Online Medical Safety Course for Tattoo Artists
In Accordance with State Of [redacted], Department Of Health For Practicing And Operating Tattoo Establishments
(Section 381.00775, F. S., and Chapter 64E-28, F. A. C.)
(Original Title Redacted for Client Privacy)
[Designed and written by: Naheed A.]
Training Outline
Introduction
Creating living art is a unique talent, but it puts tattooists at risk of coming in contact with their client's blood. Tattooing is an invasive procedure that may expose artists to serious skin and blood infections. The skin protects us against many infections, such as hepatitis B virus, hepatitis C virus, or human immunodeficiency virus (HIV). Tattoo artists are also at risk of becoming infected through accidental cuts and punctures.
It is essential for tattoo artists to be fully aware of the potential dangers of their procedures and to understand the preventive measures that need to be taken to minimize the likelihood of infection. From wearing gloves to sanitizing tools and machines, there are ways to prevent these serious and often deadly diseases.
This course will discuss the things you, as a tattoo artist, can do to lessen the risks associated. It will also discuss ways to prevent cross-contamination and how to properly clean and sanitize tools and machines.
Objectives
After completing this course, participants should be able to:
Florida Regulations
Effective January 1, 2012, the Florida Department of Health implemented sections 381.00771 - 381.00791, Florida Statutes (F. S.), and The Practice of Tattooing. These statutes provide rules to provide the minimum standards relating to tattoo artists and tattoo establishments in accordance with Chapter 64E-28, Florida Administrative Code, particularly:
(effective January 1, 2012)
64E-28.003 Licensure Requirements for a Tattoo Artist
64E-28.004 Registration Requirements for a Guest Tattoo Artist
64E-28.005 Licensure Requirements for a Tattoo Establishment
64E-28.007 Operational Requirements for a Tattoo Establishment
64E-28.008 Operational Requirements for a Temporary Tattoo Establishment
64E-28.009 Standards of Practice for a Tattoo Artist or Guest Tattoo Artist
The Guide for Tattoo Establishment Operational Requirements will assist you with understanding what the operational requirements for a tattoo establishment are in order to pass an inspection in compliance with the abovementioned statutes and standards.
Definitions
Acquired Immunodeficiency Syndrome (AIDS) – Last stage of infection caused by the human immunodeficiency virus (HIV) (see HIV), which results in severe damage to the body’s immune system and leaves the body at higher risk of developing more serious conditions.
Antiseptic – A chemical agent that destroys or inhibits microorganisms on skin or tissue and limits/prevents their infections.
Bacteria – Microscopic organisms too small to see for the naked human eye capable of causing infections when a person is exposed to them under certain circumstances (e.g., open sores).
Bloodborne Pathogens/infections – Pathogenic microorganisms present in human blood (or other potentially infectious materials such as other body fluids) that can lead to serious infections and diseases.
Body Fluids – Fluids normally present in the body such as blood, mucous, sweat, saliva, urine, ooze from a festering sore, tears or vaginal/penile secretions that may contain infectious agents.
Definitions
Cleaning – Refers to the act of removing blood (and other body fluids), organic material, tissue, and dirt from the surface of an object by scrubbing with a brush, detergent, and water, therefore, reducing the presence of microorganisms.
Contamination – An item or surface that becomes infected by microorganisms.
Cross-contamination – The transfer of infectious agents from something contaminated to something clean or sterile (see sterilization) (e.g. from a contaminated surface to another clean one)
Detergent – A product that enhances the cleansing action of water or another solvent
Disinfectant – A chemical reagent that destroys microorganisms and infectious agents
Disinfection – The act of destroying or killing most microorganisms present on an object or surface
Gloves – Protective personal equipment (PPE) that must be worn to protect against exposure to blood and other body fluids. Disposable gloves are single-use gloves that are disposed of after each use.
Definitions
Hepatitis B virus (HBV) – Virus that causes hepatitis B disease, a serious liver infection; the virus can cause lifelong infection, cirrhosis, liver cancer, liver failure, and death. It takes 90 days (on average) to produce infection after the virus enters the virus
Definitions
Infection control – refers to practices and measures taken to minimize the risk of spreading infections; in tattoo establishments, transmission needs to be prevented from client to client, from client to tattooist, and from tattooist to client.
Infectious waste – Biological waste (that includes human waste, animal waste, and objects/materials) contaminated with blood and body fluids (e.g., used needles, syringes and other sharps) containing infectious microorganisms (major concerns are HBV, HCV and HIV).
Microorganism – Also called a microbe or germ (e.g., bactéria, virus or fungus).
Pathogen – A microorganism that can cause disease in humans.
Regulated infectious waste – Includes all waste potentially contaminated with disease-causing microorganisms, which presents a recognized infectious hazard to waste disposal workers and to the environment if appropriate measures are not taken.
Reusable – Instrument, material or object designated by the manufacturer as suitable for reuse or reprocessing. Opposite of single-use.
Definitions
Single-use – Instrument, material, or object designated for one use only and that must be discarded after use.
Sharps disposal container – Specially designed box with a lid that allows the safe disposal of needles and syringes.
Spillage kit – Set of equipment specifically designed to deal with cleaning up substances from objects and surfaces, of spills of all manner of substances, namely blood and body fluids
Sterilization – Process that destroys all forms of microbial life, including the most resistant forms, usually relying on heat, chemical, or gas
Standard precautions – Work practices that instruct everyone to assume that all blood and body fluids are potential sources of infection, regardless of perceived risk. Such measures involve the use of protective equipment and safe work practices as well as the correct disposal of potentially infected material.
Transmission – Process when someone with an infection passes it along to others.
Why do you need training?
The “Body Art Regulations Act” requires artists to be trained on bloodborne pathogens and common infections and disease prevention to provide safe and clean working settings to artists and clients.
The major components of the “Body Art Regulations Act” are:
The work area must be kept clean and sanitized.
Needles and other skin-penetrating objects must be sterile.
Tattoo artists and their clothing must be clean. Cuts, infections, or skin lesions must not be exposed.
Needles and other sharp objects, which may contain blood or body fluids, must be properly disposed of.
Privacy laws do not allow tattoo establishments to be aware of the client’s medical history or bloodborne pathogen status information. You should always assume that all clients can be a source of infection.
Anatomy of The Skin
The skin covers the entire external surface of the human body and provides a protective barrier against radiation, temperature, trauma, and microorganisms (that may cause infections, such as hepatitis B virus, hepatitis C virus, and human immunodeficiency virus HIV).
Anatomy of the skin:
Skin anatomy. Source: CDC
Creating Living Art (Tattooing)
Tattooing process. Source: The Guardian
Tattoos are created by injecting ink into the dermis layer of the skin that is showed through the epidermis (outer layer). Injection is done by a needle attached to a handheld tool that moves the needle up and down at a rate of several vibrations per minute.
Injection by needle opens intact skin, and use of a contaminated needle or ink can be a potential source of infection.
Intact skin = No risk.
Non-Intact Skin = Greater risk of infection.
Bloodborne Pathogens
Identification, Description, Mode Of Transmission, and Incubation Periods
WHAT ARE BLOODBORNE PATHOGENS (BBP)?
Pathogenic microorganisms present in human blood (or other potentially infectious materials such as other body fluids) can lead to diseases
Examples of primary concern (deadliest pathogens):
Human Immunodeficiency Virus (HIV)
Hepatitis B (HBV)
Hepatitis C (HCV)
Human Immunodeficiency Virus (HIV)
Single, red-colored H9-T cell infected by numerous mustard-colored HIV particles which are attached to the cell’s surface membrane. Source: NIAID.
Hepatitis B (HBV)
Reported cases of hepatitis B in the U.S. have generally declined from 1980 to 2014. Source: CDC
*Source: Hepatitis B Foundation
Hepatitis C (HCV)
Reported cases of hepatitis C in the U.S. are rapidly increasing since 2010. Source: CDC
Other bloodborne diseases
Zika Virus (left) and Ebola Virus (right) can be spread through contaminated blood or infectious body fluids.
Source: CDC / C.Goldsmith
Source: CDC / F. Murphy
Other bloodborne diseases
Examples:
RISK OF EXPOSURE / MODE OF TRANSMISSION:
Contamination sources:
• Blood
• Other potentially infectious materials (OPIM)
– Human body fluids
– Any unfixed tissue or organ from human
– Cultures, culture mediums, or other solutions
– Experimental animal blood, tissues, or organs infected with HIV or HBV
Source: Washington Hospitality Association
RISK OF EXPOSURE / MODE OF TRANSMISSION:
The spread of bloodborne pathogens occurs through:
In most work situations, transmission is most likely to occur because of accidental puncture from contaminated needles, broken glass, or other sharps; contact between broken or damaged skin and infected body fluids; or contact between mucous membranes and infected body fluids.
RISK OF EXPOSURE / MODE OF TRANSMISSION:
Anytime there is blood-to-blood contact with infected blood or body fluids, there is a slight potential for transmission. Unbroken skin forms an impermeable barrier against bloodborne pathogens. However, infected blood can enter your system through:
• Open sores
• Cuts
• Abrasions
• Acne
• Any sort of damaged or broken skin such as sunburn or blisters
Bloodborne pathogens may also be transmitted through the mucous membranes of the eyes, nose, and mouth. For example, a splash of contaminated blood to your eye, nose, or mouth could result in transmission.
RISK OF EXPOSURE / MODE OF TRANSMISSION:
How exposure occurs:
• Needlesticks
• Cuts from other contaminated sharps
• Contact of mucous membrane or broken skin with contaminated blood or OPIM
Examples:
Four Types Of Microorganisms:
Viruses, Fungi, Bacteria & Parasites
What Are They?
What Are Microorganisms?
Microorganisms are living organisms that are too small to see with the naked eye. The prefix ‘micro’ means 'very small’. These organisms grow in many places, including the air, soil, skin, and body.
Many microorganisms can help make life easier by cleaning up pollution, making food, and improving health. However, some microorganisms cause disease.
Source: News Medical
The Four Types Of Microorganisms
There are four main types of microorganisms that can affect your health: bacteria, viruses, fungi, and parasites. These microbes are all different organisms that exist in nature.
There are many different types of microorganisms. Some are harmful and cause diseases such as infections and cancer. Others are helpful and can benefit health by supporting digestion, helping the immune system fight disease, or aiding in nutrient absorption. Each type of microorganism has its own specific role to play in the body.
Source: ALTA Candles
1. VIRUS
Viruses are the simplest organisms on the planet. They are often smaller than a single strand of hair, but they can do a lot of damage. They can bring on a range of mild infections and serious diseases.
Viruses cannot grow or reproduce on their own; they must infiltrate another organism’s cells and take over their reproductive system to reproduce. Because of this, viruses can only be treated with antiviral medications, which target the invading organisms and prevent them from reproducing. While viruses are mostly known for their negative effects, they are also responsible for many of the vaccinations that keep people healthy.
Source: CDC
1. VIRUS
The Types of Viruses Include:
• Animal Viruses – Animal viruses can jump from animals to humans. Examples include the viruses that cause measles, chickenpox, and rabies.
• Bacteria-Like Viruses – Bacteria-like viruses are similar to bacteria in that they can’t reproduce outside of the host cells. Examples include hepatitis B, influenza, and streptococcus.
• Human Viruses – Human viruses are completely dependent on humans to reproduce. Examples include HIV, the virus that causes the common cold, and the viruses that cause chickenpox and shingles.
Influenza virus. Source: CDC
2. FUNGI
As the name suggests, fungi grow in a variety of environments, including soil, leaves, and decaying material. This makes fungi a very common microorganism; you can find them almost anywhere.
While you’re probably more familiar with mushrooms, fungi can also appear in a number of other forms, including mold. Healthy fungi are a necessary part of the ecosystem, but they can also be harmful to humans. When the spores grow in or on a person’s skin or in the lungs, they can cause infections.
Source: CDC
2. FUNGI
The Types Of Fungi Include:
• Plant Pathogenic Fungi - Plant pathogenic fungi attack plants and cause diseases like rust, which causes iron deficiency in plants.
• Animal Pathogenic Fungi - Animal pathogenic fungi infect animals, but very few of these fungi have been found in humans.
• Human Pathogenic Fungi - Human pathogenic fungi can cause a wide range of diseases, from athlete’s foot to ringworm to yeast infections.
Ringworm. Source: CDC
3. BACTERIA
Bacteria are single-celled microorganisms that are the most common and abundant microorganisms on Earth. Although they’re beneficial in some ways, they can also be harmful, causing diseases and infections.
Bacteria are extremely adaptable, allowing them to thrive in a wide range of environments. They can be found in soil, water, the air, and on the surfaces of many different types of materials. Bacteria are very small, so they can easily be inhaled into your lungs or ingested into your digestive tract.
Source: CDC
3. BACTERIA
The Types Of Bacteria Include:
• Animal Pathogenic Bacteria - Animal pathogens, like the types that cause tetanus and salmonella, can infect both animals and humans.
• Human Pathogenic Bacteria - Human pathogens, like the types of bacteria that cause diphtheria and tuberculosis, are present in almost every environment.
• Plant Pathogenic Bacteria - Plant pathogens infect plants, but very few of these bacteria have been found in humans.
Salmonella. Source: CDC
4. PARASITES
Parasites are organisms that live inside or on another organism, feeding off its nutrients. The host often suffers from the effects of the parasite’s feeding habits, and in some cases, parasites can prove fatal.
Parasites often need to find a host to reproduce, which makes them especially dangerous. They can infect humans, animals, and plants.
Source: Insider
4. PARASITES
The Types Of Parasites Include:
• Animal Parasites - Animal parasites include lice, fleas, and ticks.
• Human Parasites - Human parasites include intestinal worms, pinworms, and blood flukes.
• Plant Parasites - Plant parasites include fungi that infect plants, like rusts, which can also infect humans.
Giardiasis. Source: CDC
SUMMARY
Viruses, fungi, bacteria, and parasites are all types of microorganisms that can cause harm to humans. While viruses cannot survive outside of a host, fungi, bacteria, and parasites all live in or on a host’s body. While viruses cannot reproduce on their own, fungi, bacteria, and parasites need other organisms to survive. Viruses, fungi, bacteria, and parasites can all be harmful to humans, depending on the type of organism and the amount of exposure to them.
Diseases Caused by each Category associated with Tattooing
RISKS AND POTENTIAL DISEASES CAUSED BY TATTOOING
The process of tattooing can be risky if it is not performed correctly and safely. In fact, there are some risks that can lead to various diseases. The risk of contracting an infection increases when the procedure is not performed properly or by using unsterilized equipment.
Fortunately, there are various measures one can take to eliminate these risks and prevent the spread of disease associated with tattooing. In the next sections, we will discuss more about the risks associated with tattooing and the diseases caused by each class of microorganisms associated with this practice.
MOST COMMON INFECTION CAUSED BY TATTOOING
Methicillin-resistant Staphylococcus Aureus (MRSA), often referred to simply as “staph,” is a type of bacteria commonly carried on the skin or in the nose of healthy people. Sometimes, staph can cause an infection. Staph bacteria are one of the most common causes of skin infections in the United States. Most of these skin infections are minor and can be treated without antibiotics.
MRSA is transmitted most frequently by direct skin-to-skin contact or contact with shared items or surfaces that have come into contact with someone else's infection.
MRSA skin infections can occur anywhere, including tattoo parlors. However, some settings have factors that make it easier for MRSA to be transmitted. These factors are:
• frequent skin-to-skin contact
• compromised skin (cuts or abrasions)
• contaminated items and surfaces
• lack of cleanliness
1. VIRAL INFECTIONS
Viral infections are caused by viruses and are among the most common risks associated with tattooing.
>> It is recommended to practice safe tattooing procedures to reduce the risk of these infections.
Viral infections can be categorized into local or systemic infections. Local infections include skin infections, wound/tissue infections, and cellulitis. Systemic infections are rare and include meningitis, encephalitis, hepatitis, and acute respiratory distress syndrome (ARDS).
Cytomegalovirus.
Source: BSIP/Universal Images Group via Getty Images
•Skin infections - are the most common form of viral infection associated with tattooing. They are characterized by redness, swelling, and pain. These skin infections are caused by the herpes simplex virus and cytomegalovirus
•Wound/tissue infections - are also a type of viral infection that can occur as a result of toxins released by the virus. It happens when the client has an open wound or when the artist uses a dirty, unsterilized needle.
•Cellulitis - is a type of viral infection that affects the soft tissues below the skin and around joints and muscles. If left untreated, it can spread to the bloodstream and become very serious.
•Meningitis - is a type of viral infection that can lead to serious complications and even death if left untreated. It is caused by herpes simplex virus, cytomegalovirus, or varicella-zoster virus.
2. FUNGAL INFECTIONS
Fungal infections are caused by the presence of fungi and are among the most common risks associated with tattooing.
>> To reduce the risk of these infections, it is advised to use safe tattooing techniques.
Fungal infections can be categorized into local and systemic infections. Local infections include skin infections and wound/tissue infections. Meningitis, encephalitis, and arthrogryposis are examples of systemic infections.
Source: CDC
2. FUNGAL INFECTIONS
•Skin Infections - are the most common form of fungal infection associated with tattooing. They are characterized by redness, swelling, and pain. These skin infections are caused by dermatophytes and Tinea versicolor.
•Wound/Tissue Infections - are also a type of fungal infection that can occur when the artist uses a dirty, unsterilized needle.
•Meningitis - is a type of fungal infection that can lead to serious complications and even death if left untreated. It is caused by dermatophytes and Tinea versicolor.
Tinea corporis. ?Source: Cureus (DOI: 10.7759/cureus.21210
3. BACTERIAL INFECTIONS
Bacterial infections are caused by the presence of bacteria and are among the most common risks associated with tattooing.
>> However, they can be prevented by practicing safe tattooing procedures and disinfection strategies.
Bacterial infections can be categorized into local and systemic infections. Local infections include skin infections, wound/tissue infections, and cellulitis. Systemic infections are rare and include infectious diseases like sepsis, meningitis, and endocarditis.
Source: CDC
3. BACTERIAL INFECTIONS
4. PARASITIC INFECTIONS
Parasite/protozoan infections are caused by the presence of protozoa and are among the most common risks associated with tattooing.
>> It is recommended to practice safe tattooing procedures to reduce the risk of these infections.
Protozoan infections can be categorized into local and systemic infections. Local infections include skin infections and wound/tissue infections. Systemic infections are rare and include meningitis, encephalitis, and arthrogryposis.
Source: CDC
4. PARASITIC INFECTIONS
•Skin infections - are the most common form of protozoan infection associated with tattooing. They are characterized by redness, swelling, and pain. These skin infections are caused by Trichophyton rubrum and T. mentagrophytes.
•Wound/tissue infections - are also a type of protozoan infection that can occur when the artist uses a dirty, unsterilized needle.
•Meningitis - is a type of protozoan infection that can lead to serious complications and even death if left untreated. It is caused by Trichophyton rubrum and T. mentagrophytes.
Trichophyton rubrum. Source: CDC
SUMMARY
Diseases caused by various classes of microorganisms associated with tattooing range from bacterial and viral to fungal and protozoan infections. Skin or wound/tissue infections are among the most common diseases. Cellulitis or systemic infections are rarer. There is a risk of contracting an infection when the procedure is not performed properly or using unsterilized equipment, so you have to be careful. Therefore, it is important to practice safe tattooing procedures, such as using new, sterile equipment, disinfection, and proper disposal, to reduce the risk of contracting an infection and spreading it to others.
Contamination and Transmission in Tattoo Establishments
Before tattoo artist opens their doors to the public, they must be sure all the equipment is clean and sterile.
Contaminated equipment can cause infections, which may then be transmitted to customers.
In addition, unhygienic working conditions can lead to the spread of germs and bacteria in the air.
The staff at a tattoo establishment should be well-trained in infection control practices and should follow strict handwashing procedures.
Many states have passed laws that require tattoo artists to obtain a license and/or certification before they are allowed to work. This is intended to ensure that they are fully aware of health regulations and are able to keep themselves and their clients safe from infections.
Tattooists work in close proximity to each other, so there’s always a risk of contamination. Contamination usually occurs due to dirty surfaces; dirty equipment; cross-contamination (when one artist works on another artist’s client); and poor personal hygiene.
When it comes to transmission, it’s important to keep in mind that not everyone who gets a tattoo will become infected. However, if you do contract an infection, there’s a greater chance of passing it along to others due to conditions like poor hygiene or skin trauma.
What Is The Difference Between
Contamination And Transmission?
Contamination and transmission in tattoo establishments are two different things, but it can be hard to differentiate between the two. Both contamination and transmission can happen in any type of establishment, including tattoo studios.
Contamination is when dirt, bacteria, or germs make their way into a facility and cause an infection.
Transmission is when someone with an infection passes it along to others.
While contamination is typically easy to prevent, transmission is more difficult to prevent.
Example guidelines in tattoo procedures:
SUMMARY
The staff at a tattoo establishment should be well-trained in infection control practices. Often, tattoo artists are required to obtain a license and/or certification to be able to work.
Contamination is when microbes/microorganisms make their way into a facility and cause an infection whereas transmission is when someone with an infection passes it along to others.
Methods of Disease Prevention in Tattoo Establishments
Prevent Cross-Contamination
Cross-contamination is the act of spreading bacteria and viruses from one surface to another. Since bloodborne pathogens can live on objects and surfaces for up to a week, germs could be spread when surfaces are not disinfected the right way or if equipment is not cleaned and sterilized between clients.
Some examples of cross-contamination are:
• A tattooist places his tools on a counter that has not been disinfected and then uses the tools for a tattooing procedure without sterilizing them.
• A tattooist, while working on a client, answers the phone without removing her gloves. By not removing her gloves, the artist may spread bacteria and viruses from the gloves onto the phone. Other people using the phone could then be exposed to a disease.
GOLDEN RULE: WORK FROM THE CLEANEST AREA TOWARD THE DIRTIEST AREA
Sterilization and Disinfection
There are many misconceptions about what it means for a tattoo artist to sterilize their equipment. The most common misconception is that sterilization means that the artist must use brand-new equipment for each client. This is not true.
When people refer to sterilization, they mean that the artist is using equipment that has been cleaned to the point of being free of bacteria, viruses, and other microorganisms.
To sterilize equipment, it is first necessary to wash it thoroughly with soap and water. This serves to remove any visible dirt, debris, and oil (which can promote bacterial growth). Once the equipment is clean, it can be placed in an autoclave, which uses high-pressure steam to remove any remaining bacteria.
Tattoo Equipment
While your equipment doesn’t need to be new, it does need to be clean. New equipment can be sterile, but it might also be full of bacteria and other germs that were on the surface before the item was packaged. Used equipment needs to be cleaned thoroughly, but it also needs to be disinfected.
A tattoo machine consists of a power source, an oscillating unit, and a needle bar. The machine should be unplugged between each client to prevent the spread of germs. Other machine components, such as the foot pedal, cord, and plug, should be disinfected between clients. The power source of the machine (or the "cart", as it’s often called) should be thoroughly disinfected between clients. This can usually be done by wiping down the exterior of the cart with a bleach solution.
Tattoo Ink
Pigments suspended in water are used to make tattoo ink. The amount of pigment used in each formulation determines the color, while the amount of water used affects the consistency of the liquid.
Tattoo ink pigments are made from metals and minerals. The most common pigments are iron oxide and titanium dioxide. Ink particles are too small to see with the naked eye and can only be seen under a microscope. These particles enter the body when you get a tattoo and can cause infections and allergic reactions.
This is why it is important to choose a quality brand of tattoo ink that is free of impurities. The best way to prevent infection caused by ink is to make sure that it is sterile. Tattoo artists can sterilize ink by mixing it with ethyl alcohol and letting it sit for at least 24 hours.
Storage of equipment, inks, pigments, needles, tubes, etc.
It is essential for sterilized equipment to be stored in a way that keeps it dry and clean and protects the packaging from contamination. You should only handle sterilized packages with clean gloves.
Touching sterilized packages with bare hands or gloves that have been used in a body art procedure can result in cross-contamination. Pathogens can then be transferred to the sterilized equipment when the packages are opened.
Sterile packages should always be evaluated before use. An instrument should never be used if the package is wet, torn, or punctured.
Tattoo Aftercare Products
Aftercare products include ointments, sprays, and gels that are applied to the tattoo during the healing process. These products help remove dead skin, keep the tattoo moist, and prevent scabs, infections, and other skin irritations. Aftercare products must be sterile before they can be applied to a fresh tattoo.
This can be done by boiling the product for 10 minutes or by using a chemical sterilization solution. Aftercare products are not a substitute for proper hygiene during the healing process. It is still important to wash the tattoo with mild soap and water and to cover the tattoo with a clean bandage to avoid infection.
Aseptic Techniques In Tattoo Establishments
Aseptic practices are a set of measures and procedures that are used to reduce the risk of infection during a medical procedure.
If you own or work in a tattoo establishment and want to ensure your clients have the safest experience possible, it is important to implement aseptic techniques.
Aseptic practices are simple but effective methods that help reduce the risk of infection during tattooing. There are different types of aseptic techniques and different ways for you to implement them in your tattoo establishment.
Sterilization
Sterilization is a very important part of aseptic practices. When you sterilize medical instruments, it means that you kill pathogens such as bacteria.
The best way to sterilize tattoo equipment is to use a sterilization machine (e.g., steam sterilizer). It is important to note that not all machines are created equal. Some are designed to kill pathogens on different surfaces, and some are designed to destroy pathogens in a certain amount of time.
Make sure you purchase a steam sterilizer that kills bacteria and fungi on all surfaces that come into contact with the tattoo equipment in a specific amount of time. Once the sterilization process is complete, you can store your equipment in a clean, dry area away from sunlight.
Hand-Washing And Glove Use
Hand-washing is one of the most important aseptic techniques. You should encourage your employees to wash their hands with warm water and antibacterial soap before beginning their shift and each time they touch a new piece of equipment.
It is important to note that antibacterial soap is no more effective than general soap in reducing the risk of infection. General soap is sufficient to reduce the risk of infection and is much cheaper than antibacterial soap.
Gloves are another important aseptic technique that can protect your hands when you are in contact with blood or bodily fluids. Some people use non-sterile gloves while tattooing, and this can lead to the transmission of blood-borne diseases.
Hand-Washing And Glove Use
1. Pinch and hold the outside of the glove near the wrist area.
2. Peel downwards, away from the wrist, turning the glove inside-out.
3. With your “un-gloved” hand, slide your finger/s under the wrist of the remaining glove. Do not touch the outer surface of the glove.
4. Peel downwards, away from the wrist, turning your other glove inside-out.
5. Dispose of the contaminated gloves.
6. Wash your hands thoroughly with water and soap.
Source: Spectrum Health Lakeland
Use Of Single-Use Items
Medical instruments are sometimes cleaned and sterilized before they are used, but other times they are used once and thrown away. The same goes for some of the supplies used in a tattoo establishment, such as gloves, drapes, and foot pedals.
If there is a chance that blood or bodily fluids are contaminating your instruments, these items should be disposed of immediately after the procedure. Some items can be cleaned and reused, but it is important to check the manufacturer's instructions.
Disinfection of Tattoo
Equipment and Surfaces
Disinfection is another important aseptic technique that can be applied to tattoo equipment. The best way to disinfect tattoo equipment is to soak it in a disinfectant solution for several minutes (at least 20 minutes). Make sure the disinfectant solution has been approved by the FDA as a disinfectant for medical equipment.
Some disinfectants can leave a residue that can be harmful if it comes into contact with the skin. Disinfectants such as bleach and hydrogen peroxide do not leave a harmful residue and are effective in killing bacteria and other pathogens.
Ventilation And Airflow
The air in your tattoo establishment should be clean and free of airborne pathogens and dust. You can achieve this by installing a proper ventilation system and making sure that it is clean and free of cobwebs. You can also use air filters and air scrubbers to clean the air in your tattoo establishment.
Airflow is important to consider when designing a tattoo establishment. You want to make sure that there is a flow of air throughout the building and that no one is sitting in an area where there is no airflow. The areas where tattooing is being performed should have a slight breeze so that the particles in the air do not accumulate on the client's skin.
Example guidelines for sanitation:
Other precautions specific to tattooing include:
•checking gloves for pinhole tears during tattooing, since petroleum-based ointment erodes latex.
•pouring ink in advance, using clean tissue to open ink bottles during tattooing and preventing nozzles from touching contaminated surfaces.
•patting tubes dry after rinsing during color changes - never blowing excess water from them.
•spraying liquid soap into a tissue, not directly onto bleeding area, since blood can become airborne when the spray hits it.
•giving pens used for drawing on the skin, which should be medical grade and sterile, to the client.
SUMMARY
Aseptic techniques are a necessary part of any tattoo establishment. They help reduce the risk of infection, which is especially important for people who have existing health issues. Aseptic practices are simple but effective methods that can be applied in any establishment. Make sure that all equipment is sterilized, all surfaces are disinfected, and all procedures are performed in a clean and dry environment. If your tattoo establishment is following these practices, you can be sure that your clients will receive the safest tattoo possible.
Steps To Take Following an Exposure Incident
The first step following an exposure incident in a tattoo shop is to follow your employer’s Exposure Control Plan (ECP). It is written by the shop owner and describes the steps an employer will take to minimize employee exposure to bloodborne pathogens. The details included in an exposure control plan should be specific to each shop.
Therefore, your employer will likely have a specific process to follow after an exposure incident, and it is important to follow this process in order to minimize your risk of illness.
SUMMARY
An Exposure Control Plan usually identifies:
1.Potential hazards in the shop, and who is most likely to come in contact with them
2.How the employer will minimize the artists’ exposure to infectious material
3.List of tasks done in the shop and how you might be exposed to infectious material while performing them
4.How the shop owner will maintain medical records
5.How labels and signs will be used to protect everyone in the shop
6.What to do with sharps after using them on clients
7.The cleaning processes and safety routines of the shop
8.Who is in charge of making sure biohazard waste is disposed of properly
9.What related training you are being offered (shops usually offer BBP
training yearly)
1.If you are being offered a hepatitis B vaccine
2. What PPE you should be using, where it’s stored, and how to use it
3. Who reports needlestick injuries, and what needs to be done in reaction to them.
Source: OSHA
If your employer does not have an exposure control plan in place, the CDC recommends taking the following steps:
1. Discontinue work and get yourself to fresh air.
2. Assume that all materials may be contaminated, and take appropriate precautions (e.g., use protective clothing and gloves).
3. Wash exposed areas with soap and water and change out of potentially contaminated clothing.
4. Monitor yourself for symptoms and seek medical attention as needed.
SUMMARY
Following your employer’s exposure control plan is extremely important after an exposure incident because it should have all the necessary instructions on how to proceed after the incident.
If your employer does not have an exposure control plan: discontinue work, assume all materials are contaminated, clean exposed areas and seek medical attention as needed.
How To Properly Dispose of Contaminated Needles and Disposable Items
How to properly dispose of
contaminants and disposables
This can depend on a number of factors, including where you are, who you are disposing of the items with, and what items you are disposing of. However, there are some general guidelines you can follow to dispose of contaminated needles and disposable items safely and efficiently:
First, make sure you have the appropriate containers to transport the items. Sharps disposal containers must be closeable, puncture resistant, leak-proof, and labeled as well as durable enough to withstand transportation without damage. These features allow for safe disposal in a container that is familiar to all workers.
Disposable piercing needles, tattoo needles, and razors must be discarded into a sharps disposal container. Body artists must throw away used or contaminated sharps into a sharps disposal container. It is safer to put disposable razors into a sharps disposal container rather than the trash. This will protect the person changing or handling the trash bag from getting cut with a used razor. Sharps disposal containers must be kept in a place that is near a work area so artists can quickly and safely dispose of used sharps.
When handling or disposing a used sharp, tattooists and piercers should use a tool instead of their fingers to pick up or hold the sharp. This may reduce needlesticks.
If sharps disposal containers become full, they must be replaced so the containers do not spill over. An artist could get a needlestick if he or she throws away a sharp item into a full container. It is a good idea to replace sharps disposal containers when they are 2/3 full.
Sharps Incident Log:
Though regulations do not generally require a body artist to keep an injury log, a record of cuts from sharps can increase awareness of sharps-related injuries. An Incidence Log lets artists know how often sharps-related injuries happen and under what conditions.
The Sharps Injury Log should include at least:
•Date of the injury
•Type and brand of the device involved (syringe, suture needle)
•Department or work area where the incident occurred
•Explanation of how the incident occurred
Recording needlesticks and cuts from sharps also allow artists to learn from their mistakes and others' mistakes to help reduce exposures.
Second, transport the items safely and carefully using appropriate methods. It is important to avoid damaging the containers or exposing anyone involved in transporting the materials to any potential risks of contamination.
Third, once you have arrived at your final destination, dispose of the items in accordance with local regulations and procedures. This may involve incineration or chemical decontamination procedures, depending on the specifics of your situation.
Finally, make sure you properly document each step of the process so that all parties involved are aware of what actions were taken and by whom. This will help ensure that everyone is operating safely and legally throughout the entire disposal process.
SUMMARY
Be sure to dispose all contaminated and disposable material in closeable, puncture resistant, leak-proof, and labeled disposal containers.
When handling or disposing a used sharp, use a tool instead of their fingers to pick up or hold the sharp.
Transport the containers safely and carefully, following local regulations and documenting each step.
How To Properly Sterilize Tools Used During Procedures and Disinfect Surfaces Between Clients
After each procedure, tools and equipment should be cleaned and sterilized to prevent the spread of bloodborne diseases, such as HIV and hepatitis B and C. The CDC recommends that you follow these steps for cleaning and sterilizing your equipment:
1. Remove all blood, body fluids, and tissue from your instruments using an appropriate disinfectant.
2. Soak your instruments in a disinfectant solution for at least 20 minutes or use a sterilization machine (e.g., steam sterilizer) to kill all pathogens
3. Rinse your instruments thoroughly with clean water.
4. Dry your instruments using a clean towel or paper towel.
5. Store your instruments in a clean, dry area away from direct sunlight or other sources of heat or moisture that may damage the instruments.
After each procedure, surfaces should be disinfected. Follow these instructions:
1.Body artists should disinfect surfaces, such as the client's chair and counter space, between procedures.
2.Always check the labels of disinfectant to make sure it does not contain toxic components (e.g., glutaraldehyde) for body art environments.
3.The Environmental Protection Agency (EPA) has a list of registered disinfectants that are made to kill certain bacteria and viruses. Tuberculocidal disinfectants are best for cleaning surfaces contaminated with blood (because the germ that causes tuberculosis is one of the most difficult to kill, so it will eliminate HIV, HBD and HCD viruses)
4.Many disinfectants need to stay on surfaces for a specific amount of time to fully disinfect the surface before being wiped down. The instructions included with the disinfectant should note the amount of time needed to properly disinfect an area.
SUMMARY
Clean and sterilize tools and equipment and disinfect surfaces between procedures to prevent the spread of bloodborne diseases such as HIV, hepatitis B and C.
Soak your instruments in a disinfectant solution for at least 20 minutes, then rinse with clean water and dry carefully.
Use tuberculocidal disinfectants to clean surfaces and store your instruments in a clean and dry area.
How To Clean Up If There is a Spill Of Body Fluids In Tattoo Establishments
This is an extremely difficult situation to be in, and you will likely feel overwhelmed and unsure of how to proceed. Here are some easy-to-follow 5 steps that may help you clean up after a spill of body fluids in a tattoo establishment:
1. Remove any excess fluid with paper towels.
2. Use disinfecting wipes to clean up any remaining fluid.
3. Wipe down all surfaces with an anti-bacterial wipe.
4. Ensure that all surfaces are dry before resuming operations in the establishment.
5. Discard any contaminated materials in a safe manner, such as in a plastic bag that is clearly marked as biohazardous waste.
Most tattoo shops should have a spillage kit to deal with blood and body fluids spills. This kit contains all the relevant equipment should be readily available to deal with a spillage of body fluids. The kit should be kept in a designated place. Depending on the size of the establishment there may be more than one kit. The spillage kit should include:
• Sterile, unpowdered latex gloves or vinyl gloves
• Disposable plastic apron
• Disposable paper towels
• Waste bag
• Small container of general-purpose detergent
• Hypochlorite solution or granules (e.g. household bleach or milton) or Sodium Dichloroisocyanurate compound (NaDCC) (e.g. Presept, Sanichlor).
Specific steps to follow using spillage kit solutions: (for high-risk body fluids, e.g., blood)
• Prevent access to the area containing the spillage until it has been safely dealt with;
• Open the windows to ventilate the room if possible;
• Soak up excess fluid using disposable paper towels and/or absorbent powder;
• Cover area with kit solutions and leave for at least two minutes;
• Remove organic matter using the towels and discard;
• Clean area with detergent and hot water;
• Rinse area with water and dry thoroughly;
• Clean the bucket/bowl in fresh soapy water and dry;
• Discard protective clothing;
• Wash hands.
Specific steps to follow using detergent and water: (for low-risk body fluids, e.g., vomit)
• Prevent access to the area until spillage has been safely dealt with;
• Wear gloves and apron;
• Mop up organic matter with paper towels and/or absorbent crystals;
• Clean surface thoroughly using a solution of detergent and hot water and paper towels or
disposable cloths;
• Rinse the surface and dry thoroughly;
• Dispose of materials;
• Clean the bucket/bowl in fresh hot, soapy water and dry;
• Discard protective clothing;
• Wash hands.
SUMMARY
Use spillage kits available at your tattoo establishment. Follow 5 easy steps to clean up after a spill of body fluids:
1.Remove any excess fluid with paper towels.
2.Use disinfecting wipes to clean up remaining fluids
3.Wipe down all surfaces
4.Dry all surfaces before resuming operations
5.Discard any contaminated materials safely
Standard Precautions
Universal Precautions – which some tattoo artists refer to as a "sterile chain of events" – is a set of precautionary steps defined by the Center for Disease Control (CDC) to prevent the spread of disease.
All tattoo parlors must adhere to rules set by the Occupational Safety and Health Administration (OSHA) and Centers for Disease Control & Prevention (CDC). Tattoo parlors are subject to such regulations to prevent and reduce blood exposure generated during tattooing.
Tattoo artists are required by law to follow Universal Precautions for the safety of themselves and their clients. Any artist found not following this sterile chain of events can have their licensing and/or certification revoked. Any studio found not following the guidelines can be shut down.
ll tattoo parlors must adhere to rules set by the Occupational Safety and Health Administration (OSHA) and Centers for Disease Control & Prevention (CDC). Tattoo parlors are subject to such regulations to prevent and reduce blood exposure generated during tattooing.
Specifically, there are a number of precautions to take when working in a tattoo shop:
– First and foremost, you must always wash your hands thoroughly with soap and water before preparing any sterile supplies or instruments.
– You should also wear disposable gloves while tattooing.
– And last but not least, you must be aware of the risks associated with certain tattoo equipment, such as needles that are rusty or dirty, ink that has been sitting on the shelf for too long or that has dried out, and so on.
Universal precautions should be followed to ensure safety and protection:
•During work, the tattoo artist must wear barrier gowns, gloves, goggles or eyeglasses and face shield to avoid contact and exchange of body fluids. The gloves and barrier gowns, in particular, must be changed after each client.
•All materials applied to skin of clients must be from bulk, commercially-packaged, single-use containers only. This applies to dyes or pigments used in tattooing. It must be stored in an area away from toilets or other areas with high-contamination levels.
•Make sure to employ barrier protection whenever handling hazardous and sharps waste.
If you follow these precautions, you will be much more likely to prevent infections from spreading within the shop. To keep yourself safe, always ask for recommendations from other artists who have had experience working in the same shop.
SUMMARY
Follow the Universal Precautions ("sterile chain of events“) to prevent the spread of infectious diseases:
1) Wash your hands thoroughly with soap and water
2) Wear protective equipment while tattooing
3) Clean and disinfect equipment, tools and surfaces between procedures
4) Properly dispose of contaminated materials
5) Be aware of the risks
Inability to follow such criteria may lead to getting your licensing and/or certification revoked.
CONCLUSION
Tattooists are at risk of coming in contact with bloodborne pathogens (BBP) from their client's blood and/or body fluids, which may expose tattoo artists to serious skin and blood infections.
Artists can beexposed to a range ofinfectiousmicroorganismsanddiseasesduringthesetup, procedure, break down and clean-upstages. These exposure can occur through needle sticks, contact with dried blood on equipment and surfaces, blood splashes or through direct or indirect contact with client’s lesions.
Preventive measures (Standard Precautions) such as keeping a clean establishment, good hygiene/sanitizing practices andusing safe workmeasureshelpsensure a safe and professional environment for tattoo artists and clients.
RESOURCE/REFERENCES
https://www.floridahealth.gov/environmental-health/tattooing/tattoo-establishment.html
https://www.floridahealth.gov/environmental-health/tattooing/_documents/Chapter64E_28.pdf
https://www.cdc.gov/niosh/topics/body_art/stateregs/ca.html
http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_0251-0300/ab_300_bill_20111009_chaptered.htm
https://www.osha.gov/sites/default/files/Bloodborne_Pathogens_PPT_v-03-01-17.pptx
https://www.cdc.gov/niosh/docs/2007-138/
https://www.labor.nc.gov/documents/ig-007-guide-bloodborne-pathogens-workplace
http://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf
https://www.fda.gov/cosmetics/cosmetic-products/tattoos-permanent-makeup-fact-sheet
https://www.ajicjournal.org/article/S0196-6553(09)00832-3/fulltext
https://www.fda.gov/consumers/consumer-updates/think-you-ink-are-tattoos-safe
https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm
https://www.osha.gov/laws-regs/regulations/standardnumber/1904/1904.8
https://www.cdc.gov/niosh/topics/body_art/more-info.html
https://www.oshatrain.org/courses/studyguides/607studyguide.pdf
TEST / QUIZ
Next slide
This quiz is designed to allow you to self-check your comprehension of the concepts and ideas of this presentation.
It entails questions regarding all 11 modules addressed throughout this presentation.
Read each question carefully. Select the best answer, even if more than one answer seems possible
QUESTIONNAIRE
WITH
MULTIPLE CHOICE QUESTIONS
1. What are bloodborne pathogens (BBP)?
a) Deadly viruses that infect humans
b) Microorganisms created in the human bloodstream
c) Pathogenic microorganisms present in human body fluids
d) Blood stains
2. Which of the following is a BBP of primary concern (deadliest pathogen)?
a) Hepatitis B
b) Hepatitis D
c) Malaria
d) Relapsing fever
3. What kind of chronic disease is caused by an HIV infection?
a) Chronic liver disease
b) Pneumonia
c) Vascular Disease (Vasculopathy)
d) Acquired Immunodeficiency Syndrome (AIDS)
4. Why are HIV infections so destructive?
a) “Flu-like symptoms”
b) Incurable, long-lasting
c) Immune system is compromised
d) All of the above
5. What is the incubation period (on average) of Hepatitis B?
a) 3 days
b) 30 days
c) 90 days
d) 120 days
6. How much time can HBV survive in a drop of dried blood?
a) 1 day
b) 1 week
c) 1 month
d) 1 year
7. What is the most common bloodborne infection in the US?
a) HIV
b) Hepatitis B
c) Hepatitis C
d) Hepatitis D
8. Which of the following is a major symptom of HCD?
a) Yellow skin or eyes (jaundice)
b) Hair loss
c) Skin rash
d) Swollen feet
9. What are the contamination sources of bloodborne pathogens?
a) Blood only
b) Blood and other body fluids
c) Saliva only
d) Saliva and mucous secretions
10. Spread of bloodborne pathogens occurs through ________.
a) Direct contact (e.g., blood-to-blood contact)
b) Indirect contact (e.g. touching infected objected)
c) Vector-borne transmission (e.g., mosquito bite)
d) All of the above
11. In which of the following situations can infected blood enter your system?
a) Contact with open sore
b) Contact with undamaged skin
c) Broken leg injury
d) Contact with sterilized cup
12. What are microorganisms?
a) Dead organisms unable to harm human health
b) Microbes that only cause human infections
c) Microscopic organisms too small to see with the naked eye
d) Macroscopic organisms seen by the naked eye
13. Which of the following is one of main 4 types of microorganisms?
14. What is the most common infection caused by tattooing?
15. _______ is a type of systemic viral infection caused by cytomegalovirus that can lead to serious complications.
16. Practicing safe tattooing procedures and disinfection strategies _________.
a) Entertains the client
b) Reduces the risk of spreading infections
c) Causes bacterial and viral infections
d) Increases the risk of contracting infections
17. What safety procedures can reduce the risk of tattooing-related infections?
a) Using aftercare products that help the healing process
b) Using sterile equipment and ensure good ventilation
c) Disinfect surfaces and properly dispose contaminants
d) All of the above
18. What is the difference between contamination and transmission?
a) Transmission is easy to prevent but contamination is more difficult
b) Contamination is the act of passing pathogens to others
c) Transmission is when dirt, bacteria, or germs contaminate a facility and cause an infection
d) Contamination is the act of causing an infection due to contaminated surfaces or objects
19. _____ is the act of spreading bacteria and viruses from one surface to another.
a) Cleaning
b) Cross-contamination
c) Spraying
d) Pouring
20. If an artist is exposed to another person’s blood, they should immediately _____.
a) Notify the shop owner
b) Seek medical attention
c) Wash the infected area before calling for help
d) Both A and B are correct
21. The following are all precautions specific to tattooing, except _____.
a) Pouring ink in advance
b) Spraying liquid soap into a tissue
c) Keeping pens used for drawing on the skin for future use
d) Patting tubes dry after rinsing during color changes
22. Why should tattoo artists wash hands before and after wearing gloves?
a) Lessens the spread of viruses and bacteria
b) Sanitation purposes
c) To decrease the chance of infection
d) To protect the client
23. _____ techniques help reduce the risk of infections.
a) Septic
b) Aseptic
c) Microbial
d) Antimicrobial
24. What is the golden rule to avoid cross-contamination?
a) Work from the dirtiest area toward the cleanest area
b) Work from the cleanest area toward the dirtiest area
c) Rules set by my employer
d) Respect client’s requirements
25. One of the most important safety practices in tattooing is _______.
a) Hand-washing and glove use
b) Avoid blood spillage
c) Being client-driven
d) Advertise good health habits
26. A __________ is the best tool used to sterilize tattoo equipment.
a) Disinfectant solution
b) Sterilization machine
c) Hand dryer
d) Humid towel
27. What is the first step following an exposure incident?
a) Panic and warn everyone
b) Follow your employer’s exposure control plan
c) Contact medical authorities
d) Tell nobody and seek medical attention
28. After each procedure, tools and equipment should be ______.
a) Cleaned and sterilized
b) Sprayed with water and dried
c) Immediately ready for the next client
d) Disposed of
29. In what kind of area should tattooing tools and equipment be stored in?
a) Humid and sunny area
b) Dry and sunny area
c) Clean and dry area
d) Clean and humid area
30. When should a tattoo artist disinfect surfaces?
a) Only at the end of workday
b) Between procedures
c) Only in the morning and before clients arrive
d) In the middle of a procedure
31. _________ disinfectants are best for cleaning surfaces contaminated with blood.
a) Bactericidal
b) Tuberculocidal
c) Antifungal
d) Water-based
32. Tattoo equipment and tools should be soaked in a disinfectant solution for at least ______.
a) 5 minutes
b) 10 minutes
c) 20 minutes
d) 30 minutes
33. How to properly dispose of contaminated needles and disposables?
a) Place them in sharps disposal containers next to you
b) Reuse them as needed
c) Ask a colleague to dispose of the material
d) Place them in disposal containers far away from the client
34. Which of the following characteristics are needed in disposal containers?
a) Spacious and waterproof
b) Closeable, puncture-proof and leak-proof
c) Only labelled as such, no matter the format
d) No requirements
35. How should you transport your disposal containers?
a) Safely and carefully
b) Documenting each step
c) According to local regulations
d) All of the above
36. The Sharps Injury Log must include all of the following, except _____.
a) Date of the injury
b) Name of the employee
c) Explanation of how the incident occurred
d) Department where the incident occurred
37. Which of the following should a spillage kit contain?
a) Disposable paper towels and waste bag
b) Water and soap
c) New tattooing equipment
d) All of the above
38. Why should a tattoo artist use a tool instead of their fingers to pick up or throw away a used needle?
a) Reduces needlesticks
b) Protects the client
c) Protects the tattoo artist
d) It is easier
39. What are the basics of standard precautions?
a) Complying with the rules of the tattoo parlor
b) Using gloves, disinfecting all surfaces and prevent cross-contamination
c) Carefully following client’s instructions
d) Having a valid license to practice
40. What would happen to a tattoo artist who does not follow universal precautions?
a) They will receive a warning from OSHA
b) Their licensing can be revoked
c) Their certification can be revoked
d) Both B and C are correct