APP Manual Layout.indd - Association of Professional Piercers
APP Manual Layout.indd - Association of Professional Piercers
APP Manual Layout.indd - Association of Professional Piercers
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UPDATED AFTERCARE BROCHURES<br />
Newly reformatted with additions reflecting new trends and<br />
frequently asked questions from <strong>Piercers</strong> and Piercees<br />
alike.<br />
NEW AFTERCARE:<br />
• Clear concise instructions on cleaning<br />
• "Less is more" message<br />
• More information on jewelry issues<br />
• Facial piercings now covered in Oral Aftercare instructions<br />
NEW FORMAT/DESIGNS:<br />
• Cohesive appearance <strong>of</strong> all <strong>APP</strong> brochures<br />
• Eye-catching and aesthetically pleasing<br />
• Pr<strong>of</strong>essional image to support <strong>APP</strong> standards<br />
The new brochures are available for sale on the <strong>APP</strong> web site<br />
(www.safepiercing.org) for $20 per 100, postage paid.<br />
Subjects include:<br />
• Aftercare Guidelines for Facial and Body Piercing*<br />
• Aftercare Guidelines for Oral Piercing*<br />
• Picking Your Piercer*<br />
• Troubleshooting for You and Your Healthcare Pr<strong>of</strong>essional<br />
(with jewelry removal tips and hints)<br />
• Oral Piercing Risks and Safety Measures<br />
*Available in Spanish<br />
FREE SAMPLES AVAILABLE UPON REQUEST<br />
Order by fax or phone (888) 888-1<strong>APP</strong><br />
or visit our website: www.safepiercing.org<br />
MARK YOUR CALENDARS!<br />
The annual <strong>APP</strong> Conference and Exposition takes place every<br />
year in beautiful Las Vegas, Nevada.<br />
There are classes <strong>of</strong>fered in everything from piercing technique to<br />
marketing, current industry legislation to accounting, studio setup<br />
to aftercare. There is something for everyone, from the first<br />
time attendee to the long term shop owner, with classes geared<br />
specifically for health care pr<strong>of</strong>essionals.<br />
The exposition includes venders from all segments <strong>of</strong> the body<br />
piercing industry from the United States and abroad. Thousands<br />
<strong>of</strong> items are available at the year’s largest gathering <strong>of</strong> manufacturers<br />
and distributors directly targeting the body piercing market.<br />
For updates about the conference please visit:<br />
www.safepiercing.org<br />
or call (505) 242-2144 or (888) 888-1<strong>APP</strong>
THE ASSOCIATION OF PROFESSIONAL PIERCERS MANUAL<br />
U.S. EDITION CONTENTS<br />
WHAT IS THE <strong>APP</strong>? ............................................................................................................................. 1<br />
INTRO TO MICROBIOLOGY FOR THE PIERCER ............................................................................... 5<br />
INFECTION CONTROL ......................................................................................................................... 9<br />
STERILE CHART ................................................................................................................................ 14<br />
CLEANING, DISINFECTION AND STERILIZATION .......................................................................... 15<br />
EQUIPMENT ....................................................................................................................................... 19<br />
ENVIRONMENT .................................................................................................................................. 25<br />
SKIN PREPARATION ......................................................................................................................... 29<br />
AFTERCARE ........................................................................................................................................31<br />
PIERCING HEALING TIMES .............................................................................................................. 35<br />
JEWELRY ............................................................................................................................................ 37<br />
ETHICS AND LEGALITIES ................................................................................................................. 43<br />
COMPLIANCE AND TRAINING ..........................................................................................................49<br />
EMERGENCIES .................................................................................................................................. 53<br />
AFTERWARD ...................................................................................................................................... 58<br />
GLOSSARY ......................................................................................................................................... 59<br />
UNDERSTANDING MSDS .................................................................................................................. 63<br />
<strong>APP</strong>ENDIX A - FULL TEXT OF BLOODBORNE PATHOGENS STANDARD 1910.1030 .................. 65<br />
<strong>APP</strong>ENDIX B - HEPATITIS B VACCINE DECLINATION (MANDATORY) ......................................... 77<br />
<strong>APP</strong>ENDIX C - <strong>APP</strong>LICATIONS FOR MEMBERSHIP ........................................................................ 79<br />
This manual was fi rst published in 1998 and was revised in 2002 and 2005.<br />
Previous edition credits are extended to:<br />
Gahdi Elias, Allen Falkner, Tracy Faraka, Kent Fazekas, Michaela Gray, Drew Lewis, Cheyenne Morrisson, David Vidra,<br />
Dr. Jack Ward [Original Edition]; and to: Elayne Angel, Scott Brewer, Steve Joyner, Lisa Lystad, M.D., Patrick McCarthy,<br />
Sky Renfro, Bethra Szumski, April Williams-Warner, Dr. Jack Ward [2002 Edition].<br />
Contributors to the 2005 edition include: Elayne Angel, Alicia Cardenas, Luis Garcia, Phish Goldblatt, Schane Gross, April<br />
Johnson, Jason King, Paul King, Megg Mass, Christina Shull, Crystal Sims, Bethra Szumski, James Weber, and the intrepid<br />
Caitlin McDiarmid.<br />
Some cover photos courtesy <strong>of</strong> Evolution Body Piercing, Inc.<br />
Cover design by Paul Romano, www.workhardened.com<br />
Copyright © 1998, 2002, 2005. All rights reserved. The goal <strong>of</strong> the <strong>Association</strong> <strong>of</strong> Pr<strong>of</strong>essional <strong>Piercers</strong> is to circulate vital<br />
health, safety and educational information to the piercing industry, health care workers and the general public. This manual<br />
is copyrighted under Federal Law. Any reproduction <strong>of</strong> its contents is prohibited without prior written permission. For specifi c<br />
reprint permissions, please contact us directly.
WHAT IS THE <strong>APP</strong>?<br />
The <strong>Association</strong> <strong>of</strong> Pr<strong>of</strong>essional <strong>Piercers</strong> (<strong>APP</strong>) is an<br />
international health and safety organization dedicated<br />
to the dissemination <strong>of</strong> information about body piercing.<br />
We are a fully voluntary and nonpr<strong>of</strong>i t alliance <strong>of</strong> individuals<br />
and corporations concerned about the safety<br />
and standards <strong>of</strong> the body piercing industry.<br />
Governed by an elected Board <strong>of</strong> Directors, the<br />
<strong>APP</strong> unites piercing pr<strong>of</strong>essionals who freely share<br />
resources to help fellow members, piercers, healthcare<br />
pr<strong>of</strong>essionals, health inspectors, and the public access<br />
the most current and accurate information about our<br />
art form and its procedures.<br />
THE ORIGINS OF THE <strong>APP</strong><br />
In 1994, representatives from several piercing studios<br />
organized a political action group in response to problematic<br />
legislation in California (Proposition AB101).<br />
The organization quickly grew to accommodate members<br />
nationwide and around the world, becoming the<br />
world’s largest body piercing education facilitator and<br />
providing invaluable organization and representation<br />
for the piercing pr<strong>of</strong>ession.<br />
WHAT IS THE PURPOSE OF<br />
THIS MANUAL?<br />
This manual is intended as a reference and study aid for<br />
all people who care about the promotion and practice <strong>of</strong><br />
responsible body piercing -- including piercers, health<br />
<strong>of</strong>fi cials, legislators, medical and insurance pr<strong>of</strong>essionals,<br />
and members <strong>of</strong> the general public. Those<br />
in countries other than the US are invited to use this<br />
manual as a guide, keeping in mind that regulations,<br />
available products and industry standard techniques<br />
may vary by location. Please consult with pr<strong>of</strong>essional<br />
piercing associations in your own country.<br />
WHAT ARE THE LIMITATIONS<br />
OF THIS MANUAL?<br />
The following manual is not a training course or a formula<br />
to make one an instant piercer. This manual is<br />
intended to provide a basic overview <strong>of</strong> the health and<br />
safety concerns faced by all body piercers and to <strong>of</strong>fer<br />
guidelines that minimize expected risks. This manual is<br />
not a substitute for formal training and education.<br />
Although this manual is updated periodically, information<br />
in this edition may not be current or appropriate<br />
for your individual practice. It is imperative that each<br />
piercer seek out and evaluate new health and safety<br />
techniques and products with reference to his/her own<br />
practice and local circumstances. For recent updates<br />
to this information, please see our website.<br />
While this manual and its information, suggestions<br />
and guidelines are <strong>of</strong>fered for use throughout the world,<br />
this version is specifi cally designated as the “USA Edition.”<br />
We recognize that laws vary and not all products,<br />
chemical formulas, tools and jewelry types are readily<br />
available or desirable everywhere. As a result, we <strong>of</strong>fer<br />
the USA Edition as a general foundation and encourage<br />
<strong>APP</strong> members in other areas <strong>of</strong> the world to update,<br />
clarify and edit this version (with permission) to be<br />
appropriate to their region.<br />
THE <strong>APP</strong>:<br />
• Provides a pr<strong>of</strong>essional association and peer support<br />
for piercers.<br />
• Publishes a quarterly newsletter dedicated to piercing-related<br />
news, research and information to keep<br />
geographically dispersed individuals current in the<br />
industry.<br />
• Standardizes and publicizes industry procedures and<br />
protocols regarding hygiene, quality and education,<br />
and assists piercers in meeting and/or exceeding<br />
these standards.<br />
• Provides support and assistance in implementation<br />
<strong>of</strong> appropriate legislation for the industry.<br />
• Provides piercing, business, health and safety education<br />
through annual conferences for piercers, health<br />
inspectors, and others related to the industry.<br />
• Promotes consumer education and public understanding<br />
<strong>of</strong> body piercing practices through educational<br />
lectures, publications, staffed phone and email<br />
lines, a comprehensive website and media relations.<br />
(See the inside front cover <strong>of</strong> this manual for more<br />
information.)<br />
1
• Promotes alliance between the piercing and healthcare<br />
industries through cross-attendance at healthrelated<br />
conferences and lectures, joint publications<br />
and research, resource sharing and ongoing<br />
dialogue.<br />
• Does not police the piercing industry or piercers. The<br />
<strong>APP</strong> will, however, respond to and resolve complaints<br />
against its members and claims <strong>of</strong> membership which<br />
are invalid.<br />
• Does not license or certify piercers. Members do<br />
receive a certifi cate <strong>of</strong> membership which must be<br />
renewed annually. Attendees <strong>of</strong> <strong>APP</strong> classes receive<br />
a certifi cate <strong>of</strong> seminar participation.<br />
• Does not teach people “how to pierce” or perform<br />
piercings at its functions. The <strong>APP</strong> provides supplemental<br />
education to piercers and has Corporate<br />
Members who provide basic piercing education.<br />
• Does not dictate the piercing technique(s) or products<br />
its members use, what aftercare they suggest, or<br />
what specifi c piercings they may choose to perform,<br />
provided they respect local laws and regulations.<br />
• Addresses only the practice <strong>of</strong> body piercing. The<br />
<strong>APP</strong> does not have a position on tattooing, branding,<br />
scarifi cation, dermal punching, scalpeling, implants,<br />
or other types <strong>of</strong> body modifi cation where they are<br />
allowed by law.<br />
MEMBERSHIP<br />
The <strong>APP</strong> has fi ve types <strong>of</strong> memberships:<br />
2<br />
• Pr<strong>of</strong>essional Business Member<br />
• Pr<strong>of</strong>essional Business Member-at-Large<br />
• Associate Member<br />
• Corporate Member<br />
• Patron Member<br />
Pr<strong>of</strong>essional Business Members and Pr<strong>of</strong>essional<br />
Business Members at Large:<br />
• Are body piercers;<br />
• Uphold a set <strong>of</strong> safety and hygiene standards that are<br />
equal to, or more stringent than those established by<br />
state or local governments;<br />
• Have at least one year <strong>of</strong> pr<strong>of</strong>essional piercing experience;<br />
• Have knowledge <strong>of</strong> appropriate sterilization and<br />
cross-contamination prevention through Bloodborne<br />
Pathogens Training, required annually for membership;<br />
• Work in a studio that meets current environmental<br />
criteria for hygiene, safety, and ethical practice;<br />
• Undergo training and certifi cation in CPR, Bloodborne<br />
Pathogens, and First Aid, renewed according<br />
to membership requirements;<br />
• Must provide monthly spore test results for their<br />
studio’s autoclave(s) (sterilizer)<br />
• Must sign the <strong>APP</strong> Health and Safety Agreement and<br />
answer an extensive questionnaire to prove knowledge<br />
<strong>of</strong> and adherence to current best practice.<br />
Associate Members:<br />
• Are either piercers with less than one year <strong>of</strong> pr<strong>of</strong>essional<br />
experience, or non-piercing employees in a<br />
piercing studio (owners, counter people);<br />
• If beginning piercers, must meet the same standards<br />
as our Business Members;<br />
• If non-piercers, must work in a studio that meets<br />
studio requirements;<br />
• Must work in a studio which has at least one <strong>APP</strong><br />
Business member on current staff.<br />
Corporate Members:<br />
• Are companies that provide support services to<br />
the piercing industry; Some examples <strong>of</strong> Corporate<br />
Members are health and technical educators, medical<br />
supply companies, jewelry wholesalers and insurance<br />
companies;<br />
• Must provide a letter <strong>of</strong> intent;<br />
• Must provide documentation regarding their business,<br />
including jewelry samples if applicable.<br />
Patron Members:<br />
• Are individuals who work outside the piercing industry<br />
and who support the <strong>APP</strong> and its goals.<br />
HOW DO I BECOME A MEMBER?<br />
A full list <strong>of</strong> membership requirements, including<br />
personal and environmental criteria, is included in<br />
the Appendix. This includes the Application for <strong>APP</strong><br />
Membership, Health and Safety Agreement and Ques-
tionnaire. For questions please contact us directly at<br />
info@safepiercing.org.<br />
<strong>APP</strong> PUBLICATIONS, PROD-<br />
UCTS AND EDUCATIONAL<br />
SERVICES:<br />
• Brochures for piercers, educators, consumers, and<br />
healthcare personnel (Available titles listed inside<br />
front cover)<br />
• Health and Safety Procedure <strong>Manual</strong><br />
• The Point quarterly newsletter<br />
• Public Service Announcements for Radio and Print<br />
(available on cd and in written format)<br />
• <strong>APP</strong> T-shirts - New designs every year<br />
• <strong>APP</strong> Annual Conference and Exposition<br />
° Piercing-related, industry-specifi c classes <strong>of</strong>fered in<br />
Techniques, Equipment, Management, Aftercare,<br />
Studio Set-Up, Business Documentation, Bloodborne<br />
Pathogens, CPR, First Aid and more<br />
° Week-long conference with roundtable discussions,<br />
social events, and networking<br />
° Largest body jewelry and piercing-related product<br />
exposition in the US<br />
° Package and individual class prices available<br />
• Website: www.safepiercing.org<br />
° Contact information for current members<br />
° Getting Pierced: Everything you need to know,<br />
including how to fi nd a good piercer and Aftercare<br />
information<br />
° FAQ’s: Piercing and Minors, Pregnancy, Piercing<br />
Guns, Genital Piercings, Oral Piercings, and<br />
more...<br />
° Job Board: free listing <strong>of</strong> jobs available and those<br />
seeking positions<br />
3
AN INTRODUCTION TO MICROBIOLOGY<br />
FOR THE PROFESSIONAL PIERCER<br />
Although body piercing has historically been considered<br />
a ritual art form, in modern times the practice cannot be<br />
separated from our knowledge <strong>of</strong> biological science. In<br />
order to be fully educated in the fi eld, piercers should<br />
have a working knowledge <strong>of</strong> the science behind the<br />
art. In particular piercers should understand the basics<br />
<strong>of</strong> Microbiology, Bacteriology, Immunology, and<br />
Virology. Scientifi c facts will provide the pr<strong>of</strong>essional<br />
piercer with the necessary knowledge to carry out<br />
appropriate hygiene and safety practices in the work<br />
environment and to make informed decisions under<br />
changing conditions.<br />
DEFINITIONS<br />
Cross-contamination is the act <strong>of</strong> spreading<br />
pathogenic (disease-causing) organisms from one item<br />
or surface to another.<br />
It is the responsibility <strong>of</strong> the pr<strong>of</strong>essional piercer to<br />
operate at all times with a high regard for the health<br />
and safety <strong>of</strong> their customers, their co-workers, and<br />
themselves. Employing appropriate protocols will<br />
minimize the risk <strong>of</strong> cross-contamination with harmful<br />
microorganisms such as bacteria and viruses.<br />
Microbiology is the study <strong>of</strong> microscopic organisms.<br />
Some microorganisms are benefi cial or resident to<br />
the individual, but others are detrimental, potentially<br />
causing illness or even death. By understanding how<br />
microorganisms live and reproduce, the piercer will be<br />
able to minimize disease transmission risks.<br />
Bacteriology is the study <strong>of</strong> bacteria.<br />
Many varieties <strong>of</strong> bacteria exist in our environment,<br />
some good, some bad. Some bacteria normally live on<br />
our bodies (resident) and help protect us from foreign<br />
strains (transient), or otherwise work with the body<br />
chemistry to optimize health. The type <strong>of</strong> bacteria in<br />
yogurt may aid the digestive tract, while bacteria on<br />
teeth can cause tooth decay. Bacteria are <strong>of</strong> immense<br />
importance because <strong>of</strong> their capacity for rapid growth<br />
and reproduction. Bacteria are capable <strong>of</strong> surviving<br />
without a host.<br />
Immunology is the study <strong>of</strong> the ability to resist<br />
infection.<br />
The immune system treads a fine line between<br />
successful defense <strong>of</strong> the organism and its complete<br />
destruction. An underreaction may allow pathogens to<br />
gain a foothold and overpower the individual. However,<br />
an overreaction can also lead to dire consequences for<br />
the individual.<br />
Virology is the study <strong>of</strong> viruses, which are submicroscopic<br />
organisms.<br />
Viruses differ from other microorganisms in that they<br />
depend on the cells they invade for growth and reproduction.<br />
Some viruses do not kill cells but cause illness,<br />
and then seem to disappear. They can remain latent<br />
and later cause another, sometimes much more severe<br />
form <strong>of</strong> disease. Viruses cause measles, mumps, polio,<br />
herpes, infl uenza, and the common cold. Some viral<br />
infections can be treated with drugs, some cannot.<br />
Bacteria are single-celled microorganisms so small<br />
that they cannot be seen without the assistance <strong>of</strong> powerful<br />
magnifi cation.<br />
They have characteristics <strong>of</strong> both plants and animals.<br />
There are hundreds <strong>of</strong> different types <strong>of</strong> bacteria, subdivided<br />
into families with common properties. Two very<br />
important and relevant classifi cations <strong>of</strong> bacteria exist.<br />
They are either nonpathogenic (harmless), or they are<br />
pathogenic (harmful, with the ability to cause disease).<br />
Nonpathogenic bacteria are the most plentiful. Some<br />
are actually benefi cial and perform important functions<br />
in our bodies, such as assisting in digestion or<br />
protecting the skin from overcolonization by invading<br />
organisms.<br />
Millions <strong>of</strong> microscopic organisms inhabit the spaces<br />
in which we live and work. Particles <strong>of</strong> organic matter<br />
including bacteria, viruses, fungi, and spores are present<br />
despite the most dedicated efforts to keep things<br />
clean. Fortunately, the majority <strong>of</strong> these organisms<br />
are harmless or can be dealt with successfully by the<br />
immune system.<br />
However, if there is an opening into the body, some<br />
<strong>of</strong> these organisms can enter and cause illness, particularly<br />
when the body’s own defenses are compromised<br />
5
through illness, inadequate nutrition, and other risk<br />
factors. While some organisms cause only temporary<br />
minor discomfort, others can result in serious or even<br />
fatal diseases. Since microorganisms are omnipresent,<br />
it is important to understand how to prevent them<br />
from gaining access into the body through piercings<br />
both during a procedure and afterward. It is also<br />
important to help clients understand how hygiene,<br />
nutrition, and lifestyle can facilitate or devastate their<br />
healing process.<br />
The most common forms <strong>of</strong> bacteria <strong>of</strong> concern for<br />
piercers are Coccus, Bacillus and Spirillum.<br />
Coccus (plural Cocci)<br />
Cocci are spherical or ovoid in form. One <strong>of</strong> the most<br />
commonly occurring bacteria <strong>of</strong> concern to piercers is<br />
Staphylococcus. This bacterium is present in boils, abscesses,<br />
and most surface infections. It can enter the<br />
body during the piercing or any time during the healing<br />
stages while the piercing is an open wound. This risk<br />
makes client education and post-piercing care critical<br />
in prevention. Some Staph is becoming resistant to<br />
antibiotic treatment, making prevention even more essential<br />
to the health <strong>of</strong> our clients.<br />
Other common types <strong>of</strong> Cocci are Diplococci (which<br />
causes Pneumonia) and Streptococci. Other diseases<br />
caused by this family <strong>of</strong> bacteria are Scarlet Fever and<br />
Meningitis.<br />
Bacillus (plural Bacilli)<br />
This bacteria belongs to the family Bacillaceae. All<br />
species are rod-shaped and sometimes occur in chains.<br />
Bacillus is the organism that causes dysentery, cholera,<br />
and diphtheria.<br />
Spirillum (plural Spirilla)<br />
This is a genus <strong>of</strong> spiral-shaped microorganisms<br />
belonging to the family Pseudomonadacea. When in<br />
fl exible form they are called spirochetes. Syphilis is<br />
in this group.<br />
Pathogenic organisms that cause diseases such<br />
as tetanus, tuberculosis and diphtheria are generally<br />
beyond our concern when Standard Precautions are<br />
observed. To minimize exposure risk:<br />
• Focus<br />
• Utilize clean technique<br />
• Understand appropriate sterilization, and<br />
• Practice it at all times.<br />
6<br />
MICROORGANISMS OF<br />
THE SKIN<br />
There are two types <strong>of</strong> skin microorganisms:<br />
Resident: Those that survive and multiply on the<br />
skin. Resident fl ora can be removed with antimicrobial<br />
soaps. Some <strong>of</strong> the normal resident bacteria <strong>of</strong> the skin<br />
include diptheroids (found in outer ear, armpits, and<br />
groin/genital areas), micrococci, (Staphylococci epidermis<br />
found on skin surfaces) and a variety <strong>of</strong> canes<br />
(Propionibacterium canes, Corynebacterium canes<br />
found on the face and other skin surfaces).<br />
Transient: Those that were acquired through recent<br />
exposure. These can survive for a limited amount <strong>of</strong><br />
time, generally less than 24 hours. Most <strong>of</strong>ten they<br />
are acquired from others who are infected. Soap is<br />
effective for the removal <strong>of</strong> most transient microorganisms.<br />
If conditions are conducive, overgrowth <strong>of</strong> some<br />
transient bacteria can occur. Staphylococcus aureus<br />
colonization is found in boils, folliculitis and carbuncles.<br />
Streptococcus infections can take the form <strong>of</strong> cellulitis,<br />
impetigo and pneumonia.<br />
FACTORS THAT INFLUENCE<br />
THE SURVIVAL AND GROWTH<br />
OF MICROORGANISMS<br />
There are three main considerations determining<br />
whether or not a microorganism is potentially a problem<br />
for you or your clients:<br />
1. Stability <strong>of</strong> an organism in its physical environment;<br />
2. Availability <strong>of</strong> the correct transmission medium<br />
needed by the organism to spread;<br />
3. Quantity <strong>of</strong> organisms expelled from the host into<br />
the transmission medium.<br />
Pathogenicity: The potential <strong>of</strong> an organism to<br />
cause disease. The factors that infl uence the pathogenicity<br />
<strong>of</strong> an organism are:<br />
1. Host susceptibility;<br />
2. Organism strength and number;<br />
3. Portal <strong>of</strong> entry: The organism must have a way<br />
into the host.<br />
Transmission: The method by which an infectious<br />
agent is passed. The transmission <strong>of</strong> an organism is
dictated by the availability <strong>of</strong> an appropriate Agent, Host<br />
and Environment. Eliminating the route <strong>of</strong> transmission<br />
to the portal <strong>of</strong> entry (a fresh piercing) interrupts this<br />
process and is well within the piercer’s control.<br />
Routes <strong>of</strong> transmission are:<br />
Direct contact: Person-to-person spread; requires<br />
actual physical contact between the existing host and<br />
a new portal <strong>of</strong> entry (e.g. the piercer and a client). A<br />
needle stick is a direct contact route <strong>of</strong> transmission.<br />
Indirect contact: Exposure to microorganisms deposited<br />
fi rst on inanimate objects and then transferred<br />
to the client. Objects in the environment that are not<br />
adequately disinfected or sterilized between clients can<br />
result in indirect contact exposure. This is generally<br />
referred to as cross-contamination. Using tools fi rst<br />
at the counter and then for a piercing procedure without<br />
sterilizing would be an example. Touching non-sterile<br />
items with gloved hands during a procedure, and then<br />
continuing to work on the client without changing gloves<br />
would also be considered cross-contamination.<br />
Airborne: Pathogenic organisms can also be acquired<br />
by inhaling infected droplets that become airborne when<br />
an infected person coughs or sneezes. Termed “droplet<br />
transmission,” this can easily be avoided with simple<br />
precautions, such as covering the mouth and nose<br />
when coughing or sneezing (and then wash hands!)<br />
Vector-borne: The transmission <strong>of</strong> organisms by an<br />
animal or insect bite, or through exposure to animal<br />
blood or other infectious bodily fl uids.<br />
Zoonosis: Zoonotic diseases are diseases <strong>of</strong> animals<br />
that may be transmitted to humans under natural conditions.<br />
Once infected, humans can transmit some <strong>of</strong><br />
these diseases to one another. While no reasonable<br />
piercer should be working on animals, it is possible<br />
for these diseases to enter the piercing environment<br />
by allowing pets or other animals, their droppings or<br />
accessories, into the piercing studio.<br />
Proper hygiene as well as many local regulations dictate<br />
that animals never belong in the piercing studio or<br />
in any space contiguous with a piercing studio (e.g. an<br />
adjoining <strong>of</strong>fi ce). Clean and enclosed fi sh aquaria may<br />
be permissible, however dogs, cats, rodents, reptiles<br />
and birds present a potential threat to client and staff<br />
safety and should never be admitted. One possible<br />
exception would be a guide dog or assistance animal.<br />
In this case reasonable alternatives and precautions<br />
should be sought to avoid the contamination <strong>of</strong> the<br />
piercing environment while considering the needs <strong>of</strong><br />
the client.<br />
BREAKING THE CHAIN<br />
OF INFECTION<br />
It is essential that the pr<strong>of</strong>essional piercer understand<br />
how infection occurs, and more importantly, how to<br />
prevent this from happening in the work environment.<br />
The “Chain <strong>of</strong> Infection” requires that these elements<br />
be present:<br />
1. An Infectious Agent, such as bacteria or virus<br />
2. A Reservoir (existing host)<br />
3. A Portal <strong>of</strong> Exit from the reservoir (the path out <strong>of</strong><br />
the existing host)<br />
4. A Vehicle <strong>of</strong> Transmission for the agent (the path<br />
between hosts)<br />
5. A Portal <strong>of</strong> Entry (the path into a new host)<br />
6. A New Host<br />
The single most important thing piercers can do to<br />
break this chain is WASH THEIR HANDS. This very<br />
simple and basic step has been proven to reduce or<br />
eliminate most pathogenic bacteria from the hands.<br />
This is the fi rst line <strong>of</strong> defense in the prevention <strong>of</strong><br />
disease transmission.<br />
7
HANDWASHING<br />
Frequent and conscientious handwashing is the most<br />
important action a piercer can take to reduce the presence<br />
and transmission <strong>of</strong> pathogenic microorganisms.<br />
Correct handwashing procedures are easy to follow<br />
and are extremely effective when used throughout<br />
the day.<br />
A studio’s handwashing sink should be used only for<br />
hand washing (never tool cleaning) and should have<br />
hands-free operation. Hands should not come into<br />
contact with faucets or handles. If the sink does not<br />
have a foot pedal or motion sensor operated system,<br />
an elbow or dry disposable paper towel can be used<br />
to operate the water fl ow.<br />
The use <strong>of</strong> quality liquid soap in a pump or automatic<br />
dispenser is strongly encouraged. Bar soaps collect<br />
bacteria and other dangerous contaminants from handling.<br />
Liquid antimicrobial or antibacterial soap has<br />
been proven most effective in the inhibiting <strong>of</strong> bacterial<br />
growth and is preferred.<br />
Choose a gentle, dye- and fragrance-free anti-microbial<br />
or antibacterial soap made for healthcare workers<br />
and others who wash frequently. Most commercial<br />
soaps are not intended for those who wash their hands<br />
frequently. They can leave hands chaffed, chapped<br />
and irritated and may kill benefi cial resident fl ora. This<br />
can actually increase the potential risk <strong>of</strong> pathogen<br />
transmission to the piercer. See the <strong>APP</strong> website for<br />
suggested products (www.safepiercing.org).<br />
Single-use paper towels should be dispensed from<br />
a stationary, fully covered paper towel dispenser that<br />
dispenses only one paper towel at a time. Paper towel<br />
rolls run the risk <strong>of</strong> contamination <strong>of</strong> the entire roll from<br />
handling. Air dryers cut down on paper waste but may<br />
blow pathogenic matter around the area.<br />
HOW TO WASH<br />
HANDS PROPERLY:<br />
1. Wet hands thoroughly with tepid water.<br />
2. Dispense a dime-sized amount <strong>of</strong> liquid soap into<br />
palm and lather.<br />
3. Vigorously scrub all surfaces <strong>of</strong> both hands up to<br />
mid-forearm.<br />
INFECTION CONTROL<br />
4. Pay special attention to nails, nail beds, between<br />
fi ngers and wrists.<br />
5. Continue for a minimum <strong>of</strong> thirty seconds.<br />
6. Pat hands dry with a single-use paper towel.<br />
A moisturizing lotion can be used to prevent overdrying<br />
and cracking. Maintaining the health <strong>of</strong> the hands,<br />
skin, nails and nail beds is crucial in the fi rst line <strong>of</strong><br />
defense against transmission <strong>of</strong> disease. Several<br />
brands <strong>of</strong> lotion that also seal and protect skin (“invisible<br />
gloves”) are available through healthcare product<br />
suppliers. Lotion must be allowed to dry before donning<br />
gloves to maintain glove integrity and minimize<br />
exposure to glove chemicals.<br />
HAND SANITIZERS<br />
Waterless hand sanitizer gels have become staples<br />
in many piercing shops because they are easy to use<br />
and do not require a trip to the sink. Some piercers<br />
use them in between glove changes, or keep them at<br />
the counter for clients entering the shop.<br />
However, careful consideration should be given as<br />
to when their use is appropriate. While some studies<br />
show these products to be as effective as hand washing<br />
in certain situations, other research indicates that they<br />
do not signifi cantly reduce overall amounts <strong>of</strong> bacteria<br />
on the hands, and in some cases may even increase it.<br />
Most tests proving sanitizers’ germ-killing capacities at<br />
up to 99.9% effective were done on inanimate objects,<br />
not on living skin. Physiological conditions on human<br />
skin may yield far different results.<br />
Alcohol-based hand sanitizers work by stripping the<br />
outer layer <strong>of</strong> oil from the skin, thereby killing transient<br />
bacteria and delaying regrowth and surfacing <strong>of</strong> resident<br />
bacteria. To use, a dime-sized drop <strong>of</strong> sanitizer<br />
should be pumped onto the skin and rubbed over all<br />
surfaces until dry. If hands are dry within 20 seconds,<br />
not enough gel was used.<br />
Hand sanitizers are not cleaning agents. They do not<br />
remove surface dirt or visible soil. Dirt, food, lubricant<br />
and other things on your hands will make them less<br />
effective. Therefore, in order for hand sanitizers to<br />
work properly, hands must fi rst be washed with soap<br />
and water before applying.<br />
9
HAND SANITIZERS VERSUS<br />
ANTIMICROBIAL SOAPS<br />
In 2002, the Centers for Disease Control released<br />
guidelines “recommending alcohol-based gel as a<br />
suitable alternative to hand washing for health-care<br />
personnel in health-care settings” (CDC, 2002) when<br />
moving between patients. The Food and Drug Administration,<br />
on the other hand, says that hand sanitizers<br />
may be used as a supplement, but not as a substitute<br />
for hand washing.<br />
In an FDA comparison study, plain soaps antimicrobial<br />
hand soaps, E2-rated hand soaps (a USDA Classifi cation<br />
requiring equivalency to 50 parts per million chlorine),<br />
and instant hand sanitizers were tested to gauge<br />
their relative effectiveness in reducing bacteria on hands.<br />
With a 20-second wash procedure, all three types <strong>of</strong><br />
soap effectively reduced bacteria. E2 soaps were signifi -<br />
cantly more effective than the other two soaps. Instant<br />
hand sanitizers, on the other hand, showed a signifi cant<br />
increase in bacterial numbers on hands.<br />
According to most publications, while hand sanitizers<br />
are acceptable for use in addition to a thorough<br />
handwashing, and are certainly better than no cleaning<br />
at all, they are not a substitute for scrubbing with soap<br />
and water. Additionally, they are generally advised for<br />
healthcare workers, but not for food handlers or the general<br />
public. Since piercers fall squarely into none <strong>of</strong> these<br />
groups, each must come to his/her own conclusion.<br />
A fi nal word <strong>of</strong> caution: While <strong>of</strong>ten advertised as<br />
being less irritating to hands than regular washing,<br />
alcohol-based hand sanitizers can be overdrying, causing<br />
cracked skin, contact dermatitis, and accelerating<br />
potential latex sensitivities. If you opt to use these<br />
products for your staff and/or clientele, choose a brand<br />
carefully, consider non-alcohol varieties, and have an<br />
alternative available for clients who cannot or will not<br />
use these products.<br />
GLOVES<br />
Gloves are practically, legally and ethically imperative<br />
for pr<strong>of</strong>essional piercers. Finding appropriate gloves<br />
and learning how to don them properly will protect the<br />
piercer from potential contaminants and reduce the risk<br />
<strong>of</strong> disease transmission between client, piercer and<br />
co-workers. It is important to follow the basic rules <strong>of</strong><br />
glove use:<br />
1. Wash hands prior to donning gloves and immediately<br />
afterwards.<br />
10<br />
2. Keep fi ngernails trim and smooth, and remove<br />
jewelry and watches to prevent accidental tears<br />
(per OSHA regulations).<br />
3. Use only disposable gloves.<br />
4. Store gloves properly, away from light, heat and<br />
moisture.<br />
When should gloves be worn?<br />
• During all set-up and cleaning. This prevents crosscontamination<br />
and protects hands from exposure to<br />
harsh chemical disinfectants.<br />
• During sweeping, mopping and trash removal. Any<br />
object on the piercing studio fl oor should be considered<br />
contaminated and only touched with gloved<br />
hands.<br />
• During all disinfection or sterilization procedures.<br />
• When working in Biohazard Areas or dealing with<br />
contaminated tools or containers. Many piercers<br />
double-glove when processing contaminated instruments.<br />
(Check with your glove manufacturer to<br />
ensure this will not compromise glove integrity.)<br />
• When transporting sterilized implements from the<br />
autoclave to designated storage space. Clean gloves<br />
should be available in all areas where transport may<br />
be initiated.<br />
• During contact with a client. A pr<strong>of</strong>essional piercer<br />
should never touch the area <strong>of</strong> a client’s piercing<br />
with ungloved hands. This protects against possible<br />
transmission <strong>of</strong> a client’s resident and transient fl ora.<br />
It also provides a level <strong>of</strong> pr<strong>of</strong>essionalism and comfort<br />
between the client and piercer.<br />
• During a period <strong>of</strong> contact only, not continuously.<br />
When should gloves be changed?<br />
• If glove integrity is compromised (gloves become<br />
weakened or contaminated).<br />
• If a visible weak spot, pinhole or tear is detected or<br />
suspected.<br />
• When gloves turn yellow or brown.<br />
Changes in glove color can take place after<br />
prolonged wear. This is normal and occurs from<br />
a reaction between traces <strong>of</strong> copper on sweaty<br />
skin and dithiocarbamate, a curing chemical<br />
found on the surface <strong>of</strong> some gloves. Since this<br />
reaction can accelerate the breakdown <strong>of</strong> rubber,<br />
gloves should be changed frequently enough<br />
to prevent it. Four minutes is the maximum<br />
amount <strong>of</strong> time suggested for using each pair <strong>of</strong><br />
latex gloves.
• When moving from “fi eld” to “fi eld”<br />
(from non-sterile to sterile tools, or between<br />
segments <strong>of</strong> a procedure). To prevent crosscontamination<br />
gloves should be changed<br />
when moving from a more contaminated area<br />
to less contaminated area (see Sterile Chart<br />
on page 14).<br />
• During a procedure.<br />
Many studios develop a written plan concerning<br />
glove changes during a procedure.<br />
For example, a studio may require at least fi ve<br />
pairs <strong>of</strong> gloves per procedure for:<br />
1. Initial set up <strong>of</strong> tray and instruments<br />
2. Opening autoclave packages<br />
3. Initial skin prep and marking<br />
4. Piercing procedure<br />
5. Post-procedure clean up<br />
Although the number <strong>of</strong> gloves used in a procedure<br />
will vary, setting a minimum number <strong>of</strong> gloves used<br />
can help reduce the likelihood <strong>of</strong> cross-contamination.<br />
The important point is that every piercer understand the<br />
concept <strong>of</strong> cross-contamination, and change gloves as<br />
necessary to avoid compromising fi elds.<br />
Many piercers use hand sanitizers and lotions as an<br />
additional cleanser or barrier, and to minimize potential<br />
contamination through dry, cracked skin. If using latex<br />
gloves, be aware that petroleum- or oil-based products<br />
must be avoided. Chemicals in petroleum products can<br />
penetrate the latex, compromising its barrier integrity.<br />
Water-based lotions should be chosen, applied after<br />
glove use and washing (post-piercing) and allowed to<br />
fully dry before donning new gloves. Anti-infl ammatory,<br />
conditioning and chemical barrier lotions are also<br />
available for the healthcare industry and may minimize<br />
skin irritation from constant washing and chemical<br />
exposure.<br />
If a glove becomes hard, brittle or too s<strong>of</strong>t, or loses<br />
its elasticity, shape or usual color, it may be degraded<br />
and should not be used. As requested by the FDA,<br />
glove manufacturers may print expiration dates on<br />
glove boxes. Gloves should be used before this date.<br />
If the date is unknown, be sure to use glove shipments<br />
in the order they were received, and to store all gloves<br />
in clean, cool, dry and well-ventilated conditions in their<br />
original packaging.<br />
Gloves should never be washed, disinfected or<br />
autoclaved unless specifi cally recommended by the<br />
manufacturer. As explained by OSHA, “Washing with<br />
disinfecting agents may cause deterioration <strong>of</strong> the glove<br />
material and may encourage “wicking” or enhanced<br />
penetration <strong>of</strong> liquids into the glove via undetected<br />
pores thereby transporting potentially infectious materials<br />
into contact with the hand.” (OSHA instruction<br />
CPL 2-2.44C)<br />
Whenever you have doubt about the integrity <strong>of</strong> your<br />
gloves, remove the gloves, wash hands and don fresh<br />
gloves. <strong>Piercers</strong> should be aware that sensitization<br />
to latex (latex allergies) are becoming increasingly<br />
common among both piercers and clients. To protect<br />
the health <strong>of</strong> their staff and clients, many studios are<br />
choosing alternative synthetic gloves and eliminating<br />
latex from their practices.<br />
STERILE GLOVES<br />
Some piercers choose to use sterile gloves during<br />
piercing procedures; some are required to do so by<br />
state law. There are arguments for and against the<br />
use <strong>of</strong> sterile gloves. Where the issue is not dictated<br />
by law, a studio should make a research-based decision<br />
about whether or not to use sterile gloves in its<br />
practice.<br />
Sterile gloves are not required by <strong>APP</strong> standards,<br />
though piercers who choose to go beyond the established<br />
minimum guidelines may do so.<br />
Donning Sterile Gloves<br />
<strong>Piercers</strong> should use the “open donning” method. The<br />
(right-handed) technique is as follows:<br />
1. Pick up the cuff <strong>of</strong> the right glove with left hand.<br />
Slide right hand into the glove until you have a snug<br />
fi t over the thumb joint and knuckles. Your bare left<br />
hand should only touch the folded cuff - the rest <strong>of</strong><br />
the glove is sterile. Do not use bare hand to adjust<br />
fi t.<br />
2. Slide right fi ngertips into the folded cuff <strong>of</strong> the left<br />
glove. Pull out the glove and fi t right hand into it.<br />
3. Unfold the cuffs down over wrists. Make sure gloved<br />
fi ngertips do not touch bare forearms or wrists.<br />
Donning Clean Gloves<br />
1. With freshly washed hands, remove one glove<br />
from the clean glove box by grasping it at the bottom<br />
edge. Be careful to reach into box as little as<br />
possible, and not to touch the fi ngers <strong>of</strong> any glove<br />
with bare hands. (Discard individual gloves that<br />
accidentally contact hands, or that present “fi ngers<br />
fi rst” and cannot be removed by the cuff.)<br />
2. Grasp rolled cuff and slide your hand as far into the<br />
glove as possible. DO NOT use your bare hand to<br />
adjust fi t from the outside.<br />
11
3. With your now gloved hand, reach into the clean<br />
glove box and remove a second glove.<br />
4. Without touching bare skin to the outside <strong>of</strong> either<br />
glove, slide your other hand into the second<br />
glove.<br />
5. Now adjust both gloves for fi t. Remember that any<br />
portion <strong>of</strong> glove touched by bare hands should not<br />
then be touched with gloved hands.<br />
CHOOSING THE RIGHT GLOVE<br />
Latex<br />
Latex is a polymeric membrane <strong>of</strong> natural rubber derived<br />
from the sap <strong>of</strong> the rubber tree (Hevea Brasiliensis).<br />
It is made heat-stable, resilient, strong and elastic<br />
through vulcanization (heating with sulphur) and the<br />
addition <strong>of</strong> accelerators and antioxidants. Non-sterile<br />
medical grade latex gloves are used by many piercers<br />
for everyday duties within the studio. Latex gloves<br />
vary in thickness and texture and should be chosen<br />
for durability, comfort and tactile sensitivity.<br />
Latex gloves are sometimes powdered to ease donning.<br />
These powders are usually cornstarch or talcbased<br />
and are placed in the glove after manufacturing.<br />
Research has shown that glove powder can lead to<br />
granulomas in open tissue, and may increase potential<br />
for airborne latex proteins and latex sensitivities. Consider<br />
using non-powdered gloves for all procedures.<br />
Many manufacturers are now processing gloves with<br />
a polymer coating such as silicone for easy donning<br />
without powder.<br />
Latex gloves contain protein antigens and curing<br />
agents (such as accelerators and antioxidants) that may<br />
cause an allergic dermatitis or systematic anaphylaxis<br />
(discussed further below). Even those gloves labeled<br />
“hypoallergenic” will not always prevent reactions in a<br />
highly sensitive person. Those with severe sensitivities<br />
may be unable to enter a shop with airborne latex<br />
proteins or powders. Latex gloves should never be<br />
used on a client who informs you <strong>of</strong> an allergy to latex,<br />
and many shops have chosen to become latex-free<br />
for the safety <strong>of</strong> all clients and staff. If latex is the primary<br />
type <strong>of</strong> glove used in a studio, latex-free gloves<br />
should be stocked for clients with latex allergies and<br />
a comprehensive latex allergy procedure should be<br />
developed.<br />
NON-LATEX ALTERNATIVES<br />
Many piercers opt for latex-free synthetic alternatives<br />
such as Nitrile. While all the options listed below are<br />
12<br />
latex-free, not all synthetic materials are appropriate for<br />
all uses. Synthetics also vary widely in price. When<br />
bought in bulk from well-chosen manufacturers, many<br />
<strong>of</strong> the best synthetic glove products can be found at<br />
reasonable prices.<br />
Vinyl<br />
Vinyl (PVC) gloves are an easily available alternative to<br />
latex. However, they are not as strong as latex and are<br />
more easily punctured. They fi t loosely, are non-elastic,<br />
and may slip, exposing the piercer’s skin or interfering<br />
with skilled procedures.<br />
Vinyl gloves are the most porous <strong>of</strong> exam glove options,<br />
and may allow penetration by even large molecules<br />
<strong>of</strong> blood and fl uids over long exposure. The failure<br />
rate <strong>of</strong> stressed vinyl gloves is reported at about 51.3%<br />
(compared with 3% for latex and 0% for Nitrile).*<br />
Additionally, vinyl gloves do not necessarily eliminate<br />
the potential for contact dermatitis because many <strong>of</strong> the<br />
same chemicals used in processing latex gloves are<br />
also used in vinyl gloves. Those reacting to additives<br />
in latex gloves may need to avoid vinyl as well. For<br />
these reasons, vinyl gloves are less than ideal for most<br />
procedural applications in the studio.<br />
Nitrile<br />
Nitrile gloves are a protein-free, low-chemical, synthetic<br />
alternative made from nitrile polymer. They are three<br />
times more resistant to chemicals and punctures than<br />
latex <strong>of</strong> the same thickness and have a reported stress<br />
failure rate <strong>of</strong> 0%.*<br />
While nitrile’s thickness and lack <strong>of</strong> elasticity require<br />
getting used to after thin latex, many piercers fi nd these<br />
gloves to be more secure and to allow full dexterity.<br />
They are available with textured fi ngertips for increased<br />
grip, and can be had in a range <strong>of</strong> colors to increase<br />
client awareness <strong>of</strong> glove use.<br />
Although slightly more expensive than latex, nitrile<br />
gloves are reasonable when bought in bulk and <strong>of</strong>fer<br />
an excellent synthetic alternative for those desiring<br />
high quality protection and minimal risk <strong>of</strong> chemical-<br />
or allergen-exposure. Test several manufacturers’<br />
products to fi nd an optimum product for your individual<br />
needs and budget.<br />
Polyurethane and Styrene Co-polymers<br />
Other high quality synthetic alternatives such as Tactylite<br />
and Allergard are available. Some have very<br />
little allergy potential and provide a good barrier. Fit,<br />
feel and cost vary by material, brand and design. In<br />
general these gloves are more expensive than others,
ut may well be worth it depending upon a piercer’s<br />
preferences and circumstances. Contact individual<br />
suppliers for samples.<br />
*Adenna, Inc. ©1997-2004.<br />
LATEX SENSITIVITIES<br />
Since the implementation and recommendation <strong>of</strong> Universal<br />
Precautions by the Centers for Disease Control<br />
and Prevention (CDC) and Occupational Safety and<br />
Health Administration (OSHA) , latex sensitivities have<br />
been on the rise. Estimates suggest 2 - 6% <strong>of</strong> the general<br />
population is latex sensitive. Among healthcare<br />
workers this percentage rises to 8 - 12%. Due to the<br />
extensive exposure many people in the healthcare,<br />
emergency service, body art and other industries have<br />
to latex gloves and protective gear, allergic reactions<br />
among these groups are increasingly common and if<br />
unchecked can interfere with continued employment.<br />
Reactions can range from minor rash to life-threatening<br />
respiratory distress. Because latex allergies are<br />
actually sensitization reactions from overexposure to<br />
latex, and because latex is so pervasive in our home<br />
and work environments, prevention through limiting<br />
exposure is crucial. Those who come into frequent<br />
contact with latex through the skin or inhalation become<br />
sensitized, and may go on to develop full allergic<br />
reactions. These reactions <strong>of</strong>ten occur gradually, but<br />
can also come on quite suddenly. Those who use<br />
gloves at work, have had multiple surgeries, or who<br />
have multiple allergic sensitivities or spina bifi da are<br />
especially at risk.<br />
In the piercing studio, many items besides gloves<br />
contain latex. Adhesive tape, rubber bands, some<br />
autoclave wrap, CPR masks, and even the handles<br />
<strong>of</strong> some tools and covering on ballpoint pens may<br />
contain traces <strong>of</strong> latex. All <strong>of</strong> these can trigger reactions.<br />
<strong>Piercers</strong> should understand the types <strong>of</strong> latex<br />
reaction and how to deal with latex-sensitive clients<br />
and coworkers.<br />
The three types <strong>of</strong> latex hypersensitivity reactions that<br />
occur are classifi ed in order <strong>of</strong> severity as Irritant Contact<br />
Dermatitis, Type IV Reaction and Type I Reaction.<br />
Irritant Contact Dermatitis<br />
This type <strong>of</strong> reaction is actually not an allergy, but rather<br />
a surface irritation caused by excessive handwashing,<br />
harsh soaps, chemicals, hand sanitizers and/or glove<br />
powder. It can appear as overly dry, cracked, sore or<br />
fl aky skin and rash. To avoid or relieve contact dermatitis,<br />
switch to milder products, avoid powdered gloves,<br />
and use a soothing hand sealant after washing. Avoid<br />
hand sanitizer or products that increase irritation and be<br />
aware that cracked skin is open to latex, chemical and<br />
pathogenic penetration. Although contact dermatitis<br />
is not serious in itself, it can lead to further problems<br />
if not cared for.<br />
Type IV Reaction: Chemical Protein<br />
Hypersensitivity<br />
Type IV is a delayed reaction to an allergen that usually<br />
appears 48 to 96 hours after contact. Most people with<br />
Type IV hypersensitivity experience some form <strong>of</strong> dermatitis,<br />
such as rash, scales, infl ammation, or eczema.<br />
Reactions may also include conjunctivitis, runny nose<br />
or asthma-like symptoms from airborne detritus. It is<br />
generally believed that this type <strong>of</strong> response is due to<br />
the chemicals used in manufacturing the rubber and<br />
not due to the latex itself.<br />
Type I Reaction: Latex Protein Sensitivity<br />
This is an immediate and systemic response to latex<br />
proteins. People with this type <strong>of</strong> reaction may have<br />
intense burning and irritation at the contact site, hives<br />
within 5 to 60 minutes, itchy eyes, swelling <strong>of</strong> lips and<br />
tongue, abdominal pain, asthma, nausea, and in severe<br />
cases death from anaphylactic shock.<br />
What To Do<br />
For their own health and that <strong>of</strong> their clients, it is imperative<br />
that pr<strong>of</strong>essional piercers take these health<br />
concerns seriously. If you suspect you have a latex<br />
sensitivity, consult a doctor or allergist. Because severe<br />
reactions can develop suddenly and continued<br />
exposure increases this risk, cease all contact with<br />
latex products. This will <strong>of</strong>ten mean making the entire<br />
studio latex-free. The use <strong>of</strong> low-chemical, low-protein,<br />
low-endotoxin powder free synthetic gloves (such as<br />
nitrile) is recommended in suspected cases <strong>of</strong> all three<br />
types <strong>of</strong> hypersensitivity. Question all clients regarding<br />
latex sensitivity prior to piercing and use only non-latex<br />
materials on clients with a history <strong>of</strong> sensitivity. Hand<br />
sealants, non-latex gloves and avoidance <strong>of</strong> chemical<br />
triggers may ease dermatitis and Type IV Reactions.<br />
Medications and allergy therapies are available to minimize<br />
some symptoms <strong>of</strong> Type I Reactions, but there is<br />
no clinically recognized treatment or cure.<br />
For more information<br />
NIOSH has issued an Alert, Preventing Allergic Reactions<br />
to Natural Rubber Latex in the Workplace (DHHS<br />
[NIOSH] Publication No. 97-135). Free copies are<br />
available from the NIOSH Publications Offi ce: 1-800-<br />
35-NIOSH (1-800-356-4674).<br />
13
From STERILE to CLEAN to CONTAMINATED<br />
Every piercer should thoroughly grasp how their environment and the tools they use pass through stages from<br />
sterile to clean to contaminated. The chart below should help your understanding. Visualize sterile as white and<br />
contaminated as dark red with several shades in between. Always remember that when a lighter colored item<br />
comes in contact with a darker one it becomes that color, and can pass it on, until it is disinfected or sterilized.<br />
Nothing darker than pale pink should ever come in contact with a piercing, directly or indirectly. Bare hands<br />
should avoid red items. If red items are touched, hands should be immediately washed. Dark red items should<br />
never be touched with bare hands.<br />
14<br />
WHITE<br />
Sterile.<br />
No living matter.<br />
Autoclaved<br />
implements, jewelry,<br />
needles, etc. in unopened,<br />
sterile bags,<br />
untouched.<br />
PALEST<br />
PINK<br />
Very clean.<br />
Only very small<br />
quantities <strong>of</strong> airborne<br />
matter.<br />
Sterile implements<br />
just removed from<br />
their bags.<br />
Disinfected implements<br />
only touched<br />
with freshly gloved<br />
hands, trays or<br />
surfaces immediately<br />
after disinfection/<br />
bleaching.<br />
Bagged “sterile”<br />
implements after<br />
several weeks in<br />
storage.<br />
STERILE CHART<br />
PALE<br />
PINK<br />
Clean.<br />
Only small quantities<br />
<strong>of</strong> airborne matter.<br />
Presterilized corks,<br />
rubber bands, nonsterile<br />
latex gloves,<br />
tissues, cotton<br />
swabs, etc. stored in<br />
protective containers<br />
and only touched with<br />
freshly gloved hands.<br />
Surface <strong>of</strong> “sterile”<br />
fi eld, only touched<br />
with freshly gloved<br />
hands.<br />
Needles, forceps,<br />
sterilized jewelry, etc.<br />
after several minutes<br />
in open air, unused.<br />
Surface <strong>of</strong> skin immediately<br />
after aseptic<br />
skin prep.<br />
Hands immediately<br />
after correct hand<br />
washing procedure.<br />
PINK<br />
Not clean.<br />
Normal levels <strong>of</strong><br />
airborne matter.<br />
Needles, forceps,<br />
corks, rubber bands,<br />
etc.., after extended<br />
exposure to open air<br />
or frequent handling.<br />
Clothing, surfaces,<br />
implements, neither<br />
contaminated with<br />
bloodborne organisms,<br />
nor recently<br />
disinfected.<br />
Unused jewelry prior<br />
to sterilization/disinfection.<br />
Piercing room<br />
furniture, etc.<br />
Dirty.<br />
RED<br />
High levels <strong>of</strong><br />
airborne matter and<br />
possible presence <strong>of</strong><br />
bloodborne matter.<br />
Floors, countertops,<br />
sinks, doorknobs,<br />
light switches, and<br />
other areas that may<br />
have been exposed<br />
to bloodborne<br />
contaminants, either<br />
directly or indirectly.<br />
Unbroken, uncleaned<br />
skin.<br />
Frequently handled<br />
display jewelry.<br />
Phones<br />
Money<br />
DARK<br />
RED<br />
Contaminated.<br />
High levels <strong>of</strong><br />
airborne/bloodborne<br />
matter.<br />
Bodily fl uids, new or<br />
old. Piercings, new<br />
or healed.<br />
Broken skin <strong>of</strong> any<br />
kind.<br />
Used piercing<br />
implements, used<br />
disposable piercing<br />
needles.<br />
Previously worn<br />
jewelry.
Cleaning, disinfection and sterilization are all part <strong>of</strong><br />
the same process, but they differ signifi cantly in the<br />
number and types <strong>of</strong> microorganisms killed. Understanding<br />
the differences enables the piercer to choose<br />
the correct way to make contaminated items safe to<br />
use. It also determines proper disposal methods for<br />
items that cannot be decontaminated and are unsafe<br />
for use in the studio.<br />
CLEANING<br />
CLEANING, DISINFECTION<br />
& STERILIZATION<br />
Cleaning is the process that physically removes debris<br />
and reduces many <strong>of</strong> the microorganisms present on<br />
an object.<br />
Cleaning is the fi rst step in the decontamination process.<br />
It is important to clean items prior to disinfecting<br />
and/or sterilizing them. There are some items that will<br />
not require disinfecting or sterilizing prior to use, and<br />
for which only thorough cleaning with an antibacterial<br />
or antimicrobial soap is necessary.<br />
Washing hands before and after performing piercings,<br />
and several times during the day is such a<br />
decontamination process. Of course, even the most<br />
stringent handwashing does not take the place <strong>of</strong><br />
wearing gloves.<br />
Tools used in piercing procedures must be thoroughly<br />
cleaned before sterilization in order to remove gross<br />
matter such as body fl uids and lubricants. Otherwise<br />
the presence <strong>of</strong> these can keep steam from effectively<br />
reaching all surfaces during a sterilization cycle. In<br />
order to do this thoroughly without the risks <strong>of</strong> manual<br />
scrubbing, studios should use an ultrasonic cleaner.<br />
Ultrasonic Cleaners are a quick and safe way to<br />
execute the critical step <strong>of</strong> removing matter from instruments<br />
and jewelry prior to sterilizing. Ultrasonics<br />
do NOT sterilize.<br />
Ultrasonics work by using ultrasound energy (wave<br />
motion above the level <strong>of</strong> audible sound). This energy is<br />
transmitted to the cleaning solution within the machine<br />
where it creates tiny bubbles <strong>of</strong> vaporized liquid that<br />
explode when they reach a high pressure. An extremely<br />
thorough cleaning <strong>of</strong> all surfaces, even inside <strong>of</strong> tubes<br />
and hinges, occurs as shock waves dislodge debris<br />
from the contaminated articles placed in the bath.<br />
For optimal results the technician must carefully follow<br />
the manufacturer’s guidelines for use <strong>of</strong> solution,<br />
additives, temperature, baskets, lids and timers. For<br />
example, even Stainless Steel forceps may appear corroded<br />
if the solution is not properly Ph-balanced. With<br />
bench-top models, soils removed from components<br />
will be suspended in the solution. If all items are not<br />
rinsed immediately after the cycle, the soils in the solution<br />
will redeposit themselves on tools during drying.<br />
All forceps and hinged tools must be run with the jaws<br />
open to expose all contaminated surfaces.<br />
There is some controversy regarding the risk <strong>of</strong><br />
aerosolized (airborne) contaminants during the running<br />
cycle <strong>of</strong> an ultrasonic. To be safe, the <strong>APP</strong> strongly<br />
encourages the use <strong>of</strong> lids during running cycles. Some<br />
piercers even enclose the ultrasonic unit or add secondary<br />
barriers to minimize potential risks from airborne<br />
aerosolized pathogens. A HEPA fi lter in the cleaning<br />
room is an excellent additional precaution.<br />
DISINFECTION<br />
Disinfection is the process that kills some but not all<br />
disease-causing microorganisms.<br />
Some nonpathogenic microorganisms can remain<br />
on any item that you have disinfected. What kind and<br />
how many <strong>of</strong> those you might kill depends on what<br />
level <strong>of</strong> disinfection you use. Bacterial spores and the<br />
Mycobacterium Tuberculosis var. bovis are diffi cult-tokill,<br />
laboratory test microorganisms used to classify the<br />
strength <strong>of</strong> a chemical disinfectant as follows.<br />
Three Levels <strong>of</strong> Disinfection<br />
1. Low-Level Disinfection is the least effective process<br />
and is what most <strong>of</strong> us think <strong>of</strong> when we talk<br />
about “clean.” It does not kill bacterial spores or<br />
M.tuberculosis var. bovis.<br />
2. Intermediate-Level Disinfection is a process<br />
that kills the tough tuberculosis microorganism.<br />
This is important because a process that kills<br />
M.tuberculosis var. bovis is also effective against<br />
a host <strong>of</strong> other organisms that are much easier to<br />
kill, such those that cause HIV.<br />
3. High-Level Disinfection is a process that will<br />
destroy some, but not all bacterial spores, as well<br />
15
16<br />
as bacteria, fungi, and viruses (like the one causing<br />
Hepatitis B), in addition to the microorganisms<br />
killed at the Intermediate Level. According to the<br />
CDC, High- Level Disinfection can only be achieved<br />
with a chemical solution that can sterilize given<br />
appropriate conditions. However, although High-<br />
Level Disinfection kills the same types <strong>of</strong> organisms<br />
as sterilization, only full autoclave sterilization<br />
renders items that have been contaminated with<br />
Bloodborne Pathogens safe for reuse.<br />
STERILIZATION<br />
Sterilization is the process that kills all microbial life.<br />
In addition to all bacteria, viruses and fungi, sterilization<br />
will also kill bacterial spores, which are resilient and<br />
are the most diffi cult microorganisms to kill. A process<br />
able to eliminate bacterial spores will kill other types <strong>of</strong><br />
microorganisms such as fungi and viruses. Sterilization<br />
eliminates the organisms that cause Tuberculosis,<br />
Hepatitis B, Hepatitis C and HIV, as well as all other<br />
infectious agents. When you have sterilized properly,<br />
there will be no microorganisms alive.<br />
Any item or product in your shop that may have been<br />
exposed to bloodborne pathogen contamination must<br />
be sterilized prior to use. This includes reusable items<br />
such as tools, forceps and setup trays. If a contaminated<br />
reusable item cannot be sterilized appropriately,<br />
it must be discarded. Single-use, disposable items<br />
such as piercing needles must also be sterilized prior<br />
to use. However, once used disposables must never<br />
be sterilized and reused.<br />
Many piercing studio operators do not yet understand<br />
the need to sterilize all jewelry before use in<br />
new piercings. Logically, there is no point <strong>of</strong> using a<br />
sterile needle just to follow it with non-sterile jewelry.<br />
We can only know how jewelry is handled within our<br />
own shops, and must therefore ensure that no potential<br />
contaminants from the manufacturers or shipping<br />
contact our clients. Regardless <strong>of</strong> the source <strong>of</strong> their<br />
jewelry, a reputable piercing shop should insert only<br />
high quality body piercing jewelry that is sterilized on<br />
the premises prior to insertion.<br />
It is not a manufacturer’s responsibility to sell only<br />
sterilized jewelry. At the same time, manufacturers<br />
also must not misrepresent what is being sold by falsely<br />
labelling jewelry as “sterile” or “ready for insertion,”<br />
or by making other misleading claims. Best practice<br />
for any shop is to run new jewelry shipments through<br />
an ultrasonic cycle (preferably in a clean ultrasonic<br />
reserved for clean jewelry), and to then autoclave all<br />
pieces prior to use.<br />
Sterilization Procedure Options<br />
• Steam under Pressure (Saturated steam/steam<br />
autoclave): 220-270 kip pressure at 140 degrees<br />
Celsius (284 degrees Fahrenheit) for 15-40 minutes<br />
depending on cycle.<br />
• Dry Heat (Dry-Clave): Processing at 177 C (350<br />
F) for 1 hour. This is appropriate only for items that<br />
cannot withstand steam exposure.<br />
• Gas Plasma (ETO gas/chemical autoclave): Requires<br />
specifi c site construction for venting <strong>of</strong> potentially<br />
toxic fumes and is not practical for piercers.<br />
• Gamma Radiation (exposure to specifi c radioactive<br />
waves): Highly regulated and costly, requiring<br />
specifi c site construction and disposal criteria. Impractical<br />
for piercers.<br />
• Liquid Chemical (cold sterilization): Immersion in<br />
an EPA (Environmental Protection Agency) approved<br />
and FDA (Food and Drug Administration) controlled<br />
chemical agent per manufacturers’ guidelines (commonly<br />
10-12 hours). Maintaining the sterility <strong>of</strong> items<br />
once removed from the solution is diffi cult. Problems<br />
with disposal and exposure to toxic chemicals make<br />
this method impractical for piercers.<br />
Sterilization in the Studio<br />
Pressurized steam is the only practical and cost-effective<br />
method <strong>of</strong> sterilization in the piercing studio. For our<br />
purposes, sterilization requires an autoclave, a piece <strong>of</strong><br />
medical equipment that employs the steam under pressure<br />
method <strong>of</strong> sterilization. Autoclaves can be obtained<br />
from a medical supplier and range between $600 and<br />
several thousand dollars, depending on size, type and<br />
features. Items that have already been cleaned and processed<br />
in an ultrasonic are placed in specially-designed<br />
sealable autoclave bags that allow penetration by steam<br />
during the sterilization cycle, but protect sterile items<br />
from contamination after processing. Until these bags<br />
are opened during a piercing procedure, their contents<br />
remain sterile unless bag integrity is compromised by<br />
puncture, moisture or age.<br />
Having a clave on premises is not helpful if it is not<br />
in working order. Manufacturer guidelines for maintenance<br />
should be stringently followed. Medical suppliers<br />
also provide easy in-house methods for studios<br />
to check the viability <strong>of</strong> the sterilization process. Most<br />
autoclave bags have indicator strips that change color<br />
when exposed to steam, making it easy to distinguish<br />
bags that have been processed from those that have<br />
not. However, the color change <strong>of</strong> indicator strips on<br />
the autoclave packaging is not a reliable method <strong>of</strong><br />
determining if an autoclave is working properly. It tests<br />
only exposure to steam, not whether the heat, pressure
and duration <strong>of</strong> that exposure was suffi cient to achieve<br />
sterilization.<br />
Integrator strips are another method for checking<br />
clave reliability in house. Integrators are strips or devices<br />
used in pouches and/or autoclave chambers that<br />
prove the conditions for sterilization were met. They<br />
are similar to indicators, except that they change color<br />
when they have been exposed to the ideal combination<br />
<strong>of</strong> steam, pressure, heat and timing. They should ideally<br />
be run and logged daily.<br />
Spore tests are the most thorough way <strong>of</strong> testing<br />
autoclave function. They are periodically run through<br />
an autoclave cycle, and then sent to an external testing<br />
facility for analysis. The testing facility checks to see<br />
that there is no subsequent growth <strong>of</strong> bacterial spores on<br />
the medium. Since spores are extremely diffi cult to kill,<br />
the lack <strong>of</strong> spores on the test medium after autoclaving<br />
indicates that more fragile organisms have also been<br />
destroyed and the autoclave is functioning properly.<br />
Spore tests are absolutely necessary to ensure that<br />
items are indeed being sterilized. Failed spore tests<br />
require an immediate halt in piercing operations until<br />
tools and other items can be reliably resterilized. For<br />
this reason some shops keep more than one autoclave<br />
on premises. Your studio should have a written policy<br />
outlining the procedure that must be followed immediately<br />
following notifi cation <strong>of</strong> a failed spore test.<br />
Studios should develop and follow a written sterilization<br />
program that includes how and when indicator,<br />
integrator and spore tests will be run, recorded and<br />
fi led. Batch numbers can be included in the log so that<br />
a given set <strong>of</strong> tools can be quickly traced to a particular<br />
cycle and double-checked in case a concern regarding<br />
a particular piercing or client arise. Some new autoclaves<br />
come conveniently equipped with a printer that<br />
will provide a sheet documenting the sterilization cycle<br />
<strong>of</strong> each load. This printout is simply a written record<br />
and does not take the place <strong>of</strong> an indicator, integrator<br />
or spore test. Logs proving autoclave use and integrity<br />
are essential to the conscientious running <strong>of</strong> a studio,<br />
and will be invaluable should post documentation be<br />
required for regulatory or legal purposes (e.g. in the<br />
event <strong>of</strong> a lawsuit).<br />
Statim<br />
Some piercing studios use steam-fl ushing pressurepulse<br />
autoclaves (such as Statim autoclaves) for<br />
sterilization. The sterilization process in this type <strong>of</strong><br />
autoclave facilitates air removal and steam penetration,<br />
and has an extremely short processing time. The<br />
steam-fl ush pressure-pulse autoclave is acceptable<br />
for sterilization in the piercing studio as long as certain<br />
guidelines are followed:<br />
• Due to the high number <strong>of</strong> cycles run each day, these<br />
autoclaves must be spore tested weekly.<br />
• Daily, weekly and monthly maintenance <strong>of</strong> steam,<br />
pressure-pulse autoclaves is required. This type <strong>of</strong><br />
autoclave requires a more rigorous maintenance<br />
schedule than traditional autoclaves and a written log<br />
<strong>of</strong> all maintenance should be kept.<br />
The Statim has three sterilization cycles, each designed<br />
to sterilize a specifi c type <strong>of</strong> instrument.<br />
• Unwrapped cycle - 275 F for 3.5 minutes<br />
• Wrapped cycle - 275 F for 10 minutes<br />
• Rubber and plastic cycle - 250 F for 15 minutes<br />
The following can be sterilized in the Statim 2000:<br />
Nylon, polycarbonate (Lexan), polypropylene, PFTE<br />
(Tefl on), acetal (Delrin) polysulfone (Udel), polyetherimide<br />
(Ultem) silicone rubber, and polyester.<br />
The following cannot be sterilized in the Statim 2000<br />
on any cycle:<br />
Polyethylene, ABS, styrene, cellulosics, PVC, acrylic<br />
(Plexiglas), PPO (Noryl) latex, neoprene, and similar<br />
materials.<br />
If you are not sure, do not load items until you have<br />
checked with the manufacturer. Processing <strong>of</strong> these materials<br />
may lead to instrument or equipment damage.<br />
Do not mix instrument types (i.e. plastics and unwrapped<br />
tools) in the same Statim load.<br />
DISINFECTING SOLUTIONS<br />
What can I use as a disinfecting agent in<br />
my shop?<br />
What disinfectants you use will depend on the application<br />
and product availability. Appropriate products are<br />
marketed under many names and in several categories.<br />
All require exposure times <strong>of</strong> at least 10 minutes in order<br />
to effectively disinfect, with the exception <strong>of</strong> surfaces<br />
already considered “clean” (See Sterility Chart on page<br />
14 for explanation).<br />
Everything in the immediate piercing environment<br />
should be decontaminated with no less than an Intermediate<br />
Level <strong>of</strong> disinfection.<br />
Note that disinfectants are used only on inanimate<br />
surfaces (objects) and antiseptics are used only on<br />
animate (living) surfaces.<br />
Disinfecting solutions are grouped into families according<br />
to similar characteristics and properties. Choose<br />
products proven to be nontoxic, broad spectrum, hospital<br />
grade disinfectants, with a narrow effi cacy time and<br />
17
a long, stable shelf life. Labelling should specifi cally<br />
state that the product is bactericidal, virucidal, fungicidal<br />
and tuberculocidal. Some may also be described as<br />
germicidal or sporicidal as well.<br />
Glutaraldehyde - 2% Solutions<br />
These are non-biodegradable biohazards and have<br />
been classifi ed by the FDA as toxic. These solutions are<br />
commonly found in two varieties, the acidic and the alkaline.<br />
The alkaline type will require an activating agent<br />
to bring them to the proper Ph levels, thereby making<br />
them usable. They generally require a long exposure<br />
time in order to be effective. Most, if not all <strong>of</strong> these<br />
that are currently available require special ventilation<br />
and vapor monitoring equipment and must be disposed<br />
<strong>of</strong> according to specifi c local and federal regulations.<br />
Once activated, these products have a limited shelf life<br />
and are rendered ineffective fairly quickly.<br />
Some common products in the alkaline solutions<br />
family are Cidex Plus, Procide, and Omnicide. Common<br />
acidic Glutaraldehyde products are Sterall and<br />
Banicide. The acidic formulations do not require activation,<br />
but are only tuberculocidal after about 30 minutes<br />
<strong>of</strong> exposure time.<br />
All Glutaraldehyde solutions destroy unlike metals.<br />
Using any <strong>of</strong> these products with mixed metals such as<br />
stainless steel tools, brass jaw pliers, and plated pliers<br />
will lead to rapid corrosion.<br />
Phenolics - 10% Solutions<br />
Phenols are surface disinfectants and are not broad<br />
spectrum enough to make them useful for most surfaces<br />
in the piercing studio. These are sold under such names<br />
as Birex, Procide, and Lysol.<br />
Iodophores<br />
These are iodine-based disinfectants that will stain<br />
surfaces and discolor metals. This makes them a poor<br />
choice for soaking jewelry or tools. Additionally these<br />
disinfectants have been shown to potentially contain<br />
high levels <strong>of</strong> an organism called Pseudomonas, which<br />
grows in the solutions when stored for an extended period<br />
<strong>of</strong> time. Furthermore, many individuals are iodine<br />
sensitive or allergic to these products. Biocide, Microdyne,<br />
and Iod<strong>of</strong>i ve are common product names.<br />
Chlorine Compounds<br />
Sodium hypochlorite, more commonly known as bleach,<br />
acts as a protein disintegrator. Most pathogens are<br />
protein-based, making this an effective surface disinfectant.<br />
A solution <strong>of</strong> 10% bleach to 90% water will destroy<br />
18<br />
most pathogens in less than 10 minutes. For bleach<br />
to be effective, the surface area must be aggressively<br />
scrubbed fi rst, and the solution allowed to remain on<br />
the surface for a full 10 minutes. The diluted mixture<br />
has a shelf life <strong>of</strong> less than 48 hours so it should not be<br />
mixed and stored for later use.<br />
Many people are highly sensitive to this chemical and<br />
some may experience severe allergic reactions to vapors<br />
in a recently cleaned room. Using other chemicals<br />
(particularly ammonia-based cleaners) in the same area<br />
may produce a toxic reaction and poisonous gas.<br />
A bleach solution is incompatible with stainless steel<br />
tools or surfaces. Its use in ultrasonic cleaners or autoclaves<br />
will not only void warranties, but will destroy<br />
these costly pieces <strong>of</strong> equipment. Jewelry should never<br />
be soaked in even a weak bleach solution.<br />
Quaternary Ammonium Compounds<br />
Known as “Super-Quats,” these products are sometimes<br />
mixed with other chemicals such as alcohol. Although<br />
towelette wipes impregnated with Super-Quat solutions<br />
are excellent surface cleaners, not all disinfectants in<br />
this group will kill Tuberculosis, which is a particularly<br />
hardy pathogen. These products should also not be<br />
used for soaking jewelry. Common product names are<br />
Saniklens, Aseptic-seryl, and Bafi x.<br />
Synergistic Formulas<br />
A synergistic action involves two or more agents cooperating<br />
with each other to result in an effect greater<br />
than the additive effect <strong>of</strong> each agent operating by<br />
itself. These solutions are non-toxic, biodegradable,<br />
broad-spectrum disinfectants that are also non-corrosive<br />
and nonstaining. Once opened, the stability <strong>of</strong><br />
these solutions ranges from 6 to 10 months maintaining<br />
full potency. They do not require special disposal<br />
handling.<br />
Synergistic solutions are available in spray bottles,<br />
liquid pour bottles, foams, and impregnated towelettes.<br />
They can be used as hard surface disinfectants and<br />
for jewelry soaking. (Note that autoclave sterilization<br />
remains the only appropriate way to prepare jewelry<br />
for use in a fresh piercing.) Two <strong>of</strong> the most common<br />
products used by pr<strong>of</strong>essional piercers are the synergistic<br />
formulas Madacide and Discide.<br />
Isopropyl Alcohol<br />
Alcohol can be used as a low-level disinfectant only. It<br />
is not recommended as a soak or for disinfecting contaminated<br />
environments because it is not a suffi ciently<br />
effective cleaner.
DISPOSABLE SUPPLIES<br />
To minimize the risk <strong>of</strong> cross-contamination and to<br />
ensure that the piercing procedure is as clean as<br />
possible, many components <strong>of</strong> a piercing set-up are<br />
disposable. Unless supplies will be sterilized in a<br />
Statim autoclave immediately prior to the procedure, all<br />
disposables must be individually packaged in autoclave<br />
bags, sterilized, and remain in their pouches stored in<br />
enclosed, nonporous containers until use. Disposable<br />
materials that can and should be autoclaved include<br />
piercing needles, corks, rubber bands, cotton swabs,<br />
toothpicks, and gauze.<br />
When setting up for a piercing or jewelry insertion,<br />
the piercer should fi rst select and assemble all materials<br />
and tools that might be needed for that procedure.<br />
In avoiding cross-contamination, it is entirely unacceptable<br />
to reach into the piercing cabinet or drawers<br />
with gloves that have touched a client. Therefore, the<br />
piercer should anticipate possible needs and required<br />
items before the procedure begins. If additional supplies<br />
are required, the piercer must don fresh gloves<br />
before accessing any items in the piercing cabinet/<br />
drawers, and must change gloves before touching the<br />
client or sterile tools.<br />
Use <strong>of</strong> Various Disposables<br />
Presterilized Rubber Bands: Because the jaws <strong>of</strong><br />
forceps should never be locked onto a client during<br />
piercing, these are wound around forceps handles to<br />
achieve desired tension.<br />
Presterilized Cotton Swabs: Excellent for cleaning<br />
and drying in tight spots, and for erasing stray<br />
marks. They come in several different lengths and<br />
thicknesses.<br />
Presterilized Toothpicks: Used with gentian violet<br />
for marking placement.<br />
Presterilized Wire Snips: Can be used to connect<br />
internally threaded jewelry and piercing needles to<br />
maintain needle-jewelry connections for smooth jewelry<br />
transfers.<br />
PIERCING NEEDLES<br />
Acceptable piercing needles are hollow and extremely<br />
sharp, with a smoothly sloping cutting edge and no<br />
EQUIPMENT<br />
scratches or surface fl aws that could damage the tissue.<br />
Most piercing needles are sold as “super sharp,” or<br />
double- or triple-bevelled and come in several lengths.<br />
<strong>Piercers</strong> should inspect each needle immediately before<br />
use to be sure there are no burrs or irregularities.<br />
Should the piercer choose to bend or shorten a needle,<br />
great care should be taken to avoid creating such fl aws.<br />
Some companies are now manufacturing needles in<br />
different lengths and bent options.<br />
Of course, the true test <strong>of</strong> needle sharpness and<br />
quality will be in use. Since needle quality will affect<br />
both the comfort and healing <strong>of</strong> clients, as well as the<br />
smoothness and speed <strong>of</strong> the piercer’s technique, the<br />
use <strong>of</strong> only high quality needles is encouraged.<br />
Piercing needles are available in sizes corresponding<br />
to the gauges <strong>of</strong> jewelry for fresh piercings. Needles<br />
are commonly used in 18, 16, 14, 12 and 10 gauge.<br />
Most pr<strong>of</strong>essional piercers agree that needles thinner<br />
than 18 gauge or thicker than 8 gauge are inappropriate<br />
for fresh piercings. Thicker needles may damage<br />
tissue, and the excessive weight <strong>of</strong> metal jewelry thicker<br />
than 8 gauge may result in tissue damage or delayed<br />
healing.<br />
Needle Handling, Storage, and Disposal<br />
Piercing needles have an extremely sharp, precisionground<br />
blade, making them both hazardous to ship<br />
and handle, and easily damaged. Bulk, unsterilized<br />
needles should arrive at the piercing studio in a clearly<br />
marked, thick plastic, padded roll tube. Under no circumstances<br />
should needles be mailed in a plastic bag,<br />
taped to a cardboard square, or rolling around loose<br />
in a cardboard box. These methods create the risk <strong>of</strong><br />
a needlestick, and are certain to dull the fi ne points <strong>of</strong><br />
the needles.<br />
Most piercing studios perform in-house sterilization<br />
<strong>of</strong> piercing needles. This gives certainty that proper<br />
handling has occurred at every stage <strong>of</strong> the process.<br />
Unless needles are autoclaved immediately prior to a<br />
piercing procedure in a Statim autoclave, shipments <strong>of</strong><br />
needles should be immediately packaged and labeled<br />
with gauge and date <strong>of</strong> sterilization. Sterile needles in<br />
autoclave packets must be kept in clean, dry enclosed<br />
containers until use. Some local regulations and shop<br />
policies set expiration dates on sterilized needles and<br />
tools, after which the items are no longer considered<br />
sterile. Unused sterilized needles stored past their<br />
19
expiration date should be repackaged and autoclaved,<br />
and marked with a new expiration date.<br />
After a single use, needles must be immediately<br />
disposed <strong>of</strong> into an approved Sharps container. They<br />
should never be resterilized after use nor used more<br />
than once.<br />
Sharps Disposal<br />
Untreated, used Sharps disposal containers may not<br />
be included with ordinary trash. Sharps containers and<br />
waste in red Biohazard liners must be picked up by a<br />
Biohazard waste management company or disposed<br />
<strong>of</strong> in a manner that does not violate regulated waste<br />
laws. All containers in a studio bearing the Biohazard<br />
label must have the contents disposed <strong>of</strong> according to<br />
regulated waste laws.<br />
REUSABLE EQUIPMENT<br />
Most pr<strong>of</strong>essionals will use a wide range <strong>of</strong> tools to<br />
speed the procedure and maximize the comfort <strong>of</strong> the<br />
client. Piercing tools come in many styles, qualities<br />
and price levels. <strong>Piercers</strong> are cautioned that while<br />
inexpensive tools are abundant, the quality <strong>of</strong> tools is<br />
usually exhibited in their performance and durability.<br />
Tools that work well enhance your individual technique,<br />
rather than complicate it. High quality piercing tools are<br />
made <strong>of</strong> long-life stainless steel and are designed with<br />
piercing applications in mind. Much like surgical implements,<br />
initially they will be costly, but they are intended<br />
and engineered for repeated use over many years.<br />
Following each use, the contaminated tool<br />
should be:<br />
1. Cleaned in an ultrasonic. (See ultrasonic manufacturers’<br />
instructions for optimal solution and cycle<br />
length.)<br />
2. Rinsed<br />
3. Dried<br />
4. Bagged and labeled with date (as well as batch<br />
number and operator initials if required). To prolong<br />
life <strong>of</strong> instruments with movable parts, many<br />
pr<strong>of</strong>essionals apply surgical instrument lubrication<br />
(and allow it to dry) prior to bagging.<br />
5. Sterilized in an autoclave<br />
20<br />
*Note: Steps 1-4 should be performed only in an<br />
area designated as contaminated, and by properly<br />
trained personnel wearing personal protective<br />
equipment.<br />
TYPES OF TOOLS<br />
Forceps<br />
Forceps come in a variety <strong>of</strong> shapes and sizes and are<br />
used to align and secure tissue, increasing accuracy<br />
and speed <strong>of</strong> the piercing. Properly applied, forceps<br />
gently compress the piercing site while causing the<br />
piercee minimal discomfort and no additional tissue<br />
damage. Some forceps are designed for specifi c body<br />
parts, such as<br />
the septum and<br />
navel. Others<br />
are available<br />
modified to an<br />
individual piercer’s<br />
preference,<br />
f o r i n s t a n c e<br />
with a slotted,<br />
smooth or serrated<br />
head.<br />
Hemostats (“Multipurpose Tools”)<br />
These are useful for holding jewelry, beads and<br />
needles during procedures. They are available with<br />
smooth or serrated jaws,<br />
and some are customized<br />
with grooves for opening<br />
and closing rings as well.<br />
The smooth-jawed are<br />
less likely to scratch the<br />
delicate fi nish on jewelry.<br />
However, either fi nish <strong>of</strong><br />
jaw should be wrapped in<br />
sterile protective padding,<br />
such as plastic surgical<br />
tape or a cloth band-aid,<br />
for optimum protection.<br />
Needle Holders<br />
Needle holders are used in surgery for suturing. Their<br />
strong jaws with a central groove make them ideal for<br />
opening and closing small gauge and small diameter<br />
rings.<br />
Needle Receiving Tubes (“NRTs”)<br />
NRTs are used to support and protect the tissue<br />
around piercings when forceps may not be preferred.<br />
They are <strong>of</strong>ten used for nostrils, septums, Prince Alberts,<br />
vertical clitoral<br />
hoods, and some ear<br />
cartilage piercings.<br />
NRTs come in vari-
ous lengths, sizes and modifi cations. They are usually<br />
hollow stainless steel tubes with perfectly smooth<br />
openings, <strong>of</strong>ten with one fl ared or angled end. Some<br />
piercers prefer a shatter-resistant, autoclavable, clear<br />
Borosilicate glass NRT, which allows full needle visibility<br />
during the procedure.<br />
Pliers<br />
Many kinds <strong>of</strong> pliers are used in piercing procedures,<br />
and are described below. Optimally pliers should be<br />
made <strong>of</strong> stainless steel to withstand repeated autoclaving.<br />
The obvious exception is smooth brass-jaw pliers,<br />
which have the unique advantage <strong>of</strong> being unlikely to<br />
scratch the surface <strong>of</strong> jewelry due to their brass-coated<br />
jaws. Many pliers can be nickel- or chrome-plated<br />
to resist rusting, but will eventually break down and<br />
become unusable. The corroding metal can damage<br />
the delicate components <strong>of</strong> the autoclave. These tools<br />
must be replaced at the fi rst sign <strong>of</strong> rust.<br />
Ring Closing Pliers:<br />
Used to narrow the<br />
gap on captive rings to<br />
create proper tension<br />
for holding the bead.<br />
Ring Opening (or Expanding)<br />
Pliers: Used to remove and insert<br />
captive beads and occasionally to<br />
widen the gap on captive rings for<br />
insertion and removal.<br />
Bending Pliers: Used for custom<br />
bending nostril screws, fishtail<br />
labrets and needles. These are<br />
usually jewelers’ pliers and are<br />
available with a<br />
number <strong>of</strong> different<br />
head shapes.<br />
The most commonly<br />
used are<br />
called “double<br />
rounds.”<br />
Connecting Snips<br />
Small pieces <strong>of</strong> wire used to stabilize the jewelry<br />
transfer during the initial piercing when using internally<br />
threaded jewelry. Even experienced piercers fi nd the<br />
wire connection between the jewelry and needle helpful<br />
in maintaining alignment. When nicely fi nished and<br />
made <strong>of</strong> titanium or niobium wire in contrasting colors,<br />
connecting snips are easily distinguished on the piercing<br />
tray and are safe for re-sterilizing.<br />
Calipers<br />
These instruments are used for measuring the<br />
jewelry gauge<br />
and diameter, or<br />
the distance between<br />
markings<br />
for piercing placement.<br />
They are available in both standard inch and<br />
metric calibrations, and some <strong>of</strong>fer both units <strong>of</strong> measurement.<br />
Though calipers are available in both plastic<br />
and metal, few styles can be autoclaved. Usually the<br />
fancier and more accurate models cannot be sterilized,<br />
so great care should be taken not to contaminate them.<br />
There are a few simple styles available in autoclavable<br />
stainless steel. Though less accurate and somewhat<br />
harder to read, they have an obvious advantage in the<br />
piercing studio.<br />
Gauge Wheels<br />
Most American body jewelry<br />
manufacturers have standardized<br />
measurement <strong>of</strong><br />
the thickness <strong>of</strong> their jewelry<br />
wire with the Browne and<br />
Sharp/American Standard<br />
wire gauge system. In other<br />
industries this system has<br />
been historically used for measuring gold wire. There<br />
are some variances between wholesale companies, so<br />
it is always wise to double-check jewelry gauge to the<br />
wheel and to the needle before the piercing procedure.<br />
Outside the US, manufacturers use metric millimeters<br />
for measuring gauge.<br />
Insertion Tapers<br />
These are tapered pieces <strong>of</strong> 18g<br />
and larger stainless steel or titanium,<br />
used to gradually expand an existing<br />
piercing channel. Tapers are most<br />
<strong>of</strong>ten used to stretch a piercing up to<br />
the next gauge, to locate/stretch a<br />
healed piercing that has shrunk, and<br />
to quickly locate the piercing channel<br />
if a jewelry transfer is lost during the<br />
initial piercing.<br />
Reusable tapers are made <strong>of</strong> autoclavable<br />
materials and are available in many lengths,<br />
slopes and styles. In particular, concave tapers are<br />
used with non-threaded or larger initial jewelry, and<br />
pin-coupling tapers are available for inserting smaller<br />
gauge internal jewelry. When using tapers, understand<br />
21
that longer, gently sloping tapers (3 inches and up) are<br />
best for stretching, while shorter tapers are used for<br />
jewelry transfers. The longer and more gradual the<br />
taper, the more gentle the stretch.<br />
Piercing Trays<br />
Piercing trays are the basic foundation upon which the<br />
piercing set-up and aseptic fi eld is laid. All procedures<br />
should be worked from an autoclaved tray set-up or<br />
autoclaved tray liner, rather than a countertop or other<br />
surface. Trays should be made <strong>of</strong> autoclavable plastic<br />
or stainless steel, and covered with a plastic-backed<br />
dental bib or another impenetrable tray liner. Bagged<br />
equipment can be laid out upon the liner just prior to<br />
a procedure.<br />
The actual procedure surface is called an “aseptic<br />
fi eld,” and is a sterilized surface that becomes exposed<br />
to air contact only at the beginning <strong>of</strong> the piercing<br />
procedure. The aseptic fi eld used by most piercers is<br />
the inside surface <strong>of</strong> a freshly opened sterile forceps<br />
pack, or a sterile 3x3 or 4x4 gauze. Once a forceps or<br />
gauze pack is opened, sterile tools, needles, jewelry<br />
and disposables can be dropped onto the fl attened<br />
inside surface for use.<br />
Needles, jewelry and tools should never be placed<br />
on a non-sterile tray or tray liner surface. “Clean” is not<br />
suffi cient enough for a procedure surface. Procedure<br />
surfaces must be sterile. Optimally, piercing trays<br />
should fi t into the autoclave and should be sterilized<br />
at least daily, or immediately if cross-contamination is<br />
suspected.<br />
Sundry Jars<br />
These autoclavable tempered glass and/or stainless<br />
steel jars are useful for storing individually packaged<br />
sterile items. There are also a few grades <strong>of</strong> autoclavable<br />
plastic available. Sundry jars should not be used<br />
to store bulk sterilized unpackaged items because<br />
they are periodically open to air contact, and because<br />
bulk sterilized items are only sterile until removed from<br />
autoclave packaging. (Again, “clean” items are not<br />
clean enough for a piercing procedure.) Sundry jars<br />
need to be disinfected daily and sterilized weekly, or<br />
immediately if cross-contamination is suspected.<br />
22<br />
THE PIERCING GUN<br />
<strong>APP</strong> members make a commitment to using the best<br />
piercing techniques for hygiene, healing and client<br />
comfort. These require: piercing instruments that are<br />
sterile and/or disposable; jewelry that is sterile, implant<br />
grade and anatomy-appropriate; and methods that<br />
minimize tissue trauma and scarring. Although piercing<br />
gun companies continue to respond innovatively to<br />
some <strong>of</strong> the risks listed below, at the time <strong>of</strong> this printing<br />
the use <strong>of</strong> an ear stud gun cannot be accepted in the<br />
practice <strong>of</strong> <strong>APP</strong> members.<br />
While piercing guns may seem to be a quick, easy<br />
and convenient way <strong>of</strong> creating holes, they can have<br />
major drawbacks in terms <strong>of</strong> sterility, tissue damage<br />
and inappropriate jewelry design. These concerns,<br />
which have been documented in the medical literature,<br />
are addressed below.<br />
Reusable ear piercing guns can put clients in<br />
direct contact with the blood and body fl uids <strong>of</strong><br />
previous clients.<br />
During a piercing, microspray <strong>of</strong> body fl uid from one<br />
client can aerosolize and contaminate the inside <strong>of</strong> a<br />
gun. Even if sterile jewelry packs are used, the next<br />
client’s tissue and jewelry may contact contaminated<br />
surfaces, potentially transmitting bloodborne pathogens<br />
through the reusable ear piercing gun. Although guns<br />
may be exposed to bloodborne pathogens dozens <strong>of</strong><br />
times a day, few, if any, gun piercing establishments<br />
possess the expensive equipment (steam autoclave or<br />
chemclave) necessary to sterilize them.<br />
Considering the dozens <strong>of</strong> clients who may have direct<br />
contact with a single gun in one day, pathogens like<br />
hepatitis, pseudomonas and common staph constitute<br />
a serious public health threat if they are introduced into<br />
even one reusable piercing gun. Young children and<br />
those with immature or compromised immune systems<br />
may be at higher risk.<br />
Piercing guns can cause signifi cant tissue damage.<br />
Piercing guns use pressure to force a dull metal shaft<br />
through the skin. The procedure can cause similar tissue<br />
damage to a blunt force trauma, such as signifi cant<br />
pain, swelling, scarring, and an increased potential for<br />
complications.<br />
The more serious complications associated with gun<br />
piercing increase when stud guns are used on structural<br />
tissue such as cartilage. Cartilage has less blood fl ow
than lobe tissue and a correspondingly longer healing<br />
time. Therefore infections in this area are more common<br />
and can be much more destructive. The use <strong>of</strong><br />
non-sterile piercing equipment and insuffi cient aftercare<br />
has been associated with increased incidence <strong>of</strong><br />
auricular chondritis, a severe and disfi guring infection<br />
in cartilage tissue. This can result in deformity and collapse<br />
<strong>of</strong> structural ear tissue, requiring antibiotic therapy<br />
and extensive reconstructive surgery to correct.<br />
The length, design and material <strong>of</strong> traditional gun<br />
studs are inappropriate for initial piercings.<br />
Traditional ear piercing studs are too short for some<br />
earlobes, most cartilage and other body parts. Once<br />
they are locked on by the gun mechanism’s pressure,<br />
compressed tissue remains constricted and can become<br />
irritated. Diminished air and blood circulation<br />
can lead to prolonged healing, scarring, swelling and<br />
possibly impaction. Both piercers and medical personnel<br />
have seen stud gun jewelry embedded in ear<br />
lobes and cartilage (as well as navels, nostrils and lips),<br />
sometimes requiring surgical removal.<br />
Jewelry that fi ts too closely also increases the risk <strong>of</strong><br />
infection because it does not allow for thorough clean-<br />
ing. Body fl uids normally discharged during healing<br />
can become trapped around the hole by inappropriately<br />
designed jewelry. Unless this discharge is thoroughly<br />
and frequently removed, it can attract bacteria and<br />
becomes an invitation to secondary infection<br />
Ear piercing studs made <strong>of</strong> materials that are not<br />
FDA-approved or ASTM-certifi ed as safe for long term<br />
implant in the human body should not be used. Even<br />
when coated in non-toxic gold plating, materials from<br />
underlying alloys can leach into human tissue through<br />
corrosion, scratches and surface defects, causing cy-<br />
totoxicity and allergic reaction. Since manufacturing<br />
a durable corrosion- and defect-free coating for such<br />
studs is extremely diffi cult, medical literature recom-<br />
mends only implant grade (ASTM F-138) steel and<br />
titanium for piercing stud composition. Studs made <strong>of</strong><br />
any other materials, including non-implant grade steel<br />
(steel not batch-certifi ed as ASTM F-138), should not be<br />
used, regardless <strong>of</strong> the presence <strong>of</strong> surface plating.<br />
Misuse <strong>of</strong> ear piercing guns is extremely common.<br />
Even though many manufacturers’ instructions and<br />
local regulations prohibit it, many gun piercers do not<br />
stop at piercing only the lobes, and may pierce ear<br />
cartilage, nostrils, navels, eyebrows, tongues and other<br />
body parts with the ear stud guns. This is absolutely<br />
inappropriate and very dangerous.<br />
Considering that a large proportion <strong>of</strong> gun piercers’<br />
clientele are minors or young adults, it is not surprising<br />
that few gun piercing complications are reported to<br />
medical personnel. Many <strong>of</strong> the clients may have been<br />
pierced without the consent <strong>of</strong> parents or guardians who<br />
provide healthcare access. Therefore, many cases<br />
<strong>of</strong> infection, scarring and minor complications may go<br />
unreported and untreated. Because <strong>of</strong> the ease <strong>of</strong><br />
acquiring a gun piercing and the lack <strong>of</strong> awareness <strong>of</strong><br />
risk, many consumers fail to associate negative experiences<br />
with the stud gun itself. They believe that, since<br />
it is quicker and easier to acquire a gun piercing than a<br />
manicure, gun piercing must be inherently risk-free.<br />
Legislation has begun to prohibit the use <strong>of</strong> guns<br />
on ear cartilage and non-lobe locations, and New<br />
Hampshire has made all non-sterile equipment illegal,<br />
but these changes are not yet nationwide. As pr<strong>of</strong>essional<br />
piercers and public health advocates, we have<br />
an obligation to provide consumers and legislators with<br />
accurate and adequate information to understand the<br />
risks and benefi ts <strong>of</strong> gun piercing.<br />
FURTHER REFERENCES ON<br />
EAR PIERCING GUNS<br />
1. Journal <strong>of</strong> the American Medical <strong>Association</strong>. 2004<br />
February 25; 291(8): 981.<br />
Outbreak <strong>of</strong> Pseudomonas aeruginosa Infections<br />
Caused by Commercial Piercing <strong>of</strong><br />
Upper Ear Cartilage<br />
William E. Keene, PhD, MPH<br />
Amy C. Markum, RN, BSN<br />
Mansour Samadpour, PhD<br />
2. Pediatric Emergency Care. 1999 Jun15 (3): 189-92.<br />
Ear-piercing techniques as a cause <strong>of</strong> auricular chondritis.<br />
More DR, Seidel JS, Bryan PA.<br />
Department <strong>of</strong> Emergency Medicine, Harbor-UCLA<br />
Medical Center,<br />
Los Angeles, California, USA.<br />
3. Journal <strong>of</strong> Laryngology and Otology. 2001 Jul; 115(7):<br />
519-21.<br />
Ear deformity in children following high ear-piercing:<br />
current practice, consent issues and legislation.<br />
Jervis PN, Clifton NJ, Woolford TJ.<br />
Department <strong>of</strong> Otolaryngology, Royal Hallamshire<br />
Hospital, Sheffi eld, UK.<br />
23
4. International Journal <strong>of</strong> Pediatric Otorhinolaryngology.<br />
1990 Mar; 19(1): 73-6.<br />
Embedded earrings: a complication <strong>of</strong> the ear-piercing<br />
gun.<br />
Muntz HR, Pa-C DJ, Asher BF.<br />
Department <strong>of</strong> Pediatric Otolaryngology, St. Louis<br />
Children's Hospital, Washington University Medical<br />
Center, MO 63110.<br />
5. Plastic and Reconstructive Surgery. 2003 Feb;<br />
111(2): 891-7; discussion 898.<br />
Ear reconstruction after auricular chondritis secondary<br />
to ear piercing.<br />
Margulis A, Bauer BS, Alizadeh K.<br />
Northwestern University Medical School, The Children's<br />
Memorial Medical Center, Chicago, Ill 60614,<br />
USA.<br />
6. Contact Dermatitis. 1984 Jan; 10(1): 39-41.<br />
Nickel release from ear piercing kits and earrings.<br />
Fischer T, Fregert S, Gruvberger B, Rystedt I.<br />
7. British Journal <strong>of</strong> Plastic Surgery. 2002 April; 55(3):<br />
194-7.<br />
Piercing the upper ear: a simple infection, a diffi cult<br />
reconstruction.<br />
Cicchetti S, Skillman J, Gault DT.<br />
Department <strong>of</strong> Plastic and Reconstructive Surgery,<br />
Mount Vernon Hospital,<br />
Northwood, UK.<br />
8. American Journal <strong>of</strong> Infection Control. 2001 Aug;<br />
29(4): 271-4.<br />
Body piercing as a risk factor for viral hepatitis: an<br />
integrative research review.<br />
Hayes MO, Harkness GA.<br />
University <strong>of</strong> New Hampshire, School <strong>of</strong> Health and<br />
Human Services, Durham, USA.<br />
9. Cutis. 1994 Feb; 53(2): 82.<br />
Embedded earrings.<br />
Cohen HA, Nussinovitch M, Straussberg R.<br />
Pediatric Community Clinic, Petach Tikvah, Israel.<br />
10. Scandinavian Journal <strong>of</strong> Rheumatology. 2001; 30(5):<br />
311.<br />
Does mechanical insult to cartilage trigger relapsing<br />
polychondritis?<br />
Alissa H, Kadan<strong>of</strong>f R, Adams E.<br />
11. Toxicology In Vitro. 2000 Dec; 14(6): 497-504.<br />
Cytotoxicity due to corrosion <strong>of</strong> ear piercing studs.<br />
24<br />
Rogero SO, Higa OZ, Saiki M, Correa OV, Costa I.<br />
Instituto de Pesquisas Energeticas e Nucleares,<br />
IPEN, PO Box 11049, CEP 05422-970, SP, Sao<br />
Paulo, Brazil.<br />
12. Journal <strong>of</strong> the American Medical <strong>Association</strong>. 1974<br />
Mar 11; 227(10): 1165.<br />
Ear piercing and hepatitis: Nonsterile instruments<br />
for ear piercing and the subsequent onset <strong>of</strong> viral<br />
hepatitis.<br />
Johnson CJ, Anderson H, Spearman J, Madson J.<br />
13. Journal <strong>of</strong> the American Medical <strong>Association</strong>. 1969<br />
Mar 24; 207(12): 2285.<br />
Hepatitis from ear piercing.<br />
Van Sciver AE.<br />
14. The Lancet: Infectious Diseases. 2002 December<br />
1; 2(12): 715.<br />
Piercing the cartilage and not the lobes leads to<br />
ear infections<br />
Pam Das
RECEPTION AND SALES ROOM<br />
Counter<br />
The counter surface should be a nonporous surface<br />
such as glass or metal that can be easily disinfected<br />
as needed throughout the day. An FDA-approved hard<br />
surface disinfectant should be used according to the<br />
manufacturer’s instructions for this purpose. Glass<br />
cleaner should be used to minimize streaking.<br />
Keep disposable relish cups, sealable plastic<br />
baggies, dental bibs and tissues at the counter to<br />
minimize cross-contamination by customers. Have<br />
clients place previously worn jewelry into relish cups<br />
or baggies, never on the counter. Even new, unworn<br />
jewelry brought in by a client must be handled as if it is<br />
contaminated. It very well might have been “just tried<br />
on for a second,” which is reason enough to treat it as<br />
contaminated. Throw away contaminated disposable<br />
items once they have contained a client’s own jewelry,<br />
whether they report it was previously worn or not.<br />
It is extremely common for customers to touch their<br />
jewelry and piercings when they are at the counter,<br />
even when they are asked to refrain from such activity.<br />
Keep a close watch on your customers and politely but<br />
fi rmly insist that they not handle their own jewelry and/or<br />
piercings on the premises. Fully explain your concern<br />
for their safety and the reasons behind the rule, and<br />
do not tolerate this potential for cross-contamination in<br />
the studio. If a client does touch their own jewelry or<br />
piercing (whether new or healed), immediately require<br />
them to wash their hands or provide germicidal hand<br />
wipes for their use to prevent cross-contamination <strong>of</strong><br />
the studio. Be consistent with requiring hand sanitizing<br />
after each and every such contact. A posted sign at<br />
the front counter can explain:<br />
“For your health and that <strong>of</strong> others, please do<br />
not remove, insert, or handle your jewelry in the<br />
store. We will do it for you.”<br />
With the possible exception <strong>of</strong> a welcoming handshake,<br />
touch pierced clients only with freshly gloved<br />
hands. Many piercers feel that wearing gloves for<br />
contact <strong>of</strong> even non-pierced areas establishes a level<br />
<strong>of</strong> pr<strong>of</strong>essional detachment between the piercer and<br />
the client.<br />
Dial calipers, gauge wheels, ring expanding pliers,<br />
and other tools that are used at the counter should be<br />
used for new, unworn jewelry only.<br />
ENVIRONMENT<br />
Disinfect or sterilize the front counter tools as necessary.<br />
Should contamination occur, items that cannot<br />
be autoclaved must be disposed <strong>of</strong>.<br />
Display<br />
Display jewelry should be protected from potential contamination.<br />
Customers should not be allowed to touch<br />
display jewelry to any part <strong>of</strong> their skin, piercing, or<br />
own jewelry. When in doubt, handled items should be<br />
autoclaved before being returned to the display case.<br />
Sterile jewelry used for initial piercings should not<br />
be kept in the display case. If jewelry from the display<br />
case is to be used for an initial piercing, the item must<br />
meet all criteria for initial piercing jewelry and must be<br />
sterilized before use. If display or stock jewelry cannot<br />
be autoclaved, contact the manufacturer for proper<br />
handling, care and maintenance. Whenever possible,<br />
handle display jewelry with gloved hands.<br />
THE PIERCING ROOM<br />
The piercing room must be a completely separate<br />
enclosed room with walls and door(s) made <strong>of</strong> nonporous<br />
material (tile, semigloss paint, sealed brick,<br />
vinyl). Unsealed brick, cement, wood and other uneven<br />
or porous wall surfaces can trap and harbor diseasecausing<br />
pathogens.<br />
Flooring in the piercing room should be made <strong>of</strong><br />
linoleum, tile (ceramic, vinyl), sealed wood, or other<br />
nonporous material, and should have approximately<br />
4-6 inches <strong>of</strong> splash guard around the perimeter to<br />
protect walls. Floors should be mopped daily with a<br />
disinfectant specifi c to the type <strong>of</strong> fl ooring.<br />
Lighting in the piercing room must be bright and<br />
adjustable. Depending on lighting needs, fi xed lighting<br />
can be combined with adjustable lamps. Lamps<br />
that are touched or adjusted during procedures must<br />
be disinfected at least daily and throughout the day as<br />
needed when the potential for cross-contamination exists.<br />
<strong>Piercers</strong> who touch light fi xtures during procedures<br />
must change gloves before resuming the procedure.<br />
To prevent client contact with Biohazard and clean<br />
areas <strong>of</strong> the piercing room, a specifi c area should be<br />
provided and visibly marked for client’s belongings.<br />
The Sharps container and contaminated tools should<br />
not be located close to sterilized piercing implements<br />
25
and supplies. Many piercers use a Biohazard-labeled<br />
shelf above their trash can for contaminated tools.<br />
This establishes a single contamination area in the<br />
room. Used piercing implements should be kept in an<br />
enclosed, nonporous tray or container marked “Biohazard.”<br />
The Sharps container should be secured to avoid<br />
accidental spillage, and should be at a height easily<br />
accessible to all piercers employed in the studio.<br />
Packaged equipment and other supplies used during<br />
procedures should be stored in a cabinet, credenza,<br />
or other enclosed, nonporous storage area. These<br />
supplies should be handled only with clean, freshly<br />
gloved hands.<br />
A HEPA fi lter or other air purifi cation device should be<br />
located in each piercing room and throughout the studio<br />
in other necessary locations. Purifi ers are selected<br />
according to square footage specifi cations and should<br />
be maintained according to manufacturer’s instructions.<br />
Replacing fi lters as recommended is essential to the<br />
proper functioning <strong>of</strong> these air cleaning devices.<br />
Signs visibly convey important information to distracted<br />
clients and minimize the need to repeatedly<br />
announce some information. Some examples <strong>of</strong> useful<br />
signs for the studio:<br />
26<br />
Over the piercing setup area:<br />
“Do not touch or put anything on this table.”<br />
In areas where contaminated items are located:<br />
“Biohazard: Do not Touch.”<br />
On non-Biohazard trash cans:<br />
Furniture<br />
“Contaminated Waste”<br />
Storage units and medical supply cabinets should be<br />
<strong>of</strong> a nonporous, easily disinfected surface material, and<br />
have several drawers for storing air- and light- sensitive<br />
supplies. Furnishings should be disinfected no less<br />
than once daily and whenever cross-contamination<br />
occurs.<br />
Mayo stands are portable tray holding devices.<br />
These stainless steel rolling carts must be disinfected<br />
before and after each use. Any stand or surface used<br />
as a procedure surface must also be disinfected.<br />
Client seating is available in a wide variety <strong>of</strong> styles.<br />
The most commonly used types are dentist’s chairs,<br />
massage tables, and gynecological exam tables.<br />
Choose your furniture for comfort, adjustability, and<br />
ease <strong>of</strong> disinfection.<br />
Seating covers should be <strong>of</strong> a nonporous material<br />
such as vinyl or sealed leather. Disposable table paper<br />
is a suggested additional covering (mandatory where<br />
required by law). Client seating must be disinfected<br />
before and after each use even if no contamination is<br />
apparent. Scabies, parasites, and other transmissible<br />
organisms may be transferred from the hair or clothing<br />
<strong>of</strong> a client to the table or chair.<br />
Trash cans must be heavy-grade plastic or metal,<br />
lidded, foot-pedal operated, and clearly labeled. Cans<br />
should be fi tted with plastic liners and placed where<br />
they will be accessible to piercers yet out <strong>of</strong> the reach<br />
<strong>of</strong> clients.<br />
According to usual medical standards, most piercing<br />
studios do not produce enough blood- soaked trash to<br />
necessitate regulated biohazard waste management.<br />
However, it is appropriate to voluntarily use a biohazard<br />
waste container that is collected by a biohazard waste<br />
service weekly or monthly. Red biohazard trash can<br />
liners should be used in these containers and should<br />
never be disposed with regular trash. Be certain to<br />
check local regulations on handling regulated waste.<br />
Reasonable access to a sink used exclusively for<br />
handwashing is mandatory. In-room prep sinks are<br />
ideal. This sink should be used only for pre- and post-<br />
piercing handwashing, and optimally should operate via<br />
a hands-free method (foot pedals, motion sensors).<br />
Air conditioners, fans, and heaters should be used<br />
with caution in the piercing room because they can blow<br />
contaminants into the designated clean areas <strong>of</strong> the<br />
room. If used, turn these devices toward the door and<br />
away from the piercing supply cabinet, trays, and seating.<br />
Airfl ow should always be “from clean to dirty”.<br />
BIOHAZARD AND STERILIZA-<br />
TION ROOM(S)<br />
Two Room Set-Up<br />
An ideal studio design would include two rooms for<br />
sterilization procedures: one contaminated; one<br />
“clean.” The fi rst room would contain the biohazard<br />
sink, presoak container, ultrasonic cleaning unit, and<br />
autoclave packaging materials. Here shop staff would<br />
decontaminate and package used forceps, tapers,<br />
pliers and other tools. The second room, or “clean<br />
room,” would contain a handwashing sink, autoclave(s),<br />
and an additional (uncontaminated) ultrasonic unit for<br />
processing new jewelry.<br />
While it is not commonly seen in the piercing industry,<br />
there are some studios that have eliminated the
need for a biohazard processing area in their studio<br />
by using only disposable tools and equipment. This<br />
may not be a viable option for most studios due to the<br />
increased cost.<br />
One Room Set-Up<br />
Many studios have limited space and must place sterilization<br />
and biohazard processing in one room. This<br />
can be done effectively provided the two areas are<br />
clearly separated.<br />
The ultrasonic unit and “dirty” sink should be positioned<br />
as far away from the autoclave(s) and “clean”<br />
area as possible to reduce the risk <strong>of</strong> contaminating the<br />
outside <strong>of</strong> the autoclave and/or items being removed<br />
from the autoclave. (See Sterility Chart on page 14.)<br />
Nonporous barriers such as Plexiglas can be erected<br />
to create boundaries between clean and dirty zones.<br />
All contaminated surfaces and objects should be clearly<br />
labeled “Biohazard.”<br />
General Guidelines<br />
The sterilization room(s) should be as far from client<br />
traffi c as possible and should be labeled to keep clients<br />
from entering the room:<br />
“Warning: Biohazard! Employees Only”<br />
Remember that once an item is used in the biohazard<br />
area, it cannot be used for any other purpose or<br />
in any other room unless it can be autoclaved. This<br />
includes tissue and glove boxes, paper towel rolls,<br />
pencils, tape, etc.<br />
<strong>Piercers</strong> working in facilities that share space with<br />
other body art practitioners such as tattooists must<br />
have an ultrasonic unit dedicated for their own use.<br />
Ultrasonic cleaners used for contaminated processing<br />
require a solid tight-fi tting lid to reduce the quantity <strong>of</strong><br />
airborne contaminants. Everything in the proximity<br />
<strong>of</strong> the ultrasonic unit is considered contaminated and<br />
should be handled only with protective gloves.<br />
The autoclave area has tremendous potential for<br />
cross-contamination. Operating procedures must be<br />
carefully outlined and consistently followed.<br />
1. Gloves should be changed when moving from the<br />
contaminated area to the autoclave area and any<br />
other time when moving to a surface cleaner than<br />
what was just touched.<br />
2. Don clean gloves to open the autoclave before<br />
loading tools into it. Place contaminated items into<br />
the open autoclave, without touching any clean<br />
surfaces with dirty gloves.<br />
3. Dispose <strong>of</strong> gloves and wash hands before return-<br />
ing to the autoclave. A new set <strong>of</strong> gloves should<br />
be donned before shutting the autoclave door and<br />
starting the cycle.<br />
4. Once an autoclave cycle is complete and the contents<br />
are dry, promptly remove sterile items from<br />
the autoclave and place them in safe storage. This<br />
will minimize the potential for cross-contaminating<br />
the recently sterilized objects. Extra care must be<br />
taken to avoid contaminating the sterile packages<br />
as they are removed from the autoclave with freshly<br />
gloved hands.<br />
OSHA guidelines, printed sterilization procedures,<br />
and any other signage required in the area should be<br />
framed or laminated to allow for proper cleaning.<br />
THE RESTROOM<br />
Restroom sinks should have hot and cold water, a<br />
paper towel dispenser, and liquid antibacterial soap<br />
in a pump dispenser. A trash can with liner must be<br />
provided. The toilet, sink, doorknobs, lights witches,<br />
and other frequently-handled surfaces must be thoroughly<br />
cleaned daily, and disinfected throughout the<br />
day as needed.<br />
It is also appropriate to include signage such as:<br />
“For your own health and that <strong>of</strong> others, please<br />
do not remove, insert, or handle your jewelry in<br />
our bathroom. We will do it for you.”<br />
27
The Purpose <strong>of</strong> Skin Preparation<br />
The purpose <strong>of</strong> skin preparation (“skin prep”) before<br />
a piercing is to render the surface <strong>of</strong> the area to be<br />
pierced as free as possible from oil, perspiration, dirt,<br />
and transient and resident bacteria.<br />
STAGES OF SKIN PREP<br />
Antiseptic Solutions<br />
Chemical agents selected for skin prep should have<br />
the following properties:<br />
• A broad-spectrum antimicrobial action<br />
• Rapid activation and prolonged effectiveness<br />
• Minimal irritation/sensitization potential<br />
• Quick and convenient application<br />
The chart below compares some <strong>of</strong> the frequently-<br />
and historically-used products in this industry.<br />
COMPARISON OF SKIN PREP PRODUCTS<br />
Hibiclens Betadine Linear Alcohol Techni-Care<br />
Scrub Time (Minutes) 8 3.5 11 .5<br />
Dermatitis Potential 30% 30% High
the reasons explained below.<br />
Injectable Anesthetics<br />
These are illegal unless administered by a licensed<br />
medical practitioner. Using an injectable product such<br />
as Lidocaine or Xylocaine is ill-advised and inappropriate.<br />
The injection would be more uncomfortable and<br />
take longer to administer than the piercing itself. Fluid<br />
injected into tissue also distorts the area and causes<br />
additional trauma. This can hamper accurate piercing<br />
placement and is likely to result in additional discomfort<br />
as the anesthesia dissipates.<br />
Serious complications such as an allergic reaction<br />
may be caused by the anesthetic as well. All else aside,<br />
there is little sense in sticking a client with a needle and<br />
injecting their body with a foreign substance in order<br />
to perform a piercing.<br />
Topical Anesthetics<br />
The use <strong>of</strong> over-the-counter topical anesthetics such<br />
as creams is not necessary for body piercings. These<br />
products are ineffective for minimizing sensation to the<br />
area that will be pierced. An effective topical anesthetic<br />
only numbs the upper layers <strong>of</strong> tissue and, as with<br />
injectable agents, the potential for allergic reactions<br />
exists.<br />
A prescription-strength topical anesthetic is illegal<br />
unless prescribed by a licensed medical pr<strong>of</strong>essional.<br />
These may induce tissue edema (swelling), alter skin<br />
texture and affect accurate jewelry placement. These<br />
effects make the piercing procedure itself more challenging<br />
for the piercer to perform. It is diffi cult to be<br />
sure <strong>of</strong> the ultimate appearance <strong>of</strong> the piercing when<br />
tissue is distorted. The tissue will only resume normal<br />
shape gradually as the effects <strong>of</strong> the product on the<br />
tissue are diminished.<br />
Ethyl Chloride is a prescription-only freeze spray.<br />
When sprayed on tissue, it can result in frostbite damage<br />
and can complicate and delay healing. It is quite<br />
painful to have applied, and takes much longer to<br />
administer than a simple piercing.<br />
Every effort should be made to discourage clients<br />
who have access to anesthetics from using them prior<br />
to piercing. While the client may have legal access to<br />
these medications and take full responsibility for their<br />
own actions, you are responsible for the quality and<br />
safety <strong>of</strong> the work you perform. Some piercers refuse<br />
to pierce clients who have used anesthetics until after<br />
the chemicals have dissipated from the site.<br />
Ice is another method <strong>of</strong> superfi cial freezing. Like<br />
ethyl chloride, it may result in tissue damage. All <strong>of</strong><br />
30<br />
the complications related to ethyl chloride apply to ice.<br />
Additionally, ice is not sterile.<br />
The only appropriate use <strong>of</strong> ice during a piercing<br />
would be for the client to hold an ice cube in his/her<br />
hand. This works as sensory confusion much like a<br />
doctor or nurse pinching one hip while injecting the<br />
other. This ice cube technique can be helpful for highly<br />
anxious piercees.<br />
Drugs and Alcohol<br />
Purposely self-medicating with prescription or recreational<br />
drugs or alcohol prior to a piercing is unwise and<br />
is an inappropriate behavior. An ethical piercer who<br />
becomes aware that a client is in an altered state will<br />
refuse to perform the piercing. In addition to the obvious<br />
ethical breach, such a situation involves dangers<br />
for both parties. Only individuals in full possession <strong>of</strong><br />
their faculties should be pierced.
Client education and continued care are essential<br />
services every piercer should provide. Clients need<br />
to understand the importance <strong>of</strong> maintaining a clean<br />
environment, and be given full written instructions for<br />
appropriate piercing care during healing. A well-placed<br />
piercing fi tted with high quality jewelry performed under<br />
hygienic conditions can still go awry if proper aftercare<br />
procedures are not observed.<br />
Many misconceptions still exist about what products<br />
and methods are most effective for piercing care. The<br />
<strong>APP</strong> has established an industry standard <strong>of</strong> suggestions<br />
for piercing care. While we recognize the fact that<br />
each human body is unique, we have found that the<br />
following guidelines are optimal for uneventful, timely<br />
healing for the vast majority <strong>of</strong> piercees. Even clients<br />
with prior experience healing piercings should receive<br />
complete instructions every time, as is now required by<br />
many local laws. Many suggestions have changed over<br />
time, and it is important to impart the most recent care<br />
guidelines available. The following care instructions<br />
should be provided to each piercee both verbally and<br />
in a written format to take home with them.<br />
Preprinted tri-fold pamphlets containing these written<br />
care guidelines are available from the <strong>APP</strong>. See the inside<br />
cover <strong>of</strong> this manual or website for more details.<br />
AFTERCARE GUIDELINES<br />
FOR BODY PIERCINGS<br />
Cleaning Solutions<br />
Use either one or both <strong>of</strong> the following solutions for<br />
body piercing:<br />
• Packaged sterile saline solution with no additives<br />
(read the label) or non-iodized sea salt mixture.<br />
Dissolve 1/8-1/4 teaspoon <strong>of</strong> non-iodized (iodine<br />
free) sea salt into one cup (8 oz) <strong>of</strong> warm distilled<br />
or bottled water. A stronger mixture is not better!<br />
Saline solution that is too strong can irritate the<br />
piercing.<br />
• Liquid anti-microbial or germicidal soap.<br />
Cleaning Instructions for Body Piercings<br />
1. WASH hands thoroughly prior to cleaning, or touching<br />
on or near piercing for any reason.<br />
2. SALINE: Soak for several minutes at least two<br />
AFTERCARE<br />
to three times daily. Simply invert a cup <strong>of</strong> warm<br />
solution over the area and press it against the<br />
skin to form a vacuum. The longer the soaks, the<br />
better. For certain placements it may be easier to<br />
apply fresh gauze or a cotton ball saturated with<br />
saline solution. Follow soaks with a brief rinse to<br />
remove any residue.<br />
3. SOAP: To be used no more than once or twice a<br />
day. While showering, lather up a pearl size drop<br />
<strong>of</strong> the soap to clean the jewelry and the piercing.<br />
Leave the cleanser on the piercing no more than<br />
thirty seconds, then rinse thoroughly to remove all<br />
traces <strong>of</strong> soap from the piercing.<br />
4. DRY with disposable paper products such as gauze<br />
or tissues. Re used cloth towels can harbor bacteria<br />
and catch on new piercings causing injury. Pat<br />
gently to avoid trauma.<br />
What Is Normal?<br />
• Initially: Some bleeding, localized swelling, tenderness,<br />
or bruising.<br />
• During Healing: Some discoloration, itching, secretion<br />
<strong>of</strong> whitish-yellow fl uid (not pus) that forms<br />
crust on jewelry when dried. The tissue may tighten<br />
around jewelry as it heals.<br />
• Once Healed: Jewelry may not move freely in the<br />
piercing. That is okay. DO NOT force it. If you fail<br />
to clean the piercing as part <strong>of</strong> your daily hygiene<br />
routine, smelly (but normal) secretions may accumulate.<br />
Continue cleaning piercing in the shower<br />
after healing.<br />
A piercing may seem healed before healing is complete.<br />
Piercings heal from the outside in and, although<br />
it feels healed, the tissue on the inside remains fragile<br />
longer. BE PATIENT and keep cleaning throughout<br />
the entire healing period.<br />
Even healed piercings can shrink or close in minutes<br />
after having been there for years! This varies from<br />
person to person. If you like your piercing, leave the<br />
jewelry in place.<br />
What To Do<br />
• Wash hands prior to touching the piercing. Leave<br />
it alone except when cleaning. It is not necessary<br />
to rotate the jewelry while healing except possibly<br />
during cleaning.<br />
31
• Stay healthy. Get enough sleep and eat a nutritious<br />
diet. The healthier your lifestyle, the easier it is for<br />
your piercing to heal. Exercise during healing is fi ne,<br />
just “listen” to your body.<br />
• Keep the bed clean. Make sure bedding is clean and<br />
changed regularly. Wear clean, breathable clothing<br />
that protects your piercing while sleeping.<br />
• Showering is preferable to taking a bath because<br />
bathtubs tend to harbor bacteria. If you would like to<br />
take a bath, clean the tub well before each use.<br />
What To Avoid<br />
• Avoid Undue Trauma such as friction from clothing,<br />
excessive motion <strong>of</strong> the area, playing with jewelry and<br />
vigorous cleaning. These activities can lead to unsightly<br />
and painful scar tissue, migration, prolonged<br />
healing, and other complications.<br />
• Avoid Chemicals such as alcohol, hydrogen peroxide,<br />
Betadine, Hibiclens or ointments.<br />
• Avoid Over Cleaning. This can delay healing and<br />
irritate the piercing.<br />
• Avoid All Contact. Oral contact, rough play, and<br />
contact with others’ bodily fl uids on or near your<br />
piercing during healing can irritate your piercing and<br />
expose you to infection.<br />
• Avoid Stress and Recreational Drug Use including<br />
excessive caffeine, nicotine, and alcohol.<br />
• Avoid Submerging Piercing in bodies <strong>of</strong> water<br />
such as lakes, pools and jacuzzis. You could also<br />
protect the piercing with waterpro<strong>of</strong> bandages such<br />
as Tegaderm, available at drugstores.<br />
• Avoid Cosmetics. Keep all beauty and personal<br />
care products away from the area on or around the<br />
piercing -- including cosmetics, lotions, and sprays.<br />
• Avoid Accessories. Do not hang charms or other objects<br />
from jewelry until the piercing is fully healed.<br />
HINTS AND TIPS<br />
Jewelry<br />
• Leave Jewelry In During Healing. Unless there is<br />
a problem with the size, style or material <strong>of</strong> the initial<br />
jewelry, leave it in place for the entire healing period.<br />
A qualifi ed piercer should perform any necessary jewelry<br />
changes during healing. See the <strong>APP</strong> website<br />
for “Picking your Piercer” brochure.<br />
• If Temporary Removal Is Necessary. Contact your<br />
piercer if a medical procedure or other event requires<br />
removal. There are non-metallic jewelry alternatives<br />
to keep the hole open.<br />
32<br />
• Leave Jewelry In At All Times. Even old, wellhealed<br />
piercings can shrink or close in minutes after<br />
having been there for years! Reinsertion can be<br />
diffi cult or impossible.<br />
• Check Balls. With clean hands or a paper product,<br />
regularly check threaded ends on jewelry for tightness.<br />
(“Righty-tighty, lefty-loosey”.)<br />
• Carry A Spare: In case <strong>of</strong> loss or breakage, keep<br />
a clean spare ball with you.<br />
• Ready To Remove? If you decide you no longer<br />
want the piercing, seek pr<strong>of</strong>essional help to remove<br />
jewelry and continue cleaning piercing until the hole<br />
closes. In most cases only a small indentation will<br />
remain.<br />
• Never remove jewelry during infection! If the surface<br />
seals over, the infection can be trapped inside,<br />
complicating treatment.<br />
FOR PARTICULAR AREAS<br />
Navel<br />
A hard, vented eye patch (sold at pharmacies) can<br />
protect the area from restrictive clothing (such as<br />
stockings), excess irritation, and impact during physical<br />
activities such as contact sports. It can be applied with<br />
surgical tape under tight clothing, or secured using a<br />
length <strong>of</strong> ace bandage around the body (to avoid irritation<br />
from the adhesive).<br />
Ear/Ear Cartilage and Facial<br />
Use the t-shirt trick: Dress your pillow in a large, clean<br />
t-shirt and turn it over or inside-out nightly, one clean<br />
t-shirt provides four clean surfaces for sleeping.<br />
Maintain cleanliness <strong>of</strong> telephones, headphones,<br />
eyeglasses, helmets, hats and anything that contacts<br />
the pierced area.<br />
Use caution when styling your hair and advise your<br />
stylist <strong>of</strong> a new or healing piercing.<br />
Nipple<br />
The support <strong>of</strong> a tight cotton tank top or sports bra<br />
provides protection and be comfortable, especially for<br />
sleeping.<br />
Genital<br />
Wash hands before touching on or near the piercing.<br />
Prince Albert and Apadravya piercings can bleed<br />
freely for the fi rst few days. Keep wrapped in sterile<br />
gauze as needed. Sex or blood thinners may exacerbate<br />
or renew bleeding.
If using soap to clean, urinate after cleaning any<br />
piercing that is near the urethra.<br />
In most cases gentle, fl uid-safe sexual activity is<br />
fi ne as soon as you feel ready. Comfort and hygiene<br />
are vital.<br />
To increase comfort and decrease trauma, soak in<br />
warm saline solution or plain water to remove any crusty<br />
matter prior to sexual activity.<br />
Use barriers such as condoms, dental dams, and<br />
Tegaderm* to avoid contact with a partner’s bodily<br />
fl uids, even in long-term relationships.<br />
Use a new container <strong>of</strong> water based lubricant.* Do<br />
not use your own or others’ saliva as a lubricant.<br />
After sex, an additional saline soak or clean water<br />
rinse is suggested.<br />
*Consult your piercer or the <strong>APP</strong> website, or call<br />
(888) 888-1<strong>APP</strong> for current suggested products. This<br />
will allow for us to keep current as advances are made<br />
in the fi eld.<br />
AFTERCARE GUIDELINES<br />
FOR ORAL PIERCINGS<br />
Cleaning Solutions<br />
Use either one or both <strong>of</strong> the following cleaning solutions<br />
for inside the mouth:<br />
• Antimicrobial or antibacterial alcohol-free mouth<br />
rinse *<br />
• Packaged sterile saline solution* with no additives<br />
(read label) or Non-iodized Sea Salt Mixture:<br />
Dissolve 1/8 to 1/4 teaspoon <strong>of</strong> Non-iodized (iodinefree)<br />
Sea Salt into one cup (8 oz) <strong>of</strong> warm distilled or<br />
bottled water. A stronger mixture is not better! Saline<br />
solution that is too strong can irritate the piercing.<br />
Note: Those with high blood pressure or a heart<br />
condition should check with a doctor before using a<br />
saline product inside the mouth as the primary cleaning<br />
solution.<br />
Cleaning Instructions for Inside the Mouth<br />
Rinse mouth 4-5 times daily with cleansing solution<br />
for 30-60 seconds after meals and at bedtimes during<br />
the entire healing period. Overcleaning may cause<br />
discoloration or irritation <strong>of</strong> the tongue.<br />
Cleaning Instructions for the Exterior <strong>of</strong><br />
Labret (cheek and lip) Piercings<br />
Soak in saline solution and/or wash with liquid antimicrobial<br />
or germicidal soap* as described below:<br />
1. WASH hands thoroughly prior to cleaning or touching<br />
on or near your piercing for any reason.<br />
2. SALINE: Soak at least two to three times daily.<br />
Simply soak directly in a cup <strong>of</strong> warm saline solution<br />
for a few minutes. The longer you soak, the better.<br />
For certain placements it may be easier to apply<br />
fresh gauze or a cotton ball saturated with saline<br />
solution. A brief rinse will remove any residue.<br />
3. SOAP: Use no more than once or twice a day.<br />
While showering, lather up a pearl-size drop <strong>of</strong><br />
soap to clean the jewelry and the piercing. Leave<br />
the cleanser on the piercing no more than thirty<br />
seconds, then rinse thoroughly to remove all traces<br />
<strong>of</strong> soap from the piercing.<br />
4. DRY with disposable paper products such as gauze<br />
or tissues. Cloth towels can harbor bacteria and<br />
catch on new piercings causing injury. Pat gently<br />
to avoid trauma.<br />
What Is Normal?<br />
For The First Three To Five Days: Signifi cant swelling,<br />
light bleeding, bruising, and/or tenderness.<br />
After That: Some swelling, light secretion <strong>of</strong> a whitish-yellow<br />
fl uid (not pus).<br />
A piercing may seem healed before healing is complete.<br />
Piercings heal from the outside in, and although<br />
it may feel healed, the tissue remains fragile on the<br />
inside. BE PATIENT, and keep cleaning throughout<br />
the entire healing period.<br />
Even healed piercings can shrink or close in minutes<br />
after having been there for years. This varies from<br />
person to person. If you like your piercing, leave the<br />
jewelry in place.<br />
What To Do<br />
• Help Reduce Swelling: Dissolve small pieces <strong>of</strong><br />
ice in the mouth.<br />
Take an over the counter, nonsteroidal anti-infl ammatory<br />
such as Ibupr<strong>of</strong>i n or Naproxyn Sodium* according<br />
to package instructions.<br />
Sleep with your head elevated above your heart for<br />
the fi rst few nights.<br />
• Maintain Good Oral Hygiene: Use a new s<strong>of</strong>tbristled<br />
toothbrush and keep it clean (put it through<br />
the dishwasher).<br />
Brush teeth, and use your chosen rinse (saline or<br />
mouthwash) after every meal.<br />
During healing, fl oss daily and gently brush teeth,<br />
tongue and jewelry.<br />
33
34<br />
Once healed, brush jewelry more thoroughly to avoid<br />
plaque build up.<br />
• Stay Healthy: The healthier your lifestyle, the easier<br />
it will be for a piercing to heal.<br />
Get enough sleep and eat a nutritious diet.<br />
What To Avoid<br />
• DO NOT PLAY WITH THE JEWELRY. Long-term<br />
effects <strong>of</strong> playing with and clicking the jewelry against<br />
the teeth can result in permanent damage to teeth<br />
and other oral structures. See the <strong>APP</strong>’s Brochure:<br />
“Oral Piercing Risks and Safety Measures” for more<br />
information.<br />
• Avoid undue trauma. Excessive talking or playing<br />
with the jewelry during healing can lead to unsightly<br />
and uncomfortable scar tissue, migration, and other<br />
complications.<br />
• Avoid Alcohol. Mouthwash containing alcohol can<br />
irritate the area and delay healing.<br />
• Avoid Oral Sexual Contact including French (wet)<br />
kissing or oral sex during healing, even with a long<br />
term partner.<br />
• Avoid Chewing gum, tobacco, fi ngernails, pencils,<br />
sunglasses, etc.<br />
• Avoid Sharing plates, cups, and eating utensils.<br />
• Avoid smoking! It increases risks and lengthens<br />
healing time.<br />
• Avoid Stress and All Recreational Drug Use.<br />
• Avoid Bloodthinners including any aspirin or alcohol,<br />
or large amounts <strong>of</strong> caffeine.<br />
• Avoid Submerging in bodies <strong>of</strong> water such as lakes<br />
and pools.<br />
*Consult your piercer or the <strong>APP</strong> website, or call<br />
(888) 888-1<strong>APP</strong> for current suggested products. This<br />
will allow you to keep current as advances are made<br />
in the fi eld.<br />
HINTS AND TIPS<br />
Jewelry<br />
• Replace Jewelry. Once the swelling has subsided,<br />
it is vital to replace the original longer jewelry with a<br />
shorter post. Consult your piercer for his/her downsize<br />
policy. Because this necessary jewelry change<br />
may occur during healing, it should be done by a<br />
qualifi ed piercer.<br />
• Check Balls. With clean hands or paper product,<br />
be sure to regularly check threaded ends on your<br />
jewelry for tightness (“Righty-tighty, lefty-loosey”).<br />
• Carry A Spare: In case <strong>of</strong> loss or breakage, keep<br />
a clean spare ball with you.<br />
• Ready To Remove? If you decide you no longer<br />
want the piercing, seek pr<strong>of</strong>essional help to remove<br />
jewelry and continue cleaning piercing until the hole<br />
closes. In most cases only a small indentation will<br />
remain.<br />
• Never remove jewelry during infection! If the surface<br />
seals over, the infection can be trapped inside,<br />
complicating treatment.<br />
Eating<br />
• Eat small bites <strong>of</strong> food, placed directly onto the<br />
molars.<br />
• Chew Slowly.<br />
• Avoid spicy, salty, acidic or hot temperature foods<br />
or beverages for a few days.<br />
• Cold foods and beverage are soothing and help<br />
reduce swelling.<br />
• For tongue piercings: Try to keep your tongue level<br />
in your mouth as you chew and swallow.<br />
• For labret (cheek and lip) piercings: Be cautious<br />
about opening your mouth too wide as this can result<br />
in the backing <strong>of</strong> the jewelry catching on the teeth.<br />
Each body is unique and healing times may vary<br />
considerably. If you have any questions, please contact<br />
your piercer.<br />
DISCLAIMER<br />
These guidelines are based on a combination <strong>of</strong> vast<br />
pr<strong>of</strong>essional experience, common sense, research and<br />
extensive clinical practice. This is not to be considered<br />
a substitute for medical advice from a doctor. If you suspect<br />
an infection, seek medical attention. Keep in mind<br />
that the removal <strong>of</strong> jewelry can lead to further complications.<br />
Be aware that many doctors have not received<br />
specifi c training regarding piercing. Your local piercer<br />
may be able to refer you to a piercing friendly medical<br />
pr<strong>of</strong>essional. See the <strong>APP</strong> Brochure “Troubleshooting<br />
For You And Your Healthcare Pr<strong>of</strong>essional”.
PIERCING HEALING TIMES<br />
Below is a list <strong>of</strong> average healing times for various piercings. Because these differ from many clients’<br />
expectations, details <strong>of</strong> healing times and suggested aftercare should be provided to clients<br />
before they consent to be pierced. Inform piercees that since human bodies differ, healing times<br />
vary and cannot be guaranteed. When in doubt they should continue aftercare for at least the<br />
maximum time listed below.<br />
Ampallang 6-9 Months or longer<br />
Apadravya 6-9 Months or longer<br />
Cheek 6-9 Months or longer<br />
Clitoral Hood 6-8 Weeks or longer<br />
Clitoris 6-8 Weeks or longer<br />
Conch 6-9 Months or longer<br />
Daith 6-9 Months or longer<br />
Dydoe 6-9 Months or longer<br />
Ear Cartilage<br />
(all variations) 6-9 Months or longer<br />
Earl (Bridge) 3-4 Months or longer<br />
Earlobe 6-8 Weeks or longer<br />
Eyebrow 6-8 Weeks or longer<br />
Foreskin 6-8 Weeks or longer<br />
Fourchette 6-8 Weeks or longer<br />
Frenum 3-4 Months or longer<br />
Guiche 3-4 Months or longer<br />
Labia (inner) 6-8 Weeks or longer<br />
Labia (outer) 3-4 Months or longer<br />
Labret 6-8 Weeks or longer<br />
Lip (side) 6-8 Weeks or longer<br />
Lorum 3-4 Months or longer<br />
Navel 6-9 Months or longer<br />
Nipple<br />
(female) 6-9 Months or longer<br />
Nipple<br />
(male) 3-4 Months or longer<br />
Prince Albert 6-8 Weeks or longer<br />
Pubic 3-4 Months or longer<br />
Rook 6-9 Months or longer<br />
Scrotum 3-4 Months or longer<br />
Septum 6-8 Weeks or longer<br />
Surface 6-9 Months or longer<br />
Tongue 6-8 Weeks or longer<br />
Tragus 6-9 Months or longer<br />
Triangle 3-4 Months or longer<br />
6-8 Weeks: Clitoral Hood, Clitoris, Earlobe, Eyebrow, Foreskin, Fourchette,<br />
Inner Labia, Labret, Lip, Prince Albert, Septum, Tongue<br />
3-4 Months: Earl, Frenum, Guiche, Outer Labia, Lorum, Male Nipple, Pubic,<br />
Scrotum, Triangle<br />
6-9 Months: Ampallang, Apadravya, Cheek, Conch, Daith, Dydoe, Ear Cartilage,<br />
Navel, Female Nipple, Rook, Surface Piercings, Tragus<br />
35
STANDARDS AND<br />
CERTIFICATIONS<br />
Of the countless metals and alloys available, few have<br />
been proven safe and effective for initial wear in body<br />
piercings. To fi nd the most acceptable materials for<br />
internal wear, our industry utilizes material guidelines<br />
used for medical implants, as defi ned by the ISO and<br />
ASTM.<br />
ISO<br />
The International Organization for Standardization<br />
(ISO) is a worldwide non-governmental federation<br />
<strong>of</strong> national standard bodies from over 140 countries.<br />
The mission <strong>of</strong> ISO is to promote the development and<br />
distribution <strong>of</strong> international standardization for scientifi c<br />
and technological practices, including medical, metal,<br />
and chemical activity.<br />
ASTM<br />
The American Standard for Testing Materials (ASTM)<br />
is a not-for-pr<strong>of</strong>i t organization that provides a global forum<br />
for the development and distribution <strong>of</strong> consensus<br />
standards for materials and testing. Despite its name,<br />
ASTM standards are accepted and used internationally<br />
in scientifi c and medical research, development<br />
and testing.<br />
Use <strong>of</strong> ISO and ASTM standards are voluntary and<br />
only become legally binding when a governmental body<br />
makes them so, or when they are cited in a contract.<br />
Manufacturers in a variety <strong>of</strong> industries will sometimes<br />
state a product has been tested according to ASTM or<br />
ISO standard by citing the applicable code number on<br />
the product label or packaging. In the case <strong>of</strong> metals<br />
this will appear on the mill sheet.<br />
Mill Sheet<br />
Also referred to as a mill certifi cate or material certifi -<br />
cate, this is a document created by a metal foundry,<br />
provided to the wire mill, and then to the manufacturer.<br />
It guarantees the specifi cations <strong>of</strong> the alloy and is your<br />
pro<strong>of</strong> <strong>of</strong> content quality.<br />
On request, any manufacturer producing body jewelry<br />
should produce the mill certifi cates obtained from the<br />
wire mill where their raw material was purchased. If a<br />
jewelry manufacturer is unwilling or unable to produce<br />
this certifi cation, their steel and titanium jewelry cannot<br />
be considered to meet ASTM or ISO standards<br />
JEWELRY<br />
and should not be used. Some area laws now require<br />
that shops provide mill sheets proving the ASTM/ISO<br />
compliance (and therefore the biocompatibility) <strong>of</strong> their<br />
jewelry.<br />
CERTIFIED MATERIALS FOR<br />
NEW PIERCINGS<br />
ASTM Compliant Stainless Steel<br />
Low carbon stainless steels, such as 316L and 316LVM<br />
are used in the body jewelry industry because <strong>of</strong> their<br />
proven biocompatibility. For many years 316LVM was<br />
the preferred steel standard for a fresh piercing. While<br />
this is a good start, it is important to know that not all<br />
316L or 316LVM stainless will meet ASTM certifi cation,<br />
and may vary in biocompatibility. Therefore shops must<br />
have mill certifi cates from jewelry manufacturers showing<br />
that the steel being used is F-138 compliant.<br />
Stainless steel contains nickel, which is a well-documented<br />
irritant. One signifi cant benefi t <strong>of</strong> implant-certifi<br />
ed materials is a passive layer <strong>of</strong> chromium oxide that<br />
allows virtually no nickel to contact the customer.<br />
Implant Certifi ed Titanium<br />
Implant Certifi ed Titanium (ASTM F-136) is an extremely<br />
inert and lightweight alloy. Additionally, titanium<br />
can be anodized to create jewelry <strong>of</strong> different colors.<br />
The colors are created by producing an oxide layer<br />
<strong>of</strong> varying thicknesses and do not affect the biocompatibility.<br />
They may fade with time and certain types<br />
<strong>of</strong> chemical exposure, but again this does not affect<br />
biocompatibility.<br />
OTHER <strong>APP</strong>ROPRIATE MATERIALS<br />
FOR NEW PIERCINGS<br />
There are other materials considered acceptable for<br />
fresh piercings, but which do not have ISO and ASTM<br />
standards. The following are considered acceptable<br />
because they either have a long history <strong>of</strong> successful<br />
use, or have favorable biocompatibility ratings.<br />
Niobium<br />
Niobium is very similar to titanium but does not have<br />
a set ASTM standard. It is used extensively in the<br />
medical industry for implant components and has<br />
been the subject <strong>of</strong> thorough biocompatibility testing.<br />
37
Like titanium it can be anodized to produce different<br />
colors. Unlike titanium, it can also be colored black<br />
in either a glossy or matte fi nish. Matte fi nish black<br />
niobium has a rough fi nish and is NOT acceptable for<br />
fresh piercings.<br />
Solid 14K or 18K White or Yellow Gold<br />
Medical documentation relating to gold biocompatibility<br />
is scarce. However, gold has been used successfully<br />
for piercing jewelry for thousands <strong>of</strong> years and is considered<br />
by both our industry and the medical industry to be<br />
biocompatible for most people when it is pure enough.<br />
All gold jewelry contains a mixture <strong>of</strong> gold and other<br />
metals called an alloy. Every jeweler uses different alloy<br />
mixtures and <strong>of</strong>ten guards the recipes as trade secrets.<br />
Since the specifi c percentage <strong>of</strong> each metal are different<br />
to obtain, it is impossible to set specifi c standards and<br />
metal requirements for gold alloys. However, we can<br />
say the following:<br />
The purest form <strong>of</strong> gold, 24k, contains no other materials<br />
but is too s<strong>of</strong>t for use in body jewelry. Jewelry that<br />
is too s<strong>of</strong>t is easily scratched, nicked or burred, and is<br />
diffi cult to thread without stripping. Jewelry less than 14k<br />
is less than 57% gold and can contain large amounts<br />
<strong>of</strong> other metals that may react to the body. Therefore,<br />
it should not be used. 18k is an optimum standard for<br />
body jewelry, and 14k may also be used.<br />
Only solid white or yellow gold is appropriate for insertion<br />
into the body. Colored golds, such as rose or green<br />
gold, are alloys with variations in the amount <strong>of</strong> copper,<br />
silver or other metals. These alloys are more likely to<br />
cause adverse reactions in the body and should only be<br />
used for beads and decorative attachments.<br />
In the making <strong>of</strong> white gold alloys, metals such as<br />
nickel, platinum or palladium are used to make the gold<br />
white in appearance. Because <strong>of</strong> the risk <strong>of</strong> nickel reactions,<br />
most manufacturers <strong>of</strong>fer nickel-free white gold,<br />
which is strongly recommended for use in body jewelry<br />
and is required by some area regulations.<br />
Platinum<br />
This very heavy and expensive precious metal is extremely<br />
inert and is therefore ideal for body jewelry. It<br />
is a brilliant white color and is harder to work than other<br />
precious metals. Styles may be limited as a result <strong>of</strong> both<br />
its high cost and greater diffi culty in manufacturing.<br />
PTFE<br />
This inert plastic comes as a solid rod and uses tapped<br />
balls. When a ball is twisted onto the end <strong>of</strong> the rod,<br />
the existing pattern inside the ball effectively “threads”<br />
38<br />
the post, keeping the ball in place. PTFE is quite useful<br />
in medical situations where metal jewelry cannot<br />
be worn.<br />
Tygon<br />
This micro-bore tubing is used in many medical applications<br />
because it is USP Class 6-compliant. Male<br />
balls can be threaded into the hollow center, creating<br />
barbell-style jewelry that can be cut to custom size.<br />
Because <strong>of</strong> changes in the material over use time,<br />
Tygon should be changed every two months. Additionally,<br />
the manufacturer does not recommend it for<br />
long-term use.<br />
JEWELRY MATERIALS FOR<br />
HEALED PIERCINGS<br />
When used and cared for responsibly, the following materials<br />
are generally appropriate for healed piercings.<br />
Because all bodies are different, be aware that some<br />
individuals may experience sensitivity or reactions to<br />
one or more <strong>of</strong> these.<br />
Tempered Glass (Pyrex)<br />
Lead-free glass plugs are usually safe and comfortable<br />
in piercings, especially in stretched ear lobes. Borosilicate<br />
glass is autoclaveable but can be susceptible<br />
to breakage in thinner pieces.<br />
High-Density, Low-Porosity Non-Toxic<br />
Hardwoods<br />
Hardwood plugs are a popular and comfortable choice<br />
for many clients. Because some woods are toxic or have<br />
been treated with various chemicals, it is important to<br />
purchase plugs from a knowledgeable and reputable<br />
manufacturer. Wood cannot be autoclaved or disinfected<br />
so each wood piece should be worn by only one<br />
piercee. Accepting returns or exchanges <strong>of</strong> wood pieces<br />
is never appropriate. A non-chemical soap is suggested<br />
for cleaning wood jewelry. Periodic conditioning <strong>of</strong> wood<br />
plugs with cosmetic-grade natural oils can improve durability,<br />
appearance and long-term comfort.<br />
Other Organic Materials<br />
Several types <strong>of</strong> organic jewelry are acceptable for use<br />
in healed piercings. These include (but are not limited<br />
to) stone, horn, bone, coconut wood, bamboo, and<br />
petrifi ed ivory. These materials are most <strong>of</strong>ten used in<br />
ear lobes. In some areas, such as lips, moisture may<br />
cause porous jewelry to swell, making removal more<br />
diffi cult. Care should be taken in both choosing and<br />
conditioning organic jewelry.
High-Density, Low-Porosity<br />
Nontoxic Plastics<br />
There is some controversy surrounding the long-term<br />
wear <strong>of</strong> acrylic jewelry. While a clean piece <strong>of</strong> FDA<br />
approved acrylic is an acceptable choice for a healed<br />
piercing for some clients, its chemical components are<br />
less biocompatible than many other materials. Some<br />
grades are more likely to cause reactions than others<br />
and should be chosen with caution. Acrylic cannot be<br />
autoclaved or disinfected and should therefore be considered<br />
appropriate for single person use only. Acrylic<br />
can crack, shatter or cloud when coming in contact with<br />
alcohol or alcohol-based disinfectants, hair products<br />
and mouthwashes. Petroleum-based lubricants can<br />
cause plastics to break down, potentially releasing<br />
chemical irritants into the skin. Acute sensitivities to<br />
acrylic can develop suddenly even in those who have<br />
worn it comfortably in the past. Therefore care should<br />
be taken when choosing and using acrylic jewelry.<br />
JEWELRY TO AVOID<br />
Conventional Jewelry<br />
Jewelry designed specifi cally for earlobe piercing or<br />
purchased at a conventional jewelry store is never appropriate<br />
for use in body piercings. The materials and<br />
workmanship are seldom <strong>of</strong> implant quality, and the<br />
styles may involve sharp edges and/or details that may<br />
trap bacteria. Earring wires and posts are also much<br />
too thin, which can cause discomfort and potentially cut<br />
into a piercing. Ear studs with butterfl y closures trap<br />
excreted body fl uids and bacteria.<br />
Gold-fi lled, Rolled, or Plated Jewelry<br />
This type <strong>of</strong> jewelry is always unacceptable for body<br />
piercings. These products are made by placing a very<br />
thin layer <strong>of</strong> gold over either inferior metal jewelry (e.g.<br />
nickel or aluminum), or over a steel piece fi rst covered<br />
by an underplating <strong>of</strong> nickel or copper (to help the gold<br />
adhere to the steel). The thin gold outer layer can wear<br />
<strong>of</strong>f, leaving sharp edges and exposing the poor quality<br />
metals underneath. Furthermore, the plating process is<br />
<strong>of</strong>ten achieved by means <strong>of</strong> a cyanide bath or mercury<br />
amalgam. This process creates the potential for these<br />
two highly toxic chemicals to contact the body and leach<br />
into the bloodstream.<br />
Silver<br />
Silver is an unstable alloy that oxidizes (tarnishes) easily<br />
and is not biocompatible. Many piercees fi nd that<br />
even if they wear silver comfortably in ear piercings,<br />
other areas <strong>of</strong> the body are more sensitive and are<br />
quickly irritated by it. Even sterling silver is not appropriate<br />
for use in body piercings. Many piercees will<br />
have reactions to silver beads or charms that contact<br />
sensitive skin near piercings or rest against piercing<br />
holes (especially on navels).<br />
Other Grades <strong>of</strong> Stainless Steel<br />
High carbon steel and steel <strong>of</strong> the 302, 306, and 400<br />
series are inappropriate for piercing jewelry. Many <strong>of</strong><br />
these grades <strong>of</strong> steel break down or corrode when in<br />
continued contact with body fl uids. Always request mill<br />
certifi cates directly from the manufacturers. They are<br />
required by law to provide these documents detailing<br />
the composition <strong>of</strong> the metal.<br />
Aluminum<br />
Aluminum resembles niobium in appearance and<br />
is similar to titanium in weight. However, it is never<br />
appropriate for body jewelry. Long-term aluminum<br />
exposure has been connected to neurological damage,<br />
Alzheimer’s Disease and metal sensitivities.<br />
THINGS TO LOOK FOR IN<br />
QUALITY JEWELRY<br />
Jewelry Quality<br />
Because the jewelry industry is overly saturated with<br />
substandard jewelry, it is common for piercers and clients<br />
alike to forget that quality jewelry, not cost, should<br />
be the deciding factor in the purchasing <strong>of</strong> jewelry. Keep<br />
in mind that this jewelry will be worn inside the body<br />
in continuous contact with internal tissue. It should be<br />
<strong>of</strong> the best materials, design and workmanship available.<br />
Furthermore, the unique individual, anatomy and<br />
location should be considered in determining the most<br />
appropriate jewelry in each case.<br />
Polish<br />
High quality piercing jewelry must be polished to a<br />
mirror fi nish. Jewelry that is not highly polished will<br />
be more porous, potentially causing discomfort and<br />
delayed healing. Poorly polished jewelry may also<br />
have compromised biocompatibility.<br />
Piercing jewelry must be free <strong>of</strong> all polishing compounds.<br />
These may appear as deposits near a fi xed<br />
bead or in the threading. All jewelry must also be free<br />
<strong>of</strong> nicks, scratches and burrs.<br />
39
Annealing<br />
Annealing is a heat treatment that tempers metal,<br />
making it more pliable and easier to open and close.<br />
Annealed jewelry does not need to be opened forcefully<br />
with pliers, reducing the risk that it will be scratched during<br />
procedures. Jewelry that is well annealed should<br />
be able to be opened with only fi nger pressure in sizes<br />
such as 14 gauge 1/2” diameter and 12 gauge 5/8”<br />
diameter. There will still be more than enough tensile<br />
strength to hold in a captive bead.<br />
Curved jewelry such as captive rings or fi xed bead<br />
rings is made from wire that is wrapped in the manufacturing<br />
process. This wrapping can change the molecular<br />
structure <strong>of</strong> the metal. It should be annealed<br />
to restore it to its pre-wrapping grade.<br />
Threading<br />
The United States <strong>APP</strong> membership elected to require<br />
internally threaded jewelry for initial piercings. External<br />
threads may tear new tissue, trap bacteria and release<br />
polishing materials into the initial piercing.<br />
Balls for tapped/threaded jewelry thicker than 16<br />
gauge should be countersunk so that the bead fi ts onto<br />
the end <strong>of</strong> the jewelry more closely, thus minimizing<br />
accumulation <strong>of</strong> excreted matter.<br />
Non-Threading<br />
Threadless (press-fi t) barbells and balls are a new<br />
jewelry option in the industry. Well made jewelry <strong>of</strong><br />
this type is an acceptable alternative to traditional<br />
threaded jewelry.<br />
Machining<br />
Many people currently manufacturing body piercing<br />
jewelry are amateurs who do not have the knowledge<br />
or skill to produce well-machined jewelry. <strong>Piercers</strong> must<br />
therefore carefully check all pieces prior to use.<br />
• Beads and posts should be drilled to match, and<br />
should not be <strong>of</strong>f-center.<br />
• Check for gaps between the ball and post that could<br />
retain bacteria and signify poor drilling.<br />
• Ends <strong>of</strong> rings and posts should not be blunt or sharp,<br />
but smoothly rounded for painless insertion.<br />
Jewelry Size, Gauge, Diameter<br />
Each piece <strong>of</strong> jewelry is measured using two proportions:<br />
Gauge and Diameter. Gauge refers to the thickness<br />
<strong>of</strong> the wire. Most American piercers use the Brown<br />
and Sharpe/American wire gauging system. Most other<br />
countries measure gauge in metric millimeters.<br />
40<br />
The diameter <strong>of</strong> a ring is its width measured across<br />
the inside <strong>of</strong> the ring. The diameter or length <strong>of</strong> a<br />
barbell is the length <strong>of</strong> the shaft measured between<br />
the balls.<br />
Inexperienced and uncaring piercers frequently insert<br />
inappropriately sized jewelry into new piercings. A<br />
skilled piercer knows that each body is unique and will<br />
individually select pieces <strong>of</strong> appropriate gauge, size,<br />
and style for each client. Initial jewelry should be selected<br />
for its suitability during healing. Remember that<br />
the piercing is permanent but the jewelry can always<br />
be changed after healing.<br />
JEWELRY STYLES<br />
Captive Bead<br />
Ring<br />
This ring is the most commonly<br />
used type <strong>of</strong> body jewelry. It<br />
consists <strong>of</strong> a gapped ring with<br />
a bead held captive in the gap<br />
by the tension <strong>of</strong> the ring. The<br />
ring is opened by removing<br />
and replacing the bead (“popping” the bead in and<br />
out). This style may not be appropriate for jewelry <strong>of</strong><br />
very thin sizes, particularly in s<strong>of</strong>ter gold, when there<br />
is not enough pressure/tension to keep the bead from<br />
falling out.<br />
Fixed Bead Ring<br />
This has a bead permanently<br />
soldered or fixed<br />
onto one end <strong>of</strong> the ring,<br />
and is opened and closed<br />
by bending the ring sideways<br />
(as if tearing a coin). This style is most suitable for<br />
piercings in which the jewelry is not changed frequently.<br />
Since thicker or harder rings can be diffi cult to open or<br />
close, fi xed bead rings are most <strong>of</strong>ten made in smaller<br />
gauges and in gold.<br />
Barbell<br />
This piece <strong>of</strong> jewelry is a straight post<br />
with one threaded ball on each end. It<br />
is most commonly seen in tongue piercings,<br />
but can be used in many other<br />
piercings in which a ring is not suitable,<br />
or when jewelry needs to lie close to the<br />
body with a minimal pr<strong>of</strong>i le.
Curved Barbell<br />
These are similar to barbells<br />
with two threaded<br />
balls, but have a shaft that<br />
curves in a uniform arc like<br />
a crescent moon. They are<br />
most commonly associated<br />
with navel piercings, but are also appropriate in other<br />
areas where friction from protruding jewelry is problematic,<br />
but a straight barbell is unsuitably shaped.<br />
J Barbell<br />
The J Barbell is a curved barbell<br />
whose shaft is shaped like a “J”.<br />
These are used in navels for which<br />
the J curve more closely mimics<br />
the piercee’s anatomy than does<br />
the crescent curved barbell.<br />
Circular Barbell<br />
This is similar in shape<br />
to a ring, but with more<br />
versatility <strong>of</strong> a barbell’s<br />
screw-on balls. The<br />
threaded balls allow it<br />
to be easily removed and reinserted. A circular barbell<br />
is especially suitable when the look <strong>of</strong> a large gauge<br />
ring is desired without the diffi culty <strong>of</strong> opening and<br />
closing a ring <strong>of</strong> such thickness.<br />
Surface Barbell<br />
This “staple shaped” barbell<br />
was developed specifi cally<br />
for use in surface piercings.<br />
The theory is that the staple shape helps coax<br />
the body into healing by minimizing upward pressure<br />
on the tissue over the piercing and allowing blood to<br />
fl ow freely in the local tissue, thereby minimizing the<br />
chances <strong>of</strong> migration.<br />
Nostril Screw<br />
Nostril screws are based on an<br />
old East Indian design. The<br />
screw allows the stud to hug<br />
the inside <strong>of</strong> the nostril without<br />
injuring the septum or falling<br />
out easily. It does not require a backing (which can<br />
trap bacteria) as a regular stud earring does. This is<br />
more attractive, safer, and superior for comfort.<br />
There are left-bend and a right-bend nostril screws,<br />
depending on whether the jewelry is worn in the right<br />
or left nostril. The tail end <strong>of</strong> the screw should point up<br />
and away, concealed inside the nostril. Also, nostrils<br />
can vary considerably in thickness, and dimensions<br />
must be taken into account when selecting or custom<br />
bending the nostril screw for each client.<br />
Labret Stud<br />
A labret stud is essentially a minibarbell<br />
with a small, fl at disc on one<br />
end. These are most commonly<br />
used for labret piercings and in<br />
places where a fl at back fi ts most<br />
comfortably with anatomical structures<br />
on one side <strong>of</strong> the piercing<br />
(e.g. against teeth, some inner ear<br />
cartilage). They <strong>of</strong>ten come with both ends threaded so<br />
that ball and disc sizes and shapes can be customized<br />
to the client’s individual anatomy and preferences.<br />
Fishtail Labret<br />
The fi shtail is an alternative<br />
to the labret stud for<br />
lip piercing. Its shape resembles<br />
a nostril screw,<br />
but it is longer and <strong>of</strong>ten thicker to suit the thick and<br />
s<strong>of</strong>t lip tissue. After allowing suffi cient length to wear<br />
through the lip, the post is bent at a right angle, and the<br />
“tail” is worn resting along the bottom <strong>of</strong> the gumline<br />
inside the lip on one side. These are most comfortable<br />
when fi t and custom bent to the client’s mouth.<br />
Threadless<br />
Barbell<br />
This has the same shapes<br />
and uses as the barbell,<br />
curved barbell or labret<br />
post, except that instead<br />
<strong>of</strong> the usual screw-on<br />
ball(s), a “snap together”<br />
ball is pressed into the<br />
post.<br />
Septum Retainer<br />
Retainers are specialized pieces <strong>of</strong><br />
jewelry, used only in septum piercings<br />
and <strong>of</strong>ten shaped like a staple<br />
or U. They are useful for clients<br />
41
who want to keep jewelry in their septum piercings,<br />
yet need to make the piercing inconspicuous. The<br />
center <strong>of</strong> the piece is worn through the piercing and<br />
the “legs” are fl ipped up and forward inside the nostrils<br />
to remain unseen.<br />
Plugs and/or<br />
Eyelets<br />
These styles can be worn<br />
in healed stretched or<br />
enlarged piercings, most<br />
<strong>of</strong>ten in ear lobes. They can be made <strong>of</strong> a variety<br />
<strong>of</strong> materials, including stainless steel, glass, wood,<br />
stone, horn, bone, amber, and gold. They are <strong>of</strong>ten<br />
fl ared at one or both ends to keep the jewelry in place.<br />
Plugs that are not fl ared are <strong>of</strong>ten kept in place with<br />
small o-rings <strong>of</strong> high-grade silicon or latex. O-rings<br />
should be worn slightly away from the skin to allow<br />
air to contact the piercing, let moisture escape, and<br />
minimize potential reactions. Silicon is best for those<br />
with latex sensitivities.<br />
42
It is widely accepted that the following ethical standards<br />
should be adhered to in every piercing establishment.<br />
In some cases local or state laws will exceed these<br />
standards. The <strong>APP</strong> suggests that every piercer<br />
consult with an attorney in his/her state to determine<br />
whether state and/or local regulations affect the application<br />
<strong>of</strong> these standards.<br />
PERSONAL BOUNDARIES<br />
ETHICS AND LEGALITIES<br />
<strong>APP</strong> literature outlines a client’s rights with regard to<br />
piercing services. The piercer also has the right to expect<br />
appropriate behavior from his/her clients. These<br />
boundaries are to protect both piercer and client from<br />
potentially dangerous or inappropriate situations. The<br />
following are reasons a piercer may decline to perform<br />
a particular piercing, reschedule or abort a piercing, or<br />
dismiss a client from the studio permanently:<br />
• The client appears intoxicated, behaves erratically, or<br />
is not in full possession <strong>of</strong> his or her mental or physical<br />
facilities. Note: In cases attributable to medical<br />
or psychiatric conditions, the piercer may tactfully<br />
request a signed letter from or a conversation with the<br />
client’s doctor, psychiatrist or other caregiver verifying<br />
the client’s ability to make responsible choices.<br />
• The client maintains poor personal hygiene that could<br />
compromise the well-being <strong>of</strong> the piercing and/or that<br />
signifi cantly affects the ability <strong>of</strong> the piercer to perform<br />
the procedure.<br />
• The client makes comments or gestures <strong>of</strong> a sexual<br />
or otherwise inappropriate/<strong>of</strong>fensive nature.<br />
• The piercer may wish to consider not only his/her<br />
own personal boundaries, but also his/her obligation<br />
to ensure a studio atmosphere that is respectful <strong>of</strong> all<br />
clients and staff. Many shops refuse to serve clients<br />
who repeatedly make racist, sexual, homophobic,<br />
or otherwise <strong>of</strong>fensive comments, or who behave<br />
rudely towards other clients or shop personnel.<br />
Posting a statement to this effect may help minimize<br />
your liability for discrimination, as well as advertise<br />
your intentions to those waiting. (For example: “We<br />
reserve the right to refuse service to anyone who is<br />
drunk, disorderly, or disrespectful.”) Clients who are<br />
aggressive or unruly in the waiting room <strong>of</strong>ten get<br />
worse as they become more nervous, and may need<br />
to return at a later date when they are better able to<br />
control themselves.<br />
• It is also important to remember that the shop staff<br />
must set and maintain behavior standards for the<br />
studio. The content and style <strong>of</strong> staff interaction,<br />
apparel and personal habits, studio design, decoration,<br />
website, music, and shop policies all refl ect your<br />
level <strong>of</strong> pr<strong>of</strong>essionalism. Clients use this information<br />
to judge both what to expect <strong>of</strong> you and what you<br />
expect <strong>of</strong> them.<br />
• In localities where shop personnel are extremely visible<br />
or well-known, these expectations may extend<br />
into <strong>of</strong>f-work hours outside the studio. You may<br />
want to consider how you want to be perceived by<br />
clients who meet or observe you when you are not<br />
at work.<br />
PIERCERS ARE NOT PERFECT<br />
No piercer, however experienced or skilled, is perfect.<br />
Unfortunately, in every career some piercings will be<br />
poorly placed, jewelry transfers will be missed, and<br />
items will be dropped. <strong>Piercers</strong> should always handle<br />
these situations with pr<strong>of</strong>essionalism, honesty, and<br />
tact. Blaming the client (“It’s your fault -- you moved.”)<br />
is never appropriate and contributes to a sense <strong>of</strong> panic<br />
and regret in the room. Piercing is a service pr<strong>of</strong>ession.<br />
As a pr<strong>of</strong>essional piercer, it is part <strong>of</strong> your job description<br />
to expect and allow for client reactions. A piercer<br />
should take responsibility for the error and correct it to<br />
suit the client’s needs and preferences.<br />
If the client is displeased with the results or you determine<br />
the piercing may not heal successfully due to<br />
an inaccuracy in placement, it should be removed and<br />
re-pierced, either immediately or at a later date. If you<br />
have made a mistake, it is appropriate to <strong>of</strong>fer additional<br />
services free <strong>of</strong> charge. If the client has experienced<br />
undue discomfort it may be reasonable to <strong>of</strong>fer an additional<br />
discount, free piercing, or jewelry.<br />
DETERMINING <strong>APP</strong>ROPRIATE-<br />
NESS OF A PIERCING<br />
Sometimes it is inappropriate to perform even the most<br />
standard piercing. A piercer should politely refuse to<br />
perform a piercing that could be dangerous, ill suited,<br />
unsuccessful, or for which they are not trained. It is<br />
helpful to have an educated and piercing friendly phy-<br />
43
sician to contact when clients do not have a physician<br />
that they are comfortable consulting.<br />
The following examples for which a second and/or<br />
medical opinion may be needed before proceeding:<br />
• There is an obvious skin or tissue abnormality that<br />
may include but is not limited to rashes, lumps,<br />
bumps, scars, lesions, swellings, fl uid, tenderness,<br />
moles, freckles, and/or abrasions;<br />
• The client is or has impending plans to become<br />
pregnant and wishes to get a nipple, navel, or other<br />
piercing. (It is advisable to refrain from piercing<br />
during pregnancy to allow the body to focus on the<br />
important, complex, and demanding task that it is<br />
handling already. Additionally, if the client was to<br />
faint it could result in serious consequences to the<br />
unborn child.);<br />
• The client wants to pierce irregular or surgically-altered<br />
anatomy;<br />
• The client is unsuited due to occupational, recreational,<br />
or environmental factors;<br />
• The client requests piercings that are frequently<br />
unsuccessful (commonly rejected by the body),<br />
particularly when the client is uneducated about or<br />
unwilling to accept responsibility for the risks <strong>of</strong> such<br />
piercings;<br />
• The client has a heart murmur, diabetes, hemophilia,<br />
autoimmune disorder, or other medical condition(s)<br />
that may negatively infl uence the piercing procedure<br />
or healing process;<br />
• The client has a heart condition such as Mitral Valve<br />
Prolapse that requires prophylactic antibiotic treatment<br />
before dental and other procedures. In these<br />
cases the client must consult a physician prior to any<br />
procedure. Medication may be required to avoid lifethreatening<br />
complications.<br />
<strong>APP</strong>ROPRIATE PLACEMENT<br />
For thousands <strong>of</strong> years, tribal people around the world<br />
have made similar choices in piercing placements.<br />
This is not because <strong>of</strong> a lack <strong>of</strong> creativity, but because<br />
<strong>of</strong> long-term experience with the superior stability <strong>of</strong><br />
certain anatomy. As piercing has resurfaced in the<br />
globalized community, new information on anatomy,<br />
jewelry, and asepsis have made possible some piercing<br />
placements not previously considered.<br />
TECHNIQUES<br />
Techniques vary considerably from piercer to piercer.<br />
Some will utilize tools such as forceps and needle<br />
44<br />
receiving tubes, others use special hand positioning<br />
that allows for freehand piercing. Most will combine<br />
knowledge <strong>of</strong> various techniques, use <strong>of</strong> tools, and<br />
hand placements in the way that works best for them<br />
in each individual piercing situation.<br />
The most fundamental aspects for the evolution <strong>of</strong> a<br />
piercer’s personal style are proper training, continued<br />
education, and an open mind. While it is important to<br />
continue observing other piercers and learning throughout<br />
your career, new procedures and techniques should<br />
not be undertaken merely for the sake <strong>of</strong> innovation or<br />
emulation. To ensure client and piercer safety, piercers<br />
should be thoroughly trained and well skilled in<br />
the basic procedures before attempting more diffi cult<br />
methods.<br />
When trying new techniques or experimenting with<br />
new styles, it is essential to research all aspects <strong>of</strong> the<br />
procedures. Elicit multiple opinions about differences<br />
in piercee comfort, sterility, effi ciency, ease <strong>of</strong> healing,<br />
jewelry type, placement, risks and benefi ts, etc. Talk to<br />
piercers who use alternate techniques as well as those<br />
who choose not to, and fi nd out why. Also ask clients<br />
what they prefer and why, and take their responses<br />
seriously. We do what we do for them.<br />
After obtaining as much information as possible,<br />
you can make an informed decision. You may also<br />
fi nd you change back after time, or that you begin to<br />
alternate between techniques depending on individual<br />
circumstances.<br />
All piercing placements, old or new, should be decided<br />
by anatomical suitability and overall safety. Piercing<br />
placements that are ‘new’ should not be invented for<br />
the sake <strong>of</strong> personal aggrandizement or novelty.<br />
Of course, no fi eld progresses without cautious experimentation.<br />
Any trials should be a matter <strong>of</strong> personal<br />
consideration and not involve the general public. It is<br />
neither safe nor pr<strong>of</strong>essional to use paying customers<br />
to test techniques or placement theories. Experimental<br />
piercings should not be introduced to the paying public<br />
or the press until they have proven to be successful<br />
and safe for a suffi cient percentage <strong>of</strong> individuals over<br />
a reasonable amount <strong>of</strong> time.<br />
Piercing liability insurance providers may refuse<br />
to cover experimental piercing placements and local<br />
regulations may prohibit certain variations. For more<br />
information, contact your insurance provider and/or<br />
health department directly.<br />
OFF-SITE PIERCING<br />
Piercing at music festivals, nightclubs, conventions<br />
and street fairs may seem like a creative way to build
clientele. Guest piercing at other studios may seem<br />
like fun. However, these situations may create pitfalls<br />
for a piercer seeking to maintain appropriate hygiene<br />
standards, ethics, and reputation.<br />
When piercing in a public space, club or festival, the<br />
most obvious concern is control <strong>of</strong> one’s space. How<br />
will you maintain a sanitary environment in a smoky<br />
club fi lled with sweating bodies and alcohol? It can<br />
be diffi cult to distinguish between inebriated and sober<br />
clientele and false identifi cation is common. Conditions<br />
are <strong>of</strong>ten conductive neither to hygienic piercing<br />
practices nor to the safety and cleanliness <strong>of</strong> a fresh<br />
piercing. How will you keep new piercees from imbibing<br />
afterwards and heading to the packed dance fl oor?<br />
Can they avoid smoking and drinking after a tongue<br />
piercing?<br />
In such places, piercing can take on a freak-show<br />
element that is distasteful to most pr<strong>of</strong>essional piercers.<br />
Additionally, peer pressure, lack <strong>of</strong> private consultation,<br />
and the thrill <strong>of</strong> the show may push some clients<br />
to make decisions they would not otherwise make and<br />
may regret. While this is not technically your problem,<br />
you are the one creating the opportunity, and are<br />
charged with running a pr<strong>of</strong>essional and ethical business.<br />
Many piercers avoid public piercing altogether<br />
and this is a valid option.<br />
Wherever you decide to work, the setup needs to<br />
be no less hygienic than your business studio. This<br />
means nonporous fl ooring, a fully enclosed piercing<br />
room, stainless steel trays, an autoclave, Sharps<br />
containers, and observance <strong>of</strong> all hygienic practices<br />
required in a studio. If you are unable or unwilling to<br />
make the investments <strong>of</strong> time, money, and research<br />
to assemble and move a full piercing studio, it is inappropriate<br />
for you to be piercing <strong>of</strong>f-site. Additionally,<br />
many cities now have regulations limiting or prohibiting<br />
mobile piercing studios, or requiring temporary licenses<br />
and inspections. Check with local health departments<br />
before you set up shop.<br />
COMPETITIVENESS<br />
The rapid rise <strong>of</strong> popularity in piercing has led to an<br />
increased competitiveness between piercers. In some<br />
cities, two or more piercing studios operate on one<br />
block. Competing studios <strong>of</strong>ten have different levels<br />
<strong>of</strong> health and safety awareness and may be inclined<br />
to share these details with clientele. It is easy to become<br />
frustrated and engage in negative interactions<br />
with competitors, especially if you feel that you are the<br />
more informed, conscientious piercer, or when they are<br />
bad-mouthing you.<br />
Good piercers should strive to maintain a genuinely<br />
pr<strong>of</strong>essional demeanor with all other piercers, including<br />
competitors. This can facilitate the exchange <strong>of</strong><br />
information and enhance progress for the industry and<br />
all parties involved. Although it takes some careful<br />
wording, try to fi nd ways to educate clientele and the<br />
public about health concerns without making accusations<br />
against another shop. Even when another shop<br />
insists on behaving badly, maintaining a pr<strong>of</strong>essional<br />
public attitude speaks well <strong>of</strong> your experience and<br />
confi dence, and will earn your clients’ respect.<br />
It is very important to remember that anything you<br />
say about a competitor can be held against you in the<br />
event <strong>of</strong> a libel or slander lawsuit -- even if it is true.<br />
You could instead show concern for your clients’ health<br />
and safety by giving out a checklist <strong>of</strong> things to look<br />
for at any piercing studio, including your own. You<br />
can educate the wider community by putting this in a<br />
print ad.<br />
A brochure with such a checklist is available from<br />
the <strong>APP</strong>. It is entitled Picking Your Piercer and can<br />
be ordered directly from the <strong>APP</strong> website at: www.<br />
safepiercing.org. The Piercee’s Bill <strong>of</strong> Rights poster,<br />
also available on the site, further advises clients on<br />
how to choose and interact with a piercer.<br />
PAPERWORK & BUSINESS<br />
DOCUMENTATION<br />
Pr<strong>of</strong>essional piercers should obtain and keep on fi le<br />
a release/consent form for every service performed<br />
within the studio, including piercings, stretchings, and<br />
insertions. This should be done regardless <strong>of</strong> whether<br />
it is required by legislation and/or your insurance.<br />
The consent form should state that the client requested<br />
the piercing (i.e. you did not pierce him/her<br />
without consent) and you informed the client about how<br />
to properly care for the piercing. While release forms<br />
do not prevent legal action, they do provide evidence<br />
that you have made an effort to educate your client and<br />
to operate a legitimate business.<br />
The release form should also contain records <strong>of</strong> the<br />
following information from the client:<br />
• Valid photo identifi cation number and type (state issued<br />
driver’s license or ID card);<br />
• Passport or Military identifi cation. Many shops photocopy<br />
this onto the release form;<br />
• Date <strong>of</strong> birth;<br />
• Allergies, particularly to latex, iodine (if used) or any products<br />
routinely used in your studio during a piercing;<br />
45
• That client has not consumed alcoholic beverages<br />
or other intoxicants within the last 24 hours;<br />
• Information on recent intake <strong>of</strong> any medications such<br />
as blood thinners, aspirin, ibupr<strong>of</strong>i n, or other NSAIDs<br />
(see Glossary for details);<br />
• Disclosure <strong>of</strong> whether the client is under the care <strong>of</strong><br />
a physician for any condition that might affect the<br />
procedure or healing process;<br />
Sample release form:<br />
46<br />
“To induce _________ (company or piercer’s name) to pierce my __________ (name <strong>of</strong> piercing/anatomical<br />
region <strong>of</strong> piercing) and in consideration <strong>of</strong> doing so, I hereby release _________ (company or<br />
piercer’s name) from all manner <strong>of</strong> liabilities, claims, actions, and demands, in law or in equity, which I<br />
or my heirs might have now or hereafter by reason <strong>of</strong> complying with my request to be pierced.<br />
I have provided accurate information on any medical conditions I may have that could affect the outcome<br />
<strong>of</strong> this procedure. These include, but are not limited to, allergies (such as iodine, latex and metals),<br />
diabetes, anemia, hemophilia, high/low blood pressure, heart disease (including any condition that may<br />
require prophylactic antibiotics), swelling, rash, lumps or discoloration <strong>of</strong> the area to be pierced, and<br />
any immunosuppressive disorder.<br />
I have provided information on any medications I am currently taking, and on any piercings, tattoos,<br />
surgeries or serious illnesses or injuries I have experienced in the past 90 days.<br />
I certify that I am not pregnant or nursing.<br />
To ensure proper healing <strong>of</strong> my piercing, I agree to follow the written aftercare guidelines until healing<br />
is complete.<br />
I understand that this type <strong>of</strong> piercing usually takes _______ (healing time) or longer to heal.<br />
I recognize that the suggestions and aftercare given to me by _________ employees or agents are based<br />
upon their experience in this fi eld and current industry standards. Employees <strong>of</strong> __________ are not<br />
doctors, and their suggestions, whether written or verbal, stated or implied, are not meant to be taken<br />
as medical advice. In the event <strong>of</strong> a serious medical concern I should see my physician.<br />
I have signed this release on ________ (date).<br />
I declare under penalty <strong>of</strong> perjury that the above is correct.<br />
The signature <strong>of</strong> the client must be at the end <strong>of</strong> this statement, not prior to it.<br />
• Acknowledgment <strong>of</strong> having eaten within the last 2<br />
hours.<br />
Note: Clients should eat a healthy meal before being<br />
pierced to minimize dizziness, nausea or fainting.<br />
Refi ned sugar such as soda or sweets can increase<br />
the risk <strong>of</strong> these low blood sugar/vasovagal reactions;<br />
• Diabetes, hemophilia, or other medical condition(s)<br />
________________ (Signature <strong>of</strong> Client)
that may affect the piercing procedure or healing (if<br />
inquiry is allowed by law);<br />
• Any other information required by state or local authorities<br />
or insurance provider.<br />
The wording above is only a generally applicable<br />
suggestion. In certain states it is not legal to ask<br />
about some aspects <strong>of</strong> a client’s medical history on a<br />
release form (e.g. Hepatitis, STDs, or HIV status); in<br />
other states it is a requirement. Check your local laws<br />
for compliance.<br />
Piercing-specifi c liability insurance providers may require<br />
you to use one <strong>of</strong> their release forms with slightly<br />
different wording. Legally suitable wording will also<br />
vary by state and even by country, so it is advisable to<br />
consult an attorney when drafting release forms. Check<br />
and uphold your local laws.<br />
The <strong>APP</strong> fi nds it prudent to store all client paperwork<br />
indefi nitely, and many area regulations have specifi c<br />
minimum requirements for retaining release forms (e.g.<br />
three years). Again, check your local laws for specifi cs<br />
in your area.<br />
Additional details should be added to release forms<br />
for the following circumstances:<br />
• Piercings <strong>of</strong> minors<br />
• Piercings done <strong>of</strong>f-site (at clinics, conventions, etc.)<br />
• Insertion <strong>of</strong> a client’s own jewelry. (Note: Some local<br />
laws prohibit the insertion <strong>of</strong> used and/or non-sterile<br />
jewelry. Please see sections on Sterilization, Disinfection<br />
and Appropriate Jewelry for more information.)<br />
MINORS<br />
Laws regarding the piercing <strong>of</strong> minors vary by location.<br />
In the United States, the legal age <strong>of</strong> consent or legal<br />
responsibility is usually 18 years <strong>of</strong> age. Until then a<br />
minor’s body is the legal responsibility <strong>of</strong> his or her<br />
parent or legal guardian. Additionally, any contract<br />
(such as a release form) signed by a minor is not legally<br />
binding unless it is also signed by the person legally<br />
responsible for her/him. For these reasons, signifi cant<br />
caution is required when piercing minors, even on the<br />
earlobes.<br />
A child who cannot comprehend the procedure and<br />
consequences cannot consent and should not be<br />
pierced under any circumstances. Particularly with<br />
infants and toddlers, the body and immune system are<br />
still developing (this includes ear lobes), and a baby is<br />
obviously unable to care for a piercing.<br />
Some piercers agree to pierce babies or children,<br />
thinking to save them from the ear-piercing gun. It<br />
is important to remember that as pr<strong>of</strong>essionals we<br />
are responsible for our own actions and cannot try to<br />
compensate for how people choose to treat or raise<br />
their children, or how other piercers work. The best<br />
course <strong>of</strong> action is to provide parents with all pertinent<br />
information about health and safety, including the risks<br />
<strong>of</strong> the procedures, the best possible aftercare and<br />
jewelry, and how to fi nd a hygienic practitioner if they<br />
must pierce their child. While we cannot change others’<br />
actions, or change our own to accommodate theirs, we<br />
can help them make educated decisions.<br />
With consent and release from a parent or legal<br />
guardian, minors <strong>of</strong> an appropriate age may be eligible<br />
for piercing, depending on circumstances, studio policy<br />
and local laws.<br />
The <strong>APP</strong> suggests that only the following piercings<br />
be considered for minors:<br />
• Ear lobe or Cartilage<br />
• Navel<br />
• Oral/Facial<br />
• Nostril<br />
• Eyebrow<br />
Other piercings are either potentially dangerous,<br />
unethical to perform, or problematic to heal on minors<br />
whose bodies are still growing and changing.<br />
Under no circumstances is it acceptable, nor is it ever<br />
appropriate, for a piercer to perform a piercing on the<br />
nipples or genitals <strong>of</strong> an individual under 18 years <strong>of</strong><br />
age. This is ethically unconscionable and may even<br />
be deemed sexual assault in a court <strong>of</strong> law. Parents or<br />
legal guardians who consent to this type <strong>of</strong> piercing for<br />
a minor in their care may also be charged with sexual<br />
misconduct by some courts.<br />
For any piercing <strong>of</strong> a minor, a parent or legal guardian<br />
must be present to sign a consent form. State-issued<br />
photo identifi cation is required from the legal guardian,<br />
and a bona fi de form <strong>of</strong> identifi cation from the minor<br />
(driver’s license or state photo ID; birth certifi cate plus<br />
school yearbook). In the event the parent has a different<br />
last name and/or address from the child, documentation<br />
is needed to prove the relationship (for example:<br />
divorce or remarriage certifi cate; custodial or adoption<br />
papers; birth certifi cate).<br />
A unique single exception would be an emancipated<br />
and/or married minor who presents positive pro<strong>of</strong> <strong>of</strong><br />
their legal emancipation and/or marriage. In certain<br />
states such minors are considered adults for legal and<br />
practical purposes. Check local legislation regarding<br />
emancipated/married minors.<br />
A valid business practice is to simply refuse to pierce<br />
anyone under the age <strong>of</strong> 18. Many studios follow this<br />
47
policy. It is wise to check with an attorney in your<br />
state to clarify the letter <strong>of</strong> the law when deciding your<br />
studio’s policy on this matter. Once you have developed<br />
a policy that is comfortable and works well, be<br />
consistent.<br />
Photos displaying genital piercings may be considered<br />
pornographic in the hands <strong>of</strong> a minor. If minors<br />
are allowed in the studio, having two separate, welllabeled<br />
portfolios available for display is advisable. In<br />
this case you may also need to remove any explicit<br />
pictures from the walls. Explicit conversations (verbal<br />
or online) about genital piercings are also inadvisable.<br />
If your shop has a website or responds to email, be<br />
aware that photos and some information may be viewed<br />
by minors or by clients in areas where such material is<br />
illegal. Posting a warning and self-selecting statement<br />
<strong>of</strong> age may minimize your liability. For example:<br />
48<br />
“By clicking here I verify that I am over 18 and<br />
take full responsibility for viewing this site and<br />
its contents.”<br />
Again, check with your lawyer for locally appropriate<br />
wording and laws.<br />
The piercing room must be under your control at all<br />
times. You are responsible for the health and safety<br />
<strong>of</strong> everyone in your studio and must set personal and<br />
shop policy accordingly. While it is <strong>of</strong>ten helpful for a<br />
client to have a friend in the piercing room for moral<br />
support, many piercers limit the number <strong>of</strong> observers<br />
to one or two, and verbally explain to observers where<br />
to stand and how to act. Many piercers do not allow<br />
small children or others who cannot/will not behave<br />
appropriately in the piercing room.<br />
In forming your own policy, keep in mind that piercing<br />
is both a technical, hygienic procedure and a personally<br />
meaningful experience. Try to fi nd a way to work that<br />
respects both the integrity <strong>of</strong> your technique and the<br />
emotional needs <strong>of</strong> your client. If you do allow guests<br />
in the piercing room, be aware that they may become<br />
light-headed during the piercing. A low, stable folding<br />
chair can keep them out <strong>of</strong> your set-up area and<br />
minimize fainting mishaps.<br />
DRUGS AND ALCOHOL<br />
Being under the infl uence <strong>of</strong> drugs and/or alcohol is<br />
never appropriate for either party involved in a piercing<br />
procedure. A piercer must be focused, in control, and<br />
able to deal with unforeseen complications. Furthermore,<br />
he/she is responsible for the safety and health<br />
<strong>of</strong> everyone in the piercing studio. Any piercer who<br />
feels it is acceptable to work under the infl uence <strong>of</strong><br />
drugs or alcohol is reprehensible, unpr<strong>of</strong>essional, and<br />
a menace to him/herself and his/her clients. Even if<br />
he/she does not appear inebriated at work, a piercer<br />
who is addicted to alcohol or drug is a serious potential<br />
hazard. A counterperson who is under the infl uence<br />
likewise represents both a liability and an extremely<br />
poor consumer relations statement.<br />
<strong>Piercers</strong> should agree to pierce only sober, consenting<br />
clients who appear to be in full possession <strong>of</strong> their<br />
mental and physical facilities. Piercing a client who is<br />
not in a sober and sane condition raises serious ethical<br />
questions. First, an inebriated or medicated individual<br />
is not legally able to give informed consent. Any consent<br />
obtained under such conditions is not a binding<br />
contract and may put the piercer at risk. Further, once<br />
sober the client may regret the decision made under<br />
altered consciousness.<br />
Even for a skilled and focused piercer, it is dangerous<br />
to work on a client who is under the infl uence <strong>of</strong> drugs<br />
or alcohol because:<br />
• She/he may bleed more heavily, faint and/or vomit;<br />
• She/he may not be able to communicate vital information<br />
to the piercer or follow important instructions<br />
from the piercer;<br />
• She/he may move suddenly, endangering the piercer<br />
and her/himself;<br />
• She/he may become belligerent, physically or verbally<br />
inappropriate, emotional, dishonest or unmanageable;<br />
• She/he may later have inaccurate recollections <strong>of</strong> the<br />
piercing encounter, thus putting the piercer’s reputation<br />
and legal integrity at risk.<br />
While it may be tempting to take the money <strong>of</strong> those<br />
who have had a drink to get up their courage, it is<br />
ultimately a bad decision for you and for your client.<br />
Furthermore, accepting clientele who are under the<br />
infl uence contributes to public perception <strong>of</strong> the piercing<br />
industry as immoral, unsafe, and irresponsible.<br />
Few passersby will believe your studio practices high<br />
standards <strong>of</strong> hygiene if they see drunk and/or disorderly<br />
people in or around the shop.<br />
Allowing clients to get pierced after drinking or taking<br />
drugs also validates the idea that piercing pain is<br />
beyond normal tolerance and denies clients the opportunity<br />
to fully engage in their piercing experience.<br />
Getting and healing a piercing requires being aware <strong>of</strong><br />
and responsible for one’s body. Therefore, a piercee<br />
who is not ready to get a piercing done while sober is<br />
not ready to get a piercing.
OCCUPATIONAL SAFETY AND<br />
HEALTH ADMINISTRATION<br />
(OSHA) COMPLIANCE<br />
OSHA is a federal agency that monitors and regulates<br />
worker safety for all businesses with one or more employees.<br />
Whether or not piercing-specifi c legislation<br />
has passed in your area, OSHA has explicit requirements<br />
that directly relate to piercing. They apply even<br />
if you have only one employee.<br />
Since federal and state regulations may apply, it is<br />
important to inquire about the most relevant information<br />
for your area. To comply with OSHA requirements,<br />
piercing studios with one or more employees must meet<br />
these standards:<br />
Listing <strong>of</strong> standard operating procedures, detailing:<br />
• Exposure Control<br />
° Exposure Control Plan<br />
° Exposure Determination<br />
• Methods <strong>of</strong> Compliance<br />
° Observation <strong>of</strong> Universal Precautions for<br />
Bloodborne Pathogens<br />
° Engineering and Work Practice Controls<br />
° Personal Protective Equipment<br />
° Housekeeping<br />
° Regulated biohazard waste disposal<br />
• Communication <strong>of</strong> hazards to employees, written and<br />
verbal (Hazard Communication Plan)<br />
• Employer-provided Hepatitis B vaccine or declination<br />
(on fi le)<br />
• Record keeping/documentation<br />
COMPLIANCE AND TRAINING<br />
° Accurate reporting <strong>of</strong> all exposure incidents<br />
° Appropriate information and training<br />
OSHA requires that any employee who has the risk<br />
<strong>of</strong> occupational exposure to blood or other potentially<br />
infectious materials receive training at the time <strong>of</strong> initial<br />
assignment, and at least annually thereafter. Training<br />
must cover the following topics:<br />
1. An accessible copy <strong>of</strong> the regulatory text (see appendix)<br />
and an explanation <strong>of</strong> its contents<br />
2. A general explanation <strong>of</strong> the epidemiology and<br />
symptoms <strong>of</strong> bloodborne disease<br />
3. An explanation <strong>of</strong> the modes <strong>of</strong> transmission <strong>of</strong><br />
bloodborne diseases<br />
4. An explanation <strong>of</strong> the employer’s Exposure Control<br />
Plan and the means by which the employee can<br />
obtain a copy <strong>of</strong> the written plan<br />
5. An explanation <strong>of</strong> the appropriate methods for recognizing<br />
tasks and other activities that may involve<br />
exposure to blood and other potentially infectious<br />
materials<br />
6. An explanation <strong>of</strong> the use and limitations <strong>of</strong> methods<br />
that will prevent or reduce exposure including<br />
appropriate engineering controls, work practices,<br />
and personal protective equipment<br />
7. Information on the types, proper use location, removal,<br />
handling, decontamination, and disposal <strong>of</strong><br />
personal protective equipment<br />
8. An explanation <strong>of</strong> the basis for selection <strong>of</strong> personal<br />
protective equipment<br />
9. Information on the Hepatitis B vaccine, including<br />
information on its effi cacy, safety, method <strong>of</strong> administration,<br />
the benefi ts <strong>of</strong> being vaccinated, and<br />
that the vaccine and vaccination will be <strong>of</strong>fered free<br />
<strong>of</strong> charge to employees covered by the standard<br />
10. Information on the appropriate actions to take and<br />
the persons to contact in an emergency involving<br />
blood or other potentially infectious materials<br />
11. An explanation <strong>of</strong> the procedure to follow and actions<br />
to take if an exposure incident occurs including<br />
the method <strong>of</strong> reporting the incident and the<br />
medical follow-up that will be made available<br />
12. Information on the post-exposure evaluation ad<br />
follow-up that the employer is required to provide<br />
for the employee following an exposure incident<br />
13. An explanation <strong>of</strong> the signs, labels, and/or colorcoding<br />
required<br />
14. An opportunity for interactive questions and answers<br />
with the person conducting the training<br />
session during and after training session.<br />
PIERCER TRAINING<br />
The <strong>APP</strong> does not have any <strong>of</strong>fi cial requirements in this<br />
particular area, since there are many different ways to<br />
develop pr<strong>of</strong>i ciency in piercing. Some piercers learn<br />
to pierce by trial and error, by observation <strong>of</strong> a video,<br />
studying a magazine, and/or by attending a seminar or<br />
training class. However, this approach alone is limited<br />
49
in that each <strong>of</strong> these methods provides incomplete or<br />
inadequate training.<br />
It is widely agreed that an apprenticeship under a<br />
qualifi ed pr<strong>of</strong>essional piercer is the best way to most<br />
thoroughly and scrupulously learn the art <strong>of</strong> piercing.<br />
Even the most reputable training seminars including<br />
lectures on anatomy, safety, hygiene, technique, and<br />
hands-on piercing experience will not fully train you to<br />
be a piercer.<br />
A seminar that lasts only a few days or even several<br />
weeks cannot possibly provide enough exposure to<br />
the variety <strong>of</strong> anatomy or piercing or practice for you<br />
to be a qualifi ed piercer without additional training.<br />
Regardless <strong>of</strong> any certifi cates they may provide, you<br />
will not be a skilled piercer ready to work independently<br />
in the fi eld from a piercing seminar alone. However,<br />
seminars can be a wonderful foundation or addition to<br />
a formal apprenticeship.<br />
What is an Apprenticeship?<br />
An apprenticeship is defi ned as a specifi c period <strong>of</strong><br />
guided progress through the basic, intermediate, and<br />
advanced levels <strong>of</strong> piercer training.<br />
Before undertaking an apprenticeship, you should<br />
consider the following:<br />
What is your motivation for wanting to become a<br />
piercer? If you are hoping for quick money, a hip and<br />
easy job, or stable, guaranteed, lifelong employment,<br />
think again.<br />
As should be obvious from reading this manual,<br />
pursuing a pr<strong>of</strong>essional piercing career is a long-term,<br />
labor intensive and costly endeavor. In the past few<br />
years, a proliferation <strong>of</strong> studios and piercers combined<br />
with a slowdown in the economy has resulted in a<br />
shrinking job market. Even if you undertake a high<br />
quality apprenticeship, there is no guarantee <strong>of</strong> future<br />
or continuous employment.<br />
During an apprenticeship, the novice piercer should<br />
do the following:<br />
• Locate a suitable apprenticeship in a reputable studio<br />
under a well-respected, highly skilled, and experienced<br />
pr<strong>of</strong>essional.<br />
• Attend an industry specifi c bloodborne pathogens<br />
training class, such as that given by OSHA, the Red<br />
Cross, or National Safety Council.<br />
• Attend a First Aid/CPR class, such as that given by<br />
the Red Cross or YMCA.<br />
• Learn customer service, appropriate jewelry quality<br />
and selection, bedside manner, aftercare procedures,<br />
and troubleshooting.<br />
50<br />
• Spend a minimum <strong>of</strong> three months as a full-time<br />
trainee, learning sterilization, disinfection, cross-contamination<br />
avoidance, and other health and safety<br />
issues before piercing.<br />
• Train in performing insertions and stretching existing<br />
piercings before beginning to pierce. This is a<br />
valuable opportunity to practice smooth aseptic technique,<br />
skin prep, tool/jewelry handling and bedside<br />
manner with little risk.<br />
• Spend a minimum <strong>of</strong> six months to a year in full-time<br />
supervised training as an apprentice before achieving<br />
the title <strong>of</strong> piercer. The location, client volume, and<br />
standards <strong>of</strong> the training studio will help to determine<br />
the necessary duration <strong>of</strong> an apprenticeship.<br />
• Observe all procedures before attempting them, and<br />
attempt a new procedure only with close supervision<br />
by a senior/training piercer.<br />
• Acquire an understanding <strong>of</strong> human anatomy as it<br />
relates to performing and handling piercing. This<br />
is crucial. Formal classroom training in anatomy<br />
is extremely helpful for comprehending the internal<br />
anatomy. Variations in external anatomy can only be<br />
learned through time and experience with hundreds<br />
<strong>of</strong> clients. Some states have drafted legislation<br />
requiring courses in anatomy and/or physiology be<br />
taken in order to be licensed for piercing.<br />
• Perform new piercings in order <strong>of</strong> relative diffi culty,<br />
depending on client availability, mutual comfort level,<br />
and individual anatomical considerations. The apprentice<br />
should start with simpler procedures and<br />
progress to more advanced piercings over time. After<br />
suffi cient experience is achieved and pr<strong>of</strong>i ciency is<br />
demonstrated, the apprentice may begin to perform<br />
the more diffi cult or advanced piercings at the<br />
supervisor’s discretion.<br />
Apprentice Training<br />
Before taking an apprentice, please consider the<br />
following:<br />
• Do you possess the necessary qualifi cations, skill<br />
and experience, patience, communication skills,<br />
ethics, organization, commitment, time and teaching<br />
ability?<br />
• What is your motivation for taking an apprentice?<br />
Is it for pr<strong>of</strong>i t? To train your own staff for long-term<br />
employment? Ego gratifi cation?<br />
• What will happen to the apprentice after training? Will<br />
he/she be hired on in your own studio? Will he/she<br />
open a studio down the block from you or work for<br />
your competitors?
• Will he/she be able to fi nd employment in the already<br />
saturated piercing fi eld at all?<br />
• If your motivation is to fi ll a job vacancy, job boards<br />
and the <strong>APP</strong> conference are less expensive and<br />
faster means <strong>of</strong> locating qualifi ed piercers who are<br />
already trained.<br />
If you plan to train an apprentice, note the following:<br />
• An apprentice will probably interpret your methodology<br />
and techniques as the “right” way to pierce. If you<br />
are producing the next generation <strong>of</strong> pr<strong>of</strong>essionals,<br />
be sure to pass on current and correct information.<br />
• Choose your apprentices carefully because your<br />
reputation will continue to be affected by their actions<br />
as they practice piercing for years to come.<br />
The <strong>APP</strong> does not specifi cally monitor the way piercers<br />
train their apprentices. However, the following criteria<br />
are suggested for piercers <strong>of</strong>fering apprenticeships:<br />
• Compliance with appropriate state and local regulations,<br />
including business and piercing-specifi c licensing;<br />
• A senior or training piercer with at least four years <strong>of</strong><br />
full-time piercing experience<br />
• Liability insurance coverage for the studio, and for<br />
the senior/training piercer and/or apprentice<br />
• Apprentices should not charge the public full price<br />
for a supervised piercing. A small materials fee or a<br />
half price fee is more appropriate and pr<strong>of</strong>essional<br />
• If an apprentice is an employee, he or she should<br />
receive wages in accordance with federal and state<br />
requirements<br />
TITLES<br />
Establishing standard job titles related to levels <strong>of</strong> piercing<br />
expertise is diffi cult because misunderstanding and<br />
abuse <strong>of</strong> titles is widespread. The defi nitions commonly<br />
used in the piercing industry are as follows:<br />
Apprentice<br />
During the fi rst year <strong>of</strong> training, all individuals are<br />
considered to be apprentices. During this time, the<br />
individual is learning basic concepts and skills that set<br />
a fi rm foundation for the future.<br />
Piercer<br />
A Piercer is an individual who has pierced full time<br />
for a minimum <strong>of</strong> one year and can confi dently and<br />
accurately perform most common piercings. Having<br />
immediate access to a supervisor and/or a network <strong>of</strong><br />
experienced piercers who can answer questions and<br />
<strong>of</strong>fer assistance as need arises is appropriate during<br />
this phase. A Piercer should still have a trainer or<br />
peer observe and assess his/her piercings from time<br />
to time.<br />
Senior or Training Piercer<br />
A Senior Piercer has been piecing full time for four or<br />
more years and behaves in a manner befi tting a role<br />
model at all times. S/he is modest but in possession<br />
<strong>of</strong> a vast body <strong>of</strong> experience and information. A Senior<br />
Piercer continues to actively seek out new information,<br />
constructive criticism, and ideas from others. A Senior<br />
Piercer is an educator, willing to share knowledge by<br />
networking, writing, or training.<br />
Master Piercer<br />
This is an honorary title and should never be self-appointed.<br />
Unfortunately, over the past few years it has<br />
been abused to the extent <strong>of</strong> near meaninglessness.<br />
A Master Piercer is an individual with more than fi ve<br />
years <strong>of</strong> full time piercing experience, who has been<br />
acknowledged by the piercing community for a substantial<br />
contribution to the fi eld <strong>of</strong> piercing. S/he is<br />
comfortable enough with his/her abilities that s/he has<br />
no need to rely on the title, and so ironically, rarely<br />
claims it. The pr<strong>of</strong>i ciency that makes one a Master<br />
Piercer requires constant diligence and a relentless<br />
pursuit <strong>of</strong> excellence.<br />
CONTINUING EDUCATION<br />
Piercing is not a static skill. To maintain one’s abilities<br />
it is crucial to acquire continuing education throughout<br />
one’s career.<br />
Piercing seminars and conferences are not just for<br />
novices. A true pr<strong>of</strong>essional will seek out training, not<br />
only for new information, but also for the much-needed<br />
review <strong>of</strong> old facts, principles, and practices. Industry<br />
recognized advanced piercing seminars will <strong>of</strong>fer intensive<br />
hands-on, supervised training featuring the most<br />
current information and techniques.<br />
Established National and International Conferences<br />
present classes on current techniques, aftercare, jewelry<br />
materials and other technical and theoretical details<br />
<strong>of</strong> piercing. These are unparalleled events for skills<br />
training, networking, job opportunities, and sharing <strong>of</strong><br />
knowledge amongst piercers.<br />
OSHA requires that employees with an occupational<br />
risk <strong>of</strong> exposure to bloodborne pathogens receive an-<br />
51
nual training regarding risk management. There are a<br />
number <strong>of</strong> educating agencies from which to choose,<br />
but few actually relate this course work information<br />
to the piercing environment. Choose a class that will<br />
provide relevant application <strong>of</strong> this knowledge and<br />
that <strong>of</strong>fers information such as prevention <strong>of</strong> disease<br />
transmission, infection control, and sterilization training<br />
in the piercing studio.<br />
First Aid, CPR, and any advanced emergency training<br />
should be kept current.<br />
Massage schools are another available resource for<br />
piercers to learn about grounding, touch, and bedside<br />
manner.<br />
Community colleges are a good place to fi nd inexpensive<br />
college-level anatomy and physiology courses.<br />
There are many fi ne anatomy texts, CD-ROMS, and<br />
videos on the subject <strong>of</strong> the human body, particularly in<br />
medical and university bookstores. Numerous websites<br />
also contain relevant information and resources.<br />
52
BEING PREPARED IN THE<br />
STUDIO<br />
All piercing shops should have at least one fi rst aid kit<br />
that is well stocked, familiar and available to all staff,<br />
and that is used for emergencies only.<br />
At a minimum, the kit should contain;<br />
• Antiseptic ointment<br />
• Gloves<br />
• Plastic Bags<br />
• Triangular Bandage<br />
• Blanket (emergency type)<br />
• Candy, glucose tablets<br />
• Scissors and Tweezers<br />
• Hand Cleaner<br />
• Small Flashlight with extra batteries<br />
• Band Aids (assorted sizes)<br />
• CPR mask<br />
• Cold Packs<br />
• Adhesive Tape<br />
• Gauze pads (2x2 & 4x4 )<br />
• Roller Bandage<br />
• Roller Gauze (1 and 2 are good sizes)<br />
Each <strong>of</strong> the piercing stations or rooms should also<br />
be emergency equipped. These kits should contain at<br />
least the following;<br />
• Small fl ashlight /extra batteries<br />
• Band Aids<br />
• CPR mask<br />
• Cold pack<br />
• Hard sugar candy and/or packed orange juice, or<br />
glucose tablets<br />
Some emergencies in the piercing studio can be<br />
avoided by being prepared. The piercing release form<br />
can provide relevant information about the health <strong>of</strong><br />
the customer that can alert the piercer to potential<br />
problems. Knowing how to respond appropriately is<br />
important if a customer faints or a diabetic suffers an<br />
insulin reaction (see Special Circumstances section).<br />
Knowing beforehand that a particular client may be<br />
prone to such occurrences can help you plan ahead.<br />
While the release form cannot be used to gather<br />
information about the health status <strong>of</strong> a customer if<br />
the question is a violation <strong>of</strong> the person’s right to privacy,<br />
questions such as, “Are you prone to fainting?”<br />
EMERGENCIES<br />
or, “Are you diabetic?” can provide information that is<br />
important to know.<br />
Asking a person, “Are you HIV positive?” is a violation<br />
<strong>of</strong> the right to privacy and in most states is prohibited<br />
by law. In a pr<strong>of</strong>essionally run shop, OSHA safety<br />
standards will be observed and Standard Precautions<br />
employed. Therefore, information gained by the answer<br />
would have absolutely no bearing on the procedure<br />
provided to that customer.<br />
NEEDLESTICK ACCIDENTS<br />
One <strong>of</strong> the risks faced by pr<strong>of</strong>essional piercers is the<br />
possibility <strong>of</strong> an accidental exposure to blood or other<br />
potentially infectious materials (OPIM). This could<br />
happen by a needlestick with a contaminated piercing<br />
needle or exposure through splashing, spraying, or<br />
other contact with contaminated materials, objects, or<br />
surfaces.<br />
Every action in a piercing procedure should be deliberate<br />
and intended to minimize the risk <strong>of</strong> a needle<br />
accident. A pr<strong>of</strong>essional piercer who remains focused,<br />
alert and in control <strong>of</strong> the environment will greatly minimize<br />
the possibility <strong>of</strong> this event.<br />
To reduce the likelihood <strong>of</strong> a needlestick incident:<br />
• Dispose <strong>of</strong> used needles in Sharps containers immediately<br />
• Know the location <strong>of</strong> all needles at all times. Once<br />
removed from the sterile package and used, never<br />
set down or lose sight <strong>of</strong> the needle.<br />
• Don’t clutter your tray. Dispose <strong>of</strong> any necessary<br />
gauze, paper products, and packaging before piercing<br />
• Don’t rush when using, handling, or disposing <strong>of</strong><br />
needles. Focus on your actions.<br />
• Be consistent with your tray set up. If you are using<br />
needles and insertion tapers in the same procedure,<br />
keep them separate and know where everything is<br />
at all times.<br />
• Remain in control and do not pierce clients who are<br />
overly nervous or not prepared for the piercing.<br />
• Do not pierce if you are ill, tired or if you have not<br />
eaten for a prolonged period <strong>of</strong> time. Be at your<br />
best, awake, and aware; your clients deserve<br />
nothing less.<br />
53
• Examine all other equipment such as tools, corks,<br />
gloves, and rubber bands. Flaws and failure <strong>of</strong> these<br />
to perform as intended can lead to needle sticks.<br />
• If there is any possibility that an unused needle has<br />
become contaminated, it must be immediately disposed<br />
<strong>of</strong> into the Sharps container.<br />
• If the used needle is corked, do not remove the cork<br />
before disposal unless it is necessary. If re-corking<br />
is necessary, federal regulations require the use <strong>of</strong><br />
mechanical implements such as hemostats or forceps.<br />
• Always replace Sharps containers when they have<br />
been fi lled to the full line.<br />
• Never remove anything from a Sharps container.<br />
To reduce the likelihood <strong>of</strong> other exposure incidents:<br />
• Do not reach into contaminated instrument trays.<br />
Items should be removed mechanically or by the<br />
procedure outlined in your studio’s exposure control<br />
plan.<br />
• Use caution when handling contaminated sharps<br />
such as scissors or insertion tapers.<br />
• When tools are scrubbed manually, they should be<br />
completely submerged under water to prevent unnecessary<br />
splashing and spraying.<br />
• If contaminated tools are presoaked in a disinfecting<br />
solution, this must be done in the biohazard/sterilization<br />
room (as opposed to the piercing room) to<br />
prevent spills and splashes that could occur when<br />
transporting the soaking container from one room to<br />
another.<br />
• If the ultrasonic unit that you are using does not have<br />
a built-in draining system, this must be dumped slowly<br />
and steadily to avoid spills and splashes.<br />
By observing the precautions listed above and having<br />
a clearly written Exposure Control Plan that is specifi c to<br />
your studio, much can be done to minimize the fear and<br />
uncertainty that <strong>of</strong>ten follows an exposure incident.<br />
If, despite all cautions being observed, a needlestick<br />
occurs:<br />
• Secure the needle to prevent additional sticks. If<br />
necessary, call a co-worker to fi nish the procedure.<br />
• Wash the area for several minutes with antimicrobial<br />
or antibacterial liquid soap.<br />
• Rinse and bandage the wound.<br />
• Remain calm. Take some time to calm down before<br />
returning to the procedure room if you have a coworker<br />
standing in for you.<br />
54<br />
You may or may not feel that it is appropriate to ask<br />
about a client’s health status, particularly regarding<br />
Hepatitis and HIV. Depending on the laws in your area,<br />
you may be treading on very dangerous legal ground<br />
by asking someone to disclose, in whatever manner,<br />
their status regarding HIV and other communicable<br />
diseases. In some states, it is illegal to ask.<br />
Immediately fi le your OSHA’s Occupational Post-<br />
Exposure report and follow your studio’s Exposure<br />
Control Plan. These are established with your health<br />
and safety in mind.<br />
You must seek immediate medical attention, especially<br />
if your client has disclosed that they are HIV<br />
positive or if you have good reason to suspect that they<br />
may be. It is important to know that there is an HIV prophylaxis<br />
available that could prevent HIV infection, but<br />
this must be done within the fi rst 24-48 hours. While this<br />
treatment has severe negative side effects (said to be<br />
comparable to chemotherapy), it is an important option<br />
for those who have been exposed to HIV or the blood<br />
<strong>of</strong> somebody who is at high risk for HIV infection.<br />
If you are not already vaccinated, you may sign up<br />
for a ten day series <strong>of</strong> Hepatitis B shots that may help<br />
protect you from the disease. A medical pr<strong>of</strong>essional<br />
can help you determine if this is an appropriate treatment<br />
for you.<br />
Blood testing done shortly after the needlestick injury<br />
occurred is also suggested. Although immediate testing<br />
will not indicate if disease was transmitted through the<br />
needlestick injury, it will provide a baseline to compare<br />
future testing to. If the employee is unsure if they would<br />
like to have their blood immediately tested, it is also important<br />
to know that their blood can be drawn and saved<br />
for later testing, if they become inclined to do so.<br />
Mentally review the accident. Think about the events<br />
leading up to the exposure and what could be done<br />
different. Learn from your mistake and take additional<br />
precautions when in a similar situation in the future.<br />
BLEEDING<br />
Most piercings do not bleed much, if at all, but the<br />
possibility always exists. It is good practice to remind<br />
clients that any break in the skin can bleed, and that<br />
piercings are no exception. If the client is made aware<br />
in advance that the possibility <strong>of</strong> bleeding exists, they<br />
are much less likely to be concerned or anxious if it<br />
should happen.<br />
The client who has recently ingested alcohol, aspirin,<br />
caffeine or certain prescription drugs is more likely to
leed, sometimes pr<strong>of</strong>usely. Inform clients to avoid<br />
these blood-thinning agents if at all possible. <strong>Piercers</strong><br />
should prepare themselves and their client for the possibility<br />
<strong>of</strong> additional bleeding when a piercee has these<br />
agents in his/her system.<br />
Some piercings such as Prince Alberts and eyebrows<br />
are located in more vascular areas so they are more<br />
apt to bleed.<br />
Using a needle <strong>of</strong> a gauge larger than the jewelry<br />
may result in excess bleeding. To minimize bleeding<br />
and client discomfort, use a larger needle only when<br />
necessary.<br />
Removing jewelry from a fresh piercing may produce<br />
copious bleeding. In an emergency, it may be best not<br />
to remove the jewelry; let the emergency room handle<br />
the situation.<br />
When you anticipate bleeding, have sterile gauze<br />
pads ready. To stop bleeding, apply fi rm pressure for<br />
two minutes. Dispose <strong>of</strong> all used gauze pads containing<br />
blood in biohazard waste. A small disposable ice<br />
pack can be applied to help minimize swelling and<br />
bleeding.<br />
Apply ice to stop bleeding in an oral piercing. For a<br />
tongue piercing, have the client gently suck on small<br />
cubes, chipped ice, or shaved ice. The amount <strong>of</strong> blood<br />
may seem greater when mixed with saliva.<br />
Cautery (styptic) pencils and similar products are not<br />
appropriate for use on puncture wounds such as piercings.<br />
Additionally, they can be very painful.<br />
It is unpr<strong>of</strong>essional to release a client with an actively<br />
bleeding piercing. Be sure that bleeding has essentially<br />
ceased and that the area is reasonably clean before<br />
the client leaves.<br />
It is illegal for a piercer to stitch or attach tissue. If a<br />
client is bleeding pr<strong>of</strong>usely and you cannot stop it with<br />
pressure, the client must be taken to the hospital.<br />
Emergency Bleeding<br />
<strong>Piercers</strong> are not to treat bleeding emergencies, so<br />
the client should be brought to the emergency room<br />
immediately.<br />
Examples <strong>of</strong> emergency bleeding are:<br />
• Pr<strong>of</strong>use bleeding that does not stop after several<br />
minutes <strong>of</strong> pressure, particularly from oral, surfaceto<br />
surface or genital piercings, excluding the normal<br />
bleeding <strong>of</strong> a Prince Albert or apadravya<br />
• Signifi cant bleeding that persists several days after<br />
the piercing excluding the normal bleeding <strong>of</strong> a Prince<br />
Albert or apadravya.<br />
FAINTING<br />
It can happen occasionally that a customer will pass<br />
out or faint before, during, or after a piercing. For some<br />
people, even the fi lling out paperwork at the counter and<br />
picking out jewelry results in their feeling faint.<br />
Answers to a question on the release form regarding<br />
whether a client has a history <strong>of</strong> fainting can be very<br />
helpful to the piercer in preparing for that possibility.<br />
It is important to understand why some people lose<br />
consciousness (pass out). A common misconception<br />
is that low blood-sugar levels are the only cause <strong>of</strong><br />
this reaction.<br />
Fainting is frequently caused by a loss <strong>of</strong> blood fl ow<br />
to the brain. Most <strong>of</strong>ten this is a response triggered by<br />
the Pneumogastric or vagus nerve, called a vasovagal<br />
response. The occurrence <strong>of</strong> fainting is more likely if<br />
the client has consumed excessive caffeine, or certain<br />
prescription drugs. Also, if the client has not eaten a<br />
meal within 4 hours and the stomach is empty; if the<br />
weather is very hot and/or humid, if the client stands<br />
up too soon after being pierced, the client has not slept<br />
well, has a high anxiety level, or any combination <strong>of</strong><br />
the above.<br />
A client may faint or become light headed at any time.<br />
It could happen while browsing at the front counter, being<br />
marked for the piercing, during the actual piercing<br />
or several minutes after the piercing.<br />
Beware that a client’s companion may also faint!<br />
Keep watch on all people who come into your business<br />
and maintain control <strong>of</strong> the environment so that<br />
a fainting person will not surprise you.<br />
Observant employees and piercers can <strong>of</strong>ten spot<br />
a person who is having trouble. Symptoms that are<br />
frequently seen are:<br />
• Pale complexion<br />
• Headache or blurred vision<br />
• White or blue lips<br />
• Crying<br />
• Nausea<br />
• Trembling<br />
• Inability to concentrate, irritability or confusion<br />
• Excessive perspiration<br />
• Drowsiness, dizziness, or lack <strong>of</strong> coordination<br />
Whether it is the client or an onlooker experiencing<br />
the diffi culty, the course <strong>of</strong> action should be the same.<br />
If the person is not in a supine (feet elevated above the<br />
heart) position, place them in such a posture.<br />
55
Or, if they are seated, bend them forward, so the<br />
head is between the knees. Continue to talk to them,<br />
reassure them, and <strong>of</strong>fer cool water, candy, juice, and/<br />
or glucose tablets. A cold compress on the forehead,<br />
wrists and/or back <strong>of</strong> the neck may help. An actual loss<br />
<strong>of</strong> consciousness can <strong>of</strong>ten be prevented with these<br />
measures.<br />
If the client does “pass out” do not give them any sort<br />
<strong>of</strong> inhalants such as ammonia. These are considered a<br />
last resort. That is, they are only to be used if the person<br />
remains unconscious for more than two minutes,<br />
which is rare.<br />
DO NOT attempt to put anything in their mouth.<br />
Move away any object that may cause injury to the<br />
person. Some shaking or twitching is not unusual with<br />
fainting.<br />
Most <strong>of</strong>ten the person will “come to” within a few<br />
seconds. However, a few seconds can seem extraordinarily<br />
long, so it is important that you remain calm<br />
and aware. It is possible that they can still hear you,<br />
although they may be unable to respond. Attempt to<br />
achieve communication by saying their name calmly,<br />
and not too loudly.<br />
People are <strong>of</strong>ten very confused when regaining consciousness<br />
and may not know who you are or where<br />
they are, or what has taken place. Let them know where<br />
they are and what has happened. Do not let them jump<br />
up and leave the building. Although this is a very common<br />
reaction, it is ill advised. People are sometimes<br />
ashamed that they have fainted and therefore want to<br />
leave immediately<br />
Turn <strong>of</strong>f or dim bright lights in the room. The application<br />
<strong>of</strong> an ice pack to the forehead or back <strong>of</strong> the neck<br />
and/or a cool drink <strong>of</strong> water can be helpful in reducing<br />
the sense <strong>of</strong> being too warm. Have the person lie quietly<br />
for a few minutes.<br />
As they begin to feel better, fi rst have them sit up<br />
for a few minutes. Several minutes later you may allow<br />
them to stand up. If at any point they begin to feel<br />
unstable or unwell, have them lie down again. Stay with<br />
the person as long as necessary, and call for assistance<br />
from a co-worker if needed.<br />
If this should happen during a piercing, fi rst, secure<br />
the needle. It may be acceptable to attend to the piercee<br />
and fi nish the jewelry insertion later. If the presence<br />
<strong>of</strong> the needle may endanger you or the client, as with a<br />
tongue or lip piercing, immediately remove the needle<br />
and deal with the situation at hand.<br />
It may not be wise to proceed with the piercing even<br />
when the customer is fully recovered. Discuss these<br />
56<br />
concerns with the customer and if necessary, suggest<br />
they make the appointment for another day.<br />
Emotional disturbances or panic attacks can <strong>of</strong>ten<br />
take on the appearance <strong>of</strong> a serious physical condition.<br />
It is important in these instances not to draw undue<br />
attention to the situation. Such episodes are <strong>of</strong>ten<br />
humiliating for the client. A quiet place to sit, a drink<br />
<strong>of</strong> cool water, and a self-administered dose <strong>of</strong> whatever<br />
medication has been prescribed for the condition<br />
(where applicable) is generally all that is necessary to<br />
resolve the situation.<br />
LOSS OF CONSCIOUSNESS<br />
Special Circumstances<br />
The types <strong>of</strong> client reactions most <strong>of</strong>ten handled in a<br />
piercing studio are in no way life-threatening. There are,<br />
however, certain circumstances in which the symptoms<br />
discussed above including a loss <strong>of</strong> consciousness may<br />
be the result <strong>of</strong> a more serious physical condition.<br />
The knowledge gained through the required First<br />
Aid/CPR courses will increase the piercers awareness<br />
<strong>of</strong> appropriate steps to take in an emergency, and<br />
thereby increase the confi dence level <strong>of</strong> the individual<br />
should an emergency occur. The following are a few<br />
potentially more serious conditions about which all<br />
piercers should be aware:<br />
Diabetes is not an infectious disease. It is a condition<br />
that has to do with the body’s inability to effectively<br />
produce insulin in response to blood sugar. Some<br />
diabetics can control their diabetes by diet and others<br />
require medication.<br />
Insulin reactions occur when the blood sugar level<br />
is too low. This could be caused by nervous or emotional<br />
tension, strenuous exercise, too little food or a<br />
delayed meal. Consumption <strong>of</strong> food will raise blood<br />
sugar levels.<br />
Customers should be asked to record on the release<br />
form whether they have eaten within the previous 4<br />
hours. Should the symptoms (listed under the Fainting<br />
section above) appear, it is critical that the diabetic<br />
receive immediate assistance. If no treatment is given,<br />
this becomes a life-threatening event.<br />
Most diabetics are aware <strong>of</strong> their blood sugar levels<br />
and will ask for assistance when needed. Provide the<br />
customer with some form <strong>of</strong> sugar. This can be fruit<br />
juice, several pieces <strong>of</strong> candy, sugar, or soda pop<br />
(not diet). Improvement should be seen within about<br />
10 minutes. If the condition does not improve, call<br />
Emergency Medical Services (EMS).
Heart disease affl icts an estimated 70 million Americans.<br />
Of the nearly one million deaths annually attributed<br />
to cardiovascular disease, more than half result<br />
from heart attacks. A person is just as likely to suffer<br />
a heart attack in your studio as anywhere else. CPR<br />
training courses outline the proper procedures for a<br />
person suspected <strong>of</strong> suffering from a heart attack.<br />
Seizures involve convulsions and intense shaking <strong>of</strong><br />
the body with aggressive, jerky outward movements.<br />
This is much more serious than simply passing out and<br />
you should call 911. The affected party may also urinate,<br />
defecate, or vomit. This is uncommon, but natural.<br />
Maintain pr<strong>of</strong>essionalism and try not to make the client<br />
feel embarrassed about such an occurrence. Seizures<br />
may be caused by an acute or chronic condition. One<br />
chronic condition is known as epilepsy. Epilepsy is usually<br />
controlled with medication. Still, some people with<br />
epilepsy may have seizures from time to time. Just as<br />
with someone who has merely fainted, make the area<br />
safe for the client, removing any nearby objects that<br />
may cause injury. Place a thin protective cushion or<br />
article <strong>of</strong> clothing under the head and try to turn them<br />
onto their side. DO NOT attempt to hold or restrain the<br />
person or place anything in his/her mouth. Again, CPR<br />
/First Aid courses will outline in detail the proper steps<br />
to take if this occurs.<br />
57
58<br />
AFTERWARD<br />
Merely reading this manual has not in any way endowed you or anyone else with the ability to pierce or provided<br />
the knowledge to do so safely. If you plan to <strong>of</strong>fer piercing services, it is your pr<strong>of</strong>essional and ethical responsibility<br />
to seek out a highly skilled, experienced pr<strong>of</strong>essional piercer and undertake an apprenticeship. Only after extensive<br />
hands-on training and expert supervision will you be able to provide high quality pr<strong>of</strong>essional services.<br />
This manual has attempted to provide details <strong>of</strong> acceptable safety and hygiene standards, and appropriate<br />
piercing practices. Reputable piercers will work diligently to meet all relevant documented procedures and to<br />
uphold the standards described within this manual. There are equivalent methods, products and equipment that<br />
may be acceptable, if they meet the criteria <strong>of</strong> minimal customer discomfort, maximum safety and zero risk <strong>of</strong><br />
cross-contamination.<br />
Meeting all <strong>of</strong> these standards is not quick and easy; it takes a great deal <strong>of</strong> time, effort and money to create<br />
a safe working environment with all required equipment and supplies, training and preparation. A piercer<br />
who upholds all <strong>of</strong> the standards described herein should feel very proud to be a reputable, respectable and<br />
responsible piercer. If you can honestly say you do everything appropriately as described in this manual, you<br />
should pat yourself on the back and congratulate yourself! Keep up the good work and also keep up with new<br />
information as it becomes available. There is always more to learn.<br />
The industry is continuing to develop and mature. The <strong>APP</strong> is always acquiring new information, so it is likely<br />
that no matter how <strong>of</strong>ten we update this manual, some <strong>of</strong> the information contained within has already become<br />
obsolete. Whether you are a pr<strong>of</strong>essional piercer, a serious piercing enthusiast, a piercing-friendly medical<br />
pr<strong>of</strong>essional, a public health <strong>of</strong>fi cial or a concerned legislator, it is your responsibility to keep up with the latest<br />
techniques, products and other piercing information.<br />
Readers are encouraged to contact the <strong>APP</strong> by email at secretary@safepiercing.org or visit our website at<br />
www.safepiercing.org with any suggestions, comments, criticism or contributions.
GLOSSARY OF TERMS<br />
Acute: Short term or temporary; <strong>of</strong>ten severe but<br />
quickly resolved.<br />
AIDS: Acquired Immunodeficiency Syndrome, a<br />
disease that may result from HIV infection causing<br />
breakdown <strong>of</strong> the immune system.<br />
Airborne: Capable <strong>of</strong> being transmitted by air particles.<br />
Anaphylaxis: A hypersensitive (allergenic reaction)<br />
state <strong>of</strong> the body to a foreign protein or drug. Latex,<br />
iodine and other chemicals commonly found in the<br />
piercing studio can cause this reaction. Reactions<br />
are sudden in onset and can include increased irritability,<br />
cyanosis, convulsions, unconsciousness and<br />
even death. Death generally occurs due to spasms<br />
<strong>of</strong> the bronchioles in the lungs.<br />
Anesthetic: A drug or other agent used to produce<br />
insensibility to pain or touch. Most anesthetics are<br />
available by prescription only and are not legal for<br />
piercers to use on clients. Many can cause complications<br />
in the piercing procedure.<br />
Anesthetic, Injectable: A drug or other agent applied<br />
subdermally by use <strong>of</strong> a syringe or other injection<br />
device. Only trained, licensed medical pr<strong>of</strong>essionals<br />
are legally qualifi ed to administer this class <strong>of</strong><br />
prescription-only anesthetics.<br />
Anesthetic, Topical: A drug or other agent applied<br />
to the surface <strong>of</strong> the skin with the intent <strong>of</strong> providing<br />
relief from pain. Topical anesthetics include ice, ethyl<br />
chloride (spray freeze), EMLA and the xylocaine<br />
family <strong>of</strong> topical creams and ointments. Most topical<br />
anesthetics are available only by prescription and<br />
most are not intended for use in or near puncture<br />
wounds. These can irritate skin and complicate<br />
piercing procedures and should not be used.<br />
Antibacterial: Destroying or suppressing the growth<br />
or reproduction <strong>of</strong> bacteria.<br />
Antibiotic: A chemical substance produced by a living<br />
organism that has the capacity to destroy and/or<br />
suppress the growth <strong>of</strong> other microorganisms.<br />
Antibodies: Infection-fi ghting proteins released by<br />
white blood cells.<br />
Antigen: A substance that causes antibody formation.<br />
Antimicrobial: Capable <strong>of</strong> killing or suppressing the<br />
growth <strong>of</strong> microorganisms.<br />
Asepsis: A condition free from germs.<br />
Autoclave: A strong steel vessel used for sterilization<br />
<strong>of</strong> equipment and materials at high temperature and<br />
under pressure.<br />
Bacillus: (Plural Bacilli); A genus <strong>of</strong> bacteria belonging<br />
to the family Bacillaceae, and including the organisms<br />
that cause dysentery, cholera and conjunctivitis.<br />
Bacteria: Minute unicellular microorganisms with both<br />
plant and animal characteristics. Also known as germs<br />
or microbes. The primary types are cocci, spirilla and bacilli.<br />
Bacterial diseases include pneumonia, staph infections,<br />
tetanus, tuberculosis, syphilis, and diphtheria.<br />
Bacteriocidal/Bactericidal: Capable <strong>of</strong> destroying<br />
bacteria.<br />
Bloodborne Pathogen: A pathogenic microorganism<br />
that is present in human blood and can cause disease<br />
in humans.<br />
Body Substance Isolation: An infection control strategy<br />
that considers all body substances as potentially<br />
infectious.<br />
Broad Spectrum: A wide range <strong>of</strong> microorganisms.<br />
Cartilage: A type <strong>of</strong> dense connective tissue consisting<br />
<strong>of</strong> cells embedded in a substance or matrix. Cartilage<br />
has no nerve or blood supply <strong>of</strong> its own. There are<br />
several types <strong>of</strong> cartilage:<br />
Articular: Hyaline cartilage covering the articular surfaces<br />
<strong>of</strong> the bones.<br />
Costal: Cartilage connecting the true ribs and sternum.<br />
Hyaline: Flexible and slightly elastic; fi ne connective<br />
tissue found in the septum and nostrils, larynx and<br />
trachea.<br />
Elastic: A rigid network <strong>of</strong> yellow fibers that give<br />
strength and shape to the external ear and the auditory<br />
tube.<br />
Chemical Sterilization: See Sterilization, Chemical.<br />
Chronic: Long-term, protracted, ever-present or returning.<br />
Often indicates an incurable medical condition<br />
or illness.<br />
Coccus: (Plural: Cocci). A type <strong>of</strong> bacteria that is<br />
spherical or ovoid in form. Many are pathogenic,<br />
causing diseases such as scarlet fever, pneumonia<br />
and meningitis.<br />
59
Cold Sterilization: See Sterilization, Cold.<br />
Contamination: The presence or the reasonable<br />
anticipated presence <strong>of</strong> blood or other potentially<br />
infectious materials on an item or surface.<br />
Contaminated Sharps: Any contaminated object that<br />
can penetrate the skin, including but not limited to<br />
needles, snip wires and broken glass.<br />
Cross-Contamination: The act <strong>of</strong> spreading pathogenic<br />
organisms from one item or surface to another.<br />
Cyanosis: A disordered condition <strong>of</strong> the circulatory<br />
system from inadequate oxygen in the blood, resulting<br />
in a bluish color to the skin.<br />
Disease Transmission: The passage <strong>of</strong> a disease<br />
to a person.<br />
Disinfect: To free from pathogenic organisms, or to<br />
prevent pathogens from reproducing.<br />
Decontamination: The use <strong>of</strong> physical or chemical<br />
means to remove, inactivate or destroy bloodborne<br />
pathogens on a surface or item to the extent that<br />
they are no longer capable <strong>of</strong> transmitting pathogens.<br />
The item is thus rendered safe for handling, use or<br />
disposal.<br />
Direct-Contact Transmission: The transmission <strong>of</strong><br />
a disease by touching an infected person’s body<br />
fl uids.<br />
Disease: Disturbed or abnormal structure or physiological<br />
action in the living organism as a whole, or in any<br />
<strong>of</strong> its parts. Literally, the lack <strong>of</strong> ease.<br />
Edema: A swelling caused by excess fl uid in the intercellular<br />
spaces. Edema can be caused by a chemical<br />
reaction, an infection, stress to the area, (as in<br />
improper piercing technique) or other causes.<br />
Engineering Controls: Physical controls such as<br />
sharps disposal containers that isolate or remove the<br />
bloodborne pathogen from the workplace.<br />
Epithelial Tissue: A membranous tissue consisting<br />
<strong>of</strong> one or more layers <strong>of</strong> compactly joined cells <strong>of</strong><br />
various types and sizes<br />
Exposure Control Plan: A systematized protocol<br />
created by an employer to protect employees from<br />
infection by identifying jobs that require employee<br />
training, protective equipment, and immunizations.<br />
Exposure Determination: The identifi cation and documentation<br />
<strong>of</strong> job classifi cations in which occupational<br />
exposure to blood can occur.<br />
Exposure Incident: A specifi c mucous, non-intact skin<br />
60<br />
or parenteral contact with blood or other potentially<br />
infectious materials that results from the performance<br />
<strong>of</strong> an employee’s duties.<br />
Fascia: A fi brous membrane covering, supporting and<br />
separating muscles. Fascia also unites the skin with<br />
underlying tissue.<br />
Fungal: Any inflammatory condition caused by a<br />
fungus.<br />
Fungicidal: That which is capable <strong>of</strong> killing fungi.<br />
Gamma Radiation Sterilization: See Sterilization,<br />
Gamma Ray.<br />
Germicidal: That which is capable <strong>of</strong> killing germs.<br />
Handwashing Facility: An area dedicated to handwashing<br />
that provides an adequate supply <strong>of</strong> running<br />
potable water, soap and single-use towels.<br />
HBV: Hepatitis B Virus. HBV is one <strong>of</strong> the viruses<br />
that cause illness directly affecting the liver and is a<br />
bloodborne pathogen.<br />
HCV: Hepatitis C Virus. HCV is one strain <strong>of</strong> the<br />
Hepatitis Virus formerly referred to as non-A-non-B<br />
Hepatitis.<br />
HEPA: High Effi ciency Particulate Air (fi lter) used to<br />
improve air quality and reduce the quantity <strong>of</strong> airborne<br />
contaminants.<br />
Hepatitis: A disease that causes swelling, soreness,<br />
and loss <strong>of</strong> normal function <strong>of</strong> the liver. Symptoms<br />
include weakness, fatigue, anorexia, nausea, abdominal<br />
pain, fever, jaundice and headache.<br />
HIV: Human Immunodefi ciency Virus is a virus that<br />
infects immune system blood cells in humans and<br />
renders them less effective in preventing disease.<br />
Immune: Resistant to infectious disease.<br />
Immune System: The body’s group <strong>of</strong> natural responses<br />
for fi ghting disease.<br />
Immunization: A process or procedure by which resistance<br />
to infection is produced in people.<br />
Indirect-Contact Transmission: The transmission<br />
<strong>of</strong> a disease from one host to another through a<br />
contaminated object.<br />
Inert: Devoid <strong>of</strong> active properties.<br />
Indicator: Indicators are paper or tape strips impregnated<br />
with a chemical that changes color when exposed<br />
to heat and steam in an autoclave. They are<br />
<strong>of</strong>ten found on autoclave tape, autoclave pouches,<br />
and strips, but are not limited to these items. Activated<br />
indicator marks are useful for identifying packages<br />
and articles which have been exposed to the
physical conditions <strong>of</strong> an autoclave cycle, but they<br />
not prove sterilization.<br />
Integrator: Integrators are strips or devices used in<br />
pouches and/or autoclave chambers that prove the<br />
conditions for sterilization were met. They are similar<br />
to indicators, except that they change color when they<br />
have been exposed to the ideal combination <strong>of</strong> steam,<br />
pressure, heat and timing.<br />
Jaundice: A yellow discoloration <strong>of</strong> the skin, mucous<br />
membranes, and/or whites <strong>of</strong> the eyes, characteristic<br />
<strong>of</strong> the later stages <strong>of</strong> Hepatitis or other liver<br />
disease.<br />
Microorganism: A bacteria, virus, or other microscopic<br />
organism that may enter the body. Microorganisms<br />
that cause infection or disease are called germs.<br />
Mucous Membrane: Any one <strong>of</strong> the four types <strong>of</strong> thin<br />
sheets <strong>of</strong> tissue that cover various parts <strong>of</strong> the body,<br />
such as the lining <strong>of</strong> the mouth or nose.<br />
Mucus: The clear secretion <strong>of</strong> the mucous membranes.<br />
Non-Intact skin: Skin that has a break in the surface.<br />
It includes but is not limited to abrasions, cuts, hangnails,<br />
paper cuts and burns.<br />
NSAIDs: Nonsteroidal anti-infl ammatory medications<br />
such as ibupr<strong>of</strong>en.<br />
Occupational Exposure: Reasonable anticipated<br />
exposure to potentially infectious material that may<br />
result from the performance <strong>of</strong> an employee’s duties.<br />
Occupational Safety & Health Administration<br />
(OSHA): The federal agency responsible for the<br />
development, administration and enforcement <strong>of</strong><br />
employment-related health and safety regulations.<br />
Opportunistic Infection: An infection that strikes a<br />
person with a weakened immune system.<br />
Pre-Cleaning: The act <strong>of</strong> soaking or otherwise disinfecting<br />
a contaminated tool prior to actual sterilization.<br />
Pre-cleaning is not a substitute for cleaning tools in<br />
an ultrasonic machine.<br />
Spore Test: A biological monitoring process in which<br />
a third party laboratory culturing service is engaged<br />
to monitor spore growth on media processed in a<br />
studio’s autoclave. The service provides documentation<br />
that serves as a tangible record and legal<br />
document proving a studio’s ability to achieve proper<br />
sterilization.<br />
Sporicidal: Kills mold and other spores. Spores, especially<br />
TB, are generally very hard to kill, so sporicidal<br />
agents are powerful enough to kill a broad range <strong>of</strong><br />
organisms.<br />
Steam Sterilization: See Sterilization, Steam.<br />
Sterilization: The complete elimination <strong>of</strong> all microbial<br />
life. If an object is sterile, nothing lives on its surfaces.<br />
As the air around us is teeming with organisms, nothing<br />
that has been in contact with air is considered<br />
sterile.<br />
Sterilization, Cold: Killing organisms by long-term<br />
immersion in a liquid sterilant solution (usually 24<br />
- 72 hours).<br />
Sterilization, Chemical: Sterilization by exposure to<br />
Ethylene Oxide (EO) gas.<br />
Sterilization, Gamma Ray: An effective, very rapid<br />
method <strong>of</strong> sterilization by means <strong>of</strong> exposure to<br />
gamma radiation.<br />
Sterilization, Steam: Sterilization by means <strong>of</strong> exposure<br />
to high pressure, superheated steam. The<br />
most common, effi cient sterilization method for most<br />
piercers. This is also known as “hospital” or autoclave<br />
sterilization.<br />
Sterilization, Liquid: See Sterilization, Cold.<br />
Thermal Death Time: The amount <strong>of</strong> time required to<br />
kill a given organism at a given temperature, measured<br />
in minutes. Generally, the higher the temperature,<br />
the shorter the thermal death time. Minimum<br />
TDT for most autoclaves and a majority <strong>of</strong> organisms<br />
is 15 minutes at 270 F.<br />
Tuberculocidal: A very strong agent capable <strong>of</strong> destroying<br />
hardy TB spores.<br />
Virucidal: Capable <strong>of</strong> killing viruses.<br />
Virus: An ultra-microscopic microorganism that is<br />
parasitic within living cells. Many viruses can cause<br />
disease in humans. A virus cannot grow or reproduce<br />
apart from a living cell. It invades living cells and<br />
uses their chemical machinery to keep itself alive<br />
and to replicate itself. It may reproduce with fi delity<br />
or with errors (mutations). This ability to mutate is<br />
responsible for the ability <strong>of</strong> some viruses to change<br />
slightly in each infected person, making treatment<br />
more diffi cult.<br />
61
UNDERSTANDING MATERIAL SAFETY DATA<br />
SHEETS (MSDS)<br />
According to OSHA standards, MSDS must be<br />
kept on fi le for all chemicals used within the studio.<br />
This includes everything from window/glass cleaner<br />
and hard surface disinfectants to skin prep products<br />
and soaps used for hand washing and more.<br />
Copies <strong>of</strong> MSDSs for all potentially hazardous chemicals<br />
to which employees may be exposed must be readily<br />
available to all employees during each work shift.<br />
CHEMICAL PRODUCT<br />
INFORMATION<br />
This section provides the name, address, and telephone<br />
number <strong>of</strong> the company that produced the product, the<br />
MSDS’s date <strong>of</strong> issue, and the name <strong>of</strong> the material.<br />
The name <strong>of</strong> the material on the MSDS must be spelled<br />
exactly as it is on the container you received. In addition,<br />
you will fi nd the following information:<br />
• Product Name<br />
• Commercial or marketing name<br />
• Synonym<br />
• Approved chemical name and/or synonyms<br />
• Chemical Family<br />
• Group <strong>of</strong> chemicals with related physical and chemical<br />
properties<br />
• Formula: Chemical formula, if applicable; i.e., the<br />
conventional scientifi c defi nition for a material<br />
• CAS Number<br />
• Number assigned to chemicals or materials by the<br />
Chemical Abstracts Service (CAS)<br />
• Composition <strong>of</strong> Ingredients<br />
This section lists the product’s individual hazardous<br />
chemicals and their relative percentages. The<br />
material’s corresponding CAS Number must also be<br />
listed. All ingredients that meet the OSHA Hazard Communication<br />
standard criteria <strong>of</strong> a hazardous ingredient<br />
must be identifi ed here.<br />
Manufacturers may also choose to list active ingredients,<br />
signifi cant ingredients regulated under other<br />
Federal, state, or local regulations, or a complete ingredient<br />
disclosure, including nonhazardous components.<br />
Complex mixtures recognized as single substances<br />
may be listed as single components. If any <strong>of</strong> the<br />
hazardous components is a trade secret, this will be<br />
indicated in lieu <strong>of</strong> identifying the component. Suppliers<br />
<strong>of</strong> such products must still provide health hazard<br />
data on the MSDS and additional information to safety<br />
pr<strong>of</strong>essionals who have a verifi able need to know.<br />
HAZARDOUS IDENTIFICATION<br />
INFORMATION<br />
This section is divided into two parts. The fi rst part<br />
describes the material’s appearance and gives an<br />
overview <strong>of</strong> the most signifi cant immediate concerns<br />
for emergency personnel.<br />
The second part provides information on the potential<br />
adverse health effects and symptoms associated with<br />
exposure to the material, its components, or known by<br />
products. In addition, this section lists all <strong>of</strong> the routes<br />
<strong>of</strong> entry pertinent to this material. Acute (short-term)<br />
and chronic (long-term) health effects, symptoms <strong>of</strong><br />
exposure, and medical conditions aggravated by exposure<br />
must be stated. If the material is carcinogenic,<br />
that fact must be stated.<br />
First Aid Measures<br />
This section describes medical and fi rst aid treatments<br />
for accidental exposure by route <strong>of</strong> exposure (i.e. inhalation,<br />
skin, eye, ingestion). Any known antidotes<br />
that may be administered by a layperson or specially<br />
trained personnel will be indicated here.<br />
Fire Fighting Measures<br />
This section provides basic fi re fi ghting guidance for<br />
trained fi re fi ghters, emergency responders, employees,<br />
and occupational health and safety pr<strong>of</strong>essionals.<br />
It describes the fl ammable and explosive properties <strong>of</strong><br />
the material, the proper extinguishing materials, and the<br />
precautions and procedures to safely and effectively<br />
fi ght the fi re.<br />
Accidental Release Measures<br />
This section provides spill, and leak procedures, and<br />
response procedures for emergency responders and<br />
environmental pr<strong>of</strong>essionals. It describes evacuation<br />
procedures, and other emergency advice to protect<br />
the health and safety <strong>of</strong> the responders and the environment.<br />
63
Handling and Storage Information<br />
This section provides safe handling and storage<br />
information for employees, occupational health and<br />
safety pr<strong>of</strong>essionals, and employers. General handling<br />
precautions and practices are described to prevent<br />
release <strong>of</strong> hazardous substances to the environment<br />
and overexposure during contact with the material, and<br />
also to minimize continued contact after handling.<br />
In addition, this section explains necessary storage<br />
conditions to avoid damage to containers, contact with<br />
incompatible materials and subsequent dangerous<br />
reactions, evaporation or decomposition <strong>of</strong> the stored<br />
material, or fl ammable and explosive atmospheres in<br />
the storage area.<br />
Exposure Controls/Personal Protection<br />
This section discusses methods intended for occupational<br />
health and safety pr<strong>of</strong>essionals and employers<br />
for reducing worker exposure to hazardous materials.<br />
Exposure controls include engineering controls such<br />
as ventilation and special process conditions (e.g.<br />
isolation, enclosure), or administrative controls (e.g.<br />
training, labeling, warning devices).<br />
This section also provides guidance on personal protective<br />
equipment (PPE) including respirators, safety<br />
glasses, goggles, gloves, aprons, and boots.<br />
Physical and Chemical Properties<br />
This section lists physical data, including a material’s<br />
boiling point, solubility in water, viscosity, specifi c gravity,<br />
melting point, evaporation rate, molecular weight,<br />
appearance and odor. These properties can help in<br />
predicting how the material will act and react so that<br />
you can determine safe handling procedures and select<br />
appropriate personal protective equipment.<br />
Stability and Reactivity Information<br />
This section lists materials and circumstances that<br />
could be hazardous when combined with the material<br />
covered by the MSDS. This section provides information<br />
on chemical incompatibilities, conditions to avoid,<br />
decomposition products, and the material’s stability.<br />
Toxicology Information<br />
This section provides information on toxicity testing <strong>of</strong><br />
the material and/or its components. The information<br />
in this section is intended for medical pr<strong>of</strong>essionals,<br />
occupational health and safety pr<strong>of</strong>essionals, and<br />
toxicologists.<br />
Ecological Information<br />
This section assists you in evaluating the effect a<br />
chemical may have if it’s released into the environment.<br />
64<br />
It may also be useful in evaluating waste treatment<br />
practices.<br />
Disposal Considerations<br />
This section provides proper disposal information for<br />
environmental pr<strong>of</strong>essionals or individuals responsible<br />
for waste management activities. Information may<br />
include special disposal methods or limitations per Federal,<br />
state, or local regulations, and waste management<br />
options, such as recycling or reclamation. It may also<br />
include RCRA waste classifi cations and EPA waste<br />
identifi cation numbers and descriptions.<br />
Transport Information<br />
This section provides shipping classifi cation information<br />
for the employer, distributor, emergency responders,<br />
and transport/shipping departments. If regulated,<br />
shipping information includes U.S. Department <strong>of</strong><br />
Transportation (DOT) hazardous materials description/<br />
proper shipping name, hazard class, and identifi cation<br />
numbers (UN or NA numbers).<br />
Regulatory Information<br />
This section provides regulatory information for employers<br />
and regulatory compliance personnel. U.S. Federal<br />
regulations such as OSHA, TSCA, SARA, CERCLA,<br />
and CWA are addressed. Reportable quantities (RQ)<br />
for spills or discharges and threshold planning quantities<br />
(TPQ) for hazardous materials stored at facilities<br />
are listed.<br />
Other Information<br />
This section provides a location for additional information,<br />
such as a list <strong>of</strong> references, keys/legends, or<br />
preparation and revision indicators. Hazard ratings<br />
defi ning the acute health, fl ammability, and reactivity<br />
hazards <strong>of</strong> a material may also be included.
FULL TEXT OF BLOODBORNE<br />
PATHOGENS STANDARD<br />
1910.1030<br />
(a) Scope and Application. This section applies<br />
to all occupational exposure to blood or other potentially<br />
infectious materials as defi ned by paragraph (b)<br />
<strong>of</strong> this section.<br />
(b) Defi nitions. For purposes <strong>of</strong> this section, the<br />
following shall apply:<br />
Assistant Secretary means the Assistant Secretary<br />
<strong>of</strong> Labor for Occupational Safety and Health, or designated<br />
representative.<br />
Blood means human blood, human blood components,<br />
and products made from human blood.<br />
Bloodborne Pathogens means pathogenic microorganisms<br />
that are present in human blood and can<br />
cause disease in humans. These pathogens include,<br />
but are not limited to hepatitis B virus (HBV) and human<br />
immunodefi ciency virus (HIV).<br />
Clinical Laboratory means a workplace where diagnostic<br />
or other screening procedures are performed<br />
on blood or other potentially infectious materials.<br />
Contaminated means the presence or the reasonably<br />
anticipated presence <strong>of</strong> blood or other potentially<br />
infectious materials on an item or surface.<br />
Contaminated Laundry means laundry which has<br />
been soiled with blood or other potentially infectious<br />
materials or may contain sharps.<br />
Contaminated Sharps means any contaminated<br />
object that can penetrate the skin including, but not<br />
limited to, needles, scalpels, broken glass, broken<br />
capillary tubes, and exposed ends <strong>of</strong> dental wires.<br />
Decontamination means the use <strong>of</strong> physical or<br />
chemical means to remove, inactivate, or destroy<br />
bloodborne pathogens on a surface or item to the<br />
point where they are no longer capable <strong>of</strong> transmitting<br />
infectious particles and the surface or item is<br />
rendered safe for handling, use, or disposal.<br />
Director means the Director <strong>of</strong> the National Institute<br />
for Occupational Safety and Health, U.S.<br />
Department <strong>of</strong> Health and Human Services, or des-<br />
<strong>APP</strong>ENDIX A<br />
ignated representative.<br />
Engineering Controls means controls (e.g., sharps<br />
disposal containers, self-sheathing needles, safer<br />
medical devices, such as sharps with engineered<br />
sharps injury protections and needleless systems)<br />
that isolate or remove the bloodborne pathogens<br />
hazard from the workplace.<br />
Exposure Incident means a specifi c eye, mouth, other<br />
mucous membrane, non-intact skin, or parenteral<br />
contact with blood or other potentially infectious<br />
materials that results from the performance <strong>of</strong> an<br />
employee’s duties.<br />
Handwashing Facilities means a facility providing an<br />
adequate supply <strong>of</strong> running potable water, soap and<br />
single use towels or hot air drying machines.<br />
Licensed Healthcare Pr<strong>of</strong>essional is a person whose<br />
legally permitted scope <strong>of</strong> practice allows him or her<br />
to independently perform the activities required by<br />
paragraph (f) Hepatitis B Vaccination and Post-exposure<br />
Evaluation and Follow-up.<br />
HBV means hepatitis B virus.<br />
HIV means human immunodefi ciency virus, experimental<br />
animals infected with HIV or HBV.<br />
Needleless Systems means a device that does not<br />
use needles for (1) the collection <strong>of</strong> bodily fl uids<br />
or withdrawal <strong>of</strong> body fl uids after initial venous or<br />
arterial access is established; (2) the administration<br />
<strong>of</strong> medication or fl uids; or (3) any other procedure<br />
involving the potential for occupational exposure to<br />
bloodborne pathogens due to percutaneous injuries<br />
from contaminated sharps.<br />
Occupational Exposure means reasonably anticipated<br />
skin, eye, mucous membrane, or parenteral<br />
contact with blood or other potentially infectious<br />
materials that may result from the performance <strong>of</strong><br />
an employee’s duties.<br />
Other Potentially Infectious Materials means (1)<br />
The following human body fl uids: semen, vaginal<br />
secretions, cerebrospinal fl uid, synovial fl uid, pleural<br />
fl uid, pericardial fl uid, peritoneal fl uid, amniotic fl uid,<br />
saliva in dental procedures, any body fl uid that is<br />
visibly contaminated with blood, and all body fl uids<br />
in situations where it is diffi cult or impossible to differentiate<br />
between body fl uids; (2) Any unfi xed tissue<br />
or organ (other than intact skin) from a human<br />
65
66<br />
(living or dead); and (3) HIV-containing cell or tissue<br />
cultures, organ cultures, and HIV- or HBV-containing<br />
culture medium or other solutions; and blood, organs,<br />
or other tissues from experimental animals infected<br />
with HIV or HBV.<br />
Parenteral means piercing mucous membranes or the<br />
skin barrier through such events as needlesticks,<br />
human bites, cuts, and abrasions.<br />
Personal Protective Equipment is specialized clothing<br />
or equipment worn by an employee for protection<br />
against a hazard. General work clothes (e.g.,<br />
uniforms, pants, shirts or blouses) not intended to<br />
function as protection against a hazard are not considered<br />
to be personal protective equipment.<br />
Production Facility means a facility engaged in industrial-scale,<br />
large-volume or high concentration<br />
production <strong>of</strong> HIV or HBV.<br />
Regulated Waste means liquid or semiliquid blood or<br />
other potentially infectious materials; contaminated<br />
items that would release blood or other potentially<br />
infectious materials in a liquid or semiliquid state if<br />
compressed; items that are caked with dried blood<br />
or other potentially infectious materials and are capable<br />
<strong>of</strong> releasing these materials during handling;<br />
contaminated sharps; and pathological and microbiological<br />
wastes containing blood or other potentially<br />
infectious materials.<br />
Research Laboratory means a laboratory producing<br />
or using research-laboratory-scale amounts <strong>of</strong> HIV<br />
or HBV. Research laboratories may produce high<br />
concentrations <strong>of</strong> HIV or HBV but not in the volume<br />
found in production facilities.<br />
Sharps with Engineered Sharps Injury Protections<br />
means a non-needle sharp or a needle device used<br />
for withdrawing body fl uids, accessing a vein or artery,<br />
or administering medications or other fl uids, with<br />
a built-in safety feature or mechanism that effectively<br />
reduces the risk <strong>of</strong> an exposure incident.<br />
Source Individual means any individual, living or dead,<br />
whose blood or other potentially infectious materials<br />
may be a source <strong>of</strong> occupational exposure to the<br />
employee. Examples include, but are not limited to,<br />
hospital and clinic patients; clients in institutions for<br />
the developmentally disabled; trauma victims; clients<br />
<strong>of</strong> drug and alcohol treatment facilities; residents<br />
<strong>of</strong> hospices and nursing homes; human remains;<br />
and individuals who donate or sell blood or blood<br />
components.<br />
Sterilize means the use <strong>of</strong> a physical or chemical procedure<br />
to destroy all microbial life including highly<br />
resistant bacterial endospores.<br />
Universal Precautions is an approach to infection<br />
control. According to the concept <strong>of</strong> Universal Precautions,<br />
all human blood and certain human body<br />
fl uids are treated as if known to be infectious for HIV,<br />
HBV, and other bloodborne pathogens.<br />
Work Practice Controls means controls that reduce<br />
the likelihood <strong>of</strong> exposure by altering the manner in<br />
which a task is performed (e.g., prohibiting recapping<br />
<strong>of</strong> needles by a two-handed technique).<br />
(c) Exposure Control<br />
(c)(1) Exposure Control Plan.<br />
(c)(1)(i) Each employer having an employee(s) with<br />
occupational exposure as defi ned by paragraph (b) <strong>of</strong><br />
this section shall establish a written Exposure Control<br />
Plan designed to eliminate or minimize employee<br />
exposure.<br />
(c)(1)(ii) The Exposure Control Plan shall contain at<br />
least the following elements:<br />
(c)(1)(ii)(A) The exposure determination required by<br />
paragraph (c)(2),<br />
(c)(1)(ii)(B) The schedule and method <strong>of</strong> implementation<br />
for paragraphs (d) Methods <strong>of</strong> Compliance, (e)<br />
HIV and HBV Research Laboratories and Production<br />
Facilities, (f) Hepatitis B Vaccination and Post-Exposure<br />
Evaluation and Follow-up, (g) Communication <strong>of</strong><br />
Hazards to Employees, and (h) Recordkeeping, <strong>of</strong> this<br />
standard, and<br />
(c)(1)(ii)(C) The procedure for the evaluation <strong>of</strong><br />
circumstances surrounding exposure incidents as required<br />
by paragraph (f)(3)(i) <strong>of</strong> this standard.<br />
(c)(1)(iii) Each employer shall ensure that a copy <strong>of</strong><br />
the Exposure Control Plan is accessible to employees<br />
in accordance with 29 CFR 1910.1020(e).<br />
(c)(1)(iv) The Exposure Control Plan shall be reviewed<br />
and updated at least annually and whenever<br />
necessary to refl ect new or modifi ed tasks and procedures<br />
which affect occupational exposure and to refl ect<br />
new or revised employee positions with occupational<br />
exposure. The review and update <strong>of</strong> such plans shall<br />
also:<br />
(c)(1)(iv)(A) reflect changes in technology that<br />
eliminate or reduce exposure to bloodborne pathogens;<br />
and<br />
(c)(1)(iv)(B) document annually consideration and<br />
implementation <strong>of</strong> appropriate commercially available<br />
and effective safer medical devices designed to elimi-
nate or minimize occupational exposure.<br />
(c)(1)(v) An employer, who is required to establish<br />
an Exposure Control Plan shall solicit input from nonmanagerial<br />
employees responsible for direct patient<br />
care who are potentially exposed to injuries from<br />
contaminated sharps in the identifi cation, evaluation,<br />
and selection <strong>of</strong> effective engineering and work practice<br />
controls and shall document the solicitation in the<br />
Exposure Control Plan.<br />
(c)(1)(vi) The Exposure Control Plan shall be made<br />
available to the Assistant Secretary and the Director<br />
upon request for examination and copying.<br />
(c)(2) Exposure Determination.<br />
(c)(2)(i) Each employer who has an employee(s)<br />
with occupational exposure as defi ned by paragraph<br />
(b) <strong>of</strong> this section shall prepare an exposure determination.<br />
This exposure determination shall contain the<br />
following:<br />
(c)(2)(i)(A) A list <strong>of</strong> all job classifi cations in which all<br />
employees in those job classifi cations have occupational<br />
exposure;<br />
(c)(2)(i)(B) A list <strong>of</strong> job classifi cations in which some<br />
employees have occupational exposure, and(c)(2)(i)(C)<br />
A list <strong>of</strong> all tasks and procedures or groups <strong>of</strong> closely<br />
related task and procedures in which occupational exposure<br />
occurs and that are performed by employees in<br />
job classifi cations listed in accordance with the provisions<br />
<strong>of</strong> paragraph (c)(2)(i)(B) <strong>of</strong> this standard.<br />
(c)(2)(ii) This exposure determination shall be made<br />
without regard to the use <strong>of</strong> personal protective equipment.<br />
(d) Methods <strong>of</strong> Compliance<br />
(d)(1) General. Universal precautions shall be observed<br />
to prevent contact with blood or other potentially<br />
infectious materials. Under circumstances in which<br />
differentiation between body fl uid types is diffi cult or<br />
impossible, all body fl uids shall be considered potentially<br />
infectious materials.<br />
(d)(2) Engineering and Work Practice Controls.<br />
(d)(2)(i) Engineering and work practice controls shall<br />
be used to eliminate or minimize employee exposure.<br />
Where occupational exposure remains after institution<br />
<strong>of</strong> these controls, personal protective equipment shall<br />
also be used.<br />
(d)(2)(ii) Engineering controls shall be examined and<br />
maintained or replaced on a regular schedule to ensure<br />
their effectiveness.<br />
(d)(2)(iii) Employers shall provide handwashing facilities<br />
which are readily accessible to employees.<br />
(d)(2)(iv) When provision <strong>of</strong> handwashing facilities<br />
is not feasible, the employer shall provide either an<br />
appropriate antiseptic hand cleanser in conjunction<br />
with clean cloth/paper towels or antiseptic towelettes.<br />
When antiseptic hand cleansers or towelettes are used,<br />
hands shall be washed with soap and running water<br />
as soon as feasible.<br />
(d)(2)(v) Employers shall ensure that employees<br />
wash their hands immediately or as soon as feasible<br />
after removal <strong>of</strong> gloves or other personal protective<br />
equipment.<br />
(d)(2)(vi) Employers shall ensure that employees<br />
wash hands and any other skin with soap and water, or<br />
fl ush mucous membranes with water immediately or as<br />
soon as feasible following contact <strong>of</strong> such body areas<br />
with blood or other potentially infectious materials.<br />
(d)(2)(vii) Contaminated needles and other contaminated<br />
sharps shall not be bent, recapped, or removed<br />
except as noted in paragraphs (d)(2)(vii)(A) and<br />
(d)(2)(vii)(B) below. Shearing or breaking <strong>of</strong> contaminated<br />
needles is prohibited.<br />
(d)(2)(vii)(A) Contaminated needles and other<br />
contaminated sharps shall not be bent, recapped or<br />
removed unless the employer can demonstrate that no<br />
alternative is feasible or that such action is required by<br />
a specifi c medical or dental procedure.<br />
(d)(2)(vii)(B) Such bending, recapping or needle<br />
removal must be accomplished through the use <strong>of</strong> a<br />
mechanical device or a one-handed technique.<br />
(d)(2)(viii) Immediately or as soon as possible after<br />
use, contaminated reusable sharps shall be placed<br />
in appropriate containers until properly reprocessed.<br />
These containers shall be:<br />
(d)(2)(viii)(A) puncture resistant;<br />
(d)(2)(viii)(B) labeled or color-coded in accordance<br />
with this standard;<br />
(d)(2)(viii)(C) leakpro<strong>of</strong> on the sides and bottom;<br />
and<br />
(d)(2)(viii)(D) in accordance with the requirements set<br />
forth in paragraph (d)(4)(ii)(E) for reusable sharps<br />
(d)(2)(ix) Eating, drinking, smoking, applying cosmetics<br />
or lip balm, and handling contact lenses are<br />
prohibited in work areas where there is a reasonable<br />
likelihood <strong>of</strong> occupational exposure.<br />
(d)(2)(x) Food and drink shall not be kept in refrigerators,<br />
freezers, shelves, cabinets or on countertops or<br />
67
enchtops where blood or other potentially infectious<br />
materials are present.<br />
(d)(2)(xi) All procedures involving blood or other potentially<br />
infectious materials shall be performed in such<br />
a manner as to minimize splashing, spraying, spattering,<br />
and generation <strong>of</strong> droplets <strong>of</strong> these substances.<br />
(d)(2)(xii) Mouth pipetting/suctioning <strong>of</strong> blood or other<br />
potentially infectious materials is prohibited.<br />
(d)(2)(xiii) Specimens <strong>of</strong> blood or other potentially<br />
infectious materials shall be placed in a container which<br />
prevents leakage during collection, handling, processing,<br />
storage, transport, or shipping.<br />
(d)(2)(xiii)(A) The container for storage, transport,<br />
or shipping shall be labeled or color-coded according<br />
to paragraph (g)(1)(i) and closed prior to being stored,<br />
transported, or shipped. When a facility utilizes Universal<br />
Precautions in the handling <strong>of</strong> all specimens, the<br />
labeling/color-coding <strong>of</strong> specimens is not necessary<br />
provided containers are recognizable as containing<br />
specimens. This exemption only applies while such<br />
specimens/containers remain within the facility. Labeling<br />
or color-coding in accordance with paragraph<br />
(g)(1)(i) is required when such specimens/containers<br />
leave the facility.<br />
(d)(2)(xiii)(B) If outside contamination <strong>of</strong> the primary<br />
container occurs, the primary container shall be placed<br />
within a second container which prevents leakage during<br />
handling, processing, storage, transport, or shipping<br />
and is labeled or color-coded according to the requirements<br />
<strong>of</strong> this standard.<br />
(d)(2)(xiii)(C) If the specimen could puncture the primary<br />
container, the primary container shall be placed<br />
within a secondary container which is puncture-resistant<br />
in addition to the above characteristics.<br />
(d)(2)(xiv) Equipment which may become contaminated<br />
with blood or other potentially infectious materials<br />
shall be examined prior to servicing or shipping<br />
and shall be decontaminated as necessary, unless<br />
the employer can demonstrate that decontamination<br />
<strong>of</strong> such equipment or portions <strong>of</strong> such equipment is<br />
not feasible.<br />
(d)(2)(xiv)(A) A readily observable label in accordance<br />
with paragraph (g)(1)(i)(H) shall be attached<br />
to the equipment stating which portions remain contaminated.<br />
(d)(2)(xiv)(B) The employer shall ensure that this<br />
information is conveyed to all affected employees, the<br />
servicing representative, and/or the manufacturer, as<br />
appropriate, prior to handling, servicing, or shipping so<br />
that appropriate precautions will be taken.<br />
68<br />
(d)(3) Personal Protective Equipment -<br />
(d)(3)(i) Provision. When there is occupational exposure,<br />
the employer shall provide, at no cost to the<br />
employee, appropriate personal protective equipment<br />
such as, but not limited to, gloves, gowns, laboratory<br />
coats, face shields or masks and eye protection, and<br />
mouthpieces, resuscitation bags, pocket masks, or<br />
other ventilation devices. Personal protective equipment<br />
will be considered “appropriate” only if it does not<br />
permit blood or other potentially infectious materials to<br />
pass through to or reach the employee’s work clothes,<br />
street clothes, undergarments, skin, eyes, mouth, or<br />
other mucous membranes under normal conditions <strong>of</strong><br />
use and for the duration <strong>of</strong> time which the protective<br />
equipment will be used.(d)(3)(ii) Use. The employer<br />
shall ensure that the employee uses appropriate personal<br />
protective equipment unless the employer shows<br />
that the employee temporarily and briefl y declined to<br />
use personal protective equipment when, under rare<br />
and extraordinary circumstances, it was the employee’s<br />
pr<strong>of</strong>essional judgment that in the specifi c instance<br />
its use would have prevented the delivery <strong>of</strong> health<br />
care or public safety services or would have posed<br />
an increased hazard to the safety <strong>of</strong> the worker or coworker.<br />
When the employee makes this judgement, the<br />
circumstances shall be investigated and documented in<br />
order to determine whether changes can be instituted<br />
to prevent such occurrences in the future.<br />
(d)(3)(iii) Accessibility. The employer shall ensure<br />
that appropriate personal protective equipment in the<br />
appropriate sizes is readily accessible at the worksite<br />
or is issued to employees. Hypoallergenic gloves, glove<br />
liners, powderless gloves, or other similar alternatives<br />
shall be readily accessible to those employees who are<br />
allergic to the gloves normally provided.<br />
(d)(3)(iv) Cleaning, Laundering, and Disposal. The<br />
employer shall clean, launder, and dispose <strong>of</strong> personal<br />
protective equipment required by paragraphs (d) and<br />
(e) <strong>of</strong> this standard, at no cost to the employee.<br />
(d)(3)(v) Repair and Replacement. The employer<br />
shall repair or replace personal protective equipment<br />
as needed to maintain its effectiveness, at no cost to<br />
the employee.<br />
(d)(3)(vi) If a garment(s) is penetrated by blood or<br />
other potentially infectious materials, the garment(s)<br />
shall be removed immediately or as soon as feasible.<br />
(d)(3)(vii) All personal protective equipment shall be<br />
removed prior to leaving the work area.<br />
(d)(3)(viii) When personal protective equipment is removed<br />
it shall be placed in an appropriately designated
area or container for storage, washing, decontamination<br />
or disposal.<br />
(d)(3)(ix) Gloves. Gloves shall be worn when it can<br />
be reasonably anticipated that the employee may have<br />
hand contact with blood, other potentially infectious<br />
materials, mucous membranes, and non-intact skin;<br />
when performing vascular access procedures except as<br />
specifi ed in paragraph (d)(3)(ix)(D); and when handling<br />
or touching contaminated items or surfaces.<br />
(d)(3)(ix)(A) Disposable (single use) gloves such as<br />
surgical or examination gloves, shall be replaced as<br />
soon as practical when contaminated or as soon as<br />
feasible if they are torn, punctured, or when their ability<br />
to function as a barrier is compromised.<br />
(d)(3)(ix)(B) Disposable (single use) gloves shall not<br />
be washed or decontaminated for re-use.<br />
(d)(3)(ix)(C) Utility gloves may be decontaminated for<br />
re-use if the integrity <strong>of</strong> the glove is not compromised.<br />
However, they must be discarded if they are cracked,<br />
peeling, torn, punctured, or exhibit other signs <strong>of</strong> deterioration<br />
or when their ability to function as a barrier<br />
is compromised.<br />
(d)(3)(ix)(D) If an employer in a volunteer blood donation<br />
center judges that routine gloving for all phlebotomies<br />
is not necessary then the employer shall:<br />
(d)(3)(ix)(D)(1) Periodically reevaluate this policy;<br />
(d)(3)(ix)(D)(2) Make gloves available to all employees<br />
who wish to use them for phlebotomy;<br />
(d)(3)(ix)(D)(3) Not discourage the use <strong>of</strong> gloves for<br />
phlebotomy; and<br />
(d)(3)(ix)(D)(4) Require that gloves be used for phlebotomy<br />
in the following circumstances:<br />
(d)(3)(ix)(D)(4)(i) When the employee has cuts,<br />
scratches, or other breaks in his or her skin;<br />
(d)(3)(ix)(D)(4)(ii) When the employee judges that<br />
hand contamination with blood may occur, for example,<br />
when performing phlebotomy on an uncooperative<br />
source individual; and<br />
(d)(3)(ix)(D)(4)(iii) When the employee is receiving<br />
training in phlebotomy.<br />
(d)(3)(ix)(D)(4)(ii) When the employee judges that<br />
hand contamination with blood may occur, for example,<br />
when performing phlebotomy on an uncooperative<br />
source individual; and<br />
(d)(3)(ix)(D)(4)(iii) When the employee is receiving<br />
training in phlebotomy.<br />
(d)(3)(x) Masks, Eye Protection, and Face Shields.<br />
Masks in combination with eye protection devices,<br />
such as goggles or glasses with solid side shields,<br />
or chin-length face shields, shall be worn whenever<br />
splashes, spray, spatter, or droplets <strong>of</strong> blood or other<br />
potentially infectious materials may be generated and<br />
eye, nose, or mouth contamination can be reasonably<br />
anticipated.<br />
(d)(3)(xi) Gowns, Aprons, and Other Protective Body<br />
Clothing. Appropriate protective clothing such as, but<br />
not limited to, gowns, aprons, lab coats, clinic jackets,<br />
or similar outer garments shall be worn in occupational<br />
exposure situations. The type and characteristics will<br />
depend upon the task and degree <strong>of</strong> exposure anticipated.<br />
(d)(3)(xii) Surgical caps or hoods and/or shoe covers<br />
or boots shall be worn in instances when gross<br />
contamination can reasonably be anticipated (e.g.,<br />
autopsies, orthopaedic surgery).<br />
(d)(4) Housekeeping -<br />
(d)(4)(i) General. Employers shall ensure that the<br />
worksite is maintained in a clean and sanitary condition.<br />
The employer shall determine and implement an<br />
appropriate written schedule for cleaning and method<br />
<strong>of</strong> decontamination based upon the location within<br />
the facility, type <strong>of</strong> surface to be cleaned, type <strong>of</strong> soil<br />
present, and tasks or procedures being performed in<br />
the area.<br />
(d)(4)(ii) All equipment and environmental and working<br />
surfaces shall be cleaned and decontaminated<br />
after contact with blood or other potentially infectious<br />
materials.<br />
(d)(4)(ii)(A) Contaminated work surfaces shall be<br />
decontaminated with an appropriate disinfectant after<br />
completion <strong>of</strong> procedures; immediately or as soon as<br />
feasible when surfaces are overtly contaminated or<br />
after any spill <strong>of</strong> blood or other potentially infectious<br />
materials; and at the end <strong>of</strong> the work shift if the surface<br />
may have become contaminated since the last<br />
cleaning.<br />
(d)(4)(ii)(B) Protective coverings, such as plastic<br />
wrap, aluminum foil, or imperviously-backed absorbent<br />
paper used to cover equipment and environmental<br />
surfaces, shall be removed and replaced as soon as<br />
feasible when they become overtly contaminated or<br />
at the end <strong>of</strong> the workshift if they may have become<br />
contaminated during the shift.<br />
(d)(4)(ii)(C) All bins, pails, cans, and similar receptacles<br />
intended for reuse which have a reasonable<br />
likelihood for becoming contaminated with blood or<br />
other potentially infectious materials shall be inspected<br />
69
and decontaminated on a regularly scheduled basis and<br />
cleaned and decontaminated immediately or as soon<br />
as feasible upon visible contamination.<br />
(d)(4)(ii)(D) Broken glassware which may be contaminated<br />
shall not be picked up directly with the hands.<br />
It shall be cleaned up using mechanical means, such<br />
as a brush and dust pan, tongs, or forceps.(d)(4)(ii)(E)<br />
Reusable sharps that are contaminated with blood or<br />
other potentially infectious materials shall not be stored<br />
or processed in a manner that requires employees to<br />
reach by hand into the containers where these sharps<br />
have been placed.<br />
70<br />
(d)(4)(iii) Regulated Waste—<br />
(d)(4)(iii)(A) Contaminated Sharps Discarding and<br />
Containment.<br />
(d)(4)(iii)(A)(1) Contaminated sharps shall be discarded<br />
immediately or as soon as feasible in containers<br />
that are:<br />
(d)(4)(iii)(A)(1)(i) Closable;<br />
(d)(4)(iii)(A)(1)(ii) Puncture resistant;<br />
(d)(4)(iii)(A)(1)(iii) Leakpro<strong>of</strong> on sides and bottom;<br />
and<br />
(d)(4)(iii)(A)(1)(iv) Labeled or color-coded in accordance<br />
with paragraph (g)(1)(i) <strong>of</strong> this standard.<br />
(d)(4)(iii)(A)(2) During use, containers for contaminated<br />
sharps shall be:<br />
(d)(4)(iii)(A)(2)(i) Easily accessible to personnel and<br />
located as close as is feasible to the immediate area<br />
where sharps are used or can be reasonably anticipated<br />
to be found (e.g., laundries);<br />
(d)(4)(iii)(A)(2)(ii) Maintained upright throughout<br />
use; and<br />
(d)(4)(iii)(A)(2)(iii) Replaced routinely and not be allowed<br />
to overfi ll.<br />
(d)(4)(iii)(A)(3) When moving containers <strong>of</strong> contaminated<br />
sharps from the area <strong>of</strong> use, the containers<br />
shall be:<br />
(d)(4)(iii)(A)(3)(i) Closed immediately prior to removal<br />
or replacement to prevent spillage or protrusion <strong>of</strong> contents<br />
during handling, storage, transport, or shipping;<br />
(d)(4)(iii)(A)(3)(ii) Placed in a secondary container if<br />
leakage is possible. The second container shall be:<br />
(d)(4)(iii)(A)(3)(ii)(A) Closable;<br />
(d)(4)(iii)(A)(3)(ii)(B) Constructed to contain all contents<br />
and prevent leakage during handling, storage,<br />
transport, or shipping; and<br />
(d)(4)(iii)(A)(3)(ii)(C) Labeled or color-coded according<br />
to paragraph (g)(1)(i) <strong>of</strong> this standard.<br />
(d)(4)(iii)(A)(4) Reusable containers shall not be<br />
opened, emptied, or cleaned manually or in any other<br />
manner which would expose employees to the risk <strong>of</strong><br />
percutaneous injury.<br />
(d)(4)(iii)(B) Other Regulated Waste Containment -<br />
(d)(4)(iii)(B)(1) Regulated waste shall be placed in<br />
containers which are:<br />
(d)(4)(iii)(B)(1)(i) Closable;<br />
(d)(4)(iii)(B)(1)(ii) Constructed to contain all contents<br />
and prevent leakage <strong>of</strong> fl uids during handling, storage,<br />
transport or shipping;<br />
(d)(4)(iii)(B)(1)(iii) Labeled or color-coded in accordance<br />
with paragraph (g)(1)(i) this standard; and<br />
(d)(4)(iii)(B)(1)(iv) Closed prior to removal to prevent<br />
spillage or protrusion <strong>of</strong> contents during handling, storage,<br />
transport, or shipping.(d)(4)(iii)(B)(2) If outside<br />
contamination <strong>of</strong> the regulated waste container occurs,<br />
it shall be placed in a second container. The second<br />
container shall be:<br />
(d)(4)(iii)(B)(2)(i) Closable;<br />
(d)(4)(iii)(B)(2)(ii) Constructed to contain all contents<br />
and prevent leakage <strong>of</strong> fl uids during handling, storage,<br />
transport or shipping;<br />
(d)(4)(iii)(B)(2)(iii) Labeled or color-coded in accordance<br />
with paragraph (g)(1)(i) <strong>of</strong> this standard; and<br />
(d)(4)(iii)(B)(2)(iv) Closed prior to removal to prevent<br />
spillage or protrusion <strong>of</strong> contents during handling, storage,<br />
transport, or shipping.<br />
(d)(4)(iii)(C) Disposal <strong>of</strong> all regulated waste shall be<br />
in accordance with applicable regulations <strong>of</strong> the United<br />
States, States and Territories, and political subdivisions<br />
<strong>of</strong> States and Territories.<br />
(d)(4)(iv) Laundry.<br />
(d)(4)(iv)(A) Contaminated laundry shall be handled<br />
as little as possible with a minimum <strong>of</strong> agitation.<br />
(d)(4)(iv)(A)(1) Contaminated laundry shall be bagged<br />
or containerized at the location where it was used and<br />
shall not be sorted or rinsed in the location <strong>of</strong> use.<br />
(d)(4)(iv)(A)(2) Contaminated laundry shall be placed<br />
and transported in bags or containers labeled or colorcoded<br />
in accordance with paragraph (g)(1)(i) <strong>of</strong> this<br />
standard. When a facility utilizes Universal Precautions<br />
in the handling <strong>of</strong> all soiled laundry, alternative labeling<br />
or color-coding is suffi cient if it permits all employees<br />
to recognize the containers as requiring compliance
with Universal Precautions.<br />
(d)(4)(iv)(A)(3) Whenever contaminated laundry is<br />
wet and presents a reasonable likelihood <strong>of</strong> soakthrough<br />
<strong>of</strong> or leakage from the bag or container, the<br />
laundry shall be placed and transported in bags or<br />
containers which prevent soak-through and/or leakage<br />
<strong>of</strong> fl uids to the exterior.<br />
(d)(4)(iv)(B) The employer shall ensure that employees<br />
who have contact with contaminated laundry<br />
wear protective gloves and other appropriate personal<br />
protective equipment.<br />
(d)(4)(iv)(C) When a facility ships contaminated laundry<br />
<strong>of</strong>f-site to a second facility which does not utilize<br />
Universal Precautions in the handling <strong>of</strong> all laundry, the<br />
facility generating the contaminated laundry must place<br />
such laundry in bags or containers which are labeled or<br />
color-coded in accordance with paragraph (g)(1)(i).<br />
(e) HIV and HBV Research Laboratories<br />
and Production Facilities.<br />
(e)(1) This paragraph applies to research laboratories<br />
and production facilities engaged in the culture, production,<br />
concentration, experimentation, and manipulation<br />
<strong>of</strong> HIV and HBV. It does not apply to clinical or diagnostic<br />
laboratories engaged solely in the analysis <strong>of</strong><br />
blood, tissues, or organs. These requirements apply in<br />
addition to the other requirements <strong>of</strong> the standard.<br />
(e)(2) Research laboratories and production facilities<br />
shall meet the following criteria:<br />
(e)(2)(i) Standard Microbiological Practices. All<br />
regulated waste shall either be incinerated or decontaminated<br />
by a method such as autoclaving known to<br />
effectively destroy bloodborne pathogens.<br />
(e)(2)(ii) Special Practices.<br />
(e)(2)(ii)(A) Laboratory doors shall be kept closed<br />
when work involving HIV or HBV is in progress.<br />
(e)(2)(ii)(B) Contaminated materials that are to be<br />
decontaminated at a site away from the work area<br />
shall be placed in a durable, leakpro<strong>of</strong>, labeled or colorcoded<br />
container that is closed before being removed<br />
from the work area.<br />
(e)(2)(ii)(C) Access to the work area shall be limited<br />
to authorized persons. Written policies and procedures<br />
shall be established whereby only persons who have<br />
been advised <strong>of</strong> the potential biohazard, who meet any<br />
specifi c entry requirements, and who comply with all<br />
entry and exit procedures shall be allowed to enter the<br />
work areas and animal rooms.<br />
(e)(2)(ii)(D) When other potentially infectious materials<br />
or infected animals are present in the work area or<br />
containment module, a hazard warning sign incorporating<br />
the universal biohazard symbol shall be posted on<br />
all access doors. The hazard warning sign shall comply<br />
with paragraph (g)(1)(ii) <strong>of</strong> this standard.<br />
(e)(2)(ii)(E) All activities involving other potentially<br />
infectious materials shall be conducted in biological<br />
safety cabinets or other physical-containment devices<br />
within the containment module. No work with these<br />
other potentially infectious materials shall be conducted<br />
on the open bench.<br />
(e)(2)(ii)(F) Laboratory coats, gowns, smocks, uniforms,<br />
or other appropriate protective clothing shall be<br />
used in the work area and animal rooms. Protective<br />
clothing shall not be worn outside <strong>of</strong> the work area and<br />
shall be decontaminated before being laundered.<br />
(e)(2)(ii)(G) Special care shall be taken to avoid<br />
skin contact with other potentially infectious materials.<br />
Gloves shall be worn when handling infected animals<br />
and when making hand contact with other potentially<br />
infectious materials is unavoidable.<br />
(e)(2)(ii)(H) Before disposal all waste from work areas<br />
and from animal rooms shall either be incinerated<br />
or decontaminated by a method such as autoclaving<br />
known to effectively destroy bloodborne pathogens.<br />
(e)(2)(ii)(I) Vacuum lines shall be protected with liquid<br />
disinfectant traps and high-effi ciency particulate air<br />
(HEPA) fi lters or fi lters <strong>of</strong> equivalent or superior effi -<br />
ciency and which are checked routinely and maintained<br />
or replaced as necessary.<br />
(e)(2)(ii)(J) Hypodermic needles and syringes shall be<br />
used only for parenteral injection and aspiration <strong>of</strong> fl uids<br />
from laboratory animals and diaphragm bottles. Only<br />
needle-locking syringes or disposable syringe-needle<br />
units (i.e., the needle is integral to the syringe) shall be<br />
used for the injection or aspiration <strong>of</strong> other potentially<br />
infectious materials. Extreme caution shall be used<br />
when handling needles and syringes. A needle shall<br />
not be bent, sheared, replaced in the sheath or guard,<br />
or removed from the syringe following use. The needle<br />
and syringe shall be promptly placed in a punctureresistant<br />
container and autoclaved or decontaminated<br />
before reuse or disposal.<br />
(e)(2)(ii)(K) All spills shall be immediately contained<br />
and cleaned up by appropriate pr<strong>of</strong>essional staff or<br />
others properly trained and equipped to work with potentially<br />
concentrated infectious materials.<br />
(e)(2)(ii)(L) A spill or accident that results in an exposure<br />
incident shall be immediately reported to the labo-<br />
71
atory director or other responsible person.(e)(2)(ii)(M)<br />
A biosafety manual shall be prepared or adopted and<br />
periodically reviewed and updated at least annually or<br />
more <strong>of</strong>ten if necessary. Personnel shall be advised <strong>of</strong><br />
potential hazards, shall be required to read instructions<br />
on practices and procedures, and shall be required to<br />
follow them.<br />
72<br />
(e)(2)(iii) Containment Equipment.<br />
(e)(2)(iii)(A) Certifi ed biological safety cabinets (Class<br />
I, II, or III) or other appropriate combinations <strong>of</strong> personal<br />
protection or physical containment devices, such as<br />
special protective clothing, respirators, centrifuge safety<br />
cups, sealed centrifuge rotors, and containment caging<br />
for animals, shall be used for all activities with other<br />
potentially infectious materials that pose a threat <strong>of</strong><br />
exposure to droplets, splashes, spills, or aerosols.<br />
(e)(2)(iii)(B) Biological safety cabinets shall be certifi<br />
ed when installed, whenever they are moved and at<br />
least annually.<br />
(e)(3) HIV and HBV research laboratories shall meet<br />
the following criteria:<br />
(e)(3)(i) Each laboratory shall contain a facility for<br />
hand washing and an eye wash facility which is readily<br />
available within the work area.<br />
(e)(3)(ii) An autoclave for decontamination <strong>of</strong> regulated<br />
waste shall be available.<br />
(e)(4) HIV and HBV production facilities shall meet<br />
the following criteria:<br />
(e)(4)(i) The work areas shall be separated from areas<br />
that are open to unrestricted traffi c fl ow within the<br />
building. Passage through two sets <strong>of</strong> doors shall be<br />
the basic requirement for entry into the work area from<br />
access corridors or other contiguous areas. Physical<br />
separation <strong>of</strong> the high-containment work area from<br />
access corridors or other areas or activities may also<br />
be provided by a double-doored clothes-change room<br />
(showers may be included), airlock, or other access<br />
facility that requires passing through two sets <strong>of</strong> doors<br />
before entering the work area.<br />
(e)(4)(ii) The surfaces <strong>of</strong> doors, walls, fl oors and<br />
ceilings in the work area shall be water resistant so<br />
that they can be easily cleaned. Penetrations in these<br />
surfaces shall be sealed or capable <strong>of</strong> being sealed to<br />
facilitate decontamination.<br />
(e)(4)(iii) Each work area shall contain a sink for<br />
washing hands and a readily available eye wash facility.<br />
The sink shall be foot, elbow, or automatically<br />
operated and shall be located near the exit door <strong>of</strong> the<br />
work area.<br />
(e)(4)(iv) Access doors to the work area or containment<br />
module shall be self-closing.<br />
(e)(4)(v) An autoclave for decontamination <strong>of</strong> regulated<br />
waste shall be available within or as near as<br />
possible to the work area.<br />
(e)(4)(vi) A ducted exhaust-air ventilation system<br />
shall be provided. This system shall create directional<br />
airfl ow that draws air into the work area through the<br />
entry area. The exhaust air shall not be recirculated to<br />
any other area <strong>of</strong> the building, shall be discharged to<br />
the outside, and shall be dispersed away from occupied<br />
areas and air intakes. The proper direction <strong>of</strong> the airfl ow<br />
shall be verifi ed (i.e., into the work area).<br />
(e)(5) Training Requirements. Additional training<br />
requirements for employees in HIV and HBV research<br />
laboratories and HIV and HBV production facilities are<br />
specifi ed in paragraph (g)(2)(ix).<br />
(f) Hepatitis B Vaccination and Post-exposure<br />
Evaluation and Follow-up<br />
(f)(1) General.(f)(1)(i) The employer shall make available<br />
the hepatitis B vaccine and vaccination series to<br />
all employees who have occupational exposure, and<br />
post-exposure evaluation and follow-up to all employees<br />
who have had an exposure incident.<br />
(f)(1)(ii) The employer shall ensure that all medical<br />
evaluations and procedures including the hepatitis B<br />
vaccine and vaccination series and post-exposure<br />
evaluation and follow-up, including prophylaxis, are:<br />
(f)(1)(ii)(A) Made available at no cost to the employee;<br />
(f)(1)(ii)(B) Made available to the employee at a<br />
reasonable time and place;<br />
(f)(1)(ii)(C) Performed by or under the supervision <strong>of</strong><br />
a licensed physician or by or under the supervision <strong>of</strong><br />
another licensed healthcare pr<strong>of</strong>essional; and<br />
(f)(1)(ii)(D) Provided according to recommendations<br />
<strong>of</strong> the U.S. Public Health Service current at the time<br />
these evaluations and procedures take place, except<br />
as specifi ed by this paragraph (f).<br />
(f)(1)(iii) The employer shall ensure that all laboratory<br />
tests are conducted by an accredited laboratory at no<br />
cost to the employee.<br />
(f)(2) Hepatitis B Vaccination.<br />
(f)(2)(i) Hepatitis B vaccination shall be made available<br />
after the employee has received the training required
in paragraph (g)(2)(vii)(I) and within 10 working days<br />
<strong>of</strong> initial assignment to all employees who have occupational<br />
exposure unless the employee has previously<br />
received the complete hepatitis B vaccination series,<br />
antibody testing has revealed that the employee is<br />
immune, or the vaccine is contraindicated for medical<br />
reasons.<br />
(f)(2)(ii) The employer shall not make participation<br />
in a prescreening program a prerequisite for receiving<br />
hepatitis B vaccination.<br />
(f)(2)(iii) If the employee initially declines hepatitis B<br />
vaccination but at a later date while still covered under<br />
the standard decides to accept the vaccination, the<br />
employer shall make available hepatitis B vaccination<br />
at that time.<br />
(f)(2)(iv) The employer shall assure that employees<br />
who decline to accept hepatitis B vaccination <strong>of</strong>fered<br />
by the employer sign the statement in Appendix A.<br />
(f)(2)(v) If a routine booster dose(s) <strong>of</strong> hepatitis B vaccine<br />
is recommended by the U.S. Public Health Service<br />
at a future date, such booster dose(s) shall be made<br />
available in accordance with section (f)(1)(ii).<br />
(f)(3) Post-exposure Evaluation and Follow-up. Following<br />
a report <strong>of</strong> an exposure incident, the employer<br />
shall make immediately available to the exposed employee<br />
a confi dential medical evaluation and follow-up,<br />
including at least the following elements:<br />
(f)(3)(i) Documentation <strong>of</strong> the route(s) <strong>of</strong> exposure,<br />
and the circumstances under which the exposure incident<br />
occurred;<br />
(f)(3)(ii) Identification and documentation <strong>of</strong> the<br />
source individual, unless the employer can establish<br />
that identifi cation is infeasible or prohibited by state or<br />
local law;<br />
(f)(3)(ii)(A) The source individual’s blood shall be<br />
tested as soon as feasible and after consent is obtained<br />
in order to determine HBV and HIV infectivity. If consent<br />
is not obtained, the employer shall establish that legally<br />
required consent cannot be obtained. When the source<br />
individual’s consent is not required by law, the source<br />
individual’s blood, if available, shall be tested and the<br />
results documented.<br />
(f)(3)(ii)(B) When the source individual is already<br />
known to be infected with HBV or HIV, testing for the<br />
source individual’s known HBV or HIV status need<br />
not be repeated.(f)(3)(ii)(C) Results <strong>of</strong> the source<br />
individual’s testing shall be made available to the exposed<br />
employee, and the employee shall be informed<br />
<strong>of</strong> applicable laws and regulations concerning disclo-<br />
sure <strong>of</strong> the identity and infectious status <strong>of</strong> the source<br />
individual.<br />
(f)(3)(iii) Collection and testing <strong>of</strong> blood for HBV and<br />
HIV serological status;<br />
(f)(3)(iii)(A) The exposed employee’s blood shall be<br />
collected as soon as feasible and tested after consent<br />
is obtained.<br />
(f)(3)(iii)(B) If the employee consents to baseline<br />
blood collection, but does not give consent at that time<br />
for HIV serologic testing, the sample shall be preserved<br />
for at least 90 days. If, within 90 days <strong>of</strong> the exposure<br />
incident, the employee elects to have the baseline<br />
sample tested, such testing shall be done as soon as<br />
feasible.<br />
(f)(3)(iv) Post-exposure prophylaxis, when medically<br />
indicated, as recommended by the U.S. Public Health<br />
Service;<br />
(f)(3)(v) Counseling; and<br />
(f)(3)(vi) Evaluation <strong>of</strong> reported illnesses.<br />
(f)(4) Information Provided to the Healthcare Pr<strong>of</strong>essional.<br />
(f)(4)(i) The employer shall ensure that the healthcare<br />
pr<strong>of</strong>essional responsible for the employee’s Hepatitis B<br />
vaccination is provided a copy <strong>of</strong> this regulation.<br />
(f)(4)(ii) The employer shall ensure that the healthcare<br />
pr<strong>of</strong>essional evaluating an employee after an exposure<br />
incident is provided the following information:<br />
(f)(4)(ii)(A) A copy <strong>of</strong> this regulation;<br />
(f)(4)(ii)(B) A description <strong>of</strong> the exposed employee’s<br />
duties as they relate to the exposure incident;<br />
(f)(4)(ii)(C) Documentation <strong>of</strong> the route(s) <strong>of</strong> exposure<br />
and circumstances under which exposure occurred;<br />
(f)(4)(ii)(D) Results <strong>of</strong> the source individual’s blood<br />
testing, if available; and<br />
(f)(4)(ii)(E) All medical records relevant to the appropriate<br />
treatment <strong>of</strong> the employee including vaccination<br />
status which are the employer’s responsibility<br />
to maintain.<br />
(f)(5) Healthcare Pr<strong>of</strong>essional’s Written Opinion.<br />
The employer shall obtain and provide the employee<br />
with a copy <strong>of</strong> the evaluating healthcare pr<strong>of</strong>essional’s<br />
written opinion within 15 days <strong>of</strong> the completion <strong>of</strong> the<br />
evaluation.<br />
(f)(5)(i) The healthcare pr<strong>of</strong>essional’s written opinion<br />
for Hepatitis B vaccination shall be limited to whether<br />
Hepatitis B vaccination is indicated for an employee,<br />
and if the employee has received such vaccination.<br />
73
(f)(5)(ii) The healthcare pr<strong>of</strong>essional’s written opinion<br />
for post-exposure evaluation and follow-up shall be<br />
limited to the following information:<br />
(f)(5)(ii)(A) That the employee has been informed <strong>of</strong><br />
the results <strong>of</strong> the evaluation; and<br />
(f)(5)(ii)(B) That the employee has been told about<br />
any medical conditions resulting from exposure to blood<br />
or other potentially infectious materials which require<br />
further evaluation or treatment.<br />
(f)(5)(iii) All other fi ndings or diagnoses shall remain<br />
confi dential and shall not be included in the written<br />
report.<br />
(f)(6) Medical Recordkeeping. Medical records<br />
required by this standard shall be maintained in accordance<br />
with paragraph (h)(1) <strong>of</strong> this section.<br />
(g) Communication <strong>of</strong> Hazards to Employees<br />
74<br />
(g)(1) Labels and Signs -(g)(1)(i) Labels.<br />
(g)(1)(i)(A) Warning labels shall be affi xed to containers<br />
<strong>of</strong> regulated waste, refrigerators and freezers<br />
containing blood or other potentially infectious material;<br />
and other containers used to store, transport or ship<br />
blood or other potentially infectious materials, except<br />
as provided in paragraph (g)(1)(i)(E), (F) and (G).<br />
(g)(1)(i)(B) Labels required by this section shall include<br />
the following legend:<br />
(g)(1)(i)(C) These labels shall be fl uorescent orange<br />
or orange-red or predominantly so, with lettering and<br />
symbols in a contrasting color.<br />
(g)(1)(i)(D) Labels shall be affixed as close as<br />
feasible to the container by string, wire, adhesive, or<br />
other method that prevents their loss or unintentional<br />
removal.<br />
(g)(1)(i)(E) Red bags or red containers may be substituted<br />
for labels.<br />
(g)(1)(i)(F) Containers <strong>of</strong> blood, blood components,<br />
or blood products that are labeled as to their contents<br />
and have been released for transfusion or other clinical<br />
use are exempted from the labeling requirements<br />
<strong>of</strong> paragraph (g).<br />
(g)(1)(i)(G) Individual containers <strong>of</strong> blood or other<br />
potentially infectious materials that are placed in a<br />
labeled container during storage, transport, shipment<br />
or disposal are exempted from the labeling requirement.<br />
(g)(1)(i)(H) Labels required for contaminated equipment<br />
shall be in accordance with this paragraph and<br />
shall also state which portions <strong>of</strong> the equipment remain<br />
contaminated.<br />
(g)(1)(i)(I) Regulated waste that has been decontaminated<br />
need not be labeled or color-coded.<br />
(g)(1)(ii) Signs.<br />
(g)(1)(ii)(A) The employer shall post signs at the<br />
entrance to work areas specifi ed in paragraph (e), HIV<br />
and HBV Research Laboratory and Production Facilities,<br />
which shall bear the following legend:<br />
(Name <strong>of</strong> the Infectious Agent) (Special requirements<br />
for entering the area) (name, telephone number <strong>of</strong> the<br />
laboratory director or other responsible person.)<br />
(g)(1)(ii)(B) These signs shall be fl uorescent orangered<br />
or predominantly so, with lettering and symbols in<br />
a contrasting color.<br />
(g)(2) Information and Training.<br />
(g)(2)(i) Employers shall ensure that all employees<br />
with occupational exposure participate in a training<br />
program which must be provided at no cost to the<br />
employee and during working hours.<br />
(g)(2)(ii) Training shall be provided as follows:<br />
(g)(2)(ii)(A) At the time <strong>of</strong> initial assignment to tasks<br />
where occupational exposure may take place;<br />
(g)(2)(ii)(B) Within 90 days after the effective date <strong>of</strong><br />
the standard; and<br />
(g)(2)(ii)(C) At least annually thereafter.<br />
(g)(2)(iii) For employees who have received training<br />
on bloodborne pathogens in the year preceding the effective<br />
date <strong>of</strong> the standard, only training with respect to<br />
the provisions <strong>of</strong> the standard which were not included<br />
need be provided.<br />
(g)(2)(iv) Annual training for all employees shall be<br />
provided within one year <strong>of</strong> their previous training.<br />
(g)(2)(v) Employers shall provide additional training<br />
when changes such as modifi cation <strong>of</strong> tasks or<br />
procedures or institution <strong>of</strong> new tasks or procedures<br />
affect the employee’s occupational exposure. The additional<br />
training may be limited to addressing the new<br />
exposures created.<br />
(g)(2)(vi) Material appropriate in content and vocabulary<br />
to educational level, literacy, and language<br />
<strong>of</strong> employees shall be used.<br />
(g)(2)(vii) The training program shall contain at a<br />
minimum the following elements:<br />
(g)(2)(vii)(A) An accessible copy <strong>of</strong> the regulatory text<br />
<strong>of</strong> this standard and an explanation <strong>of</strong> its contents;
(g)(2)(vii)(B) A general explanation <strong>of</strong> the epidemiology<br />
and symptoms <strong>of</strong> bloodborne diseases;<br />
(g)(2)(vii)(C) An explanation <strong>of</strong> the modes <strong>of</strong> transmission<br />
<strong>of</strong> bloodborne pathogens;<br />
(g)(2)(vii)(D) An explanation <strong>of</strong> the employer’s exposure<br />
control plan and the means by which the employee<br />
can obtain a copy <strong>of</strong> the written plan;<br />
(g)(2)(vii)(E) An explanation <strong>of</strong> the appropriate<br />
methods for recognizing tasks and other activities that<br />
may involve exposure to blood and other potentially<br />
infectious materials;<br />
(g)(2)(vii)(F) An explanation <strong>of</strong> the use and limitations<br />
<strong>of</strong> methods that will prevent or reduce exposure including<br />
appropriate engineering controls, work practices,<br />
and personal protective equipment;<br />
(g)(2)(vii)(G) Information on the types, proper use,<br />
location, removal, handling, decontamination and disposal<br />
<strong>of</strong> personal protective equipment;<br />
(g)(2)(vii)(H) An explanation <strong>of</strong> the basis for selection<br />
<strong>of</strong> personal protective equipment;<br />
(g)(2)(vii)(I) Information on the hepatitis B vaccine,<br />
including information on its effi cacy, safety, method <strong>of</strong><br />
administration, the benefi ts <strong>of</strong> being vaccinated, and<br />
that the vaccine and vaccination will be <strong>of</strong>fered free<br />
<strong>of</strong> charge;<br />
(g)(2)(vii)(J) Information on the appropriate actions to<br />
take and persons to contact in an emergency involving<br />
blood or other potentially infectious materials;<br />
(g)(2)(vii)(K) An explanation <strong>of</strong> the procedure to follow<br />
if an exposure incident occurs, including the method<br />
<strong>of</strong> reporting the incident and the medical follow-up that<br />
will be made available;<br />
(g)(2)(vii)(L) Information on the post-exposure evaluation<br />
and follow-up that the employer is required to provide<br />
for the employee following an exposure incident;<br />
(g)(2)(vii)(M) An explanation <strong>of</strong> the signs and labels<br />
and/or color coding required by paragraph (g)(1); and<br />
(g)(2)(vii)(N) An opportunity for interactive questions<br />
and answers with the person conducting the training<br />
session.<br />
(g)(2)(viii) The person conducting the training shall<br />
be knowledgeable in the subject matter covered by the<br />
elements contained in the training program as it relates<br />
to the workplace that the training will address.<br />
(g)(2)(ix) Additional Initial Training for Employees in<br />
HIV and HBV Laboratories and Production Facilities.<br />
Employees in HIV or HBV research laboratories and<br />
HIV or HBV production facilities shall receive the fol-<br />
lowing initial training in addition to the above training<br />
requirements.(g)(2)(ix)(A) The employer shall assure<br />
that employees demonstrate pr<strong>of</strong>i ciency in standard<br />
microbiological practices and techniques and in the<br />
practices and operations specifi c to the facility before<br />
being allowed to work with HIV or HBV.<br />
(g)(2)(ix)(B) The employer shall assure that employees<br />
have prior experience in the handling <strong>of</strong> human<br />
pathogens or tissue cultures before working with HIV<br />
or HBV.<br />
(g)(2)(ix)(C) The employer shall provide a training<br />
program to employees who have no prior experience<br />
in handling human pathogens. Initial work activities<br />
shall not include the handling <strong>of</strong> infectious agents. A<br />
progression <strong>of</strong> work activities shall be assigned as<br />
techniques are learned and pr<strong>of</strong>i ciency is developed.<br />
The employer shall assure that employees participate<br />
in work activities involving infectious agents only after<br />
pr<strong>of</strong>i ciency has been demonstrated.<br />
(h) Recordkeeping<br />
(h)(1) Medical Records.<br />
(h)(1)(i) The employer shall establish and maintain an<br />
accurate record for each employee with occupational<br />
exposure, in accordance with 29 CFR 1910.1020.<br />
(h)(1)(ii) This record shall include:<br />
(h)(1)(ii)(A) The name and social security number <strong>of</strong><br />
the employee;<br />
(h)(1)(ii)(B) A copy <strong>of</strong> the employee’s hepatitis B vaccination<br />
status including the dates <strong>of</strong> all the hepatitis<br />
B vaccinations and any medical records relative to the<br />
employee’s ability to receive vaccination as required<br />
by paragraph (f)(2);<br />
(h)(1)(ii)(C) A copy <strong>of</strong> all results <strong>of</strong> examinations,<br />
medical testing, and follow-up procedures as required<br />
by paragraph (f)(3);<br />
(h)(1)(ii)(D) The employer’s copy <strong>of</strong> the healthcare<br />
pr<strong>of</strong>essional’s written opinion as required by paragraph<br />
(f)(5); and<br />
(h)(1)(ii)(E) A copy <strong>of</strong> the information provided to<br />
the healthcare pr<strong>of</strong>essional as required by paragraphs<br />
(f)(4)(ii)(B)(C) and (D).<br />
(h)(1)(iii) Confi dentiality. The employer shall ensure<br />
that employee medical records required by paragraph<br />
(h)(1) are:<br />
(h)(1)(iii)(A) Kept confi dential; and<br />
(h)(1)(iii)(B) Not disclosed or reported without the<br />
75
employee’s express written consent to any person<br />
within or outside the workplace except as required by<br />
this section or as may be required by law.<br />
(h)(1)(iv) The employer shall maintain the records<br />
required by paragraph (h) for at least the duration <strong>of</strong><br />
employment plus 30 years in accordance with 29 CFR<br />
1910.1020.<br />
76<br />
(h)(2) Training Records.<br />
(h)(2)(i) Training records shall include the following<br />
information:<br />
(h)(2)(i)(A) The dates <strong>of</strong> the training sessions;<br />
(h)(2)(i)(B) The contents or a summary <strong>of</strong> the training<br />
sessions;<br />
(h)(2)(i)(C) The names and qualifi cations <strong>of</strong> persons<br />
conducting the training; and<br />
(h)(2)(i)(D) The names and job titles <strong>of</strong> all persons<br />
attending the training sessions.<br />
(h)(2)(ii) Training records shall be maintained for 3<br />
years from the date on which the training occurred.<br />
(h)(3) Availability.(h)(3)(i) The employer shall ensure<br />
that all records required to be maintained by this<br />
section shall be made available upon request to the<br />
Assistant Secretary and the Director for examination<br />
and copying.<br />
(h)(3)(ii) Employee training records required by<br />
this paragraph shall be provided upon request for<br />
examination and copying to employees, to employee<br />
representatives, to the Director, and to the Assistant<br />
Secretary.<br />
(h)(3)(iii) Employee medical records required by this<br />
paragraph shall be provided upon request for examination<br />
and copying to the subject employee, to anyone<br />
having written consent <strong>of</strong> the subject employee, to the<br />
Director, and to the Assistant Secretary in accordance<br />
with 29 CFR 1910.1020.<br />
(h)(4) Transfer <strong>of</strong> Records.<br />
(h)(4)(i) The employer shall comply with the requirements<br />
involving transfer <strong>of</strong> records set forth in 29 CFR<br />
1910.1020(h).<br />
(h)(4)(ii) If the employer ceases to do business and<br />
there is no successor employer to receive and retain<br />
the records for the prescribed period, the employer shall<br />
notify the Director, at least three months prior to their<br />
disposal and transmit them to the Director, if required by<br />
the Director to do so, within that three month period.<br />
(h)(5) Sharps Injury Log.<br />
(h)(5)(i) The employer shall establish and maintain<br />
a sharps injury log for the recording <strong>of</strong> percutaneous<br />
injuries from contaminated sharps. The information in<br />
the sharps injury log shall be recorded and maintained<br />
in such manner as to protect the confi dentiality <strong>of</strong> the<br />
injured employee. The sharps injury log shall contain,<br />
at a minimum:<br />
(h)(5)(i)(A) the type and brand <strong>of</strong> device involved in<br />
the incident,<br />
(h)(5)(i)(B) the department or work area where the<br />
exposure incident occurred, and<br />
(h)(5)(i)(C) an explanation <strong>of</strong> how the incident occurred.<br />
(h)(5)(ii) The requirement to establish and maintain<br />
a sharps injury log shall apply to any employer who is<br />
required to maintain a log <strong>of</strong> occupational injuries and<br />
illnesses under 29 CFR 1904.<br />
(h)(5)(iii) The sharps injury log shall be maintained<br />
for the period required by 29 CFR 1904.6.<br />
(i) Dates<br />
(i)(1) Effective Date. The standard shall become effective<br />
on March 6, 1992.<br />
(i)(2) The Exposure Control Plan required by paragraph<br />
(c) <strong>of</strong> this section shall be completed on or before<br />
May 5, 1992.<br />
(i)(3) Paragraph (g)(2) Information and Training and<br />
(h) Recordkeeping shall take effect on or before June<br />
4, 1992.<br />
(i)(4) paragraphs (d)(2) Engineering and Work Practice<br />
Controls, (d)(3) Personal Protective Equipment,<br />
(d)(4) Housekeeping, (e) HIV and HBV Research<br />
Laboratories and Production Facilities, (f) Hepatitis B<br />
Vaccination and Post-Exposure Evaluation and Follow-up,<br />
and (g)(1) Labels and Signs, shall take effect<br />
July 6, 1992.
HEPATITIS B VACCINE<br />
DECLINATION (MANDATORY)<br />
<strong>APP</strong>ENDIX B<br />
I understand that due to my occupational exposure to blood or other potentially infectious materials I may be<br />
at risk <strong>of</strong> acquiring Hepatitis B Virus (HBV) infection. I have been given the opportunity to be vaccinated with<br />
Hepatitis B vaccine, at no charge to myself. However, I decline the Hepatitis B vaccination at this time. I understand<br />
that by declining this vaccine, I continue to be at risk <strong>of</strong> acquiring Hepatitis B, a serious disease. If in the<br />
future I continue to have occupational exposure to blood or other potentially infectious materials and I want to<br />
be vaccinated with Hepatitis B vaccine, I can receive the vaccination series at no charge to me.<br />
Employee Signature __________________________________<br />
Date ______________________________________________<br />
Employer Signature __________________________________<br />
Date ______________________________________________<br />
77
<strong>APP</strong>LICATIONS FOR MEMBERSHIP<br />
MEMBERSHIP TYPES AND ELIGIBILITY CRITERIA:<br />
Pr<strong>of</strong>essional Business Member* Works full time as a piercer and has more than one year <strong>of</strong> pr<strong>of</strong>essional<br />
experience. Must meet both personal and environmental membership criteria.<br />
Pr<strong>of</strong>essional Member at Large* Pierces part time or periodically at more than one studio and has been a<br />
pr<strong>of</strong>essional business member for more than three years. Must meet personal and environmental membership<br />
criteria at all studios.<br />
Associate Member* Has less than one year <strong>of</strong> pr<strong>of</strong>essional experience, or is a non-piercer working in a piercing<br />
establishment. If working as a piercer, personal and environmental criteria must be met. If working as a<br />
non-piercer, environmental criteria must be met. Associate membership will be valid only in a studio currently<br />
employing at least one pr<strong>of</strong>essional business member.<br />
Corporate Associate Member An entity or individual working in a fi eld or providing a service that is associated<br />
with the application <strong>of</strong> body piercing. Examples <strong>of</strong> Corporate Associate Members are jewelry manufacturers,<br />
medical suppliers, insurers, educators, etc. Applicants must contact the current Secretary for a list <strong>of</strong> criteria.<br />
Patron Member An individual who supports the <strong>APP</strong> and its goals but is not actively involved in the body piercing<br />
industry. This membership may not be used for the promotion <strong>of</strong> any form <strong>of</strong> piercing services, jewelry sales<br />
or web services. Dues are the only requirement for this membership.<br />
*International Member A subdivision <strong>of</strong> memberships for piercers or non-piercers working in the piercing industry<br />
outside <strong>of</strong> the United States <strong>of</strong> America. International personal criteria differs slightly from the standard<br />
to accommodate for classes and training available, among other continental differences.<br />
MEMBERSHIP DUES:<br />
Pr<strong>of</strong>essional Business Member & Pr<strong>of</strong>essional Member At Large $150.00 ($50.00 annual renewal)<br />
Associate Member $100.00 ($50.00 annual renewal)<br />
Corporate Associate Member $200.00 ($200.00 annual renewal)<br />
Patron $50.00 ($50.00 annual renewal)<br />
Dues are billed upon acceptance. DO NOT SEND them with your application; DO SEND a non-refundable $25.00<br />
processing fee per video. One video is required per studio.<br />
03/05<br />
<strong>APP</strong>ENDIX C<br />
The <strong>Association</strong> <strong>of</strong> Pr<strong>of</strong>essional <strong>Piercers</strong><br />
Attn: Secretary<br />
2132 A Central Ave SE #285<br />
Albuquerque, NM 87106<br />
If you have any questions about your application, the current Secretary can be reached at<br />
secretary@safepiercing.org, or call 1-888-888-1<strong>APP</strong> or 1-505-242-2144.<br />
PLEASE ALLOW 6-8 WEEKS FOR PROCESSING<br />
79
<strong>APP</strong>LICATION FOR PATRON MEMBERSHIP<br />
A patron member is someone not actively involved in the body piercing industry, but supports the <strong>APP</strong> and it’s<br />
goals. This membership may not be used for the promotion <strong>of</strong> any form <strong>of</strong> piercing services, jewelry or web<br />
services. Dues are the only requirement for this type <strong>of</strong> membership.<br />
80<br />
Patron membership dues are $50 ($50 annual renewal).<br />
Please submit completed application to:<br />
The <strong>Association</strong> <strong>of</strong> Pr<strong>of</strong>essional <strong>Piercers</strong><br />
Attn: Secretary<br />
2132 A Central Ave SE #285<br />
Albuquerque, NM 87106<br />
If you have any questions about your application, the current Secretary can be reached at<br />
secretary@safepiercing.org, or call 1-888-888-1<strong>APP</strong> or 1-505-242-2144.<br />
Name _________________________________________________________________________________<br />
Name <strong>of</strong> Business (if applicable)____________________________________________________________<br />
Address_______________________________________________________________________________<br />
City, State, Zip__________________________________________________________________________<br />
Phone________________________________________ Fax_____________________________________<br />
Email_________________________________________________________________________________<br />
Signature <strong>of</strong> Applicant ______________________________________________ Date ________________<br />
By my signature above I certify that I have read and I agree to the terms <strong>of</strong> this application.<br />
04/05<br />
PLEASE ALLOW 6-8 WEEKS FOR PROCESSING
CORPORATE ASSOCIATE MEMBERSHIP <strong>APP</strong>LICATION<br />
Corporate Associate Member Is an entity or individual working in a fi eld or providing a service that is associated<br />
with the application <strong>of</strong> body piercing. Examples <strong>of</strong> Corporate Associate Members are jewelry manufacturers,<br />
medical suppliers, insurers, educators, etc.<br />
Corporate Associate Membership dues are $200.00 ($200.00 annual renewal).<br />
Dues are billed upon acceptance. DO NOT SEND them with your application.<br />
Please submit completed application to:<br />
The <strong>Association</strong> <strong>of</strong> Pr<strong>of</strong>essional <strong>Piercers</strong><br />
Attn: Secretary<br />
2132 A Central Ave SE #285<br />
Albuquerque, NM 87106<br />
If you have any questions about your application, the current Secretary can be reached at<br />
secretary@safepiercing.org, or call 1-888-888-1<strong>APP</strong> or 1-505-242-2144.<br />
Name <strong>of</strong> Company______________________________________________________________________<br />
Name <strong>of</strong> Contact ________________________________________________________________________<br />
Company Address_______________________________________________________________________<br />
City, State, Zip__________________________________________________________________________<br />
Phone________________________________________ Fax_____________________________________<br />
Website _______________________________________________________________________________<br />
Email__________________________________________________________________________________<br />
Would you like your email address on our website? qYes qNo<br />
Please include the following documentation:<br />
q A completed copy <strong>of</strong> this application form.<br />
q Letter <strong>of</strong> intent, requesting membership and outlining in what way your company is relevant to body piercing.<br />
q Business documentation: business license or other items verifying the company or group as an entity.<br />
q Signed logo usage agreement. (The term ‘license’ in this agreement refers only to the use <strong>of</strong> the logo, your<br />
company may not claim to be ‘<strong>APP</strong> licensed’).<br />
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CORPORATE ASSOCIATE MEMBERSHIP <strong>APP</strong>LICATION CONT.<br />
THE FOLLOWING CRITERIA MUST BE INCLUDED FOR WHOLESALE JEWELRY DISTRIBUTORS:<br />
q Catalog or brochure.<br />
q Mill specs for all gauges <strong>of</strong> steel and Titanium wire, balls, and bar.<br />
q MSDS sheets for Gold and Niobium.<br />
q Samples, disassembled, <strong>of</strong> the following:<br />
• 3 14 gauge 1/2” steel captive bead rings w/steel balls<br />
• 3 14 gauge 1/2” titanium captive bead rings w/titanium balls<br />
• 3 12 gauge steel barbells<br />
• 3 12 gauge titanium barbells<br />
Independent metal testing may be conducted by the <strong>APP</strong> at any time to verify provided documentation. This will<br />
be at your expense, approximate cost is $300- $500.<br />
THE FOLLOWING CRITERIA MUST BE INCLUDED FOR AFTERCARE PRODUCT DISTRIBUTORS:<br />
q MSDS sheets for all aftercare products being distributed.<br />
Results <strong>of</strong> extensive clinical studies performed by one or more independent laboratory or other documentation<br />
may be requested.<br />
THE FOLLOWING CRITERIA MUST BE INCLUDED FOR EDUCATORS:<br />
q Qualifi cations <strong>of</strong> the class instructor(s).<br />
q A copy <strong>of</strong> the class curriculum.<br />
q Copies <strong>of</strong> all handouts, workbooks or materials given to class participants.<br />
q A voided copy <strong>of</strong> any certifi cates or awards given upon course completion*.<br />
*Certifi cates distributed for piercer training must state the number <strong>of</strong> hours or days the course took to complete,<br />
and that completion <strong>of</strong> the course does not claim that the participant is certifi ed or licensed to pierce.<br />
OTHER INDUSTRY SPECIFIC CRITERIA MAY BE REQUESTED ON AN INDIVIDUAL BASIS.<br />
Signature <strong>of</strong> Applicant ______________________________________________ Date ________________<br />
By my signature above I certify that I have read and I agree to the terms <strong>of</strong> this application.<br />
04/05<br />
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PROFESSIONAL BUSINESS/ASSOCIATE MEMBERSHIP <strong>APP</strong>LICATION<br />
Type <strong>of</strong> <strong>APP</strong> Membership desired (please check one):<br />
q Pr<strong>of</strong>essional Business Member q Pr<strong>of</strong>essional Business Member at Large<br />
q Associate Member – Piercer q Associate Member- Non Piercer<br />
Name <strong>of</strong> Applicant________________________________________________________________________<br />
Studio & Address_________________________________________________________________________<br />
City__________________________________________ Country __________________________________<br />
Studio Phone___________________________________ Fax _____________________________________<br />
Home Address___________________________________________________________________________<br />
Phone_________________________________________ Website _________________________________<br />
qYes qNo Would you like your email address on our website? Email_______________________________<br />
THE FOLLOWING PERSONAL CRITERIA MUST BE INCLUDED FOR EACH PIERCER <strong>APP</strong>LYING:<br />
q A completed copy <strong>of</strong> this application form.<br />
q A completed questionnaire, preferably typewritten.<br />
q A copy <strong>of</strong> current CPR certifi cation or equivalent training.<br />
q A copy <strong>of</strong> current First Aid certifi cation or equivalent training.<br />
q A copy <strong>of</strong> current Bloodborne Pathogen Training Certifi cate or equivalent training (to be renewed annually regardless<br />
<strong>of</strong> expiration date).<br />
q Signed Health and Safety Agreement.<br />
q Signed Logo Usage Agreement<br />
q Pro<strong>of</strong> <strong>of</strong> how long piercer has been piercing pr<strong>of</strong>essionally. A notarized statement,* dated business document, or newspaper<br />
article are examples <strong>of</strong> appropriate pro<strong>of</strong>.<br />
*If a notarized statement is submitted as pro<strong>of</strong>, it must come from a party other than the applicant.<br />
THE FOLLOWING ENVIRONMENTAL CRITERIA MUST BE INCLUDED UNLESS ENVIRONMENTAL<br />
CRITERIA HAS BEEN SUBMITTED WITHIN THE LAST YEAR**:<br />
q A walk through 360 degree video <strong>of</strong> applicant’s entire studio including store front, foyer, piercing room(s), biohazard<br />
area, sterilization area, restroom, inside all drawers, closets, and all other spaces. Narration is appreciated.<br />
q $25 processing fee per video. One video is required per studio. VHS or DVD (region 1) are the preferred video formats.<br />
Other video formats may require additional time to process and any fees incurred for video transferring will be charged<br />
to applicants. Please contact the current Secretary for more information.<br />
q Photograph <strong>of</strong> all applicant’s autoclaves with make, model and serial number printed on the back <strong>of</strong> photo Autoclaves<br />
should be medical grade with a dry cycle.<br />
q Copy <strong>of</strong> two most recent spore test results from all autoclaves in use.<br />
q Copies <strong>of</strong> all release forms in use at applicant’s studio.<br />
q Copies <strong>of</strong> all aftercare information distributed at applicant’s studio.<br />
q Copy <strong>of</strong> studio’s business license.<br />
q Business card.<br />
q One or more samples <strong>of</strong> applicant’s advertising.<br />
**Any and all materials should be updated voluntarily by the member if signifi cant changes are made in the environment, advertising, equipment, aftercare etc. These updates to the member’s<br />
fi le should be done at the time any changes are made.<br />
As an Applicant to the <strong>Association</strong> <strong>of</strong> Pr<strong>of</strong>essional <strong>Piercers</strong> (<strong>APP</strong>), I understand that my video tape (and other materials) becomes the property <strong>of</strong> the <strong>APP</strong>. I hereby release the <strong>APP</strong> and/or its<br />
legal representatives and assigns, the irrevocable and unrestricted right to use these materials for education, training, and for any other purpose and in any manner and medium. I hereby release<br />
the <strong>APP</strong> and its legal representatives and assigns from all claims and liability relating to said tapes and materials.<br />
Signature <strong>of</strong> Applicant ______________________________________________ Date ________________<br />
By my signature above I certify that I have read and I agree to the terms <strong>of</strong> this application.<br />
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84<br />
“WALK THROUGH 360° VIDEO” CRITERIA<br />
Revised 03/2005<br />
The purpose <strong>of</strong> submitting a walk through 360° video with your membership application is to help us determine the level <strong>of</strong> health and safety<br />
awareness in your studio. We look for the criteria on this list, and also note anything that may be a potential hazard to clients or staff. Items<br />
that are required for membership have been labeled as such. Other items are strong suggestions that are not required for membership <strong>of</strong><br />
themselves, however the studio that lacks several <strong>of</strong> these may not be operating at the level that is desired <strong>of</strong> <strong>APP</strong> members.<br />
FRONT COUNTER/DISPLAY AREA<br />
q REQUIRED FOR MEMBERSHIP: The counter surface should be glass, metal, or other non-porous surface<br />
that can be disinfected several times each day.<br />
q Gloves and disposable products to prevent cross-contamination should be kept at the front counter area.<br />
BIOHAZARD/STERILIZATION ROOM(S)<br />
q REQUIRED FOR MEMBERSHIP: A completely separate and enclosed biohazard room for processing used implements,<br />
jewelry and supplies is crucial to your health and safety and that <strong>of</strong> your clients.<br />
q REQUIRED FOR MEMBERSHIP: All fl ooring in the piercing room/s and biohazard room must be non-porous and easily<br />
disinfected.<br />
q REQUIRED FOR MEMBERSHIP: There must be clear delineation between clean and dirty areas. Biohazard areas<br />
should be labeled as such. The ultrasonic unit and the sink used for rinsing contaminated tools should be positioned as<br />
far away from sterilizer as possible to reduce the risk <strong>of</strong> contaminating freshly autoclaved items. If space is a problem,<br />
one solution would be to install a Plexiglas barrier to divide clean and dirty areas.<br />
q There should be at a minimum one ultrasonic cleaner to process contaminated items. Failure to remove debris from<br />
instruments or jewelry prior to sterilization can negatively affect the effi cacy <strong>of</strong> the autoclave. The Center for Disease<br />
Control considers manual scrubbing <strong>of</strong> instruments to be an act that will actually increase the likelihood <strong>of</strong> exposure,<br />
due to pathogens on the equipment becoming airborne. Many studios have a second ultrasonic cleaning unit used only<br />
to process new jewelry.<br />
q An air purifi er or separate ventilation for this space is strongly suggested.<br />
q Hand washing should never take place at the contaminated sink.<br />
PUBLIC/EMPLOYEE RESTROOM<br />
q REQUIRED FOR MEMBERSHIP: No sterilization equipment may be housed in the public restroom.<br />
q The restroom used by employees should have liquid soap in a pump or wall-mounted dispenser and a paper towel<br />
dispenser with easy, one-handed access.<br />
PIERCING ROOM<br />
q REQUIRED FOR MEMBERSHIP: A completely separate enclosed piercing room with walls and door(s) is a required.<br />
No other services such as tattooing, hair styling, or retail sales should take place within this room.<br />
q REQUIRED FOR MEMBERSHIP: All fl ooring in the piercing room/s must be non-porous and easily disinfected.<br />
q REQUIRED FOR MEMBERSHIP: All surfaces in the piercing room that could potentially be contaminated during a<br />
procedure must be non-porous to allow for proper cleaning. This includes piercing table, mat and base, shelving, and<br />
counters.<br />
q REQUIRED FOR MEMBERSHIP: Pre-sterilized piercing implements should be kept in enclosed and non- porous containers,<br />
drawers or cabinets.<br />
q It is strongly suggested that there be clearly visible delineation between clean and dirty areas. The Sharps container<br />
and contaminated-tools tray should not be close to sterilized piercing implements and supplies. One solution would<br />
be to install a labeled biohazard shelf above the trashcan for the contaminated materials, thereby establishing a single<br />
contamination area in the room.<br />
q Used piercing implements should be kept in a lidded, non-porous tray or container that is marked “Biohazard”.
q The Sharps container should be secure to avoid accidental spillage. In the United States, NIOSH suggests that the<br />
Sharps container be mounted with the opening 56” from the fl oor and OSHA requires that operators have reasonable<br />
access to it. Additionally, the Sharps container should be located such that it can be easily utilized by the piercer in all<br />
phases <strong>of</strong> a procedure without putting clients or observers at risk.<br />
q All biohazardous waste containers should be marked as Biohazard, be lidded and have foot operation. It is appropriate<br />
to label your other lidded trashcans “Do Not Touch”. These should be placed in low or no traffi c areas to avoid accidental<br />
exposure.<br />
q A HEPA air fi lter or other air purifi cation system located in the piercing room is extremely benefi cial, especially if other<br />
services are <strong>of</strong>fered within the studio.<br />
q As many surfaces as possible in the piercing room should be non-porous. All pictures, posters, and wall hangings should<br />
be framed.<br />
q As many products as possible should be sterile and single use. This includes the marking implement.<br />
q All packaged equipment, sundry jars, or other materials and equipment used during a piercing should be handled<br />
only with clean freshly gloved hands.<br />
EMPLOYEE HAND-WASHING AREA<br />
q REQUIRED FOR MEMBERSHIP: Reasonable access to a sink used for hand-washing is mandatory. In-room prep<br />
sinks are preferable.<br />
q Optimally, the sink used for pre and post-piercing hand-washing should operate via a hands-free method.<br />
q Wall-mounted or pump liquid soap dispensers and paper towel dispensers should have easy, one-handed access. This<br />
will greatly reduce the likelihood <strong>of</strong> cross-contamination.<br />
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86<br />
HEALTH AND SAFETY AGREEMENT<br />
The <strong>APP</strong> requires a signed agreement on record from each individual member. Violation <strong>of</strong> these basic, critical<br />
health and safety requirements is grounds for immediate revocation <strong>of</strong> membership. Please initial each numbered<br />
line as indicated to show that you have read and fully understand each point.<br />
1.____ I agree not to use ear-piercing guns in my studio due to the impossibility <strong>of</strong> properly sterilizing the equipment<br />
and the inappropriateness <strong>of</strong> ear piercing gun jewelry.<br />
2.____ I agree that all needles will be pre-sterilized, used on one person only in one sitting, and will be immediately<br />
disposed <strong>of</strong> in a medical sharps container.<br />
3.____ I agree that all forceps, tubes, etc. will be pre-sterilized. If they are not used immediately, they will be<br />
stored in sterile bags and used on only one person in one sitting. After one such use, instruments will be appropriately<br />
decontaminated and then sterilized in an autoclave.<br />
4.____ I agree that as many supplies as possible including corks, rubber bands, toothpicks etc., should be individually<br />
packaged and pre-sterilized in an autoclave and disposed <strong>of</strong> immediately after a single use. Skin prep<br />
products will be properly dispensed if acceptable based on the product or individually packaged and disposed<br />
<strong>of</strong> immediately after use.<br />
5.____ I agree that a new pair <strong>of</strong> medical-grade (sterile and/or non-sterile) will be donned appropriately and<br />
worn for every procedure and that gloves will be changed frequently, and whenever there is the slightest chance<br />
for cross-contamination.<br />
6.____ I agree that the room used for piercings will be an enclosed room and used exclusively for piercing and<br />
jewelry insertion. This room must also be kept separate from the sterilization area. Piercing room, biohazard<br />
room, bathrooms and other common areas, will be kept scrupulously clean and shall be disinfected frequently. All<br />
surfaces shall be non-porous, allowing them to be cleaned with an FDA-approved disinfectant solution throughout<br />
the day and whenever cross- contamination might occur.<br />
7.____ I agree that all jewelry for initial piercings will be autoclaved prior to insertion.<br />
8.____ I will use only appropriate jewelry in initial piercings. Appropriate jewelry is made <strong>of</strong> implant certifi ed<br />
stainless steel that is ASTM F-138 compliant or ISO 5832-1 compliant, implant certifi ed titanium (Ti6Al4V ELI)<br />
that is ASTM F-136 compliant or ISO 5832-3 compliant, solid 14 karat or higher white or yellow gold, Niobium<br />
(Nb), solid platinum, or a dense low-porosity plastic such as Tygon or PTFE. Threaded jewelry for initial piercings<br />
must have internal tapping (no threads on posts) starting from 16 gauge. Jewelry must be free <strong>of</strong> nicks,<br />
scratches, burrs, and polishing compounds. Ring ends should be rounded.<br />
9.____ I agree that it is important to be open, available and not under the infl uence <strong>of</strong> legal or illegal substances<br />
which might compromise my abilities. I agree to maintain my certifi cation in First Aid/ CPR, and Bloodborne<br />
Pathogen training. I agree to meet or exceed all health, safety and legal standards as required by my state and<br />
local authorities. I understand that it is important not to misrepresent myself, my abilities, or my standards in<br />
any way. I agree to consider all new health and safety suggestions, as they become known to me and to make<br />
appropriate changes in my technique as applicable. I agree that it is the moral, ethical, and pr<strong>of</strong>essional responsibility<br />
<strong>of</strong> all piercers to continue to seek out, absorb and share health and safety information relevant to the craft<br />
throughout my career. I also agree to adhere to the <strong>APP</strong> logo specifi cation and guidelines.<br />
Name (please print): __________________________________________<br />
Studio Name: _______________________________________________<br />
Signature_____________________________________________ Date _____________________<br />
Witness______________________________________________ Date _____________________
A PIERCEE'S BILL OF RIGHTS<br />
EVERY PERSON BEING PIERCED HAS THE RIGHT:<br />
1. To be pierced in a hygienic environment by a clean, conscientious, sober piercer wearing a fresh pair <strong>of</strong> disposable<br />
medical examination gloves.<br />
2. To be pierced with a brand new, completely sterilized single-use needle that is immediately disposed <strong>of</strong> in a<br />
medical Sharps container after use on one piercing.<br />
3. To be touched only with freshly sterilized and appropriate implements, properly used and disposed <strong>of</strong> or re-sterilized<br />
(where appropriate) in an autoclave prior to use on anyone else.<br />
4. To know that piercing guns are NEVER appropriate, and are <strong>of</strong>ten dangerous when used on anything<br />
-- including earlobes.<br />
5. To the peace <strong>of</strong> mind that comes from knowing that their piercer knows and practices the very highest standards<br />
<strong>of</strong> sterilization and hygiene.<br />
6. To a have a knowledgeable piercer evaluate and discuss appropriate piercings and jewelry for her/his individual<br />
anatomy and lifestyle.<br />
7. To be fully informed <strong>of</strong> all risks and possible complications involved in his/her piercing choice before making<br />
any decisions.<br />
8. To seek and receive a second opinion either from another piercer within the studio or from another studio.<br />
9. To have initial piercings fitted with jewelry <strong>of</strong> appropriate size, material, design, and construction to best promote<br />
healing. Gold-plated, gold-filled or sterling silver jewelry is never appropriate for any new or unhealed<br />
piercing.<br />
10. To see pictures, be given a tour <strong>of</strong> the piercing studio, and to have all questions fully and politely answered<br />
before making or following through on any decision.<br />
11. To be fully informed about proper aftercare, both verbally and in writing, and to have continuing access to the<br />
piercer for assistance throughout the healing process.<br />
12. To be treated with respect, sensitivity and knowledge regardless <strong>of</strong> gender, sexual orientation, race, religion,<br />
ethnicity, ability, health status or piercing choice.<br />
13. To change her/his mind, halt the procedure and leave at any point if the situation seems uncomfortable<br />
or improper.