With the lingering threat of HIV/AIDS and Hepatitis, strong measures are being taken by local governments to standardize the health procedures followed by tattoo shops. Many reputable tattoo shops govern themselves, following strict codes of cleanliness and anti cross-contamination practices. But when it comes to your health, common sense should rule above all else. If you see something that you feel will jeopardize your health, question it. Don’t take unnecessary chances.
A QUICK OVERVIEW
A shop that practices sterile procedures will do the following;
- Autoclave – The preferred method of sterilizing equipment is by autoclaving. The process uses pressurized steam to kill bacteria. Needles and ink tubes should be in sealed pouches with an indicator strip and should be opened in front of you.
- Gloves – The tattoo artist should use gloves at all times. Gloves should be removed every time the artist walks away or reaches for non-disposable items to prevent cross-contamination. Non-latex gloves should be available for those with latex allergies.
- Cross-contamination proceedures – Although the HIV/AIDS virus dies within several minutes of contact with air, the Hepatitis B virus can live up to two weeks. Cross-contamination can occur when an artist touches an unsterilized object with his gloves (telephone, uncovered spray bottles, dropped items) then returning to work on you.
- Disposable ink cups – Ink for your tattoo becomes contaminated through the tattooing process and should be poured into small plastic cups prior to you getting tattooed. These then get thrown out after your tattoo is completed. If the artist needs to replenish his ink, the gloves should be taken off prior to refilling.
- Disposable needles – Needles should be taken out of a sterilized pouch in front of you prior to your tattoo. After your tattoo is completed, it should be properly disposed of in a ‘sharps’ container.
- Disposable tubes – Years ago the common practice was to use stainless steel tubes that were cleaned and sterilized between uses. With the increased pressure from health departments pushing single use setups, many of today’s artists use disposable plastic tubes. Like with the needles, the packaging should be shown to you prior to it being opened.
- Overall cleanliness – Counters should be clean and a new setup done for each new tattoo. All disposables should be properly disposed of after the tattoo. The artist should wash his/her hands prior to and immediately after your tattoo. The shop floor should be clean and the artist’s clothing should be clean and neat. Non-disposable items used during your tattoo should be covered with plastic and then disinfected or sterilized after the tattoo.
COMMUNICABLE DISEASES THAT POSE A RISK
Currently there are some 200+ communicable diseases that can be transmitted through tattooing. That is not to say that getting a tattoo will give you any number of these diseases. Many of these can’t even be found within our geographical area and some are harder to transmit than others.
Of obvious concern are the more deadly and/or easily transmittable diseases such as HIV/AIDS and hepatitis B and C. Of these two the hepatitis virus is of greater concern due to its properties. Here is some information regarding these two diseases;
- HIV/AIDS: Although the threat of contracting the HIV virus is very frightening due to its deadly nature, there have been no documented cases of anyone contracting the virus from getting tattooed. This does not suggest that the potential for infection is not there. A study showed that the ratio of transmission from an accidental needle stick is one in 200. There are two factors that attribute to the low risk of this type of contraction; inherent properties of the virus and the means of viral transmission.– Inherent properties: Two major properties inherent in the HIV virus itself help to minimize the possibility of contamination from tattoo needles. The first being that the virus itself dies quickly once outside its living host and in the open air. Secondly, unlike other bacteria, the HIV virus cannot reproduce outside its host. This means that once contaminated blood leaves the body and mixes with the air, inks and the green soap used to wipe the tattoo surface, the virus begins to die instantly. The virus can also be easily killed with household disinfectants, bleach, alcohol and boiling water.– Means of transmission: The term needle in tattooing is a misnomer since tattoos are not applied by needles but rather with pins. A needle is typically a hollow core implement that is used primarily for intravenous injections such as a syringe or IV needle. Tattoo ‘needles’ are solid core and push the ink into the skin rather than inject it. This requires that the ink, and any contaminated blood mixed with it, must adhere to the outside surface of the pins causing the virus to come into contact with the open air. Under clinical control, it requires about 1 ml (approx.2 drops) of blood containing a large enough concentration of the virus to infect another person. It is unlikely that such a large amount of contaminated blood can be introduced into a client through a tattoo ‘needle’ and even less likely to have a large enough amount of the virus survive that it can contaminate another person.
“HIV-AIDS and Transmission” © 1998 Centers for Disease Control
“Misperceptions About HIV and Its Transmission” © 1999 Centers for Disease Control and Prevention
“An Ounce Of Prevention – Facts about AIDS and the HIV Virus” © 1998 American Foundation for AIDS Research
“Safe Tattooing” by © 1999 Steve Gilbert, Tattoos.com
- HEPATITIS: Viral hepatitis refers to several common diseases caused by viruses that can lead to swelling and tenderness of the liver. The most common types of viral hepatitis are hepatitis A, B and C. Hepatitis B and C can lead to serious, permanent liver damage and are known to be transmittable through tattooing. There are other forms of hepatitis that are less common; these include hepatitis D and E, as well as three other lesser known viruses.Unlike the HIV virus, hepatitis can survive outside its host for up to two weeks and can resists most normal forms of disinfection. Also, studies show that the ratio of hepatitis transmission through accidental needle stick is much greater than that of HIV. About one in five as opposed to one in 200 for HIV.SOURCES:
“Facts About Hepatitis” © 1998 American Liver Foundation
“Safe Tattooing” by © 1999 Steve Gilbert, Tattoos.com
One other type of infection that should be noted here is the staphylococcus bacteria, otherwise called a staph infection. A new tattoo is considered to be a fresh wound since the action of tattooing causes the surface of the skin to be broken and some bleeding does occur. If not cared for properly and the tattoo aftercare is not followed, the area may become susceptible to bacterial infection, including infection from the staph bacteria. Although not life threatening, a staph infection is of concern and needs to be treated by a medical doctor. Simple sterility practices and careful attention to cleanliness during the healing process is usually sufficient precautions to avoid a staph infection.
OTHER TYPES OF HEALTH PROBLEMS
Aside from the various contagion mentioned above, there are a number of non-communicable health problems that must be taken into consideration. These include heart problems, severe scoriasis, drug or alcohol impairness, epilepsy, hemophilia, allergy to color pigments and a list of other health problems too long to include.
Most tattoo parlors require a waiver to be filled out and signed before getting a tattoo. Although the waiver you sign also acts as a means of identifying potential problems, it is ultimately your responsibility to make the artist aware of any pre-existing medical or physical conditions that may affect your health. Whenever there is a doubt of a health problem, it is always advised that you seek out counsel from your family doctor prior to getting a tattoo.
Cross-contamination refers to the transferring of contaminants from its original source to a secondary location where it can be picked up to contaminate a third source. An example would be when a tattoo artist is working on an infected client and he fails to remove his gloves before using a pen to sign for a package, and the pen belongs to the delivery person. That delivery person runs the risk of becoming infected from the other person’s blood whenever the pen is handled.
Although there is no real substantial proof that any virus can be readily transmitted from one person to another and infect the second in this manner, the risk is always there. Most diseases require a substantial amount of the virus itself to be transferred before it has enough strength to infect the new host. Minimal contact like the example above may not contain enough contaminants to infect the second person.
One of the main ways of combating cross-contamination is by maintaining what is termed a sterile field. This is an invisible demarcation line around the tattoo artist, the client and the tools and equipment needed to render the tattoo. Whenever this line is to be broken (answering the phone, writing a note, refilling ink cups, etc.) the tattoo artist’s gloves should be removed and disposed of. No contaminated materials should cross that invisible line. This action contains any blood borne pathogens within a controllable area where sterility can be maintained. All contaminated materials should be properly disposed of and the area disinfected upon completion of the tattoo.
Wherever there is blood there is the risk of contamination. Most tattoo parlors have an established practice of disinfection and sterilization that eliminates the risk of cross-contamination.
By following simple preventative procedures and maintaining a sterile field, the risk of cross-contamination is minimized. Also a stringent cleaning habit before and after a tattoo helps to keep the spread of diseases in check. A clean shop, equipment, and personnel are a must and should be looked out for at all times. If you see any questionable acts, think twice about getting tattooed at that shop.
The most effective means of sterilization is the autoclave. This medical device kills disease bearing bacteria and viruses by pressurized steam and high temperatures. The effective range is a temperature of 250°-275° Fahrenheit at 15 Ibs. of pressure. All reusable, non-disposable equipment that comes into contact with a client’s blood is to be properly sterilized. This requires that the equipment be cleaned of all blood, inks and foreign matter and packaged in a self-sealing sterilization pouch before autoclaving. Ask your tattoo artist to show you this indicator before the pouch is opened. If it has not changed color according to the manufacturer’s directions, ask for a new setup.
Most commonly available pouches contain a built-in sterilization indicator that changes color when the pouch has reached the appropriate temperature. This provides visual proof for the clients to confirm upon receiving a tattoo. The packaged equipment is then inserted into the autoclave and run through a cycle at a temperature of 250°-275° Fahrenheit and at a pressure of 15 Ibs. for no less than 30 minutes.
DISPOSAL OF BIOHAZARDOUS WASTE
Biohazardous waste is considered to be anything that contains bodily fluids. This includes blood, urine, mucous, and any other fluids emanating from the human body. In a tattoo environment, this means any blood that is emitted from a fresh tattoo.
During the tattooing procedure, it is a common practice to wipe any excess inks and blood from the working area with clean paper towels. These paper towels are then disposed of in a lined and lidded trash container marked as biohazardous waste with an approved biohazard label. Never into a commonly used trash barrel.
Water used to clean the ink from the machine’s ink tube is also considered biohazardous waste. This liquid is also disposed of in the above mentioned trash container. At no time is this liquid to be disposed of in a publicly used sink.
Needles used in the tattooing process should be single use needles. They are to be disposed of in your presence in an approved ‘sharps’ container upon completion of the tattoo. This is commonly done by either tossing the whole needle into a ‘sharps’ container or breaking off the pins and throwing those into a ‘sharps’ container. At no time are needles to be disposed of into a plastic bag lined trash container.