Anonymous
02-06-2005, 09:10 PM
Shop Space - page 01
TATTOOING CAN BE A SERIOUS HEALTH RISK TO THE TATTOOER, THE CLIENT, AS WELL AS EVERY PERSON WHO ENTERS A TATTOO SHOP. Tattooists have an ethical, if not legal responsibility to see that proper procedures are in place that ensure exposure to health risks are minimized. Many individuals carry blood borne infections, without displaying recognizable symptoms of illness. Any tattoo shop is open to contact with a variety of viral and bacterial infections. The application of protective, preventive procedures is needed at all times, for every client, without exception.
Cross-contamination refers to the unintentional transmission of infection from person to object, then from the contaminated object to another person. In a tattoo shop, this most commonly occurs in the work area, or is a result of improper procedure during the cleaning and sterilizing of contaminated instruments.
Hepatitis viruses can remain active on a surface for a period of days to weeks, depending on the environmental conditions. A contaminated object, surface, or instrument can become a common link between two or more people, and transmission of infection can occur from client to client. The possibility of client to staff, and staff to client transmission must also be considered. If correct procedures are established and maintained, the possibility of disease transmission can be minimized.
xx ZONES xx
Infection control requires that a shop environment is considered in terms of separate areas or zones. The zones are established by usage-reception area, work area, cleaning area, and washroom. The zones should be designated as clean or contaminated. The integrity of these zones, once established, must not be compromised.
A contaminated zone is an area in which there has been any exposure of bodily fluids, especially blood. Overspray created during the tattooing procedure may contain micro-organisms which can settle and survive on surfaces, establishing an area as contaminated. Any person entering an area which is potentially contaminated must be aware of this fact or access to this area should be restricted.
An area in which any possible exposure to contaminants has been eliminated is a clean zone, this area can be maintained through disinfection and strict adherence to procedure.
Contaminated zones in a shop should be contained, and separated as much as possible from the rest of the shop. This area should not be accessible to anyone, except staff and the client being tattooed. Any person with an uncovered, fresh tattoo, should not be allowed outside the designated contaminated zone. The tattooist should never leave the work area with contaminated gloves on.
The reception area of a shop should be established and maintained as a clean zone.
The area where instruments are cleaned prior to sterilization must be considered a contaminated area. There should be no public access to this area.
The area in which tattooing is done should be considered contaminated as soon as the session begins. Before the next client enters this area it must be returned to a safe, clean condition. The preparation of the tattooing area is disinfection after the previous appointment. During the tattooing procedure any surface or object in the room that the tattooing is being done in may become contaminated. The tattooing area must be easily cleaned. Waste receptacles should have a large opening without a lid. Plastic bags should be a heavy gauge which will not easily tear or puncture. Materials that will be needed during the tattooing procedure should be laid out for each session. They should be easily accessible to avoid unnecessary hand contact and consequent contamination of counter surfaces, drawer handles, and cabinet knobs. A disposable cup of water should be used to rinse the machine tube during the procedure, as sinks are problematic due to the difficulty in re-establishing cleanliness.
xx DISPOSABLE ITEMS xx
Disposable items should be used wherever possible. Disposable caps should be used for pigment. Disposable razors should be used once only, then discarded. Items that will be re-used, such as tubes and needle bars, should be made of stainless steel and sterilized after each use.
xx NON-DISPOSABLE ITEMS xx
Items that are not disposable, and cannot be sterilized must be covered with a disposable plastic barrier, to prevent contamination from reaching surfaces. Anything that will be touched by the tattooer during the tattooing procedure must be covered with plastic bags, such as, spray bottles, clip cords, and tattoo machines. Plastic backed napkins should be used to create a disposable work surface. When removing plastic barriers, care must be taken not to contaminate the area it was covering.
:: next - page 02
© 2004 Eikon Device - Machinegun Magazine online
Shop Space - page 02
xx SURFACES AND OBJECTS xx
Objects and surfaces in the tattooing work area that are either not disposed of, sterilized after one use, or have not been covered, must be brought to a high level of disinfection. Efficient chemical disinfection requires exposure to the disinfectant for a significant amount of time, for many products it is as much as twenty minutes. This is difficult in a busy shop environment, where clients are seen consecutively in the same work area. Extensive use of disposable plastic barriers, such as dental bibs, will reduce the need for chemical disinfection of the work area between clients. Counters and tabletops that have not been covered have been exposed to airborne particles which may contain contaminants. These areas must be wiped down with detergent germicide, and left to air dry between appointments.
The task of choosing an appropriate product for cleaning and disinfection of items such as tables, chairs, counter tops and floors can be very confusing. Some time must be spent becoming knowledgeable about the available products, and what is needed for the shop.
"Five specific questions should be asked about any product under consideration:
What are the recommended uses of the product?
What is the active antimicrobial ingredient?
How is the product used?
Will the product damage surfaces or equipment?
What is the product's toxicity?" 1
Ask for documentation on products. If a sales representative is unable to provide technical information about their product, speak to someone who can. If the supplier seems incapable of providing substantial data, look elsewhere for another product.
New products for cleaning and disinfection appear on the market constantly. However, the active ingredient used in these products is generally the same as contained in many older products. It should be an active antimicrobial agent. If you are uncertain about a disinfection product, or process, consult the municipal health department. Health department personnel have access to information that makes them a valuable source of assistance. They should not be regarded with fear or suspicion.
When a tattooing session is completed, the instruments that are to be sterilized must be taken to an area designated for cleaning contaminated instruments prior to sterilization. Thorough pre-cleaning to physically remove all matter is mandatory prior to sterilization. As it is nearly impossible to clean the small spaces between needles in multiple needle configurations, re-use is strongly discouraged. Any object to be sterilized must be physically clean prior to sterilization. Any particles left on the instruments can impair the sterilization process.
Ultrasonic cleaning is not a substitute for sterilization. It should be considered as a cleaning process only. Ultrasonic cleaning is preferred over manual cleaning, for it has more efficient penetration into the small spaces of tubes. A major concern is the risk of nicks or cuts by anyone scrubbing the instruments by hand, as well as exposure to over-spray and splatter. These should be considered as common potentials for cross-contamination.
Items should be packaged and sealed in autoclave bags, and dated prior to sterilization. Care should be taken that the packages are completely dry before they are stored. "The maximum time a sterilized pack can be stored is debatable. Paper/plastic peel pouches are said to be safe for six to twelve months. Contamination is event-related, not time-related. The conditions of storage and the amount of handling to which the packs are subjected are more important determinants of contamination. Sterile packs should be kept on closed shelves away from moisture or possible contamination, and handled as little as possible prior to use." 2
The use of gloves is not a substitute for hand washing. Hand washing remains one of the simplest, and most important means of preventing cross-contamination. Hands should be washed with soap and water as soon as gloves are removed.
xx MEANS OF STERILIZATION xx
Effective methods for sterilization are relatively limited. There are five methods commonly used to sterilize instruments: Autoclaves (steam under pressure), Dry Heat Sterilizers (hot air oven), Chemical Sterilization (Gluteraldehyde), Chemical Vapour, and Ethylene Oxide Gas.
The most suitable sterilization system is determined by the tolerances of the instruments being sterilized. An autoclave remains the easiest and most appropriate method of sterilization available for tattooing because the instruments being sterilized can withstand high temperature and steam under pressure.
An autoclave accomplishes sterilization in much less time than a dry heat sterilizer can. Sterilization of unwrapped instruments takes 20 minutes at 126Æ’C (260Æ’F), and 30 minutes at 126Æ’C (260Æ’F) for wrapped instruments.3 An autoclave raises the boiling point of water to 121Æ’C (250Æ’F) by increasing the air pressure by one atmosphere (15 psi or 103.4 KPA).4 Autoclaves use distilled water to prevent scale deposition on instruments.
Dry heat sterilization is used mainly for materials that cannot be sterilized safely with steam under pressure, either because of the pressure or the steam. Dry heat would take one hour at 170Æ’C (340Æ’F), or two hours at 160Æ’C (320Æ’F).5 Timing must start when the entire contents of the sterilizer has reached the peak temperature needed for that particular load. Some wrapping materials are intolerant of dry heat, which complicates storage of dry heat processed instruments.
Chemical sterilization has many limitations, and should only be used for instruments that are intolerant of heat. Gluteraldehyde products are the only chemicals that are sufficiently sporicidal to accomplish sterilization. Exposure time is long (6 - 10 hours). During this period of immersion, no other instruments may be added or removed from the bath, as this interrupts the process. Because of toxicity, gluteraldehyde baths must be covered and left in areas with good ventilation. Glutaraldehyde must be thoroughly rinsed off instruments with sterile water before they are used.
Chemical vapour sterilization uses a combination of alcohols, formaldehyde, ketone, water and acetone, heated under pressure to produce a sterilant gas. Temperatures used are 260Æ’F - 270Æ’F (126Æ’C - 132Æ’C) at 20 to 40 pounds pressure. It requires 20 minutes at temperature, and adequate ventilation is required.
Ethylene Oxide Vapour in Chamber - time duration of cycle varies by temperature and concentration of gas. Relatively low operating temperature means ethylene oxide sterilization is suitable for relatively heat-sensitive items. Adequate ventilation is required and exhaust of ventilation must be controlled. An indicator strip or tape should be included on each sterilizer bag. Most sterilizing bags or pouches have a process indicator on them. A process indicator is printed with an ink that changes colour with exposure to heat, steam or chemical vapour. A colour change indicates that a pouch has been processed, but it is not proof of proper sterilization.
A sterilizer should be tested at least monthly to ensure that it is functioning properly. Biological monitors or spore tests are small strips of paper, or ampules containing living non-pathogenic resistant spores. The biological monitors are placed in hard to reach areas of the sterilizer, and then cultured. If the spores have been sterilized they will not germinate. Some biological monitors must be returned to the company for culturing, and some come with a colour indicator that indicates proper sterilization.
XX SHARPS DISPOSAL XX
Needle configurations should be discarded directly into a sharps container. "Sharps containers must be disposed of by one of the following methods:
removed by a licensed biomedical waste management company.
taken to a hospital or laboratory which will ensure proper disposal.
autoclaved and disposed of with general wastes." 6
XX WASTE DISPOSAL XX
The disposal of potentially contaminated waste is generally legislated municipally. Local health departments can provide information about a tattooist's responsibility as it pertains to waste disposal.
Garbage containers should be lined with heavy gauge garbage bags. Never allow bags to overfill. Do not place hard or heavy objects in bags which could cause potential tears or punctures. Keep waste from contaminated areas out of clean areas. In all areas bags should be sealed, then promptly removed. Waste collection receptacles and dumpsters should be kept locked awaiting collection.
Although waste produced during the tattooing process should be considered contaminated, it does not fall within the scope of regulated hazardous waste. The Bloodborne Pathogens Standard uses the term, "regulated waste," to refer to the following categories of waste which require special handling at a minimum;
"liquid or semi-liquid blood or other potentially infectious materials;
items contaminated with blood or other potentially infectious material and which would release these substances in a liquid or semi-liquid state if compressed;
items that are caked with dried blood or other potentially infectious material and are capable of releasing these materials during handling;
contaminated sharps; and
pathological and microbiological wastes containing blood or other potentially infectious material." 7
To ensure that everyone involved in the tattooing process is safe from exposure to infection through cross-contamination, it is important to follow proper methods of cleaning, disinfection and sterilization. Adequate levels of cleaning, disinfection, and sterilization can be achieved quite efficiently and cost-effectively.
:: next - page 03
© 2004 Eikon Device - Machinegun Magazine online
TATTOOING CAN BE A SERIOUS HEALTH RISK TO THE TATTOOER, THE CLIENT, AS WELL AS EVERY PERSON WHO ENTERS A TATTOO SHOP. Tattooists have an ethical, if not legal responsibility to see that proper procedures are in place that ensure exposure to health risks are minimized. Many individuals carry blood borne infections, without displaying recognizable symptoms of illness. Any tattoo shop is open to contact with a variety of viral and bacterial infections. The application of protective, preventive procedures is needed at all times, for every client, without exception.
Cross-contamination refers to the unintentional transmission of infection from person to object, then from the contaminated object to another person. In a tattoo shop, this most commonly occurs in the work area, or is a result of improper procedure during the cleaning and sterilizing of contaminated instruments.
Hepatitis viruses can remain active on a surface for a period of days to weeks, depending on the environmental conditions. A contaminated object, surface, or instrument can become a common link between two or more people, and transmission of infection can occur from client to client. The possibility of client to staff, and staff to client transmission must also be considered. If correct procedures are established and maintained, the possibility of disease transmission can be minimized.
xx ZONES xx
Infection control requires that a shop environment is considered in terms of separate areas or zones. The zones are established by usage-reception area, work area, cleaning area, and washroom. The zones should be designated as clean or contaminated. The integrity of these zones, once established, must not be compromised.
A contaminated zone is an area in which there has been any exposure of bodily fluids, especially blood. Overspray created during the tattooing procedure may contain micro-organisms which can settle and survive on surfaces, establishing an area as contaminated. Any person entering an area which is potentially contaminated must be aware of this fact or access to this area should be restricted.
An area in which any possible exposure to contaminants has been eliminated is a clean zone, this area can be maintained through disinfection and strict adherence to procedure.
Contaminated zones in a shop should be contained, and separated as much as possible from the rest of the shop. This area should not be accessible to anyone, except staff and the client being tattooed. Any person with an uncovered, fresh tattoo, should not be allowed outside the designated contaminated zone. The tattooist should never leave the work area with contaminated gloves on.
The reception area of a shop should be established and maintained as a clean zone.
The area where instruments are cleaned prior to sterilization must be considered a contaminated area. There should be no public access to this area.
The area in which tattooing is done should be considered contaminated as soon as the session begins. Before the next client enters this area it must be returned to a safe, clean condition. The preparation of the tattooing area is disinfection after the previous appointment. During the tattooing procedure any surface or object in the room that the tattooing is being done in may become contaminated. The tattooing area must be easily cleaned. Waste receptacles should have a large opening without a lid. Plastic bags should be a heavy gauge which will not easily tear or puncture. Materials that will be needed during the tattooing procedure should be laid out for each session. They should be easily accessible to avoid unnecessary hand contact and consequent contamination of counter surfaces, drawer handles, and cabinet knobs. A disposable cup of water should be used to rinse the machine tube during the procedure, as sinks are problematic due to the difficulty in re-establishing cleanliness.
xx DISPOSABLE ITEMS xx
Disposable items should be used wherever possible. Disposable caps should be used for pigment. Disposable razors should be used once only, then discarded. Items that will be re-used, such as tubes and needle bars, should be made of stainless steel and sterilized after each use.
xx NON-DISPOSABLE ITEMS xx
Items that are not disposable, and cannot be sterilized must be covered with a disposable plastic barrier, to prevent contamination from reaching surfaces. Anything that will be touched by the tattooer during the tattooing procedure must be covered with plastic bags, such as, spray bottles, clip cords, and tattoo machines. Plastic backed napkins should be used to create a disposable work surface. When removing plastic barriers, care must be taken not to contaminate the area it was covering.
:: next - page 02
© 2004 Eikon Device - Machinegun Magazine online
Shop Space - page 02
xx SURFACES AND OBJECTS xx
Objects and surfaces in the tattooing work area that are either not disposed of, sterilized after one use, or have not been covered, must be brought to a high level of disinfection. Efficient chemical disinfection requires exposure to the disinfectant for a significant amount of time, for many products it is as much as twenty minutes. This is difficult in a busy shop environment, where clients are seen consecutively in the same work area. Extensive use of disposable plastic barriers, such as dental bibs, will reduce the need for chemical disinfection of the work area between clients. Counters and tabletops that have not been covered have been exposed to airborne particles which may contain contaminants. These areas must be wiped down with detergent germicide, and left to air dry between appointments.
The task of choosing an appropriate product for cleaning and disinfection of items such as tables, chairs, counter tops and floors can be very confusing. Some time must be spent becoming knowledgeable about the available products, and what is needed for the shop.
"Five specific questions should be asked about any product under consideration:
What are the recommended uses of the product?
What is the active antimicrobial ingredient?
How is the product used?
Will the product damage surfaces or equipment?
What is the product's toxicity?" 1
Ask for documentation on products. If a sales representative is unable to provide technical information about their product, speak to someone who can. If the supplier seems incapable of providing substantial data, look elsewhere for another product.
New products for cleaning and disinfection appear on the market constantly. However, the active ingredient used in these products is generally the same as contained in many older products. It should be an active antimicrobial agent. If you are uncertain about a disinfection product, or process, consult the municipal health department. Health department personnel have access to information that makes them a valuable source of assistance. They should not be regarded with fear or suspicion.
When a tattooing session is completed, the instruments that are to be sterilized must be taken to an area designated for cleaning contaminated instruments prior to sterilization. Thorough pre-cleaning to physically remove all matter is mandatory prior to sterilization. As it is nearly impossible to clean the small spaces between needles in multiple needle configurations, re-use is strongly discouraged. Any object to be sterilized must be physically clean prior to sterilization. Any particles left on the instruments can impair the sterilization process.
Ultrasonic cleaning is not a substitute for sterilization. It should be considered as a cleaning process only. Ultrasonic cleaning is preferred over manual cleaning, for it has more efficient penetration into the small spaces of tubes. A major concern is the risk of nicks or cuts by anyone scrubbing the instruments by hand, as well as exposure to over-spray and splatter. These should be considered as common potentials for cross-contamination.
Items should be packaged and sealed in autoclave bags, and dated prior to sterilization. Care should be taken that the packages are completely dry before they are stored. "The maximum time a sterilized pack can be stored is debatable. Paper/plastic peel pouches are said to be safe for six to twelve months. Contamination is event-related, not time-related. The conditions of storage and the amount of handling to which the packs are subjected are more important determinants of contamination. Sterile packs should be kept on closed shelves away from moisture or possible contamination, and handled as little as possible prior to use." 2
The use of gloves is not a substitute for hand washing. Hand washing remains one of the simplest, and most important means of preventing cross-contamination. Hands should be washed with soap and water as soon as gloves are removed.
xx MEANS OF STERILIZATION xx
Effective methods for sterilization are relatively limited. There are five methods commonly used to sterilize instruments: Autoclaves (steam under pressure), Dry Heat Sterilizers (hot air oven), Chemical Sterilization (Gluteraldehyde), Chemical Vapour, and Ethylene Oxide Gas.
The most suitable sterilization system is determined by the tolerances of the instruments being sterilized. An autoclave remains the easiest and most appropriate method of sterilization available for tattooing because the instruments being sterilized can withstand high temperature and steam under pressure.
An autoclave accomplishes sterilization in much less time than a dry heat sterilizer can. Sterilization of unwrapped instruments takes 20 minutes at 126Æ’C (260Æ’F), and 30 minutes at 126Æ’C (260Æ’F) for wrapped instruments.3 An autoclave raises the boiling point of water to 121Æ’C (250Æ’F) by increasing the air pressure by one atmosphere (15 psi or 103.4 KPA).4 Autoclaves use distilled water to prevent scale deposition on instruments.
Dry heat sterilization is used mainly for materials that cannot be sterilized safely with steam under pressure, either because of the pressure or the steam. Dry heat would take one hour at 170Æ’C (340Æ’F), or two hours at 160Æ’C (320Æ’F).5 Timing must start when the entire contents of the sterilizer has reached the peak temperature needed for that particular load. Some wrapping materials are intolerant of dry heat, which complicates storage of dry heat processed instruments.
Chemical sterilization has many limitations, and should only be used for instruments that are intolerant of heat. Gluteraldehyde products are the only chemicals that are sufficiently sporicidal to accomplish sterilization. Exposure time is long (6 - 10 hours). During this period of immersion, no other instruments may be added or removed from the bath, as this interrupts the process. Because of toxicity, gluteraldehyde baths must be covered and left in areas with good ventilation. Glutaraldehyde must be thoroughly rinsed off instruments with sterile water before they are used.
Chemical vapour sterilization uses a combination of alcohols, formaldehyde, ketone, water and acetone, heated under pressure to produce a sterilant gas. Temperatures used are 260Æ’F - 270Æ’F (126Æ’C - 132Æ’C) at 20 to 40 pounds pressure. It requires 20 minutes at temperature, and adequate ventilation is required.
Ethylene Oxide Vapour in Chamber - time duration of cycle varies by temperature and concentration of gas. Relatively low operating temperature means ethylene oxide sterilization is suitable for relatively heat-sensitive items. Adequate ventilation is required and exhaust of ventilation must be controlled. An indicator strip or tape should be included on each sterilizer bag. Most sterilizing bags or pouches have a process indicator on them. A process indicator is printed with an ink that changes colour with exposure to heat, steam or chemical vapour. A colour change indicates that a pouch has been processed, but it is not proof of proper sterilization.
A sterilizer should be tested at least monthly to ensure that it is functioning properly. Biological monitors or spore tests are small strips of paper, or ampules containing living non-pathogenic resistant spores. The biological monitors are placed in hard to reach areas of the sterilizer, and then cultured. If the spores have been sterilized they will not germinate. Some biological monitors must be returned to the company for culturing, and some come with a colour indicator that indicates proper sterilization.
XX SHARPS DISPOSAL XX
Needle configurations should be discarded directly into a sharps container. "Sharps containers must be disposed of by one of the following methods:
removed by a licensed biomedical waste management company.
taken to a hospital or laboratory which will ensure proper disposal.
autoclaved and disposed of with general wastes." 6
XX WASTE DISPOSAL XX
The disposal of potentially contaminated waste is generally legislated municipally. Local health departments can provide information about a tattooist's responsibility as it pertains to waste disposal.
Garbage containers should be lined with heavy gauge garbage bags. Never allow bags to overfill. Do not place hard or heavy objects in bags which could cause potential tears or punctures. Keep waste from contaminated areas out of clean areas. In all areas bags should be sealed, then promptly removed. Waste collection receptacles and dumpsters should be kept locked awaiting collection.
Although waste produced during the tattooing process should be considered contaminated, it does not fall within the scope of regulated hazardous waste. The Bloodborne Pathogens Standard uses the term, "regulated waste," to refer to the following categories of waste which require special handling at a minimum;
"liquid or semi-liquid blood or other potentially infectious materials;
items contaminated with blood or other potentially infectious material and which would release these substances in a liquid or semi-liquid state if compressed;
items that are caked with dried blood or other potentially infectious material and are capable of releasing these materials during handling;
contaminated sharps; and
pathological and microbiological wastes containing blood or other potentially infectious material." 7
To ensure that everyone involved in the tattooing process is safe from exposure to infection through cross-contamination, it is important to follow proper methods of cleaning, disinfection and sterilization. Adequate levels of cleaning, disinfection, and sterilization can be achieved quite efficiently and cost-effectively.
:: next - page 03
© 2004 Eikon Device - Machinegun Magazine online