your practitioner or seek medical attention immediately if you suffer from @ZZe^c\i]Ze^ZgX^c\XaZVc# You can also use mild antibacterial solutions any of the above or have any concerns and soaps to wash the wound site of an ear regarding infection in your piercing or if piercing. Ask your local pharmacist to advise there are any signs of an allergic reaction you and always follow the manufacturers’ to any of the products used. instructions. If irritation, redness or drying For further advice or information: occurs discontinue use. Antibacterial wash is For further advice or information: of a concern or problem, the practitioner is Contact your local Environmental Health NOT suitable for nostrils, septum or vertical Contact your local Environmental Health Department, or your local Public Health lips due to the tissue’s delicate nature. Department, or your local Public Health England Health Protection Team England Health Protection Team Dry the piercing using ONLY fresh disposable This Information is provided by: paper towel/kitchen roll. A communal This Information is provided by: Public Health England North West hand/bath towel should never be used. Public Health England North West Public Health England East Midlands Public Health England East Midlands Tattoo and Piercing Industry Union Tattoo and Piercing Industry Union advised to keep records of any action taken
Your practitioner is: Your practitioner is:
June 2013 June 2013 and advice given. See Appendix 09– Aftercare follow-up Oral Body and record sheet 03piercing 04surface piercing References Oral piercing Body and surface piercing Key Advice aftercare Key Advice The aftercare of body piercing Hand washing The aftercare of body piercing Hand washing aftercare Hand washing is the single most important Hand washing is the single most important Calderdale Local Authority (2008). Advice and is important to promote good is important to promote good method of reducing infection. Hands Do not pick at any discharge and method of reducing infection. Hands must Do not pick at any discharge and healing and prevent the risk of not healing and prevent the risk of not must be washed prior to touching the move, twist or turn the piercingdo be washed prior to touching the affected move, twist or turn the piercingdo infection. affected area, therefore reducing the risk whilst dry. If any secreted discharge has infection. area, therefore reducing the risk of infection. whilst dry. If any secreted discharge has of infection. hardened then turning jewellery may hardened then turning jewellery may Healing times for piercing will cause the discharge to tear the piercing, Healing times for piercing will Wash your hands in warm water and liquid cause the discharge to tear the piercing, Wash your hands in warm water and allowing bacteria to enter the wound soap, always dry your hands thoroughly allowing bacteria to enter the wound and safe practice for permanent tattooing plus advice vary with the type and position liquid soap, always dry your hands vary with the type and position of the piercing and vary from and prolonging the healing time. with a clean towel or paper towel. This prolonging the healing time. thoroughly with a clean towel or paper of the piercing and vary from should remove most germs and prevent Do not Do not person to person. towel. This should remove most germs use sunbeds for the first two person to person. them being transferred to the affected area. wear tight clothing following and prevent them being transferred to weeks, or if you decide to then cover the nipple piercing For the first few weeks it is the affected area. wound area with a breathable plaster For the first few weeks it is A new piercing can be tender, itchy and during tanning. Do not wear tight clothing e.g. tights, and safe practice for body piercing. (http://www. normal for the area to be red, slightly red and can remain so for a belts or high waisted clothing after naval A new piercing can be tender, itchy and normal for the area to be red, tender and swollen. Do not few weeks. A pale, odourless fluid may piercing as this may irritate the wound slightly red and can remain so for a swim for the first 24 hours tender and swollen. following a piercing. sometimes discharge from the piercing and and delay healing. An approximate healing times few weeks. A pale, odourless fluid may form a crust. This should not be confused sometimes discharge from the piercing Special aftercare for tongue piercing Approximate healing times Do not for oral piercing are: with pus, which would indicate infection. use sunbeds for the first two and form a crust. This should not be For the first few days take care when for surface, navel and nipple weeks, or if you decide to then cover the calderdale.gov.uk/business/licences/skinpiercing/ wound area with a breathable plaster confused with pus, which would indicate eating and avoid spicy foods. piercing can be as long as Body and surface piercing aftercare Tongue piercing – 2 to 4 weeks. infection. during tanning. 6 months to 1 year. including Nape, Horizontal Navel, Niple, Lip – 3 to 6 weeks Cold products such as ice and ice cream Horizontal Eyebrow, Wrist, Anti-eyebrow, Oral piercing aftercare Do not swim for the first 24 hours Cheek – 2 to 3 months can help reduce swelling. Madison, Chin, Vertical Bridge, Pubic, For the internal healing of oral piercing Remember these times are following a piercing. Handweb and Prayer. Remember these times are including all piercing of the tongue , lip Refrain from oral sex of any description approximate and will depend Signs of infection index.html) and cheek until the piercing has fully healed. Soak the piercing for a few minutes by If appropriate aftercare is not followed approximate and will depend on how healthy you are and submerging the area of skin containing the infection may occur. The signs of on how healthy you are and Gargle after each meal with an alcohol-free Signs of infection whether you look after the piercing in a clean jug or bowl containing infection are: whether you look after the mouthwash or a warm salt water solution If appropriate aftercare is not followed piercing properly until healed. a warm water solution (1/4 level teaspoon (1/4 level teaspoon of preferably sea salt to infection may occur. The signs of piercing properly until healed. of preferably sea salt to an egg cup/shot HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh an egg cup/shot glass of warm water). infection are: As with all body art, infection glass of warm water). Alternatively wet a around the wound. clean cloth or gauze in the solution and As with all body art, infection is For the external healing of oral piercing: HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh is a risk. To reduce these 6hZkZgZWjgc^c\VcYi]gdWW^c\ apply as a warm compress. This will soften Dartford Borough Council (2009). Code of practice including all piercings to the lip and cheek around the wound. sensation round the site. a risk. To reduce these risks take risks take advice from your any discharge and allow you to clean the 6hZkZgZWjgc^c\VcYi]gdWW^c\ advice from your practitioner Wet a clean cloth or gauze in the warm practitioner regarding entry and exit points of the piercing with >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an sensation round the site. regarding aftercare. salt water solution and apply as a warm aftercare. The risk of infection a cotton bud or gauze. Once the discharge painful to touch. is removed or softened then jewellery can compress. This will soften any discharge >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an can be greatly reduced by good The risk of infection can be be gently moved so as to work a little warm 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc and allow you to clean the entry and exit painful to touch. general hygiene including: with an offensive smell. for hygienic piercing. (www.dartford.gov.uk) greatly reduced by good general points of the piercing with a cotton bud water through the piercing. When cleaning 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc or gauze dipped into the warm salt water always tighten the ball on any bars by Speak to your practitioner or seek medical hygiene including: with an offensive smell. solution. Once the discharge is removed =VcYlVh]^c\WZ[dgZ screwing the ball to the right. attention immediately if you suffer from any of the above or have any concerns =VcYlVh]^c\WZ[dgZidjX]^c\ or softened then jewellery can be gently HeZV`idndjgegVXi^i^dcZgdghZZ`bZY^XVa touching the piercing Do this twice each day, preferably after regarding infection in your piercing or if moved so as to work a little warm water attention immediately if you suffer from washing or bathing. the piercing there are any signs of an allergic reaction through the piercing. When cleaning any of the above or have any concerns @ZZe^c\i]Ze^ZgX^c\XaZVc# You can also use mild antibacterial solutions to any of the products used. @ZZe^c\i]Ze^ZgX^c\XaZVc# always tighten the ball on any bars by regarding infection in your piercing or if screwing the ball to the right. and soaps to wash the wound site. Ask your National Institute for Health and Care Excellence there are any signs of an allergic reaction local pharmacist to advise you and always to any of the products used. Do this twice each day, preferably after follow the manufacturers’ instructions. washing or bathing. If irritation, redness or drying occurs For further advice or information: discontinue use. For further advice or information: Dry the piercing using ONLY fresh Contact your local Environmental Health Contact your local Environmental Health disposable paper towel/kitchen roll. Dry the piercing using ONLY fresh disposable (2012). Infection control: Prevention and control of Department, or your local Public Health Department, or your local Public Health A communal hand/bath towel should paper towel/kitchen roll. A communal England Health Protection Team England Health Protection Team never be used. hand/bath towel should never be used. This Information is provided by: This Information is provided by: Do not Do not Public Health England North West use cotton wool to clean the Public Health England North West use cotton wool to clean the piercing as the fibres in the cotton wool may piercing as the fibres in the cotton wool Public Health England East Midlands Public Health England East Midlands get caught in the piercing. may get caught in the piercing. Tattoo and Piercing Industry Union Tattoo and Piercing Industry Union healthcare-associated infections in primary and Your practitioner is: Your practitioner is: community care (CG139). (http://guidance.nice.org. June 2013 June 2013 uk/CG139)
Genital piercing Genital Microdermal 05(female) 06piercing (male) 07implants
Genital piercing Genital piercing Microdermal implants Key Advice (female Key Advice (male Key Advice The aftercare of body piercing Hand washing ) aftercare The aftercare of body piercing Hand washing ) aftercare The aftercare of body piercing Hand washing aftercare is important to promote good Hand washing is the single most is important to promote good Hand washing is the single most important is important to promote good Hand washing is the single most important Do not method of reducing infection. Hands must Do not healing and prevent the risk of important method of reducing infection. swim for the first 24 hours healing and prevent the risk of method of reducing infection. Hands Do not use antibacterial products as healing and prevent the risk of pick at any discharge and Hands must be washed prior to touching following a piercing. must be washed prior to touching the they can kill the good bacteria that are be washed prior to touching the affected not move, twist or turn the piercing infection. infection. area, therefore reducing the risk of infection. do the affected area, therefore reducing the infection. affected area, therefore reducing the risk naturally present. whilst dry. If any secreted discharge has Do not hardened then turning jewellery may risk of infection. pick at any discharge and of infection. Microdermal implants or dermal Wash your hands in warm water and liquid Healing times for piercing will not move, twist or turn the piercing Healing times for piercing will Do not cause the discharge to tear the piercing, do swim for the first 24 hours anchors are small pieces of soap, always dry your hands thoroughly vary with the type and position Wash your hands in warm water and whilst dry. If any secreted discharge has vary with the type and position Wash your hands in warm water and liquid following a piercing. with a clean towel or paper towel. This allowing bacteria to enter the wound and of the piercing and vary from liquid soap, always dry your hands hardened then turning jewellery may soap, always dry your hands thoroughly jewellery made from titanium should remove most germs and prevent prolonging the healing time. of the piercing and vary from Do not thoroughly with a clean towel or paper cause the discharge to tear the piercing, with a clean towel or paper towel. This pick at any discharge and inserted into the skin with the them being transferred to the affected area. Do not person to person. person to person. not wear clothing that will rub against towel. This should remove most germs allowing bacteria to enter the wound and should remove most germs and prevent move, twist or turn the piercingdo the piercing as this may irritate the whilst dry. If any secreted discharge has stem protruding above, onto A new piercing can be tender, itchy and and prevent them being transferred to prolonging the healing time. them being transferred to the affected area. wound and delay healing. For the first few weeks it is For the first few weeks it is hardened then turning jewellery may which an attachment of your slightly red and can remain so for a the affected area. normal for the area to be red, Refrain normal for the area to be red, A new piercing can be tender, itchy and cause the discharge to tear the piercing, choice is fitted. This attachment few weeks. A pale, odourless fluid may Do not use sunbeds for the first two from any type of sexual activity sometimes discharge from the piercing and tender and swollen. until the piercing has healed or is ‘dry’. slightly red and can remain so for a allowing bacteria to enter the wound and weeks, or if you decide to then cover the A new piercing can be tender, itchy and tender and swollen. should remain in place for at form a crust. This should not be confused wound area with a breathable plaster slightly red and can remain so for a few weeks. A pale, odourless fluid may prolonging the healing time. Always least three months or until the with pus, which would indicate infection. during tanning. The healing time for a few weeks. A pale, odourless fluid may use barrier protection such as The healing time for a sometimes discharge from the piercing and condoms, otherwise you are at increased Refrain piercing has fully healed. Once it genital piercing can be from sometimes discharge from the piercing genital piercing can be from form a crust. This should not be confused from any type of sexual activity Keeping the implant piercing clean Do not swim for the first 24 hours risk of acquiring a sexually transmitted until the piercing has healed or is ‘dry’. and form a crust. This should not be with pus, which would indicate infection. has fully healed other pieces of The implant needs to be cleaned twice following a piercing. 2 to12 weeks. infection. 2 to12 weeks. each day. Cleaning more frequently may confused with pus, which would indicate jewellery can be attached. Accidental damage or loss of disc Male Genital piercing aftercare Always use barrier protection such as damage the skin and slow down the Remember these times are infection. Signs of infection Remember these times are condoms, otherwise you are at increased Contact your practitioner if the implant including glans penis piercing such as Healing times for piercing will healing process. Your practitioner may also approximate and will depend approximate and will depend risk of acquiring a sexually transmitted advise you to soak the implant in warm salt gets caught in anything or the piercing Female Genital piercing aftercare If appropriate aftercare is not followed PA, Reverse PA, Apadravya, Ampallang, vary with the type and position on how healthy you are and infection may occur. The signs of on how healthy you are and infection. water twice a week. becomes damaged. including Clitoral Hood, Inner and Outer Dydoe and Frenum, as well as for other of the piercing and vary from whether you look after the infection are: whether you look after the piercings including Hafada, Scrotum, Make up a quantity of warm salt water In the unlikely event the disc breaks or Labia, Fourchette, Christina and Triangle. Signs of infection comes off, return to the practitioner and Foreskin and Guiche. person to person. solution (1/4 level teaspoon of preferably sea piercing properly until healed. HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh piercing properly until healed. If appropriate aftercare is not followed have a new disk fitted immediately. If the Soak the piercing for a few minutes by salt to an egg cup/shot glass of warm water). around the wound. infection may occur. The signs of For the first few weeks it is disc is not replaced the implant may get As with all body art, infection is submerging the area of skin containing As with all body art, infection is Soak the piercing for a few minutes by Use a clean cloth or gauze dipped in the submerging the area of skin containing infection are: normal for the area to be red, lost under the skin and will require removal. a risk. To reduce these risks take the piercing in a clean container, such as 6hZkZgZWjgc^c\VcYi]gdWW^c\ solution and apply as a warm compress a risk. To reduce these risks take the piercing in a clean container, such as tender and swollen. Signs of infection a bowl containing a warm water solution sensation round the site. HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh and also to dab the area to make sure the advice from your practitioner (1/4 level teaspoon of preferably sea salt advice from your practitioner a bowl containing a warm water solution area under the disc is cleaned as this may If appropriate aftercare is not followed around the wound. As with all body art, infection is regarding aftercare. to an egg cup/shot glass of warm water). >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an regarding aftercare. (1/4 level teaspoon of preferably sea salt become encrusted. infection may occur. The signs of infection are: Alternatively wet a clean cloth or gauze painful to touch. to an egg cup/shot glass of warm water). 6hZkZgZWjgc^c\VcYi]gdWW^c\ a risk. To reduce these risks take The risk of infection can be The risk of infection can be This will soften any discharge and allow in the solution and apply as a warm Alternatively wet a clean cloth or gauze sensation round the site. advice from your practitioner you to clean the piercing points with a HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh greatly reduced by good compress. This will soften any discharge 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc greatly reduced by good in the solution and apply as a warm regarding aftercare. cotton bud or gauze dipped into the warm around the wound. and allow you to clean the entry and exit with an offensive smell. compress. This will soften any discharge >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an general hygiene including: general hygiene including: salt water solution. points of the piercing with a cotton bud and allow you to clean the entry and exit painful to touch. The risk of infection can be 6hZkZgZWjgc^c\VcYi]gdWW^c\ Speak to your practitioner or seek medical If the area around the implant becomes or gauze. Once the discharge is removed points of the piercing with a cotton bud sensation round the site. =VcYlVh]^c\WZ[dgZ attention immediately if you suffer from =VcYlVh]^c\WZ[dgZ greatly reduced by good general encrusted soak the piercing for a few or softened then jewellery can be gently or gauze. Once the discharge is removed 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an touching the piercing any of the above or have any concerns touching the piercing or softened then jewellery can be gently with an offensive smell. hygiene including: minutes by submerging the area of skin moved so as to work a little warm water containing the piercing in a clean jug painful to touch. regarding infection in your piercing or if moved so as to work a little warm water @ZZe^c\i]Ze^ZgX^c\XaZVc# through the piercing. When cleaning @ZZe^c\i]Ze^ZgX^c\XaZVc# =VcYlVh]^c\WZ[dgZidjX]^c\ or bowl containing the warm salt water there are any signs of an allergic reaction through the piercing. When cleaning Speak to your practitioner or seek medical 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc always tighten the ball on any bars by solution and loosen the discharge using a to any of the products used. always tighten the ball on any bars by attention immediately if you suffer from the implant. with an offensive smell. screwing the ball to the right. any of the above or have any concerns cotton bud or clean floss. screwing the ball to the right. @ZZe^c\i]Z^beaVciXaZVc# HeZV`idndjgegVXi^i^dcZgdghZZ`bZY^XVa Do this twice each day, preferably after regarding infection in your piercing or if Always dry the area thoroughly after attention immediately if you suffer from washing or bathing. Do this twice each day, preferably after there are any signs of an allergic reaction cleaning your implant using ONLY fresh any of the above or have any concerns washing or bathing. to any of the products used. disposable paper towel/kitchen roll. regarding infection in your piercing or if Dry the piercing using ONLY fresh A communal hand/bath towel should there are any signs of an allergic reaction
disposable paper towel/kitchen roll. When cleaning always tighten the ball on never be used. to any of the products used.
A communal hand/bath towel should any bars by screwing the ball to the right. For further advice or information: For further advice or information: Do not over clean the site as this may For further advice or information: never be used. damage the skin around the implant Contact your local Environmental Health Dry the piercing using ONLY fresh Contact your local Environmental Health Contact your local Environmental Health Department, or your local Public Health disposable paper towel/kitchen roll. Department, or your local Public Health Do not Department, or your local Public Health Do not use antibacterial products as change the cap of the microdermal England Health Protection Team A communal hand/bath towel should England Health Protection Team implant until fully healed. If in any doubt take England Health Protection Team they can kill the good bacteria that are naturally present. This Information is provided by: never be used. This Information is provided by: advice from your operator This Information is provided by: ➲ Public Health England North West Public Health England North West Do not Public Health England North West Main contents use cotton wool to clean the Public Health England East Midlands Public Health England East Midlands piercing as the fibres in the cotton wool Public Health England East Midlands Tattoo and Piercing Industry Union Tattoo and Piercing Industry Union may get caught in the piercing. Tattoo and Piercing Industry Union
Your practitioner is: Your practitioner is: Your practitioner is:
29 June 2013 June 2013 June 2013 Tattooing and body piercing guidance
PART A
Toolkit Section 04 Decontamination Click on text to view PRINCIPLES OF PRINCIPLES OF Categorization of risks DECONTAMINATION DECONTAMINATION A general categorization of the risks that items Need for vigilance Decontamination is a combination of processes pose with regard to transmission of infection and Categorization of risks that render reusable items safe for reuse. the minimum decontamination standard that DECONTAMINATION PRACTICE should apply is set out in the following table: Layout of decontamination • For invasive items used in tattooing and area body piercing, these decontamination Risk Use of item Decontamination Decontamination of invasive processes will involve cleaning and (minimum items sterilization, after which environmental standard) Cleaning recontamination should be minimised and High Items Sterile or sterile Use of disinfectants recontamination with blood must be totally introduced single-use Sterilization eliminated. Pre-sterilized single-use items into normally Sterilizer operation, validation, are a good alternative. maintenance and record keeping sterile body • Using items once and then discarding them Care of items after sterilization areas or in Decontamination of blood and removes the need for decontaminating contact with body fluids in the working them. a break in skin or mucous environment items • Where an item is marked it is 2 membrane Appendix 10– single-use and must not be reused even if Decontamination requirements decontaminated. Medium In contact Disinfect or single- for equipment used in • For items used in association with with intact use tattooing and skin piercing mucous invasive items, these decontamination Appendix 11– Equipment membranes sterilization standard: self- processes should include both cleaning assessment and decision making and sterilization. Where this is not possible Low In contact Clean or clean tool for tattoo and body piercing (tattooing motors for example), their with intact and disinfect if practitioners contamination should be minimised skin contaminated with Appendix 12 – Equipment by the use of impervious covers which blood or body fluid and body piercing jewellery should be removed carefully after use Minimal Not normally No specific sterilization standard for so as not to contaminate the surface of in contact treatment tattooists and body piercers the item, and the item itself should be with skin (e.g. required, domestic. Appendix 13 – Autoclave daily chemically disinfected. Alternatively items floors and cleaning. Spills or record sheet can be single-use, such as with ink caps. walls) splashes of blood Further reading As with invasive items, environmental or body fluid recontamination should be minimised and should be safely cleared. recontamination with blood must be totally eliminated. DECONTAMINATION PRACTICE • For surfaces, contamination with blood should be made safe by careful application Layout of decontamination area of chemical disinfectants. The layout of a decontamination facility Need for vigilance is important, whether it is in a separate room or a dedicated part of the treatment It is vital that, once decontaminated, items are room, within body art premises. Items to be not directly or indirectly contaminated with decontaminated must flow along a defined blood or body fluid. This requires scrupulous process pathway from dirty (i.e. used and handling procedures and physical separation contaminated), through cleaning (which may from undecontaminated items and the have both a manual and an ultrasonic stage), ➲ Main contents surfaces they may have contaminated. through sterilization and into a phase of clean storage and return to use. 30 Tattooing and body piercing guidance
PART A
Toolkit Section 04 Decontamination Click on text to view PRINCIPLES OF At any stage, items must not be re-contaminated instruments: cleaning should be done under the DECONTAMINATION by direct or indirect contact with items at a lesser detergent solution surface to prevent splashing Need for vigilance stage of decontamination, e.g. items that have and care should be taken to avoid injury. Categorization of risks been cleaned must not be put on the same Any detergent should be safe for those who DECONTAMINATION PRACTICE surface or handled with the same utensils used for dirty items; items that have been sterilized use it, but thick washing-up gloves should Layout of decontamination nevertheless be used. If manual cleaning is area must not make contact with any surface that used, the detergent should be at or around Decontamination of invasive has been used for items before they have been items sterilized. In addition to this beware of using a neutral pH. It is common to use detergents Cleaning clean-looking item in the mistaken belief that it containing enzymes. However, it is thought Use of disinfectants has been fully decontaminated. that short exposures of dirt containing proteins Sterilization to these enzymes may give insufficient time for Sterilizer operation, validation, Only by having a progression through a effective action. There are also concerns that maintenance and record keeping defined layout, can the location of an item some of the enzyme mixtures (“subtilisins”) Care of items after sterilization correspond to its stage in the decontamination can give rise to allergic reactions in some who Decontamination of blood and process. This is always important, but come into contact with them. This should be body fluids in the working particularly so if more than one practitioner considered in risk assessments. Use of non- environment items uses the same facility, or if multiple copies of enzymatic detergents should be considered. Appendix 10 – identical equipment items are available for use, Decontamination requirements e.g. tattoo machine grips. Cleaning should be carried out in a sink for equipment used in dedicated to instrument cleaning and not one tattooing and skin piercing It is an advantage if the decontamination shared with other functions (handwashing, Appendix 11– Equipment occurs in a dedicated room but if this is not eating utensil washing etc.). It can help to sterilization standard: self- possible, it should still occur in a dedicated area attain the correct dilution of a detergent if assessment and decision making tool for tattoo and body piercing in which a defined flow from dirty to clean can the sink is indelibly marked to a fill-line of practitioners be clearly established. known volume, allowing a measured addition Appendix 12 – Equipment of detergent to achieve the correct dilution. and body piercing jewellery Decontamination of invasive items Warm, but not hot, water should be used (hot sterilization standard for Any item that pierces the skin poses a high risk of water may coagulate proteins onto an item tattooists and body piercers transmission of infection. Only items intended and make then difficult to remove). Utensils Appendix 13 – Autoclave daily for reuse after cleaning and steam sterilization used for instrument cleaning should be record sheet should be reused. If any uncertainty exists dedicated solely for that purpose and should Further reading whether an item can be decontaminated by this be observably fit for purpose (e.g. bristles method then confirmation should be obtained on brushes in good order). Cleaning should from the supplier. take place under the surface of the detergent solution to minimise the potential of splashing See Appendix 10 – Decontamination the practitioner with the blood being removed. requirements for equipment used in tattooing and skin piercing Cleaning should be done as soon after an Cleaning item is used as possible as drying makes All items should be cleaned before sterilization. contamination less easily removed. It may If any blood or other proteinaceous material is make cleaning easier if items are stored left on an item that is to be steam sterilized it between use in clean fresh tap water or in a will become firmly fixed on the items and very high humidity atmosphere (such as a closed difficult to remove subsequently. vessel with a small amount of water).
Cleaning should use methods, detergents and Validation of cleaning should be by careful visual inspection of each item in good light. ➲ Main contents concentrations of those detergents compatible with items and specifically intended for Items with complex surfaces may require 31 instrument cleaning. The cleaning method should subsequent additional cleaning in an not put practitioners at risk from contaminants on ultrasonic waterbath (ultrasound creates Tattooing and body piercing guidance
PART A
Toolkit Section 04 Decontamination Click on text to view PRINCIPLES OF strong microcurrents in water by a process Sterilization DECONTAMINATION known as “cavitation” and is very effective Sterilization is the complete elimination of all Need for vigilance at removing soiling from otherwise hidden microbial life to a very high level of quality Categorization of risks crevices). Ultrasonic waterbaths should be assurance. It must be a robustly efficient DECONTAMINATION PRACTICE used, maintained and validated according to process guaranteed to work on every occasion. Layout of decontamination the manufacturer’s instructions. Whilst there are many theoretical ways in which area Use of disinfectants sterilization can be achieved, the only way that Decontamination of invasive body art practitioners can achieve it with the Chemical disinfection has far lower levels of items required quality is by steam sterilization. Cleaning quality assurance than steam sterilization and Use of disinfectants should not be used for invasive items. It should Other methods are either too complex or lack Sterilization only be used for decontamination of the equivalent quality assurance. Steam sterilizers Sterilizer operation, validation, environment and non-invasive items. Chemical are devices that can expose items to be maintenance and record keeping disinfectants are usually inactivated by organic sterilized to pure steam at above atmospheric Care of items after sterilization matter and should only be used after cleaning pressure in a chamber. The process must be Decontamination of blood and has removed the vast majority of organic automatic and steam sterilizers must monitor body fluids in the working matter. Disinfectants should be used in a environment items the process to ensure that all parameters controlled manner according to guidance and of sterilization have been met or, if any Appendix 10 – manufacturer’s instructions (e.g. the correct Decontamination requirements have failed, to clearly indicate a failed cycle. for equipment used in dilution, freshly prepared, applied as directed). (Pressure cookers do not have this inbuilt tattooing and skin piercing Do not mix disinfectants with other detergents quality assurance and are not suitable for Appendix 11 – Equipment or chemicals unless following manufacturer’s body art instrument sterilization. Devices sterilization standard: self- instructions. sold as baby bottle steam sterilizers use assessment and decision making lower temperatures and are not suitable for The disinfectant of choice for general tool for tattoo and body piercing body art instrument sterilization). The type practitioners disinfection of the environment should be a of steam sterilizer suitable for use by body hypochlorite solution containing 1,000 parts Appendix 12 – Equipment art practitioners is known variously as a small and body piercing jewellery per million available chlorine (ppm av Cl). steam sterilizer, a benchtop steam sterilizer or a sterilization standard for This is usually made by dilution of tablets of transportable steam sterilizer. These are small tattooists and body piercers sodium dichloisocyanurate (NaDCC), a form steam sterilizers that generate their own steam Appendix 13– Autoclave daily of solid, stable hypochlorite, pre-measured to and are powered by a standard domestic record sheet give specific hypochlorite concentration when electrical supply and should conform to the Further reading dissolved in given volumes of water (always standard BS EN 13060. follow manufacturer’s instructions for attaining the correct concentration). Whilst solid NaDCC To effect the energy transfer necessary for is stable on dry storage, the hypochlorite sterilization, steam must be able to condense solutions it generates are unstable and should on all surfaces of an item, therefore hinged be made-up daily. Always use in accordance items should be opened and items should with the manufacturer’s materials safety data not overlap each other. If pockets of air are sheet. Hypochlorite solutions may bleach present, this blocks the ability of steam to fabrics and corrode metals other than good make contact with the surface in air. If porous quality stainless steel. They should never be (e.g. fabrics), hollow or wrapped items are mixed with strong acids (the production of placed in chambers that are then filled with highly toxic chlorine gas can result). They steam, this will not remove air from these loads should be used in well ventilated areas. but will only compress the air in them, leading to inadequate sterilization.
➲ Main contents
32 Tattooing and body piercing guidance
PART A
Toolkit Section 04 Decontamination Click on text to view PRINCIPLES OF • Small steam sterilizers are produced in 3 A steam sterilizer should monitor each DECONTAMINATION different types: sterilization cycle and produce a record (e.g. Need for vigilance Type B steam sterilizers (also known as printout) of the cycle parameters, primarily Categorization of risks “vacuum” or “porous load” sterilizers): These the temperatures attained throughout the DECONTAMINATION PRACTICE have sterilization cycles that start by pulling sterilizing phase and the times of those Layout of decontamination a vacuum on the chamber to remove temperature readings. If the sterilizer cannot area most of the air in the chamber and within produce a record of cycle parameters, Decontamination of invasive porous, hollow or wrapped items; this is equivalent records should be produced by items followed by a series of pulses and removal observation of a cycle at the start of each Cleaning of steam to dilute any remaining air, day the sterilizer will be used. Steam sterilizers Use of disinfectants before the chamber is brought to sterilizing should be validated and maintained by Sterilization conditions. These sterilizers are suitable people specifically trained to do so according Sterilizer operation, validation, for porous, hollow or wrapped items. Any to a schedule provided by the sterilizer maintenance and record keeping wrapping must conform to the standard manufacturer. Records of validation and Care of items after sterilization maintenance should be retained as locally Decontamination of blood and BS EN 868, showing they are of a type that advised by the inspecting authority. body fluids in the working does not prevent the passage of steam and environment items will resist the passage of contamination See Appendix 13 – Autoclave daily record Appendix 10 – after sterilization has occurred. sheet Decontamination requirements for equipment used in Type S steam sterilizers: These are similar to There is a legal requirement to have a written tattooing and skin piercing type B, but have only been validated to process scheme of periodic examination of steam Appendix 11– Equipment specific loads (and are normally produced to sterilizers under the Pressure Systems Safety sterilization standard: self- sterilize wrapped dental handpieces). These Regulations (Northern Ireland) 2004. The assessment and decision making sterilizers are suitable for porous, hollow or written scheme shall be drawn up by, or tool for tattoo and body piercing wrapped items only if validated for those certified as being suitable by a competent practitioners specific items to be processed. person as defined by the Regulations. Appendix 12 – Equipment A certificate of insurance is required for the and body piercing jewellery Type N steam sterilizers: These are steam sterilizer as a pressure vessel (Medical Devices sterilization standard for sterilizers with no assisted air removal. These tattooists and body piercers Agency, 2002). sterilizers are suitable for non-porous, non- Appendix 13 – Autoclave daily hollow (solid) and unwrapped items only. Care of items after sterilization record sheet If items are wrapped, they will remain sterile as Further reading Type B and S sterilizers tend to be more long as the wrapping remains intact and dry. expensive to buy and maintain and normally have longer cycle times than type N. If items are unwrapped, they can be placed in a clean, lidded container. Great care should See Appendix 11– Equipment sterilization be taken not to recontaminate them, with standard: self-assessment and decision particular emphasis on recontamination from making tool for tattoo and body piercing undecontaminated instruments or surfaces practitioners contaminated by blood or body fluid as they See Appendix 12 – Equipment and body are transferred into or out of the container, or as piercing jewellery sterilization standard for other items are removed from the container. This tattooists and body piercers is best achieved by having only those items in one container that will be used in a single procedure. Sterilizer operation, validation, If a container does become contaminated, it maintenance and record keeping should be washed and processed (open) in a Sterilizers should only be used by those steam sterilizer or discarded. ➲ Main contents trained in their correct operation. Sterilizers should be operated according to the sterilizer 33 manufacturer’s instructions. Tattooing and body piercing guidance
PART A
Toolkit Section 04 Decontamination Click on text to view Further reading PRINCIPLES OF Decontamination of blood DECONTAMINATION and body fluids in the working Medicines and Healthcare products Regulatory Authority (MHRA). Sterilization, Disinfection Need for vigilance environment and Cleaning of Medical Equipment: Guidance Categorization of risks Blood and other body fluids in the environment on Decontamination from the Microbiology DECONTAMINATION PRACTICE pose a risk of infection transmission: with blood Advisory Committee to Department of Health. Layout of decontamination the main hazards are of blood borne viruses; Part 1 – Principles (2010); part 2 – Protocols area with other body fluids a wider spectrum of (2005); Part 3 – Procedures (2006). http://www. Decontamination of invasive infectious micro-organisms are relevant. mhra.gov.uk/Publications/Safetyguidance/ items Environmental contamination with blood Otherdevicesafetyguidance/CON007438 Cleaning or other body fluids should be dealt with by Use of disinfectants Medical Devices Agency (2002). Benchtop Steam the removal of the contaminating material Sterilizers – Guidance on Purchase, Operation and Sterilization and disinfection as soon as possible after Maintenance. Sterilizer operation, validation, maintenance and record keeping the contamination occurs. The longer any (http://www.mhra.gov.uk/groups/dts-bi/documents/ Care of items after sterilization contamination remains on a surface, the more publication/con007327.pdf) it poses a direct risk to those who come in Decontamination of blood and Hoffman PN, Bradley CR, Ayliffe GAJ (2004). body fluids in the working contact with it, as well as the indirect risk of it Disinfection in Healthcare. 3rd Edn. Blackwell environment items being transferred to other surfaces from which Publishing. ISBN 1405126426 Appendix 10– it may contaminate instruments that come Decontamination requirements into contact with clients. for equipment used in tattooing and skin piercing Remember: The person most at risk, is the Appendix 11 – Equipment person clearing the contamination. They sterilization standard: self- should have safe methods of working and use assessment and decision making appropriate personal protective equipment tool for tattoo and body piercing (PPE ) – which should always include single-use practitioners gloves, with additional PPE such as aprons if Appendix 12 – Equipment the contamination is extensive. and body piercing jewellery sterilization standard for Most environmental contamination is likely to tattooists and body piercers be minor. Such contamination can be removed Appendix 13 – Autoclave daily using single-use wipes and then, once clean, record sheet the area treated with a suitable disinfectant Further reading such as hypochlorite. (See cautions on hypochlorites above). If there is likely to be more extensive contamination, purpose-made disinfectant spill kits can be brought-in in readiness and used.
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Toolkit Section 05 Product quality of tattoo ink Click on text to view BACKGROUND AND CONTEXT BACKGROUND AND CONTEXT This form of environmental contamination of inks, prior to their use on the client, is rarely MICROBIOLOGICAL AND Requirements already exist at both European reported on. Despite the continually improving CHEMICAL QUALITY and national level, whereby ink products standards in tattooing health and safety - much CONCERNS should be sterile and inert at first use. These of it related to eliminating the risk of BBV RECOMMENDATIONS TO specified standards are not necessarily legally transmission - the ‘environmental’ aspect of IMPROVE THE QUALITY OF binding, though bylaw requirements would INK PRODUCTS USED FOR tattooing infection control remains beyond the become so if adopted by a local authority. At TATTOOING control of most practitioners. the European level the quality requirements References for inks were initially laid down in 2003 by Poor quality tattoo inks increase the potential the Council of Europe, and further revised in for localised bacterial skin infections as well as 2008 (see at – https://wcd.coe.int/ViewDoc. dermal allergies following tattooing treatments jsp?id=45869&Lang=en). (Limentani et al., 1979; Jacob, 2002; Charnock, 2004; Suhair, 2007; Drage et al., 2010). Ink A common requirement for byelaws is that the related problems might therefore be directly inks should be sterile at first use and should related to the chemical and/or microbiological be inert (i.e. non-reactive with the body). The quality of the ink or pigments used. Where containers used to hold the inks for each this occurs, other efforts to maintain customer should be either disposed of at the tattooing hygiene standards could potentially end of each session of treatment, or cleaned be undermined if the inks themselves are and sterilized before re-use. contaminated at the point of use. For EHOs out in the field and for tattooists, Tattoo ink products are typically purchased there is an expectation that ink manufacturers from suppliers or directly from manufacturers will provide products that are fit for and are delivered intra-dermally during purpose. However, at present there are few treatment, so there is an increased potential independent sources of data to confirm for the client’s body to be exposed to their the quality of inks used in the UK, and no components, compared with, for example, a authoritative information to indicate whether topically applied skin colorant. this is universally achievable. Some studies have shown that certain products may be Some inks are sold with little or no accompanying contaminated with microorganisms and/or product data, and their composition may remain metals, and the quality of inks used in the UK is uncertain even at the point of use. likely to vary between manufacturers because of an absence of common standard quality Reports of metal sensitivity following requirements. tattooing have been published in the UK, and dermatological responses have been MICROBIOLOGICAL AND linked with particular ink colours, especially CHEMICAL QUALITY CONCERNS red products [some containing mercury] and greens/blue [chromate/cobalt] (Jacob, 2002; The risks associated with tattooing treatments Mortimer et al., 2003; Gass & Todd, 2007). have been acknowledged for many years, and have been reported internationally (Lehman RECOMMENDATIONS TO IMPROVE et al., 2010). In addition to the standard safer THE QUALITY OF INK PRODUCTS sharps controls to mitigate the risk of Blood USED FOR TATTOOING: Borne Virus (BBV) transmission during tattooing, • The presence of an accompanying another potential hazard is that of infection product data sheet is a fundamental via the ‘environmental’ route. This is typically requirement to ensure that, as far as associated with naturally occurring bacteria and ➲ Main contents possible, the appropriate quality tests have fungi that have gained entry to the ink product been undertaken and passed for the ink. 35 at some stage during its manufacture or storage. Tattooists should therefore work wherever Tattooing and body piercing guidance
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Toolkit Section 05 Product quality of tattoo ink Click on text to view References BACKGROUND AND CONTEXT possible with inks that are accompanied by the manufacturer’s product quality Charnock C (2004). Tattooing dyes and pigments MICROBIOLOGICAL AND contaminated with bacteria. Tidsskr Nor CHEMICAL QUALITY information, and should request this Laegeforen. 124(7):933-5. CONCERNS information from their supplier if it is not provided; and, Drage LA, Ecker PM, Orenstein R, Phillips PK and RECOMMENDATIONS TO Edson RS (2010). An outbreak of Mycobacterium IMPROVE THE QUALITY OF • Practitioners should note the batch chelonae infections in tattoos. Journal of the INK PRODUCTS USED FOR numbers of the products they purchase, American Academy of Dermatology. 62(3):501-6. TATTOOING with delivery dates, as new inks are Gass JK and Todd PM (2007). Multiple References purchased and received. Some suppliers manifestations of chromate contact allergy. already provide a product listing and batch Contact Dermatitis. 56:290–291. numbers with their delivery note, and this Jacob CI (2002). Tattoo-associated dermatoses: a would equally serve as a dated record of ink case report and review of the literature. Dermatol products received. This record can then be Surg. 28(10):962-5. used in case of any subsequent concerns Lehman EJ, Huy J, Levy E, Viet SM, Mobley A and over ink quality. Wherever possible, and to McCleery TZ (2010). strengthen the quality control link between Bloodborne pathogen risk reduction activities in client and product(s) used, the colour of the the body piercing and tattooing industry. American inks used on each client should be noted at Journal of Infection. 38(2):130-8. the time of treatment. Limentani AE, Elliott LM, Noah ND, Lamborn JK (1979). An outbreak of hepatitis B from tattooing. Lancet. 2(8133):86-8.
Mortimer NJ, Chave TA and Johnston GA (2003). Red tattoo reactions. Clinical and Experimental Dermatology. 28:508–510.
Suhair OS, Miles HFJ, Simmons P, Stickley J and De Giovanni JV (2007). Awareness of the risk of endocarditis associated with tattooing and body piercing among patients with congenital heart disease and paediatric cardiologists in the United Kingdom. Archives of Disease in Childhood. 92:1013-1014
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Toolkit Section 06 Body piercing jewellery Click on text to view GENERAL GENERAL NICKEL DIRECTIVE NICKEL DIRECTIVE The style of body piercing jewellery is distinct The Nickel Directive was a European Union References from traditional jewellery worn in the ear lobe Directive regulating the use of nickel in jewellery such as studs and butterfly designs. and other products that come into contact with the skin. The requirements also cover a Variations on the barbell and (captive) ring wide range of other items such as necklaces, design are those most commonly seen in body bracelets, wristwatch cases, zips and buttons. piercing because these substantial shapes minimise the risk of embedding, tearing and Since June 2009 it has been subsumed into migration. the EU REACH Regulation (Registration, Evaluation, Authorisation, legislation and High quality jewellery is made with smooth restriction of Chemicals). Nevertheless, the surfaces and joins in order to reduce the risk of term nickel directive is still used to refer to the irritation or of harbouring infection. restrictions on nickel usage and the prescribed Practitioners should ensure that all jewellery test for quantifying nickel release from used for skin piercings is sterile prior to its use. products. Jewellery can only be used if the Where jewellery is not purchased pre-sterilized nickel release rate from those parts of these but is sterilized within the premises, the products coming into direct and prolonged method by which sterilization has been carried contact with the skin is 0.5 micrograms per out will determine how sterile the jewellery square centimetre per week, or less. For body remains (see sterilization section). If jewellery piercing jewellery, post assemblies - the part is processed and stored properly, it may retain of the jewellery that is inserted into the wound its sterility indefinitely. However, practitioners caused by the piercing of the skin, including should be advised to discuss issues such as both the piece that goes through the wound shelf life with equipment (and packaging) and those parts of the jewellery intended manufacturers. to hold the piece in and against the wound (earring “back” or balls on the end of a piercing A number of materials are used in skin piercing bar or stud) - are prohibited unless their rate jewellery and acceptable materials include: of nickel release is 0.2 micrograms per square centimetre per week, or less. • Titanium. • Niobium. One problem with these requirements is that • Platinum. they do not apply to jewellery manufactured for export to countries outside the European • Gold – preferably solid gold 14 carat or Union. Where practitioners cannot prove that 18 carat (for ear piercing). The use of gold jewellery being used is in compliance with higher than 18 carat is not recommended these requirements, it is advised that use of in body piercing as it is too soft and the that jewellery stops until the practitioner can potential exists for scratching or pitting of obtain evidence from the manufacturer of its the metal which may increase the risk of compliance. infection at the piercing site. The use of gold lower than 14 carat is not recommended References in body piercing as it tends to be lower in The Regulation now incorporates the Nickel quality and has the potential to contain Directive (REACH), at item 27 of Annex XVII. metallic impurities, which may lead to Further information is available from: http://www. allergic response in the pierced individual. teg.co.uk/nickel/94-27-EC.htm
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Toolkit Section 07 Governance Click on text to view TRAINING AND TRAINING AND COMPETENCIES • Needle stick injury (and basic first aid practice in relation to this). COMPETENCIES All tattooists and body piercers should PROCEDURE MANUALS/ undertake accredited training and be able • Safe sharps handling/disposal. POLICIES to demonstrate their competencies before • COSHH risk assessment/safe handling AUDIT AND QUALITY starting to practice. This guidance recognises, of chemicals. MONITORING however, that tattooists and body piercers • Training/education of staff. RECORD KEEPING in the UK do not have access to a nationally • Staff health including hepatitis B CONSENT AND AFTERCARE recognised and accredited course, nor is there vaccination status. DOCUMENTATION a nationally agreed set of competencies or See Appendix 08– contains an ongoing objective monitoring of professional AUDIT AND QUALITY example of a consent form and competence by a recognised professional body. MONITORING there are a variety of written aftercare leaflets available Tattooists and body piercers currently Services, policies and practices should be See Appendix 09– Aftercare undertake unaccredited courses, often run monitored on a regular basis by the premises follow-up record sheet by private companies, and/or undergo local manager/lead practitioner, not only to ensure References training and assessment against locally practice is up to date and evidence based, but determined competencies through self-funded for quality purposes as well. By having written, apprentice/mentorship schemes. These up-to-date policies and procedures, training methods vary in terms of quality, documentation of staff training and proof of duration and content. written, evidence based procedures/policies being followed, a premises can provide evidence of The absence of tattoo and body piercing quality standards being maintained. This is useful accredited training and competencies is an when premises are asked by other professionals, area that needs to be addressed nationally and clients, for proof of good practice procedures and is outside the scope of this guidance. and help demonstrate competence and quality in From an infection control viewpoint, any the event of a complaint. agreed national training and competencies for tattooists and body piercers should include the Undertaking audits is part of providing infection control areas listed in the procedure evidence of quality performance. The manuals/policies section (below). template infection control audit tool which is included with this guidance could be used PROCEDURE MANUALS/POLICIES for undertaking infection control audits at a tattooing /body piercing premises. It provides It is recommended that practitioners produce a spreadsheet which gives percentage scores a written procedure/policy manual for use by against good practice target scores in each staff. It should be based on evidence – based section and overall. guidance and be easily available and be easily understood by all groups of staff. Policies/ It is suggested that audits are initially procedures should be reviewed annually so undertaken every six months (or more that practice is up to date and should indicate frequently if scores are below standard targets) ownership (i.e. who is responsible for managing and an action plan developed to address any the policy) and authorship. gaps in audit findings. As a minimum an audit Policies/procedures should include: should be undertaken annually. It is important that there are named individuals designated • Hand washing procedure. against each action and that a deadline is • Cleaning policy and rota. given for each action so that progress can be • Decontamination procedures. identified against these by designated staff, as well allowing monitoring of progress to be ➲ Main contents • Management of waste. followed by the manager/owner. A repeat audit 38 • Management of blood spillages. allows the recording of changes made, as well • Use of personal protective equipment (PPE). as good practice to be monitored over time. Tattooing and body piercing guidance
PART A
Toolkit Section 07 Governance Click on text to view TRAINING AND RECORD KEEPING CONSENT AND AFTERCARE COMPETENCIES DOCUMENTATION Accurate records are invaluable if infection PROCEDURE MANUALS/ problems occur and may assist the practitioner Consent forms must be signed before any POLICIES when investigations are conducted – for procedure is commenced. Both written AUDIT AND QUALITY example, for verifying procedures performed and verbal aftercare information should be MONITORING and equipment check-tests carried out, when provided to the client as evidence of good and RECORD KEEPING they were performed and on whom/by whom. safe practice. CONSENT AND AFTERCARE It is important to keep accurate records of See Appendix 08 – contains an example of DOCUMENTATION every client including: a consent form and there are a variety of See Appendix 08– contains an • Full name, address, telephone number, date written aftercare leaflets available example of a consent form and there are a variety of written of birth and proof of age if needed. AFTERCARE FOLLOW-UP RECORD SHEET aftercare leaflets available • Relevant medical history/ allergies. (ATTACH TO CONSENT FORM)
See Appendix 09– Aftercare • Consent signature of client/ parent. NAME OF CLIENT: follow-up record sheet • Date and type of procedure conducted, ______
References site of procedure, type of jewellery (if Date & Description of any concern or problem Signature of time Action taken/advice given practitioner applicable).
• The name of the practitioner.
All records should be used safely and stored securely, maintaining client confidentiality (e.g. locked paper records, safe use of computers
to ensure clients details are not accessible by
the general public or others with no legitimate reason to access them. Records should be kept safely on the premises named in the licence
for a period of no less than 3 years (Dartford Borough Council 2009).
Staff training records should also be kept on site, as well as health and safety records such
as risk assessments, an accident/incident book, and a log book with details of regular equipment checks. See Appendix 09 – Aftercare follow-up record sheet
References Dartford Borough Council (2009). Code of practice for hygienic piercing. (www.dartford.gov.uk)
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PART A
Toolkit Management of infectious disease incidents relating Section 08 to tattooing and skin piercing Click on text to view proceedings, and if required seek guidance DEFINITION OF AN OUTBREAK DEFINITION OF AN OUTBREAK OR regarding the chain of evidence for a potential OR INCIDENT INCIDENT prosecution. OUTBREAK/INCIDENT INITIAL An infectious disease related outbreak or RESPONSE incident can be defined as: In the case of a tattooing/body piercing setting, most incidents would be expected to relate to References • An incident in which two or more people experiencing a similar illness are linked in suspected blood borne virus transmission to time/place. another person (be that from a practitioner to a client, from a client to the practitioner or from • A greater than expected rate of infection client to client via contaminated equipment or compared with the usual background rate materials). for the place and time where the outbreak The infection control practices in place within has occurred. the establishment would be reviewed as a key OUTBREAK/INCIDENT INITIAL part of any incident investigation. RESPONSE References In Northern Ireland, incidents/outbreaks are Health Protection Agency (2011). London Infectious recognised using surveillance methodology Disease Outbreak Management Plan. by the Health Protection Team within the Health Protection Agency (2012). The Public Health Agency, local authorities or Communicable Disease Outbreak Plan V1.3. microbiologists in regional laboratories. As (Internal document). soon as it becomes apparent that an incident/ outbreak may exist, immediate contact between these parties is essential.
A risk assessment is undertaken following receipt of initial information and a decision made as to whether an outbreak or incident exists. In order to inform all subsequent decisions and actions, key facts would be established by the duty (or on-call) Health Protection Team.
An outbreak/incident is usually declared by the Consultant in Communicable Disease Control (CCDC) or Consultant in Health Protection (CHP) after consultation with a consultant microbiologist and/or senior environmental health officer. The involvement and assistance of the tattoo/body piercing premises concerned would be a high priority.
Once an outbreak/incident is declared, a multi-agency outbreak/incident control team would be set up to fully investigate the incident, ensure control measures are in place and a report generated with lessons learned. All legal powers relating to the investigation ➲ Main contents of outbreaks lie with the local authority. An outbreak/incident control team would give 40 due consideration to the possibility of legal Tattooing and body piercing guidance
PART B – Appendix 01
Toolkit Infection, its causes and spread (continued including a glossary of infection-related terms)
Click on text to view THE CAUSES OF INFECTION Bacteria can replicate independently and some bacteria can form spores that survive Appendix 01 – Infection, its Numerous microorganisms harmlessly colonise in the environment for long periods of time, causes and spread, including the skin and the mucosal surfaces to form the a glossary of infection-related e.g. Mycobacterium tuberculosis, Group normal flora of the human body. The presence terms A Streptococcus, Salmonella Enteritidis. of microorganisms does not constitute an Appendix 02 – Blood borne Antibiotics are used to treat bacterial infection. Colonising microorganisms cause viruses infections; bacteria can develop resistance no damage and often provide benefit to the Appendix 03– Safe use and to antibiotics, e.g. MRSA (meticillin resistant person. It is when there is associated tissue disposal of sharps Staphylococcus aureus). damage that an infectious disease exists. Appendix 04– First Aid Potential pathogens can also act as colonisers following a blood/body fluid Viruses are smaller than bacteria and cannot exposure such as Staphylococcus aureus replicate independently but grow inside the host’s cells. Viruses cannot be treated with Appendix 05– Protocol for GLOSSARY OF INFECTION- cleaning up a blood or a blood antibiotics; there are a few anti-viral drugs stained body fluid spill RELATED TERMS: available that are active against a limited Appendix 06 – Principles for A pathogen is an organism capable of invading number of viruses such as influenza. Many good waste handling the body and causing disease. Such an organism common viral infections resolve without Appendix 07– Template is termed pathogenic (Bannister et al, 2006) treatment, e.g. measles, mumps, and rubella. protocol for environmental cleaning of premises An infectious disease is an illness caused Pathogenic Fungi can be either moulds or yeasts. Infections caused by moulds or yeasts Appendix 08– Tattooing/body by a pathogen, which invades body tissues piercing consent form and causes damage. Not all infectious include ringworm caused by Trichophtyon rubrum and thrush, which is a common yeast Appendix 09– Aftercare follow- diseases spread from person to person, e.g. up record sheet Legionnaires’ disease. infection caused by Candida albicans. Appendix 10 – A communicable disease is an infectious TRANSMISSION (SPREAD) OF Decontamination requirements for equipment used in tattooing disease that is capable of spreading from INFECTION and skin piercing person to person, e.g. measles, tuberculosis. How an infection is spread (transmitted) varies according to the type of microorganism. Some Appendix 11– Equipment Self infection (endogenous infection) sterilization standard- self microorganisms may be transmitted by more An infection that arises from the person’s own assessment and decision than one route: making tool for tattoo and body body flora e.g. bacteria that colonise the skin piercing practitioners get into a break in the skin (wound) and cause • Direct or indirect contact, e.g. Herpes Appendix 12 – Equipment an infection such as an abscess caused by simplex virus, respiratory syncytial virus, and body piercing jewellery Staphylococcus aureus. Staphylococcus aureus. sterilization standard for • Respiratory droplets, e.g. influenza virus, tattooists and body piercers Cross infection (exogenous infection) mumps, Bordetella pertussis (whooping This is an infection that arises from an external Appendix 13– Autoclave daily cough). record sheet source e.g. from another person or via the environment. • Airborne, e.g. pulmonary tuberculosis, measles, chickenpox. GROUPS OF ORGANISMS CAPABLE • Other infectious agents, such as blood- OF CAUSING INFECTION. borne viruses, e.g. hepatitis B and C and Pathogens relevant to body art can be D viruses (HBV, HCV, HDV) and HIV are classified into: transmitted rarely in healthcare settings, via percutaneous (sharps/ needles) or mucous Bacteria are single celled organisms of membrane exposure (blood/ body fluid approximately one-thousandth to five- splashes to eyes/ mouth/ open wounds). ➲ Main contents thousandth of a millimetre in diameter.
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PART B – Appendix 02
Toolkit Infection, its causes and spread (including a glossary of infection-related terms)
Click on text to view IN TATTOOING AND SKIN Indirect contact Appendix 01 – Infection, its PIERCING PROCEDURES, Indirect spread of infection is said to occur when causes and spread, including INFECTION TRANSMISSION CAN an intermediate carrier is involved in the spread a glossary of infection-related OCCUR BY DIRECT CONTACT AND of pathogens such as hands, fomites or vectors. terms INDIRECT CONTACT. Appendix 02 – Blood borne • Hands – The hands of the practitioners viruses Direct contact (person to person) are probably the most important vehicles of cross-infection within the tattooing Appendix 03– Safe use and Direct transmission occurs when disposal of sharps microorganisms are transferred from one and skin piercing environment. The hands of staff and clients can carry microbes Appendix 04– First Aid infected person to another person without a following a blood/body fluid contaminated intermediate object or person. to other body sites, equipment and staff. exposure Examples of direct contact include: Therefore, promotion of hygienic practices for everyone is the key to preventing and Appendix 05– Protocol for • Blood or other body fluids (including blood cleaning up a blood or a blood controlling infections. stained) that enter the body through stained body fluid spill • A fomite is defined as an object that contact with a mucous membrane or breaks Appendix 06 – Principles for becomes contaminated with infected (i.e. piercings, cuts, abrasions) in the skin. good waste handling organisms and which subsequently Appendix 07– Template transmits those organisms to another protocol for environmental person. Examples of potential fomites are cleaning of premises instruments or practically any inanimate Appendix 08– Tattooing/body article e.g. contaminated needles/ piercing consent form tattooing equipment (blood-borne viruses). Appendix 09– Aftercare follow- up record sheet References Bannister B, Gillespie S and Jones J (2006). Infection Appendix 10 – Decontamination requirements Microbiology and Management. 3rd edition. for equipment used in tattooing Blackwell Publishing. and skin piercing Appendix 11– Equipment sterilization standard- self assessment and decision making tool for tattoo and body piercing practitioners Appendix 12 – Equipment and body piercing jewellery sterilization standard for tattooists and body piercers Appendix 13– Autoclave daily record sheet
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PART B – Appendix 02
Toolkit Blood borne viruses
Click on text to view Blood borne viruses (BBVs) are viral infections The infection is not passed on through everyday which are spread through infected blood activities such as coughing, sneezing, shaking Appendix 01 – Infection, its causes and spread, including and body fluids, such as semen. The BBVs of hands or sharing food, crockery, baths or toilets. a glossary of infection-related greatest concern in the tattoo and piercing terms industry are hepatitis B virus (HBV), hepatitis C BBVs can cause serious, chronic diseases (e.g. liver cirrhosis, cancer) or even death to the Appendix 02 – Blood borne virus (HCV), hepatitis D virus (HDV) and human viruses immunodeficiency virus (HIV). Hepatitis B and individual affected. If an individual has an ongoing (chronic) infection, they will pose a Appendix 03– Safe use and C viruses infect and damage the liver. Hepatitis disposal of sharps D (HDV) requires the presence of the hepatitis continuing risk of infection to others. Appendix 04– First Aid B virus to survive in the body. This means that Sometimes an individual may be infected with following a blood/body fluid it is only possible to have hepatitis D if one also a blood borne virus, but not be aware that they exposure has hepatitis B. HIV stops a person’s body from have the infection and that they are therefore Appendix 05– Protocol for fighting infections properly. an infectious risk to others. cleaning up a blood or a blood stained body fluid spill BBVs can be passed on or ‘transmitted’ if an Infections from BBVs can be prevented or Appendix 06 – Principles for infected person’s blood is able to enter another avoided in the tattoo and body piercing setting, good waste handling person’s bloodstream. This can happen in a if robust infection control practices (including Appendix 07– Template number of different ways: immunisation against hepatitis B) are used by protocol for environmental • Sexual contact, both heterosexual and all practitioners at all times when dealing with cleaning of premises homosexual. anyone else’s blood and body fluids. Appendix 08– Tattooing/body piercing consent form • Infected blood passing from one person to Reference: another e.g. through cuts or damaged skin. British Liver Trust (http://www.britishlivertrust.org.uk) Appendix 09– Aftercare follow- up record sheet • Sharing razors or toothbrushes. Appendix 10 – • Sharing needles and syringes. Decontamination requirements • Through ear piercing and other types of for equipment used in tattooing body piercing, tattooing and acupuncture if and skin piercing equipment is not properly sterilized. Appendix 11– Equipment sterilization standard- self • From mother to baby during or after assessment and decision pregnancy. making tool for tattoo and body • All blood donations are now screened for piercing practitioners hepatitis B virus, but before this started it Appendix 12 – Equipment was possible to become infected through and body piercing jewellery blood transfusions. sterilization standard for tattooists and body piercers Appendix 13– Autoclave daily record sheet
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Click to download PART B – Appendix 03 PDF version
Toolkit Safe use and disposal of sharps
Click on text to view Before use: After use: Appendix 01 – Infection, its • Ensure that sharps disposal box is correctly • Disposal of sharps is the responsibility of causes and spread, including assembled. the user. a glossary of infection-related • Ensure that the label on the box is filled in • Dispose of sharps immediately after use. terms upon assembly. Appendix 02 – Blood borne • Do not bend or break needles before disposal viruses • Ensure appropriate colour sharps box lid (e.g. a tattoo needle from a needle bar). for use based on medicinal contamination Appendix 03– Safe use and • Do not leave full sharps boxes for disposal disposal of sharps and how the waste should be treated and by other staff. disposed of i.e. orange lid for sharps derived Appendix 04– First Aid • Fill sharps boxes only to the ‘fill’ line and from tattooing/body piercing procedures. following a blood/body fluid never overfill. exposure • Sharps boxes are type approved for solids • Shut and lock box when full for disposal. Appendix 05– Protocol for and should not be used for quantities of cleaning up a blood or a blood liquid waste. • Never use tape to seal sharps boxes. stained body fluid spill • Sharps boxes must comply with UN 3291 • Label box with source such as name of Appendix 06 – Principles for and BS7320 standards. person/ premises and describe waste good waste handling content. • Boxes must be available in different sizes. Appendix 07– Template Tamper-proof sharps containers are also • Dispose of sharps boxes as clinical waste protocol for environmental for incineration only. cleaning of premises available. • Never place sharps boxes in clinical/ Appendix 08– Tattooing/body • Boxes must be available at all locations piercing consent form where sharps are used. offensive waste bags. Appendix 09– Aftercare follow- • Boxes must never be placed on the floor. • Sharps containers must never be left up record sheet unsupervised. They must be locked in a • Boxes must be placed on a level surface or cupboard/ operating/procedure room when Appendix 10 – wall-mounted below shoulder height and Decontamination requirements not in use. be near to the area they are being used. for equipment used in tattooing • Never try and retrieve items from a sharps • Boxes must never be left in areas where and skin piercing container. Appendix 11– Equipment clients may have open access to them. • Place damaged sharps containers inside sterilization standard- self • Assess, in terms of risk, the most a larger container – lock and label prior to assessment and decision appropriate size of sharps container for making tool for tattoo and body disposal. Do not place inside a waste bag. the tattoo/body piercing setting. piercing practitioners Reference Appendix 12 – Equipment During use: National Institute for Clinical Excellence (NICE) and body piercing jewellery (2012). Infection control: Prevention and control • Practitioners must be competent in sterilization standard for of healthcare-associated infections in primary and tattooists and body piercers procedures using sharps. community care (CG139). Appendix 13– Autoclave daily • The person using the sharp is responsible (http://guidance.nice.org.uk/CG139) record sheet for disposing of it. • Never pass sharps from hand to hand. • Wear appropriate personal protective equipment (gloves at a minimum). • Assemble devices with care. • Do not disassemble devices (e.g. needle bar and needle)—dispose of as a complete unit. • Do not re-sheath/recap used needles/razors. ➲ Main contents • Close sharps box opening (temporary closure device) between uses. 44 • Never move an open sharps box. • Use the handle to carry. Tattooing and body piercing guidance
Click to download PART B – Appendix 04 PDF version
Toolkit First Aid following a blood/body fluid exposure
Click on text to view Encourage bleeding where skin is punctured Appendix 01 – Infection, its or broken. causes and spread, including 1 a glossary of infection-related Do not suck the wound. terms Appendix 02 – Blood borne viruses Wash thoroughly with mild liquid soap Appendix 03– Safe use and under running warm water. disposal of sharps 2 Appendix 04– First Aid Do not use a scrubbing brush. following a blood/body fluid exposure If eyes are involved, wash immediately with Appendix 05– Protocol for cleaning up a blood or a blood water for 5-10 minutes (use tap water, or stained body fluid spill 3 sterile water if available). Appendix 06 – Principles for If the mouth is contaminated, rinse with good waste handling plenty of water. Appendix 07– Template protocol for environmental cleaning of premises Any cuts/punctures should be covered with a Appendix 08– Tattooing/body 4 waterproof plaster. piercing consent form Appendix 09– Aftercare follow- up record sheet Where there is considerable contamination of unbroken skin, remove contaminated Appendix 10 – 5 Decontamination requirements clothing and wash all affected areas with for equipment used in tattooing copious amounts of water. and skin piercing Appendix 11– Equipment The priority sterilization standard- self Remember to seek medical advice at the is to seek assessment and decision local Emergency Department as prophylactic making tool for tattoo and body advice/ medical treatment (if required) ideally needs to be piercing practitioners attention given ideally within one hour and no later Appendix 12 – Equipment immediately, than 72 hours. If relevant and if possible, it and body piercing jewellery at a local 6 is helpful if the details of the client whose sterilization standard for Emergency tattooists and body piercers needle was involved in the incident were Department, brought to the Emergency Department in Appendix 13– Autoclave daily ideally within record sheet a sealed envelope to help enable the risk one hour of the assessment process injury occurring Reference: Ensure that your manager or immediate Health and Safety senior is informed immediately of the Executive (2012) How to deal with an exposure incident. incident. Blood Borne 7 Viruses Guidance. The person who has received the injury (http://www.hse.gov. should complete an incident form as per uk/biosafety/blood- ➲ Main contents local guidelines. borne-viruses/how-deal- exposure-incident.htm) 45 Tattooing and body piercing guidance
Click to download PART B – Appendix 05 PDF version
Toolkit Protocol for cleaning up blood or a blood stained body fluid spill
Click on text to view CLEANING UP BLOOD OR A BLOOD BLOOD SPILLS ON CLOTHING STAINED BODY FLUID SPILL Appendix 01 – Infection, its Change clothes (immediately if possible) and causes and spread, including • Prevent access to the area containing the place into a plastic bag. Wash clothes as soon a glossary of infection-related spillage until it has been safely dealt with. as possible in a hot cycle. terms • Obtain chlorine based spill kit. Appendix 02 – Blood borne CLEANING UP VOMIT OR URINE viruses • Put on apron and gloves SPILLS Appendix 03– Safe use and • Apply disinfectant granules to the spill, this disposal of sharps congeals the spill to enable easier cleaning of Chlorine-based disinfectants will give off highly Appendix 04– First Aid the area OR make up and use the disinfectant toxic gas if mixed with acidic substances. following a blood/body fluid solution as per product instructions to a Ideally chlorine-based products should not be exposure dilution of 10,000ppm available chlorine. used on vomit and urine due to the slight risk Appendix 05– Protocol for Leave in place for the designated exposure of chlorine gas being released. To clean up cleaning up a blood or a blood time (at least two minutes). Ensure the vomit or urine spills, follow the same process as stained body fluid spill surface can tolerate chlorine. above but replace chlorine-based disinfectant Appendix 06 – Principles for granules with a non-chlorine based product, good waste handling DO NOT USE MOPS TO CLEAN UP BLOOD. or use paper towels to absorb as much of the Appendix 07– Template • Use the scoop and scraper (or disposable spillage as possible. Always clean areas with protocol for environmental paper towels) to pick up the congealed detergent and warm water. A chlorine-based cleaning of premises body fluid and place in the appropriate disinfectant can be used to disinfect the Appendix 08– Tattooing/body waste bag. area but only after the urine/vomit has been piercing consent form • Using the disposable paper towels and cleaned up. Appendix 09– Aftercare follow- disinfectant solution clean area thoroughly up record sheet and dry afterwards. Detergent and warm IMPORTANT NOTE Appendix 10 – water can also be used afterwards. Chlorine-based disinfectants/ Decontamination requirements absorbent granules such as sodium for equipment used in tattooing • Ensure all equipment used is disposed of in and skin piercing the appropriate waste bag and then finally dichloisocyanurate (NaDCC) should not be used on urine or vomit spills. Appendix 11– Equipment remove gloves and apron and place in the sterilization standard- self waste bag. NEVER mix chlorine-based disinfectants assessment and decision • Wash hands. with any other cleaning/disinfectants. making tool for tattoo and body Hypochlorite solutions may bleach • Ensure that the waste bag is placed in piercing practitioners fabrics and other materials, as well the appropriate disposal bin/container Appendix 12 – Equipment as corrode metals, so care is needed immediately after use. and body piercing jewellery regarding which surfaces they can be sterilization standard for • Damp-mop the affected area. used upon. tattooists and body piercers Appendix 13– Autoclave daily MANAGING BLOOD SPOTS record sheet Apply chlorine based disinfectant solution to Reference a wet paper towel and clean spillage area. National Patient Safety Agency (2009). The Revised Discard waste as above. Healthcare Cleaning Manual. (http://www.nrls.npsa. nhs.uk/resources/?EntryId45=61830) IF BLOOD/BODY FLUID SPLASHES INTO THE EYES OR MOUTH Rinse freely with water. Seek immediate medical advice if the splash gets into the mucous membrane. ➲ Main contents
46 Tattooing and body piercing guidance
Click to download PART B – Appendix 06 PDF version
Toolkit Principles for good waste handling
Click on text to view GOOD WASTE HANDLING PRINCIPLES:
Appendix 01 – Infection, its • Waste should be segregated at the point of origin. causes and spread, including a glossary of infection-related • Bags/bins should only be filled to ¾ full. terms • Waste bags should be used in foot operated pedal bins. Appendix 02 – Blood borne viruses • Waste bags should be sealed securely and marked with Appendix 03– Safe use and ‘point of origin’ label prior to disposal. disposal of sharps • Waste should be collected on a regular basis by a licensed Appendix 04– First Aid waste management contractor. following a blood/body fluid exposure • Personal protective clothing should be worn when Appendix 05– Protocol for handling waste. cleaning up a blood or a blood stained body fluid spill • Waste should be correctly bagged in appropriate colour- coded bags which must be UN-approved and comply with Appendix 06 – Principles for good waste handling BS EN ISO 7765:2004 and BS EN ISO 6383:2004. Appendix 07– Template • Waste should be double bagged where the exterior of the protocol for environmental bag is contaminated or the original bag is split, damaged cleaning of premises or leaking. Appendix 08– Tattooing/body piercing consent form • Waste should be kept in a rigid-sided, fire retardant holder or container with a foot operated lid, and, so far as is Appendix 09– Aftercare follow- reasonably practicable, out of the reach of children and up record sheet unauthorised personnel. Appendix 10 – Decontamination requirements • Waste should be stored in a labelled, lockable/secure, for equipment used in tattooing vermin-proof storage space for collection, on a well- and skin piercing drained, impervious hard standing floor, which is provided Appendix 11– Equipment with wash-down facilities. sterilization standard- self assessment and decision • Bags should be securely sealed and labelled with coded making tool for tattoo and body tags at the point of use to identify their source. piercing practitioners • Waste should not be decanted into other bags, regardless Appendix 12 – Equipment and body piercing jewellery of volume; be contaminated on the outside or re-used. sterilization standard for • ‘Sharps’ must be disposed of into approved sharps tattooists and body piercers containers that meet BS 7320/UN 3291. Appendix 13– Autoclave daily record sheet • ‘Sharps’ containers should NEVER be placed into any waste bag.
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47 Tattooing and body piercing guidance
Click to download PART B – Appendix 07 PDF version
Toolkit Template protocol for environmental cleaning of premises
Click on text to view ITEM FREQUENCY METHOD Appendix 01 – Infection, its causes and spread, including High risk treatment After use Treatment area surfaces cleaned and dried a glossary of infection-related surfaces between clients using detergent and then terms disinfected using a bleach solution (1000 ppm) Appendix 02 – Blood borne viruses Use disposable cloths/paper towels Appendix 03– Safe use and Non high risk At least daily Use general-purpose detergent disposal of sharps surfaces Appendix 04– First Aid Dry thoroughly following a blood/body fluid exposure Use disposable cloths/paper towels Appendix 05– Protocol for Hand wash basins Daily Standard detergent cleaning up a blood or a blood and sinks stained body fluid spill Appendix 06 – Principles for Floors Daily Mop with water and detergent good waste handling Appendix 07– Template Disinfectant is required only after protocol for environmental contamination with blood spillages cleaning of premises Bins As required Empty bins daily. Appendix 08– Tattooing/body piercing consent form If contaminated, clean with water and Appendix 09– Aftercare follow- detergent and then disinfect up record sheet Appendix 10 – Couches Between clients Wipe with hot, soapy water and dry thoroughly Decontamination requirements for equipment used in tattooing Clean with disinfectant against blood borne and skin piercing viruses if contaminated with blood Appendix 11– Equipment Walls/ceilings As required Routine cleaning not required sterilization standard- self assessment and decision Clean periodically with water and general making tool for tattoo and body purpose detergent piercing practitioners Appendix 12 – Equipment Clean with disinfectant against blood borne and body piercing jewellery viruses if contaminated with blood sterilization standard for tattooists and body piercers Adapted from National Patient Safety Agency (2009). The Revised Healthcare Cleaning Manual. Appendix 13– Autoclave daily (http://www.nrls.npsa.nhs.uk/resources/?EntryId45=61830) record sheet
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48 Tattooing and body piercing guidance
PART B – Appendix 08
Toolkit Tattooing/body piercing consent form
Click on text to view Click to download Click to download Word document version PDF version Appendix 01 – Infection, its causes and spread, including a glossary of infection-related terms Tattooing/Body Piercing Consent Form
Appendix 02 – Blood borne Name of Premises: viruses Address & Tel No of Premises: Appendix 03– Safe use and disposal of sharps Name of Practitioner (print): Appendix 04– First Aid Name of Client (print): following a blood/body fluid Address & Tel No of client: exposure
Appendix 05– Protocol for cleaning up a blood or a blood Age of Client and DOB: stained body fluid spill Age ID of Client Seen: Yes / No Appendix 06 – Principles for Type of Procedure: Tattoo / Body Piercing good waste handling Description:
Appendix 07– Template Site of Procedure and design if protocol for environmental applicable): cleaning of premises Type of Jewellery Used (as applicable): Appendix 08– Tattooing/body piercing consent form Appendix 09– Aftercare follow- up record sheet Appendix 10 – Decontamination requirements for equipment used in tattooing and skin piercing Appendix 11– Equipment sterilization standard- self assessment and decision making tool for tattoo and body piercing practitioners Appendix 12 – Equipment and body piercing jewellery sterilization standard for tattooists and body piercers Appendix 13– Autoclave daily record sheet
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49 This document comprises of 3 pages Tattooing and body piercing guidance
PART B – Appendix 09
Toolkit Aftercare follow-up record sheet
Click on text to view Click to download Click to download Word document version PDF version Appendix 01 – Infection, its causes and spread, including a glossary of infection-related terms AFTERCARE FOLLOW-UP RECORD SHEET Appendix 02 – Blood borne (ATTACH TO CONSENT FORM) viruses Appendix 03– Safe use and NAME OF CLIENT: disposal of sharps Appendix 04– First Aid ______following a blood/body fluid exposure Date & Description of any concern or problem Signature of Appendix 05– Protocol for time Action taken/advice given practitioner cleaning up a blood or a blood stained body fluid spill Appendix 06 – Principles for good waste handling
Appendix 07– Template protocol for environmental cleaning of premises
Appendix 08– Tattooing/body piercing consent form
Appendix 09– Aftercare follow- up record sheet Appendix 10 – Decontamination requirements for equipment used in tattooing and skin piercing
Appendix 11– Equipment sterilization standard- self assessment and decision making tool for tattoo and body piercing practitioners
Appendix 12 – Equipment and body piercing jewellery sterilization standard for tattooists and body piercers Appendix 13– Autoclave daily record sheet
➲ Main contents
50 This document comprises of 1 page Tattooing and body piercing guidance
Click to download PART B – Appendix 10 PDF version
Toolkit Decontamination requirements for equipment used in tattooing and skin piercing
Click on text to view Equipment for Application of item Recommendations Appendix 01 – Infection, its Tattooing: causes and spread, including Holders for needles i.e. tube, Hold needles that pierce skin Dismantle then clean and a glossary of infection-related tip and grip sterilize, or single-use terms Appendix 02 – Blood borne Needles and needle bars Pierce skin Single-use pre-sterilized viruses Ink caps Hold inks that will become Single-use Appendix 03– Safe use and contaminated with blood disposal of sharps Ink cap trays Hold ink caps and will become Either single-use or clean and Appendix 04– First Aid contaminated with blood sterilize following a blood/body fluid during use exposure Motors & clipcords Will become contaminated Reduce contamination by Appendix 05– Protocol for with blood via the covering with impervious cleaning up a blood or a blood practitioner’s hands barrier (e.g. plastic sleeving) stained body fluid spill Appendix 06 – Principles for Remove impervious barrier good waste handling carefully after use minimising transfer of contamination to Appendix 07– Template the item protocol for environmental cleaning of premises Thoroughly remove any visible Appendix 08– Tattooing/body contamination with detergent, piercing consent form then dry Appendix 09– Aftercare follow- up record sheet Disinfect surface with 70% alcohol Appendix 10 – Decontamination requirements Elastic bands Will become contaminated Single-use for equipment used in tattooing with blood via the and skin piercing practitioner’s hands Appendix 11– Equipment Body piercing: sterilization standard- self Needles, cannulas Pierce skin Single use pre-sterilized assessment and decision making tool for tattoo and body Clamps used for skin folds, In close contact with pierced Clean and sterilize or single-use piercing practitioners looped forceps, pliers and skin Appendix 12 – Equipment receiving tubes and body piercing jewellery Jewellery Inserted into sterile body Sterilize or pre-sterilized sterilization standard for tissues tattooists and body piercers Spatulas, cotton/gauze pads Will become contaminated Single-use Appendix 13– Autoclave daily and paper towels with blood record sheet Vernier calipers Should only be used on clean, Clean between uses unbroken skin Single use or autoclavable alternative should be used for oral and genital piercings Ear piercing guns These should only be of the Clean according to type that use single-use self- manufacturer’s instructions contained cartridge containing the stud and back, such that the gun itself makes no client ➲ Main contents contact Cartridges used with ear Single-use 51 piercing guns Tattooing and body piercing guidance
Click to download PART B – Appendix 11 PDF version Toolkit Equipment sterilization standard – self assessment and decision making tool for tattoo and body piercing practitioners
Click on text to view Appendix 01 – Infection, its Dispose of safely causes and spread, including Is the equipment and appropriately Yes a glossary of infection-related for single use? i.e. in offensive terms waste bag or Appendix 02 – Blood borne sharps bin viruses Appendix 03– Safe use and disposal of sharps Appendix 04– First Aid following a blood/body fluid No exposure Appendix 05– Protocol for cleaning up a blood or a blood stained body fluid spill Appendix 06 – Principles for The instrument The instrument good waste handling is hollow and/or is solid and wrapped (including Appendix 07– Template unwrapped protocol for environmental solid items) cleaning of premises Appendix 08– Tattooing/body piercing consent form Appendix 09– Aftercare follow- up record sheet Sterilize using non-vacuum Appendix 10 – autoclave with Decontamination requirements Sterilize using temperature and for equipment used in tattooing vacuum autoclave pressure indicator and skin piercing (type B or S) with gauges (type N) or Appendix 11– Equipment drying cycle sterilization standard- self vacuum autoclave assessment and decision (type B or S) with making tool for tattoo and body drying cycle piercing practitioners Appendix 12 – Equipment and body piercing jewellery sterilization standard for tattooists and body piercers Appendix 13– Autoclave daily record sheet
➲ Main contents
52 Tattooing and body piercing guidance
Click to download PART B – Appendix 12 PDF version
Toolkit Equipment and body piercing jewellery sterilization standard for tattooists and body piercers
Click on text to view Appendix 01 – Infection, its Option 1 Option 2 Option 3 causes and spread, including a glossary of infection-related terms Appendix 02 – Blood borne Using only: Using: Using only: viruses Appendix 03– Safe use and solid unwrapped hollow instruments Single-use disposal of sharps instruments and/or hollow body piercing and Appendix 04– First Aid and jewellery following a blood/body fluid pre-sterilized exposure solid unwrapped and/or using any instruments body piercing Appendix 05– Protocol for jewellery or body piercing jewellery which jewellery cleaning up a blood or a blood are wrapped stained body fluid spill Appendix 06 – Principles for good waste handling Appendix 07– Template protocol for environmental Your current Your current Your current cleaning of premises autoclave is autoclave is autoclave is Appendix 08– Tattooing/body non-vacuum non-vacuum vacuum (type B piercing consent form (type N) (type N) or S) with drying Appendix 09– Aftercare follow- cycle up record sheet Appendix 10 – Decontamination requirements for equipment used in tattooing No change in If you are No change in No change in and skin piercing your practice is unable to your practice is your practice is Appendix 11– Equipment sterilization standard- self required switch to using required required assessment and decision a vacuum making tool for tattoo and body autoclave piercing practitioners (type B or S) Appendix 12 – Equipment with drying and body piercing jewellery sterilization standard for cycle, then use tattooists and body piercers single-use Appendix 13– Autoclave daily instruments record sheet and pre-sterilized body piercing jewellery instead
➲ Main contents
53 Tattooing and body piercing guidance
PART B – Appendix 13
Toolkit Autoclave daily record sheet
Click on text to view Click to download Click to download Word document version PDF version Appendix 01 – Infection, its causes and spread, including a glossary of infection-related terms AUTOCLAVE DAILY RECORD SHEET Appendix 02 – Blood borne viruses Please keep these records in date order for inspection
Autoclave Type Serial Number Appendix 03– Safe use and disposal of sharps Week Commencing Location
Appendix 04– First Aid Type of Water used (ideally sterile water for irrigation) following a blood/body fluid exposure Daily test Saturday Sunday Monday Tuesday Wednesday Thursday Friday Appendix 05– Protocol for Cycle Counter cleaning up a blood or a blood Number stained body fluid spill Time to reach Appendix 06 – Principles for holding temp good waste handling Temp during holding period Appendix 07– Template Pressure during protocol for environmental holding period cleaning of premises Total time at holding temp/pressure Appendix 08– Tattooing/body Water drained at piercing consent form end of day where appropriate Appendix 09– Aftercare follow- Process check up record sheet used
Appendix 10 – Printout attached Decontamination requirements for equipment used in tattooing Initials of authorised user and skin piercing
Appendix 11– Equipment Weekly Safety Test Yes/No Comments Door seals secure sterilization standard- self assessment and decision Door safety devices making tool for tattoo and body functioning correctly Safety Valves operating correctly piercing practitioners Yearly service by a competent Appendix 12 – Equipment engineer and body piercing jewellery Comments sterilization standard for tattooists and body piercers Name Date Signature
Appendix 13– Autoclave daily record sheet PLEASE KEEP THESE RECORDS IN A RING BINDER FOR SELF AUDIT/INSPECTION
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54 This document comprises of 1 page Tattooing and body piercing guidance
PART C – Leaflet 01
Toolkit Tattoo aftercare
Click on text to view Click to download PDF Leaflet 01 – Tattoo aftercare
Leaflet 02 – Ear and face piercing aftercare Tattoo aftercare Leaflet 03 – Oral piercing Key Advice Hand washing Signs of infection aftercare Hand washing is the single most If appropriate aftercare is not followed The aftercare following a tattoo important method of reducing infection. infection may occur. The signs of is important to promote good Hands must be washed prior to touching infection are: Leaflet 04 – Body and surface the affected area, therefore reducing the healing and prevent the risk of risk of infection. HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh piercing aftercare infection. around the wound. Wash your hands in warm water and liquid soap, always dry your hands 6hZkZgZWjgc^c\VcYi]gdWW^c\ Leaflet 05 – Genital piercing For the first week or so it is thoroughly with a clean towel or paper sensation round the site. normal for the area to be red towel. This should remove most germs (female) aftercare >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an and tender. and prevent them being transferred to the affected area. painful to touch. Leaflet 06 – Genital piercing 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc As with all body art, infection is Tattoo aftercare with an offensive smell. a risk. To reduce these risks take (male) aftercare Good practice is to cover the tattooed HeZV`idndjgegVXi^i^dcZgdghZZ`bZY^XVa advice from your practitioner area with non-stick gauze which is then attention immediately if you suffer from secured with hypo-allergenic tape. Gauze Leaflet 07 – Microdermal regarding aftercare. any of the above or have any concerns permits ventilation and aids healing. regarding infection in your tattoo or if implants aftercare The risk of infection can be A tattoo covering a large area may there are any signs of an allergic reaction greatly reduced by good need to be covered with a sterile, non- to any of the products used. Poster – How to handwash general hygiene including: adhesive dressing, at least during your journey home. However, simply keeping the area clean and dry is likely to be the =VcYlVh]^c\WZ[dgZidjX]^c\ best approach. the tattoo A tattoo covering a large area may have plastic film wrap applied, this must be @ZZe^c\i]ZiViiddZY clean (taken straight from the pack and area covered with non-stick used immediately) and you should be advised when to replace this covering by gauze which is secured with your practitioner. hypo-allergenic tape. Any cream that you apply must be used from an appropriate pot/tube at home and you should wash your hands before application. Cream can be purchased from your practitioner or a pharmacist.
Antibiotic creams should not be used except if infection has occurred and under supervision of your Doctor.
For further advice or information: Contact your local Environmental Health Department, or your local Public Health England Health Protection Team This Information is provided by: Public Health England North West Public Health England East Midlands Tattoo and Piercing Industry Union
Your practitioner is:
June 2013
➲ Main contents
55 This document comprises of 1 page Tattooing and body piercing guidance
PART C – Leaflet 02
Toolkit Ear and face piercing aftercare
Click on text to view Click to download PDF Leaflet 01 – Tattoo aftercare
Leaflet 02 – Ear and face piercing aftercare Ear and face piercing aftercare Leaflet 03 – Oral piercing Key Advice Hand washing Note: Cartilage piercings occasionally form Hand washing is the single most important lumps commonly known as granulomas. aftercare The aftercare of body piercing method of reducing infection. Hands must This is just trapped fluid and can easily be is important to promote good be washed prior to touching the affected resolved using the heat and pressure from a healing and prevent the risk of area, therefore reducing the risk of infection. warm water compress once a day, replacing Leaflet 04 – Body and surface one of your daily cleanings. infection. Wash your hands in warm water and liquid piercing aftercare soap, always dry your hands thoroughly Expect some swelling and soreness from Healing times for piercing will with a clean towel or paper towel. This your new piercing. Any knock or bang can vary with the type and position should remove most germs and prevent cause swelling or soreness to flare up again throughout the healing phase. Leaflet 05 – Genital piercing of the piercing and vary from them being transferred to the affected area. person to person. A new piercing can be tender, itchy and Do not use cotton wool to clean the (female) aftercare slightly red and can remain so for a piercing as the fibres in the cotton wool For the first few weeks it is few weeks. A pale, odourless fluid may may get caught in the piercing. Leaflet 06 – Genital piercing normal for the area to be red, sometimes discharge from the piercing and Do not pick at any discharge and do form a crust. This should not be confused tender and swollen. not move, twist or turn the piercing (male) aftercare with pus, which would indicate infection. whilst dry. If any secreted discharge has Approximate healing times for the hardened then turning jewellery may Ear piercing aftercare cause the discharge to tear the piercing, Leaflet 07 – Microdermal various piercings are: Including Lobes/ Tragus/ Anti Tragus/ allowing bacteria to enter the wound and Conch/ Helix/ Snug/ Diath/ Industrial/ Rook/ prolonging the healing time. implants aftercare Ear lobe piercing – 6 to 8 weeks Translobal/ Transverse Lobe. Ear cartilage piercing – 6 to 8 weeks Do not use sunbeds for the first two weeks, or if you decide to then cover the Cheek piercing – 2 to 3 months Facial piercing aftercare Poster – How to handwash Including Eyebrow, Bridge, Jestum, Vertical wound area with a breathable plaster Eyebrow piercing – 2 to 4 months Labret, Septum/ Nostril. during tanning. Nose piercing – up to 6 months Do not swim for the first 24 hours Soak the piercing for a few minutes by following a piercing. Remember these times are submerging the area of skin containing the piercing in a clean jug or bowl containing Signs of infection approximate and will depend on a warm water solution (1/4 level teaspoon If appropriate aftercare is not followed how healthy you are and whether of preferably sea salt to an egg cup/shot infection may occur. The signs of you look after the piercing glass of warm water). Alternatively wet a infection are: properly until healed. clean cloth or gauze in the solution and HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh apply as a warm compress. This will soften around the wound. As with all body art, infection is any discharge and allow you to clean the entry and exit points of the piercing with 6hZkZgZWjgc^c\VcYi]gdWW^c\ a risk. To reduce these risks take a cotton bud or gauze. Once the discharge sensation round the site. advice from your practitioner is removed or softened then jewellery can >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an regarding aftercare. be gently moved so as to work a little warm painful to touch. water through the piercing. When cleaning 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc The risk of infection can be always tighten the ball on any bars by with an offensive smell. screwing the ball to the right. greatly reduced by good general Speak to your practitioner or seek medical hygiene including: Do this twice each day, preferably after attention immediately if you suffer from washing or bathing. any of the above or have any concerns =VcYlVh]^c\WZ[dgZidjX]^c\ regarding infection in your piercing or if the piercing. You can also use mild antibacterial solutions there are any signs of an allergic reaction and soaps to wash the wound site of an ear to any of the products used. @ZZe^c\i]Ze^ZgX^c\XaZVc# piercing. Ask your local pharmacist to advise you and always follow the manufacturers’ For further advice or information: instructions. If irritation, redness or drying Contact your local Environmental Health occurs discontinue use. Antibacterial wash is Department, or your local Public Health NOT suitable for nostrils, septum or vertical England Health Protection Team lips due to the tissue’s delicate nature. This Information is provided by: Dry the piercing using ONLY fresh disposable Public Health England North West paper towel/kitchen roll. A communal Public Health England East Midlands hand/bath towel should never be used. Tattoo and Piercing Industry Union
Your practitioner is:
June 2013
➲ Main contents
56 This document comprises of 1 page Tattooing and body piercing guidance
PART C – Leaflet 03
Toolkit Oral piercing aftercare
Click on text to view Click to download PDF Leaflet 01 – Tattoo aftercare
Leaflet 02 – Ear and face piercing aftercare Oral piercing aftercare Leaflet 03 – Oral piercing Key Advice Hand washing Do not pick at any discharge and do aftercare Hand washing is the single most important not move, twist or turn the piercing The aftercare of body piercing method of reducing infection. Hands whilst dry. If any secreted discharge has is important to promote good must be washed prior to touching the hardened then turning jewellery may Leaflet 04 – Body and surface affected area, therefore reducing the risk cause the discharge to tear the piercing, healing and prevent the risk of of infection. allowing bacteria to enter the wound piercing aftercare infection. and prolonging the healing time. Wash your hands in warm water and Healing times for piercing will liquid soap, always dry your hands Do not use sunbeds for the first two Leaflet 05 – Genital piercing vary with the type and position thoroughly with a clean towel or paper weeks, or if you decide to then cover the wound area with a breathable plaster of the piercing and vary from towel. This should remove most germs (female) aftercare and prevent them being transferred to during tanning. person to person. the affected area. Do not swim for the first 24 hours following a piercing. Leaflet 06 – Genital piercing For the first few weeks it is A new piercing can be tender, itchy and normal for the area to be red, slightly red and can remain so for a Special aftercare for tongue piercing (male) aftercare tender and swollen. few weeks. A pale, odourless fluid may For the first few days take care when sometimes discharge from the piercing eating and avoid spicy foods. An approximate healing times and form a crust. This should not be Leaflet 07 – Microdermal confused with pus, which would indicate Cold products such as ice and ice cream for oral piercing are: infection. can help reduce swelling. implants aftercare Tongue piercing – 2 to 4 weeks. Oral piercing aftercare Refrain from oral sex of any description Lip – 3 to 6 weeks For the internal healing of oral piercing until the piercing has fully healed. Poster – How to handwash Cheek – 2 to 3 months including all piercing of the tongue , lip and cheek Signs of infection Remember these times are If appropriate aftercare is not followed Gargle after each meal with an alcohol-free infection may occur. The signs of approximate and will depend mouthwash or a warm salt water solution infection are: (1/4 level teaspoon of preferably sea salt to on how healthy you are and HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh an egg cup/shot glass of warm water). whether you look after the around the wound. piercing properly until healed. For the external healing of oral piercing: 6hZkZgZWjgc^c\VcYi]gdWW^c\ including all piercings to the lip and cheek As with all body art, infection is sensation round the site. a risk. To reduce these risks take Wet a clean cloth or gauze in the warm >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an painful to touch. advice from your practitioner salt water solution and apply as a warm compress. This will soften any discharge 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc regarding aftercare. and allow you to clean the entry and exit with an offensive smell. points of the piercing with a cotton bud The risk of infection can be or gauze dipped into the warm salt water HeZV`idndjgegVXi^i^dcZgdghZZ`bZY^XVa greatly reduced by good general solution. Once the discharge is removed attention immediately if you suffer from hygiene including: or softened then jewellery can be gently any of the above or have any concerns moved so as to work a little warm water regarding infection in your piercing or if =VcYlVh]^c\WZ[dgZidjX]^c\ through the piercing. When cleaning there are any signs of an allergic reaction the piercing always tighten the ball on any bars by to any of the products used. screwing the ball to the right. @ZZe^c\i]Ze^ZgX^c\XaZVc# Do this twice each day, preferably after For further advice or information: washing or bathing. Contact your local Environmental Health Department, or your local Public Health Dry the piercing using ONLY fresh England Health Protection Team disposable paper towel/kitchen roll. A communal hand/bath towel should This Information is provided by: never be used. Public Health England North West Public Health England East Midlands Do not use cotton wool to clean the Tattoo and Piercing Industry Union piercing as the fibres in the cotton wool may get caught in the piercing.
Your practitioner is:
June 2013
➲ Main contents
57 This document comprises of 1 page Tattooing and body piercing guidance
PART C – Leaflet 04
Toolkit Body and surface piercing aftercare
Click on text to view Click to download PDF Leaflet 01 – Tattoo aftercare
Leaflet 02 – Ear and face piercing aftercare Body and surface piercing aftercare Leaflet 03 – Oral piercing Key Advice Hand washing Do not pick at any discharge and do aftercare Hand washing is the single most important not move, twist or turn the piercing The aftercare of body piercing method of reducing infection. Hands must whilst dry. If any secreted discharge has is important to promote good be washed prior to touching the affected hardened then turning jewellery may Leaflet 04 – Body and surface area, therefore reducing the risk of infection. cause the discharge to tear the piercing, healing and prevent the risk of allowing bacteria to enter the wound and piercing aftercare infection. Wash your hands in warm water and liquid prolonging the healing time. soap, always dry your hands thoroughly Do not wear tight clothing following Healing times for piercing will with a clean towel or paper towel. This nipple piercing Leaflet 05 – Genital piercing vary with the type and position should remove most germs and prevent of the piercing and vary from them being transferred to the affected area. Do not wear tight clothing e.g. tights, (female) aftercare belts or high waisted clothing after naval person to person. A new piercing can be tender, itchy and piercing as this may irritate the wound slightly red and can remain so for a and delay healing. Leaflet 06 – Genital piercing For the first few weeks it is few weeks. A pale, odourless fluid may Do not use sunbeds for the first two normal for the area to be red, sometimes discharge from the piercing and (male) aftercare form a crust. This should not be confused weeks, or if you decide to then cover the tender and swollen. with pus, which would indicate infection. wound area with a breathable plaster during tanning. Leaflet 07 – Microdermal Approximate healing times Body and surface piercing aftercare Do not swim for the first 24 hours for surface, navel and nipple including Nape, Horizontal Navel, Niple, following a piercing. implants aftercare piercing can be as long as Horizontal Eyebrow, Wrist, Anti-eyebrow, Signs of infection 6 months to 1 year. Madison, Chin, Vertical Bridge, Pubic, Poster – How to handwash Handweb and Prayer. If appropriate aftercare is not followed infection may occur. The signs of Remember these times are Soak the piercing for a few minutes by infection are: approximate and will depend submerging the area of skin containing the on how healthy you are and piercing in a clean jug or bowl containing HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh a warm water solution (1/4 level teaspoon around the wound. whether you look after the of preferably sea salt to an egg cup/shot 6hZkZgZWjgc^c\VcYi]gdWW^c\ glass of warm water). Alternatively wet a piercing properly until healed. sensation round the site. clean cloth or gauze in the solution and As with all body art, infection apply as a warm compress. This will soften >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an is a risk. To reduce these any discharge and allow you to clean the painful to touch. entry and exit points of the piercing with 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc risks take advice from your a cotton bud or gauze. Once the discharge with an offensive smell. practitioner regarding is removed or softened then jewellery can aftercare. The risk of infection be gently moved so as to work a little warm Speak to your practitioner or seek medical can be greatly reduced by good water through the piercing. When cleaning attention immediately if you suffer from always tighten the ball on any bars by any of the above or have any concerns general hygiene including: screwing the ball to the right. regarding infection in your piercing or if there are any signs of an allergic reaction Do this twice each day, preferably after =VcYlVh]^c\WZ[dgZ to any of the products used. washing or bathing. touching the piercing You can also use mild antibacterial solutions @ZZe^c\i]Ze^ZgX^c\XaZVc# and soaps to wash the wound site. Ask your local pharmacist to advise you and always follow the manufacturers’ instructions. For further advice or information: If irritation, redness or drying occurs Contact your local Environmental Health discontinue use. Department, or your local Public Health Dry the piercing using ONLY fresh disposable England Health Protection Team paper towel/kitchen roll. A communal This Information is provided by: hand/bath towel should never be used. Public Health England North West Public Health England East Midlands Do not use cotton wool to clean the Tattoo and Piercing Industry Union piercing as the fibres in the cotton wool may get caught in the piercing.
Your practitioner is:
June 2013
➲ Main contents
58 This document comprises of 1 page Tattooing and body piercing guidance
PART C – Leaflet 05
Toolkit Genital piercing (female) aftercare
Click on text to view Click to download PDF Leaflet 01 – Tattoo aftercare
Leaflet 02 – Ear and face piercing aftercare Genital piercing (female) aftercare Leaflet 03 – Oral piercing Key Advice Hand washing Do not swim for the first 24 hours aftercare Hand washing is the single most following a piercing. The aftercare of body piercing important method of reducing infection. Do not pick at any discharge and do is important to promote good Hands must be washed prior to touching not move, twist or turn the piercing Leaflet 04 – Body and surface the affected area, therefore reducing the healing and prevent the risk of whilst dry. If any secreted discharge has risk of infection. piercing aftercare infection. hardened then turning jewellery may cause the discharge to tear the piercing, Healing times for piercing will Wash your hands in warm water and liquid soap, always dry your hands allowing bacteria to enter the wound and Leaflet 05 – Genital piercing vary with the type and position thoroughly with a clean towel or paper prolonging the healing time. of the piercing and vary from towel. This should remove most germs Refrain from any type of sexual activity (female) aftercare and prevent them being transferred to person to person. until the piercing has healed or is ‘dry’. the affected area. For the first few weeks it is Always use barrier protection such as Leaflet 06 – Genital piercing A new piercing can be tender, itchy and condoms, otherwise you are at increased normal for the area to be red, slightly red and can remain so for a risk of acquiring a sexually transmitted (male) aftercare tender and swollen. few weeks. A pale, odourless fluid may infection. sometimes discharge from the piercing The healing time for a and form a crust. This should not be Signs of infection Leaflet 07 – Microdermal genital piercing can be from confused with pus, which would indicate If appropriate aftercare is not followed infection. implants aftercare 2 to12 weeks. infection may occur. The signs of Remember these times are Female Genital piercing aftercare infection are: Poster – How to handwash approximate and will depend including Clitoral Hood, Inner and Outer HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh on how healthy you are and Labia, Fourchette, Christina and Triangle. around the wound. whether you look after the Soak the piercing for a few minutes by 6hZkZgZWjgc^c\VcYi]gdWW^c\ piercing properly until healed. submerging the area of skin containing sensation round the site. the piercing in a clean container, such as As with all body art, infection is a bowl containing a warm water solution >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an a risk. To reduce these risks take (1/4 level teaspoon of preferably sea salt painful to touch. to an egg cup/shot glass of warm water). advice from your practitioner Alternatively wet a clean cloth or gauze 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc regarding aftercare. in the solution and apply as a warm with an offensive smell. compress. This will soften any discharge The risk of infection can be and allow you to clean the entry and exit Speak to your practitioner or seek medical greatly reduced by good points of the piercing with a cotton bud attention immediately if you suffer from any of the above or have any concerns general hygiene including: or gauze. Once the discharge is removed or softened then jewellery can be gently regarding infection in your piercing or if =VcYlVh]^c\WZ[dgZ moved so as to work a little warm water there are any signs of an allergic reaction to any of the products used. touching the piercing through the piercing. When cleaning always tighten the ball on any bars by @ZZe^c\i]Ze^ZgX^c\XaZVc# screwing the ball to the right. Do this twice each day, preferably after washing or bathing.
Dry the piercing using ONLY fresh For further advice or information: disposable paper towel/kitchen roll. Contact your local Environmental Health A communal hand/bath towel should Department, or your local Public Health never be used. England Health Protection Team Do not use antibacterial products as This Information is provided by: they can kill the good bacteria that are Public Health England North West naturally present. Public Health England East Midlands Tattoo and Piercing Industry Union
Your practitioner is:
June 2013
➲ Main contents
59 This document comprises of 1 page Tattooing and body piercing guidance
PART C – Leaflet 06
Toolkit Genital piercing (male) aftercare
Click on text to view Click to download PDF Leaflet 01 – Tattoo aftercare
Leaflet 02 – Ear and face piercing aftercare Genital piercing (male) aftercare Leaflet 03 – Oral piercing Key Advice Hand washing Do not use antibacterial products as Hand washing is the single most important they can kill the good bacteria that are aftercare The aftercare of body piercing method of reducing infection. Hands naturally present. is important to promote good must be washed prior to touching the Do not swim for the first 24 hours Leaflet 04 – Body and surface healing and prevent the risk of affected area, therefore reducing the risk of infection. following a piercing. piercing aftercare infection. Wash your hands in warm water and liquid Do not pick at any discharge and do Healing times for piercing will soap, always dry your hands thoroughly not move, twist or turn the piercing Leaflet 05 – Genital piercing vary with the type and position with a clean towel or paper towel. This whilst dry. If any secreted discharge has of the piercing and vary from should remove most germs and prevent hardened then turning jewellery may (female) aftercare them being transferred to the affected area. cause the discharge to tear the piercing, person to person. allowing bacteria to enter the wound and A new piercing can be tender, itchy and prolonging the healing time. For the first few weeks it is Leaflet 06 – Genital piercing slightly red and can remain so for a normal for the area to be red, few weeks. A pale, odourless fluid may Refrain from any type of sexual activity (male) aftercare tender and swollen. sometimes discharge from the piercing and until the piercing has healed or is ‘dry’. form a crust. This should not be confused Always use barrier protection such as The healing time for a with pus, which would indicate infection. condoms, otherwise you are at increased Leaflet 07 – Microdermal genital piercing can be from Male Genital piercing aftercare risk of acquiring a sexually transmitted 2 to12 weeks. infection. implants aftercare including glans penis piercing such as Remember these times are PA, Reverse PA, Apadravya, Ampallang, Signs of infection Dydoe and Frenum, as well as for other approximate and will depend If appropriate aftercare is not followed Poster – How to handwash piercings including Hafada, Scrotum, infection may occur. The signs of on how healthy you are and Foreskin and Guiche. whether you look after the infection are: Soak the piercing for a few minutes by piercing properly until healed. HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh submerging the area of skin containing around the wound. As with all body art, infection is the piercing in a clean container, such as a bowl containing a warm water solution a risk. To reduce these risks take 6hZkZgZWjgc^c\VcYi]gdWW^c\ (1/4 level teaspoon of preferably sea salt sensation round the site. advice from your practitioner to an egg cup/shot glass of warm water). regarding aftercare. Alternatively wet a clean cloth or gauze >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an in the solution and apply as a warm painful to touch. The risk of infection can be compress. This will soften any discharge greatly reduced by good and allow you to clean the entry and exit 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc with an offensive smell. general hygiene including: points of the piercing with a cotton bud or gauze. Once the discharge is removed or softened then jewellery can be gently Speak to your practitioner or seek medical =VcYlVh]^c\WZ[dgZ attention immediately if you suffer from touching the piercing moved so as to work a little warm water through the piercing. When cleaning any of the above or have any concerns regarding infection in your piercing or if @ZZe^c\i]Ze^ZgX^c\XaZVc# always tighten the ball on any bars by screwing the ball to the right. there are any signs of an allergic reaction to any of the products used. Do this twice each day, preferably after washing or bathing.
When cleaning always tighten the ball on For further advice or information: any bars by screwing the ball to the right. Contact your local Environmental Health Department, or your local Public Health Dry the piercing using ONLY fresh England Health Protection Team disposable paper towel/kitchen roll. This Information is provided by: A communal hand/bath towel should Public Health England North West never be used. Public Health England East Midlands Tattoo and Piercing Industry Union
Your practitioner is:
June 2013
➲ Main contents
60 This document comprises of 1 page Tattooing and body piercing guidance
PART C – Leaflet 07
Toolkit Microdermal implants aftercare
Click on text to view Click to download PDF Leaflet 01 – Tattoo aftercare
Leaflet 02 – Ear and face piercing aftercare Microdermal implants aftercare Leaflet 03 – Oral piercing Key Advice Hand washing Do not pick at any discharge and do Hand washing is the single most important not move, twist or turn the piercing aftercare The aftercare of body piercing method of reducing infection. Hands must whilst dry. If any secreted discharge has is important to promote good be washed prior to touching the affected hardened then turning jewellery may Leaflet 04 – Body and surface healing and prevent the risk of area, therefore reducing the risk of infection. cause the discharge to tear the piercing, allowing bacteria to enter the wound and infection. Wash your hands in warm water and liquid piercing aftercare soap, always dry your hands thoroughly prolonging the healing time. Microdermal implants or dermal with a clean towel or paper towel. This Do not wear clothing that will rub against anchors are small pieces of should remove most germs and prevent the piercing as this may irritate the Leaflet 05 – Genital piercing them being transferred to the affected area. wound and delay healing. jewellery made from titanium A new piercing can be tender, itchy and Do not use sunbeds for the first two (female) aftercare inserted into the skin with the slightly red and can remain so for a weeks, or if you decide to then cover the stem protruding above, onto few weeks. A pale, odourless fluid may wound area with a breathable plaster Leaflet 06 – Genital piercing which an attachment of your sometimes discharge from the piercing and during tanning. form a crust. This should not be confused Do not swim for the first 24 hours choice is fitted. This attachment with pus, which would indicate infection. (male) aftercare should remain in place for at following a piercing. Keeping the implant piercing clean least three months or until the The implant needs to be cleaned twice Accidental damage or loss of disc Leaflet 07 – Microdermal piercing has fully healed. Once it each day. Cleaning more frequently may Contact your practitioner if the implant damage the skin and slow down the gets caught in anything or the piercing has fully healed other pieces of becomes damaged. implants aftercare jewellery can be attached. healing process. Your practitioner may also advise you to soak the implant in warm salt In the unlikely event the disc breaks or Healing times for piercing will water twice a week. comes off, return to the practitioner and Poster – How to handwash have a new disk fitted immediately. If the vary with the type and position Make up a quantity of warm salt water solution (1/4 level teaspoon of preferably sea disc is not replaced the implant may get of the piercing and vary from salt to an egg cup/shot glass of warm water). lost under the skin and will require removal. person to person. Use a clean cloth or gauze dipped in the Signs of infection If appropriate aftercare is not followed For the first few weeks it is solution and apply as a warm compress and also to dab the area to make sure the infection may occur. The signs of normal for the area to be red, area under the disc is cleaned as this may infection are: tender and swollen. become encrusted. HlZaa^c\VcYgZYcZhhi]Vi^cXgZVhZh As with all body art, infection is This will soften any discharge and allow around the wound. a risk. To reduce these risks take you to clean the piercing points with a 6hZkZgZWjgc^c\VcYi]gdWW^c\ cotton bud or gauze dipped into the warm sensation round the site. advice from your practitioner salt water solution. >cXgZVhZYiZcYZgcZhhVcY^cXgZVh^c\an regarding aftercare. If the area around the implant becomes painful to touch. The risk of infection can be encrusted soak the piercing for a few minutes by submerging the area of skin 6cjcjhjVaY^hX]Vg\Z nZaadldg\gZZc greatly reduced by good general containing the piercing in a clean jug with an offensive smell. hygiene including: or bowl containing the warm salt water HeZV`idndjgegVXi^i^dcZgdghZZ`bZY^XVa solution and loosen the discharge using a =VcYlVh]^c\WZ[dgZidjX]^c\ attention immediately if you suffer from cotton bud or clean floss. any of the above or have any concerns the implant. Always dry the area thoroughly after regarding infection in your piercing or if cleaning your implant using ONLY fresh there are any signs of an allergic reaction @ZZe^c\i]Z^beaVciXaZVc# disposable paper towel/kitchen roll. to any of the products used. A communal hand/bath towel should For further advice or information: never be used. Contact your local Environmental Health Do not over clean the site as this may Department, or your local Public Health damage the skin around the implant England Health Protection Team Do not change the cap of the microdermal This Information is provided by: implant until fully healed. If in any doubt take Public Health England North West advice from your operator Public Health England East Midlands Do not use cotton wool to clean the Tattoo and Piercing Industry Union piercing as the fibres in the cotton wool may get caught in the piercing.
Your practitioner is:
June 2013
➲ Main contents
61 This document comprises of 1 page Tattooing and body piercing guidance
PART C – Poster
Toolkit How to handwash
Click on text to view Click to download PDF Leaflet 01 – Tattoo aftercare
Leaflet 02 – Ear and face piercing aftercare Leaflet 03 – Oral piercing How to Handwash? aftercare WASH HANDS WHEN VISIBLY SOILED! OTHERWISE, USE HANDRUB Leaflet 04 – Body and surface Duration of the entire procedure: 40-60 seconds piercing aftercare
Leaflet 05 – Genital piercing 0 1 2 (female) aftercare
Leaflet 06 – Genital piercing (male) aftercare Wet hands with water; Apply enough soap to cover Rub hands palm to palm; Leaflet 07 – Microdermal all hand surfaces; implants aftercare 3 4 5 Poster – How to handwash
Right palm over left dorsum with Palm to palm with fingers interlaced; Backs of fingers to opposing palms interlaced fingers and vice versa; with fingers interlocked;
6 7 8
Rotational rubbing of left thumb Rotational rubbing, backwards and Rinse hands with water; clasped in right palm and vice versa; forwards with clasped fingers of right hand in left palm and vice versa; 9 10 11
Dry hands thoroughly Use towel to turn off faucet; Your hands are now safe. with a single use towel;
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. WHO acknowledges the Hôpitaux Universitaires de Genève (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.
May 2009
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62 This document comprises of 1 page Tattooing and body piercing guidance
PART D
Toolkit Audit tool
Click to download Excel document
INFECTION CONTROL AUDIT FOR TATTOO AND BODY PIERCING PREMISES* NAME AND ADDRESS OF PREMISES: TELEPHONE NUMBER: OWNER/ LICENCEE’S NAME: OPERATOR’S NAME: EMAIL CONTACT DETAILS
TYPE OF PREMISES (please tick as applicable) Tattooing Body Piercing Other (please state):
DATE OF AUDIT: NAME OF AUDITOR:
Indicators met: 0 Indicators not met: 0 Indicators not applicable: 0 Overall score: -
This audit tool is to be used by practitioners, primarily, to enable good practice to be captured and documented. It can also identify best practice gaps which will need action to be taken using an action planning process. It can be used as a discussion point between practitioner and local authority officers, as to what practice gaps need to be prioritised.
Completion: Please allow approximately two hours to undertake the audit. In the "Met" column, record "Yes", "No" or "N/A" against all indicators.
To print all pages: Go to "print" and choose "entire workbook".
Calculating scores: Automatic - This tool will give you automated % scores for each standard, and an overall % score (above). However, this requires data to be entered electronically during or after audit.
Manual - Count up the number of 'Yes' answers and divide by the number of questions answered for that standard (excluding the "N/A"s), then multiply by 100 to get the percentage. To get the score for all the standards and for the audit overall, add the total number for each standard and divide by the number of questions and multiply by 100 to get the overall percentage.
*developed using Infection Prevention Society (IPS) audit tools for monitoring IC guidelines withing the community setting (2005); IPS self assessment audit for assessing implementation of HTM 01-05: decontamination in primary care dental practices and related infection prevention and control issues (2009); IPS audit tools for monitoring infection control standards (2004); International Scientific Forum on Home Hygiene (IFH) and IPS home hygiene -prevention of infection at home: a training resource for carers and their trainers (2003)
➲ Main contents
63 This document comprises of 15 work sheets Tattooing and body piercing guidance
PART E
Toolkit Literature reviews
Click to download Word document
Literature review on the epidemiology of
tattooing and its complications
V0.7
Dr Victor Aiyedun
Specialist Registrar,
Public Health Medicine
Supervised by
Dr Fortune Ncube
Consultant Epidemiologist,
Health Protection Agency, Colindale
1
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64 This document comprises of 46 pages