Cornet – Project
„Health Safety in Connection with the Use of Tattoo and Permanent Make-up Dyes“
WP3
Definition of a Common Standard for Tattooing
Definite Version
Table of contents
1.Introduction...... ...
1.1.Definitions
1.2.Health considerations and risks
1.3.Existing regulations
1.4.Target group of the code of good practice
2.Code of good practice
2.1.Professional code of ethics
2.2.Facilities and hygiene in the reception and work areas
2.3.Handling of materials and instruments
2.4.Procedures
2.5.Post-tattooing care
2.6.Collection and treatment of waste
2.7.General recommendations
1.Introduction
1.1.Definitions
By "tattooing", we mean the whole procedure by which pigment/ink is introduced under the skin using one or more needles.
Tattooing is a technique for decorating the body. A motif/drawing is created that is meant to look decorative.
Permanent make-up is a cosmetic tattooing technique by which pigments are introduced under the skin to embellish the eyes, the arch of the eyebrows and the lips.
Permanent make-up is not ornamental; it accentuates the natural features of the face, mainly for practical purposes.
Micro pigmentation or dermography includes permanent make-up and reconstructive treatments, especially enlargement of the upper/lower lip, complete colouring of the lips, correction of a labial fissure (commonly known as harelip), camouflaging of burn, operation and accident scars, reconstruction of the areola or the nipple.
The main differences between tattooing and permanent make-up/micro pigmentation lie in the type of pigment/ink used, the depth and angle of the needle, the equipment used as well as and primarily the purpose of the operation.
The purpose of tattooing, permanent make-up and micro-pigmentation is to obtain a permanent change of colour. After a certain time, the results can fade, depending on the way in which the pigment/ink was introduced, the type of pigment/ink, the equipment used, the effects of the sun/of medicines and changes and reactions in the body.
All the terms mentioned above are tattooing techniques. They are used without differentiation. The aesthetic purpose is paramount and the safety and well being of the customer are the main concern.
In this text, the term tattooing is used for both tattooing and permanent make-up, micro-pigmentation and dermography.
1.2.Health considerations and risks
Technically, these treatments are no different from the perforation of the skin performed to insert a drip or that done to the gums during dental treatment. The aim of tattooing, however, is not to improve health. The treatment actually only aims to make an aesthetic change.
Tattooing is an operation that can have health repercussions: formation of scars, bacterial infection, viral infection (hepatitis, HIV). To guard against any of these outcomes it is therefore necessary to observe the same hygiene rules at those which apply during normal medical treatments.
1.3. Existing regulations
See adjoining table (Appendix 1).
1.4.Target group of the code of good practice
Professional tattooists are the target group of the code of good practice. It is also aimed at: beauticians and other professionals whose secondary activity is micro pigmentation.
2.Code of good practice
The present code of good practice is set out under the following headings:
-Professional code of ethics;
-Facilities and hygiene in the reception and work areas;
-Handling of equipment and instruments;
-Procedures
- to be followed for tattooing;
- to be followed for washing hands;
- to be followed in case of an accidental pricking;
-Post-tattooing care;
-Collection and handling of waste.
2.1.Professional code of ethics
Age – offer
2.1.1.Tattooing can only be practised on persons aged at least 18, adult and legally responsible. People over 18 without legal responsibility cannot be tattooed.
2.1.2.In exemption to point 2.1.1., tattooing of persons under 18 years of age or without legal responsibility may be considered as long as all the following conditions are met:
-the person to be tattooed is at least 16 years old;
-the professional can reasonably estimate that the person to be tattooed has reached physical maturity or that their body will not undergo further significant changes during the next two years;
-the professional has received in advance the written authorisation of all persons who have parental authority over the person to be tattooed;
-the tattooing is carried out in the presence of at least one of the persons with legal responsibility for the minor; this condition does not apply to persons under 18 years of age who have been the subject of legal emancipation.
2.1.3.The written authorisation detailed in point 2.1.2. must contain full details of the person to be tattooed and persons with parental authority (name, first name, address, telephone number, relationship). It must also state the form, size and place on the body of the design to be tattooed. It must be retained by the professional for at least two years.
2.1.4.A tattooing carried out on medical advice is exempt from the conditions laid out in points 2.1.1. to 2.1.3.
Time to consider, information, information obligation
2.1.5.All customers, both adults and minors, have the right to a professional consultation followed by time to consider their decision before undergoing a treatment, which is without obligation.
2.1.6.It must be clearly explained to the customer that having a tattoo is a permanent and final act and that the operation is by no means painless. Moreover, it is not always possible to completely erase the result, even by laser.
2.1.7.Publicity, brochures, the website and advice content or any other publications may not leave room for misunderstanding or contain misleading information on the subject or the tattooing operation itself.
2.1.8.Before the operation customers will be informed, orally and in writing, of the potential risks and complications of the chosen procedure; of the healing time; of what they must not do during the healing time and the care procedures to be followed.
2.1.9.The professional will make it their business to find out, before the operation, about the general health of the customer and their age. Written proof must be retained for at least one year.
2.1.10.Once the operation has been completed the customer will be given written instructions on the care procedures to follow. The professional will go over these with the customer.
Anaesthesia
2.1.11.Only medical staff may carry out a sub-cutaneous anaesthetic. Professionals without medical training may not carry it out.
2.1.12.It is permitted to use anaesthetics in the form of creams, gels or sprays bought in a pharmacy by following the products’ own instructions for use.
Behaviour
2.1.13.Tattooing may not be carried out on persons who are under the influence of alcohol, drugs or medicines which affect their decision-making capacity or who, more generally, are not in possession of their decision-making capacities.
2.1.14.Tattooing may not be carried out by professionals under the influence of drugs or alcohol.
Equipment
2.1.15.Equipment (unipacks, disinfectant) used during the tattooing must carry a label listing the ingredients and, if such be the case, the CE symbol or the relevant EN-ISO standard.
2.1.16.Gloves must be latex, nitrile or vinyl and may be used only once.
Fairs, gatherings
2.1.17.Professionals only carry out their activity in their place of work. They therefore may not perform any work in other places not suitable for tattooing such as cafés, back-of-shops, kitchens, barns, cellars, trade and erotic fairs, bikers’ meetings, music festivals, exhibitions, fairs, (flea)markets.
2.1.18.Professional meetings, specifically organised by professionals, constitute an exception to point 2.1.17. It goes without saying that all the rules in the present code also apply to such meetings.
Technical quality of work
2.1.19.The professional will carry out the work demanded according to the rules of the art.
2.1.20.No unnecessary scarring will be caused to customers, who, moreover, will not be exposed to any danger as a result of the procedure or the products used.
2.2.Fitting out and hygiene in the reception and work areas
2.2.1.The reception area and the work area must be separated by a partition.
2.2.2.It is forbidden to smoke or to drink alcohol in the work area. Nor may animals be admitted to this area. The area shall be regularly ventilated.
2.2.3.The walls and floor of the work area will be made of a non-porous durable material.
2.2.4.The work area must be cleaned daily with a disinfectant. The reception must be cleaned daily with a detergent.
2.2.5.The lighting must be bright and full to avoid accidents associated with poor lighting. When an adjustable lamp is used, it must be disinfected between the visits of each customer.
2.2.6.Regular cleaning of work surfaces plays a major part in the cycles of disinfection and cleaning.
2.2.7.The armchair or couch on which the customer sits during the operation must be covered in a non-porous and easy to clean material. The armchair must be disinfected between the visits of each customer even if an examining sheet is used.
2.2.8.The trays on which equipment is placed must be stable and made of a non-porous material. They must be disinfected before and after each time they are used.
2.2.9.The work surface must be made of a non-porous material that can be cleaned and disinfected before and after every time it is used.
2.2.10.The work area is made of a disposable, impermeable, use-once-only material, for example, plastic film. When a tray is used, it must also be covered in a similar impermeable disposable material. This tray must be disinfected between each client.
2.2.11.During a tattooing session, the tattooist uses a small individual waste container (perhaps a plastic rubbish bag). When the work is completed, this individual bin is disposed of:
-Either in a waste bin situated within the work place and made of hard plastic or metal and equipped with a lid. This must open by means of a pedal action. The waste gathered in this bin must be emptied out every day into the main dustbin that is the final place where all rubbish is put. This dustbin will conform to the specific requirements for collecting household waste imposed by the council in which the establishment is situated;
-Or in the main dustbin that is the final place where all rubbish is put, which conforms to the requirements cited above.
2.2.12.The work area must be equipped with a washbasin for washing hands before and after every operation. It must be easily accessible. The wshbasin must be equipped with a tap that is operated by a pedal or with the elbow or with an infrared tap. Dispensers of liquid soap and paper towels, which must be thrown away after being used once, complete the area used for washing hands.
2.3.Handling of materials and instruments
2.3.1.A general rule: materials must be, as much as is possible, disposable. In the same way, it is recommended that inks in use-once-only packages be used. Reusable materials as well as instruments must be cleaned and, if possible, sterilised after use. All accessories that come into contact with the hands or with the customer must be encircled with adhesive tape or wrapped up before use.
2.3.2.The tattooing needles can be used only once and must be put away after use, at the moment they are detached, in a closed container that contains a disinfectant.
2.3.3.Gloves, dressings, swabs, razors, small ink or pigment recipients, as well as any other materials can be used only once.
2.3.4.All new materials and all materials that, during the operation, risk being contaminated must be cleaned and sterilised in situ in the sterilisation area in the following manner:
(1)soaked in cold water with a cleaning product added (soap, detergent or disinfectant);
(2)cleaned by ultrasound;
(3)disinfected in a disinfecting bath;
(4)sterilised in an autoclave.
2.3.5.Every surface or object must be sterilised as soon as there is risk of contamination.
2.3.6.During the tattooing activity, the professional must wear specific work clothes (a smock, for example). These clothes must not leave the place of work so that they do not risk becoming contaminated by exterior germs or by objects situated outside the room. As far as possible, plastic disposable clothing will be preferred. Cleaning of reusable clothing must be done with a disinfectant product.
Cleaning
2.3.7.Immediately after use, the instruments must be placed to soak in a bath specially reserved for this purpose and full of cold water with a cleaning product added.
2.3.8.The instruments must never be left to dry.
2.3.9.The cleaning bath must be replaced every day. When this is done, it must be rinsed and cleaned using suitable products.
2.3.10.After washing, materials are passed under cold running water and placed in the ultrasound cleaner.
2.3.11.As a precautionary measure, gloves will be worn during the washing phase. It is also advisable to protect oneself against splashes, for example by wearing plastic sleeves or a long-sleeved smock, a mask and protective goggles, …
Cleaning by ultrasound
2.3.12.Instruments must be cleaned by ultrasound using products designed for the purpose for at least 20 minutes (according to the instructions of use of the machine).
2.3.13.Detachable components must be detached and cleaned.
2.3.14.Instruments must be placed in the ultrasound machine in such a way that they do not touch the bottom of the tank. In order to do this the basket or graduated dish supplied with the ultrasonic machine must be used.
2.3.15.The level of the liquid much always reach the line marked on the machine’s vat or graduated dish, whatever the quantity of instruments to be cleaned.
Disinfection
2.3.16.The instruments must be placed to soak in a bath of powerful disinfectant in a tub specially reserved for the purpose.
2.3.17.The instruments must never be left to dry.
2.3.18.The period of soaking recommended by the maker of the disinfectant product will be adhered to (usually from 15 to 30 minutes). The expiry date of the product will be adhered to.
2.3.19.The cleaning bath must be replaced every day. When this is done, it must be rinsed and cleaned using suitable products.
2.3.20.A disinfectant product will be used that conforms to national regulations, or, in the absence of such regulations, that conforms to European standards.
2.3.21.It is forbidden to mix two different disinfectant products.
2.3.22.The maker’s instructions for diluting the disinfectant product must be followed.
2.3.23.After washing, materials are passed under cold running water and placed in the ultrasound cleaner.
Drying
2.3.24.Once disinfected, the equipment will be rinsed under cold running water and left to dry on an absorbent surface that does not leave fluff.
2.3.25.Once they are completely dry, the instruments are wrapped in sachets for the purposes of sterilisation and placed in the autoclave. They must be perfectly dry. Only dry items may be wrapped up.
Wrapping in sterilisation sachets and opening them
2.3.26.Wrapping is done using sachets specially designed for steam sterilisation (one side paper and one side plastic with a temperature indicator). Wrapping is done according to the following:
- only one object may be placed in each sachet, or one set of needles and holder per sachet;
- close the sachet by sealing or sticking it.
2.3.27.Sachets are closed using a sealing machine or hermetically sealed, either by being folded on themselves (self-adhesive sachets), or with an adhesive that changes colour during sterilisation (adhesive by autoclave).
2.3.28.Sterilisation sachets must be dated. A sachet only remains sterile for three months after sterilisation. After this time has elapsed, it becomes microporous.
2.3.29.All wrapping that is damaged, wet or opened, must be considered non-sterile.
2.3.30.To remove instruments and equipment wrapped and sterilised, it is best to use the technique known as «no touch»: separate the two sides of the sachet and let the equipment or instruments inside it fall onto the work surface without touching them.
Sterilisation in the autoclave
2.3.31.Only items which have already been cleaned and disinfected, can be properly sterilised.
2.3.32.To sterilise wrapped items, it is obligatory to use a type B autoclave that can sterilise hollow objects and components.
2.3.33.Wrapped instruments are placed in the autoclave with the paper side facing upwards so as not to impede the circulation of steam (consequently they cannot be too tightly packed together).
2.3.34.If the autoclave is not equipped with a printer that shows the progress of the cycle, indicators of the same are placed in the machine to act as a control.
2.3.35.At the end of the cycle the control indicators must be checked and it must be ensured that the packages are intact. When the door of the autoclave is opened, the contents must be completely dry. A package or instrument that is damp is not sterile. Drying cannot take place with the door open.
2.3.36.After sterilisation and drying, the sterilised instruments, still in their sterilisation sachet, are placed in a drawer, a cupboard or a closed container for a period that must not exceed one month.
2.3.37.The following instruments and equipment must be sterilised before use:
- guide-needles and handles;
- needle holders;
- needles.
2.4.Procedures
Procedure to be followed when tattooing
2.4.1.Generally, it is very important that at any moment there is a risk of cross-contamination; gloves must be thrown away, the hands washed and a new pair of clean gloves used.
2.4.2.In order to check if the customer is sensitive to certain pigments, a test can be carried out a few days before the treatment. To do this, a small quantity of pigments is deposited in a discreet place (for example, behind the ear or between the toes). The customer will check if he or she has reacted to the test over the following days.
2.4.3.To carry out tattooing, it is advisable to follow, in order, the following steps:(1) wash and disinfect the hands;(2) put on a new pair of clean gloves;
(3) all equipment that is touched during a tattooing session must be enveloped in plastic film or wrapped in plastic bags intended for that purpose. (in other words: wrap the tattooing machine’s motor and the power cable in a plastic bag intended for that purpose; wrap the control panel of the transformer in plastic; cover in plastic the armchair and armrests or the couch, the sprays and any other objects likely to be touched during a tattooing session);