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Tattooing and

body piercing
guidance

Toolkit

Main contents
ISBN 978-1-906989-72-9 July 2013
Tattooing and body piercing guidance

t
Foreword2 Appendix 02  42 43
o lki Endorsing organisations 3
Infection, its causes and spread, including
a glossary of infection-related terms
To
Introduction 45 Appendix 03 44
Blood borne viruses
Using the guidance toolkit 6
Appendix 04  45
Acknowledgements7 Safe use and disposal of sharps
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CONTENTS PART A
Section 01 8 14
Appendix 05  46
First Aid following a blood/body fluid exposure
Legislative background on tattooing and skin Appendix 06  47
piercing activities
Protocol for cleaning up blood or a blood
Section 02a 15 stained body fluid spill
Standard Principles of Infection Control Appendix 07 48
Section 02b 16 17 Principles for good waste handling
Principles of Infection Control Hand hygiene Appendix 08  49
Section 02c 18 20 Template protocol for environmental cleaning
Principles of Infection Control Personal of premises
protective equipment Appendix 09  50
Section 02d 21 23 Tattooing/body piercing consent form
Principles of Infection Control Management Appendix 10  51
of sharps and exposure to blood and body fluids
Aftercare follow-up record sheet
Section 02e 24 25
Appendix 11  52
Principles of Infection Control Safe handling,
Decontamination requirements for equipment
storage and disposal of waste materials
used in tattooing and skin piercing
Section 02f 26
Appendix 12  53
Principles of Infection Control Cleaning and
Equipment sterilization standard- self
disinfection of the environment
assessment and decision making tool for
Section 02g 27 tattoo and body piercing practitioners
References Appendix 13  54
Section 03 28 29 Equipment and body piercing jewellery
Before and aftercare of a tattoo or body piercing sterilization standard for tattooists and body
piercers
Section 04 30 34
Decontamination Appendix 14  55
Autoclave daily record sheet
Section 05  35 36
Product quality of tattoo ink PART C
Section 06 37 Leaflets to download and print out
Body piercing jewellery 01 Tattoo aftercare 56
02 Ear and face piercing aftercare 57
Section 07 38 39
Governance 03 Oral piercing aftercare 58
04 Body and surface piercing aftercare 59
Section 08 40
05 Genital piercing (female) aftercare 60
Management of infectious disease incidents
relating to tattooing and body piercing 06 Genital piercing (male) aftercare 61
07 Microdermal implants aftercare 62
PART B Poster to download
Appendix 01 41 How to handwash 63
Model Byelaws: Acupuncture, tattooing, semi-
permanent skin-colouring, cosmetic piercing PART D
and electrolysis Audit Tool to download 64

1 PART E
Literature review to download 65
Tattooing and body piercing guidance

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o lki Foreword
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Foreword Graham Jukes Dr Paul Cosford
Endorsing organisations Chief Executive, Chartered Institute of Director for Health Protection and
Introduction Environmental Health Medical Director, Public Health England
Using the guidance Tattooing and body piercing have become This guidance toolkit has been developed as
toolkit increasingly popular and fashionable. Ensuring a collaborative piece of work between health
Acknowledgements practitioners follow safe working practices is protection staff and partners for the tattoo and
important for protection of both clients and body piercing industry. Its aim is to influence
the practitioners themselves. It has been service provision, in particular by the promotion
recognized for some time that there is a need of evidence based infection prevention and
to promote safety and consistency across the control practice. This information has been
range of tattooing and body piercing practices adapted into a comprehensive, practically based
by basing requirements on best available governance framework as a resource to both
scientific information whilst also taking support and guide practitioners in the field.
account of practical experience. This guidance The need for and importance of this guidance
toolkit encompasses expert advice as well as for the industry, has been recognised by many
the opinions and experience of practitioners of health professionals and practitioners alike and
what works at a practical level. I am delighted to support and endorse this
toolkit guidance.
Alan Beswick
Principal Scientist, Health & Safety Marcus Henderson
Laboratory President, Tattoo and Piercing
Industry Union
A substantial amount of care and effort has
gone in to producing this new guidance toolkit, The vast majority of members of the
and its underlying strength lies in the evidence professional tattoo and body piercing
based nature of its content; further supported community recognise the importance of
by expert consensus where published the promotion and adoption of good practice in
evidence may be lacking. The combination of order to safeguard both practitioners and public
contributors to the toolkit confirms the desire alike. It is our hope that this document will
of the authors to get it right in terms of the provide an easy access reference guide to assist
subject matter, presentation style and general those engaged in the industry in understanding
accessibility of the information. Those who the necessity for examining their current
have contributed include senior tattooing and practices and, where needed, making changes
body piercing industry representatives, health to improve operational standards.
care professionals, infection control scientists
and health and safety specialists. The Health
and Safety Laboratory is grateful to Public
Health England and The Chartered Institute of
Environmental Health for the opportunity to be
involved in this guidance toolkit preparation,
and is fully supportive of its content.

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Tattooing and body piercing guidance

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o lki Endorsing organisations
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Foreword Chartered Institute of Public Health England (PHE)
Endorsing organisations
Environmental Health (CIEH) From its establishment in April 2013, Public
Introduction The CIEH is a registered charity and the Health England is the authoritative national
Using the guidance professional voice for environmental health. voice and expert service provider for public
toolkit It sets standards, accredits courses and health, established to protect and improve the
Acknowledgements qualifications for the education of members nations health and wellbeing, and to reduce
and other environmental health practitioners. inequalities.
It provides information, evidence and policy
advice to local and national government The three main business functions:
and environmental and public health 1. Delivering services to national and local
practitioners in the public and private sectors. government, the NHS and the public.
As an awarding body, the CIEH provides
qualifications, events, and support materials on 2. Leading for public health.
topics relevant to health, wellbeing and safety 3. Supporting the development of the specialist
to develop workplace skills and best practice. and wider public health workforce.

Health and Safety Laboratory PHE works with partners across the public health
(HSL) system and in wider society to:

The Health and Safety Laboratory (HSL) is an Deliver, support and enable improvements
Agency of Health and Safety Executive (HSE) in health and wellbeing in the areas set out
and is the UKs leading health and safety in the Public Health Outcomes Framework.
research facility, employing over 350 scientific, Lead on the design, delivery and maintenance
medical and technical specialists. Its role is of systems to protect the population against
to support the HSE Mission and directly help existing and future threats to health by
organisations become healthier, safer and providing a comprehensive range of health
therefore, more productive places in which protection services.
to work. HSL capabilities encompass a wide
range of topics including: occupational and Tattooing and Piercing
environmental health, human factors and Industry Union (TPIU)
risk assessment; safety engineering; work The TPIU has been working hard to become
environment and specialist photographic and the recognised trade association representing
technical services. This breadth of expertise individual TPI workers and their studios;
underpins our particular strength in creating providing a collective voice for the industry;
multi-disciplinary teams to solve health and helping to educate and inform our members
safety problems.. on issues specific to our profession and to raise
standards in the industry through sharing of
information and discussion.

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Tattooing and body piercing guidance

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Foreword This guidance toolkit has been prepared by a panel of health protection
Endorsing organisations and practitioner representatives. It comprises a consensus of expert advice
Introduction which it is intended will provide an authoritative source of information.
Using the guidance Its contents are supported by extensive literature reviews (Part E).
toolkit
Acknowledgements The purpose of the guidance toolkit is to support local authority and other
regulatory officers in determining their requirements for effective control
of risk in these activities and to promote a consistent approach. Similarly, it
is intended to be of assistance to practitioners and businesses undertaking
these activities to support them in adopting acceptable standards of
practice. The use of this guidance toolkit will help to ensure the health and
safety of both clients and operators and that tattooing and skin piercing
practitioners will be operating in compliance with legal requirements.

Background Over the years a variety of legislation has


been introduced, mainly for local adoption,
Tattooing and body piercing procedures have
to encourage and support safe practice.
become more popular and fashionable in the
Model bylaws have been made available,
United Kingdom (UK) as a whole, particularly
but have not been accompanied by standard
in the last decade. The range of tattooing and
requirements for compliance. As a response
body piercing procedures has also increased.
to on-going concerns, a number of sets of
There are no published data on the prevalence
local/regional guidelines have been developed
of tattoos in the general UK population. There
by different agencies, often initiated by
are also no comprehensive data for the UK on
environmental health or health protection
the prevalence of body piercing, but a small
specialists (this guidance toolkit draws upon
study has estimated that the prevalence of
some of the previously published material).
body piercing, other than of earlobes, in the
However, there have been difficulties previously
general adult population in England was 10%
in engaging practitioners in the development
(Bone A et al, 2008).
of such guidelines and in securing adoption
There are known and well reported health risks and wider implementation.
which can be attributed to these procedures,
It is also recognised that there are no nationally
as well as associated legal issues. Improper
recognised or accredited training courses,
and unhygienic practice may result in localised
standards for practice, agreed knowledge and
skin infections at the site of the tattoo or
skills frameworks or arrangements for monitoring
piercing. There is also the risk of transmission
and reporting of professional competence.
of blood-borne viruses, for example Hepatitis
The absence of accredited training and
B, Hepatitis C, Hepatitis D or HIV, which can
competencies for tattooing and body piercing is
have more serious and long term health
an area that needs to be addressed nationally
consequences. It is therefore important that
and is outside the scope of this guidance. The
practitioners have safe working practices,
working group has, however, been greatly
and particularly that good infection control
assisted in the preparation of this guidance by
practices are followed at all times, so that both
the Tattoo and Piercing Industry Union who are
clients and practitioners are protected.
recognised as a professional body for tattoo and
body piercing practitioners in the UK.
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Tattooing and body piercing guidance

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Foreword Development of the guidance
Endorsing organisations This guidance was developed in response to
Introduction concerns raised by tattoo and body piercing
Using the guidance practitioners, as well as health protection
toolkit and environmental health specialists. These
Acknowledgements concerns were particularly in regard to the
lack of robust and consistent guidance on
standards of hygiene and safety. This has
been leading to inconsistency in advice and
variations in standards of practice.

A multi-agency steering group was set up


comprising representatives from the Chartered
Institute of Environmental Health, Health
and Safety Laboratory, Public Health England
(formerly Health Protection Agency), Tattoo
and Piercing Industry Union and also individuals
with practical experience of working in this area
as expert advisors, practitioners or regulators.

The guidance is supported by extensive


documentary evidence of scientific knowledge,
reported research and published literature
encompassing expert advice and the opinions
and experience of practitioners of what works
at a practical level.

References
Bone A., Ncube F., Nichols T. & Noah ND. (2008)
Body piercing in England: a survey of piercing at
sites other than earlobe. BMJ; 336; 1426-1428.

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Tattooing and body piercing guidance

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Foreword The guidance has been written as a key point of reference for use nationally
Endorsing organisations by tattoo and body piercing practitioners who work in regulated premises,
Introduction local authority officers in their regulatory role and health protection staff
Using the guidance who are asked to provide expert advice. The guidance does not cover mobile
toolkit
operators or non-registered practitioners, although the risks encountered
The Audit Tool
in relation to their activities will be of equal or greater concern. It does not
Providing feedback
address the risks associated with procedures other than those commonly
Acknowledgements
accepted as necessary for tattooing and the insertion of body jewellery,
although the procedures recommended for infection control are based upon
sound principles of infection control and will have wider application.

The material is arranged so as to be readily No copyright is being claimed for the toolkit or
accessible as a web-based toolkit, organised any of the material it contains and the authors
in a manner that reflects the tattoo and encourage its wider distribution and use.
body piercing setting, and with supportive
documentation and literature that can be In offering and using the advice contained in
downloaded and saved or printed in the this guidance it must be clearly understood that:
manner that users prefer. Legislation may change over time
and the advice given is based on the
It is intended that the adoption of the
information available at the time this
standards recommended in this guidance,
toolkit was produced it is not necessarily
particularly those relating to infection control
comprehensive and is subject to revision in
and decontamination, will help to establish
the light of further information.
standards for good practice. Governance is
promoted by the inclusion of template consent Only the courts can interpret legislation
forms, aftercare advice leaflets and a good with any authority, and
practice infection control audit tool. This advice is not intended to be definitive
legal guidance nor is it a substitute for the
The Audit Tool relevant law and independent legal advice
should be sought where appropriate.
This audit tool can be downloaded and used
as individual sections or as a complete tool. Providing feedback
It is intended to be used by tattoo and body
piercing practitioners, regulatory officers and The working group intend to reconvene to
health protection practitioners to generate consider all feedback provided on the use
evidence of the environment, practice and of this guidance toolkit after it has been in
procedures in meeting standards and whether operation for 6 months after publication.
practitioners are applying best practice and To that end feedback on your experience
following guidance. The tool can be repeated is positively encouraged and will be
to see if standards have been maintained or acknowledged and recorded for consideration.
improved. Please send your feedback to Ian Gray,
i.gray@cieh.org Principal Policy Officer at the
Chartered Institute of Environmental Health.

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Tattooing and body piercing guidance

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Foreword Tattooing and Skin Piercing Other guidance taken into
Endorsing organisations
Working Party Members account
Introduction For the Chartered Institute of Calderdale Council: Advice and safe practice
Using the guidance Environmental Health for permanent tattooing and advice and safe
toolkit practice for body piercing (2008)
David Kidney, Head of Policy (Chair of working
Acknowledgements
group) Dartford Borough Council: Code of practice for
hygienic skin piercing (2009)
Ian Gray, Principal Policy Officer,
Tattooing and Body Piercing Infection Control
For Public Health England (formerly Guidelines from Local Health Protection Teams
the Health Protection Agency) (formerly Health Protection Agency Health
Victor Aiyedun, Specialist Registrar in Public Protection Units)
Health Medicine
Editorial Group
Peter Hoffman, Consultant Clinical Scientist Alan Beswick
Susanne Howes, Health Protection Specialist Ian Gray, Convenor
Ann Lusmore, Health Protection Lead Nurse Marcus Henderson
Fortune Ncube, Consultant Epidemiologist Susanne Howes
Barry Walsh, Consultant in Communicable Ann Lusmore
Disease Control
Special acknowledgement
For the Health and Safety
Laboratory The working party would like to record its
appreciation of the Chartered Institute of
Dr. Alan Beswick, Principal Scientist, Environmental Health for undertaking the
Microbiology design and publication of the guidance toolkit.
For the Tattoo and Piercing
Industry Union
Marcus Henderson, President

Richard Stevens, Secretary

Representatives of Local Authority


Environmental Health Services
John Carlton, London Borough of Wandsworth

David Edwards, Medway Council

Michelle Garrigan, Sheffield City Council

Shona McQuade, Dartford Borough Council

Independent Advisor
Main contents Norman Noah, London School of Hygiene and
Tropical Medicine
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Tattooing and body piercing guidance

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Legislative background on tattooing


Section 01 and skin piercing activities
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Summary Summary Outside London
Specific controls The use of legislation in this area of Generally, outside London there are provisions
Outside London activity is primarily to ensure that infection to register both the premises (which can
In London control arrangements are adequate and include a practitioners home) and the
General controls effectively carried out wherever so-called practitioners themselves. The local authority
Determining requirements
special treatments are carried out. Special will also have powers to enact bylaws to
Licensing and Treatments are usually defined as treatments regulate particular activities. However, as these
registration in England & are adoptive powers, there may be some local
for persons requiring massage, manicure,
Wales (excluding London) authorities which do not have such registration
acupuncture, tattooing, cosmetic piercing,
Licensing/registration in procedures in place and are relying on the
chiropody, light, electric or other special
London general legislation to control these activities.
treatment of a like kind or vapour, sauna or
Exemptions within London
other bath. In London
Health and Safety At
Work (Etc) Act 1974 The primary means of enforcing infection Some local authorities in London operate a
General duties control arrangements is by use of the licensing registration system similar to that outside
Risk assessment or registration provisions. These are prescriptive London. However, in most of London, and
Control of substances methods with offences and penalties for non- certain other Councils in England, there are
hazardous to health specific local powers with a system for licensing
compliance. The licensing and registration
Management of contractors premises where skin piercing or other so-
provisions are largely concerned with setting
Enforcement called special treatments are provided which
requirements for good standards by requiring
Public health controls includes tattooing.
the maintenance of established hygiene
Age limits and consent controls in respect of premises, equipment, Registration can be applied to a practitioners
Tattooing procedures and practices. However, there home where regulated activities take place. The
Other skin piercing activities are additional controls contained in primary
Acupuncture and electrolysis
registration is for fixed premises, however, the
legislation that do contain provisions for the law allows local authorities to adopt a condition
Ear and nose piercing
immediate prohibition of activities or persons of registration that permits the registered
Consent
or for the closure of premises where risk of practitioner to work away from their fixed
Use of local anaesthetic
infection can be demonstrated. premises, although many do not permit this.
medication
Appendix 1 Model Byelaws The legislation relating to tattooing and skin
piercing activities, as well as other so-called
General controls
special treatments, can therefore be broadly The primary health and safety legislation applies
split into two main areas: across the whole of England & Wales and is
available for use by all local authorities without
Specific controls by registration or licensing the need for adoption. It can be used to impose
of premises and people carrying out the and enforce infection control requirements in
activities, and relation to all skin piercing activities, including
General controls of activities through primary peripatetic practitioners who visit a clients home.
legislation that is not specific to particular It allows for immediate prohibition of persons or
activities but applies to all of them. premises that pose an imminent risk to health or
safety. The use of health and safety legislation is
Specific controls governed by substantial amounts of regulatory
Arrangements for licensing and registration guidance and approved codes of practice.
will differ depending on the particular However, none of this relates specifically to skin
requirements of the local authority in whose piercing and therefore, regulatory officers need
area the business is located or the activity is to use their skills of risk assessment within an
being carried out. infection control setting.
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Legislative background on tattooing


Section 01 and skin piercing activities (continued)
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Summary There is also public health legislation which b) The cleanliness of persons so registered
Specific controls
provides local authorities with health and persons assisting persons so registered
Outside London protection powers to impose restrictions or in their practice and;
In London requirements to protect public health where c) The cleansing and, so far as is appropriate,
General controls voluntary cooperation to avert a health risk the sterilization of instruments, materials
Determining requirements cannot be secured and where other methods and equipment used in connection with the
Licensing and of control are ineffective, unsuitable or registered practices.
registration in England & disproportionate to the risk involved. Although
Wales (excluding London) these powers are very extensive, there are This is, therefore, specific legislation to ensure
stringent criteria for their use and safeguards proper infection control measures.
Licensing/registration in
London for people who might be affected by them. The Secretary of State issued model bylaws,
Exemptions within London relating specifically to infection control, which
(See below for public health controls)
Health and Safety At local authorities could formally adopt. The Act
Work (Etc) Act 1974 Determining requirements (LGA03) added further model bylaws in respect
General duties It is intended that this national guidance will of cosmetic piercing and semi-permanent skin-
Risk assessment
provide an additional authoritative source colouring. The model bylaws have been reissued
Control of substances
of information to support local authorities in as a single document covering all activities that
hazardous to health
determining their requirements for effective are regulated under the LGMPA 82.
Management of contractors
control of risk in these activities and adopting
Enforcement See Appendix 01 Model Byelaws:
a consistent approach in the application of the
Public health controls Acupuncture, tattooing, semi-permanent skin-
legislation. Similarly, it will be of assistance to
Age limits and consent colouring, cosmetic piercing and electrolysis
those businesses and practitioners undertaking
Tattooing The local authority can request reasonable
these activities to ensure that they are able
Other skin piercing activities information from applicants for registration.
to operate safely and comply with legal
Acupuncture and electrolysis This cannot include details concerning persons
requirements.
Ear and nose piercing
whom the applicant has given treatments to,
Consent
Licensing and registration however, it could include evidence of training
Use of local anaesthetic requirements in England & or competency for those being registered.
medication
Wales (excluding London)
Appendix 1 Model Byelaws The registration is mandatory in that the
There are provisions in Part VIII of the The local authority must issue a registration if
Local Government (Miscellaneous Provisions) the application has been properly made. A
Act 1982 (LGMPA82) for local authorities in registration can only be refused where a person
England & Wales to require the registration has previously been convicted of an offence
of persons carrying on the practices of under Section 16(1) or (2) of the Act (see below)
acupuncture, tattooing, ear piercing or and the convicting magistrate cancelled the
electrolysis. These powers are adoptive, and previous registration. A registration can only be
local authorities are able to choose which cancelled by a magistrate upon conviction of
of these practices would be required to be an offence, and this is in lieu of a fine.
registered in their area. The Local Government
Act 2003 (LGA03), Section 120, added semi- There are 3 possible offences
permanent skin-colouring and cosmetic Carrying on the business of acupuncture,
piercing to this list of activities for which tattooing, ear piercing or electrolysis without
registration can be required. being registered, contrary to Section 16(1).
The Act allows for local authorities to make Contravening any bylaws made under the
byelaws, for the purpose of securing: Act, contrary to Section 16(2).
Main contents a) The cleanliness of premises and fittings in Failing to display a copy of the registration
such premises; and bylaws at the premises, contrary to
9 Section 16(9).
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Legislative background on tattooing


Section 01 and skin piercing activities (continued)
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Summary The penalties for offences are fines on the there is no real limitation on what these may
Specific controls
Standard Scale of Level 3 (currently 1000) for cover, but the Act does list nine specific areas,
Outside London offences against Section 16(1) and Section some of which are not related to infection
In London 16(2), and Level 2 (currently 500) for an control. The London local authorities can
General controls offence against Section 16(9). also make standard conditions that will be
Determining requirements attached to all licences issued, however, there
There are some exemptions from the are no standardised conditions across London
Licensing and
registration requirements. It does not apply to under the LLAA91. Therefore the requirements
registration in England &
Wales (excluding London) practices carried out by or under the supervision can vary between individual London local
of a person who is registered as a medical authorities, however, they all include infection
Licensing/registration in
London practitioner (a Doctor registered with the control and other more general safety issues.
Exemptions within London
General Medical Council) or for acupuncture by
a dentist, or their respective premises. Under the LLAA91 it is the premises that
Health and Safety At
Work (Etc) Act 1974 are required to be licensed, not the persons
Local authority officers can be authorised to carrying out the treatments. However,
General duties enter any premises where they have reason to
Risk assessment some London local authorities will name
believe any of these three offences are being individual practitioners on the licence. Training
Control of substances
committed, but where entry is refused the requirements for practitioners may be
hazardous to health
authority of a warrant issued by a Justice of specified in conditions attached to the licence
Management of contractors
Enforcement
the Peace has to be obtained. and some London local authorities operate
Public health controls free (but mandatory) registration schemes for
Licensing and registration
Age limits and consent practitioners through conditions on the licence.
requirements in London
Tattooing
Other skin piercing activities The Greater London (General Powers) Act 1981 Exemptions within London
Acupuncture and electrolysis (GLGPA81) provided London boroughs with The LLAA91 allows several exemptions from
Ear and nose piercing a similar adoptive registration system as the the requirement for a licence:
Consent LGMPA82 which applied in the rest of England
a) Treatments carried out for no gain or
Use of local anaesthetic and Wales, together with model bylaws and
reward are exempt.
medication similar offences relating to infection control.
These legal provisions were mainly replaced b) Doctors registered with the General
Appendix 1 Model Byelaws
in 1991 (see below), however some London Medical Council (GMC) are exempt for all
boroughs are continuing to use the GLGPA81. treatments.
c) Members of bona fide bodies of health
The London Local Authorities Act 1991 practitioners can be exempted where
(LLAA91), Part II provides a system of licensing they use their skills in curing or alleviating
for premises offering special treatment, which of bodily diseases or ailments, but this
is defined as treatment for persons requiring does not include a person whose skills are
massage, manicure, acupuncture, tattooing, employed mainly for cosmetic alteration or
cosmetic piercing, chiropody, light, electric or decorative purposes.
other special treatment of a like kind or vapour,
d) Dentists registered with the General Dental
sauna or other baths. Although not mentioned
Council (GDC) are exempt for acupuncture.
in this list, semi-permanent skin-colouring
is regulated as a treatment of a like kind to e) Various other exemptions are allowed but
tattooing, and electrolysis is regulated as an they do not extend to skin piercing or skin
electrical treatment. colouring activities.
The licence for the premises is not mandatory
The LLAA91 is adoptive. No model byelaws
as it can be refused on 13 different grounds
have been issued, however, the Act allows
Main contents including, the suitability of the applicant;
boroughs to issue a licence on such terms
structural stability of the premises; likely
10 and conditions and subject to such restrictions
nuisance caused by the business; training
as may be specified. Effectively this means
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Legislative background on tattooing


Section 01 and skin piercing activities (continued)
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Summary of staff; suitability of equipment and fire persons have a general duty of care to ensure
Specific controls
precautions. When granted it is renewable their activities do not expose them or the
Outside London on an annual basis with the same grounds to general public to risks to their health or safety.
In London refuse the renewal each year. If the licence is
Within the framework of its overall strategy the
General controls not renewed then it ceases to exist. The licence
HSE has developed individual sector strategies,
Determining requirements can be varied at any time, or transferred to
with stakeholder involvement. Each sector
Licensing and another person, although this can be refused.
strategy sets out a series of aims grouped
registration in England &
The local authority must notify the Police and under the goals of the HSE Strategy which, if
Wales (excluding London)
the Fire Authority of each application, and met, will address what needs to be done for
Licensing/registration in each sector to improve its health and safety
London these bodies can make comments that the
local authority may consider, and act upon, if performance. The HSE Beauty Sector Strategy
Exemptions within London
they so wish. The consultation requirement is 2012-15 can be found at:
Health and Safety At
Work etc. Act 1974 for notification only and the consultees do not
http://www.hse.gov.uk/aboutus/
have to respond.
General duties strategiesandplans/sector-strategies/beauty.htm
Risk assessment
Offences include operating a special
Control of substances
treatment premises without a licence, or not Risk assessment
hazardous to health
in accordance with the terms of the licence A risk assessment is the key step in protecting
Management of contractors
(a breach of conditions). The licence can be workers and the public, as well as complying
Enforcement
revoked by the local authority if the licensee is with the law. The risk assessment is a careful
Public health controls
convicted of a breach of conditions. Officers examination of what work activities could
Age limits and consent cause harm to people and this then guides
authorised by the local authority have powers
Tattooing decisions about precautions that need to
of entry where they believe an offence may
Other skin piercing activities be taken, including infection prevention and
have been committed, and a warrant is not
Acupuncture and electrolysis control measures.
required. Penalties on conviction for offences
Ear and nose piercing
are fines up to Level 4 on the Standard Scale
Consent The HSE provides detailed advice on carrying
(currently 2500)
Use of local anaesthetic out risk assessments http://www.hse.gov.uk/
medication risk/risk-assessment.htm including interactive
Health and Safety At Work
Appendix 1 Model Byelaws etc. Act tools http://www.hse.gov.uk/risk/shop.htm

The Health & Safety at Work etc. Act 1974 The Management of Health and Safety at
(HASWA74) applies across the whole of Work Regulations 1999 requires all employers
England & Wales and to all persons engaged and self employed persons to:
in tattooing and skin piercing activities for gain Undertake a risk assessment of their
or reward. This includes peripatetic workers activities;
who carry out treatments in the clients home,
Remove, where possible, that risk or;
although only the Health & Safety Executive
have powers in relation to peripatetic workers. Where residual risk is unavoidable, to
provide control measures to reduce it as
It provides means of securing effective far as possible, including as a last resort,
infection control and the following areas are provision of personal protective equipment;
particularly applicable. Provide training to staff and persons they
use to undertake their business activities
General duties (contractors) to ensure they understand the
Under Section 2 of the Act, all employers have risks and the control measures.
a general duty of care to ensure the health,
Main contents safety and welfare of their employees. Under One of the risks that must be considered here
Section 3, both employers and self-employed is that of possible complications relating to
11
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Legislative background on tattooing


Section 01 and skin piercing activities (continued)
Click on text to view
Summary the procedure of skin piercing (for example: not employed by the person who owns and/
Specific controls
migration, scarring, teeth damage with oral or manages the premises where they work. In
Outside London piercing). Also, to be considered here will be these cases, they are usually self-employed and
In London contra-indications for tattooing, cosmetic have some form of contract, formal or informal,
General controls piercing and other activities, some for with the owner of the shop premises whereby
Determining requirements obvious reasons, others not so obvious. The they pay the owner to allow them to work there.
Licensing and practitioner therefore has to make sure that a In these circumstances the shop owner can be
registration in England & fully informed consent procedure is adopted. said to be contracting out to the practitioner
Wales (excluding London) This means gathering information from the and in effect endorsing their work.
Licensing/registration in client about their health and suitability for
London the treatment, and giving the client enough These tattooists and piercers are therefore
Exemptions within London information about the possible complications contractors undertaking the activities of
that could arise from the treatment for them to the business owner for them. This means
Health and Safety At
Work etc. Act 1974 make their own decision. that the premises owners cannot abdicate
General duties
their own general duties under HASWA 74
Risk assessment Control of substances hazardous to the individual practitioners. They have a
Control of substances to health duty to ensure that persons working on their
hazardous to health premises are competent and that they carry
The Control of Substances Hazardous to
Management of contractors out their work in a safe manner. The only way
Health Regulations 2002 requires that a
Enforcement they can do this satisfactorily is to assess the
specific risk assessment is carried out by
Public health controls practitioners for themselves and monitor their
employers or self employed persons who
Age limits and consent activities to ensure they have carried out their
work with substances hazardous to health.
Tattooing own risk assessment, as they are required to
Substances which are hazardous to health
Other skin piercing activities do by law, and that they are following control
include biological agents. The hazards in this
Acupuncture and electrolysis measures they have identified. The business
context are the organisms which can cause
Ear and nose piercing owner has the ultimate power to remove the
communicable diseases could be transmitted
Consent risk, by stopping particular contractors working
from person to person by unhygienic practices.
Use of local anaesthetic at their premises.
medication Therefore a specific risk assessment in respect
Appendix 1 Model Byelaws of infection control is necessary for all persons Enforcement
undertaking tattooing and skin piercing activities. The requirements of HASWA74 are enforceable
through improvement and prohibition notices.
Businesses employing less than 5 people do Improvement notices give a time limit for
not have to record the findings of this risk compliance with requirements. Prohibition
assessment, however they still have to satisfy notices can have the effect of immediately
regulatory officers that their risk assessment is stopping the operations of a business or the
suitable and sufficient. activities of a person where imminent risk
The courts may accept that where a is apparent. All offences under HASWA74
practitioner can demonstrate that they are are punishable by unlimited fines and prison
operating in accordance with these National sentences, so they provide a substantial
Guidelines, then their assessment is sufficient. inducement for business to comply with
requirements.
Management of contractors
The Management of Health and Safety at
Work Regulations 1999 (Sections 10, 12 & 13)
contains legal provisions which can be of
Main contents particular importance to the many tattooists
and cosmetic piercers who do not own the
12 premises which they operate from and are
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Legislative background on tattooing


Section 01 and skin piercing activities (continued)
Click on text to view
Summary Public health controls permanent tattooing (except when carried out
Specific controls
for medical reasons by a duly qualified medical
In March 2010 a set of new health protection
Outside London practitioner or by a person working under their
regulations were made under the amended
In London direction). The practitioner has a defence if they
Public Health (Control of Disease) Act 1984
General controls can show that they had good reason to believe
to continue the process of modernising
Determining requirements that the person was over 18 years of age. The
health protection legislation in England. The
Licensing and consent of a client under 18 is not a defence. The
regulations, the Health Protection [Part 2A
registration in England & Police enforce this legislation and fines are up to
Orders] Regulations 2010, provide updated
Wales (excluding London) Level 3 on the Standard Scale (currently 1000).
local authority powers to protect public health
Licensing/registration in
where voluntary cooperation to avert a health Other skin piercing activities
London
risk cannot be secured and where other
Exemptions within London There is no statutory minimum age for any other
methods of control are ineffective, unsuitable
Health and Safety At form of skin piercing activity. Within London, the
or disproportionate to the risk involved.
Work etc. Act 1974 licensing framework makes it possible for local
General duties Powers that impose restrictions or requirements authorities to state a minimum age for these
Risk assessment are conditional on strict criteria being met. Before activities. However, this has not been consistently
Control of substances making use of these powers, the local authority applied: some boroughs set no age restrictions;
hazardous to health some prohibit cosmetic piercing under 18 or 16,
or Justice of the Peace must be satisfied that the
Management of contractors
criteria relating to a particular threat to health and some allow it with parental consent; others
Enforcement
are met. The criteria cover evidence of infection allow above the belt skin piercing above the
Public health controls
or contamination, assessment of the potential ages of 16 or18, and yet others ban all types of
Age limits and consent for significant harm to human health, risk of genital and nipple piercing.
Tattooing spread to others and necessity for action to be Acupuncture and electrolysis
Other skin piercing activities taken in order to reduce or remove that risk. The
Acupuncture and electrolysis When carried out properly these do not cause
legislation also contains safeguards for people
Ear and nose piercing harm to the body, and leave no permanent
who might be subject to the legal measures.
Consent markings. For this reason they are not likely to
Use of local anaesthetic The measures are contained in the Public raise any concerns over common assault charges,
medication Health (Control of Disease) Act 1984 (as although practitioners should be aware of possible
Appendix 1 Model Byelaws amended) together with the Health Protection indecent assault complications (see below).
(Local Authority Powers) Regulations 2010 and Consent should still be obtained before treatment
the associated provisions. takes place, and in the case of a minor this should
be obtained from the parents or legal guardians.
A web-based interactive toolkit has been
developed to assist in the use of these health Ear and nose piercing
protection powers. http://www.cieh.org/ Ear piercing, and in some cultures nose
WorkArea/showcontent.aspx?id=37814 piercing, is generally considered acceptable
when carried out on a minor, even below the
Age limits and consent age of five, provided that a parent or legal
guardian gives consent and is present whilst
The need for limits on age, and requirements
the procedure is carried out.
for consent, can be a controversial area
because in many circumstances specific Semi-permanent skin-colouring, cosmetic piercing,
requirements have not been made in law. beading, branding, scarring, cutting and other
Consent is a complex area of law, and one that extreme forms of body modification do cause
is often misunderstood by the general public, actual harm and generally leave permanent marks
and also some skin piercing practitioners. and can result in disfigurement. They can therefore
Main contents be considered as assaults to the body, and so
Tattooing potentially subject to the legislation concerning
13 The Tattooing of Minors Act 1969 imposes assault. This means that the question of age and
a statutory minimum age of 18 years for the clients informed consent are very important
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Legislative background on tattooing


Section 01 and skin piercing activities (continued)
Click on text to view
Summary Consent licensed for local anaesthesia prior to tattoo or
In the legal proceedings of R v Brown (1994) body piercing.1 The client may wish to obtain a
Specific controls
1 AC 212, the House of Lords ruled on appeal topical local anaesthetic preparation prior to the
Outside London
that consent could not be a defence against procedure; however responsibility for purchasing
In London
sections 20 and 47 of the Offences Against and application of the product should remain
General controls
the Person Act 1861 which deals with common with the client. The client should be advised
Determining requirements
assaults. However, the law also recognises that to read the Patient Information Leaflet which
Licensing and accompanies the product and should be aware
registration in England & certain activities that give rise to harm are
lawful. This includes surgery, tattooing, ear of the following:
Wales (excluding London)
piercing and violent sports. The courts have Warnings, cautions and contraindications.
Licensing/registration in
also held that the law allows children under the Side effects.
London
age of 18 to consent to cosmetic body piercing
Exemptions within London That they are using the licensed product for
provided they are sufficiently mature to
Health and Safety At an un-licensed indication.
understand the nature of the request. This kind
Work etc. Act 1974 of assessment is clearly a subjective matter for Recommendations regarding
General duties the operator who will need to ensure that the administration and application.
Risk assessment client is provided with sufficient information to Alternatively, a qualified practitioner,
Control of substances allow them to proceed in an informed way and e.g. doctor, may prescribe a topical local
hazardous to health without pressure. anaesthetic product to be self-administered
Management of contractors by the client, or can prescribe and administer
Enforcement Under the Sexual Offences Act 1956, girls
a topical local anaesthetic product, in
Public health controls and boys under the age of 16 cannot legally
accordance with legal requirements of their
give consent to intimate sexual contact under
Age limits and consent professional registration.2
any circumstances, so piercing of nipples and
Tattooing genitalia (for girls) or genitalia (for boys) can be Local anaesthetic injections are prescription-only
Other skin piercing activities regarded as an assault offence. Evidence that medicines (POMs) therefore they can only be
Acupuncture and electrolysis such contact was for sexual gratification would prescribed by a suitably qualified practitioner.
Ear and nose piercing be required in order to constitute an indecent Local anaesthetic injections are not licensed for
Consent assault. The Female Genital Mutilation Act local anaesthesia prior to tattoo or body piercing.
Use of local anaesthetic 2003 states that certain procedures in respect In addition they should not be administered
medication of female genitals is illegal unless carried out parenterally unless adequate resuscitation
Appendix 1 Model Byelaws for medical reasons. equipment is available.1 Information on the
supply and administration of injectable medicines
The signing of a declaration and providing proof
outside their licensed medicinal uses is available
of age should be a fundamental part of the
from the Medicines and Healthcare Regulatory
client consultation process and practitioners
Agency (MHRA)2 and from the Nursing and
should always require that the client signs
Midwifery Council (NMC).3
a consent form prior to any work being
commenced. However, the consent will only be References
valid if the customer has been fully informed 1. British National Formulary (BNF) http://www.
as to the nature of the process, the likely effect medicinescomplete.com/mc/bnf/current/PHP8663-
local-anaesthesia.htm (accessed 22/4/2013)
and potential problems involved. An example
2. MHRA; Frequently asked questions: Supply and
of a consent form is provided in Appendix 9. administration of Botox, Vistabel, Dysport and
However, for practitioners own protection, it is other injectable medicines outside their licensed
recommended that any consent forms they use medicinal uses such as in cosmetic procedures http://
are worded with the advice of a solicitor who is www.mhra.gov.uk/Howweregulate/Medicines/
familiar with this area of law. Availabilityprescribingsellingandsupplyingof
medicines/Frequentlyraisedissues/BotoxVistabel
Dysportandotherinjectablemedicines
Use of local anaesthetic incosmeticprocedures/index.htm (accessed
medication 22/4/2013)
Main contents 3. NMC; Remote prescribing and injectable cosmetic
There is a range of topical local anaesthetic medicinal products http://www.nmc-uk.org/Nurses-
products for surface (skin) anaesthesia available and-midwives/Regulation-in-practice/Regulation-in-
14 from community pharmacies (Pharmacy only (P) Practice-Topics/Remote-prescribing-and-injectable-
medicines), however none of these products are cosmetic-medicinal-products/ (accessed 22/4/2013)
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Section 02a Infection prevention and control


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Section 02a Introduction Responsibilities
Under the Health and Safety at Work etc.
Introduction Infection, its causes and spread
Infection, its causes
Act (1974), all employers should ensure that
The causes and methods of spread of all their employees are appropriately trained
and spread
infections that are likely to arise in connection and proficient in the procedures necessary for
Factors in infection
control practice
with tattooing and skin piercing, are well working safely. Employers and their employees
Responsibilities understood. are also responsible to ensure that any person
Standard Principles of See Appendix 02 Infection, its causes on the premises is not placed at any avoidable
Infection Control risk, as far as is reasonably practicable. They
and spread
Appendix 02 Infection, its also have a responsibility to protect voluntary
causes and spread Unsafe or unhygienic practices by tattooing/ workers. Employers are also required by the
Section 02b body piercing practitioners can lead to the Control of Substances Hazardous to Health
Principles of Infection spread of infectious diseases that can affect Regulations 2002, known as COSHH, to review
Control Hand hygiene the health of the client as well as jeopardise every procedure carried out by their employees
Section 02c the health of the practitioner. Although some which involves contact with a substance
bacterial or viral infections may be spread during hazardous to health, including pathogenic
Principles of Infection
Control Personal procedures that do not involve skin penetration, micro-organisms. Specific guidance is available
protective equipment it is the occupational risk of transmission of from the Department of Health (Department
Section 02d
infections such as blood-borne viruses (BBVs), of Health, 1998).
such as hepatitis B, hepatitis C, hepatitis D and
Principles of Infection
Control Management of
HIV, which can arise and which are of primary Standard Principles of
sharps and exposure to concern. Precautions to minimise the possibility Infection Control
blood and body fluids of exposure to blood from an infected client This guidance is based upon standard principles
Section 02e or practitioner should be put in place by the which are the basic level of infection control
adoption of safe practices and procedures. This practice. Compliance with these standard
Principles of Infection
Control Safe handling, should include immunisation against hepatitis B principles reduces the risk of transmission of
storage and disposal of (Department of Health, 2010a). blood-borne and other pathogens.
waste materials
Section 02f Factors in infection control practice Everyone providing treatments to clients
Principles of Infection The risk of transmission of infection can be should know about and be able to carry
Control Cleaning and minimised by: out these standard principles for infection
disinfection of the prevention and control (National Institute for
environment Good cleanliness of the premises where the
Health and Care Excellence 2012). To that end
tattooing and/or body piercing is taking
Section 02g References they should have received training in:
place, and of the fixtures and fittings.
Good personal hygiene of the practitioners. Hand hygiene and skin care.
Correct cleaning and sterilization or The use of personal protective equipment
disposal of instruments, materials and (PPE).
equipment processes in place. Sharps management and management of
It is therefore important that the safe exposure to blood and body fluids.
working practices described in this Safe handling, storage and disposal of
guidance are followed at all times in order waste materials.
to protect both the client and practitioner. Cleaning and disinfection of the
environment.

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Section 02b Infection prevention and control


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Section 02a Principles of Infection As a gold standard for infection control
Control Hand hygiene purposes, NHS Estates (2002) recommend that
Introduction
hand wash basins should:
Standard Principles of Hand hygiene is a major component of the
Infection Control standard principles and one of the most Have elbow/foot-operated or non-touch
effective methods to prevent transmission mixer taps.
Section 02b
of pathogens by reducing the number Have wall-mounted cartridge soap
Principles of Infection
Control Hand hygiene of microorganisms that may be present. dispensers and paper towels available at
Hand washing facilities
The spread of infection from hands is well each hand wash basin.
When to wash hands recognised and the importance of compliance Not have a plug or overflow or be capable
What to use to wash hands with hand hygiene practices is emphasised in of taking a sink plug.
How to carry out hand washing all national and international guidelines.
Not have taps aligned to run directly into
Use of hand rubs
Hand washing facilities the drain aperture.
Hand care
Use of hand cream Hand washing facilities should be adequate Have waterproof splashbacks.
Care of broken skin and conveniently located in treatment areas Have space allowed at the design stage for
Poster How to handwash (Department of Health, 2010a). Hand the placement of waste bins next to the
Section 02c washing instructions should be clearly hand wash basin.
displayed at the hand wash basin, such as in
Principles of Infection When to wash hands
Control Personal the form of a poster.
protective equipment Before and after an intervention with
See Poster How to handwash each client.
Section 02d
Hand wash basins must be designated for that After contact with any blood or body fluids.
Principles of Infection
Control Management of purpose only and have a constant supply of hot Immediately after the removal of gloves.
sharps and exposure to and cold running water, ideally delivered through After using a tissue or handkerchief.
blood and body fluids a mixer tap. Under no circumstances should
After smoking.
Section 02e equipment be washed in hand wash basins.
After visiting the toilet.
Principles of Infection
Liquid soap dispensers with single use Before and after eating.
Control Safe handling,
storage and disposal of liquid soap cartridges/bottles should be
Immediately after any other activity or
waste materials used, ideally wall-mounted, although free
contact with a clients surroundings that
Section 02f standing dispensers would be considered
could potentially result in hands becoming
suitable. Disposable liquid soap cartridges are
Principles of Infection contaminated.
Control Cleaning and recommended because they do not permit a
disinfection of the topping-up process and this minimizes the risk What to use for hand washing
environment of contamination.
For an ordinary hygienic hand wash, the
Section 02g References use of liquid soap is sufficient. Preparations
Wall-mounted disposable paper towels should
be next to the hand wash basins, and fully containing antiseptics that have a residual
stocked at the start of each working day to effect on the skin surface are not required for
minimise or reduce the need to fill up within use in tattoo and body piercing settings.
hours during which the premises is operational
(NHS Estates, 2002).

A foot-operated pedal bin, of an appropriate


size, should be placed next to the hand wash
basin for disposal of paper towels.

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Section 02b Infection prevention and control


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Section 02a How to carry out hand washing Use of hand rubs
Introduction There are three distinct and essential stages Hand rubs containing alcohol based products
to handwashing (National Institute for Health can enable practitioners to quickly and effectively
Standard Principles of
Infection Control and Care Excellence, 2012) clean their hands before and after contact with
clients. However, the use of a hand alcohol
Section 02b 1. Preparation rub/gel is not a substitute for using soap and
Principles of Infection Before washing hands, all wrist and hand water for hand washing e.g. when undertaking
Control Hand hygiene
jewellery should be removed. Cuts and tattooing and body piercing procedures (see
Hand washing facilities abrasions must be covered with waterproof above), and should not be used when the hands
When to wash hands
dressings. Fingernails should be kept short, are visibly soiled or potentially contaminated
What to use to wash hands
clean and free from nail polish. Hands should with body fluids (National Institute for Health
How to carry out hand washing
be made wet by placing them under tepid and Care Excellence, 2012). Hand rubs should
Use of hand rubs
running water before applying liquid soap. conform to the standard BS EN 1500. The hand
Hand care
Use of hand cream rub solution must come into contact with all
2. Washing and rinsing surfaces of the hand; the hands must be rubbed
Care of broken skin
Poster How to handwash
The hand wash solution must come into together paying particular attention to the tips of
contact with all of the surfaces of the the fingers, the thumbs and the areas between
Section 02c
hand. The hands must be rubbed together the fingers, until the solution has evaporated.
Principles of Infection vigorously for a minimum of 1015
Control Personal
seconds, paying particular attention to Hand care
protective equipment
the tips of the fingers, the thumbs and the Use of hand cream
Section 02d
areas between the fingers. Hands should A hand cream can be applied regularly to
Principles of Infection be rinsed thoroughly.
Control Management of protect skin from the drying effects of regular
sharps and exposure to hand decontamination (National Institute
3. Drying
blood and body fluids for Health and Care Excellence, 2012). Each
Section 02e
In a tattooing and body piercing setting, practitioner should have their own supply and
good quality disposable soft paper towels a communal pot should not be used.
Principles of Infection
would be considered the method of choice
Control Safe handling, Care of broken skin
storage and disposal of because communal towels are a source of
waste materials cross-contamination. Paper towels should Unbroken skin is the best defence because it
Section 02f be stored in a wall-mounted dispenser provides the perfect barrier against infection.
next to the washbasin and thrown away Small areas of broken or infected skin on
Principles of Infection
Control Cleaning and in a pedal operated waste bin. Hands exposed parts of the practitioners body should
disinfection of the should not be used to lift the lid or they will be covered with a waterproof dressing that
environment become re-contaminated. completely covers the affected area.
Section 02g References

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Section 02c Infection prevention and control


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Section 02a Principles of Infection Types of protective clothing
Control Personal Work clothing
Introduction
protective equipment Practitioner clothing should be clean at all
Standard Principles of
Infection Control Personal protective equipment (PPE) should be times, and professional in appearance. Work
Section 02b available to all practitioners and staff who may clothing should be changed daily. Staff clothing
be at risk whilst working in the premises. should not impede good hand washing,
Principles of Infection
Control Hand hygiene therefore the wearing of short sleeved tops is
Assessment of risk advocated (Department of Health, 2010b).
Section 02c
Regulation 3 of the Management of Health Gloves
Principles of Infection
and Safety at Work Regulations 1999 (Health
Control Personal The Control of Substances Hazardous to
protective equipment and Safety Executive, 2008) requires every
Health Regulations (Health and Safety
Assessment of risk employer to make a suitable and sufficient
Executive, 2002) require employers to assess
Types of protective clothing assessment of:
any substances hazardous to health, including
Work clothing a) risks to the health and safety of their biohazards within blood and body fluids (such
Gloves employees to which they are exposed as blood-borne viruses) and take steps to
Glove choice whilst they are at work; and reduce the risk of exposure.
Synthetic materials
Latex gloves
b) risks to health and safety of persons not in their
The use of gloves has two purposes:
Sterile gloves
employment arising out of or in connection
Gloves used for cleaning with the conduct by them of their undertaking. 1. To protect the hands from becoming
Aprons Therefore the selection of protective contaminated with dirt and microorganisms.
Eye and face protection equipment must be based on an assessment 2. By changing gloves, to prevent transfer of
Section 02d of the risk of transmission of infection between microbes from one client to another.
Principles of Infection the practitioner and client and vice versa:
Control Management of Gloves must be worn when carrying out invasive
sharps and exposure to Anticipated Wear Wear plastic Wear eye procedures, when in contact with sterile sites
blood and body fluids level of disposable or fluid and face and non-intact skin or mucous membranes, and
exposure gloves repellent protection during all activities that have been assessed
Section 02e
apron
Principles of Infection as carrying a risk of exposure to blood, body
Control Safe handling, No fluids, secretions or excretions, or to sharp or
storage and disposal of exposure contaminated instruments (National Institute
waste materials to blood/
body fluids for Health and Care Excellence, 2012).
Section 02f anticipated X X X
The correct method for wearing and removing
Principles of Infection
Control Cleaning and gloves can be found on the WHO Save Lives
disinfection of the website: (http://www.who.int/gpsc/5may/
environment Exposure Glove_Use_Information_Leaflet.pdf). Hands
to blood/ must be washed and dried thoroughly before
Section 02g References
body fluids
anticipated
putting on disposable gloves.
but low risk Yes Yes X
of splashing Gloves can tear or puncture visibly during use,
or leakage may occur through microscopic
holes. Hands may also become contaminated
Exposure as gloves are removed. Gloves therefore must
to blood/ not be seen as a substitute for good hand
body fluids
anticipated
hygiene. Used gloves should be disposed of as
with high Yes Yes Yes offensive waste (see waste section).
Main contents risk of
splashing
18 to the face
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Section 02c Infection prevention and control


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Section 02a Gloves are single-use items (National Institute Is less elastic than latex but does shape to
for Health and Care Excellence, 2012). This the wearers hand over time.
Introduction
means they must be put on immediately Can be used for handling certain chemicals
Standard Principles of before an episode of client contact or (Infection Control Nurses Association, 2002).
Infection Control
procedure and removed as soon as the activity
Section 02b is completed, or when leaving the client for However, nitrile contains the same types of
Principles of Infection any reason. Gloves must be changed between chemicals as latex in the manufacturing process
Control Hand hygiene different procedural activities for the same and allergic reactions have been reported.
Section 02c client and between dealing with different Polyisoprene and Neoprene
Principles of Infection clients, or removed if they become torn. Offers effective protection against viral
Control Personal penetration.
Glove choice
protective equipment
Gloves should be made available in a range of Has similar elasticity and physical
Assessment of risk
Types of protective clothing sizes for use by different practitioners (National properties as latex.
Work clothing Institute of Clinical Excellence, 2012). Is suitable for individuals sensitised to latex
Gloves proteins.
All gloves used for direct client care must
Glove choice Can be used when a latex free environment
conform to current EU legislation (CE marked
Synthetic materials is necessary (Infection Control Nurses
Latex gloves
as for single use) and should be appropriate
for the task. Only PPE meeting the basic health Association, 2002).
Sterile gloves
and safety requirements of the EC Personal Vinyl
Gloves used for cleaning
Aprons Protective Equipment Directive requirements is Is suitable for use in areas where there is a
Eye and face protection entitled to carry a CE mark and be sold for use low biohazard risk.
Section 02d in the EC (Health and Safety Executive, 2012a). Provides a good alternative for use when
Practitioners should therefore look for the CE staff or clients are sensitised to latex.
Principles of Infection
Control Management of mark information on glove packs plus EN 374-
In lab tests shows increased permeability
sharps and exposure to 1:2003 or EN 374-2. These markings show the
to blood borne viruses than latex.
blood and body fluids gloves are protective against chemicals and
can resist microorganisms at a performance Possesses lower tensile strength than latex
Section 02e
level 2 test in penetration tests. Although and breaks down more frequently.
Principles of Infection
Control Safe handling, this cannot infer protection against viruses, Is prone to leaking.
storage and disposal of because they are not used in the performance Is inelastic and can be baggy to wear.
waste materials tests, in practice this is the highest level of
Is inexpensive in comparison to synthetic
Section 02f protection afforded against microorganisms
rubbers (Infection Control Nurses
Principles of Infection (Health and Safety Executive, 2012a).
Association, 2002).
Control Cleaning and
Synthetic materials
disinfection of the Overall, vinyl gloves can be used to perform
environment Neoprene and nitrile gloves are synthetic gloves many tasks, but, depending on the quality
Section 02g References which have been shown to have comparable in- of the glove may not be appropriate when
use barrier performance to natural rubber latex handling blood/blood-stained fluids (Royal
gloves in laboratory and clinical studies. College of Nursing, 2012).
Nitrile Polythene
Provides an excellent biological barrier, These gloves are not recommended for use
resistant to punctures and tears. when undertaking activities involving blood/
Comparable to latex in terms of barrier body fluids exposure and therefore should not
performance. be used in the tattooing and body piercing
Is a good alternative for latex sensitive setting. They are ill fitting, have heat sealed
Main contents seams that are predisposed to split and have
individuals.
19 a tendency to tear (Infection Control Nurses
Can be used where a latex free
Association, 2002).
environment is necessary.
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Section 02c Infection prevention and control


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Section 02a Latex gloves (natural rubber latex) Gloves used for cleaning
Latex gloves may be the preferred choice for For environmental cleaning purposes or for
Introduction
procedures in tattooing and body piercing manual pre-cleaning of equipment prior to
Standard Principles of
because of latexs tactile sensitivity, barrier disinfection/sterilization, general-purpose
Infection Control
property against viruses, good fit and optimal rubber gloves should be used. The gloves should
Section 02b
elasticity and user familiarity. However, latex be washed with general-purpose detergent
Principles of Infection is a known skin and respiratory sensitiser and and warm water, and dried between uses. They
Control Hand hygiene
in a small number of people it can cause should be changed weekly, or more frequently
Section 02c serious allergy (see below) (Health and Safety if the gloves become damaged (for example if
Principles of Infection Executive, 2012a). There may also be issues there are signs of peeling, cracking and tears)
Control Personal when using latex gloves alongside petroleum- (National Patient Safety Agency, 2007).
protective equipment
based lubricants which may affect the gloves
Assessment of risk Aprons
integrity and therefore its protection ability.
Types of protective clothing A disposable plastic apron must be worn when
Work clothing Latex allergies are becoming common with there is a risk that clothing may be exposed
Gloves prolonged use of latex gloves (Infection Control to blood, body fluids, secretions or excretions
Glove choice Nurses Association, 2002). The use of appropriate (with the exception of sweat or tears) (National
Synthetic materials synthetic gloves is therefore recommended to Institute for Health and Care Excellence, 2012).
Latex gloves avoid becoming sensitised. It is recognised, Plastic aprons should be used as single-use
Sterile gloves however, that within certain work environments, items and changed between clients. They
Gloves used for cleaning latex gloves are still used in large numbers due should be discarded and disposed of as
Aprons
to their efficacy and low cost. If latex gloves offensive waste after use.
Eye and face protection
are worn, then powder free, low protein content
Section 02d Eye and face protection
materials must be chosen to help prevent latex
Principles of Infection allergy (Health and Safety Executive, 2012). Eye protection and face masks must be worn
Control Management of where there is a risk of blood, body fluids,
sharps and exposure to Where latex gloves are in use, monitoring of secretions or excretions splashing into the eyes
blood and body fluids clients and staff should be undertaken. Any and face (National Institute for Health and
Section 02e sensitivity shown to natural rubber latex in Care Excellence, 2012). A risk assessment of
Principles of Infection either clients or staff should be documented the planned procedure should be undertaken
Control Safe handling, and action must be taken to remove further to help inform decision making (e.g. when
storage and disposal of exposure risks. Alternatives to natural rubber manually cleaning equipment as part of
waste materials
latex gloves therefore must be made available decontamination processes).
Section 02f (Health and Safety Executive, 2012). Further
Principles of Infection information on latex allergy can be found If reusable goggles/protective glasses are
Control Cleaning and on-line at: http://www.hse.gov.uk/skin/employ/ used, they should be washed after each client
disinfection of the
latex-gloves.htm and detailed information on or task using a general purpose detergent,
environment rinsed and stored dry. Eye protection should be
skin care and dermatitis in the work place can
Section 02g References be found at: http://www.hse.gov.uk/skin/ compatible with any facemask used.

Sterile gloves Face masks (such as surgical masks) should


Sterile gloves are used for major surgical only be used if there is a risk of splashing of
procedures and are not applicable to blood/body fluid droplets into the mouth
tattooing/body piercing. or nose. If used, masks should be changed
between clients and disposed of immediately
after use. They must not be carried or worn
around the neck.

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Section 02d Infection prevention and control


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Section 02a Principles of Infection Sharps/needlestickinjuries and
Introduction Control Management of exposure to blood and body fluids
Standard Principles of sharps and exposure to blood Types of injury/exposure
Infection Control and body fluids
Section 02b A blood/body fluid injury/exposure incident
Principles of Infection Introduction includes:
Control Hand hygiene
All body fluids should be regarded as potentially Inoculation of blood by a needle or
Section 02c
infectious. Blood carries the highest risk of other sharps.
Principles of Infection
Control Personal transmitting blood borne viruses such as hepatitis Contamination of broken skin with
protective equipment B, C , D and human immunodeficiency virus (HIV). blood.
Section 02d Blood borne viruses may also be transmitted by
Blood splashes to mucous membrane,
Principles of Infection other body fluids, especially if contaminated by
Control Management of e.g. eyes or mouth.
blood (Health Protection Agency, 2009).
sharps and exposure to Swallowing a persons blood, e.g. after
blood and body fluids
Introduction
See appendix 03 Blood borne viruses mouth-to-mouth resuscitation.
Sharps and needles Sharps and needles Contamination where the individual has
Sterile needles an open wound, and clothes have been
Sharps/needlestick injuries The word sharps is a generic term that
and exposure to blood/ includes needles, scalpels, stitch cutters, glass soaked by blood.
body fluid spills ampoules and sharp instruments that may Bites (where the skin is broken).
Types of injury/exposure
Risks of transmission of blood- become contaminated with blood or body
Risks of transmission of blood-borne
borne viruses following a sharps fluid. In tattooing/body piercing premises,
injury/exposure viruses following a significant injury/
sharps include equipment such as razors,
Management of sharps/ exposure
needlestick injuries and exposure needle bars with needles attached and
to blood and body fluids cannulae (sometimes used for body piercing). Transmission of blood borne viruses (BBVs)
Sharps/needlestick injuries may result from contamination of mucous
Blood/body fluid spills Sharps contaminated with blood or other membranes of the eyes or the mouth, or
Occupational health for blood
borne virus prevention
body fluids should be classified as hazardous of broken skin, with infected blood or other
Risk assessment waste and handled accordingly. infectious material. There is no evidence
Vaccination requirements that BBVs can be transmitted by blood
See Section 02e
Appendix 03 Blood borne viruses contamination of intact skin, inhalation or by
Appendix 04 Safe use and All sharps must be handled and disposed of faecal-oral contamination.
disposal of sharps safely and with extreme care. After use they
Appendix 05 First Aid following should be placed immediately into yellow sharps The transmission risks after a mucocutaneous
a sharps/ needlestick injury and
exposure to blood/body fluid boxes/bins with orange lids, compliant with UN exposure (splash exposure) are lower than
Appendix 06 Protocol for 3291 and BS7320 standards. This is to reduce those after a percutaneous exposure (sharps
cleaning up a blood or a blood the risk of exposure to blood-borne viruses, injury), estimated at 1 in a 1000 for HIV
stained body fluid spill for example through an accidental sharps (Health Protection Agency 2008). There is
Section 02e or needlestick injury (National Institute for currently no evidence on the risk of transmission
Principles of Infection Health and Care Excellence, 2012). for hepatitis B virus (HBV) and hepatitis C virus
Control Safe handling,
storage and disposal of (HCV) following mucocutaneous exposure
waste materials
See Appendix 04 Safe use and disposal
(Health Protection Agency, 2008).
of sharps
Section 02f
Principles of Infection Sterile needles The risk of infection following a percutaneous
Control Cleaning and Only sterile single-use needles should be injury, especially deep penetrating injuries
disinfection of the
environment used for skin piercing or tattooing. Needles involving a hollow-bore needle or a device visibly
Section 02g References should be examined for imperfections prior contaminated with blood has been estimated at:
to their use and discarded if any are found. 1 in 3 when a source patient is infected
Main contents Needles should either be used directly from the with HBV and is classed as being highly
packaging or placed on a sterile surface/tray infectious at the time.
21 for immediate use.
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Section 02a 1 in 30 when the patient is infected with HCV. Occupational health for blood
Introduction 1 in 300 when the patient is infected with HIV borne virus prevention
Standard Principles of (Health Protection Agency, 2008). Risk assessment
Infection Control
Section 02b Apart from the overall duty to carry out risk
Management of sharps/needlestick
Principles of Infection assessment of hazards in the workplace, the
injuries and exposure to blood and
Control Hand hygiene Control of Substances Hazardous to Health
body fluids
Section 02c (COSHH). Regulations place a specific duty on
Principles of Infection Injuries where a persons broken skin or eyes, employers to assess the risks from exposure to
Control Personal mouth or other mucous membranes are hazardous substances, including pathogens
protective equipment
exposed to another persons blood or body (called biological agents in COSHH), and to
Section 02d fluids, therefore, may carry a risk of infection bring into effect the measures necessary to
Principles of Infection with blood borne viruses.
Control Management of protect workers and others from those risks as
sharps and exposure to far as is reasonably practicable.
blood and body fluids
Sharps/needlestick injuries
Introduction Prompt first aid and immediate risk assessment is In these circumstances the assessment of risks
Sharps and needles
needed in the event of such incidents to establish to health should include:
Sterile needles
Sharps/needlestick injuries the type of exposure sustained and to help
How to prevent exposure to biological
and exposure to blood/ determine what appropriate action is needed.
body fluid spills agents.
Types of injury/exposure See Appendix 05 First Aid following a Steps needed to achieve adequate control
Risks of transmission of blood- blood/body fluid exposure
borne viruses following a sharps of exposure.
injury/exposure Blood/body fluid spills Steps needed to avoid accidental needle-
Management of sharps/
needlestick injuries and exposure Blood and body fluid spills must be dealt with stick/sharps injury.
to blood and body fluids quickly and effectively. Specialist body fluid
Sharps/needlestick injuries Vaccination requirements
spill kits are available to purchase. These can
Blood/body fluid spills Those at risk of blood/body fluid exposure
Occupational health for blood be stored in a safe designated area in the
borne virus prevention premises, enabling easy access and timely through sharps or splashes, therefore, should
Risk assessment clear up. The expiry dates of products inside have a full course of hepatitis B vaccine. An
Vaccination requirements
kits should be regularly checked and out of accelerated course consisting of three doses at
Appendix 03 Blood borne viruses zero, one and two months (followed by a fourth
date items replaced as necessary. Posters and
Appendix 04 Safe use and dose at twelve months after the first dose
disposal of sharps simple training should be provided on the use
of the body fluid spill kits. for those at continued risk of exposure), and
Appendix 05 First Aid following
a sharps/ needlestick injury and antibody titres (blood levels) should be checked
exposure to blood/body fluid The body fluid spill kit should contain: one to four months after the completion of the
Appendix 06 Protocol for primary course of vaccine. It is recommended
cleaning up a blood or a blood Disposable plastic aprons and synthetic
that those at continued risk of infection
stained body fluid spill (e.g. nitrile) gloves.
Section 02e
should be offered a once only single booster,
Disposable cloths. approximately five years after completion of the
Principles of Infection
Control Safe handling, General purpose detergent. primary immunisation course (antibody levels
storage and disposal of Chlorine granules. do not need to be checked before or after this
waste materials
See Appendix 06 Protocol for cleaning up booster dose). (Department of Health 2006).
Section 02f
Principles of Infection blood or a blood stained body fluid spill Under the Health and Safety at Work etc
Control Cleaning and
disinfection of the Act 1974, employers must pay for protective
environment measures such as immunisation. This is usually
Section 02g References provided through the company occupational
health provider. In the absence of an
Main contents occupational health service, the employee
could be asked to arrange immunisation
22 through their own GP, but the employer must
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Section 02a make alternative arrangements if this cannot
Introduction be done, and reimburse any charges made to
Standard Principles of the employee for such arrangements. As with
Infection Control all control measures, immunisation needs to be
Section 02b checked and reviewed and boosters provided,
Principles of Infection where necessary.
Control Hand hygiene
Section 02c It would be considered good practice for
Principles of Infection practitioners to keep copies of their vaccination
Control Personal
protective equipment history/antibody level results. If practitioners
Section 02d
refuse to have hepatitis B vaccination, it is
Principles of Infection
advised the employer should consider asking
Control Management of the employee to sign a disclaimer form.
sharps and exposure to
blood and body fluids If the response to the hepatitis vaccine is
Introduction not sufficient, the GP will need to investigate
Sharps and needles
Sterile needles whether there is a specific reason for non-
Sharps/needlestick injuries response to the vaccine. It is most important
and exposure to blood/ for non-responders to know their status. They
body fluid spills
Types of injury/exposure may need to be protected by other measures
Risks of transmission of blood- (e.g. immunoglobulin) following a needlestick/
borne viruses following a sharps sharps injury.
injury/exposure
Management of sharps/
needlestick injuries and exposure There is no vaccine against hepatitis C and
to blood and body fluids human immunodeficiency virus (HIV). Robust
Sharps/needlestick injuries infection control measures should be employed
Blood/body fluid spills
at all times to minimise the risk of exposure to
Occupational health for blood
borne virus prevention these viruses.
Risk assessment
Vaccination requirements If a practitioner is found to be positive for
Appendix 03 Blood borne viruses a blood borne virus disease, they should be
Appendix 04 Safe use and assessed and advised by their GP in relation to
disposal of sharps
working practices.
Appendix 05 First Aid following
a sharps/ needlestick injury and
exposure to blood/body fluid
Appendix 06 Protocol for
cleaning up a blood or a blood
stained body fluid spill
Section 02e
Principles of Infection
Control Safe handling,
storage and disposal of
waste materials
Section 02f
Principles of Infection
Control Cleaning and
disinfection of the
environment
Section 02g References

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Section 02e Infection prevention and control


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Section 02a Principles of Infection There are a few municipal non-healthcare
Introduction
Control Safe handling, waste streams that are classed to be similar
storage and disposal of in nature to healthcare waste and are hence
Standard Principles of
Infection Control
waste materials included within the Department of Healths
waste guidances assessment framework.
Section 02b Good waste management is important to:
Waste such as sharps and related wastes
Principles of Infection Reduce the health and safety risk to staff, from tattoo and body piercing practice
Control Hand hygiene clients and visitors. is specifically included in this definition
Section 02c (Department of Health 2012).
Protect the environment.
Principles of Infection
Reduce waste disposal costs. Soft waste from body-piercing or tattooing
Control Personal
protective equipment practice can normally be assumed to present
Responsibility for waste materials
Section 02d no risk of infection, unless an indication to
All organisations have a legal responsibility to the contrary is provided by a healthcare
Principles of Infection dispose of waste safely, ensuring no harm is
Control Management of professional (Department of Health 2012).
caused either to staff, members of the public However, as waste contaminated with non-
sharps and exposure to
blood and body fluids or the environment. This responsibility begins infectious body fluids is capable of causing
when waste is generated and ends with its offence, it would be classed as offensive
Section 02e
final disposal. It is essential that persons waste (see below) and would require
Principles of Infection
handling waste fulfil their legal responsibilities appropriate packaging to indicate the bag
Control Safe handling,
storage and disposal of
by taking care to prevent injury or transmission contents (Department of Health 2012). Sharps
waste materials of infection to themselves or others. waste would always be considered hazardous
Responsibility for waste
Premises should have a waste policy. The waste and should be disposed of accordingly
materials (see below) (Department of Health 2012).
practitioner is responsible for ensuring that
National guidance on waste
management contracts are in place for collection and safe Offensive waste
Offensive waste disposal of offensive/hazardous waste from The guidance from the Department of Health
Sharps the premises. It is essential to ensure with the (Department of Health 2012) states that used
All other waste waste management provider that appropriate gloves and aprons, swabs, small dressings, and
Disposal of aerosol cans, glass, documentation is generated when necessary. cotton wool contaminated with body fluids
bottles, broken crockery and dry The manager of the premises is also responsible arising from cosmetic piercing and other body
cell batteries for monitoring the performance of staff and art plus other special treatment procedures
Appendix 07 Principles for waste contractors, as per agreed contract.
good waste handling would be considered as offensive/hygiene waste
where it is generated in quantity (one bag of 7 kg
Section 02f National guidance on waste
or more in any collection interval). Offensive
Principles of Infection management
waste should be placed into a yellow/black bag
Control Cleaning and In 2012 The Department of Health published
disinfection of the
(tiger bag) for disposal so that subsequent
the Safe Management of Healthcare Waste holders of the waste can handle and dispose of
environment
to replace the 2006 version and to enable the material appropriately. Only where such
Section 02g References
waste legislation in England to be in line with waste is generated in small quantities (less
Europe (Department of Health, 2012). The than 7 kg in one bag in any collection period)
document is to be used as a best practice guide should it be disposed in the black-bag (general
for the safe and effective handling of waste. waste) stream (Department of Health 2012).
The previous clinical waste classification system
using groups A to E can no longer be used, Sharps
as the groups do not reflect the appropriate Sharps should always be handled and disposed
segregation for transport or disposal. of as hazardous waste (see Section 02d).
In England and Wales, sharps not
Main contents See Appendix 07 Principles for good
contaminated with medicinal products (such as
waste handling
24 those generated at a body piercing/tattooing
premises), should be disposed of in a standards
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Section 02a compliant yellow sharps bin with an orange lid
(Department of Health, 2012).
Introduction
Standard Principles of All other waste
Infection Control All other non-contaminated waste such as
Section 02b paper should be placed in black bags, or bags
Principles of Infection for recycling, within a foot operated pedal bin
Control Hand hygiene and disposed of as normal household waste.
Section 02c Aerosols, batteries and broken glass should not
Principles of Infection
be placed in these bags.
Control Personal Disposal of Aerosol Cans, Glass, Bottles,
protective equipment
Broken Crockery and Dry Cell Batteries
Section 02d
These items should always be placed in a
Principles of Infection designated cardboard box, lined with a plastic
Control Management of
bag so that it is leak-proof. The box should be
sharps and exposure to
blood and body fluids labelled to indicate its contents and method
of disposal.
Section 02e
Principles of Infection
Control Safe handling,
storage and disposal of
waste materials
Responsibility for waste
materials
National guidance on waste
management
Offensive waste
Sharps
All other waste
Disposal of aerosol cans, glass,
bottles, broken crockery and dry
cell batteries
Appendix 07 Principles for
good waste handling
Section 02f
Principles of Infection
Control Cleaning and
disinfection of the
environment
Section 02g References

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Section 02a Principles of Infection Colour-coding for cleaning
Introduction
Control Cleaning and equipment
disinfection of the The aim of a colour-coding system for cleaning
Standard Principles of
Infection Control
environment equipment is to prevent cross-contamination
Section 02b Cleaning is the process that physically removes There is a national colour-coding system for
Principles of Infection contamination with organic material such as the NHS (National Patient Safety Agency,
Control Hand hygiene blood and body fluids, along with dirt and 2007b) (e.g. blue for general areas, red for
Section 02c dust. Cleaning does not necessarily destroy toilet areas/wash hand basins),which could
microorganisms from the item that is being be adapted for use in the tattooing and body
Principles of Infection
Control Personal
cleaned. However, providing and maintaining piercing setting.
protective equipment a clean and readily cleanable environment
facilitates the prevention and control of Use of chemicals
Section 02d
infections. Household detergent is adequate for most
Principles of Infection
Control Management of routine environmental cleaning. For high risk
sharps and exposure to
Equipment for cleaning environmental surfaces such as treatment
blood and body fluids Cleaning equipment that is regularly used surfaces, a hypochlorite solution of 1000 parts
Section 02e should be fit for purpose, easy-to-use and well- per million (PPM) available chlorine should be
Principles of Infection maintained (National Patient Safety Agency, used. This solution should be made up for use
Control Safe handling, 2007a). A clutter-free environment and the on a daily basis, following the manufacturers
storage and disposal of adoption of local clean as you go policies instructions, in a labelled container
waste materials
will provide the foundation for quality service provided by the commercial manufacturer
Section 02f provision in a clean, safe place. Good cleaning (using, for example, one tablet of sodium
Principles of Infection practice includes having: dichloisocyanurate (NaDCC) per litre format).
Control Cleaning and After twenty-four hours the solution must be
disinfection of the The provision and maintenance of a clean
discarded. The hypochlorite solution must
environment and appropriate environment by using
not be transferred into a trigger spray bottle
Equipment for cleaning systems to manage the environments
but be used directly from the container onto
Colour-coding for cleaning cleanliness with a documented cleaning
a disposable cloth or paper towels. Surfaces
equipment policy and rota plus a regular audit
contaminated with blood should be cleaned in
Use of chemicals programme.
accordance with the guidance on dealing with
Appendix 08 Template Equipment which is suitable for purpose,
protocol for environmental blood spillage as a higher concentration of
is able to be kept clean (i.e. impervious hypochlorite will be required (see Appendix 06
cleaning of premises
surfaces) and maintained in good physical Protocol for cleaning up blood or a blood
Section 02g References
repair. stained body fluid spill).
Working from the cleanest area towards
the dirtiest area to greatly reduce the risk of All chemicals should be handled and stored
cross contamination. in accordance with the manufacturers
instructions/COSHH guidance (Health and
A person in charge who has direct
Safety Executive, 2002). Material safety data
responsibility for ensuring that cleanliness
sheets should be accessible to all staff. All
standards are maintained.
chemicals used on the premises should be
Single use cloths for cleaning tasks and used and stored in an identified cool, dry and
cleaning equipment such as mops and well ventilated place (room/cabinet) that is
buckets kept in good order (i.e. cleaned lockable, out of reach of visitors and members
daily, renewed regularly and stored safely of the public and in the original containers.
(cleaned, dried and stored inverted) in a Expiry dates should be routinely checked.
Main contents designated area after use).
See Appendix 08 Template protocol for
26 environmental cleaning of premises
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References Health and Safety Executive (2008). Health and
Section 02a
Calderdale Local Authority (2008). Advice and Safety Regulation a short guide. (http://www.hse.
Introduction safe practice for permanent tattooing plus advice gov.uk/pubns/hsc13.pdf)
Standard Principles of and safe practice for body piercing. (http://www.
calderdale.gov.uk/business/licences/skinpiercing/ Health and Safety Executive (2012a). The use of
Infection Control gloves. Blood Borne Viruses Guidance. (http://www.
index.html)
Section 02b hse.gov.uk/biosafety/blood-borne-viruses/use-of-
Dartford Borough Council (2009). Code of practice gloves.htm)
Principles of Infection
for hygienic piercing. (www.dartford.gov.uk)
Control Hand hygiene Health and Safety Executive (2012b). How to deal
Department of Health (1998). UK Health with an exposure incident. Blood Borne Viruses
Section 02c Guidance. (http://www.hse.gov.uk/biosafety/blood-
Departments Guidance for Clinical Health Care
Principles of Infection Workers: Protection Against Infection with borne-viruses/how-deal-exposure-incident.htm)
Control Personal Blood-borne Viruses Recommendations of the
Expert Advisory Group on AIDS and the Advisory Health & Safety at Work etc Act (1974).
protective equipment
Group on Hepatitis. HMSO (http://www.dh.gov. (http://www.legislation.gov.uk/ukpga/1974/37)
Section 02d
uk/en/Publicationsandstatistics/Publications/ Infection Control Nurses Association (ICNA)
Principles of Infection PublicationsPolicyAndGuidance/DH_4002766) (now Infection Prevention Society (IPS)) (2002). A
Control Management of comprehensive glove choice. Fitwise, England.
sharps and exposure to
Department of Health (2006). Immunisation
against Infectious Disease. (http://www.dh.gov. Management of Health and Safety at Work
blood and body fluids
uk/en/Publicationsandstatistics/Publications/ Regulations. (www.opsi.gov.uk/si/si1999/19993242.
Section 02e PublicationsPolicyAndGuidance/DH_079917) htm)
Principles of Infection Department of Health (2010a). The Health
Control Safe handling, NHS Estates (2002). Infection control in the built
and Social Care Act 2008. Code of Practice environment. Design and planning (HBN 30 (2)).
storage and disposal of on the prevention and control of infections The Stationery Office.
waste materials and related guidance. (http://www.dh.gov.
uk/en/Publicationsandstatistics/Publications/ National Institute for Health and Care Excellence
Section 02f
PublicationsPolicyAndGuidance/DH_122604) (2012). Infection control: Prevention and control of
Principles of Infection healthcare-associated infections in primary and
Control Cleaning and Department of Health (2010b). Uniforms and community care (CG139). (http://guidance.nice.org.
disinfection of the
workwear: guidance on uniform and workwear uk/CG139)
policies for NHS employers. (http://www.dh.gov.
environment
uk/en/Publicationsandstatistics/Publications/ National Patient Safety Agency (NPSA) (2007a).
Section 02g References PublicationsPolicyAndGuidance/DH_114751) The national specifications for cleanliness in the
NHS: a framework for setting and measuring
Department of Health (2012). Safe management performance outcomes. (http://www.nrls.npsa.nhs.
of healthcare waste V2.0. (http://www.dh.gov. uk/resources/?EntryId45=59818)
uk/prod_consum_dh/groups/dh_digitalassets/
documents/digitalasset/dh_133874.pdf) National Patient Safety Agency (NPSA) (2007b).
NHS colour coding hospital cleaning materials
Health Protection Agency (2008). Eye of the and equipment 15. (http://www.nrls.npsa.nhs.uk/
Needle: UK surveillance of significant exposures to resources/?EntryId45=59810)
BBV in healthcare workers. (www.hpa.org.uk/web/
HPAwebFile/HPAweb_C/1227688128096) National Patient Safety Agency (NPSA) (2009). The
Revised Healthcare Cleaning Manual. (http://www.
Health Protection Agency (2009). Inoculation nrls.npsa.nhs.uk/resources/?EntryId45=61830)
Injuries and Children in Schools and similar settings:
Risk Assessment Guidelines for Health Protection Royal College of Nursing (2012). Wipe it out-
Units. (http://www.hpa.org.uk/webc/HPAwebFile/ Essential practice for infection prevention
HPAweb_C/1259152291335) and control. Guidance for nursing staff.
(http://www.rcn.org.uk/__data/assets/pdf_
Health and Safety Executive (2002). Guidance file/0008/427832/004166.pdf)
on Control of Substances Hazardous to Health
Regulations.(http://www.hse.gov.uk/coshh/)

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Skin preparation Skin Preparation In the case of body piercing of minors, they
must have a parent or other responsible adult
Need for aftercare Where shaving is required, only single-use
present when aftercare advice is given.
Care of skin after tattooing razors are acceptable. Either a 70% alcohol-
Care of skin after piercing impregnated single use swab (typically 70% Good practice is to include on the consent
Aftercare leaflets isopropyl alcohol) or a 0.5% chlorhexidine in form a tick box or similar indicator to record
What to do if a client 70% alcohol single use swabs (National Institute that aftercare advice has been explained and
returns with an infection for Health and Care Excellence, 2012) can be discussed at the time that the consent form
Appendix 09 Tattooing and used for skin disinfection. If the skin is visibly dirty was signed.
body piercing consent form then the area should first be cleaned with soap
See Appendix 09 Tattooing/body piercing
Appendix 10 Aftercare and water and dried with a paper towel.
follow-up record sheet consent form
References
Where it is necessary to mark the skin, a single Maintaining a good level of hygiene around
use toothpick dipped into gentian violet or the treated area is essental during the healing
other suitable dye could be used. The dye period.
should be dispensed into a single-use pot
for each client. Otherwise the entire bottle Care of skin after tattooing
should be discarded after each client. As an
Good practice is to cover the tattooed area
alternative, or where large areas of skin need
with sterile non-adhesive gauze which is then
to be marked, then a single-use commonly
secured with hypo-allergenic tape. Gauze
available marker pen could be used, or a
permits ventilation and aids healing.
suitable single-use alternative. (Dartford
Borough Council, 2009) A sterile, non-adhesive dressing may be
appropriate for larger areas, at least during
Where products such as petroleum jelly are
the clients journey home, but in many cases
used for procedures, an appropriate amount of
simply keeping the area clean and dry is likely
material should be dispensed, using a single-
to be the best approach. If plastic film wrap
use implement (Calderdale Local Authority,
is used for larger areas then it must be clean
2008), into a single-use pot for every client.
(taken directly from the pack) and the client
Practitioners should not use cream/lotion direct
should be advised on when and how to replace
from a jar/tube. Roll-on or stick applicators
this covering.
are not acceptable for use. The practitioners
hands, even if gloved, should never come into Care of skin after piercing
contact with the contents of these jars/tubes.
The piercing site should be kept clean and dry
Need for aftercare to promote healing.

All piercings must be performed using good When checking the pierced site, hands should
infection prevention technique and pre- be clean. It is not normally necessary to rotate
sterilized equipment to reduce the chance or remove a piece of jewellery however, if the
of infection occurring. The aftercare of body client has been advised to do this, it should be
piercing sites and tattooed areas is also very handled as little as possible, with clean hands
important in order to promote good healing and using a clean tissue and, if possible, to
which lowers the risk of infection and reduces touch only the jewellery item.
the risk of scarring.
Clients should be advised about healing times
Practitioners must explain to their clients the as these may be prolonged because of the time
known potential complications associated with it takes for the jewellery tunnel to become dry
the particular procedure they are being asked and then to heal after the initial piercing.
Main contents to carry out. Upon completion of a treatment,
28 they must provide both verbal and written
aftercare advice relevant to that treatment.
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Click on text to view
Skin preparation Aftercare leaflets What to do if a client
Need for aftercare Lapses in aftercare are common causes of returns with an infection
Care of skin after tattooing infection following piercing and clients should be If any of the following signs or symptoms of
Care of skin after piercing provided with an appropriate aftercare leaflet an infection develop, urgent medical attention
Aftercare leaflets such as those available within this guidance. should be sought:
What to do if a client Click on the aftercare leaflet thumbnail
returns with an infection
Redness spreading around the site and
below to view the links for downloading extending away from it.
Appendix 09 Tattooing and
body piercing consent form Pus or green/yellow fluid oozing from the site.
Bleeding that is not controlled by light
01 02
Appendix 10 Aftercare Tattoo Ear and face
follow-up record sheet piercing pressure.
References
Tattoo after Ear and fac
Pain (rather than discomfort).
Key Advic
e
care Key Advic
e e piercing af
Hand washin
The afterc
are Hand washin
tercare
Swelling.
The afterc
are follow g is important of body piercing Hand washin g
is important ing a tattoo Hand washin
Signs of infecti healing and to promote good method of g is the single most importa Note: Cartilag
g is the single reducing infectio nt lumps e piercings
to promote important
method of most on prevent the be washed
prior to touchin n. Hands must commonly occasionally
healing and good Hands must reducing infectio infection. risk of area, therefo This is just known form
prevent the be washed n.
If appropriate re reducing g the affected trapped fluid as granulomas.
infection. risk of the affecte prior
d area, therefo to touching infection may aftercare is not followe Healing times Wash your
the risk of infectio resolved using and
the heat and can easily be
d n. warm water
risk of infectio re reducing infection are: occur. The signs of for piercing soap, always
hands in warm compress once pressure from a
n. the vary with will water and one of your
For the first Wash your
the
of the pierci type and position with a clean dry your hands thoroug liquid daily cleanin a day, replacing
gs.
week or so hands in warm Swelling towel or paper hly Expect some
normal for it is liquid soap, water and
and redness
that ng and vary should remove towel. This swelling and
the area to always around the wound increas es perso n to perso from them being most germs your new piercing soreness

Heat.
thoroughly dry your hands . n. and prevent
and tende be red with a clean transferred
to the affecte cause swelling . Any knock or bangfrom
r. towel. This
should remove
towel or paper A severe
burning and For the first A new piercin d area. through or soreness can
and preven throbbing few weeks g can be tender, out the healing to flare up again
t them being most germs sensation round normal for it slightly red phase.
As with all
body the affecte
d area. transferred the site. the area to is few weeks.
and can remain itchy and
so for a
Do not use
cotton wool
to tender and be red,
a risk. To reduc art, infection is
A
Increased
tendern swollen. sometimes pale, odourless fluid piercing as
the to clean the
e these risks Tattoo afterca painful to touch. ess and increasingly form a crust.
discharge from may may get caughtfibres in the cotton
advice from take re Approximat with pus, which This should the piercing and in the piercing wool
your practi e not .
regarding tioner Good practic An unusua
l discharge various piercinhealing times for the would indicatbe confused
e infection.
Do not pick
not move, at any discharge and
aftercare. e is to cover with an offensi (yellow or green) gs are: twist or turn do
area with non-sti the tattooe Ear piercin whilst dry.
ck gauze which d ve smell. g aftercare If any secretethe piercing
secured with Ear lobe piercin

Immobility of, or reluctance to move, a


The risk of hypo-allergeni is then Speak to your Including Lobes/ hardened then d dischar
infection permits ventilat Ear cartila g 6 to Tragus/ Anti turning jewelle ge has
ge piercing 8 weeks
c practitioner Conch/ Helix/
greatly reduc can be ion and aids tape. Gauze attention immed or seek medica Translo Snug/ Diath/ Tragus/ cause the dischar
ge ry may
healing iately if you l Cheek piercin 6 to 8 weeks Industrial/ to
ed . any of the bal/ Transve Rook/ allowing bacteria to enter tear the piercing
general hygie by good A tattoo coverin above suffer from g 2 to 3 rse Lobe. ,
regarding infectioor have any concern Eyebrow piercin prolonging
ne including: need to be g a large area
may s
months Facial piercin the healing the wound and
covered
adhesive dressin with a sterile, non- there are any n in your tattoo Nose piercin g 2 to 4 g aftercare time.
g up to 6 months
or if Including Eyebro Do not use
Hand washi journey home. g, at least during to any of the signs of an allergic reactio Labret, Septum w, Bridge, Jestum weeks, or if
sunbeds for
ng before your products used. n Reme months / Nostril. , Vertical you decide the first two
the tattoo touching the area clean However, simply keeping mber these wound area to
with a breathathen cover the
times are Soak the piercing
best approa and dry is likely to be

limb/digit/part of the body.


approximat during tanning ble plaster
ch. the e submerging for a few minute .
Keeping how health and will depend on piercing in the area of skin contain by
s Do not swim
the tattoo A tattoo coverin y you
you look after are and whether
a
a warm waterclean jug or bowl contain ing the following a for the first 24 hours
ed plastic film g a large piercing.
area covere wrap applied area may have prope the piercin of prefera
solution (1/4
level
ing Signs
d with non-s clean (taken , this must rly until heale g bly teaspo of infecti
gauze which tick straight from be d. glass of warmsea salt to an egg cup/shoon If appropriate on
used immed
is secured
with iately) and the pack and As with all clean cloth water). Alterna
tively wet a
t infection may aftercare is not followe
hypo-allerg advised when you should
be body apply as a
or gauze in
the infection are: occur. The signs of d
enic tape. your practiti to replace this coverin a risk. To reduc art, infection is any dischar
warm compre solution and
oner. g by ss. This will
advice from e these risks take ge
entry and exit and allow you to cleansoften
Swelling
and
Any cream your practi around the redness that increas
that regarding tioner a cotton bud points of the piercing the wound. es
from an approp you apply must be aftercare.
used is removed or gauze. Once the dischar with A severe
burning and
and you should riate pot/tube at home

Where the client informs the practitioner


or softened ge sensation throbbing
wash your The risk of be gently moved then jewelle round the
application.
Cream can hands before
infection can water through so as to work a littlery can Increased site.
from your be purchased greatly reduc be the piercing warm tenderness
hygiene included by good general
practitioner always tighten . When cleanin painful to and increas
or a pharma touch. ingly
cist. ing: screwing the the ball on any bars g An unusua
Antibiotic creams ball to the by l discharge
Hand washi right. with (yellow
except if infectio should not be used Do this twice an offensive or green)
ng before smell.
supervision n has occurre
d and under the piercin touching washing or each day, preferably Speak to your
of your Doctor g. bathing. after attention immed practitioner
or seek medica
.
Keeping

of a concern or problem, the practitioner is


You can also any of the iately if l
the piercin
g clean. and soaps use mild antibacterial above or have you suffer from
to regardi any concern
piercing. Ask wash the wound site solutions there ng infection in your piercing s
your local pharma of an ear are any signs
you and always cist to advise to any of the of an allergic or if
instructions. follow the products used. reaction
manufacturers
For furthe
r advice or occurs discontIf irritation, redness or For furthe
r advice or
Contac t your information: NOT suitable inue use. Antibacterialdrying Contac t your information:
Department, local Environmental lips due to for nostrils, septum wash is Depart
or vertical
local Environ
ment, or your mental Health
or your local Health the tissues

advised to keep records of any action taken


England Health Public Health delicate nature. England Health local Public
Protection Dry the piercing Protection Health
This Inform Team paper towel/k using ONLY fresh This Inform Team
ation is provide disposable Public ation is provide
Public Health d by: hand/bath itchen roll. A commu Health d by:
Public Health England North West towel should
never be used.
nal Public Health England North West
Tattoo and England East Midlan Tattoo and England East Midlan
Piercing Industr ds Piercing Industr ds
y Union y Union
Your practiti Your practiti

and advice given.


oner is: oner is:

June 2013 June 2013

See Appendix 10 Aftercare follow-up

03 Oral
piercing 04 Body and
surface piercing
record sheet

References
Oral pierci Body and
Key Advic
The afterc
is important
e
are of body
piercing
to promote
ngHand washin
Hand washin g
method of
g is the single
aftercare
most importa Do not pick
Key Advic
e
The afterc
are of body
is important
to promote
piercing
surface pie
rcing Hand washin
Hand washin
g
g is the single Do not pick
aftercare Calderdale Local Authority (2008). Advice and
safe practice for permanent tattooing plus advice
method of
healing and good reducin
must be washed g infection. Hands nt not move,
at any dischar
ge and do healing and good reducing infectiomost important not move,
at any dischar
ge and do
prevent the twist or turn prevent the be washed
prior to touchin n. Hands must twist or turn
infection. risk of affected area, prior to touching the whilst dry. the
If any secrete piercing infection. risk of area, therefo whilst dry. the piercing
of infection. therefore reducing the hardened re reducing g the affected If any
hardened then secreted discharge
Healing times risk then turning d discharge has the risk of infectio turning jewelle has
cause
the dischar jewelle ry may Healing times Wash your n. cause
the dischar ry may
vary with for piercing Wash your allowing bacteri ge to tear the piercin for piercin soap, always
hands in warm
allowing bacteri ge to tear the piercing
the type and will hands in warm a to enter g, vary with the type g will dry your hands
water and
liquid a to enter ,
liquid soap,

and safe practice for body piercing. (http://www.


water and and prolong with a clean prolonging
of the pierci position thoroughly
always dry
your hands ing the healingthe wound of the piercin and positio
n towel or paper thoroughly the healing the wound and
ng and vary with a clean time. g and vary should remove towel. This Do not wear
time.
person to from towel. This towel or paper Do not use person to from most germs
person. should remove weeks, or if
sunbeds for person. them being
transferred and prevent nipple piercin tight clothing followin
and preven
t them being most germs you decide the first two to the affecte g g
For the first the affecte transferred wound area to
with a breathathen cover the For the first A new piercing d area. Do
few weeks d area. to during tanning few weeks can be tender, not wear
normal for
the area to
it is .
ble plaster
normal for it is slightly red
and can remain itchy and belts or high tight clothing e.g. tights,
A new piercin the area to waisted

calderdale.gov.uk/business/licences/skinpiercing/
tender and be red, Do not swim few weeks. clothin
slightly red g can be tender, itchy tender and be red, A pale, odourle so for a piercing as
this may irritate g after naval
swollen. and can remain and following a for the first 24 hours swollen. sometimes
discharge fromss fluid may and delay the wound
few weeks. so piercing. form healing.
An approximat A for a a crust. This the piercing
sometimes pale, odourless fluid Approximat with pus, which should not be confuse and Do not use sunbed
for oral pierci e healing times discharge may Special afterca e healing
and form a from the piercin re for tongue times would indicat d weeks, or if s for the first
ng are: crust. This g
For the first
few days take piercing for surface, navel e infection.
wound area
you decide
to then cover
two
confused with should not eating and care when and nipple Body and
Tongue pierci pus, which be avoid spicy piercing can surface piercin with
during tanning a breathable plasterthe

index.html)
ng 2 to 4 infection. would indicat foods. be as long including Nape, g aftercare
Lip 3 to weeks. e Cold produc 6 months as Horizontal .
6 weeks ts to 1 year. Horizontal Navel, Niple, Do not swim
Cheek 2 Oral piercin can help reducesuch as ice and ice Eyebro
Madison, Chin, w, Wrist, Anti-eyebrow,
to 3 mont g
For the interna aftercare swelling. cream
Remember following a for the first 24 hours
hs these times Handweb and Vertical Bridge, Pubic, piercing.
Remember including all l healing of oral piercing Refrain from approximat are Prayer. Signs of infecti
piercing of oral
these times and cheek the tongue until the piercin sex of any descrip e and will Soak the piercing on
approximat are , lip g has fully tion on how depend for If appropriate
e and will healed. healthy you submerging a few minute
s by infection may aftercare is not followe
on how health depend Gargle after Signs of infecti whether you are and piercing in
the area of
skin contain d
each meal infection are: occur. The signs of

Dartford Borough Council (2009). Code of practice


y you are mouthwash with If appropriate on look after a clean jug ing the
whether you and or a warm salt an alcohol-free infection may aftercare is not followe
piercing prope the a warm water or bowl contain
piercing prope
look after
the
(1/4 level teaspoo water solution
d
rly until healed of preferably solution (1/4 level teaspoing Swelling
an egg cup/sho n of preferably sea infection are: occur. The signs of . sea
glass of warm salt to an egg cup/shoon
and redness
that increas
rly until heale t glass of warm salt to As with all around the
wound. es
d. water). body art, clean cloth water). Alterna t
As with all Swelling is a risk. To infect tively wet a
reduce these ion
body For the externa and or gauze in A severe
a risk. To reduc art, infection is including all l healing of oral piercing around the redness that increases risks take
apply as a the
warm compre solution and
burning
sensation round and throbbing
piercings to wound. any dischar ss. This will

for hygienic piercing. (www.dartford.gov.uk)


: advice from
advice from e these risks take the lip and ge soften the site.
Wet a clean cheek A severe
burning and practitioner your entry and exit and allow you to clean Increased
your practi cloth sensati throbb regard ing points of the tenderness
regarding tioner salt water solutionor gauze in the warm on round the ing aftercare. a cotton bud the
or gauze. Oncepiercing with
painful to touch. and increas
ingly
aftercare. site. The
can be great risk of infection
compress. and apply Increased is removed the dischar
This as a warm tenderness or softened ge An unusua
The risk of and allow you will soften any dischar painful to and increas ly reduced be gently moved then jewelle l discharge
infection water through so as to work a little can
ry with an offensi (yellow or green)
greatly reduc can be points of the to clean the entry and
ge touch. ingly general
hygiene includ by good warm ve smell.
ed piercing with exit An unusua ing: always tighten the piercing. When Speak to your
hygiene includ by good general or gauze dipped a cotton bud l discharge
screwing the the ball on any bars
cleaning practitioner
green) Hand washing
with an offensi (yellow or
ing: solution. Once into the warm salt attention immed or seek medica

National Institute for Health and Care Excellence


water ve smell. before ball to the by iately if you l
Hand washi or softened the discharge is remove Speak to your touching
the piercing Do this twice
right. any of the
above suffer from
ng then jewelle d regarding infectioor have any concern
the piercing before touching moved so as ry practitioner each day, prefera
to work a littlecan be gently attention immed
iately if you
or seek medica
l Keeping
washing or
bathing. bly after there are any n in your piercing s
through the warm water any of the the signs of an or if
Keeping piercing above suffer from pierci You to allergic
always tighten . When cleanin regarding infectioor have any concern ng clean. can also use any of the
products used. reaction
the piercing g mild antibac
clean. screwing the the ball on any bars there are any n in your piercing s and soaps
to wash the terial solution
ball to the by signs or if local wound s

(2012). Infection control: Prevention and control of


right. to any of the of an allergic pharmacist site. Ask your
Do this twice products used. reaction follow the to advise
each day, prefera manufacturers you and always
washing or bly after If irritation, instructions.
bathing. redness or
For furthe discontinue drying occurs For furthe
Dry the piercin r advice or use. r advice or
g using ONLY Contac t your information: Dry the piercing Contac t your information:
disposable
paper towel/k fresh Department, local Environmental paper towel/k using ONLY fresh disposa Department, local Environmental
A communal or your local Health or Health
ble England Health your local Public Health

healthcare-associated infections in primary and


itchen roll.
never be used.hand/bath towel should
England Health
Protection
Public Health hand/bath itchen roll. A commu Protection
This Inform Team towel should nal This Inform Team
ation is provide never be used. ation is provide
Public Health Do not use Public Health
Do not use d by: cotton wool d by:
piercing as
cotton wool
to clean the Public Health England North West piercing as
the fibres in
to clean the Public Health England North West
the
may get caughtfibres in the cotton Tattoo and England East Midlan get caught the Englan
in the piercing cotton wool may Tattoo and Piercing d East Midlands
in the piercing wool Piercing Industr ds . Industry Union

community care (CG139). (http://guidance.nice.org.


. y Union
Your practiti Your practiti
oner is: oner is:

uk/CG139)
June 2013 June 2013

05 Genital piercing
(female) 06 Genital
piercing (male) 07 Microdermal
implants
Genital pie Genital pie Microderm
Key Advic rcing (female) af Key Advic rcing (male) after Key Advic
al implant
s aftercare
e e e
The afterc
is important
are of body
to promote
piercing
Hand washin
Hand washin
g
g is the single
tercare
Do not swim
The afterc
is important
are of body
to promote
piercing
Hand washin
Hand washin g
method of
g is the single
care Do not use
The afterc
are
is important of body piercing
to promote
Hand washin
Hand washin g
method of g is the single most importa Do not pick
healing and good important most healing and good most import healing good reducing infectio at any dischar
prevent the Hands must
method of
reducing infectio following a for the first 24 hours prevent the
reducin
must be washed g infection. Hands ant they can kill
antibacterial
produc ts as infect and prevent the be washed
prior to touchin n. Hands must
nt not move,
twist or turn ge and do
infection. risk of piercing. infection. risk of the ion. risk of
the affecte
be washed
prior n. affected area, prior to touching naturally presen good bacteria that area, therefo
re reducing g the affected
whilst dry.
If the piercin
g
d area, therefo to touching Do not pick of infectio therefore reducin the t. are
Wash your the risk of infectio hardened any secreted dischar
Healing times risk of infectio re reducing at any dischar Microderma then turning ge
n. the not move, ge and do Healing times n. g the risk Do not swim l implants soap, always
hands in warm n. cause
the dischar jewellery mayhas
vary with for piercing whilst dry.
twist or turn
the piercin for piercing for the first anchors are or dermal dry your hands water and
liquid allowing bacteri ge to tear the piercin
the type and will Wash If any secrete g vary with will Wash your followin g a piercing. 24 hours small with a clean towel
your hands
hardened the type and hands in warm jewellery made pieces of thoroughly prolonging a to enter g,
of the pierci position liquid soap, in warm water then turning d discharge has of the pierci position soap, always water and should remove or paper the healing the wound
ng and vary thoroughly
always dry
your hands
and cause the jewellery may ng and vary with a clean
dry your hands
thoroug
liquid Do not pick insert from titaniu them being most germs towel. This Do not wear time. and
person to from dischar perso from towel hly at any dischar ed into m and prevent
person. towel. This
with a clean
towel or paper allowing bacteri ge to tear the piercin n to perso should remove or paper towel. not move,
twist or turn ge and do the skin with transferred
to the affecte the piercin clothing that will rub
should remove a to enter g, n. most germs This whilst dry. the stem protru the A new piercin d area. wound g as this may against
For the first and prevent most germs prolonging
the healing the wound For the first them being and prevent If any secrete piercing ding above slightly red g can be tender, itchy and delay irritate the
few weeks them being transfe time. and
few weeks
transfe rred to the affecte harden ed d dischar which an attach , onto and can remain and healing
normal for it is the affecte rred to normal for it is d area. cause the then turning jewelle ge haschoice ment few weeks. Do not use .
is fitted. This of your
d area. Refrain from A new piercin A so for a sunbeds for
the area to any type of the area to dischar ry may sometimes pale, odourless fluid
tender and be red, A new piercin until the piercin sexual activity tende be red, slightly red g can be tender, itchy allowing bacteri ge to tear the piercin should attachment discharge may
weeks, or if
you decide the first two
swollen. g has healed r and swolle and can remain and a to enter g, remain in form a crust. from wound area to
slightly red g can be tender, itchy or is dry. n. few weeks.
A so for a prolonging
the healing the wound least place for at with pus, which This should the piercing and
during tanning with a breathathen cover the
The healin
g time for few weeks.
and can remain
so
and Always use
barrier protect The healin sometimes pale, odourless fluid time. and three month
s
not
would indicatbe confused .
ble plaster
A for a condom g time for a dischar may Refrain from piercing has or until e infection.
genital pierci a sometimes pale, odourless fluid s, otherwise ion such as genita form a crust. ge from
This should the piercing and until the any type fully heale the Keeping the Do not swim
ng discharge may risk of acquiri you are at l piercing
piercing has of sexual activityhas fully heale d. Once The implan implant piercing following a for the first 24 hours
2 to12 weeks can be from and form a
crust. This
from the piercin
g infection. ng a sexuall increas
y transmitted ed 2 to12 weeks
can be from with pus, which not be
would indicat confused healed or is d other pieces it t
each day. needs to be cleaned
clean piercing.
. confused with should not . e infection. Always use dry. jewellery of Cleaning more twice Accidental
pus, which be Male Genita can be attach damage the
Remember infection. would indicat Signs of infecti Remember l piercing condoms,
barrier protect ed. healing process skin and slowfrequently may Contac t yourdamage or loss of
these times e these times aftercare otherwise ion such as Healin down the disc
approximat are If appropriate
on approximat are including glans
penis piercin risk of acquiri you are at g times for advise you . Your practiti gets caught practitioner if the implan
e and will Female Genita e and will PA, Reverse ng a sexuall increas vary piercing will to oner may also becom in anythin t
on how health depend l piercing infection may aftercare is not followe on how health depend PA, Apadra g such as infection. y transmitted ed with the type water twice soak the implant in es damaged. g or the piercing
including Clitoral aftercare d Dydoe and vya, Ampal of the piercin and positi a week. warm salt
whether you
y you are
and Hood, Inner infection are: occur. The signs of whether you
y you are
and
Frenum
piercings includi , as well as for
lang,
g and vary on Make up a In the unlikely
Labia, Fourch and Outer other Signs of infecti person to quantity of event the
look after ette, Christin look after Foreskin and ng Hafada on person. from solution (1/4 warm salt comes off,
return to the disc breaks or
piercing prope the a and Triangl Swelling piercing prope the Guiche , Scrotum, If approp level teaspoo water have a practitioner
rly until heale Soak the piercin e. and rly until heale . riate salt to an egg cup/sho n of prefera new disk fitted
d. g for a few around the redness that increases d. Soak the piercin infection may aftercare is not followe For the first t glass of warm bly sea disc is not replace immediately. and
As with all submerging minutes by wound. As with all d norma few weeks Use a clean If the
body art, the area of body subme g for a few infection are: occur. The signs of l for it is cloth or gauze water). lost under
the
d the implan
t may
a risk. To reduc infection the piercing in skin containing A severe a risk. To reduc art, infection rging the area of minute s by the area to solutio n and dipped in the skin and will require get
is a bowl contain a clean container, such burning and is the piercin skin contain tender and be red, and also to apply as a warm compre Signs of infecti removal.
advice from e these risks take (1/4 level teaspo ing a warm as sensation
round the
throbbing
advice from e these risks take g in
a bowl contain a clean container, such
ing Swelling
and rednes swollen.
area under
dab the area
to ss If appropriate on
your practi water solutio site. your ing a warm as around s that increases As with the make afterca
regarding tioner to an egg on of prefera n Increased regarding practitioner (1/4 level teaspo water the wound all body become encrustdisc is cleaned as
sure the infection may re is not followe
bly sea salt on of prefera solution .
aftercare.
Alternatively
cup/shot glass
of warm water). painful to
tenderness
and increas
aftercare. to an egg
cup/shot glass bly sea salt A severe a risk. To reduc art, infection is ed. this may infection are: occur. The signs of d
This will soften
The risk of
infection in the solutio wet a clean cloth or gauze
touch. ingly The
risk of infect Alternatively of warm water). sensation
burning and
throbbing advice from e these risks take you to clean any discharge and Swelling
greatly reduc can be compress.
n and apply An unusua greatly reduc ion can be in the solutio wet a clean cloth or gauze round the
site. your practi
cotton bud the piercing points with allow and
around the redness that increas
ed This will soften as a warm l discharge ed by good n and apply regarding
aftercare.
tioner wound. es
general hygie by good with an offensi (yellow or compress. Increased or gauze dipped a
and allow
you any dischar ve smell. green) general This will soften as a warm tenderness salt water into the warm A severe
ne including: points of the to clean the entry and ge hygiene includ and allow
you any dischar painful to and increas
inglyThe risk of infect
solution. burning and
Hand washi or gauze. Oncepiercing with a cotton exit Speak to your ing: points of the to clean the entry and ge touch.
ion can be If the area sensation throbbing
practitioner Hand washi greatly reduc around the round the
ng before the dischar bud attention immed or seek medica ng before or gauze. Oncepiercing with a cotton exit An unusua ed encrusted
soak the piercin implant becom site.
touching or softene
d then jewelle ge is removed any of the iately if l touching the dischar bud l discharge hygiene includ by good general minutes by
submerging g for a few
es Increased
tenderness
the piercing moved so
as to work ry can be gently above or have you suffer from the piercing or softene
d then ge is remove with an offensi
ve
(yellow or
green) ing: contain the
painful to
touch.
and increas
a little regardi ng infectio any concer moved so jewelle ry can be gently d smell. ing the area of ingly
Keeping
the piercing
through the
piercing. When warm water there are any n in your piercin ns Keeping the as to work
a little Speak to your Hand washi or bowl containpiercing in a clean skin An unusua
always tighten g or if piercing clean. through the
piercing. When warm water practitioner ng before solution and ing the warm salt
jug l discharge
clean.
screwing the the ball on any bars
cleaning to any of the signs of an allergic reactio always tighten attention immed or seek medica the implant. touching water with an offensi (yellow or
produc ts used. n cleaning any of the iately if l cotton bud loosen the discharge ve smell. green)
ball to the
right.
by screwing the the ball on any bars above or have you suffer from Keepi or clean floss. using a Speak to your
ball to the by regarding any concer ng the impla Always dry attention immed practitioner
Do this twice right. infection in or seek medica
washin each day, prefera Do this there are any your piercin ns nt clean. cleanin
the area thorou
ghly any of iately if you l
twice g or if g your implan after the above suffer from
g or bathing
.
bly after
washing or each day, preferably to any of the signs of an allergic reactio disposable t using regarding or have any
bathing. after produc ts used. n paper towel/k ONLY fresh infection in concer
Dry the piercin A communal itchen roll. there are any your piercin ns
disposable g using ONLY
fresh When cleanin never be used.hand/bath towel should g
to any of the signs of an allergic or if
reaction

Main contents
A communal
paper towel/k
itchen roll. any bars by g always tighten the Do not over
produc ts used.
For furthe screwing the ball on For furthe For furthe
never be used.hand/bath towel should r advice or
Contac t your information:
ball to the
right.
r advice or
information: damage the clean the site as this r advice or
Contac t your information:
Dry the piercin Contac t your skin around may
Do not use Department, local Environmental disposable g using ONLY Department, local Environmental Do not change the implan
t Department, local Environmental
or your local Health paper towel/k fresh or your local Health or your local Health
they can kill
antibac terial
produc ts as
England Health Public Health A communal itchen roll. England Health Public Health implant until the cap of the microde England Health Public Health
the
naturally presen good bacteria that This Inform
Protection
Team never be used.hand/bath towel should This Inform
Protection
Team advice from fully healed. If in any rmal
This
Protection
Team
ation is provide ation is provide your operato doubt take Information
t. are Public Health Public Health Do not use r Public Health is provided
d by: d by: by:
Public Health England North West Public Health England North West piercing as
cotton wool
to clean Public Health England North West
the the
Tattoo and England East Midlan Tattoo and England East Midlan may get caughtfibres in the cotton Tattoo and England East Midlan
Piercing Industr ds Piercing Industr ds in the piercin wool Piercing Industr ds
y Union y Union g. y Union
Your practiti Your practiti Your practiti
oner is: oner is: oner is:

29 June 2013 June 2013 June 2013


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Section 04 Decontamination
Click on text to view
Principles of Principles of Categorization of risks
decontamination decontamination A general categorization of the risks that items
Need for vigilance pose with regard to transmission of infection and
Decontamination is a combination of processes
Categorization of risks the minimum decontamination standard that
that render reusable items safe for reuse.
Decontamination practice should apply is set out in the following table:
Layout of decontamination For invasive items used in tattooing and
area body piercing, these decontamination Risk Use of item Decontamination
Decontamination of invasive processes will involve cleaning and (minimum
items sterilization, after which environmental standard)
Cleaning recontamination should be minimised and
Use of disinfectants High Items Sterile or sterile
recontamination with blood must be totally
Sterilization introduced single-use
eliminated. Pre-sterilized single-use items
Sterilizer operation, validation,
into normally
are a good alternative. sterile body
maintenance and record keeping
Care of items after sterilization
Using items once and then discarding them areas or in
Decontamination of blood and removes the need for decontaminating contact with

2
body fluids in the working them. a break in skin
environment items or mucous
Where an item is marked it is
Appendix 11
membrane
single-use and must not be reused even if
Decontamination requirements decontaminated. Medium In contact Disinfect or single-
for equipment used in with intact use
tattooing and skin piercing For items used in association with
mucous
Appendix 12 Equipment
invasive items, these decontamination
membranes
sterilization standard: self- processes should include both cleaning
assessment and decision making and sterilization. Where this is not possible Low In contact Clean or clean
tool for tattoo and body piercing (tattooing motors for example), their with intact and disinfect if
practitioners contamination should be minimised skin contaminated with
Appendix 13 Equipment by the use of impervious covers which blood or body fluid
and body piercing jewellery should be removed carefully after use Minimal Not normally No specific
sterilization standard for
so as not to contaminate the surface of in contact treatment
tattooists and body piercers
the item, and the item itself should be with skin (e.g. required, domestic.
Appendix 14 Autoclave daily floors and cleaning. Spills or
chemically disinfected. Alternatively items
record sheet walls) splashes of blood
can be single-use, such as with ink caps.
Further reading
As with invasive items, environmental or body fluid
recontamination should be minimised and should be safely
cleared.
recontamination with blood must be totally
eliminated.
Decontamination Practice
For surfaces, contamination with blood
should be made safe by careful application Layout of decontamination area
of chemical disinfectants. The layout of a decontamination facility
is important, whether it is in a separate
Need for vigilance
room or a dedicated part of the treatment
It is vital that, once decontaminated, items are room, within body art premises. Items to be
not directly or indirectly contaminated with decontaminated must flow along a defined
blood or body fluid. This requires scrupulous process pathway from dirty (i.e. used and
handling procedures and physical separation contaminated), through cleaning (which may
from undecontaminated items and the have both a manual and an ultrasonic stage),
surfaces they may have contaminated. through sterilization and into a phase of clean
Main contents
storage and return to use.
30
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Section 04 Decontamination
Click on text to view
Principles of At any stage, items must not be re-contaminated instruments: cleaning should be done under the
decontamination by direct or indirect contact with items at a lesser detergent solution surface to prevent splashing
Need for vigilance stage of decontamination, e.g. items that have and care should be taken to avoid injury.
Categorization of risks been cleaned must not be put on the same
surface or handled with the same utensils used Any detergent should be safe for those who
Decontamination practice
for dirty items; items that have been sterilized use it, but thick washing-up gloves should
Layout of decontamination
must not make contact with any surface that nevertheless be used. If manual cleaning is
area
has been used for items before they have been used, the detergent should be at or around
Decontamination of invasive
items sterilized. In addition to this beware of using a neutral pH. It is common to use detergents
Cleaning clean-looking item in the mistaken belief that it containing enzymes. However, it is thought
Use of disinfectants has been fully decontaminated. that short exposures of dirt containing proteins
Sterilization to these enzymes may give insufficient time for
Sterilizer operation, validation, Only by having a progression through a effective action. There are also concerns that
maintenance and record keeping defined layout, can the location of an item some of the enzyme mixtures (subtilisins)
Care of items after sterilization correspond to its stage in the decontamination can give rise to allergic reactions in some who
Decontamination of blood and process. This is always important, but come into contact with them. This should be
body fluids in the working particularly so if more than one practitioner considered in risk assessments. Use of non-
environment items
uses the same facility, or if multiple copies of enzymatic detergents should be considered.
Appendix 11
identical equipment items are available for use,
Decontamination requirements Cleaning should be carried out in a sink
for equipment used in e.g. tattoo machine grips.
dedicated to instrument cleaning and not one
tattooing and skin piercing
It is an advantage if the decontamination shared with other functions (handwashing,
Appendix 12 Equipment occurs in a dedicated room but if this is not eating utensil washing etc.). It can help to
sterilization standard: self-
assessment and decision making
possible, it should still occur in a dedicated area attain the correct dilution of a detergent if
tool for tattoo and body piercing in which a defined flow from dirty to clean can the sink is indelibly marked to a fill-line of
practitioners be clearly established. known volume, allowing a measured addition
Appendix 13 Equipment of detergent to achieve the correct dilution.
and body piercing jewellery Decontamination of invasive items Warm, but not hot, water should be used (hot
sterilization standard for Any item that pierces the skin poses a high risk of water may coagulate proteins onto an item
tattooists and body piercers transmission of infection. Only items intended and make then difficult to remove). Utensils
Appendix 14 Autoclave daily for reuse after cleaning and steam sterilization used for instrument cleaning should be
record sheet should be reused. If any uncertainty exists dedicated solely for that purpose and should
Further reading whether an item can be decontaminated by this be observably fit for purpose (e.g. bristles
method then confirmation should be obtained on brushes in good order). Cleaning should
from the supplier. take place under the surface of the detergent
solution to minimise the potential of splashing
See Appendix 11 Decontamination
the practitioner with the blood being removed.
requirements for equipment used in
tattooing and skin piercing Cleaning should be done as soon after an
Cleaning item is used as possible as drying makes
All items should be cleaned before sterilization. contamination less easily removed. It may
If any blood or other proteinaceous material is make cleaning easier if items are stored
left on an item that is to be steam sterilized it between use in clean fresh tap water or in a
will become firmly fixed on the items and very high humidity atmosphere (such as a closed
difficult to remove subsequently. vessel with a small amount of water).

Cleaning should use methods, detergents and Validation of cleaning should be by careful
concentrations of those detergents compatible visual inspection of each item in good light.
Main contents
with items and specifically intended for Items with complex surfaces may require
31 instrument cleaning. The cleaning method should subsequent additional cleaning in an
not put practitioners at risk from contaminants on ultrasonic waterbath (ultrasound creates
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Section 04 Decontamination
Click on text to view
Principles of strong microcurrents in water by a process Sterilization
decontamination known as cavitation and is very effective Sterilization is the complete elimination of all
Need for vigilance at removing soiling from otherwise hidden microbial life to a very high level of quality
Categorization of risks crevices). Ultrasonic waterbaths should be assurance. It must be a robustly efficient
Decontamination practice used, maintained and validated according to process guaranteed to work on every occasion.
Layout of decontamination the manufacturers instructions. Whilst there are many theoretical ways in which
area Use of disinfectants sterilization can be achieved, the only way that
Decontamination of invasive body art practitioners can achieve it with the
items Chemical disinfection has far lower levels of
required quality is by steam sterilization.
Cleaning quality assurance than steam sterilization and
Use of disinfectants should not be used for invasive items. It should Other methods are either too complex or lack
Sterilization only be used for decontamination of the equivalent quality assurance. Steam sterilizers
Sterilizer operation, validation, environment and non-invasive items. Chemical are devices that can expose items to be
maintenance and record keeping disinfectants are usually inactivated by organic sterilized to pure steam at above atmospheric
Care of items after sterilization matter and should only be used after cleaning pressure in a chamber. The process must be
Decontamination of blood and has removed the vast majority of organic automatic and steam sterilizers must monitor
body fluids in the working matter. Disinfectants should be used in a
environment items
the process to ensure that all parameters
controlled manner according to guidance and of sterilization have been met or, if any
Appendix 11
manufacturers instructions (e.g. the correct have failed, to clearly indicate a failed cycle.
Decontamination requirements
for equipment used in dilution, freshly prepared, applied as directed). (Pressure cookers do not have this inbuilt
tattooing and skin piercing Do not mix disinfectants with other detergents quality assurance and are not suitable for
Appendix 12 Equipment
or chemicals unless following manufacturers body art instrument sterilization. Devices
sterilization standard: self- instructions. sold as baby bottle steam sterilizers use
assessment and decision making lower temperatures and are not suitable for
tool for tattoo and body piercing The disinfectant of choice for general
body art instrument sterilization). The type
practitioners disinfection of the environment should be a
of steam sterilizer suitable for use by body
Appendix 13 Equipment hypochlorite solution containing 1,000 parts
art practitioners is known variously as a small
and body piercing jewellery per million available chlorine (ppm av Cl).
steam sterilizer, a benchtop steam sterilizer or a
sterilization standard for This is usually made by dilution of tablets of
tattooists and body piercers transportable steam sterilizer. These are small
sodium dichloisocyanurate (NaDCC), a form
steam sterilizers that generate their own steam
Appendix 14 Autoclave daily of solid, stable hypochlorite, pre-measured to
record sheet and are powered by a standard domestic
give specific hypochlorite concentration when
electrical supply and should conform to the
Further reading dissolved in given volumes of water (always
standard BS EN 13060.
follow manufacturers instructions for attaining
the correct concentration). Whilst solid NaDCC To effect the energy transfer necessary for
is stable on dry storage, the hypochlorite sterilization, steam must be able to condense
solutions it generates are unstable and should on all surfaces of an item, therefore hinged
be made-up daily. Always use in accordance items should be opened and items should
with the manufacturers materials safety data not overlap each other. If pockets of air are
sheet. Hypochlorite solutions may bleach present, this blocks the ability of steam to
fabrics and corrode metals other than good make contact with the surface in air. If porous
quality stainless steel. They should never be (e.g. fabrics), hollow or wrapped items are
mixed with strong acids (the production of placed in chambers that are then filled with
highly toxic chlorine gas can result). They steam, this will not remove air from these loads
should be used in well ventilated areas. but will only compress the air in them, leading
to inadequate sterilization.

Main contents
32
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Section 04 Decontamination
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Principles of Small steam sterilizers are produced in 3 A steam sterilizer should monitor each
decontamination different types: sterilization cycle and produce a record (e.g.
Need for vigilance Type B steam sterilizers (also known as printout) of the cycle parameters, primarily
Categorization of risks vacuum or porous load sterilizers): These the temperatures attained throughout the
Decontamination practice have sterilization cycles that start by pulling sterilizing phase and the times of those
Layout of decontamination a vacuum on the chamber to remove temperature readings. If the sterilizer cannot
area most of the air in the chamber and within produce a record of cycle parameters,
Decontamination of invasive porous, hollow or wrapped items; this is equivalent records should be produced by
items followed by a series of pulses and removal observation of a cycle at the start of each
Cleaning of steam to dilute any remaining air, day the sterilizer will be used. Steam sterilizers
Use of disinfectants should be validated and maintained by
before the chamber is brought to sterilizing
Sterilization people specifically trained to do so according
conditions. These sterilizers are suitable
Sterilizer operation, validation, to a schedule provided by the sterilizer
for porous, hollow or wrapped items. Any
maintenance and record keeping
wrapping must conform to the standard manufacturer. Records of validation and
Care of items after sterilization
BS EN 868, showing they are of a type that maintenance should be retained as locally
Decontamination of blood and
body fluids in the working does not prevent the passage of steam and advised by the inspecting authority.
environment items will resist the passage of contamination See Appendix 14 Autoclave daily record
Appendix 11 after sterilization has occurred. sheet
Decontamination requirements
for equipment used in Type S steam sterilizers: These are similar to There is a legal requirement to have a written
tattooing and skin piercing type B, but have only been validated to process scheme of periodic examination of steam
Appendix 12 Equipment specific loads (and are normally produced to sterilizers under the Pressure Systems Safety
sterilization standard: self- sterilize wrapped dental handpieces). These Regulations, 2000 by a Competent Person
assessment and decision making sterilizers are suitable for porous, hollow or (pressure vessels) under these regulations.
tool for tattoo and body piercing
wrapped items only if validated for those A certificate of insurance is required for the
practitioners
specific items to be processed. sterilizer as a pressure vessel (Medical Devices
Appendix 13 Equipment Agency, 2002).
and body piercing jewellery Type N steam sterilizers: These are steam
sterilization standard for sterilizers with no assisted air removal. These Care of items after sterilization
tattooists and body piercers
sterilizers are suitable for non-porous, non- If items are wrapped, they will remain sterile as
Appendix 14 Autoclave daily hollow (solid) and unwrapped items only. long as the wrapping remains intact and dry.
record sheet
Further reading Type B and S sterilizers tend to be more If items are unwrapped, they can be placed
expensive to buy and maintain and normally in a clean, lidded container. Great care should
have longer cycle times than type N. be taken not to recontaminate them, with
particular emphasis on recontamination from
See Appendix 12 Equipment sterilization undecontaminated instruments or surfaces
standard: self-assessment and decision contaminated by blood or body fluid as they
making tool for tattoo and body piercing are transferred into or out of the container, or as
practitioners other items are removed from the container. This
See Appendix 13 Equipment and body is best achieved by having only those items in one
piercing jewellery sterilization standard for container that will be used in a single procedure.
tattooists and body piercers If a container does become contaminated, it
should be washed and processed (open) in a
Sterilizer operation, validation, steam sterilizer or discarded.
maintenance and record keeping
Sterilizers should only be used by those
Main contents trained in their correct operation. Sterilizers
should be operated according to the sterilizer
33 manufacturers instructions.
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Section 04 Decontamination
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Principles of Decontamination of blood Further reading
decontamination and body fluids in the working Medicines and Healthcare products Regulatory
environment Authority (MHRA). Sterilization, Disinfection
Need for vigilance
and Cleaning of Medical Equipment: Guidance
Categorization of risks Blood and other body fluids in the environment on Decontamination from the Microbiology
Decontamination practice pose a risk of infection transmission: with blood Advisory Committee to Department of Health.
Layout of decontamination the main hazards are of blood borne viruses; Part 1 Principles (2010); part 2 Protocols
area with other body fluids a wider spectrum of (2005); Part 3 Procedures (2006). http://www.
Decontamination of invasive infectious micro-organisms are relevant. mhra.gov.uk/Publications/Safetyguidance/
items Otherdevicesafetyguidance/CON007438
Environmental contamination with blood
Cleaning
or other body fluids should be dealt with by Medical Devices Agency (2002). Benchtop Steam
Use of disinfectants
the removal of the contaminating material Sterilizers Guidance on Purchase, Operation and
Sterilization
and disinfection as soon as possible after Maintenance.
Sterilizer operation, validation,
maintenance and record keeping the contamination occurs. The longer any (http://www.mhra.gov.uk/groups/dts-bi/documents/
Care of items after sterilization contamination remains on a surface, the more publication/con007327.pdf)
Decontamination of blood and it poses a direct risk to those who come in
Hoffman PN, Bradley CR, Ayliffe GAJ (2004).
body fluids in the working contact with it, as well as the indirect risk of it Disinfection in Healthcare. 3rd Edn. Blackwell
environment items being transferred to other surfaces from which Publishing. ISBN 1405126426
Appendix 11 it may contaminate instruments that come
Decontamination requirements into contact with clients.
for equipment used in
tattooing and skin piercing Remember: The person most at risk, is the
Appendix 12 Equipment person clearing the contamination. They
sterilization standard: self- should have safe methods of working and use
assessment and decision making appropriate personal protective equipment
tool for tattoo and body piercing
(PPE ) which should always include single-use
practitioners
gloves, with additional PPE such as aprons if
Appendix 13 Equipment
the contamination is extensive.
and body piercing jewellery
sterilization standard for
Most environmental contamination is likely to
tattooists and body piercers
be minor. Such contamination can be removed
Appendix 14 Autoclave daily
using single-use wipes and then, once clean,
record sheet
the area treated with a suitable disinfectant
Further reading
such as hypochlorite. (See cautions on
hypochlorites above). If there is likely to be
more extensive contamination, purpose-made
disinfectant spill kits can be brought-in in
readiness and used.

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Section 05 Product quality of tattoo ink


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Background and context Background and context Microbiological and
Microbiological and Requirements already exist at both European
chemical quality concerns
chemical quality and national level, whereby ink products The risks associated with tattooing treatments
concerns
should be sterile and inert at first use. These have been acknowledged for many years, and
Recommendations to specified standards are not necessarily legally have been reported internationally (Lehman
improve the quality of
binding, though bylaw requirements would et al., 2010). In addition to the standard safer
ink products used for
tattooing
become so if adopted by a local authority. At sharps controls to mitigate the risk of Blood
the European level the quality requirements Borne Virus (BBV) transmission during tattooing,
See Appendix 01 Model
Byelaws: Acupuncture, tattooing,
for inks were initially laid down in 2003 by another potential hazard is that of infection
semi-permanent skin-colouring, the Council of Europe, and further revised in via the environmental route. This is typically
cosmetic piercing and electrolysis 2008 (see at https://wcd.coe.int/ViewDoc. associated with naturally occurring bacteria and
References jsp?id=45869&Lang=en). fungi that have gained entry to the ink product
at some stage during its manufacture or storage.
In 2003 the UK Government published byelaws, This form of environmental contamination
for use by local authority environmental health of inks, prior to their use on the client, is rarely
officers (EHOs) to aid enforcement in this area. reported on. Despite the continually improving
These have since been revised. standards in tattooing health and safety - much
See Appendix 01 Model Byelaws: of it related to eliminating the risk of BBV
Acupuncture, tattooing, semi-permanent skin- transmission - the environmental aspect of
colouring, cosmetic piercing and electrolysis tattooing infection control remains beyond the
control of most practitioners.
The Welsh Assembly has also published its
own byelaws to accommodate this area of Poor quality tattoo inks increase the potential
enforcement and, like the UK model byelaws for localised bacterial skin infections as well as
that preceded them, these stipulate that dermal allergies following tattooing treatments
..for the purposes of tattooing or semi- (Limentani et al., 1979; Jacob, 2002; Charnock,
permanent skin-colouring, only sterile inert 2004; Suhair, 2007; Drage et al., 2010). Ink
pigment, dispensed into single use pots or related problems might therefore be directly
pre-packed in single use vials, is used. The related to the chemical and/or microbiological
full documentation can be seen at: http:// quality of the ink or pigments used. Where
wales.gov.uk/topics/health/protection/ this occurs, other efforts to maintain
communicabledisease/acupuncture/?lang=en. tattooing hygiene standards could potentially
be undermined if the inks themselves are
A common requirement for all the above,
contaminated at the point of use.
where applied, is that the inks should be sterile
at first use and should be inert (i.e. non- Tattoo ink products are typically purchased
reactive with the body). For EHOs out in the from suppliers or directly from manufacturers
field and for tattooists, there is an expectation and are delivered intra-dermally during
that ink manufacturers will provide products treatment, so there is an increased potential
that are fit for purpose. However, at present for the clients body to be exposed to their
there are few independent sources of data components, compared with, for example, a
to confirm the quality of inks used in the UK, topically applied skin colorant.
and no authoritative information to indicate
whether this is universally achievable. Some Some inks are sold with little or no accompanying
studies have shown that certain products may product data, and their composition may remain
be contaminated with microorganisms and/or uncertain even at the point of use.
metals, and the quality of inks used in the UK is
Main contents Reports of metal sensitivity following
likely to vary between manufacturers because
tattooing have been published in the UK,
35
of an absence of common standard quality
and dermatological responses have been
requirements.
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Section 05 Product quality of tattoo ink


Click on text to view
Background and context linked with particular ink colours, especially References
red products [some containing mercury] and Charnock C (2004). Tattooing dyes and pigments
Microbiological and contaminated with bacteria. Tidsskr Nor
chemical quality greens/blue [chromate/cobalt] (Jacob, 2002; Laegeforen. 124(7):933-5.
concerns Mortimer et al., 2003; Gass & Todd, 2007).
Drage LA, Ecker PM, Orenstein R, Phillips PK and
Recommendations to Edson RS (2010). An outbreak of Mycobacterium
improve the quality of Recommendations to improve chelonae infections in tattoos. Journal of the
ink products used for the quality of ink products American Academy of Dermatology. 62(3):501-6.
tattooing used for tattooing:
Gass JK and Todd PM (2007). Multiple
See Appendix 01 Model The presence of an accompanying manifestations of chromate contact allergy.
Byelaws: Acupuncture, tattooing, product data sheet is a fundamental Contact Dermatitis. 56:290291.
semi-permanent skin-colouring,
requirement to ensure that, as far as Jacob CI (2002). Tattoo-associated dermatoses: a
cosmetic piercing and electrolysis
possible, the appropriate quality tests have case report and review of the literature. Dermatol
References been undertaken and passed for the ink. Surg. 28(10):962-5.
Tattooists should therefore work wherever Lehman EJ, Huy J, Levy E, Viet SM, Mobley A and
possible with inks that are accompanied McCleery TZ (2010).
by the manufacturers product quality
Bloodborne pathogen risk reduction activities in
information, and should request this the body piercing and tattooing industry. American
information from their supplier if it is not Journal of Infection. 38(2):130-8.
provided; and,
Limentani AE, Elliott LM, Noah ND, Lamborn JK
Practitioners should note the batch (1979). An outbreak of hepatitis B from tattooing.
numbers of the products they purchase, Lancet. 2(8133):86-8.
with delivery dates, as new inks are Mortimer NJ, Chave TA and Johnston GA (2003).
purchased and received. Some suppliers Red tattoo reactions. Clinical and Experimental
already provide a product listing and batch Dermatology. 28:508510.
numbers with their delivery note, and this Suhair OS, Miles HFJ, Simmons P, Stickley J and
would equally serve as a dated record of ink De Giovanni JV (2007). Awareness of the risk
of endocarditis associated with tattooing and
products received. This record can then be
body piercing among patients with congenital
used in case of any subsequent concerns heart disease and paediatric cardiologists in the
over ink quality. Wherever possible, and to United Kingdom. Archives of Disease in Childhood.
strengthen the quality control link between 92:1013-1014
client and product(s) used, the colour of the
inks used on each client should be noted at
the time of treatment.

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Section 06 Body piercing jewellery


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General General Nickel Directive
Nickel Directive The style of body piercing jewellery is distinct The Nickel Directive was a European Union
References from traditional jewellery worn in the ear lobe Directive regulating the use of nickel in jewellery
such as studs and butterfly designs. and other products that come into contact
with the skin. The requirements also cover a
Variations on the barbell and (captive) ring wide range of other items such as necklaces,
design are those most commonly seen in body bracelets, wristwatch cases, zips and buttons.
piercing because these substantial shapes
minimise the risk of embedding, tearing and Since June 2009 it has been subsumed into
migration. the EU REACH Regulation (Registration,
Evaluation, Authorisation, legislation and
High quality jewellery is made with smooth restriction of Chemicals). Nevertheless, the
surfaces and joins in order to reduce the risk of term nickel directive is still used to refer to the
irritation or of harbouring infection. restrictions on nickel usage and the prescribed
Practitioners should ensure that all jewellery test for quantifying nickel release from
used for skin piercings is sterile prior to its use. products. Jewellery can only be used if the
Where jewellery is not purchased pre-sterilized nickel release rate from those parts of these
but is sterilized within the premises, the products coming into direct and prolonged
method by which sterilization has been carried contact with the skin is 0.5 micrograms per
out will determine how sterile the jewellery square centimetre per week, or less. For body
remains (see sterilization section). If jewellery piercing jewellery, post assemblies - the part
is processed and stored properly, it may retain of the jewellery that is inserted into the wound
its sterility indefinitely. However, practitioners caused by the piercing of the skin, including
should be advised to discuss issues such as both the piece that goes through the wound
shelf life with equipment (and packaging) and those parts of the jewellery intended
manufacturers. to hold the piece in and against the wound
(earring back or balls on the end of a piercing
A number of materials are used in skin piercing bar or stud) - are prohibited unless their rate
jewellery and acceptable materials include: of nickel release is 0.2 micrograms per square
centimetre per week, or less.
Titanium.
Niobium. One problem with these requirements is that
Platinum. they do not apply to jewellery manufactured
for export to countries outside the European
Gold preferably solid gold 14 carat or
Union. Where practitioners cannot prove that
18 carat (for ear piercing). The use of gold
jewellery being used is in compliance with
higher than 18 carat is not recommended
these requirements, it is advised that use of
in body piercing as it is too soft and the
that jewellery stops until the practitioner can
potential exists for scratching or pitting of
obtain evidence from the manufacturer of its
the metal which may increase the risk of
compliance.
infection at the piercing site. The use of gold
lower than 14 carat is not recommended References
in body piercing as it tends to be lower in The Regulation now incorporates the Nickel
quality and has the potential to contain Directive (REACH), at item 27 of Annex XVII.
metallic impurities, which may lead to Further information is available from: http://www.
allergic response in the pierced individual. teg.co.uk/nickel/94-27-EC.htm

Main contents
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Section 07 Governance
Click on text to view
Training and Training and competencies Needle stick injury (and basic first aid
competencies practice in relation to this).
All tattooists and body piercers should
Procedure manuals/ undertake accredited training and be able Safe sharps handling/disposal.
policies COSHH risk assessment/safe handling
to demonstrate their competencies before
Audit and quality starting to practice. This guidance recognises, of chemicals.
monitoring
however, that tattooists and body piercers Training/education of staff.
Record keeping in the UK do not have access to a nationally Staff health including hepatitis B
Consent and aftercare recognised and accredited course, nor is there vaccination status.
documentation a nationally agreed set of competencies or
See Appendix 09 contains an ongoing objective monitoring of professional Audit and quality
example of a consent form and competence by a recognised professional body. monitoring
there are a variety of written
aftercare leaflets available Tattooists and body piercers currently Services, policies and practices should be
See Appendix 10 Aftercare undertake unaccredited courses, often run monitored on a regular basis by the premises
follow-up record sheet by private companies, and/or undergo local manager/lead practitioner, not only to ensure
References training and assessment against locally practice is up to date and evidence based, but
determined competencies through self-funded for quality purposes as well. By having written,
apprentice/mentorship schemes. These up-to-date policies and procedures,
training methods vary in terms of quality, documentation of staff training and proof of
duration and content. written, evidence based procedures/policies being
followed, a premises can provide evidence of
The absence of tattoo and body piercing quality standards being maintained. This is useful
accredited training and competencies is an when premises are asked by other professionals,
area that needs to be addressed nationally and clients, for proof of good practice procedures
and is outside the scope of this guidance. and help demonstrate competence and quality in
From an infection control viewpoint, any the event of a complaint.
agreed national training and competencies for
tattooists and body piercers should include the Undertaking audits is part of providing
infection control areas listed in the procedure evidence of quality performance. The
manuals/policies section (below). template infection control audit tool which
is included with this guidance could be used
Procedure manuals/policies for undertaking infection control audits at a
tattooing /body piercing premises. It provides
It is recommended that practitioners produce
a spreadsheet which gives percentage scores
a written procedure/policy manual for use by
against good practice target scores in each
staff. It should be based on evidence based
section and overall.
guidance and be easily available and be easily
understood by all groups of staff. Policies/ It is suggested that audits are initially
procedures should be reviewed annually so undertaken every six months (or more
that practice is up to date and should indicate frequently if scores are below standard targets)
ownership (i.e. who is responsible for managing and an action plan developed to address any
the policy) and authorship. gaps in audit findings. As a minimum an audit
Policies/procedures should include: should be undertaken annually. It is important
that there are named individuals designated
Hand washing procedure. against each action and that a deadline is
Cleaning policy and rota. given for each action so that progress can be
Decontamination procedures. identified against these by designated staff,
Main contents Management of waste.
as well allowing monitoring of progress to be
followed by the manager/owner. A repeat audit
38 Management of blood spillages. allows the recording of changes made, as well
Use of personal protective equipment (PPE). as good practice to be monitored over time.
Tattooing and body piercing guidance

t
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Section 07 Governance
Click on text to view
Training and Record keeping Consent and aftercare
competencies
Accurate records are invaluable if infection
documentation
Procedure manuals/ problems occur and may assist the practitioner Consent forms must be signed before any
policies
when investigations are conducted for procedure is commenced. Both written
Audit and quality example, for verifying procedures performed and verbal aftercare information should be
monitoring
and equipment check-tests carried out, when provided to the client as evidence of good and
Record keeping they were performed and on whom/by whom. safe practice.
Consent and aftercare It is important to keep accurate records of
See Appendix 09 contains an example of
documentation every client including:
a consent form and there are a variety of
See Appendix 09 contains an
Full name, address, telephone number, date written aftercare leaflets available
example of a consent form and
there are a variety of written of birth and proof of age if needed.
aftercare leaflets available AFTERCARE FOLLOW-UP RECORD SHEET
Relevant medical history/ allergies. (ATTACH TO CONSENT FORM)

See Appendix 10 Aftercare Consent signature of client/ parent. NAME OF CLIENT:


follow-up record sheet
Date and type of procedure conducted, ____________________________
References
site of procedure, type of jewellery (if Date & Description of any concern or problem Signature of
time Action taken/advice given practitioner
applicable).
The name of the practitioner.
All records should be used safely and stored
securely, maintaining client confidentiality (e.g.
locked paper records, safe use of computers
to ensure clients details are not accessible by
the general public or others with no legitimate
reason to access them. Records should be kept
safely on the premises named in the licence
for a period of no less than 3 years (Dartford
Borough Council 2009).

Staff training records should also be kept on


site, as well as health and safety records such
as risk assessments, an accident/incident
book, and a log book with details of regular
equipment checks.
See Appendix 10 Aftercare follow-up
record sheet
References
Dartford Borough Council (2009). Code of practice
for hygienic piercing. (www.dartford.gov.uk)

Main contents
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Management of infectious disease incidents relating


Section 08 to tattooing and skin piercing
Click on text to view
Definition of an outbreak
Definition of an outbreak or due consideration to the possibility of legal
or incident
incident proceedings, and if required seek guidance
regarding the chain of evidence for a potential
Outbreak/incident initial An infectious disease related outbreak or
prosecution.
response incident can be defined as:
An incident in which two or more people In the case of a tattooing/body piercing setting,
References
experiencing a similar illness are linked in most incidents would be expected to relate to
time/place. suspected blood borne virus transmission to
another person (be that from a practitioner to
A greater than expected rate of infection
a client or from a client to the practitioner).
compared with the usual background rate
The infection control practices in place within
for the place and time where the outbreak
the establishment would be reviewed as a key
has occurred.
part of any incident investigation.
Outbreak/incident initial 1
As of April 2013, the Health Protection Agency
response became Public Health England (PHE), although
functions relating to these procedures remain
In England, incidents/outbreaks are recognised largely unchanged.
using surveillance methodology by the Public
Health England (formerly the Health Protection References
Agency)1, local authorities or microbiologists in Health Protection Agency (2011). London Infectious
laboratories at a local or national level. At the Disease Outbreak Management Plan.
local level is the Health Protection Team. As Health Protection Agency (2012). The
soon as it becomes apparent that an incident/ Communicable Disease Outbreak Plan V1.3.
outbreak may exist, immediate contact (Internal document).
between these parties is essential.

A risk assessment is undertaken following


receipt of initial information and a decision
made as to whether an outbreak or incident
exists. In order to inform all subsequent
decisions and actions, key facts would be
established by the duty (or on-call) Health
Protection Team.

An outbreak/incident is usually declared by the


Consultant in Communicable Disease Control
(CCDC) or Consultant in Health Protection
(CHP) after consultation with a consultant
microbiologist and/or senior environmental
health officer. The involvement and assistance
of the tattoo/body piercing premises
concerned would be a high priority.

Once an outbreak/incident is declared, a


multi-agency outbreak/incident control
team would be set up to fully investigate the
incident, ensure control measures are in place
and a report generated with lessons learned.
Main contents All legal powers relating to the investigation
of outbreaks lie with the local authority. An
40 outbreak/incident control team would give
Tattooing and body piercing guidance

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To

Model Byelaws: Acupuncture, tattooing, semi-permanent


skin-colouring, cosmetic piercing and electrolysis
Click on text to view Click to
download
Appendix 01 Model Byelaws:
Acupuncture, tattooing, semi-
permanent skin-colouring,
cosmetic piercing and
electrolysis
Appendix 02 Infection, its MODEL BYELAWS
causes and spread, including
a glossary of infection-related Acupuncture, tattooing, semi-permanent skin-colouring,
terms cosmetic piercing and electrolysis
Appendix 03 Blood borne
viruses
Byelaws for the purposes of securing the cleanliness of premises registered under sections 14(2) or
Appendix 04 Safe use and 15(2) or both of the Local Government (Miscellaneous Provisions) Act 1982 and fittings in such
premises and of persons registered under sections 14(1) or 15(1) or both of the Act and persons
disposal of sharps assisting them and of securing the cleansing and, so far as appropriate, sterilization of instruments,
materials and equipment used in connection with the practice of acupuncture or the business of
Appendix 05 First Aid tattooing, semi-permanent skin-colouring, cosmetic piercing or electrolysis, or any two or more of
such practice and businesses made by in pursuance of sections 14(7) or 15(7) or
following a blood/body fluid both of the Act.
exposure
Interpretation
Appendix 06 Protocol for
1.(1) In these byelaws, unless the context otherwise requires
cleaning up a blood or a blood The Act means the Local Government (Miscellaneous Provisions) Act 1982;
stained body fluid spill client means any person undergoing treatment;
hygienic piercing instrument means an instrument such that any part of the instrument that
Appendix 07 Principles for touches a client is made for use in respect of a single client, is sterile, disposable and is fitted
good waste handling with piercing jewellery supplied in packaging that indicates the part of the body for which it is
intended, and that is designed to pierce either
Appendix 08 Template (a) the lobe or upper flat cartilage of the ear, or
(b) either side of the nose in the mid-crease area above the nostril;
protocol for environmental
operator means any person giving treatment, including a proprietor;
cleaning of premises premises means any premises registered under sections 14(2) or 15(2) of the Act;
Appendix 09 Tattooing/body proprietor means any person registered under sections 14(1) or 15(1) of the Act;
treatment means any operation in effecting acupuncture, tattooing, semi-permanent skin-
piercing consent form colouring, cosmetic piercing or electrolysis;
the treatment area means any part of premises where treatment is given to clients.
Appendix 10 Aftercare follow-
(2) The Interpretation Act 1978 shall apply for the interpretation of these byelaws as it applies
up record sheet for the interpretation of an Act of Parliament.

Appendix 11 2.(1) For the purpose of securing the cleanliness of premises and fittings in such premises a
proprietor shall ensure that
Decontamination requirements (a) any internal wall, door, window, partition, floor, floor covering or ceiling is kept clean
for equipment used in tattooing and in such good repair as to enable it to be cleaned effectively;
(b) any waste material, or other litter arising from treatment is handled and disposed of in
and skin piercing accordance with relevant legislation and guidance as advised by the local authority;
Appendix 12 Equipment (c) any needle used in treatment is single-use and disposable, as far as is practicable, or
otherwise is sterilized for each treatment, is suitably stored after treatment and is
sterilization standard- self disposed of in accordance with relevant legislation and guidance as advised by the local
authority;
assessment and decision
(d) any furniture or fitting in premises is kept clean and in such good repair as to enable it
making tool for tattoo and body to be cleaned effectively;
piercing practitioners
Appendix 13 Equipment
and body piercing jewellery 1
sterilization standard for
tattooists and body piercers
Appendix 14 Autoclave daily
record sheet

Main contents
41
This PDF comprises of 6 pages
Tattooing and body piercing guidance

t
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To

Infection, its causes and spread


(including a glossary of infection-related terms)
Click on text to view The causes of infection Bacteria can replicate independently and
some bacteria can form spores that survive
Appendix 01 Model Byelaws: Numerous microorganisms harmlessly colonise
Acupuncture, tattooing, semi- in the environment for long periods of time,
the skin and the mucosal surfaces to form the
permanent skin-colouring, e.g. Mycobacterium tuberculosis, Group
normal flora of the human body. The presence
cosmetic piercing and A Streptococcus, Salmonella Enteritidis.
electrolysis of microorganisms does not constitute an
Antibiotics are used to treat bacterial
infection. Colonising microorganisms cause
Appendix 02 Infection, its infections; bacteria can develop resistance
causes and spread, including no damage and often provide benefit to the
to antibiotics, e.g. MRSA (meticillin resistant
a glossary of infection-related person. It is when there is associated tissue
Staphylococcus aureus).
terms damage that an infectious disease exists.
Appendix 03 Blood borne Potential pathogens can also act as colonisers Viruses are smaller than bacteria and cannot
viruses such as Staphylococcus aureus replicate independently but grow inside the
Appendix 04 Safe use and hosts cells. Viruses cannot be treated with
disposal of sharps Glossary of infection- antibiotics; there are a few anti-viral drugs
Appendix 05 First Aid related terms: available that are active against a limited
following a blood/body fluid A pathogen is an organism capable of invading number of viruses such as influenza. Many
exposure common viral infections resolve without
the body and causing disease. Such an organism
Appendix 06 Protocol for is termed pathogenic (Bannister et al, 2006) treatment, e.g. measles, mumps, and rubella.
cleaning up a blood or a blood
stained body fluid spill An infectious disease is an illness caused Pathogenic Fungi can be either moulds or
Appendix 07 Principles for by a pathogen, which invades body tissues yeasts. Infections caused by moulds or yeasts
good waste handling and causes damage. Not all infectious include ringworm caused by Trichophtyon
Appendix 08 Template diseases spread from person to person, e.g. rubrum and thrush, which is a common yeast
protocol for environmental Legionnaires disease. infection caused by Candida albicans.
cleaning of premises
Appendix 09 Tattooing/body A communicable disease is an infectious Transmission (spread) of
piercing consent form disease that is capable of spreading from infection
Appendix 10 Aftercare follow- person to person, e.g. measles, tuberculosis. How an infection is spread (transmitted) varies
up record sheet according to the type of microorganism. Some
Self infection (endogenous infection)
Appendix 11 microorganisms may be transmitted by more
Decontamination requirements
An infection that arises from the persons own
than one route:
for equipment used in tattooing body flora e.g. bacteria that colonise the skin
and skin piercing get into a break in the skin (wound) and cause Direct or indirect contact, e.g. Herpes
Appendix 12 Equipment an infection such as an abscess caused by simplex virus, respiratory syncytial virus,
sterilization standard- self Staphylococcus aureus. Staphylococcus aureus.
assessment and decision Respiratory droplets, e.g. influenza virus,
making tool for tattoo and body Cross infection (exogenous infection)
mumps, Bordetella pertussis (whooping
piercing practitioners This is an infection that arises from an external
cough).
Appendix 13 Equipment source e.g. from another person or via the
and body piercing jewellery environment. Airborne, e.g. pulmonary tuberculosis,
sterilization standard for measles, chickenpox.
tattooists and body piercers Groups of organisms capable Other infectious agents, such as blood-
Appendix 14 Autoclave daily of causing infection. borne viruses, e.g. hepatitis B and C and
record sheet D viruses (HBV, HCV, HDV) and HIV are
Pathogens relevant to body art can be
classified into: transmitted rarely in healthcare settings, via
percutaneous (sharps/ needles) or mucous
Bacteria are single celled organisms of membrane exposure (blood/ body fluid
approximately one-thousandth to five- splashes to eyes/ mouth/ open wounds).
Main contents thousandth of a millimetre in diameter.

42
Tattooing and body piercing guidance

t
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Infection, its causes and spread


(including a glossary of infection-related terms)
Click on text to view In tattooing and skin Indirect contact
Appendix 01 Model Byelaws: piercing procedures, Indirect spread of infection is said to occur when
Acupuncture, tattooing, semi- infection transmission can an intermediate carrier is involved in the spread
permanent skin-colouring, occur by direct contact and of pathogens such as hands, fomites or vectors.
cosmetic piercing and indirect contact.
electrolysis Hands The hands of the practitioners
Appendix 02 Infection, its Direct contact (person to person) are probably the most important vehicles
causes and spread, including Direct transmission occurs when of cross-infection within the tattooing
a glossary of infection-related and skin piercing environment. The hands
microorganisms are transferred from one
terms of staff and clients can carry microbes
infected person to another person without a
Appendix 03 Blood borne contaminated intermediate object or person. to other body sites, equipment and staff.
viruses Therefore, promotion of hygienic practices
Examples of direct contact include:
Appendix 04 Safe use and for everyone is the key to preventing and
disposal of sharps Blood or other body fluids (including blood controlling infections.
Appendix 05 First Aid stained) that enter the body through
A fomite is defined as an object that
following a blood/body fluid contact with a mucous membrane or breaks
becomes contaminated with infected
exposure (i.e. piercings, cuts, abrasions) in the skin.
organisms and which subsequently
Appendix 06 Protocol for
transmits those organisms to another
cleaning up a blood or a blood
stained body fluid spill person. Examples of potential fomites are
instruments or practically any inanimate
Appendix 07 Principles for
good waste handling article e.g. contaminated needles/
tattooing equipment (blood-borne viruses).
Appendix 08 Template
protocol for environmental References
cleaning of premises Bannister B, Gillespie S and Jones J (2006). Infection
Appendix 09 Tattooing/body Microbiology and Management. 3rd edition.
piercing consent form Blackwell Publishing.
Appendix 10 Aftercare follow-
up record sheet
Appendix 11
Decontamination requirements
for equipment used in tattooing
and skin piercing
Appendix 12 Equipment
sterilization standard- self
assessment and decision
making tool for tattoo and body
piercing practitioners
Appendix 13 Equipment
and body piercing jewellery
sterilization standard for
tattooists and body piercers
Appendix 14 Autoclave daily
record sheet

Main contents
43
Tattooing and body piercing guidance

t
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To

Blood borne viruses


Click on text to view Blood borne viruses (BBVs) are viral infections The infection is not passed on through everyday
which are spread through infected blood activities such as coughing, sneezing, shaking
Appendix 01 Model Byelaws:
Acupuncture, tattooing, semi- and body fluids, such as semen. The BBVs of hands or sharing food, crockery, baths or toilets.
permanent skin-colouring, greatest concern in the tattoo and piercing
cosmetic piercing and industry are hepatitis B virus (HBV), hepatitis C BBVs can cause serious, chronic diseases (e.g.
electrolysis virus (HCV), hepatitis D virus (HDV) and human liver cirrhosis, cancer) or even death to the
Appendix 02 Infection, its immunodeficiency virus (HIV). Hepatitis B and individual affected. If an individual has an
causes and spread, including C viruses infect and damage the liver. Hepatitis ongoing (chronic) infection, they will pose a
a glossary of infection-related
D (HDV) requires the presence of the hepatitis continuing risk of infection to others.
terms
B virus to survive in the body. This means that Sometimes an individual may be infected with
Appendix 03 Blood borne
it is only possible to have hepatitis D if one also a blood borne virus, but not be aware that they
viruses
has hepatitis B. HIV stops a persons body from have the infection and that they are therefore
Appendix 04 Safe use and fighting infections properly.
disposal of sharps an infectious risk to others.
Appendix 05 First Aid BBVs can be passed on or transmitted if an Infections from BBVs can be prevented or
following a blood/body fluid infected persons blood is able to enter another avoided in the tattoo and body piercing setting,
exposure persons bloodstream. This can happen in a if robust infection control practices (including
Appendix 06 Protocol for number of different ways: immunisation against hepatitis B) are used by
cleaning up a blood or a blood
stained body fluid spill Sexual contact, both heterosexual and all practitioners at all times when dealing with
homosexual. anyone elses blood and body fluids.
Appendix 07 Principles for
good waste handling Infected blood passing from one person to Reference:
Appendix 08 Template another e.g. through cuts or damaged skin. British Liver Trust (http://www.britishlivertrust.org.uk)
protocol for environmental Sharing razors or toothbrushes.
cleaning of premises
Sharing needles and syringes.
Appendix 09 Tattooing/body
piercing consent form Through ear piercing and other types of
Appendix 10 Aftercare follow-
body piercing, tattooing and acupuncture if
up record sheet equipment is not properly sterilized.
Appendix 11 From mother to baby during or after
Decontamination requirements pregnancy.
for equipment used in tattooing
All blood donations are now screened for
and skin piercing
hepatitis B virus, but before this started it
Appendix 12 Equipment
was possible to become infected through
sterilization standard- self
assessment and decision
blood transfusions.
making tool for tattoo and body
piercing practitioners
Appendix 13 Equipment
and body piercing jewellery
sterilization standard for
tattooists and body piercers
Appendix 14 Autoclave daily
record sheet

Main contents
44
Tattooing and body piercing guidance

t
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PDF version
To

Safe use and disposal of sharps


Click on text to view Before use: After use:
Appendix 01 Model Byelaws: Ensure that sharps disposal box is correctly Disposal of sharps is the responsibility of
Acupuncture, tattooing, semi- assembled. the user.
permanent skin-colouring,
cosmetic piercing and
Ensure that the label on the box is filled in Dispose of sharps immediately after use.
electrolysis upon assembly. Do not bend or break needles before disposal
Appendix 02 Infection, its Ensure appropriate colour sharps box lid (e.g. a tattoo needle from a needle bar).
causes and spread, including for use based on medicinal contamination Do not leave full sharps boxes for disposal
a glossary of infection-related and how the waste should be treated and by other staff.
terms disposed of i.e. orange lid for sharps derived
Fill sharps boxes only to the fill line and
Appendix 03 Blood borne from tattooing/body piercing procedures.
viruses never overfill.
Sharps boxes are type approved for solids
Appendix 04 Safe use and Shut and lock box when full for disposal.
and should not be used for quantities of
disposal of sharps Never use tape to seal sharps boxes.
liquid waste.
Appendix 05 First Aid Label box with source such as name of
following a blood/body fluid
Sharps boxes must comply with UN 3291
and BS7320 standards. person/ premises and describe waste
exposure
content.
Appendix 06 Protocol for Boxes must be available in different sizes.
cleaning up a blood or a blood Tamper-proof sharps containers are also Dispose of sharps boxes as clinical waste
stained body fluid spill available. for incineration only.
Appendix 07 Principles for Boxes must be available at all locations Never place sharps boxes in clinical/
good waste handling
where sharps are used. offensive waste bags.
Appendix 08 Template
Boxes must never be placed on the floor. Sharps containers must never be left
protocol for environmental unsupervised. They must be locked in a
cleaning of premises Boxes must be placed on a level surface or
cupboard/ operating/procedure room when
Appendix 09 Tattooing/body wall-mounted below shoulder height and
not in use.
piercing consent form be near to the area they are being used.
Never try and retrieve items from a sharps
Appendix 10 Aftercare follow- Boxes must never be left in areas where
container.
up record sheet clients may have open access to them.
Place damaged sharps containers inside
Appendix 11 Assess, in terms of risk, the most
Decontamination requirements a larger container lock and label prior to
appropriate size of sharps container for
for equipment used in tattooing disposal. Do not place inside a waste bag.
and skin piercing
the tattoo/body piercing setting.
Reference
Appendix 12 Equipment During use: National Institute for Clinical Excellence (NICE)
sterilization standard- self (2012). Infection control: Prevention and control
assessment and decision
Practitioners must be competent in of healthcare-associated infections in primary and
making tool for tattoo and body procedures using sharps. community care (CG139).
piercing practitioners The person using the sharp is responsible (http://guidance.nice.org.uk/CG139)
Appendix 13 Equipment for disposing of it.
and body piercing jewellery
Never pass sharps from hand to hand.
sterilization standard for
tattooists and body piercers Wear appropriate personal protective
Appendix 14 Autoclave daily equipment (gloves at a minimum).
record sheet Assemble devices with care.
Do not disassemble devices (e.g. needle bar
and needle)dispose of as a complete unit.
Do not re-sheath/recap used needles/razors.
Close sharps box opening (temporary
Main contents
closure device) between uses.
45 Never move an open sharps box.
Use the handle to carry.
Tattooing and body piercing guidance

t
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PDF version
To

First Aid following a blood/body fluid exposure


Click on text to view
Encourage bleeding where skin is punctured
Appendix 01 Model Byelaws:
or broken.
Acupuncture, tattooing, semi- 1
permanent skin-colouring,
Do not suck the wound.
cosmetic piercing and
electrolysis
Appendix 02 Infection, its
Wash thoroughly with mild liquid soap
causes and spread, including
under running warm water.
a glossary of infection-related 2
terms
Do not use a scrubbing brush.
Appendix 03 Blood borne
viruses
Appendix 04 Safe use and If eyes are involved, wash immediately with
disposal of sharps water for 5-10 minutes (use tap water, or
sterile water if available).
Appendix 05 First Aid
following a blood/body fluid
3
exposure If the mouth is contaminated, rinse with
Appendix 06 Protocol for
plenty of water.
cleaning up a blood or a blood
stained body fluid spill
Any cuts/punctures should be covered with a
Appendix 07 Principles for 4 waterproof plaster.
good waste handling
Appendix 08 Template

protocol for environmental Where there is considerable contamination
cleaning of premises of unbroken skin, remove contaminated
Appendix 09 Tattooing/body 5 clothing and wash all affected areas with
piercing consent form copious amounts of water.
Appendix 10 Aftercare follow-
up record sheet

The priority
Appendix 11 Remember to seek medical advice at the
Decontamination requirements is to seek
local Emergency Department as prophylactic
for equipment used in tattooing advice/ medical
treatment (if required) ideally needs to be
and skin piercing attention
given ideally within one hour and no later
Appendix 12 Equipment immediately,
than 72 hours. If relevant and if possible, it
sterilization standard- self
assessment and decision
6 is helpful if the details of the client whose
at a local
Emergency
making tool for tattoo and body needle was involved in the incident were
Department,
piercing practitioners brought to the Emergency Department in
ideally within
Appendix 13 Equipment a sealed envelope to help enable the risk
one hour of the
and body piercing jewellery assessment process
sterilization standard for injury occurring
tattooists and body piercers
Appendix 14 Autoclave daily Reference:
record sheet
Ensure that your manager or immediate Health and Safety
senior is informed immediately of the Executive (2012) How to
deal with an exposure
incident.
7 The person who has received the injury
incident. Blood Borne
Viruses Guidance.
(http://www.hse.gov.
should complete an incident form as per uk/biosafety/blood-
Main contents local guidelines. borne-viruses/how-deal-
exposure-incident.htm)
46
Tattooing and body piercing guidance

t
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PDF version
To

Protocol for cleaning up blood or a blood stained


body fluid spill
Click on text to view Cleaning up blood or a blood Blood spills on clothing
Appendix 01 Model Byelaws: stained body fluid spill Change clothes (immediately if possible) and
Acupuncture, tattooing, semi- Prevent access to the area containing the place into a plastic bag. Wash clothes as soon
permanent skin-colouring,
cosmetic piercing and
spillage until it has been safely dealt with. as possible in a hot cycle.
electrolysis Obtain chlorine based spill kit.
Cleaning up vomit or urine
Appendix 02 Infection, its Put on apron and gloves
causes and spread, including
spills
Apply disinfectant granules to the spill, this
a glossary of infection-related Chlorine-based disinfectants will give off highly
terms congeals the spill to enable easier cleaning of
the area OR make up and use the disinfectant toxic gas if mixed with acidic substances.
Appendix 03 Blood borne Ideally chlorine-based products should not be
viruses solution as per product instructions to a
dilution of 10,000ppm available chlorine. used on vomit and urine due to the slight risk
Appendix 04 Safe use and of chlorine gas being released. To clean up
disposal of sharps Leave in place for the designated exposure
time (at least two minutes). Ensure the vomit or urine spills, follow the same process as
Appendix 05 First Aid above but replace chlorine-based disinfectant
following a blood/body fluid
surface can tolerate chlorine.
granules with a non-chlorine based product,
exposure DO NOT USE MOPS TO CLEAN UP BLOOD. or use paper towels to absorb as much of the
Appendix 06 Protocol for Use the scoop and scraper (or disposable spillage as possible. Always clean areas with
cleaning up a blood or a blood
paper towels) to pick up the congealed detergent and warm water. A chlorine-based
stained body fluid spill
body fluid and place in the appropriate disinfectant can be used to disinfect the
Appendix 07 Principles for
waste bag. area but only after the urine/vomit has been
good waste handling
Using the disposable paper towels and cleaned up.
Appendix 08 Template
protocol for environmental disinfectant solution clean area thoroughly
cleaning of premises and dry afterwards. Detergent and warm IMPORTANT NOTE
Appendix 09 Tattooing/body water can also be used afterwards. Chlorine-based disinfectants/
piercing consent form Ensure all equipment used is disposed of in absorbent granules such as sodium
Appendix 10 Aftercare follow- the appropriate waste bag and then finally dichloisocyanurate (NaDCC) should
up record sheet remove gloves and apron and place in the not be used on urine or vomit spills.
Appendix 11 waste bag. NEVER mix chlorine-based disinfectants
Decontamination requirements Wash hands. with any other cleaning/disinfectants.
for equipment used in tattooing Hypochlorite solutions may bleach
and skin piercing Ensure that the waste bag is placed in
fabrics and other materials, as well
the appropriate disposal bin/container
Appendix 12 Equipment as corrode metals, so care is needed
sterilization standard- self immediately after use.
regarding which surfaces they can be
assessment and decision Damp-mop the affected area. used upon.
making tool for tattoo and body
piercing practitioners Managing blood spots
Appendix 13 Equipment
Apply chlorine based disinfectant solution to Reference
and body piercing jewellery
sterilization standard for a wet paper towel and clean spillage area. National Patient Safety Agency (2009). The Revised
Discard waste as above. Healthcare Cleaning Manual. (http://www.nrls.npsa.
tattooists and body piercers
nhs.uk/resources/?EntryId45=61830)
Appendix 14 Autoclave daily
record sheet If blood/body fluid splashes
into the eyes or mouth
Rinse freely with water. Seek immediate
medical advice if the splash gets into the
mucous membrane.
Main contents
47
Tattooing and body piercing guidance

t
o lki PART B Appendix 07 Click to download
PDF version
To

Principles for good waste handling


Click on text to view Good waste handling principles:
Appendix 01 Model Byelaws:
Waste should be segregated at the point of origin.
Acupuncture, tattooing, semi-
permanent skin-colouring, Bags/bins should only be filled to full.
cosmetic piercing and
electrolysis Waste bags should be used in foot operated pedal bins.
Appendix 02 Infection, its Waste bags should be sealed securely and marked with
causes and spread, including point of origin label prior to disposal.
a glossary of infection-related
terms Waste should be collected on a regular basis by a licensed
Appendix 03 Blood borne waste management contractor.
viruses
Personal protective clothing should be worn when
Appendix 04 Safe use and handling waste.
disposal of sharps
Appendix 05 First Aid Waste should be correctly bagged in appropriate colour-
following a blood/body fluid coded bags which must be UN-approved and comply with
exposure BS EN ISO 7765:2004 and BS EN ISO 6383:2004.
Appendix 06 Protocol for Waste should be double bagged where the exterior of the
cleaning up a blood or a blood
bag is contaminated or the original bag is split, damaged
stained body fluid spill
or leaking.
Appendix 07 Principles for
good waste handling Waste should be kept in a rigid-sided, fire retardant holder
Appendix 08 Template or container with a foot operated lid, and, so far as is
protocol for environmental reasonably practicable, out of the reach of children and
cleaning of premises unauthorised personnel.
Appendix 09 Tattooing/body
Waste should be stored in a labelled, lockable/secure,
piercing consent form
vermin-proof storage space for collection, on a well-
Appendix 10 Aftercare follow-
drained, impervious hard standing floor, which is provided
up record sheet
with wash-down facilities.
Appendix 11
Decontamination requirements Bags should be securely sealed and labelled with coded
for equipment used in tattooing tags at the point of use to identify their source.
and skin piercing
Waste should not be decanted into other bags, regardless
Appendix 12 Equipment
sterilization standard- self
of volume; be contaminated on the outside or re-used.
assessment and decision Sharps must be disposed of into approved sharps
making tool for tattoo and body
containers that meet BS 7320/UN 3291.
piercing practitioners
Appendix 13 Equipment Sharps containers should NEVER be placed into any
and body piercing jewellery waste bag.
sterilization standard for
tattooists and body piercers
Appendix 14 Autoclave daily
record sheet

Main contents
48
Tattooing and body piercing guidance

t
o lki PART B Appendix 08 Click to download
PDF version
To

Template protocol for environmental


cleaning of premises
Click on text to view ITEM FREQUENCY METHOD
Appendix 01 Model Byelaws:
Acupuncture, tattooing, semi- High risk treatment After use Treatment area surfaces cleaned and dried
permanent skin-colouring, surfaces between clients using detergent and then
cosmetic piercing and disinfected using a bleach solution (1000 ppm)
electrolysis
Appendix 02 Infection, its Use disposable cloths/paper towels
causes and spread, including
a glossary of infection-related Non high risk At least daily Use general-purpose detergent
terms surfaces
Dry thoroughly
Appendix 03 Blood borne
viruses Use disposable cloths/paper towels
Appendix 04 Safe use and
disposal of sharps Hand wash basins Daily Standard detergent
Appendix 05 First Aid
and sinks
following a blood/body fluid
Floors Daily Mop with water and detergent
exposure
Appendix 06 Protocol for Disinfectant is required only after
cleaning up a blood or a blood contamination with blood spillages
stained body fluid spill
Appendix 07 Principles for Bins As required Empty bins daily.
good waste handling
If contaminated, clean with water and
Appendix 08 Template
detergent and then disinfect
protocol for environmental
cleaning of premises
Couches Between clients Wipe with hot, soapy water and dry thoroughly
Appendix 09 Tattooing/body
piercing consent form Clean with disinfectant against blood borne
Appendix 10 Aftercare follow- viruses if contaminated with blood
up record sheet
Walls/ceilings As required Routine cleaning not required
Appendix 11
Decontamination requirements Clean periodically with water and general
for equipment used in tattooing
purpose detergent
and skin piercing
Appendix 12 Equipment Clean with disinfectant against blood borne
sterilization standard- self viruses if contaminated with blood
assessment and decision
making tool for tattoo and body
piercing practitioners Adapted from National Patient Safety Agency (2009). The Revised Healthcare Cleaning Manual.
(http://www.nrls.npsa.nhs.uk/resources/?EntryId45=61830)
Appendix 13 Equipment
and body piercing jewellery
sterilization standard for
tattooists and body piercers
Appendix 14 Autoclave daily
record sheet

Main contents
49
Tattooing and body piercing guidance

t
o lki PART B Appendix 09
To

Tattooing/body piercing consent form


Click on text to view Click to download Click to download
Word document version PDF version
Appendix 01 Model Byelaws:
Acupuncture, tattooing, semi-
permanent skin-colouring,
cosmetic piercing and
Tattooing/Body Piercing Consent Form
electrolysis
Name of Premises:
Appendix 02 Infection, its Address & Tel No of Premises:
causes and spread, including
a glossary of infection-related
terms Name of Practitioner (print):

Appendix 03 Blood borne Name of Client (print):


viruses Address & Tel No of client:

Appendix 04 Safe use and


disposal of sharps
Age of Client and DOB:
Appendix 05 First Aid Age ID of Client Seen: Yes / No
following a blood/body fluid Type of Procedure: Tattoo / Body Piercing
exposure Description:

Appendix 06 Protocol for


cleaning up a blood or a blood Site of Procedure and design if
applicable):
stained body fluid spill Type of Jewellery Used (as
applicable):
Appendix 07 Principles for
good waste handling
Appendix 08 Template
protocol for environmental
cleaning of premises
Appendix 09 Tattooing/body
piercing consent form
Appendix 10 Aftercare follow-
up record sheet
Appendix 11
Decontamination requirements
for equipment used in tattooing
and skin piercing
Appendix 12 Equipment
sterilization standard- self
assessment and decision
making tool for tattoo and body
piercing practitioners
Appendix 13 Equipment
and body piercing jewellery
sterilization standard for
tattooists and body piercers
Appendix 14 Autoclave daily
record sheet

Main contents
50
This document comprises of 3 pages
Tattooing and body piercing guidance

t
o lki PART B Appendix 10
To

Aftercare follow-up record sheet


Click on text to view Click to download Click to download
Word document version PDF version
Appendix 01 Model Byelaws:
Acupuncture, tattooing, semi-
permanent skin-colouring,
cosmetic piercing and
electrolysis AFTERCARE FOLLOW-UP RECORD SHEET
(ATTACH TO CONSENT FORM)
Appendix 02 Infection, its
causes and spread, including
NAME OF CLIENT:
a glossary of infection-related
terms
____________________________
Appendix 03 Blood borne
viruses
Date & Description of any concern or problem Signature of
Appendix 04 Safe use and time Action taken/advice given practitioner
disposal of sharps
Appendix 05 First Aid
following a blood/body fluid
exposure
Appendix 06 Protocol for
cleaning up a blood or a blood
stained body fluid spill
Appendix 07 Principles for
good waste handling
Appendix 08 Template
protocol for environmental
cleaning of premises
Appendix 09 Tattooing/body
piercing consent form
Appendix 10 Aftercare follow-
up record sheet
Appendix 11
Decontamination requirements
for equipment used in tattooing
and skin piercing
Appendix 12 Equipment
sterilization standard- self
assessment and decision
making tool for tattoo and body
piercing practitioners
Appendix 13 Equipment
and body piercing jewellery
sterilization standard for
tattooists and body piercers
Appendix 14 Autoclave daily
record sheet

Main contents
51
This document comprises of 1 page
Tattooing and body piercing guidance

t
o lki PART B Appendix 11 Click to download
PDF version
To

Decontamination requirements for equipment


used in tattooing and skin piercing
Click on text to view Equipment for Application of item Recommendations
Appendix 01 Model Byelaws: Tattooing:
Acupuncture, tattooing, semi-
Holders for needles i.e. tube, Hold needles that pierce skin Dismantle then clean and
permanent skin-colouring,
cosmetic piercing and
tip and grip sterilize, or single-use
electrolysis Needles and needle bars Pierce skin Single-use pre-sterilized
Appendix 02 Infection, its Ink caps Hold inks that will become Single-use
causes and spread, including contaminated with blood
a glossary of infection-related
Ink cap trays Hold ink caps and will become Either single-use or clean and
terms
contaminated with blood sterilize
Appendix 03 Blood borne during use
viruses
Motors & clipcords Will become contaminated Reduce contamination by
Appendix 04 Safe use and
with blood via the covering with impervious
disposal of sharps
practitioners hands barrier (e.g. plastic sleeving)
Appendix 05 First Aid
following a blood/body fluid Remove impervious barrier
exposure carefully after use minimising
Appendix 06 Protocol for transfer of contamination to
cleaning up a blood or a blood the item
stained body fluid spill
Thoroughly remove any visible
Appendix 07 Principles for
contamination with detergent,
good waste handling
then dry
Appendix 08 Template
protocol for environmental Disinfect surface with 70%
cleaning of premises alcohol
Appendix 09 Tattooing/body Elastic bands Will become contaminated Single-use
piercing consent form with blood via the
Appendix 10 Aftercare follow- practitioners hands
up record sheet Body piercing:
Appendix 11
Needles, cannulas Pierce skin Single use pre-sterilized
Decontamination requirements
for equipment used in tattooing Clamps used for skin folds, In close contact with pierced Clean and sterilize or single-use
and skin piercing looped forceps, pliers and skin
Appendix 12 Equipment receiving tubes
sterilization standard- self Jewellery Inserted into sterile body Sterilize or pre-sterilized
assessment and decision tissues
making tool for tattoo and body
piercing practitioners
Spatulas, cotton/gauze pads Will become contaminated Single-use
and paper towels with blood
Appendix 13 Equipment
and body piercing jewellery Vernier calipers Should only be used on clean, Clean between uses
sterilization standard for unbroken skin
tattooists and body piercers
Single use or autoclavable
alternative should be used for
Appendix 14 Autoclave daily oral and genital piercings
record sheet
Ear piercing guns These should only be of the Clean according to
type that use single-use self- manufacturers instructions
contained cartridge containing
the stud and back, such that
the gun itself makes no client
Main contents contact
Cartridges used with ear Single-use
52
piercing guns
Tattooing and body piercing guidance

t
o lki PART B Appendix 12 Click to download
PDF version
Equipment sterilization standard self assessment
To

and decision making tool for tattoo and body piercing


practitioners
Click on text to view
Appendix 01 Model Byelaws:
Dispose of safely
Acupuncture, tattooing, semi- Is the equipment and appropriately
permanent skin-colouring, Yes i.e. in offensive
for single use?
cosmetic piercing and waste bag or
electrolysis sharps bin
Appendix 02 Infection, its
causes and spread, including
a glossary of infection-related
terms
Appendix 03 Blood borne No
viruses
Appendix 04 Safe use and
disposal of sharps
Appendix 05 First Aid
following a blood/body fluid The instrument
exposure The instrument
is hollow and/or
Appendix 06 Protocol for is solid and
wrapped (including
cleaning up a blood or a blood unwrapped
stained body fluid spill
solid items)
Appendix 07 Principles for
good waste handling
Appendix 08 Template
protocol for environmental Sterilize using
cleaning of premises non-vacuum
Appendix 09 Tattooing/body autoclave with
Sterilize using
piercing consent form temperature and
vacuum autoclave
Appendix 10 Aftercare follow- pressure indicator
(type B or S) with
up record sheet gauges (type N) or
drying cycle
Appendix 11 vacuum autoclave
Decontamination requirements (type B or S) with
for equipment used in tattooing drying cycle
and skin piercing
Appendix 12 Equipment
sterilization standard- self
assessment and decision
making tool for tattoo and body
piercing practitioners
Appendix 13 Equipment
and body piercing jewellery
sterilization standard for
tattooists and body piercers
Appendix 14 Autoclave daily
record sheet

Main contents
53
Tattooing and body piercing guidance

t
o lki PART B Appendix 13 Click to download
PDF version
To

Equipment and body piercing jewellery sterilization


standard for tattooists and body piercers
Click on text to view
Appendix 01 Model Byelaws: Option 1 Option 2 Option 3
Acupuncture, tattooing, semi-
permanent skin-colouring,
cosmetic piercing and
electrolysis
Appendix 02 Infection, its
Using only: Using: Using only:
causes and spread, including solid unwrapped hollow instruments Single-use
a glossary of infection-related
terms
instruments and/or hollow body piercing and
Appendix 03 Blood borne and jewellery pre-sterilized
viruses
solid unwrapped and/or using any instruments body piercing
Appendix 04 Safe use and
disposal of sharps jewellery or body piercing jewellery which jewellery
Appendix 05 First Aid
are wrapped
following a blood/body fluid
exposure
Appendix 06 Protocol for
cleaning up a blood or a blood Your current Your current Your current
stained body fluid spill
autoclave is autoclave is autoclave is
Appendix 07 Principles for non-vacuum non-vacuum vacuum (type B
good waste handling
(type N) (type N) or S) with drying
Appendix 08 Template
protocol for environmental
cycle
cleaning of premises
Appendix 09 Tattooing/body
piercing consent form
No change in If you are No change in No change in
Appendix 10 Aftercare follow-
up record sheet your practice is unable to your practice is your practice is
Appendix 11
required switch to using required required
Decontamination requirements a vacuum
for equipment used in tattooing autoclave
and skin piercing
(type B or S)
Appendix 12 Equipment with drying
sterilization standard- self
assessment and decision
cycle, then use
making tool for tattoo and body single-use
piercing practitioners instruments
Appendix 13 Equipment and
and body piercing jewellery pre-sterilized
sterilization standard for
tattooists and body piercers
body piercing
jewellery
Appendix 14 Autoclave daily
record sheet instead

Main contents
54
Tattooing and body piercing guidance

t
o lki PART B Appendix 14
To

Autoclave daily record sheet


Click on text to view Click to download Click to download
Word document version PDF version
Appendix 01 Model Byelaws:
Acupuncture, tattooing, semi-
permanent skin-colouring,
cosmetic piercing and
electrolysis AUTOCLAVE DAILY RECORD SHEET
Appendix 02 Infection, its Please keep these records in date order for inspection
causes and spread, including Autoclave Type Serial Number
a glossary of infection-related
Week Commencing Location
terms
Appendix 03 Blood borne Type of Water used (ideally sterile water for irrigation)

viruses
Daily test Saturday Sunday Monday Tuesday Wednesday Thursday Friday
Appendix 04 Safe use and
disposal of sharps Cycle Counter
Number
Appendix 05 First Aid
Time to reach
following a blood/body fluid holding temp
exposure
Temp during
holding period
Appendix 06 Protocol for
cleaning up a blood or a blood Pressure during
holding period
stained body fluid spill Total time at
holding
Appendix 07 Principles for temp/pressure
Water drained at
good waste handling end of day where
appropriate
Appendix 08 Template
protocol for environmental Process check
used
cleaning of premises
Appendix 09 Tattooing/body Printout attached
piercing consent form Initials of
authorised user
Appendix 10 Aftercare follow-
up record sheet
Weekly Safety Test Yes/No Comments
Door seals secure
Appendix 11
Decontamination requirements Door safety devices
functioning correctly
for equipment used in tattooing
Safety Valves operating correctly
and skin piercing
Yearly service by a competent
Appendix 12 Equipment engineer
sterilization standard- self Comments
assessment and decision
making tool for tattoo and body Name Date Signature
piercing practitioners
Appendix 13 Equipment PLEASE KEEP THESE RECORDS IN A RING BINDER FOR SELF AUDIT/INSPECTION
and body piercing jewellery
sterilization standard for
tattooists and body piercers
Appendix 14 Autoclave daily
record sheet

Main contents
55
This document comprises of 1 page
Tattooing and body piercing guidance

t
o lki PART C Leaflet 01
To

Tattoo aftercare
Click on text to view Click to
download PDF
Leaflet 01 Tattoo aftercare

Leaflet 02 Ear and face


piercing aftercare
Tattoo aftercare
Leaflet 03 Oral piercing Key Advice Hand washing Signs of infection
aftercare Hand washing is the single most If appropriate aftercare is not followed
The aftercare following a tattoo important method of reducing infection. infection may occur. The signs of
is important to promote good Hands must be washed prior to touching
Leaflet 04 Body and surface the affected area, therefore reducing the
infection are:
healing and prevent the risk of risk of infection. Swelling and redness that increases
piercing aftercare infection. around the wound.
Wash your hands in warm water and
liquid soap, always dry your hands A severe burning and throbbing
Leaflet 05 Genital piercing For the first week or so it is thoroughly with a clean towel or paper sensation round the site.
normal for the area to be red towel. This should remove most germs
(female) aftercare and prevent them being transferred to Increased tenderness and increasingly
and tender. painful to touch.
the affected area.
Leaflet 06 Genital piercing As with all body art, infection is Tattoo aftercare
An unusual discharge (yellow or green)
with an offensive smell.
(male) aftercare a risk. To reduce these risks take
Good practice is to cover the tattooed
advice from your practitioner Speak to your practitioner or seek medical
area with non-stick gauze which is then
attention immediately if you suffer from
Leaflet 07 Microdermal regarding aftercare. secured with hypo-allergenic tape. Gauze
any of the above or have any concerns
permits ventilation and aids healing.
regarding infection in your tattoo or if
implants aftercare The risk of infection can be A tattoo covering a large area may there are any signs of an allergic reaction
greatly reduced by good need to be covered with a sterile, non- to any of the products used.
Poster How to handwash general hygiene including: adhesive dressing, at least during your
journey home. However, simply keeping
the area clean and dry is likely to be the
Hand washing before touching best approach.
the tattoo
A tattoo covering a large area may have
plastic film wrap applied, this must be
Keeping the tattooed clean (taken straight from the pack and
area covered with non-stick used immediately) and you should be
advised when to replace this covering by
gauze which is secured with your practitioner.
hypo-allergenic tape.
Any cream that you apply must be used
from an appropriate pot/tube at home
and you should wash your hands before
application. Cream can be purchased
from your practitioner or a pharmacist.

Antibiotic creams should not be used


except if infection has occurred and under
supervision of your Doctor.

For further advice or information:


Contact your local Environmental Health
Department, or your local Public Health
England Health Protection Team
This Information is provided by:
Public Health England North West
Public Health England East Midlands
Tattoo and Piercing Industry Union

Your practitioner is:

June 2013

Main contents
56
This document comprises of 1 page
Tattooing and body piercing guidance

t
o lki PART C Leaflet 02
To

Ear and face piercing aftercare


Click on text to view Click to
download PDF
Leaflet 01 Tattoo aftercare

Leaflet 02 Ear and face


piercing aftercare
Ear and face piercing aftercare
Leaflet 03 Oral piercing Key Advice Hand washing Note: Cartilage piercings occasionally form
Hand washing is the single most important lumps commonly known as granulomas.
aftercare The aftercare of body piercing method of reducing infection. Hands must This is just trapped fluid and can easily be
is important to promote good be washed prior to touching the affected resolved using the heat and pressure from a
area, therefore reducing the risk of infection. warm water compress once a day, replacing
Leaflet 04 Body and surface healing and prevent the risk of
one of your daily cleanings.
infection. Wash your hands in warm water and liquid
piercing aftercare soap, always dry your hands thoroughly Expect some swelling and soreness from
your new piercing. Any knock or bang can
Healing times for piercing will with a clean towel or paper towel. This
vary with the type and position should remove most germs and prevent cause swelling or soreness to flare up again
Leaflet 05 Genital piercing of the piercing and vary from them being transferred to the affected area. throughout the healing phase.

person to person. A new piercing can be tender, itchy and Do not use cotton wool to clean the
(female) aftercare slightly red and can remain so for a piercing as the fibres in the cotton wool
For the first few weeks it is few weeks. A pale, odourless fluid may may get caught in the piercing.
Leaflet 06 Genital piercing normal for the area to be red, sometimes discharge from the piercing and
form a crust. This should not be confused
Do not pick at any discharge and do
tender and swollen. not move, twist or turn the piercing
(male) aftercare with pus, which would indicate infection. whilst dry. If any secreted discharge has
Approximate healing times for the hardened then turning jewellery may
Ear piercing aftercare cause the discharge to tear the piercing,
Leaflet 07 Microdermal various piercings are: Including Lobes/ Tragus/ Anti Tragus/ allowing bacteria to enter the wound and
Conch/ Helix/ Snug/ Diath/ Industrial/ Rook/ prolonging the healing time.
implants aftercare Ear lobe piercing 6 to 8 weeks Translobal/ Transverse Lobe.
Ear cartilage piercing 6 to 8 weeks Do not use sunbeds for the first two
Facial piercing aftercare weeks, or if you decide to then cover the
Cheek piercing 2 to 3 months
Poster How to handwash Eyebrow piercing 2 to 4 months
Including Eyebrow, Bridge, Jestum, Vertical
Labret, Septum/ Nostril.
wound area with a breathable plaster
during tanning.
Nose piercing up to 6 months Do not swim for the first 24 hours
Soak the piercing for a few minutes by
following a piercing.
Remember these times are submerging the area of skin containing the
piercing in a clean jug or bowl containing Signs of infection
approximate and will depend on a warm water solution (1/4 level teaspoon If appropriate aftercare is not followed
how healthy you are and whether of preferably sea salt to an egg cup/shot infection may occur. The signs of
you look after the piercing glass of warm water). Alternatively wet a infection are:
properly until healed. clean cloth or gauze in the solution and Swelling and redness that increases
apply as a warm compress. This will soften around the wound.
As with all body art, infection is any discharge and allow you to clean the
entry and exit points of the piercing with A severe burning and throbbing
a risk. To reduce these risks take a cotton bud or gauze. Once the discharge sensation round the site.
advice from your practitioner is removed or softened then jewellery can Increased tenderness and increasingly
regarding aftercare. be gently moved so as to work a little warm painful to touch.
water through the piercing. When cleaning An unusual discharge (yellow or green)
The risk of infection can be always tighten the ball on any bars by with an offensive smell.
greatly reduced by good general screwing the ball to the right.
Speak to your practitioner or seek medical
hygiene including: Do this twice each day, preferably after attention immediately if you suffer from
washing or bathing. any of the above or have any concerns
Hand washing before touching regarding infection in your piercing or if
the piercing. You can also use mild antibacterial solutions there are any signs of an allergic reaction
and soaps to wash the wound site of an ear to any of the products used.
Keeping the piercing clean. piercing. Ask your local pharmacist to advise
you and always follow the manufacturers For further advice or information:
instructions. If irritation, redness or drying Contact your local Environmental Health
occurs discontinue use. Antibacterial wash is Department, or your local Public Health
NOT suitable for nostrils, septum or vertical England Health Protection Team
lips due to the tissues delicate nature. This Information is provided by:
Dry the piercing using ONLY fresh disposable Public Health England North West
paper towel/kitchen roll. A communal Public Health England East Midlands
hand/bath towel should never be used. Tattoo and Piercing Industry Union

Your practitioner is:

June 2013

Main contents
57
This document comprises of 1 page
Tattooing and body piercing guidance

t
o lki PART C Leaflet 03
To

Oral piercing aftercare


Click on text to view Click to
download PDF
Leaflet 01 Tattoo aftercare

Leaflet 02 Ear and face


piercing aftercare
Oral piercing aftercare
Leaflet 03 Oral piercing Key Advice Hand washing Do not pick at any discharge and do
Hand washing is the single most important not move, twist or turn the piercing
aftercare The aftercare of body piercing method of reducing infection. Hands whilst dry. If any secreted discharge has
is important to promote good must be washed prior to touching the hardened then turning jewellery may
Leaflet 04 Body and surface healing and prevent the risk of
affected area, therefore reducing the risk cause the discharge to tear the piercing,
of infection. allowing bacteria to enter the wound
piercing aftercare infection. and prolonging the healing time.
Wash your hands in warm water and
Healing times for piercing will liquid soap, always dry your hands Do not use sunbeds for the first two
Leaflet 05 Genital piercing vary with the type and position thoroughly with a clean towel or paper weeks, or if you decide to then cover the
wound area with a breathable plaster
towel. This should remove most germs
of the piercing and vary from during tanning.
(female) aftercare person to person.
and prevent them being transferred to
the affected area. Do not swim for the first 24 hours
following a piercing.
Leaflet 06 Genital piercing For the first few weeks it is A new piercing can be tender, itchy and
normal for the area to be red, slightly red and can remain so for a Special aftercare for tongue piercing
(male) aftercare tender and swollen. few weeks. A pale, odourless fluid may For the first few days take care when
sometimes discharge from the piercing eating and avoid spicy foods.
An approximate healing times and form a crust. This should not be
Leaflet 07 Microdermal confused with pus, which would indicate Cold products such as ice and ice cream
for oral piercing are: infection. can help reduce swelling.
implants aftercare
Tongue piercing 2 to 4 weeks. Oral piercing aftercare Refrain from oral sex of any description
Lip 3 to 6 weeks For the internal healing of oral piercing until the piercing has fully healed.
Poster How to handwash Cheek 2 to 3 months including all piercing of the tongue , lip
and cheek Signs of infection
If appropriate aftercare is not followed
Remember these times are Gargle after each meal with an alcohol-free infection may occur. The signs of
approximate and will depend mouthwash or a warm salt water solution infection are:
on how healthy you are and (1/4 level teaspoon of preferably sea salt to
Swelling and redness that increases
whether you look after the an egg cup/shot glass of warm water).
around the wound.
piercing properly until healed. For the external healing of oral piercing: A severe burning and throbbing
including all piercings to the lip and cheek sensation round the site.
As with all body art, infection is
a risk. To reduce these risks take Wet a clean cloth or gauze in the warm Increased tenderness and increasingly
salt water solution and apply as a warm painful to touch.
advice from your practitioner compress. This will soften any discharge
regarding aftercare. An unusual discharge (yellow or green)
and allow you to clean the entry and exit
with an offensive smell.
points of the piercing with a cotton bud
The risk of infection can be or gauze dipped into the warm salt water Speak to your practitioner or seek medical
greatly reduced by good general solution. Once the discharge is removed attention immediately if you suffer from
hygiene including: or softened then jewellery can be gently any of the above or have any concerns
moved so as to work a little warm water regarding infection in your piercing or if
Hand washing before touching through the piercing. When cleaning there are any signs of an allergic reaction
the piercing always tighten the ball on any bars by to any of the products used.
screwing the ball to the right.
Keeping the piercing clean.
Do this twice each day, preferably after For further advice or information:
washing or bathing. Contact your local Environmental Health
Department, or your local Public Health
Dry the piercing using ONLY fresh England Health Protection Team
disposable paper towel/kitchen roll.
A communal hand/bath towel should This Information is provided by:
never be used. Public Health England North West
Public Health England East Midlands
Do not use cotton wool to clean the Tattoo and Piercing Industry Union
piercing as the fibres in the cotton wool
may get caught in the piercing.

Your practitioner is:

June 2013

Main contents
58
This document comprises of 1 page
Tattooing and body piercing guidance

t
o lki PART C Leaflet 04
To

Body and surface piercing aftercare


Click on text to view Click to
download PDF
Leaflet 01 Tattoo aftercare

Leaflet 02 Ear and face


piercing aftercare
Body and surface piercing aftercare
Leaflet 03 Oral piercing Key Advice Hand washing Do not pick at any discharge and do
not move, twist or turn the piercing
aftercare The aftercare of body piercing
Hand washing is the single most important
whilst dry. If any secreted discharge has
method of reducing infection. Hands must
is important to promote good be washed prior to touching the affected hardened then turning jewellery may
Leaflet 04 Body and surface healing and prevent the risk of area, therefore reducing the risk of infection. cause the discharge to tear the piercing,
allowing bacteria to enter the wound and
piercing aftercare infection. Wash your hands in warm water and liquid prolonging the healing time.
soap, always dry your hands thoroughly
Do not wear tight clothing following
Healing times for piercing will with a clean towel or paper towel. This
Leaflet 05 Genital piercing vary with the type and position should remove most germs and prevent
nipple piercing
them being transferred to the affected area. Do not wear tight clothing e.g. tights,
(female) aftercare of the piercing and vary from belts or high waisted clothing after naval
person to person. A new piercing can be tender, itchy and piercing as this may irritate the wound
slightly red and can remain so for a and delay healing.
Leaflet 06 Genital piercing For the first few weeks it is few weeks. A pale, odourless fluid may
normal for the area to be red, sometimes discharge from the piercing and Do not use sunbeds for the first two
(male) aftercare form a crust. This should not be confused weeks, or if you decide to then cover the
tender and swollen. with pus, which would indicate infection. wound area with a breathable plaster
during tanning.
Leaflet 07 Microdermal Approximate healing times Body and surface piercing aftercare
Do not swim for the first 24 hours
for surface, navel and nipple including Nape, Horizontal Navel, Niple,
implants aftercare piercing can be as long as Horizontal Eyebrow, Wrist, Anti-eyebrow,
following a piercing.

Madison, Chin, Vertical Bridge, Pubic, Signs of infection


6 months to 1 year.
Poster How to handwash Handweb and Prayer. If appropriate aftercare is not followed
infection may occur. The signs of
Remember these times are Soak the piercing for a few minutes by
infection are:
approximate and will depend submerging the area of skin containing the
piercing in a clean jug or bowl containing Swelling and redness that increases
on how healthy you are and a warm water solution (1/4 level teaspoon around the wound.
whether you look after the of preferably sea salt to an egg cup/shot
A severe burning and throbbing
piercing properly until healed. glass of warm water). Alternatively wet a
sensation round the site.
clean cloth or gauze in the solution and
As with all body art, infection apply as a warm compress. This will soften Increased tenderness and increasingly
is a risk. To reduce these any discharge and allow you to clean the painful to touch.
entry and exit points of the piercing with
risks take advice from your a cotton bud or gauze. Once the discharge
An unusual discharge (yellow or green)
practitioner regarding with an offensive smell.
is removed or softened then jewellery can
aftercare. The risk of infection be gently moved so as to work a little warm Speak to your practitioner or seek medical
water through the piercing. When cleaning attention immediately if you suffer from
can be greatly reduced by good
always tighten the ball on any bars by any of the above or have any concerns
general hygiene including: screwing the ball to the right. regarding infection in your piercing or if
there are any signs of an allergic reaction
Hand washing before Do this twice each day, preferably after
to any of the products used.
washing or bathing.
touching the piercing
You can also use mild antibacterial solutions
Keeping the piercing clean. and soaps to wash the wound site. Ask your
local pharmacist to advise you and always
follow the manufacturers instructions. For further advice or information:
If irritation, redness or drying occurs Contact your local Environmental Health
discontinue use. Department, or your local Public Health
Dry the piercing using ONLY fresh disposable England Health Protection Team
paper towel/kitchen roll. A communal This Information is provided by:
hand/bath towel should never be used. Public Health England North West
Public Health England East Midlands
Do not use cotton wool to clean the Tattoo and Piercing Industry Union
piercing as the fibres in the cotton wool may
get caught in the piercing.

Your practitioner is:

June 2013

Main contents
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Tattooing and body piercing guidance

t
o lki PART C Leaflet 05
To

Genital piercing (female) aftercare


Click on text to view Click to
download PDF
Leaflet 01 Tattoo aftercare

Leaflet 02 Ear and face


piercing aftercare
Genital piercing (female) aftercare
Leaflet 03 Oral piercing Key Advice Hand washing Do not swim for the first 24 hours
following a piercing.
aftercare The aftercare of body piercing
Hand washing is the single most
important method of reducing infection.
is important to promote good Do not pick at any discharge and do
Hands must be washed prior to touching
Leaflet 04 Body and surface healing and prevent the risk of the affected area, therefore reducing the
not move, twist or turn the piercing
whilst dry. If any secreted discharge has
risk of infection.
infection.
piercing aftercare hardened then turning jewellery may
cause the discharge to tear the piercing,
Wash your hands in warm water and
Healing times for piercing will allowing bacteria to enter the wound and
liquid soap, always dry your hands
Leaflet 05 Genital piercing vary with the type and position thoroughly with a clean towel or paper prolonging the healing time.
of the piercing and vary from towel. This should remove most germs
(female) aftercare person to person. and prevent them being transferred to
Refrain from any type of sexual activity
until the piercing has healed or is dry.
the affected area.
For the first few weeks it is
Leaflet 06 Genital piercing A new piercing can be tender, itchy and
Always use barrier protection such as
normal for the area to be red, slightly red and can remain so for a
condoms, otherwise you are at increased
(male) aftercare tender and swollen. few weeks. A pale, odourless fluid may
risk of acquiring a sexually transmitted
infection.
sometimes discharge from the piercing
The healing time for a and form a crust. This should not be
Leaflet 07 Microdermal genital piercing can be from confused with pus, which would indicate
Signs of infection
If appropriate aftercare is not followed
2 to12 weeks. infection.
implants aftercare infection may occur. The signs of
Remember these times are Female Genital piercing aftercare infection are:

Poster How to handwash approximate and will depend including Clitoral Hood, Inner and Outer Swelling and redness that increases
Labia, Fourchette, Christina and Triangle. around the wound.
on how healthy you are and
whether you look after the Soak the piercing for a few minutes by A severe burning and throbbing
piercing properly until healed. submerging the area of skin containing sensation round the site.
the piercing in a clean container, such as
As with all body art, infection is a bowl containing a warm water solution Increased tenderness and increasingly
a risk. To reduce these risks take (1/4 level teaspoon of preferably sea salt painful to touch.
to an egg cup/shot glass of warm water).
advice from your practitioner Alternatively wet a clean cloth or gauze An unusual discharge (yellow or green)
regarding aftercare. in the solution and apply as a warm with an offensive smell.
compress. This will soften any discharge
The risk of infection can be and allow you to clean the entry and exit Speak to your practitioner or seek medical
greatly reduced by good points of the piercing with a cotton bud attention immediately if you suffer from
or gauze. Once the discharge is removed any of the above or have any concerns
general hygiene including: regarding infection in your piercing or if
or softened then jewellery can be gently
Hand washing before moved so as to work a little warm water there are any signs of an allergic reaction
through the piercing. When cleaning to any of the products used.
touching the piercing
always tighten the ball on any bars by
Keeping the piercing clean. screwing the ball to the right.

Do this twice each day, preferably after


washing or bathing.

Dry the piercing using ONLY fresh For further advice or information:
disposable paper towel/kitchen roll. Contact your local Environmental Health
A communal hand/bath towel should Department, or your local Public Health
never be used. England Health Protection Team
Do not use antibacterial products as This Information is provided by:
they can kill the good bacteria that are Public Health England North West
naturally present. Public Health England East Midlands
Tattoo and Piercing Industry Union

Your practitioner is:

June 2013

Main contents
60
This document comprises of 1 page
Tattooing and body piercing guidance

t
o lki PART C Leaflet 06
To

Genital piercing (male) aftercare


Click on text to view Click to
download PDF
Leaflet 01 Tattoo aftercare

Leaflet 02 Ear and face


piercing aftercare
Genital piercing (male) aftercare
Leaflet 03 Oral piercing Key Advice Hand washing Do not use antibacterial products as
Hand washing is the single most important they can kill the good bacteria that are
aftercare The aftercare of body piercing method of reducing infection. Hands naturally present.
is important to promote good must be washed prior to touching the
Leaflet 04 Body and surface healing and prevent the risk of affected area, therefore reducing the risk Do not swim for the first 24 hours
following a piercing.
of infection.
infection.
piercing aftercare Wash your hands in warm water and liquid Do not pick at any discharge and do
Healing times for piercing will soap, always dry your hands thoroughly not move, twist or turn the piercing
Leaflet 05 Genital piercing vary with the type and position with a clean towel or paper towel. This whilst dry. If any secreted discharge has
hardened then turning jewellery may
of the piercing and vary from should remove most germs and prevent
(female) aftercare person to person.
them being transferred to the affected area. cause the discharge to tear the piercing,
allowing bacteria to enter the wound and
A new piercing can be tender, itchy and prolonging the healing time.
For the first few weeks it is
Leaflet 06 Genital piercing slightly red and can remain so for a
normal for the area to be red, few weeks. A pale, odourless fluid may Refrain from any type of sexual activity
(male) aftercare tender and swollen. sometimes discharge from the piercing and until the piercing has healed or is dry.
form a crust. This should not be confused
The healing time for a Always use barrier protection such as
with pus, which would indicate infection.
Leaflet 07 Microdermal genital piercing can be from
condoms, otherwise you are at increased
Male Genital piercing aftercare risk of acquiring a sexually transmitted
implants aftercare 2 to12 weeks. infection.
including glans penis piercing such as
Remember these times are PA, Reverse PA, Apadravya, Ampallang, Signs of infection
Dydoe and Frenum, as well as for other
Poster How to handwash approximate and will depend
piercings including Hafada, Scrotum,
If appropriate aftercare is not followed
on how healthy you are and infection may occur. The signs of
Foreskin and Guiche.
infection are:
whether you look after the
Soak the piercing for a few minutes by
piercing properly until healed. submerging the area of skin containing
Swelling and redness that increases
around the wound.
As with all body art, infection is the piercing in a clean container, such as
a bowl containing a warm water solution A severe burning and throbbing
a risk. To reduce these risks take (1/4 level teaspoon of preferably sea salt sensation round the site.
advice from your practitioner to an egg cup/shot glass of warm water).
regarding aftercare. Alternatively wet a clean cloth or gauze Increased tenderness and increasingly
in the solution and apply as a warm painful to touch.
The risk of infection can be compress. This will soften any discharge
greatly reduced by good and allow you to clean the entry and exit An unusual discharge (yellow or green)
points of the piercing with a cotton bud with an offensive smell.
general hygiene including:
or gauze. Once the discharge is removed
or softened then jewellery can be gently Speak to your practitioner or seek medical
Hand washing before attention immediately if you suffer from
moved so as to work a little warm water
touching the piercing through the piercing. When cleaning any of the above or have any concerns
always tighten the ball on any bars by regarding infection in your piercing or if
Keeping the piercing clean. there are any signs of an allergic reaction
screwing the ball to the right.
to any of the products used.
Do this twice each day, preferably after
washing or bathing.

When cleaning always tighten the ball on For further advice or information:
any bars by screwing the ball to the right. Contact your local Environmental Health
Department, or your local Public Health
Dry the piercing using ONLY fresh England Health Protection Team
disposable paper towel/kitchen roll. This Information is provided by:
A communal hand/bath towel should Public Health England North West
never be used. Public Health England East Midlands
Tattoo and Piercing Industry Union

Your practitioner is:

June 2013

Main contents
61
This document comprises of 1 page
Tattooing and body piercing guidance

t
o lki PART C Leaflet 07
To

Microdermal implants aftercare


Click on text to view Click to
download PDF
Leaflet 01 Tattoo aftercare

Leaflet 02 Ear and face


piercing aftercare
Microdermal implants aftercare
Leaflet 03 Oral piercing Key Advice Hand washing Do not pick at any discharge and do
Hand washing is the single most important not move, twist or turn the piercing
aftercare The aftercare of body piercing method of reducing infection. Hands must whilst dry. If any secreted discharge has
is important to promote good be washed prior to touching the affected hardened then turning jewellery may
Leaflet 04 Body and surface healing and prevent the risk of area, therefore reducing the risk of infection. cause the discharge to tear the piercing,
allowing bacteria to enter the wound and
infection. Wash your hands in warm water and liquid
prolonging the healing time.
piercing aftercare soap, always dry your hands thoroughly
Microdermal implants or dermal with a clean towel or paper towel. This Do not wear clothing that will rub against
should remove most germs and prevent the piercing as this may irritate the
Leaflet 05 Genital piercing anchors are small pieces of them being transferred to the affected area. wound and delay healing.
jewellery made from titanium
A new piercing can be tender, itchy and Do not use sunbeds for the first two
(female) aftercare inserted into the skin with the slightly red and can remain so for a weeks, or if you decide to then cover the
stem protruding above, onto few weeks. A pale, odourless fluid may wound area with a breathable plaster
sometimes discharge from the piercing and during tanning.
Leaflet 06 Genital piercing which an attachment of your
form a crust. This should not be confused
choice is fitted. This attachment with pus, which would indicate infection.
Do not swim for the first 24 hours
(male) aftercare should remain in place for at following a piercing.
Keeping the implant piercing clean
least three months or until the The implant needs to be cleaned twice Accidental damage or loss of disc
Leaflet 07 Microdermal piercing has fully healed. Once it each day. Cleaning more frequently may Contact your practitioner if the implant
gets caught in anything or the piercing
has fully healed other pieces of damage the skin and slow down the
becomes damaged.
implants aftercare jewellery can be attached.
healing process. Your practitioner may also
advise you to soak the implant in warm salt In the unlikely event the disc breaks or
Healing times for piercing will water twice a week. comes off, return to the practitioner and
Poster How to handwash vary with the type and position Make up a quantity of warm salt water have a new disk fitted immediately. If the
solution (1/4 level teaspoon of preferably sea disc is not replaced the implant may get
of the piercing and vary from salt to an egg cup/shot glass of warm water). lost under the skin and will require removal.
person to person. Signs of infection
Use a clean cloth or gauze dipped in the
solution and apply as a warm compress If appropriate aftercare is not followed
For the first few weeks it is infection may occur. The signs of
and also to dab the area to make sure the
normal for the area to be red, area under the disc is cleaned as this may infection are:
tender and swollen. become encrusted. Swelling and redness that increases
As with all body art, infection is This will soften any discharge and allow around the wound.
you to clean the piercing points with a A severe burning and throbbing
a risk. To reduce these risks take cotton bud or gauze dipped into the warm sensation round the site.
advice from your practitioner salt water solution.
regarding aftercare. Increased tenderness and increasingly
If the area around the implant becomes
painful to touch.
encrusted soak the piercing for a few
The risk of infection can be minutes by submerging the area of skin An unusual discharge (yellow or green)
greatly reduced by good general containing the piercing in a clean jug with an offensive smell.
hygiene including: or bowl containing the warm salt water Speak to your practitioner or seek medical
solution and loosen the discharge using a attention immediately if you suffer from
Hand washing before touching cotton bud or clean floss. any of the above or have any concerns
the implant. Always dry the area thoroughly after regarding infection in your piercing or if
cleaning your implant using ONLY fresh there are any signs of an allergic reaction
Keeping the implant clean. disposable paper towel/kitchen roll. to any of the products used.
A communal hand/bath towel should
For further advice or information:
never be used.
Contact your local Environmental Health
Do not over clean the site as this may Department, or your local Public Health
damage the skin around the implant England Health Protection Team
Do not change the cap of the microdermal This Information is provided by:
implant until fully healed. If in any doubt take Public Health England North West
advice from your operator Public Health England East Midlands
Do not use cotton wool to clean the Tattoo and Piercing Industry Union
piercing as the fibres in the cotton wool
may get caught in the piercing.

Your practitioner is:

June 2013

Main contents
62
This document comprises of 1 page
Tattooing and body piercing guidance

t
o lki PART C Poster
To

How to handwash
Click on text to view Click to
download PDF
Leaflet 01 Tattoo aftercare

Leaflet 02 Ear and face

How to Handwash?
piercing aftercare

Leaflet 03 Oral piercing


aftercare
WASH HANDS WHEN VISIBLY SOILED! OTHERWISE, USE HANDRUB
Leaflet 04 Body and surface
Duration of the entire procedure: 40-60 seconds
piercing aftercare

Leaflet 05 Genital piercing 0 1 2


(female) aftercare

Leaflet 06 Genital piercing


(male) aftercare
Wet hands with water; Apply enough soap to cover Rub hands palm to palm;
all hand surfaces;
Leaflet 07 Microdermal
implants aftercare
3 4 5
Poster How to handwash

Right palm over left dorsum with Palm to palm with fingers interlaced; Backs of fingers to opposing palms
interlaced fingers and vice versa; with fingers interlocked;

6 7 8

Rotational rubbing of left thumb Rotational rubbing, backwards and Rinse hands with water;
clasped in right palm and vice versa; forwards with clasped fingers of right
hand in left palm and vice versa;

9 10 11

Dry hands thoroughly Use towel to turn off faucet; Your hands are now safe.
with a single use towel;

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this document. However, the published material is being distributed without warranty of any kind,
either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
WHO acknowledges the Hpitaux Universitaires de Genve (HUG), in particular the members of the Infection Control Programme, for their active participation in developing this material.

May 2009

Main contents
63
This document comprises of 1 page
Tattooing and body piercing guidance

t
lki
o PART D
To

Audit tool
Click to download
Excel document

INFECTION CONTROL AUDIT FOR TATTOO AND BODY PIERCING PREMISES*


NAME AND ADDRESS OF PREMISES:
TELEPHONE NUMBER:
OWNER/ LICENCEES NAME:
OPERATORS NAME:
EMAIL CONTACT DETAILS

TYPE OF PREMISES (please tick as applicable)


Tattooing 
Body Piercing 
Other (please state):

DATE OF AUDIT:
NAME OF AUDITOR:

Indicators met: 0
Indicators not met: 0
Indicators not applicable: 0
Overall score: -

This audit tool is to be used by practitioners, primarily, to enable good practice to be captured and documented.
It can also identify best practice gaps which will need action to be taken using an action planning process. It can
be used as a discussion point between practitioner and local authority officers, as to what practice gaps need to
be prioritised.

Completion:
Please allow approximately two hours to undertake the audit.
In the "Met" column, record "Yes", "No" or "N/A" against all indicators.

To print all pages:


Go to "print" and choose "entire workbook".

Calculating scores:
Automatic - This tool will give you automated % scores for each standard, and an overall % score (above).
However, this requires data to be entered electronically during or after audit.

Manual - Count up the number of 'Yes' answers and divide by the number of questions answered for that
standard (excluding the "N/A"s), then multiply by 100 to get the percentage. To get the score for all the
standards and for the audit overall, add the total number for each standard and divide by the number of
questions and multiply by 100 to get the overall percentage.

*developed using Infection Prevention Society (IPS) audit tools for monitoring IC guidelines withing the community setting (2005); IPS
self assessment audit for assessing implementation of HTM 01-05: decontamination in primary care dental practices and related
infection prevention and control issues (2009); IPS audit tools for monitoring infection control standards (2004); International Scientific
Forum on Home Hygiene (IFH) and IPS home hygiene -prevention of infection at home: a training resource for carers and their trainers
(2003)

Main contents
64
This document comprises of 15 work sheets
Tattooing and body piercing guidance

t
lki
o PART E
To

Literature reviews
Click to download
Word document

Literature review on the epidemiology of

tattooing and its complications


V0.7

Dr Victor Aiyedun

Specialist Registrar,

Public Health Medicine

Supervised by

Dr Fortune Ncube

Consultant Epidemiologist,

Health Protection Agency, Colindale

Main contents
65
This document comprises of 46 pages