FOR
PERMANENT MAKEUP & TATTOO ARTISTS
A general explanation of the epidemiology of blood born pathogens: Any item which has been contaminated with body fluids can potentially transfer disease. Therefore these items must be considered to be bio-hazardous waste and disposed of appropriately.
Universal precautions and exposure controls: Employees must be protected from contact with potentially infected materials. This means that gloves are to be worn for all tattoo procedures. Protective eyeglasses and mask should be worn if there is any possibility of airborne contamination.
An
explanation of proper use, handling and disposal of personal
protection equipment:
Blood soiled or material soiled by other body fluids will be red-bagged and needles and sharps will be disposed of in proper containers. A contract with
a licensed bio-hazardous waste disposal company will be
maintained.
Information regarding hepatitis infection and the options for vaccination: Hepatitis is by definition an inflammation of the liver that can be associated with cellular death. The disease may be caused by one of several viruses, from drug, chemical injury or related to metabolic disorders. Hepatitis of a viral etiology represents the most common cause. Hepatitis A, hepatitis B, and non-A, non-B hepatitis are of primary concern. Clinically they can be difficult to differentiate and diagnosis depends on serologic laboratory finding. Symptoms can include fever, joint pain, rash, fatigue, muscle pain, loss of appetite, aversion to cigarettes, photophobia, headache, sore throat, swollen Iymph nodes and itching. However, hepatitis may run a sub-clinical course with no obvious symptoms. The transmission of hepatitis A is mainly through the fecal oral route. Outbreaks are more of a problem where sanitation is below par t but can also be seen in nursery or day-care settings. Thirty to forty percent of the U.S. population has had hepatitis A, but there is no carrier state and this form of hepatitis A is always self-limiting. Hepatitis B is usually acquired by parenteral exposure, i.e. needle sticks, skin or mucosal exposure, sexual contact. All body fluids, except stool, have been found to contain hepatitis B. It is estimated that between 5% and 10% of the U.S. population have had hepatitis B and that about 0.4% are carriers. Non-A, non-B hepatitis, a category involving about four other viruses, is also transmitted primarily by parenteral exposure with approximately a carrier rate of 1 - 2%. If exposed to hepatitis A, the prompt administration of immune globulin can give passive immunity . There is no vaccine. There is a vaccine available for hepatitis B, but if exposed and there has been no previous immunization, a hepatitis immune globulin is also available. There currently is no vaccine for non-A, non-B hepatitis.
Record keeping of training sessions: A semiannual letter from supervising medical personnel will be kept as part of this record.
A basic review of bacteriology and sterilization: Bacteria are ubiquitous. Although the tattooed area should be thoroughly cleansed, removing all make-up and lotions, there is no means by which the skin can be sterilized. Instrumentation, however, should be disinfected. Tattoo needle tips are disposable, but any other non-disposable portion of the equipment that could have come into contact with body fluids must be treated. Several techniques are available for sterilization or disinfection. Dry heat (heating articles to 350° for at least 45 minutes), boiling water (boiling for 15 minutes), and ionizing radiation can be effective. Of more practical use is the use of steam under pressure (using an autoclave), the use of chemica1s (appropriate antibacterial-antiviral, and anti-fungal solutions or bleach - an appropriate solution would be Lehn and Fink Instrument Germicide, Lehn & Fink Industrial Products Division, Montvale, N.J. 07645), or ethylene oxide gas (effective for sterilizing hand pieces and available for office use as a closed system).
A review of BLS: BLS courses are available through the local hospitals. The American Heart Association also provides instruction. It is advisable that operators should avail themselves of the information. (Attached outline).
CLIENTS NOT TO BE TATTOOED:
Under 18 without parents or guardians notarized consent.
Uncontrolled diabetics.
Glaucoma clients for eyeliner.
Clients infected with AIDS or active hepatitis.
Not to tattoo in areas involved with viral or bacterial infection.
Avoid individuals with keloids, psoriasis or generalized diffuse skin disorder.
MINOR PROBLEMS:
Syncope: cold compress; smelling salts (ammonia capsules); water, soda or juice; leg elevation provides for comfort.
Breathing or pulse should be preserved or call 911.
Anxiety: cessation of procedure and provide reassurance.
Bleeding: gentle pressure and ice.
Topical allergies: symptom and sign: rash and itching. Understand the potential for allergic response, particularly to topical antibiotics - requires discontinuance of medication and referral if problem does not promptly resolve.
Conjunctivitis: inflammation of the mucous membrane covering the lids and surface of the conjunctiva, tearing, exudate.
Bacterial: Pinkeye can be caused by pneumococcus, staphylococcus, streptococcus, H. influenzae, E. coli or other common organisms. Interesting that pathogenic bacteria from the genitourinary tract grow well on the conjunctiva. Gonorrhoea can produce a profuse exudate. Acute bacterial conjunctivitis is almost always self limited, but staphylococcal and gonococcal conjunctivitis can be exceptions. Always refer for evaluation.
Marginal blepharitis: Inflammation of the eyelids, granulated eyes. Symptoms: irritation, burning, itching lid margins. Signs: red rimmed eyes and dry scales on lashes when bacterial (usually staphylococcaI). Refer for evaluation.
Hordeolum: Sty, infection of the glands of the eyelid. Symptoms: Pain. redness and swelling. Usually caused by staphylococcus, Refer for treatment.
Corneal Abrasion: Scratch on surface of the eye. Symptom: burning pain. Should resolve within 24 hours, but refer for treatment. Pain can be easily relieved with a topical ophthalmologic anesthetic.
MAJOR PROBLEM:
Symptomatic coronary artery disease: A client complaining of chest pain or pressure, particularly if radiating to the left side of the neck or shoulder may be experiencing angina which can be a precursor of a heart attack. They may become sweaty, anxious, nauseated or short of breath. The procedure should be stopped and the client made comfortable. If the client carries nitroglycerin tablets, they should be used. If symptoms persist for more than 2 minutes, call 911. Call for assistance. If client loses pulse and respiration, institute BLS if qualified.
Importance of a brief medical history : Should include name, date
and allergies.
Questions should elicit whether there has been a history of heart disease
(angina, heart attack), heart valve disease (should be on antibiotics before
treatment), bleeding problems, eye disease or infections, diabetes, epilepsy,
fainting spells, contact lenses, prone to fever blisters, history of hepatitis
or possible AIDS exposure or a possibility of pregnancy .
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