THE ASSOCIATION OF PROFESSIONAL PIERCERS

PROCEDURE MANUAL U.S. EDITION

A PIERCEE'S BILL OF RIGHTS

EVERY PERSON BEING PIERCED HAS THE RIGHT:
UPDATED AFTERCARE BROCHURES

1. To be pierced in a hygienic environment by a clean, conscientious, sober piercer wearing a fresh pair of disposable medical examination gloves.

Newly reformatted with additions reflecting new trends and

frequently asked questions from Piercers and Piercees
alike.

2. To be pierced with a brand new, completely sterilized single-use needle that is immediately disposed of in a
medical Sharps container after use on one piercing.

NEW AFTERCARE:
Clear concise instructions on cleaning
"Less is more" message
More information on jewelry issues
Facial piercings now covered in Oral Aftercare instructions
NEW FORMAT/DESIGNS:
Cohesive appearance of all APP brochures
Eye-catching and aesthetically pleasing
Professional image to support APP standards

The new brochures are available for sale on the APP web site
(www.safepiercing.org) for $20 per 100, postage paid.

MARK YOUR CALENDARS!

3. To be touched only with freshly sterilized and appropriate implements, properly used and disposed of or re-sterilized (where appropriate) in an autoclave prior to use on anyone else.

The annual APP Conference and Exposition takes place every

year in beautiful Las Vegas, Nevada.

4. To know that piercing guns are NEVER appropriate, and are often dangerous when used on anything
-- including earlobes.

There are classes offered in everything from piercing technique to

marketing, current industry legislation to accounting, studio setup to aftercare. There is something for everyone, from the first
time attendee to the long term shop owner, with classes geared
specifically for health care professionals.
The exposition includes venders from all segments of the body
piercing industry from the United States and abroad. Thousands
of items are available at the years largest gathering of manufacturers and distributors directly targeting the body piercing market.

Subjects include:
Aftercare Guidelines for Facial and Body Piercing*
Aftercare Guidelines for Oral Piercing*
Picking Your Piercer*
Troubleshooting for You and Your Healthcare Professional
(with jewelry removal tips and hints)
Oral Piercing Risks and Safety Measures

5. To the peace of mind that comes from knowing that their piercer knows and practices the very highest standards of sterilization and hygiene.
6. To a have a knowledgeable piercer evaluate and discuss appropriate piercings and jewelry for her/his individual anatomy and lifestyle.
7. To be fully informed of all risks and possible complications involved in his/her piercing choice before making
any decisions.
8. To seek and receive a second opinion either from another piercer within the studio or from another studio.
9. To have initial piercings fitted with jewelry of appropriate size, material, design, and construction to best promote healing. Gold-plated, gold-filled or sterling silver jewelry is never appropriate for any new or unhealed
piercing.
10. To see pictures, be given a tour of the piercing studio, and to have all questions fully and politely answered
before making or following through on any decision.

*Available in Spanish

11. To be fully informed about proper aftercare, both verbally and in writing, and to have continuing access to the
piercer for assistance throughout the healing process.
12. To be treated with respect, sensitivity and knowledge regardless of gender, sexual orientation, race, religion,
ethnicity, ability, health status or piercing choice.
13. To change her/his mind, halt the procedure and leave at any point if the situation seems uncomfortable
or improper.
FREE SAMPLES AVAILABLE UPON REQUEST
Order by fax or phone (888) 888-1APP
or visit our website: www.safepiercing.org

For updates about the conference please visit:

www.safepiercing.org
or call (505) 242-2144 or (888) 888-1APP

THE ASSOCIATION OF PROFESSIONAL PIERCERS MANUAL

U.S. EDITION CONTENTS

WHAT IS THE APP? ............................................................................................................................. 1
INTRO TO MICROBIOLOGY FOR THE PIERCER ............................................................................... 5
INFECTION CONTROL......................................................................................................................... 9
STERILE CHART ................................................................................................................................ 14
CLEANING, DISINFECTION AND STERILIZATION .......................................................................... 15
EQUIPMENT ....................................................................................................................................... 19
ENVIRONMENT .................................................................................................................................. 25
SKIN PREPARATION ......................................................................................................................... 29
AFTERCARE ........................................................................................................................................31
PIERCING HEALING TIMES .............................................................................................................. 35
JEWELRY............................................................................................................................................ 37
ETHICS AND LEGALITIES ................................................................................................................. 43
COMPLIANCE AND TRAINING ..........................................................................................................49
EMERGENCIES .................................................................................................................................. 53
AFTERWARD ...................................................................................................................................... 58
GLOSSARY ......................................................................................................................................... 59
UNDERSTANDING MSDS .................................................................................................................. 63
APPENDIX A - FULL TEXT OF BLOODBORNE PATHOGENS STANDARD 1910.1030 .................. 65
APPENDIX B - HEPATITIS B VACCINE DECLINATION (MANDATORY) ......................................... 77
APPENDIX C - APPLICATIONS FOR MEMBERSHIP........................................................................ 79

This manual was rst published in 1998 and was revised in 2002 and 2005.
Previous edition credits are extended to:
Gahdi Elias, Allen Falkner, Tracy Faraka, Kent Fazekas, Michaela Gray, Drew Lewis, Cheyenne Morrisson, David Vidra,
Dr. Jack Ward [Original Edition]; and to: Elayne Angel, Scott Brewer, Steve Joyner, Lisa Lystad, M.D., Patrick McCarthy,
Sky Renfro, Bethra Szumski, April Williams-Warner, Dr. Jack Ward [2002 Edition].
Contributors to the 2005 edition include: Elayne Angel, Alicia Cardenas, Luis Garcia, Phish Goldblatt, Schane Gross, April
Johnson, Jason King, Paul King, Megg Mass, Christina Shull, Crystal Sims, Bethra Szumski, James Weber, and the intrepid
Caitlin McDiarmid.
Some cover photos courtesy of Evolution Body Piercing, Inc.
Cover design by Paul Romano, www.workhardened.com
Copyright 1998, 2002, 2005. All rights reserved. The goal of the Association of Professional Piercers is to circulate vital
health, safety and educational information to the piercing industry, health care workers and the general public. This manual
is copyrighted under Federal Law. Any reproduction of its contents is prohibited without prior written permission. For specic
reprint permissions, please contact us directly.

WHAT IS THE APP?

The Association of Professional Piercers (APP) is an
international health and safety organization dedicated
to the dissemination of information about body piercing.
We are a fully voluntary and nonprot alliance of individuals and corporations concerned about the safety
and standards of the body piercing industry.
Governed by an elected Board of Directors, the
APP unites piercing professionals who freely share
resources to help fellow members, piercers, healthcare
professionals, health inspectors, and the public access
the most current and accurate information about our
art form and its procedures.

THE ORIGINS OF THE APP

In 1994, representatives from several piercing studios
organized a political action group in response to problematic legislation in California (Proposition AB101).
The organization quickly grew to accommodate members nationwide and around the world, becoming the
worlds largest body piercing education facilitator and
providing invaluable organization and representation
for the piercing profession.

WHAT IS THE PURPOSE OF

THIS MANUAL?
This manual is intended as a reference and study aid for
all people who care about the promotion and practice of
responsible body piercing -- including piercers, health
ofcials, legislators, medical and insurance professionals, and members of the general public. Those
in countries other than the US are invited to use this
manual as a guide, keeping in mind that regulations,
available products and industry standard techniques
may vary by location. Please consult with professional
piercing associations in your own country.

WHAT ARE THE LIMITATIONS

OF THIS MANUAL?
The following manual is not a training course or a formula to make one an instant piercer. This manual is
intended to provide a basic overview of the health and
safety concerns faced by all body piercers and to offer

guidelines that minimize expected risks. This manual is

not a substitute for formal training and education.
Although this manual is updated periodically, information in this edition may not be current or appropriate
for your individual practice. It is imperative that each
piercer seek out and evaluate new health and safety
techniques and products with reference to his/her own
practice and local circumstances. For recent updates
to this information, please see our website.
While this manual and its information, suggestions
and guidelines are offered for use throughout the world,
this version is specically designated as the USA Edition. We recognize that laws vary and not all products,
chemical formulas, tools and jewelry types are readily
available or desirable everywhere. As a result, we offer
the USA Edition as a general foundation and encourage
APP members in other areas of the world to update,
clarify and edit this version (with permission) to be
appropriate to their region.

THE APP:
Provides a professional association and peer support
for piercers.
Publishes a quarterly newsletter dedicated to piercing-related news, research and information to keep
geographically dispersed individuals current in the
industry.
Standardizes and publicizes industry procedures and
protocols regarding hygiene, quality and education,
and assists piercers in meeting and/or exceeding
these standards.
Provides support and assistance in implementation
of appropriate legislation for the industry.
Provides piercing, business, health and safety education through annual conferences for piercers, health
inspectors, and others related to the industry.
Promotes consumer education and public understanding of body piercing practices through educational lectures, publications, staffed phone and email
lines, a comprehensive website and media relations.
(See the inside front cover of this manual for more
information.)
1

 Promotes alliance between the piercing and healthcare industries through cross-attendance at healthrelated conferences and lectures, joint publications and research, resource sharing and ongoing
dialogue.
Does not police the piercing industry or piercers. The
APP will, however, respond to and resolve complaints
against its members and claims of membership which
are invalid.
Does not license or certify piercers. Members do
receive a certicate of membership which must be
renewed annually. Attendees of APP classes receive
a certicate of seminar participation.

Have knowledge of appropriate sterilization and

cross-contamination prevention through Bloodborne
Pathogens Training, required annually for membership;
Work in a studio that meets current environmental
criteria for hygiene, safety, and ethical practice;
Undergo training and certication in CPR, Bloodborne Pathogens, and First Aid, renewed according
to membership requirements;
Must provide monthly spore test results for their
studios autoclave(s) (sterilizer)
Must sign the APP Health and Safety Agreement and
answer an extensive questionnaire to prove knowledge of and adherence to current best practice.

Does not teach people how to pierce or perform

piercings at its functions. The APP provides supplemental education to piercers and has Corporate
Members who provide basic piercing education.

Associate Members:

Does not dictate the piercing technique(s) or products

its members use, what aftercare they suggest, or
what specic piercings they may choose to perform,
provided they respect local laws and regulations.

If beginning piercers, must meet the same standards

as our Business Members;

Addresses only the practice of body piercing. The

APP does not have a position on tattooing, branding,
scarication, dermal punching, scalpeling, implants,
or other types of body modication where they are
allowed by law.

If non-piercers, must work in a studio that meets

studio requirements;
Must work in a studio which has at least one APP
Business member on current staff.

Corporate Members:

Professional Business Member

Are companies that provide support services to

the piercing industry; Some examples of Corporate
Members are health and technical educators, medical
supply companies, jewelry wholesalers and insurance companies;

Professional Business Member-at-Large

Must provide a letter of intent;

Associate Member

Must provide documentation regarding their business, including jewelry samples if applicable.

MEMBERSHIP
The APP has ve types of memberships:

Corporate Member
Patron Member

Professional Business Members and Professional Business Members at Large:

Are body piercers;
Uphold a set of safety and hygiene standards that are
equal to, or more stringent than those established by
state or local governments;
Have at least one year of professional piercing experience;
2

Are either piercers with less than one year of professional experience, or non-piercing employees in a
piercing studio (owners, counter people);

Patron Members:
Are individuals who work outside the piercing industry
and who support the APP and its goals.

HOW DO I BECOME A MEMBER?

A full list of membership requirements, including
personal and environmental criteria, is included in
the Appendix. This includes the Application for APP
Membership, Health and Safety Agreement and Ques-

tionnaire. For questions please contact us directly at

info@safepiercing.org.

APP PUBLICATIONS, PRODUCTS AND EDUCATIONAL

SERVICES:
Brochures for piercers, educators, consumers, and
healthcare personnel (Available titles listed inside
front cover)
Health and Safety Procedure Manual
The Point quarterly newsletter
Public Service Announcements for Radio and Print
(available on cd and in written format)
APP T-shirts - New designs every year
APP Annual Conference and Exposition
Piercing-related, industry-specic classes offered in
Techniques, Equipment, Management, Aftercare,
Studio Set-Up, Business Documentation, Bloodborne Pathogens, CPR, First Aid and more
Week-long conference with roundtable discussions, social events, and networking
Largest body jewelry and piercing-related product
exposition in the US
Package and individual class prices available
Website: www.safepiercing.org
Contact information for current members
Getting Pierced: Everything you need to know,
including how to nd a good piercer and Aftercare
information
FAQs: Piercing and Minors, Pregnancy, Piercing Guns, Genital Piercings, Oral Piercings, and
more...
Job Board: free listing of jobs available and those
seeking positions

AN INTRODUCTION TO MICROBIOLOGY
FOR THE PROFESSIONAL PIERCER
Although body piercing has historically been considered
a ritual art form, in modern times the practice cannot be
separated from our knowledge of biological science. In
order to be fully educated in the eld, piercers should
have a working knowledge of the science behind the
art. In particular piercers should understand the basics of Microbiology, Bacteriology, Immunology, and
Virology. Scientic facts will provide the professional
piercer with the necessary knowledge to carry out
appropriate hygiene and safety practices in the work
environment and to make informed decisions under
changing conditions.

DEFINITIONS
Cross-contamination is the act of spreading
pathogenic (disease-causing) organisms from one item
or surface to another.
It is the responsibility of the professional piercer to
operate at all times with a high regard for the health
and safety of their customers, their co-workers, and
themselves. Employing appropriate protocols will
minimize the risk of cross-contamination with harmful
microorganisms such as bacteria and viruses.

Microbiology is the study of microscopic organisms.

Some microorganisms are benecial or resident to
the individual, but others are detrimental, potentially
causing illness or even death. By understanding how
microorganisms live and reproduce, the piercer will be
able to minimize disease transmission risks.

Bacteriology is the study of bacteria.

Many varieties of bacteria exist in our environment,
some good, some bad. Some bacteria normally live on
our bodies (resident) and help protect us from foreign
strains (transient), or otherwise work with the body
chemistry to optimize health. The type of bacteria in
yogurt may aid the digestive tract, while bacteria on
teeth can cause tooth decay. Bacteria are of immense
importance because of their capacity for rapid growth
and reproduction. Bacteria are capable of surviving
without a host.

Immunology is the study of the ability to resist

infection.
The immune system treads a fine line between
successful defense of the organism and its complete
destruction. An underreaction may allow pathogens to
gain a foothold and overpower the individual. However,
an overreaction can also lead to dire consequences for
the individual.

Virology is the study of viruses, which are submicroscopic organisms.

Viruses differ from other microorganisms in that they
depend on the cells they invade for growth and reproduction. Some viruses do not kill cells but cause illness,
and then seem to disappear. They can remain latent
and later cause another, sometimes much more severe
form of disease. Viruses cause measles, mumps, polio,
herpes, inuenza, and the common cold. Some viral
infections can be treated with drugs, some cannot.

Bacteria are single-celled microorganisms so small

that they cannot be seen without the assistance of powerful magnication.
They have characteristics of both plants and animals.
There are hundreds of different types of bacteria, subdivided into families with common properties. Two very
important and relevant classications of bacteria exist.
They are either nonpathogenic (harmless), or they are
pathogenic (harmful, with the ability to cause disease).
Nonpathogenic bacteria are the most plentiful. Some
are actually benecial and perform important functions in our bodies, such as assisting in digestion or
protecting the skin from overcolonization by invading
organisms.
Millions of microscopic organisms inhabit the spaces
in which we live and work. Particles of organic matter
including bacteria, viruses, fungi, and spores are present despite the most dedicated efforts to keep things
clean. Fortunately, the majority of these organisms
are harmless or can be dealt with successfully by the
immune system.
However, if there is an opening into the body, some
of these organisms can enter and cause illness, particularly when the bodys own defenses are compromised
5

through illness, inadequate nutrition, and other risk

factors. While some organisms cause only temporary
minor discomfort, others can result in serious or even
fatal diseases. Since microorganisms are omnipresent, it is important to understand how to prevent them
from gaining access into the body through piercings
both during a procedure and afterward. It is also
important to help clients understand how hygiene,
nutrition, and lifestyle can facilitate or devastate their
healing process.
The most common forms of bacteria of concern for
piercers are Coccus, Bacillus and Spirillum.

MICROORGANISMS OF
THE SKIN
There are two types of skin microorganisms:

Resident: Those that survive and multiply on the

skin. Resident ora can be removed with antimicrobial
soaps. Some of the normal resident bacteria of the skin
include diptheroids (found in outer ear, armpits, and
groin/genital areas), micrococci, (Staphylococci epidermis found on skin surfaces) and a variety of canes
(Propionibacterium canes, Corynebacterium canes
found on the face and other skin surfaces).

Coccus (plural Cocci)

Transient: Those that were acquired through recent

Cocci are spherical or ovoid in form. One of the most

commonly occurring bacteria of concern to piercers is
Staphylococcus. This bacterium is present in boils, abscesses, and most surface infections. It can enter the
body during the piercing or any time during the healing
stages while the piercing is an open wound. This risk
makes client education and post-piercing care critical
in prevention. Some Staph is becoming resistant to
antibiotic treatment, making prevention even more essential to the health of our clients.

exposure. These can survive for a limited amount of

time, generally less than 24 hours. Most often they
are acquired from others who are infected. Soap is
effective for the removal of most transient microorganisms. If conditions are conducive, overgrowth of some
transient bacteria can occur. Staphylococcus aureus
colonization is found in boils, folliculitis and carbuncles.
Streptococcus infections can take the form of cellulitis,
impetigo and pneumonia.

Other common types of Cocci are Diplococci (which

causes Pneumonia) and Streptococci. Other diseases
caused by this family of bacteria are Scarlet Fever and
Meningitis.

Bacillus (plural Bacilli)

This bacteria belongs to the family Bacillaceae. All
species are rod-shaped and sometimes occur in chains.
Bacillus is the organism that causes dysentery, cholera,
and diphtheria.

Spirillum (plural Spirilla)

This is a genus of spiral-shaped microorganisms
belonging to the family Pseudomonadacea. When in
exible form they are called spirochetes. Syphilis is
in this group.
Pathogenic organisms that cause diseases such
as tetanus, tuberculosis and diphtheria are generally
beyond our concern when Standard Precautions are
observed. To minimize exposure risk:
Focus
Utilize clean technique

FACTORS THAT INFLUENCE

THE SURVIVAL AND GROWTH
OF MICROORGANISMS
There are three main considerations determining
whether or not a microorganism is potentially a problem
for you or your clients:
1. Stability of an organism in its physical environment;
2. Availability of the correct transmission medium
needed by the organism to spread;
3. Quantity of organisms expelled from the host into
the transmission medium.

Pathogenicity: The potential of an organism to

cause disease. The factors that inuence the pathogenicity of an organism are:
1. Host susceptibility;
2. Organism strength and number;
3. Portal of entry: The organism must have a way
into the host.

Understand appropriate sterilization, and

Transmission: The method by which an infectious

Practice it at all times.

agent is passed. The transmission of an organism is

dictated by the availability of an appropriate Agent, Host

and Environment. Eliminating the route of transmission
to the portal of entry (a fresh piercing) interrupts this
process and is well within the piercers control.
Routes of transmission are:
Direct contact: Person-to-person spread; requires
actual physical contact between the existing host and
a new portal of entry (e.g. the piercer and a client). A
needle stick is a direct contact route of transmission.
Indirect contact: Exposure to microorganisms deposited rst on inanimate objects and then transferred
to the client. Objects in the environment that are not
adequately disinfected or sterilized between clients can
result in indirect contact exposure. This is generally
referred to as cross-contamination. Using tools rst
at the counter and then for a piercing procedure without
sterilizing would be an example. Touching non-sterile
items with gloved hands during a procedure, and then
continuing to work on the client without changing gloves
would also be considered cross-contamination.
Airborne: Pathogenic organisms can also be acquired
by inhaling infected droplets that become airborne when
an infected person coughs or sneezes. Termed droplet
transmission, this can easily be avoided with simple
precautions, such as covering the mouth and nose
when coughing or sneezing (and then wash hands!)

BREAKING THE CHAIN

OF INFECTION
It is essential that the professional piercer understand
how infection occurs, and more importantly, how to
prevent this from happening in the work environment.
The Chain of Infection requires that these elements
be present:
1. An Infectious Agent, such as bacteria or virus
2. A Reservoir (existing host)
3. A Portal of Exit from the reservoir (the path out of
the existing host)
4. A Vehicle of Transmission for the agent (the path
between hosts)
5. A Portal of Entry (the path into a new host)
6. A New Host
The single most important thing piercers can do to
break this chain is WASH THEIR HANDS. This very
simple and basic step has been proven to reduce or
eliminate most pathogenic bacteria from the hands.
This is the rst line of defense in the prevention of
disease transmission.

Vector-borne: The transmission of organisms by an

animal or insect bite, or through exposure to animal
blood or other infectious bodily uids.
Zoonosis: Zoonotic diseases are diseases of animals
that may be transmitted to humans under natural conditions. Once infected, humans can transmit some of
these diseases to one another. While no reasonable
piercer should be working on animals, it is possible
for these diseases to enter the piercing environment
by allowing pets or other animals, their droppings or
accessories, into the piercing studio.
Proper hygiene as well as many local regulations dictate that animals never belong in the piercing studio or
in any space contiguous with a piercing studio (e.g. an
adjoining ofce). Clean and enclosed sh aquaria may
be permissible, however dogs, cats, rodents, reptiles
and birds present a potential threat to client and staff
safety and should never be admitted. One possible
exception would be a guide dog or assistance animal.
In this case reasonable alternatives and precautions
should be sought to avoid the contamination of the
piercing environment while considering the needs of
the client.
7

INFECTION CONTROL
HANDWASHING

4. Pay special attention to nails, nail beds, between

ngers and wrists.

Frequent and conscientious handwashing is the most

important action a piercer can take to reduce the presence and transmission of pathogenic microorganisms.
Correct handwashing procedures are easy to follow
and are extremely effective when used throughout
the day.

5. Continue for a minimum of thirty seconds.

A studios handwashing sink should be used only for

hand washing (never tool cleaning) and should have
hands-free operation. Hands should not come into
contact with faucets or handles. If the sink does not
have a foot pedal or motion sensor operated system,
an elbow or dry disposable paper towel can be used
to operate the water ow.
The use of quality liquid soap in a pump or automatic
dispenser is strongly encouraged. Bar soaps collect
bacteria and other dangerous contaminants from handling. Liquid antimicrobial or antibacterial soap has
been proven most effective in the inhibiting of bacterial
growth and is preferred.
Choose a gentle, dye- and fragrance-free anti-microbial or antibacterial soap made for healthcare workers
and others who wash frequently. Most commercial
soaps are not intended for those who wash their hands
frequently. They can leave hands chaffed, chapped
and irritated and may kill benecial resident ora. This
can actually increase the potential risk of pathogen
transmission to the piercer. See the APP website for
suggested products (www.safepiercing.org).
Single-use paper towels should be dispensed from
a stationary, fully covered paper towel dispenser that
dispenses only one paper towel at a time. Paper towel
rolls run the risk of contamination of the entire roll from
handling. Air dryers cut down on paper waste but may
blow pathogenic matter around the area.

HOW TO WASH
HANDS PROPERLY:
1. Wet hands thoroughly with tepid water.
2. Dispense a dime-sized amount of liquid soap into
palm and lather.
3. Vigorously scrub all surfaces of both hands up to
mid-forearm.

6. Pat hands dry with a single-use paper towel.

A moisturizing lotion can be used to prevent overdrying and cracking. Maintaining the health of the hands,
skin, nails and nail beds is crucial in the rst line of
defense against transmission of disease. Several
brands of lotion that also seal and protect skin (invisible gloves) are available through healthcare product
suppliers. Lotion must be allowed to dry before donning gloves to maintain glove integrity and minimize
exposure to glove chemicals.

HAND SANITIZERS
Waterless hand sanitizer gels have become staples
in many piercing shops because they are easy to use
and do not require a trip to the sink. Some piercers
use them in between glove changes, or keep them at
the counter for clients entering the shop.
However, careful consideration should be given as
to when their use is appropriate. While some studies
show these products to be as effective as hand washing
in certain situations, other research indicates that they
do not signicantly reduce overall amounts of bacteria
on the hands, and in some cases may even increase it.
Most tests proving sanitizers germ-killing capacities at
up to 99.9% effective were done on inanimate objects,
not on living skin. Physiological conditions on human
skin may yield far different results.
Alcohol-based hand sanitizers work by stripping the
outer layer of oil from the skin, thereby killing transient
bacteria and delaying regrowth and surfacing of resident bacteria. To use, a dime-sized drop of sanitizer
should be pumped onto the skin and rubbed over all
surfaces until dry. If hands are dry within 20 seconds,
not enough gel was used.
Hand sanitizers are not cleaning agents. They do not
remove surface dirt or visible soil. Dirt, food, lubricant
and other things on your hands will make them less
effective. Therefore, in order for hand sanitizers to
work properly, hands must rst be washed with soap
and water before applying.
9

HAND SANITIZERS VERSUS

ANTIMICROBIAL SOAPS

2. Keep ngernails trim and smooth, and remove

jewelry and watches to prevent accidental tears
(per OSHA regulations).

In 2002, the Centers for Disease Control released

guidelines recommending alcohol-based gel as a
suitable alternative to hand washing for health-care
personnel in health-care settings (CDC, 2002) when
moving between patients. The Food and Drug Administration, on the other hand, says that hand sanitizers
may be used as a supplement, but not as a substitute
for hand washing.

3. Use only disposable gloves.

In an FDA comparison study, plain soaps antimicrobial

hand soaps, E2-rated hand soaps (a USDA Classication requiring equivalency to 50 parts per million chlorine), and instant hand sanitizers were tested to gauge
their relative effectiveness in reducing bacteria on hands.
With a 20-second wash procedure, all three types of
soap effectively reduced bacteria. E2 soaps were signicantly more effective than the other two soaps. Instant
hand sanitizers, on the other hand, showed a signicant
increase in bacterial numbers on hands.

During sweeping, mopping and trash removal. Any

object on the piercing studio oor should be considered contaminated and only touched with gloved
hands.

According to most publications, while hand sanitizers are acceptable for use in addition to a thorough
handwashing, and are certainly better than no cleaning
at all, they are not a substitute for scrubbing with soap
and water. Additionally, they are generally advised for
healthcare workers, but not for food handlers or the general public. Since piercers fall squarely into none of these
groups, each must come to his/her own conclusion.
A nal word of caution: While often advertised as
being less irritating to hands than regular washing,
alcohol-based hand sanitizers can be overdrying, causing cracked skin, contact dermatitis, and accelerating
potential latex sensitivities. If you opt to use these
products for your staff and/or clientele, choose a brand
carefully, consider non-alcohol varieties, and have an
alternative available for clients who cannot or will not
use these products.

GLOVES
Gloves are practically, legally and ethically imperative
for professional piercers. Finding appropriate gloves
and learning how to don them properly will protect the
piercer from potential contaminants and reduce the risk
of disease transmission between client, piercer and
co-workers. It is important to follow the basic rules of
glove use:
1. Wash hands prior to donning gloves and immediately afterwards.
10

4. Store gloves properly, away from light, heat and

moisture.

When should gloves be worn?

During all set-up and cleaning. This prevents crosscontamination and protects hands from exposure to
harsh chemical disinfectants.

During all disinfection or sterilization procedures.

When working in Biohazard Areas or dealing with
contaminated tools or containers. Many piercers
double-glove when processing contaminated instruments. (Check with your glove manufacturer to
ensure this will not compromise glove integrity.)
When transporting sterilized implements from the
autoclave to designated storage space. Clean gloves
should be available in all areas where transport may
be initiated.
During contact with a client. A professional piercer
should never touch the area of a clients piercing
with ungloved hands. This protects against possible
transmission of a clients resident and transient ora.
It also provides a level of professionalism and comfort
between the client and piercer.
During a period of contact only, not continuously.

When should gloves be changed?

If glove integrity is compromised (gloves become
weakened or contaminated).
If a visible weak spot, pinhole or tear is detected or
suspected.
When gloves turn yellow or brown.
Changes in glove color can take place after
prolonged wear. This is normal and occurs from
a reaction between traces of copper on sweaty
skin and dithiocarbamate, a curing chemical
found on the surface of some gloves. Since this
reaction can accelerate the breakdown of rubber,
gloves should be changed frequently enough
to prevent it. Four minutes is the maximum
amount of time suggested for using each pair of
latex gloves.

 When moving from eld to eld

(from non-sterile to sterile tools, or between
segments of a procedure). To prevent crosscontamination gloves should be changed
when moving from a more contaminated area
to less contaminated area (see Sterile Chart
on page 14).
During a procedure.
Many studios develop a written plan concerning
glove changes during a procedure.
For example, a studio may require at least ve
pairs of gloves per procedure for:
1.
2.
3.
4.
5.

Initial set up of tray and instruments

Opening autoclave packages
Initial skin prep and marking
Piercing procedure
Post-procedure clean up

Although the number of gloves used in a procedure

will vary, setting a minimum number of gloves used
can help reduce the likelihood of cross-contamination.
The important point is that every piercer understand the
concept of cross-contamination, and change gloves as
necessary to avoid compromising elds.
Many piercers use hand sanitizers and lotions as an
additional cleanser or barrier, and to minimize potential
contamination through dry, cracked skin. If using latex
gloves, be aware that petroleum- or oil-based products
must be avoided. Chemicals in petroleum products can
penetrate the latex, compromising its barrier integrity.
Water-based lotions should be chosen, applied after
glove use and washing (post-piercing) and allowed to
fully dry before donning new gloves. Anti-inammatory, conditioning and chemical barrier lotions are also
available for the healthcare industry and may minimize
skin irritation from constant washing and chemical
exposure.
If a glove becomes hard, brittle or too soft, or loses
its elasticity, shape or usual color, it may be degraded
and should not be used. As requested by the FDA,
glove manufacturers may print expiration dates on
glove boxes. Gloves should be used before this date.
If the date is unknown, be sure to use glove shipments
in the order they were received, and to store all gloves
in clean, cool, dry and well-ventilated conditions in their
original packaging.
Gloves should never be washed, disinfected or
autoclaved unless specically recommended by the
manufacturer. As explained by OSHA, Washing with
disinfecting agents may cause deterioration of the glove
material and may encourage wicking or enhanced

penetration of liquids into the glove via undetected

pores thereby transporting potentially infectious materials into contact with the hand. (OSHA instruction
CPL 2-2.44C)
Whenever you have doubt about the integrity of your
gloves, remove the gloves, wash hands and don fresh
gloves. Piercers should be aware that sensitization
to latex (latex allergies) are becoming increasingly
common among both piercers and clients. To protect
the health of their staff and clients, many studios are
choosing alternative synthetic gloves and eliminating
latex from their practices.

STERILE GLOVES
Some piercers choose to use sterile gloves during
piercing procedures; some are required to do so by
state law. There are arguments for and against the
use of sterile gloves. Where the issue is not dictated
by law, a studio should make a research-based decision about whether or not to use sterile gloves in its
practice.
Sterile gloves are not required by APP standards,
though piercers who choose to go beyond the established minimum guidelines may do so.

Donning Sterile Gloves

Piercers should use the open donning method. The
(right-handed) technique is as follows:
1. Pick up the cuff of the right glove with left hand.
Slide right hand into the glove until you have a snug
t over the thumb joint and knuckles. Your bare left
hand should only touch the folded cuff - the rest of
the glove is sterile. Do not use bare hand to adjust
t.
2. Slide right ngertips into the folded cuff of the left
glove. Pull out the glove and t right hand into it.
3. Unfold the cuffs down over wrists. Make sure gloved
ngertips do not touch bare forearms or wrists.

Donning Clean Gloves

1. With freshly washed hands, remove one glove
from the clean glove box by grasping it at the bottom edge. Be careful to reach into box as little as
possible, and not to touch the ngers of any glove
with bare hands. (Discard individual gloves that
accidentally contact hands, or that present ngers
rst and cannot be removed by the cuff.)
2. Grasp rolled cuff and slide your hand as far into the
glove as possible. DO NOT use your bare hand to
adjust t from the outside.
11

3. With your now gloved hand, reach into the clean

glove box and remove a second glove.
4. Without touching bare skin to the outside of either glove, slide your other hand into the second
glove.
5. Now adjust both gloves for t. Remember that any
portion of glove touched by bare hands should not
then be touched with gloved hands.

CHOOSING THE RIGHT GLOVE

Latex
Latex is a polymeric membrane of natural rubber derived from the sap of the rubber tree (Hevea Brasiliensis). It is made heat-stable, resilient, strong and elastic
through vulcanization (heating with sulphur) and the
addition of accelerators and antioxidants. Non-sterile
medical grade latex gloves are used by many piercers
for everyday duties within the studio. Latex gloves
vary in thickness and texture and should be chosen
for durability, comfort and tactile sensitivity.
Latex gloves are sometimes powdered to ease donning. These powders are usually cornstarch or talcbased and are placed in the glove after manufacturing.
Research has shown that glove powder can lead to
granulomas in open tissue, and may increase potential
for airborne latex proteins and latex sensitivities. Consider using non-powdered gloves for all procedures.
Many manufacturers are now processing gloves with
a polymer coating such as silicone for easy donning
without powder.
Latex gloves contain protein antigens and curing
agents (such as accelerators and antioxidants) that may
cause an allergic dermatitis or systematic anaphylaxis
(discussed further below). Even those gloves labeled
hypoallergenic will not always prevent reactions in a
highly sensitive person. Those with severe sensitivities may be unable to enter a shop with airborne latex
proteins or powders. Latex gloves should never be
used on a client who informs you of an allergy to latex,
and many shops have chosen to become latex-free
for the safety of all clients and staff. If latex is the primary type of glove used in a studio, latex-free gloves
should be stocked for clients with latex allergies and
a comprehensive latex allergy procedure should be
developed.

NON-LATEX ALTERNATIVES
Many piercers opt for latex-free synthetic alternatives
such as Nitrile. While all the options listed below are
12

latex-free, not all synthetic materials are appropriate for

all uses. Synthetics also vary widely in price. When
bought in bulk from well-chosen manufacturers, many
of the best synthetic glove products can be found at
reasonable prices.

Vinyl
Vinyl (PVC) gloves are an easily available alternative to
latex. However, they are not as strong as latex and are
more easily punctured. They t loosely, are non-elastic,
and may slip, exposing the piercers skin or interfering
with skilled procedures.
Vinyl gloves are the most porous of exam glove options, and may allow penetration by even large molecules of blood and uids over long exposure. The failure
rate of stressed vinyl gloves is reported at about 51.3%
(compared with 3% for latex and 0% for Nitrile).*
Additionally, vinyl gloves do not necessarily eliminate
the potential for contact dermatitis because many of the
same chemicals used in processing latex gloves are
also used in vinyl gloves. Those reacting to additives
in latex gloves may need to avoid vinyl as well. For
these reasons, vinyl gloves are less than ideal for most
procedural applications in the studio.

Nitrile
Nitrile gloves are a protein-free, low-chemical, synthetic
alternative made from nitrile polymer. They are three
times more resistant to chemicals and punctures than
latex of the same thickness and have a reported stress
failure rate of 0%.*
While nitriles thickness and lack of elasticity require
getting used to after thin latex, many piercers nd these
gloves to be more secure and to allow full dexterity.
They are available with textured ngertips for increased
grip, and can be had in a range of colors to increase
client awareness of glove use.
Although slightly more expensive than latex, nitrile
gloves are reasonable when bought in bulk and offer
an excellent synthetic alternative for those desiring
high quality protection and minimal risk of chemicalor allergen-exposure. Test several manufacturers
products to nd an optimum product for your individual
needs and budget.

Polyurethane and Styrene Co-polymers

Other high quality synthetic alternatives such as Tactylite and Allergard are available. Some have very
little allergy potential and provide a good barrier. Fit,
feel and cost vary by material, brand and design. In
general these gloves are more expensive than others,

but may well be worth it depending upon a piercers

preferences and circumstances. Contact individual
suppliers for samples.
*Adenna, Inc. 1997-2004.

LATEX SENSITIVITIES
Since the implementation and recommendation of Universal Precautions by the Centers for Disease Control
and Prevention (CDC) and Occupational Safety and
Health Administration (OSHA) , latex sensitivities have
been on the rise. Estimates suggest 2 - 6% of the general population is latex sensitive. Among healthcare
workers this percentage rises to 8 - 12%. Due to the
extensive exposure many people in the healthcare,
emergency service, body art and other industries have
to latex gloves and protective gear, allergic reactions
among these groups are increasingly common and if
unchecked can interfere with continued employment.
Reactions can range from minor rash to life-threatening respiratory distress. Because latex allergies are
actually sensitization reactions from overexposure to
latex, and because latex is so pervasive in our home
and work environments, prevention through limiting
exposure is crucial. Those who come into frequent
contact with latex through the skin or inhalation become sensitized, and may go on to develop full allergic
reactions. These reactions often occur gradually, but
can also come on quite suddenly. Those who use
gloves at work, have had multiple surgeries, or who
have multiple allergic sensitivities or spina bida are
especially at risk.
In the piercing studio, many items besides gloves
contain latex. Adhesive tape, rubber bands, some
autoclave wrap, CPR masks, and even the handles
of some tools and covering on ballpoint pens may
contain traces of latex. All of these can trigger reactions. Piercers should understand the types of latex
reaction and how to deal with latex-sensitive clients
and coworkers.
The three types of latex hypersensitivity reactions that
occur are classied in order of severity as Irritant Contact
Dermatitis, Type IV Reaction and Type I Reaction.

Irritant Contact Dermatitis

This type of reaction is actually not an allergy, but rather
a surface irritation caused by excessive handwashing,
harsh soaps, chemicals, hand sanitizers and/or glove
powder. It can appear as overly dry, cracked, sore or
aky skin and rash. To avoid or relieve contact dermatitis, switch to milder products, avoid powdered gloves,

and use a soothing hand sealant after washing. Avoid

hand sanitizer or products that increase irritation and be
aware that cracked skin is open to latex, chemical and
pathogenic penetration. Although contact dermatitis
is not serious in itself, it can lead to further problems
if not cared for.

Type IV Reaction: Chemical Protein

Hypersensitivity
Type IV is a delayed reaction to an allergen that usually
appears 48 to 96 hours after contact. Most people with
Type IV hypersensitivity experience some form of dermatitis, such as rash, scales, inammation, or eczema.
Reactions may also include conjunctivitis, runny nose
or asthma-like symptoms from airborne detritus. It is
generally believed that this type of response is due to
the chemicals used in manufacturing the rubber and
not due to the latex itself.

Type I Reaction: Latex Protein Sensitivity

This is an immediate and systemic response to latex
proteins. People with this type of reaction may have
intense burning and irritation at the contact site, hives
within 5 to 60 minutes, itchy eyes, swelling of lips and
tongue, abdominal pain, asthma, nausea, and in severe
cases death from anaphylactic shock.

What To Do
For their own health and that of their clients, it is imperative that professional piercers take these health
concerns seriously. If you suspect you have a latex
sensitivity, consult a doctor or allergist. Because severe reactions can develop suddenly and continued
exposure increases this risk, cease all contact with
latex products. This will often mean making the entire
studio latex-free. The use of low-chemical, low-protein,
low-endotoxin powder free synthetic gloves (such as
nitrile) is recommended in suspected cases of all three
types of hypersensitivity. Question all clients regarding
latex sensitivity prior to piercing and use only non-latex
materials on clients with a history of sensitivity. Hand
sealants, non-latex gloves and avoidance of chemical
triggers may ease dermatitis and Type IV Reactions.
Medications and allergy therapies are available to minimize some symptoms of Type I Reactions, but there is
no clinically recognized treatment or cure.

For more information

NIOSH has issued an Alert, Preventing Allergic Reactions to Natural Rubber Latex in the Workplace (DHHS
[NIOSH] Publication No. 97-135). Free copies are
available from the NIOSH Publications Ofce: 1-80035-NIOSH (1-800-356-4674).
13

STERILE CHART
From STERILE to CLEAN to CONTAMINATED
Every piercer should thoroughly grasp how their environment and the tools they use pass through stages from
sterile to clean to contaminated. The chart below should help your understanding. Visualize sterile as white and
contaminated as dark red with several shades in between. Always remember that when a lighter colored item
comes in contact with a darker one it becomes that color, and can pass it on, until it is disinfected or sterilized.
Nothing darker than pale pink should ever come in contact with a piercing, directly or indirectly. Bare hands
should avoid red items. If red items are touched, hands should be immediately washed. Dark red items should
never be touched with bare hands.

RED

PINK

DARK
RED

PALEST
PINK

PALE
PINK

Sterile.
No living matter.

Very clean.
Only very small
quantities of airborne
matter.

Clean.
Only small quantities
of airborne matter.

Not clean.
Normal levels of
airborne matter.

Dirty.

Contaminated.
High levels of
airborne/bloodborne
matter.

Autoclaved
implements, jewelry,
needles, etc. in unopened, sterile bags,
untouched.

Sterile implements
just removed from
their bags.

Presterilized corks,
rubber bands, nonsterile latex gloves,
tissues, cotton
swabs, etc. stored in
protective containers
and only touched with
freshly gloved hands.

Needles, forceps,
corks, rubber bands,
etc.., after extended
exposure to open air
or frequent handling.

High levels of
airborne matter and
possible presence of
bloodborne matter.

Bodily uids, new or

old. Piercings, new
or healed.

WHITE

Disinfected implements only touched

with freshly gloved
hands, trays or
surfaces immediately
after disinfection/
bleaching.
Bagged sterile
implements after
several weeks in
storage.

Surface of sterile
eld, only touched
with freshly gloved
hands.
Needles, forceps,
sterilized jewelry, etc.
after several minutes
in open air, unused.
Surface of skin immediately after aseptic
skin prep.
Hands immediately
after correct hand
washing procedure.

14

Clothing, surfaces,
implements, neither
contaminated with
bloodborne organisms, nor recently
disinfected.
Unused jewelry prior
to sterilization/disinfection. Piercing room
furniture, etc.

Floors, countertops,
sinks, doorknobs,
light switches, and
other areas that may
have been exposed
to bloodborne
contaminants, either
directly or indirectly.
Unbroken, uncleaned
skin.
Frequently handled
display jewelry.
Phones
Money

Broken skin of any

kind.
Used piercing
implements, used
disposable piercing
needles.
Previously worn
jewelry.

CLEANING, DISINFECTION
& STERILIZATION
Cleaning, disinfection and sterilization are all part of
the same process, but they differ signicantly in the
number and types of microorganisms killed. Understanding the differences enables the piercer to choose
the correct way to make contaminated items safe to
use. It also determines proper disposal methods for
items that cannot be decontaminated and are unsafe
for use in the studio.

CLEANING
Cleaning is the process that physically removes debris
and reduces many of the microorganisms present on
an object.
Cleaning is the rst step in the decontamination process. It is important to clean items prior to disinfecting
and/or sterilizing them. There are some items that will
not require disinfecting or sterilizing prior to use, and
for which only thorough cleaning with an antibacterial
or antimicrobial soap is necessary.
Washing hands before and after performing piercings, and several times during the day is such a
decontamination process. Of course, even the most
stringent handwashing does not take the place of
wearing gloves.
Tools used in piercing procedures must be thoroughly
cleaned before sterilization in order to remove gross
matter such as body uids and lubricants. Otherwise
the presence of these can keep steam from effectively
reaching all surfaces during a sterilization cycle. In
order to do this thoroughly without the risks of manual
scrubbing, studios should use an ultrasonic cleaner.

For optimal results the technician must carefully follow the manufacturers guidelines for use of solution,
additives, temperature, baskets, lids and timers. For
example, even Stainless Steel forceps may appear corroded if the solution is not properly Ph-balanced. With
bench-top models, soils removed from components
will be suspended in the solution. If all items are not
rinsed immediately after the cycle, the soils in the solution will redeposit themselves on tools during drying.
All forceps and hinged tools must be run with the jaws
open to expose all contaminated surfaces.
There is some controversy regarding the risk of
aerosolized (airborne) contaminants during the running
cycle of an ultrasonic. To be safe, the APP strongly
encourages the use of lids during running cycles. Some
piercers even enclose the ultrasonic unit or add secondary barriers to minimize potential risks from airborne
aerosolized pathogens. A HEPA lter in the cleaning
room is an excellent additional precaution.

DISINFECTION
Disinfection is the process that kills some but not all
disease-causing microorganisms.
Some nonpathogenic microorganisms can remain
on any item that you have disinfected. What kind and
how many of those you might kill depends on what
level of disinfection you use. Bacterial spores and the
Mycobacterium Tuberculosis var. bovis are difcult-tokill, laboratory test microorganisms used to classify the
strength of a chemical disinfectant as follows.

Three Levels of Disinfection

Ultrasonic Cleaners are a quick and safe way to

execute the critical step of removing matter from instruments and jewelry prior to sterilizing. Ultrasonics
do NOT sterilize.

1. Low-Level Disinfection is the least effective process and is what most of us think of when we talk
about clean. It does not kill bacterial spores or
M.tuberculosis var. bovis.

Ultrasonics work by using ultrasound energy (wave

motion above the level of audible sound). This energy is
transmitted to the cleaning solution within the machine
where it creates tiny bubbles of vaporized liquid that
explode when they reach a high pressure. An extremely
thorough cleaning of all surfaces, even inside of tubes
and hinges, occurs as shock waves dislodge debris
from the contaminated articles placed in the bath.

2. Intermediate-Level Disinfection is a process

that kills the tough tuberculosis microorganism.
This is important because a process that kills
M.tuberculosis var. bovis is also effective against
a host of other organisms that are much easier to
kill, such those that cause HIV.
3. High-Level Disinfection is a process that will
destroy some, but not all bacterial spores, as well
15

as bacteria, fungi, and viruses (like the one causing Hepatitis B), in addition to the microorganisms
killed at the Intermediate Level. According to the
CDC, High- Level Disinfection can only be achieved
with a chemical solution that can sterilize given
appropriate conditions. However, although HighLevel Disinfection kills the same types of organisms as sterilization, only full autoclave sterilization
renders items that have been contaminated with
Bloodborne Pathogens safe for reuse.

STERILIZATION
Sterilization is the process that kills all microbial life.
In addition to all bacteria, viruses and fungi, sterilization will also kill bacterial spores, which are resilient and
are the most difcult microorganisms to kill. A process
able to eliminate bacterial spores will kill other types of
microorganisms such as fungi and viruses. Sterilization eliminates the organisms that cause Tuberculosis,
Hepatitis B, Hepatitis C and HIV, as well as all other
infectious agents. When you have sterilized properly,
there will be no microorganisms alive.
Any item or product in your shop that may have been
exposed to bloodborne pathogen contamination must
be sterilized prior to use. This includes reusable items
such as tools, forceps and setup trays. If a contaminated reusable item cannot be sterilized appropriately,
it must be discarded. Single-use, disposable items
such as piercing needles must also be sterilized prior
to use. However, once used disposables must never
be sterilized and reused.
Many piercing studio operators do not yet understand the need to sterilize all jewelry before use in
new piercings. Logically, there is no point of using a
sterile needle just to follow it with non-sterile jewelry.
We can only know how jewelry is handled within our
own shops, and must therefore ensure that no potential contaminants from the manufacturers or shipping
contact our clients. Regardless of the source of their
jewelry, a reputable piercing shop should insert only
high quality body piercing jewelry that is sterilized on
the premises prior to insertion.
It is not a manufacturers responsibility to sell only
sterilized jewelry. At the same time, manufacturers
also must not misrepresent what is being sold by falsely
labelling jewelry as sterile or ready for insertion,
or by making other misleading claims. Best practice
for any shop is to run new jewelry shipments through
an ultrasonic cycle (preferably in a clean ultrasonic
reserved for clean jewelry), and to then autoclave all
pieces prior to use.
16

Sterilization Procedure Options

Steam under Pressure (Saturated steam/steam
autoclave): 220-270 kip pressure at 140 degrees
Celsius (284 degrees Fahrenheit) for 15-40 minutes
depending on cycle.
Dry Heat (Dry-Clave): Processing at 177 C (350
F) for 1 hour. This is appropriate only for items that
cannot withstand steam exposure.
Gas Plasma (ETO gas/chemical autoclave): Requires specic site construction for venting of potentially toxic fumes and is not practical for piercers.
Gamma Radiation (exposure to specic radioactive waves): Highly regulated and costly, requiring
specic site construction and disposal criteria. Impractical for piercers.
Liquid Chemical (cold sterilization): Immersion in
an EPA (Environmental Protection Agency) approved
and FDA (Food and Drug Administration) controlled
chemical agent per manufacturers guidelines (commonly 10-12 hours). Maintaining the sterility of items
once removed from the solution is difcult. Problems
with disposal and exposure to toxic chemicals make
this method impractical for piercers.

Sterilization in the Studio

Pressurized steam is the only practical and cost-effective method of sterilization in the piercing studio. For our
purposes, sterilization requires an autoclave, a piece of
medical equipment that employs the steam under pressure method of sterilization. Autoclaves can be obtained
from a medical supplier and range between $600 and
several thousand dollars, depending on size, type and
features. Items that have already been cleaned and processed in an ultrasonic are placed in specially-designed
sealable autoclave bags that allow penetration by steam
during the sterilization cycle, but protect sterile items
from contamination after processing. Until these bags
are opened during a piercing procedure, their contents
remain sterile unless bag integrity is compromised by
puncture, moisture or age.
Having a clave on premises is not helpful if it is not
in working order. Manufacturer guidelines for maintenance should be stringently followed. Medical suppliers also provide easy in-house methods for studios
to check the viability of the sterilization process. Most
autoclave bags have indicator strips that change color
when exposed to steam, making it easy to distinguish
bags that have been processed from those that have
not. However, the color change of indicator strips on
the autoclave packaging is not a reliable method of
determining if an autoclave is working properly. It tests
only exposure to steam, not whether the heat, pressure

and duration of that exposure was sufcient to achieve

sterilization.

Due to the high number of cycles run each day, these

autoclaves must be spore tested weekly.

Integrator strips are another method for checking

clave reliability in house. Integrators are strips or devices used in pouches and/or autoclave chambers that
prove the conditions for sterilization were met. They
are similar to indicators, except that they change color
when they have been exposed to the ideal combination
of steam, pressure, heat and timing. They should ideally
be run and logged daily.

Daily, weekly and monthly maintenance of steam,

pressure-pulse autoclaves is required. This type of
autoclave requires a more rigorous maintenance
schedule than traditional autoclaves and a written log
of all maintenance should be kept.

Spore tests are the most thorough way of testing

autoclave function. They are periodically run through
an autoclave cycle, and then sent to an external testing
facility for analysis. The testing facility checks to see
that there is no subsequent growth of bacterial spores on
the medium. Since spores are extremely difcult to kill,
the lack of spores on the test medium after autoclaving
indicates that more fragile organisms have also been
destroyed and the autoclave is functioning properly.
Spore tests are absolutely necessary to ensure that
items are indeed being sterilized. Failed spore tests
require an immediate halt in piercing operations until
tools and other items can be reliably resterilized. For
this reason some shops keep more than one autoclave
on premises. Your studio should have a written policy
outlining the procedure that must be followed immediately following notication of a failed spore test.
Studios should develop and follow a written sterilization program that includes how and when indicator,
integrator and spore tests will be run, recorded and
led. Batch numbers can be included in the log so that
a given set of tools can be quickly traced to a particular
cycle and double-checked in case a concern regarding
a particular piercing or client arise. Some new autoclaves come conveniently equipped with a printer that
will provide a sheet documenting the sterilization cycle
of each load. This printout is simply a written record
and does not take the place of an indicator, integrator
or spore test. Logs proving autoclave use and integrity
are essential to the conscientious running of a studio,
and will be invaluable should post documentation be
required for regulatory or legal purposes (e.g. in the
event of a lawsuit).

Statim
Some piercing studios use steam-ushing pressurepulse autoclaves (such as Statim autoclaves) for
sterilization. The sterilization process in this type of
autoclave facilitates air removal and steam penetration, and has an extremely short processing time. The
steam-ush pressure-pulse autoclave is acceptable
for sterilization in the piercing studio as long as certain
guidelines are followed:

The Statim has three sterilization cycles, each designed to sterilize a specic type of instrument.
Unwrapped cycle - 275 F for 3.5 minutes
Wrapped cycle - 275 F for 10 minutes
Rubber and plastic cycle - 250 F for 15 minutes
The following can be sterilized in the Statim 2000:
Nylon, polycarbonate (Lexan), polypropylene, PFTE
(Teon), acetal (Delrin) polysulfone (Udel), polyetherimide (Ultem) silicone rubber, and polyester.
The following cannot be sterilized in the Statim 2000
on any cycle:
Polyethylene, ABS, styrene, cellulosics, PVC, acrylic
(Plexiglas), PPO (Noryl) latex, neoprene, and similar
materials.
If you are not sure, do not load items until you have
checked with the manufacturer. Processing of these materials may lead to instrument or equipment damage.
Do not mix instrument types (i.e. plastics and unwrapped tools) in the same Statim load.

DISINFECTING SOLUTIONS
What can I use as a disinfecting agent in
my shop?
What disinfectants you use will depend on the application and product availability. Appropriate products are
marketed under many names and in several categories.
All require exposure times of at least 10 minutes in order
to effectively disinfect, with the exception of surfaces
already considered clean (See Sterility Chart on page
14 for explanation).
Everything in the immediate piercing environment
should be decontaminated with no less than an Intermediate Level of disinfection.
Note that disinfectants are used only on inanimate
surfaces (objects) and antiseptics are used only on
animate (living) surfaces.
Disinfecting solutions are grouped into families according to similar characteristics and properties. Choose
products proven to be nontoxic, broad spectrum, hospital grade disinfectants, with a narrow efcacy time and
17

a long, stable shelf life. Labelling should specically

state that the product is bactericidal, virucidal, fungicidal
and tuberculocidal. Some may also be described as
germicidal or sporicidal as well.

Glutaraldehyde - 2% Solutions

most pathogens in less than 10 minutes. For bleach

to be effective, the surface area must be aggressively
scrubbed rst, and the solution allowed to remain on
the surface for a full 10 minutes. The diluted mixture
has a shelf life of less than 48 hours so it should not be
mixed and stored for later use.

These are non-biodegradable biohazards and have

been classied by the FDA as toxic. These solutions are
commonly found in two varieties, the acidic and the alkaline. The alkaline type will require an activating agent
to bring them to the proper Ph levels, thereby making
them usable. They generally require a long exposure
time in order to be effective. Most, if not all of these
that are currently available require special ventilation
and vapor monitoring equipment and must be disposed
of according to specic local and federal regulations.
Once activated, these products have a limited shelf life
and are rendered ineffective fairly quickly.

Many people are highly sensitive to this chemical and

some may experience severe allergic reactions to vapors in a recently cleaned room. Using other chemicals
(particularly ammonia-based cleaners) in the same area
may produce a toxic reaction and poisonous gas.

Some common products in the alkaline solutions

family are Cidex Plus, Procide, and Omnicide. Common acidic Glutaraldehyde products are Sterall and
Banicide. The acidic formulations do not require activation, but are only tuberculocidal after about 30 minutes
of exposure time.

Known as Super-Quats, these products are sometimes

mixed with other chemicals such as alcohol. Although
towelette wipes impregnated with Super-Quat solutions
are excellent surface cleaners, not all disinfectants in
this group will kill Tuberculosis, which is a particularly
hardy pathogen. These products should also not be
used for soaking jewelry. Common product names are
Saniklens, Aseptic-seryl, and Bax.

All Glutaraldehyde solutions destroy unlike metals.

Using any of these products with mixed metals such as
stainless steel tools, brass jaw pliers, and plated pliers
will lead to rapid corrosion.

Phenolics - 10% Solutions

Phenols are surface disinfectants and are not broad
spectrum enough to make them useful for most surfaces
in the piercing studio. These are sold under such names
as Birex, Procide, and Lysol.

Iodophores
These are iodine-based disinfectants that will stain
surfaces and discolor metals. This makes them a poor
choice for soaking jewelry or tools. Additionally these
disinfectants have been shown to potentially contain
high levels of an organism called Pseudomonas, which
grows in the solutions when stored for an extended period of time. Furthermore, many individuals are iodine
sensitive or allergic to these products. Biocide, Microdyne, and Iodove are common product names.

A bleach solution is incompatible with stainless steel

tools or surfaces. Its use in ultrasonic cleaners or autoclaves will not only void warranties, but will destroy
these costly pieces of equipment. Jewelry should never
be soaked in even a weak bleach solution.

Quaternary Ammonium Compounds

Synergistic Formulas
A synergistic action involves two or more agents cooperating with each other to result in an effect greater
than the additive effect of each agent operating by
itself. These solutions are non-toxic, biodegradable,
broad-spectrum disinfectants that are also non-corrosive and nonstaining. Once opened, the stability of
these solutions ranges from 6 to 10 months maintaining full potency. They do not require special disposal
handling.
Synergistic solutions are available in spray bottles,
liquid pour bottles, foams, and impregnated towelettes.
They can be used as hard surface disinfectants and
for jewelry soaking. (Note that autoclave sterilization
remains the only appropriate way to prepare jewelry
for use in a fresh piercing.) Two of the most common
products used by professional piercers are the synergistic formulas Madacide and Discide.

Chlorine Compounds

Isopropyl Alcohol

Sodium hypochlorite, more commonly known as bleach,

acts as a protein disintegrator. Most pathogens are
protein-based, making this an effective surface disinfectant. A solution of 10% bleach to 90% water will destroy

Alcohol can be used as a low-level disinfectant only. It

is not recommended as a soak or for disinfecting contaminated environments because it is not a sufciently
effective cleaner.

18

EQUIPMENT
DISPOSABLE SUPPLIES
To minimize the risk of cross-contamination and to
ensure that the piercing procedure is as clean as
possible, many components of a piercing set-up are
disposable. Unless supplies will be sterilized in a
Statim autoclave immediately prior to the procedure, all
disposables must be individually packaged in autoclave
bags, sterilized, and remain in their pouches stored in
enclosed, nonporous containers until use. Disposable
materials that can and should be autoclaved include
piercing needles, corks, rubber bands, cotton swabs,
toothpicks, and gauze.
When setting up for a piercing or jewelry insertion,
the piercer should rst select and assemble all materials and tools that might be needed for that procedure.
In avoiding cross-contamination, it is entirely unacceptable to reach into the piercing cabinet or drawers
with gloves that have touched a client. Therefore, the
piercer should anticipate possible needs and required
items before the procedure begins. If additional supplies are required, the piercer must don fresh gloves
before accessing any items in the piercing cabinet/
drawers, and must change gloves before touching the
client or sterile tools.

Use of Various Disposables

Presterilized Rubber Bands: Because the jaws of
forceps should never be locked onto a client during
piercing, these are wound around forceps handles to
achieve desired tension.
Presterilized Cotton Swabs: Excellent for cleaning and drying in tight spots, and for erasing stray
marks. They come in several different lengths and
thicknesses.
Presterilized Toothpicks: Used with gentian violet
for marking placement.
Presterilized Wire Snips: Can be used to connect
internally threaded jewelry and piercing needles to
maintain needle-jewelry connections for smooth jewelry
transfers.

PIERCING NEEDLES
Acceptable piercing needles are hollow and extremely
sharp, with a smoothly sloping cutting edge and no

scratches or surface aws that could damage the tissue. Most piercing needles are sold as super sharp, or
double- or triple-bevelled and come in several lengths.
Piercers should inspect each needle immediately before use to be sure there are no burrs or irregularities.
Should the piercer choose to bend or shorten a needle,
great care should be taken to avoid creating such aws.
Some companies are now manufacturing needles in
different lengths and bent options.
Of course, the true test of needle sharpness and
quality will be in use. Since needle quality will affect
both the comfort and healing of clients, as well as the
smoothness and speed of the piercers technique, the
use of only high quality needles is encouraged.
Piercing needles are available in sizes corresponding
to the gauges of jewelry for fresh piercings. Needles
are commonly used in 18, 16, 14, 12 and 10 gauge.
Most professional piercers agree that needles thinner
than 18 gauge or thicker than 8 gauge are inappropriate for fresh piercings. Thicker needles may damage
tissue, and the excessive weight of metal jewelry thicker
than 8 gauge may result in tissue damage or delayed
healing.

Needle Handling, Storage, and Disposal

Piercing needles have an extremely sharp, precisionground blade, making them both hazardous to ship
and handle, and easily damaged. Bulk, unsterilized
needles should arrive at the piercing studio in a clearly
marked, thick plastic, padded roll tube. Under no circumstances should needles be mailed in a plastic bag,
taped to a cardboard square, or rolling around loose
in a cardboard box. These methods create the risk of
a needlestick, and are certain to dull the ne points of
the needles.
Most piercing studios perform in-house sterilization
of piercing needles. This gives certainty that proper
handling has occurred at every stage of the process.
Unless needles are autoclaved immediately prior to a
piercing procedure in a Statim autoclave, shipments of
needles should be immediately packaged and labeled
with gauge and date of sterilization. Sterile needles in
autoclave packets must be kept in clean, dry enclosed
containers until use. Some local regulations and shop
policies set expiration dates on sterilized needles and
tools, after which the items are no longer considered
sterile. Unused sterilized needles stored past their
19

expiration date should be repackaged and autoclaved,

and marked with a new expiration date.

TYPES OF TOOLS

After a single use, needles must be immediately

disposed of into an approved Sharps container. They
should never be resterilized after use nor used more
than once.

Forceps

Sharps Disposal
Untreated, used Sharps disposal containers may not
be included with ordinary trash. Sharps containers and
waste in red Biohazard liners must be picked up by a
Biohazard waste management company or disposed
of in a manner that does not violate regulated waste
laws. All containers in a studio bearing the Biohazard
label must have the contents disposed of according to
regulated waste laws.

REUSABLE EQUIPMENT
Most professionals will use a wide range of tools to
speed the procedure and maximize the comfort of the
client. Piercing tools come in many styles, qualities
and price levels. Piercers are cautioned that while
inexpensive tools are abundant, the quality of tools is
usually exhibited in their performance and durability.
Tools that work well enhance your individual technique,
rather than complicate it. High quality piercing tools are
made of long-life stainless steel and are designed with
piercing applications in mind. Much like surgical implements, initially they will be costly, but they are intended
and engineered for repeated use over many years.
Following each use, the contaminated tool
should be:
1. Cleaned in an ultrasonic. (See ultrasonic manufacturers instructions for optimal solution and cycle
length.)
2. Rinsed
3. Dried
4. Bagged and labeled with date (as well as batch
number and operator initials if required). To prolong life of instruments with movable parts, many
professionals apply surgical instrument lubrication
(and allow it to dry) prior to bagging.
5. Sterilized in an autoclave
*Note: Steps 1-4 should be performed only in an
area designated as contaminated, and by properly trained personnel wearing personal protective
equipment.
20

Forceps come in a variety of shapes and sizes and are

used to align and secure tissue, increasing accuracy
and speed of the piercing. Properly applied, forceps
gently compress the piercing site while causing the
piercee minimal discomfort and no additional tissue
damage. Some forceps are designed for specic body
parts, such as
the septum and
navel. Others
are available
modified to an
individual piercers preference,
for instance
with a slotted,
smooth or serrated head.

Hemostats (Multipurpose Tools)

These are useful for holding jewelry, beads and
needles during procedures. They are available with
smooth or serrated jaws,
and some are customized
with grooves for opening
and closing rings as well.
The smooth-jawed are
less likely to scratch the
delicate nish on jewelry.
However, either nish of
jaw should be wrapped in
sterile protective padding,
such as plastic surgical
tape or a cloth band-aid,
for optimum protection.

Needle Holders
Needle holders are used in surgery for suturing. Their
strong jaws with a central groove make them ideal for
opening and closing small gauge and small diameter
rings.

Needle Receiving Tubes (NRTs)

NRTs are used to support and protect the tissue
around piercings when forceps may not be preferred.
They are often used for nostrils, septums, Prince Alberts, vertical clitoral
hoods, and some ear
cartilage piercings.
NRTs come in vari-

ous lengths, sizes and modications. They are usually hollow stainless steel tubes with perfectly smooth
openings, often with one ared or angled end. Some
piercers prefer a shatter-resistant, autoclavable, clear
Borosilicate glass NRT, which allows full needle visibility during the procedure.

Pliers
Many kinds of pliers are used in piercing procedures,
and are described below. Optimally pliers should be
made of stainless steel to withstand repeated autoclaving. The obvious exception is smooth brass-jaw pliers,
which have the unique advantage of being unlikely to
scratch the surface of jewelry due to their brass-coated
jaws. Many pliers can be nickel- or chrome-plated
to resist rusting, but will eventually break down and
become unusable. The corroding metal can damage
the delicate components of the autoclave. These tools
must be replaced at the rst sign of rust.
Ring Closing Pliers:
Used to narrow the
gap on captive rings to
create proper tension
for holding the bead.
Ring Opening (or Expanding)
Pliers: Used to remove and insert
captive beads and occasionally to
widen the gap on captive rings for
insertion and removal.
Bending Pliers: Used for custom
bending nostril screws, fishtail
labrets and needles. These are
usually jewelers pliers and are
available with a
number of different head shapes.
The most commonly used are
called double
rounds.

Connecting Snips
Small pieces of wire used to stabilize the jewelry
transfer during the initial piercing when using internally
threaded jewelry. Even experienced piercers nd the
wire connection between the jewelry and needle helpful in maintaining alignment. When nicely nished and
made of titanium or niobium wire in contrasting colors,
connecting snips are easily distinguished on the piercing tray and are safe for re-sterilizing.

Calipers
These instruments are used for measuring the
jewelry gauge
and diameter, or
the distance between markings
for piercing placement. They are available in both standard inch and
metric calibrations, and some offer both units of measurement. Though calipers are available in both plastic
and metal, few styles can be autoclaved. Usually the
fancier and more accurate models cannot be sterilized,
so great care should be taken not to contaminate them.
There are a few simple styles available in autoclavable
stainless steel. Though less accurate and somewhat
harder to read, they have an obvious advantage in the
piercing studio.

Gauge Wheels
Most American body jewelry
manufacturers have standardized measurement of
the thickness of their jewelry
wire with the Browne and
Sharp/American Standard
wire gauge system. In other
industries this system has
been historically used for measuring gold wire. There
are some variances between wholesale companies, so
it is always wise to double-check jewelry gauge to the
wheel and to the needle before the piercing procedure.
Outside the US, manufacturers use metric millimeters
for measuring gauge.

Insertion Tapers
These are tapered pieces of 18g
and larger stainless steel or titanium,
used to gradually expand an existing
piercing channel. Tapers are most
often used to stretch a piercing up to
the next gauge, to locate/stretch a
healed piercing that has shrunk, and
to quickly locate the piercing channel
if a jewelry transfer is lost during the
initial piercing.
Reusable tapers are made of autoclavable materials and are available in many lengths,
slopes and styles. In particular, concave tapers are
used with non-threaded or larger initial jewelry, and
pin-coupling tapers are available for inserting smaller
gauge internal jewelry. When using tapers, understand
21

that longer, gently sloping tapers (3 inches and up) are

best for stretching, while shorter tapers are used for
jewelry transfers. The longer and more gradual the
taper, the more gentle the stretch.

Piercing Trays
Piercing trays are the basic foundation upon which the
piercing set-up and aseptic eld is laid. All procedures
should be worked from an autoclaved tray set-up or
autoclaved tray liner, rather than a countertop or other
surface. Trays should be made of autoclavable plastic
or stainless steel, and covered with a plastic-backed
dental bib or another impenetrable tray liner. Bagged
equipment can be laid out upon the liner just prior to
a procedure.

The actual procedure surface is called an aseptic

eld, and is a sterilized surface that becomes exposed
to air contact only at the beginning of the piercing
procedure. The aseptic eld used by most piercers is
the inside surface of a freshly opened sterile forceps
pack, or a sterile 3x3 or 4x4 gauze. Once a forceps or
gauze pack is opened, sterile tools, needles, jewelry
and disposables can be dropped onto the attened
inside surface for use.
Needles, jewelry and tools should never be placed
on a non-sterile tray or tray liner surface. Clean is not
sufcient enough for a procedure surface. Procedure
surfaces must be sterile. Optimally, piercing trays
should t into the autoclave and should be sterilized
at least daily, or immediately if cross-contamination is
suspected.

Sundry Jars
These autoclavable tempered glass and/or stainless
steel jars are useful for storing individually packaged
sterile items. There are also a few grades of autoclavable plastic available. Sundry jars should not be used
to store bulk sterilized unpackaged items because
they are periodically open to air contact, and because
bulk sterilized items are only sterile until removed from
autoclave packaging. (Again, clean items are not
clean enough for a piercing procedure.) Sundry jars
need to be disinfected daily and sterilized weekly, or
immediately if cross-contamination is suspected.
22

THE PIERCING GUN

APP members make a commitment to using the best
piercing techniques for hygiene, healing and client
comfort. These require: piercing instruments that are
sterile and/or disposable; jewelry that is sterile, implant
grade and anatomy-appropriate; and methods that
minimize tissue trauma and scarring. Although piercing gun companies continue to respond innovatively to
some of the risks listed below, at the time of this printing
the use of an ear stud gun cannot be accepted in the
practice of APP members.
While piercing guns may seem to be a quick, easy
and convenient way of creating holes, they can have
major drawbacks in terms of sterility, tissue damage
and inappropriate jewelry design. These concerns,
which have been documented in the medical literature,
are addressed below.
Reusable ear piercing guns can put clients in
direct contact with the blood and body uids of
previous clients.
During a piercing, microspray of body uid from one
client can aerosolize and contaminate the inside of a
gun. Even if sterile jewelry packs are used, the next
clients tissue and jewelry may contact contaminated
surfaces, potentially transmitting bloodborne pathogens
through the reusable ear piercing gun. Although guns
may be exposed to bloodborne pathogens dozens of
times a day, few, if any, gun piercing establishments
possess the expensive equipment (steam autoclave or
chemclave) necessary to sterilize them.
Considering the dozens of clients who may have direct contact with a single gun in one day, pathogens like
hepatitis, pseudomonas and common staph constitute
a serious public health threat if they are introduced into
even one reusable piercing gun. Young children and
those with immature or compromised immune systems
may be at higher risk.
Piercing guns can cause signicant tissue damage.
Piercing guns use pressure to force a dull metal shaft
through the skin. The procedure can cause similar tissue damage to a blunt force trauma, such as signicant
pain, swelling, scarring, and an increased potential for
complications.
The more serious complications associated with gun
piercing increase when stud guns are used on structural
tissue such as cartilage. Cartilage has less blood ow

than lobe tissue and a correspondingly longer healing

time. Therefore infections in this area are more common and can be much more destructive. The use of
non-sterile piercing equipment and insufcient aftercare has been associated with increased incidence of
auricular chondritis, a severe and disguring infection
in cartilage tissue. This can result in deformity and collapse of structural ear tissue, requiring antibiotic therapy
and extensive reconstructive surgery to correct.
The length, design and material of traditional gun
studs are inappropriate for initial piercings.
Traditional ear piercing studs are too short for some
earlobes, most cartilage and other body parts. Once
they are locked on by the gun mechanisms pressure,
compressed tissue remains constricted and can become irritated. Diminished air and blood circulation
can lead to prolonged healing, scarring, swelling and
possibly impaction. Both piercers and medical personnel have seen stud gun jewelry embedded in ear
lobes and cartilage (as well as navels, nostrils and lips),
sometimes requiring surgical removal.
Jewelry that ts too closely also increases the risk of

body parts with the ear stud guns. This is absolutely

inappropriate and very dangerous.
Considering that a large proportion of gun piercers
clientele are minors or young adults, it is not surprising that few gun piercing complications are reported to
medical personnel. Many of the clients may have been
pierced without the consent of parents or guardians who
provide healthcare access. Therefore, many cases
of infection, scarring and minor complications may go
unreported and untreated. Because of the ease of
acquiring a gun piercing and the lack of awareness of
risk, many consumers fail to associate negative experiences with the stud gun itself. They believe that, since
it is quicker and easier to acquire a gun piercing than a
manicure, gun piercing must be inherently risk-free.
Legislation has begun to prohibit the use of guns
on ear cartilage and non-lobe locations, and New
Hampshire has made all non-sterile equipment illegal,
but these changes are not yet nationwide. As professional piercers and public health advocates, we have
an obligation to provide consumers and legislators with
accurate and adequate information to understand the
risks and benets of gun piercing.

infection because it does not allow for thorough cleaning. Body uids normally discharged during healing
can become trapped around the hole by inappropriately
designed jewelry. Unless this discharge is thoroughly
and frequently removed, it can attract bacteria and
becomes an invitation to secondary infection

FURTHER REFERENCES ON
EAR PIERCING GUNS
1.

Journal of the American Medical Association. 2004

February 25; 291(8): 981.
Outbreak of Pseudomonas aeruginosa Infections
Caused by Commercial Piercing of
Upper Ear Cartilage
William E. Keene, PhD, MPH
Amy C. Markum, RN, BSN
Mansour Samadpour, PhD

2.

Pediatric Emergency Care. 1999 Jun15 (3): 189-92.

Ear-piercing techniques as a cause of auricular chondritis.
More DR, Seidel JS, Bryan PA.
Department of Emergency Medicine, Harbor-UCLA
Medical Center,
Los Angeles, California, USA.

3.

Journal of Laryngology and Otology. 2001 Jul; 115(7):

519-21.
Ear deformity in children following high ear-piercing:
current practice, consent issues and legislation.
Jervis PN, Clifton NJ, Woolford TJ.
Department of Otolaryngology, Royal Hallamshire
Hospital, Shefeld, UK.

Ear piercing studs made of materials that are not

FDA-approved or ASTM-certied as safe for long term
implant in the human body should not be used. Even
when coated in non-toxic gold plating, materials from
underlying alloys can leach into human tissue through
corrosion, scratches and surface defects, causing cytotoxicity and allergic reaction. Since manufacturing
a durable corrosion- and defect-free coating for such
studs is extremely difcult, medical literature recommends only implant grade (ASTM F-138) steel and
titanium for piercing stud composition. Studs made of
any other materials, including non-implant grade steel
(steel not batch-certied as ASTM F-138), should not be
used, regardless of the presence of surface plating.
Misuse of ear piercing guns is extremely common.
Even though many manufacturers instructions and
local regulations prohibit it, many gun piercers do not
stop at piercing only the lobes, and may pierce ear
cartilage, nostrils, navels, eyebrows, tongues and other

23

4.

5.

International Journal of Pediatric Otorhinolaryngology.

1990 Mar; 19(1): 73-6.
Embedded earrings: a complication of the ear-piercing
gun.
Muntz HR, Pa-C DJ, Asher BF.
Department of Pediatric Otolaryngology, St. Louis
Children's Hospital, Washington University Medical
Center, MO 63110.
Plastic and Reconstructive Surgery. 2003 Feb;
111(2): 891-7; discussion 898.
Ear reconstruction after auricular chondritis secondary
to ear piercing.
Margulis A, Bauer BS, Alizadeh K.
Northwestern University Medical School, The Children's Memorial Medical Center, Chicago, Ill 60614,
USA.

6.

Contact Dermatitis. 1984 Jan; 10(1): 39-41.

Nickel release from ear piercing kits and earrings.
Fischer T, Fregert S, Gruvberger B, Rystedt I.

7.

British Journal of Plastic Surgery. 2002 April; 55(3):

194-7.
Piercing the upper ear: a simple infection, a difcult
reconstruction.
Cicchetti S, Skillman J, Gault DT.
Department of Plastic and Reconstructive Surgery,
Mount Vernon Hospital,
Northwood, UK.

8.

American Journal of Infection Control. 2001 Aug;

29(4): 271-4.
Body piercing as a risk factor for viral hepatitis: an
integrative research review.
Hayes MO, Harkness GA.
University of New Hampshire, School of Health and
Human Services, Durham, USA.

9. Cutis. 1994 Feb; 53(2): 82.

Embedded earrings.
Cohen HA, Nussinovitch M, Straussberg R.
Pediatric Community Clinic, Petach Tikvah, Israel.
10. Scandinavian Journal of Rheumatology. 2001; 30(5):
311.
Does mechanical insult to cartilage trigger relapsing
polychondritis?
Alissa H, Kadanoff R, Adams E.
11. Toxicology In Vitro. 2000 Dec; 14(6): 497-504.
Cytotoxicity due to corrosion of ear piercing studs.
Rogero SO, Higa OZ, Saiki M, Correa OV, Costa I.
24

Instituto de Pesquisas Energeticas e Nucleares,

IPEN, PO Box 11049, CEP 05422-970, SP, Sao
Paulo, Brazil.
12. Journal of the American Medical Association. 1974
Mar 11; 227(10): 1165.
Ear piercing and hepatitis: Nonsterile instruments
for ear piercing and the subsequent onset of viral
hepatitis.
Johnson CJ, Anderson H, Spearman J, Madson J.
13. Journal of the American Medical Association. 1969
Mar 24; 207(12): 2285.
Hepatitis from ear piercing.
Van Sciver AE.
14. The Lancet: Infectious Diseases. 2002 December
1; 2(12): 715.
Piercing the cartilage and not the lobes leads to
ear infections
Pam Das

ENVIRONMENT
RECEPTION AND SALES ROOM
Counter
The counter surface should be a nonporous surface
such as glass or metal that can be easily disinfected
as needed throughout the day. An FDA-approved hard
surface disinfectant should be used according to the
manufacturers instructions for this purpose. Glass
cleaner should be used to minimize streaking.
Keep disposable relish cups, sealable plastic
baggies, dental bibs and tissues at the counter to
minimize cross-contamination by customers. Have
clients place previously worn jewelry into relish cups
or baggies, never on the counter. Even new, unworn
jewelry brought in by a client must be handled as if it is
contaminated. It very well might have been just tried
on for a second, which is reason enough to treat it as
contaminated. Throw away contaminated disposable
items once they have contained a clients own jewelry,
whether they report it was previously worn or not.
It is extremely common for customers to touch their
jewelry and piercings when they are at the counter,
even when they are asked to refrain from such activity.
Keep a close watch on your customers and politely but
rmly insist that they not handle their own jewelry and/or
piercings on the premises. Fully explain your concern
for their safety and the reasons behind the rule, and
do not tolerate this potential for cross-contamination in
the studio. If a client does touch their own jewelry or
piercing (whether new or healed), immediately require
them to wash their hands or provide germicidal hand
wipes for their use to prevent cross-contamination of
the studio. Be consistent with requiring hand sanitizing
after each and every such contact. A posted sign at
the front counter can explain:
For your health and that of others, please do
not remove, insert, or handle your jewelry in the
store. We will do it for you.
With the possible exception of a welcoming handshake, touch pierced clients only with freshly gloved
hands. Many piercers feel that wearing gloves for
contact of even non-pierced areas establishes a level
of professional detachment between the piercer and
the client.
Dial calipers, gauge wheels, ring expanding pliers,
and other tools that are used at the counter should be
used for new, unworn jewelry only.

Disinfect or sterilize the front counter tools as necessary. Should contamination occur, items that cannot
be autoclaved must be disposed of.

Display
Display jewelry should be protected from potential contamination. Customers should not be allowed to touch
display jewelry to any part of their skin, piercing, or
own jewelry. When in doubt, handled items should be
autoclaved before being returned to the display case.
Sterile jewelry used for initial piercings should not
be kept in the display case. If jewelry from the display
case is to be used for an initial piercing, the item must
meet all criteria for initial piercing jewelry and must be
sterilized before use. If display or stock jewelry cannot be autoclaved, contact the manufacturer for proper
handling, care and maintenance. Whenever possible,
handle display jewelry with gloved hands.

THE PIERCING ROOM

The piercing room must be a completely separate
enclosed room with walls and door(s) made of nonporous material (tile, semigloss paint, sealed brick,
vinyl). Unsealed brick, cement, wood and other uneven
or porous wall surfaces can trap and harbor diseasecausing pathogens.
Flooring in the piercing room should be made of
linoleum, tile (ceramic, vinyl), sealed wood, or other
nonporous material, and should have approximately
4-6 inches of splash guard around the perimeter to
protect walls. Floors should be mopped daily with a
disinfectant specic to the type of ooring.
Lighting in the piercing room must be bright and
adjustable. Depending on lighting needs, xed lighting can be combined with adjustable lamps. Lamps
that are touched or adjusted during procedures must
be disinfected at least daily and throughout the day as
needed when the potential for cross-contamination exists. Piercers who touch light xtures during procedures
must change gloves before resuming the procedure.
To prevent client contact with Biohazard and clean
areas of the piercing room, a specic area should be
provided and visibly marked for clients belongings.
The Sharps container and contaminated tools should
not be located close to sterilized piercing implements
25

and supplies. Many piercers use a Biohazard-labeled

shelf above their trash can for contaminated tools.
This establishes a single contamination area in the
room. Used piercing implements should be kept in an
enclosed, nonporous tray or container marked Biohazard. The Sharps container should be secured to avoid
accidental spillage, and should be at a height easily
accessible to all piercers employed in the studio.
Packaged equipment and other supplies used during
procedures should be stored in a cabinet, credenza,
or other enclosed, nonporous storage area. These
supplies should be handled only with clean, freshly
gloved hands.
A HEPA lter or other air purication device should be
located in each piercing room and throughout the studio
in other necessary locations. Puriers are selected
according to square footage specications and should
be maintained according to manufacturers instructions.
Replacing lters as recommended is essential to the
proper functioning of these air cleaning devices.
Signs visibly convey important information to distracted clients and minimize the need to repeatedly
announce some information. Some examples of useful
signs for the studio:
Over the piercing setup area:
Do not touch or put anything on this table.
In areas where contaminated items are located:
Biohazard: Do not Touch.
On non-Biohazard trash cans:
Contaminated Waste

such as vinyl or sealed leather. Disposable table paper

is a suggested additional covering (mandatory where
required by law). Client seating must be disinfected
before and after each use even if no contamination is
apparent. Scabies, parasites, and other transmissible
organisms may be transferred from the hair or clothing
of a client to the table or chair.
Trash cans must be heavy-grade plastic or metal,
lidded, foot-pedal operated, and clearly labeled. Cans
should be tted with plastic liners and placed where
they will be accessible to piercers yet out of the reach
of clients.
According to usual medical standards, most piercing
studios do not produce enough blood- soaked trash to
necessitate regulated biohazard waste management.
However, it is appropriate to voluntarily use a biohazard
waste container that is collected by a biohazard waste
service weekly or monthly. Red biohazard trash can
liners should be used in these containers and should
never be disposed with regular trash. Be certain to
check local regulations on handling regulated waste.
Reasonable access to a sink used exclusively for
handwashing is mandatory. In-room prep sinks are
ideal. This sink should be used only for pre- and postpiercing handwashing, and optimally should operate via
a hands-free method (foot pedals, motion sensors).
Air conditioners, fans, and heaters should be used
with caution in the piercing room because they can blow
contaminants into the designated clean areas of the
room. If used, turn these devices toward the door and
away from the piercing supply cabinet, trays, and seating. Airow should always be from clean to dirty.

Furniture
Storage units and medical supply cabinets should be
of a nonporous, easily disinfected surface material, and
have several drawers for storing air- and light- sensitive
supplies. Furnishings should be disinfected no less
than once daily and whenever cross-contamination
occurs.
Mayo stands are portable tray holding devices.
These stainless steel rolling carts must be disinfected
before and after each use. Any stand or surface used
as a procedure surface must also be disinfected.
Client seating is available in a wide variety of styles.
The most commonly used types are dentists chairs,
massage tables, and gynecological exam tables.
Choose your furniture for comfort, adjustability, and
ease of disinfection.
Seating covers should be of a nonporous material
26

BIOHAZARD AND STERILIZATION ROOM(S)

Two Room Set-Up
An ideal studio design would include two rooms for
sterilization procedures: one contaminated; one
clean. The rst room would contain the biohazard
sink, presoak container, ultrasonic cleaning unit, and
autoclave packaging materials. Here shop staff would
decontaminate and package used forceps, tapers,
pliers and other tools. The second room, or clean
room, would contain a handwashing sink, autoclave(s),
and an additional (uncontaminated) ultrasonic unit for
processing new jewelry.
While it is not commonly seen in the piercing industry, there are some studios that have eliminated the

need for a biohazard processing area in their studio

by using only disposable tools and equipment. This
may not be a viable option for most studios due to the
increased cost.

One Room Set-Up

Many studios have limited space and must place sterilization and biohazard processing in one room. This
can be done effectively provided the two areas are
clearly separated.
The ultrasonic unit and dirty sink should be positioned as far away from the autoclave(s) and clean
area as possible to reduce the risk of contaminating the
outside of the autoclave and/or items being removed
from the autoclave. (See Sterility Chart on page 14.)
Nonporous barriers such as Plexiglas can be erected
to create boundaries between clean and dirty zones.
All contaminated surfaces and objects should be clearly
labeled Biohazard.

General Guidelines
The sterilization room(s) should be as far from client
trafc as possible and should be labeled to keep clients
from entering the room:
Warning: Biohazard! Employees Only
Remember that once an item is used in the biohazard area, it cannot be used for any other purpose or
in any other room unless it can be autoclaved. This
includes tissue and glove boxes, paper towel rolls,
pencils, tape, etc.

ing to the autoclave. A new set of gloves should

be donned before shutting the autoclave door and
starting the cycle.
4. Once an autoclave cycle is complete and the contents are dry, promptly remove sterile items from
the autoclave and place them in safe storage. This
will minimize the potential for cross-contaminating
the recently sterilized objects. Extra care must be
taken to avoid contaminating the sterile packages
as they are removed from the autoclave with freshly
gloved hands.
OSHA guidelines, printed sterilization procedures,
and any other signage required in the area should be
framed or laminated to allow for proper cleaning.

THE RESTROOM
Restroom sinks should have hot and cold water, a
paper towel dispenser, and liquid antibacterial soap
in a pump dispenser. A trash can with liner must be
provided. The toilet, sink, doorknobs, lights witches,
and other frequently-handled surfaces must be thoroughly cleaned daily, and disinfected throughout the
day as needed.
It is also appropriate to include signage such as:
For your own health and that of others, please
do not remove, insert, or handle your jewelry in
our bathroom. We will do it for you.

Piercers working in facilities that share space with

other body art practitioners such as tattooists must
have an ultrasonic unit dedicated for their own use.
Ultrasonic cleaners used for contaminated processing
require a solid tight-tting lid to reduce the quantity of
airborne contaminants. Everything in the proximity
of the ultrasonic unit is considered contaminated and
should be handled only with protective gloves.
The autoclave area has tremendous potential for
cross-contamination. Operating procedures must be
carefully outlined and consistently followed.
1. Gloves should be changed when moving from the
contaminated area to the autoclave area and any
other time when moving to a surface cleaner than
what was just touched.
2. Don clean gloves to open the autoclave before
loading tools into it. Place contaminated items into
the open autoclave, without touching any clean
surfaces with dirty gloves.
3. Dispose of gloves and wash hands before return27

28

SKIN PREPARATION
The Purpose of Skin Preparation
The purpose of skin preparation (skin prep) before
a piercing is to render the surface of the area to be
pierced as free as possible from oil, perspiration, dirt,
and transient and resident bacteria.

Note: Betadine has a 3.5 minute scrub time, and

scrubbing must be repeated three times with separate
sterile gauze pads or swabs.

Preparation Procedure for Oral Piercing

Antiseptic Solutions

The client should be given a small amount of antimicrobial mouthwash in a disposable cup. He/She should
rinse thoroughly with the mouthwash for a minimum of
thirty seconds and should not rinse with water or touch
the lips or mouth surfaces thereafter.

Chemical agents selected for skin prep should have

the following properties:

Note: For Oral/ Facial piercing such as the lip, both

types of prep must be implemented.

A broad-spectrum antimicrobial action

Marking the Skin

Rapid activation and prolonged effectiveness

Marking should be done after aseptic skin cleaning

or oral prep. All products and implements coming in
contact with the client should be single-use and sterile
or antimicrobial, including the marking implement.
Gentian Violet (available at most pharmacies) applied
with a sterilized toothpick meets these requirements.
Any other marking implement must be single use.

STAGES OF SKIN PREP

Minimal irritation/sensitization potential

Quick and convenient application
The chart below compares some of the frequentlyand historically-used products in this industry.
COMPARISON OF SKIN PREP PRODUCTS
Hibiclens

Betadine

Linear Alcohol

Techni-Care

Scrub Time (Minutes)

3.5

11

.5

Dermatitis Potential

30%

30%

High

<1%

Amount Needed

10 ml

10 ml

N/A

2.5 ml

PH Measurement

5.86

4.0

6.8

7.2

Tissue Contraindications

Yes

Yes

Yes

None

Toxicity Chemical Burns

Eyes, Ears
Genitals

Skin

Eyes

Non-Toxic

Transdermal Penetration

No

Unknown

No

Yes

Occular Irritation

Yes

Yes

Yes

Minimal

Any skin prep product selected must be used according to manufacturers guidelines. Applicator options
include presoaked swabs, towelettes, and products
such as Techni-Care dispensed from a pump apparatus
onto sterile gauze or swabs.

Aseptic Cleaning for Skin Surfaces

Effective skin asepsis is achieved through both mechanical and chemical means. Using a suitable skin
prep, begin at the center of the site to be pierced.
While applying enough pressure to create friction,
scrub in a circular motion, widening gradually outward.
If necessary, sterile gauze can be used to dry the
area, again using a circular motion, moving from the
center outward. This minimizes the chance of pulling
contaminants from unclean skin back onto the area
already cleaned.

Client Cooperation
Once the skin is prepped, the client must be directed to
keep unwashed, ungloved hands away from the area.
If the client touches on or near the prepped skin, the
procedure for aseptic cleaning must be repeated.

ANESTHETICS
A skilled, experienced piercer should work quickly and
gently so that anesthesia is unnecessary. Whatever
sensations a piercee encounters should be momentary
and are part of an honest piercing experience. There
is no doubt that the worst part of a piercing for most
piercees is the mental aspect of worrying, imagining,
and fearing the unknown. The physical reality of it
should be easy by comparison.
Anesthetics effective for prevention of all sensation
during a piercing would require a prescription and/or
need to be administered or applied by a licensed
medical professional. The majority of piercers are not
licensed medical practitioners and therefore cannot
legally provide these medications. Medical professionals who are also trained and experienced piercers are
generally not piercing within the scope of their medical
practice. They should advise against anesthetics for
29

the reasons explained below.

Injectable Anesthetics
These are illegal unless administered by a licensed
medical practitioner. Using an injectable product such
as Lidocaine or Xylocaine is ill-advised and inappropriate. The injection would be more uncomfortable and
take longer to administer than the piercing itself. Fluid
injected into tissue also distorts the area and causes
additional trauma. This can hamper accurate piercing
placement and is likely to result in additional discomfort
as the anesthesia dissipates.
Serious complications such as an allergic reaction
may be caused by the anesthetic as well. All else aside,
there is little sense in sticking a client with a needle and
injecting their body with a foreign substance in order
to perform a piercing.

Topical Anesthetics
The use of over-the-counter topical anesthetics such
as creams is not necessary for body piercings. These
products are ineffective for minimizing sensation to the
area that will be pierced. An effective topical anesthetic
only numbs the upper layers of tissue and, as with
injectable agents, the potential for allergic reactions
exists.
A prescription-strength topical anesthetic is illegal
unless prescribed by a licensed medical professional.
These may induce tissue edema (swelling), alter skin
texture and affect accurate jewelry placement. These
effects make the piercing procedure itself more challenging for the piercer to perform. It is difcult to be
sure of the ultimate appearance of the piercing when
tissue is distorted. The tissue will only resume normal
shape gradually as the effects of the product on the
tissue are diminished.
Ethyl Chloride is a prescription-only freeze spray.
When sprayed on tissue, it can result in frostbite damage and can complicate and delay healing. It is quite
painful to have applied, and takes much longer to
administer than a simple piercing.
Every effort should be made to discourage clients
who have access to anesthetics from using them prior
to piercing. While the client may have legal access to
these medications and take full responsibility for their
own actions, you are responsible for the quality and
safety of the work you perform. Some piercers refuse
to pierce clients who have used anesthetics until after
the chemicals have dissipated from the site.
Ice is another method of supercial freezing. Like
ethyl chloride, it may result in tissue damage. All of
30

the complications related to ethyl chloride apply to ice.

Additionally, ice is not sterile.
The only appropriate use of ice during a piercing
would be for the client to hold an ice cube in his/her
hand. This works as sensory confusion much like a
doctor or nurse pinching one hip while injecting the
other. This ice cube technique can be helpful for highly
anxious piercees.

Drugs and Alcohol

Purposely self-medicating with prescription or recreational drugs or alcohol prior to a piercing is unwise and
is an inappropriate behavior. An ethical piercer who
becomes aware that a client is in an altered state will
refuse to perform the piercing. In addition to the obvious ethical breach, such a situation involves dangers
for both parties. Only individuals in full possession of
their faculties should be pierced.

AFTERCARE
Client education and continued care are essential
services every piercer should provide. Clients need
to understand the importance of maintaining a clean
environment, and be given full written instructions for
appropriate piercing care during healing. A well-placed
piercing tted with high quality jewelry performed under
hygienic conditions can still go awry if proper aftercare
procedures are not observed.
Many misconceptions still exist about what products
and methods are most effective for piercing care. The
APP has established an industry standard of suggestions for piercing care. While we recognize the fact that
each human body is unique, we have found that the
following guidelines are optimal for uneventful, timely
healing for the vast majority of piercees. Even clients
with prior experience healing piercings should receive
complete instructions every time, as is now required by
many local laws. Many suggestions have changed over
time, and it is important to impart the most recent care
guidelines available. The following care instructions
should be provided to each piercee both verbally and
in a written format to take home with them.
Preprinted tri-fold pamphlets containing these written
care guidelines are available from the APP. See the inside cover of this manual or website for more details.

AFTERCARE GUIDELINES
FOR BODY PIERCINGS
Cleaning Solutions
Use either one or both of the following solutions for
body piercing:
Packaged sterile saline solution with no additives
(read the label) or non-iodized sea salt mixture.
Dissolve 1/8-1/4 teaspoon of non-iodized (iodine
free) sea salt into one cup (8 oz) of warm distilled
or bottled water. A stronger mixture is not better!
Saline solution that is too strong can irritate the
piercing.
Liquid anti-microbial or germicidal soap.

Cleaning Instructions for Body Piercings

1. WASH hands thoroughly prior to cleaning, or touching on or near piercing for any reason.
2. SALINE: Soak for several minutes at least two

to three times daily. Simply invert a cup of warm

solution over the area and press it against the
skin to form a vacuum. The longer the soaks, the
better. For certain placements it may be easier to
apply fresh gauze or a cotton ball saturated with
saline solution. Follow soaks with a brief rinse to
remove any residue.
3. SOAP: To be used no more than once or twice a
day. While showering, lather up a pearl size drop
of the soap to clean the jewelry and the piercing.
Leave the cleanser on the piercing no more than
thirty seconds, then rinse thoroughly to remove all
traces of soap from the piercing.
4. DRY with disposable paper products such as gauze
or tissues. Re used cloth towels can harbor bacteria and catch on new piercings causing injury. Pat
gently to avoid trauma.

What Is Normal?
Initially: Some bleeding, localized swelling, tenderness, or bruising.
During Healing: Some discoloration, itching, secretion of whitish-yellow uid (not pus) that forms
crust on jewelry when dried. The tissue may tighten
around jewelry as it heals.
Once Healed: Jewelry may not move freely in the
piercing. That is okay. DO NOT force it. If you fail
to clean the piercing as part of your daily hygiene
routine, smelly (but normal) secretions may accumulate. Continue cleaning piercing in the shower
after healing.
A piercing may seem healed before healing is complete. Piercings heal from the outside in and, although
it feels healed, the tissue on the inside remains fragile
longer. BE PATIENT and keep cleaning throughout
the entire healing period.
Even healed piercings can shrink or close in minutes
after having been there for years! This varies from
person to person. If you like your piercing, leave the
jewelry in place.

What To Do
Wash hands prior to touching the piercing. Leave
it alone except when cleaning. It is not necessary
to rotate the jewelry while healing except possibly
during cleaning.
31

 Stay healthy. Get enough sleep and eat a nutritious

diet. The healthier your lifestyle, the easier it is for
your piercing to heal. Exercise during healing is ne,
just listen to your body.

Leave Jewelry In At All Times. Even old, wellhealed piercings can shrink or close in minutes after
having been there for years! Reinsertion can be
difcult or impossible.

Keep the bed clean. Make sure bedding is clean and

changed regularly. Wear clean, breathable clothing
that protects your piercing while sleeping.

Check Balls. With clean hands or a paper product,

regularly check threaded ends on jewelry for tightness. (Righty-tighty, lefty-loosey.)

Showering is preferable to taking a bath because

bathtubs tend to harbor bacteria. If you would like to
take a bath, clean the tub well before each use.

Carry A Spare: In case of loss or breakage, keep

a clean spare ball with you.

What To Avoid
Avoid Undue Trauma such as friction from clothing,
excessive motion of the area, playing with jewelry and
vigorous cleaning. These activities can lead to unsightly and painful scar tissue, migration, prolonged
healing, and other complications.
Avoid Chemicals such as alcohol, hydrogen peroxide, Betadine, Hibiclens or ointments.
Avoid Over Cleaning. This can delay healing and
irritate the piercing.
Avoid All Contact. Oral contact, rough play, and
contact with others bodily uids on or near your
piercing during healing can irritate your piercing and
expose you to infection.
Avoid Stress and Recreational Drug Use including
excessive caffeine, nicotine, and alcohol.
Avoid Submerging Piercing in bodies of water
such as lakes, pools and jacuzzis. You could also
protect the piercing with waterproof bandages such
as Tegaderm, available at drugstores.
Avoid Cosmetics. Keep all beauty and personal
care products away from the area on or around the
piercing -- including cosmetics, lotions, and sprays.

Ready To Remove? If you decide you no longer

want the piercing, seek professional help to remove
jewelry and continue cleaning piercing until the hole
closes. In most cases only a small indentation will
remain.
Never remove jewelry during infection! If the surface seals over, the infection can be trapped inside,
complicating treatment.

FOR PARTICULAR AREAS

Navel
A hard, vented eye patch (sold at pharmacies) can
protect the area from restrictive clothing (such as
stockings), excess irritation, and impact during physical
activities such as contact sports. It can be applied with
surgical tape under tight clothing, or secured using a
length of ace bandage around the body (to avoid irritation from the adhesive).

Ear/Ear Cartilage and Facial

Use the t-shirt trick: Dress your pillow in a large, clean
t-shirt and turn it over or inside-out nightly, one clean
t-shirt provides four clean surfaces for sleeping.

Avoid Accessories. Do not hang charms or other objects from jewelry until the piercing is fully healed.

Maintain cleanliness of telephones, headphones,

eyeglasses, helmets, hats and anything that contacts
the pierced area.

HINTS AND TIPS

Use caution when styling your hair and advise your

stylist of a new or healing piercing.

Jewelry

Nipple

Leave Jewelry In During Healing. Unless there is

a problem with the size, style or material of the initial
jewelry, leave it in place for the entire healing period.
A qualied piercer should perform any necessary jewelry changes during healing. See the APP website
for Picking your Piercer brochure.

The support of a tight cotton tank top or sports bra

provides protection and be comfortable, especially for
sleeping.

If Temporary Removal Is Necessary. Contact your

piercer if a medical procedure or other event requires
removal. There are non-metallic jewelry alternatives
to keep the hole open.

Prince Albert and Apadravya piercings can bleed

freely for the rst few days. Keep wrapped in sterile
gauze as needed. Sex or blood thinners may exacerbate or renew bleeding.

32

Genital
Wash hands before touching on or near the piercing.

If using soap to clean, urinate after cleaning any

piercing that is near the urethra.

1. WASH hands thoroughly prior to cleaning or touching on or near your piercing for any reason.

In most cases gentle, uid-safe sexual activity is

ne as soon as you feel ready. Comfort and hygiene
are vital.

2. SALINE: Soak at least two to three times daily.

Simply soak directly in a cup of warm saline solution
for a few minutes. The longer you soak, the better.
For certain placements it may be easier to apply
fresh gauze or a cotton ball saturated with saline
solution. A brief rinse will remove any residue.

To increase comfort and decrease trauma, soak in

warm saline solution or plain water to remove any crusty
matter prior to sexual activity.
Use barriers such as condoms, dental dams, and
Tegaderm* to avoid contact with a partners bodily
uids, even in long-term relationships.
Use a new container of water based lubricant.* Do
not use your own or others saliva as a lubricant.
After sex, an additional saline soak or clean water
rinse is suggested.
*Consult your piercer or the APP website, or call
(888) 888-1APP for current suggested products. This
will allow for us to keep current as advances are made
in the eld.

AFTERCARE GUIDELINES
FOR ORAL PIERCINGS
Cleaning Solutions
Use either one or both of the following cleaning solutions for inside the mouth:
Antimicrobial or antibacterial alcohol-free mouth
rinse *
Packaged sterile saline solution* with no additives
(read label) or Non-iodized Sea Salt Mixture:
Dissolve 1/8 to 1/4 teaspoon of Non-iodized (iodinefree) Sea Salt into one cup (8 oz) of warm distilled or
bottled water. A stronger mixture is not better! Saline
solution that is too strong can irritate the piercing.
Note: Those with high blood pressure or a heart
condition should check with a doctor before using a
saline product inside the mouth as the primary cleaning solution.

Cleaning Instructions for Inside the Mouth

Rinse mouth 4-5 times daily with cleansing solution
for 30-60 seconds after meals and at bedtimes during
the entire healing period. Overcleaning may cause
discoloration or irritation of the tongue.

3. SOAP: Use no more than once or twice a day.

While showering, lather up a pearl-size drop of
soap to clean the jewelry and the piercing. Leave
the cleanser on the piercing no more than thirty
seconds, then rinse thoroughly to remove all traces
of soap from the piercing.
4. DRY with disposable paper products such as gauze
or tissues. Cloth towels can harbor bacteria and
catch on new piercings causing injury. Pat gently
to avoid trauma.

What Is Normal?
For The First Three To Five Days: Signicant swelling, light bleeding, bruising, and/or tenderness.
After That: Some swelling, light secretion of a whitish-yellow uid (not pus).
A piercing may seem healed before healing is complete. Piercings heal from the outside in, and although
it may feel healed, the tissue remains fragile on the
inside. BE PATIENT, and keep cleaning throughout
the entire healing period.
Even healed piercings can shrink or close in minutes
after having been there for years. This varies from
person to person. If you like your piercing, leave the
jewelry in place.

What To Do
Help Reduce Swelling: Dissolve small pieces of
ice in the mouth.
Take an over the counter, nonsteroidal anti-inammatory such as Ibupron or Naproxyn Sodium* according to package instructions.
Sleep with your head elevated above your heart for
the rst few nights.
Maintain Good Oral Hygiene: Use a new softbristled toothbrush and keep it clean (put it through
the dishwasher).

Cleaning Instructions for the Exterior of

Labret (cheek and lip) Piercings

Brush teeth, and use your chosen rinse (saline or

mouthwash) after every meal.

Soak in saline solution and/or wash with liquid antimicrobial or germicidal soap* as described below:

During healing, oss daily and gently brush teeth,

tongue and jewelry.
33

Once healed, brush jewelry more thoroughly to avoid

plaque build up.
Stay Healthy: The healthier your lifestyle, the easier
it will be for a piercing to heal.
Get enough sleep and eat a nutritious diet.

What To Avoid
DO NOT PLAY WITH THE JEWELRY. Long-term
effects of playing with and clicking the jewelry against
the teeth can result in permanent damage to teeth
and other oral structures. See the APPs Brochure:
Oral Piercing Risks and Safety Measures for more
information.

jewelry for tightness (Righty-tighty, lefty-loosey).

Carry A Spare: In case of loss or breakage, keep
a clean spare ball with you.
Ready To Remove? If you decide you no longer
want the piercing, seek professional help to remove
jewelry and continue cleaning piercing until the hole
closes. In most cases only a small indentation will
remain.
Never remove jewelry during infection! If the surface seals over, the infection can be trapped inside,
complicating treatment.

Eating

Avoid undue trauma. Excessive talking or playing

with the jewelry during healing can lead to unsightly
and uncomfortable scar tissue, migration, and other
complications.

Eat small bites of food, placed directly onto the

molars.

Avoid Alcohol. Mouthwash containing alcohol can

irritate the area and delay healing.

Avoid spicy, salty, acidic or hot temperature foods

or beverages for a few days.

Avoid Oral Sexual Contact including French (wet)

kissing or oral sex during healing, even with a long
term partner.

Cold foods and beverage are soothing and help

reduce swelling.

Avoid Chewing gum, tobacco, ngernails, pencils,

sunglasses, etc.
Avoid Sharing plates, cups, and eating utensils.
Avoid smoking! It increases risks and lengthens
healing time.
Avoid Stress and All Recreational Drug Use.
Avoid Bloodthinners including any aspirin or alcohol, or large amounts of caffeine.
Avoid Submerging in bodies of water such as lakes
and pools.
*Consult your piercer or the APP website, or call
(888) 888-1APP for current suggested products. This
will allow you to keep current as advances are made
in the eld.

HINTS AND TIPS

Jewelry
Replace Jewelry. Once the swelling has subsided,
it is vital to replace the original longer jewelry with a
shorter post. Consult your piercer for his/her downsize policy. Because this necessary jewelry change
may occur during healing, it should be done by a
qualied piercer.
Check Balls. With clean hands or paper product,
be sure to regularly check threaded ends on your
34

Chew Slowly.

For tongue piercings: Try to keep your tongue level

in your mouth as you chew and swallow.
For labret (cheek and lip) piercings: Be cautious
about opening your mouth too wide as this can result
in the backing of the jewelry catching on the teeth.
Each body is unique and healing times may vary
considerably. If you have any questions, please contact
your piercer.

DISCLAIMER
These guidelines are based on a combination of vast
professional experience, common sense, research and
extensive clinical practice. This is not to be considered
a substitute for medical advice from a doctor. If you suspect an infection, seek medical attention. Keep in mind
that the removal of jewelry can lead to further complications. Be aware that many doctors have not received
specic training regarding piercing. Your local piercer
may be able to refer you to a piercing friendly medical
professional. See the APP Brochure Troubleshooting
For You And Your Healthcare Professional.

PIERCING HEALING TIMES

Below is a list of average healing times for various piercings. Because these differ from many clients expectations, details of healing times and suggested aftercare should be provided to clients
before they consent to be pierced. Inform piercees that since human bodies differ, healing times
vary and cannot be guaranteed. When in doubt they should continue aftercare for at least the
maximum time listed below.

Ampallang

6-9 Months or longer

Labia (outer)

3-4 Months or longer

Apadravya

6-9 Months or longer

Labret

6-8 Weeks or longer

Cheek

6-9 Months or longer

Lip (side)

6-8 Weeks or longer

Clitoral Hood

6-8 Weeks or longer

Lorum

3-4 Months or longer

Clitoris

6-8 Weeks or longer

Navel

6-9 Months or longer

Conch

6-9 Months or longer

Daith

6-9 Months or longer

Nipple
(female)

6-9 Months or longer

Dydoe

6-9 Months or longer

Nipple
(male)

3-4 Months or longer

Prince Albert

6-8 Weeks or longer

Ear Cartilage
(all variations) 6-9 Months or longer
Earl (Bridge)

3-4 Months or longer

Pubic

3-4 Months or longer

Earlobe

6-8 Weeks or longer

Rook

6-9 Months or longer

Eyebrow

6-8 Weeks or longer

Scrotum

3-4 Months or longer

Foreskin

6-8 Weeks or longer

Septum

6-8 Weeks or longer

Fourchette

6-8 Weeks or longer

Surface

6-9 Months or longer

Frenum

3-4 Months or longer

Tongue

6-8 Weeks or longer

Guiche

3-4 Months or longer

Tragus

6-9 Months or longer

Labia (inner)

6-8 Weeks or longer

Triangle

3-4 Months or longer

6-8 Weeks:

Clitoral Hood, Clitoris, Earlobe, Eyebrow, Foreskin, Fourchette,

Inner Labia, Labret, Lip, Prince Albert, Septum, Tongue

3-4 Months:

Earl, Frenum, Guiche, Outer Labia, Lorum, Male Nipple, Pubic,

Scrotum, Triangle

6-9 Months:

Ampallang, Apadravya, Cheek, Conch, Daith, Dydoe, Ear Cartilage,

Navel, Female Nipple, Rook, Surface Piercings, Tragus

35

36

JEWELRY
STANDARDS AND
CERTIFICATIONS
Of the countless metals and alloys available, few have
been proven safe and effective for initial wear in body
piercings. To nd the most acceptable materials for
internal wear, our industry utilizes material guidelines
used for medical implants, as dened by the ISO and
ASTM.

ISO
The International Organization for Standardization
(ISO) is a worldwide non-governmental federation
of national standard bodies from over 140 countries.
The mission of ISO is to promote the development and
distribution of international standardization for scientic
and technological practices, including medical, metal,
and chemical activity.

ASTM
The American Standard for Testing Materials (ASTM)
is a not-for-prot organization that provides a global forum for the development and distribution of consensus
standards for materials and testing. Despite its name,
ASTM standards are accepted and used internationally in scientic and medical research, development
and testing.
Use of ISO and ASTM standards are voluntary and
only become legally binding when a governmental body
makes them so, or when they are cited in a contract.
Manufacturers in a variety of industries will sometimes
state a product has been tested according to ASTM or
ISO standard by citing the applicable code number on
the product label or packaging. In the case of metals
this will appear on the mill sheet.

Mill Sheet
Also referred to as a mill certicate or material certicate, this is a document created by a metal foundry,
provided to the wire mill, and then to the manufacturer.
It guarantees the specications of the alloy and is your
proof of content quality.
On request, any manufacturer producing body jewelry
should produce the mill certicates obtained from the
wire mill where their raw material was purchased. If a
jewelry manufacturer is unwilling or unable to produce
this certication, their steel and titanium jewelry cannot be considered to meet ASTM or ISO standards

and should not be used. Some area laws now require

that shops provide mill sheets proving the ASTM/ISO
compliance (and therefore the biocompatibility) of their
jewelry.

CERTIFIED MATERIALS FOR

NEW PIERCINGS
ASTM Compliant Stainless Steel
Low carbon stainless steels, such as 316L and 316LVM
are used in the body jewelry industry because of their
proven biocompatibility. For many years 316LVM was
the preferred steel standard for a fresh piercing. While
this is a good start, it is important to know that not all
316L or 316LVM stainless will meet ASTM certication,
and may vary in biocompatibility. Therefore shops must
have mill certicates from jewelry manufacturers showing that the steel being used is F-138 compliant.
Stainless steel contains nickel, which is a well-documented irritant. One signicant benet of implant-certied materials is a passive layer of chromium oxide that
allows virtually no nickel to contact the customer.

Implant Certied Titanium

Implant Certied Titanium (ASTM F-136) is an extremely inert and lightweight alloy. Additionally, titanium
can be anodized to create jewelry of different colors.
The colors are created by producing an oxide layer
of varying thicknesses and do not affect the biocompatibility. They may fade with time and certain types
of chemical exposure, but again this does not affect
biocompatibility.

OTHER APPROPRIATE MATERIALS

FOR NEW PIERCINGS
There are other materials considered acceptable for
fresh piercings, but which do not have ISO and ASTM
standards. The following are considered acceptable
because they either have a long history of successful
use, or have favorable biocompatibility ratings.

Niobium
Niobium is very similar to titanium but does not have
a set ASTM standard. It is used extensively in the
medical industry for implant components and has
been the subject of thorough biocompatibility testing.
37

Like titanium it can be anodized to produce different

colors. Unlike titanium, it can also be colored black
in either a glossy or matte nish. Matte nish black
niobium has a rough nish and is NOT acceptable for
fresh piercings.

Solid 14K or 18K White or Yellow Gold

Medical documentation relating to gold biocompatibility
is scarce. However, gold has been used successfully
for piercing jewelry for thousands of years and is considered by both our industry and the medical industry to be
biocompatible for most people when it is pure enough.
All gold jewelry contains a mixture of gold and other
metals called an alloy. Every jeweler uses different alloy
mixtures and often guards the recipes as trade secrets.
Since the specic percentage of each metal are different
to obtain, it is impossible to set specic standards and
metal requirements for gold alloys. However, we can
say the following:
The purest form of gold, 24k, contains no other materials but is too soft for use in body jewelry. Jewelry that
is too soft is easily scratched, nicked or burred, and is
difcult to thread without stripping. Jewelry less than 14k
is less than 57% gold and can contain large amounts
of other metals that may react to the body. Therefore,
it should not be used. 18k is an optimum standard for
body jewelry, and 14k may also be used.
Only solid white or yellow gold is appropriate for insertion into the body. Colored golds, such as rose or green
gold, are alloys with variations in the amount of copper,
silver or other metals. These alloys are more likely to
cause adverse reactions in the body and should only be
used for beads and decorative attachments.
In the making of white gold alloys, metals such as
nickel, platinum or palladium are used to make the gold
white in appearance. Because of the risk of nickel reactions, most manufacturers offer nickel-free white gold,
which is strongly recommended for use in body jewelry
and is required by some area regulations.

Platinum
This very heavy and expensive precious metal is extremely inert and is therefore ideal for body jewelry. It
is a brilliant white color and is harder to work than other
precious metals. Styles may be limited as a result of both
its high cost and greater difculty in manufacturing.

PTFE
This inert plastic comes as a solid rod and uses tapped
balls. When a ball is twisted onto the end of the rod,
the existing pattern inside the ball effectively threads
38

the post, keeping the ball in place. PTFE is quite useful in medical situations where metal jewelry cannot
be worn.

Tygon
This micro-bore tubing is used in many medical applications because it is USP Class 6-compliant. Male
balls can be threaded into the hollow center, creating
barbell-style jewelry that can be cut to custom size.
Because of changes in the material over use time,
Tygon should be changed every two months. Additionally, the manufacturer does not recommend it for
long-term use.

JEWELRY MATERIALS FOR

HEALED PIERCINGS
When used and cared for responsibly, the following materials are generally appropriate for healed piercings.
Because all bodies are different, be aware that some
individuals may experience sensitivity or reactions to
one or more of these.

Tempered Glass (Pyrex)

Lead-free glass plugs are usually safe and comfortable
in piercings, especially in stretched ear lobes. Borosilicate glass is autoclaveable but can be susceptible
to breakage in thinner pieces.

High-Density, Low-Porosity Non-Toxic

Hardwoods
Hardwood plugs are a popular and comfortable choice
for many clients. Because some woods are toxic or have
been treated with various chemicals, it is important to
purchase plugs from a knowledgeable and reputable
manufacturer. Wood cannot be autoclaved or disinfected so each wood piece should be worn by only one
piercee. Accepting returns or exchanges of wood pieces
is never appropriate. A non-chemical soap is suggested
for cleaning wood jewelry. Periodic conditioning of wood
plugs with cosmetic-grade natural oils can improve durability, appearance and long-term comfort.

Other Organic Materials

Several types of organic jewelry are acceptable for use
in healed piercings. These include (but are not limited
to) stone, horn, bone, coconut wood, bamboo, and
petried ivory. These materials are most often used in
ear lobes. In some areas, such as lips, moisture may
cause porous jewelry to swell, making removal more
difcult. Care should be taken in both choosing and
conditioning organic jewelry.

High-Density, Low-Porosity
Nontoxic Plastics
There is some controversy surrounding the long-term
wear of acrylic jewelry. While a clean piece of FDA
approved acrylic is an acceptable choice for a healed
piercing for some clients, its chemical components are
less biocompatible than many other materials. Some
grades are more likely to cause reactions than others
and should be chosen with caution. Acrylic cannot be
autoclaved or disinfected and should therefore be considered appropriate for single person use only. Acrylic
can crack, shatter or cloud when coming in contact with
alcohol or alcohol-based disinfectants, hair products
and mouthwashes. Petroleum-based lubricants can
cause plastics to break down, potentially releasing
chemical irritants into the skin. Acute sensitivities to
acrylic can develop suddenly even in those who have
worn it comfortably in the past. Therefore care should
be taken when choosing and using acrylic jewelry.

JEWELRY TO AVOID

even if they wear silver comfortably in ear piercings,

other areas of the body are more sensitive and are
quickly irritated by it. Even sterling silver is not appropriate for use in body piercings. Many piercees will
have reactions to silver beads or charms that contact
sensitive skin near piercings or rest against piercing
holes (especially on navels).

Other Grades of Stainless Steel

High carbon steel and steel of the 302, 306, and 400
series are inappropriate for piercing jewelry. Many of
these grades of steel break down or corrode when in
continued contact with body uids. Always request mill
certicates directly from the manufacturers. They are
required by law to provide these documents detailing
the composition of the metal.

Aluminum
Aluminum resembles niobium in appearance and
is similar to titanium in weight. However, it is never
appropriate for body jewelry. Long-term aluminum
exposure has been connected to neurological damage,
Alzheimers Disease and metal sensitivities.

Conventional Jewelry
Jewelry designed specically for earlobe piercing or
purchased at a conventional jewelry store is never appropriate for use in body piercings. The materials and
workmanship are seldom of implant quality, and the
styles may involve sharp edges and/or details that may
trap bacteria. Earring wires and posts are also much
too thin, which can cause discomfort and potentially cut
into a piercing. Ear studs with buttery closures trap
excreted body uids and bacteria.

Gold-lled, Rolled, or Plated Jewelry

This type of jewelry is always unacceptable for body
piercings. These products are made by placing a very
thin layer of gold over either inferior metal jewelry (e.g.
nickel or aluminum), or over a steel piece rst covered
by an underplating of nickel or copper (to help the gold
adhere to the steel). The thin gold outer layer can wear
off, leaving sharp edges and exposing the poor quality
metals underneath. Furthermore, the plating process is
often achieved by means of a cyanide bath or mercury
amalgam. This process creates the potential for these
two highly toxic chemicals to contact the body and leach
into the bloodstream.

Silver
Silver is an unstable alloy that oxidizes (tarnishes) easily and is not biocompatible. Many piercees nd that

THINGS TO LOOK FOR IN

QUALITY JEWELRY
Jewelry Quality
Because the jewelry industry is overly saturated with
substandard jewelry, it is common for piercers and clients alike to forget that quality jewelry, not cost, should
be the deciding factor in the purchasing of jewelry. Keep
in mind that this jewelry will be worn inside the body
in continuous contact with internal tissue. It should be
of the best materials, design and workmanship available. Furthermore, the unique individual, anatomy and
location should be considered in determining the most
appropriate jewelry in each case.

Polish
High quality piercing jewelry must be polished to a
mirror nish. Jewelry that is not highly polished will
be more porous, potentially causing discomfort and
delayed healing. Poorly polished jewelry may also
have compromised biocompatibility.
Piercing jewelry must be free of all polishing compounds. These may appear as deposits near a xed
bead or in the threading. All jewelry must also be free
of nicks, scratches and burrs.
39

Annealing
Annealing is a heat treatment that tempers metal,
making it more pliable and easier to open and close.
Annealed jewelry does not need to be opened forcefully
with pliers, reducing the risk that it will be scratched during procedures. Jewelry that is well annealed should
be able to be opened with only nger pressure in sizes
such as 14 gauge 1/2 diameter and 12 gauge 5/8
diameter. There will still be more than enough tensile
strength to hold in a captive bead.
Curved jewelry such as captive rings or xed bead
rings is made from wire that is wrapped in the manufacturing process. This wrapping can change the molecular structure of the metal. It should be annealed
to restore it to its pre-wrapping grade.

Threading
The United States APP membership elected to require
internally threaded jewelry for initial piercings. External
threads may tear new tissue, trap bacteria and release
polishing materials into the initial piercing.
Balls for tapped/threaded jewelry thicker than 16
gauge should be countersunk so that the bead ts onto
the end of the jewelry more closely, thus minimizing
accumulation of excreted matter.

Non-Threading
Threadless (press-t) barbells and balls are a new
jewelry option in the industry. Well made jewelry of
this type is an acceptable alternative to traditional
threaded jewelry.

Machining
Many people currently manufacturing body piercing
jewelry are amateurs who do not have the knowledge
or skill to produce well-machined jewelry. Piercers must
therefore carefully check all pieces prior to use.
Beads and posts should be drilled to match, and
should not be off-center.
Check for gaps between the ball and post that could
retain bacteria and signify poor drilling.
Ends of rings and posts should not be blunt or sharp,
but smoothly rounded for painless insertion.

Jewelry Size, Gauge, Diameter

Each piece of jewelry is measured using two proportions: Gauge and Diameter. Gauge refers to the thickness of the wire. Most American piercers use the Brown
and Sharpe/American wire gauging system. Most other
countries measure gauge in metric millimeters.
40

The diameter of a ring is its width measured across

the inside of the ring. The diameter or length of a
barbell is the length of the shaft measured between
the balls.
Inexperienced and uncaring piercers frequently insert
inappropriately sized jewelry into new piercings. A
skilled piercer knows that each body is unique and will
individually select pieces of appropriate gauge, size,
and style for each client. Initial jewelry should be selected for its suitability during healing. Remember that
the piercing is permanent but the jewelry can always
be changed after healing.

JEWELRY STYLES
Captive Bead
Ring
This ring is the most commonly
used type of body jewelry. It
consists of a gapped ring with
a bead held captive in the gap
by the tension of the ring. The
ring is opened by removing
and replacing the bead (popping the bead in and
out). This style may not be appropriate for jewelry of
very thin sizes, particularly in softer gold, when there
is not enough pressure/tension to keep the bead from
falling out.

Fixed Bead Ring

This has a bead permanently soldered or fixed
onto one end of the ring,
and is opened and closed
by bending the ring sideways (as if tearing a coin). This style is most suitable for
piercings in which the jewelry is not changed frequently.
Since thicker or harder rings can be difcult to open or
close, xed bead rings are most often made in smaller
gauges and in gold.

Barbell
This piece of jewelry is a straight post
with one threaded ball on each end. It
is most commonly seen in tongue piercings, but can be used in many other
piercings in which a ring is not suitable,
or when jewelry needs to lie close to the
body with a minimal prole.

Curved Barbell
These are similar to barbells with two threaded
balls, but have a shaft that
curves in a uniform arc like
a crescent moon. They are
most commonly associated
with navel piercings, but are also appropriate in other
areas where friction from protruding jewelry is problematic, but a straight barbell is unsuitably shaped.

J Barbell
The J Barbell is a curved barbell
whose shaft is shaped like a J.
These are used in navels for which
the J curve more closely mimics
the piercees anatomy than does
the crescent curved barbell.

Circular Barbell
This is similar in shape
to a ring, but with more
versatility of a barbells
screw-on balls. The
threaded balls allow it
to be easily removed and reinserted. A circular barbell
is especially suitable when the look of a large gauge
ring is desired without the difculty of opening and
closing a ring of such thickness.

Surface Barbell
This staple shaped barbell
was developed specically
for use in surface piercings. The theory is that the staple shape helps coax
the body into healing by minimizing upward pressure
on the tissue over the piercing and allowing blood to
ow freely in the local tissue, thereby minimizing the
chances of migration.

Nostril Screw
Nostril screws are based on an
old East Indian design. The
screw allows the stud to hug
the inside of the nostril without
injuring the septum or falling
out easily. It does not require a backing (which can
trap bacteria) as a regular stud earring does. This is
more attractive, safer, and superior for comfort.

There are left-bend and a right-bend nostril screws,

depending on whether the jewelry is worn in the right
or left nostril. The tail end of the screw should point up
and away, concealed inside the nostril. Also, nostrils
can vary considerably in thickness, and dimensions
must be taken into account when selecting or custom
bending the nostril screw for each client.

Labret Stud
A labret stud is essentially a minibarbell with a small, at disc on one
end. These are most commonly
used for labret piercings and in
places where a at back ts most
comfortably with anatomical structures on one side of the piercing
(e.g. against teeth, some inner ear
cartilage). They often come with both ends threaded so
that ball and disc sizes and shapes can be customized
to the clients individual anatomy and preferences.

Fishtail Labret
The shtail is an alternative to the labret stud for
lip piercing. Its shape resembles a nostril screw,
but it is longer and often thicker to suit the thick and
soft lip tissue. After allowing sufcient length to wear
through the lip, the post is bent at a right angle, and the
tail is worn resting along the bottom of the gumline
inside the lip on one side. These are most comfortable
when t and custom bent to the clients mouth.

Threadless
Barbell
This has the same shapes
and uses as the barbell,
curved barbell or labret
post, except that instead
of the usual screw-on
ball(s), a snap together
ball is pressed into the
post.

Septum Retainer
Retainers are specialized pieces of
jewelry, used only in septum piercings and often shaped like a staple
or U. They are useful for clients
41

who want to keep jewelry in their septum piercings,

yet need to make the piercing inconspicuous. The
center of the piece is worn through the piercing and
the legs are ipped up and forward inside the nostrils
to remain unseen.

Plugs and/or
Eyelets
These styles can be worn
in healed stretched or
enlarged piercings, most
often in ear lobes. They can be made of a variety
of materials, including stainless steel, glass, wood,
stone, horn, bone, amber, and gold. They are often
ared at one or both ends to keep the jewelry in place.
Plugs that are not ared are often kept in place with
small o-rings of high-grade silicon or latex. O-rings
should be worn slightly away from the skin to allow
air to contact the piercing, let moisture escape, and
minimize potential reactions. Silicon is best for those
with latex sensitivities.

42

ETHICS AND LEGALITIES

It is widely accepted that the following ethical standards
should be adhered to in every piercing establishment.
In some cases local or state laws will exceed these
standards. The APP suggests that every piercer
consult with an attorney in his/her state to determine
whether state and/or local regulations affect the application of these standards.

It is also important to remember that the shop staff

must set and maintain behavior standards for the
studio. The content and style of staff interaction,
apparel and personal habits, studio design, decoration, website, music, and shop policies all reect your
level of professionalism. Clients use this information
to judge both what to expect of you and what you
expect of them.

PERSONAL BOUNDARIES

In localities where shop personnel are extremely visible or well-known, these expectations may extend
into off-work hours outside the studio. You may
want to consider how you want to be perceived by
clients who meet or observe you when you are not
at work.

APP literature outlines a clients rights with regard to

piercing services. The piercer also has the right to expect appropriate behavior from his/her clients. These
boundaries are to protect both piercer and client from
potentially dangerous or inappropriate situations. The
following are reasons a piercer may decline to perform
a particular piercing, reschedule or abort a piercing, or
dismiss a client from the studio permanently:
The client appears intoxicated, behaves erratically, or
is not in full possession of his or her mental or physical facilities. Note: In cases attributable to medical
or psychiatric conditions, the piercer may tactfully
request a signed letter from or a conversation with the
clients doctor, psychiatrist or other caregiver verifying
the clients ability to make responsible choices.
The client maintains poor personal hygiene that could
compromise the well-being of the piercing and/or that
signicantly affects the ability of the piercer to perform
the procedure.
The client makes comments or gestures of a sexual
or otherwise inappropriate/offensive nature.
The piercer may wish to consider not only his/her
own personal boundaries, but also his/her obligation
to ensure a studio atmosphere that is respectful of all
clients and staff. Many shops refuse to serve clients
who repeatedly make racist, sexual, homophobic,
or otherwise offensive comments, or who behave
rudely towards other clients or shop personnel.
Posting a statement to this effect may help minimize
your liability for discrimination, as well as advertise
your intentions to those waiting. (For example: We
reserve the right to refuse service to anyone who is
drunk, disorderly, or disrespectful.) Clients who are
aggressive or unruly in the waiting room often get
worse as they become more nervous, and may need
to return at a later date when they are better able to
control themselves.

PIERCERS ARE NOT PERFECT

No piercer, however experienced or skilled, is perfect.
Unfortunately, in every career some piercings will be
poorly placed, jewelry transfers will be missed, and
items will be dropped. Piercers should always handle
these situations with professionalism, honesty, and
tact. Blaming the client (Its your fault -- you moved.)
is never appropriate and contributes to a sense of panic
and regret in the room. Piercing is a service profession.
As a professional piercer, it is part of your job description to expect and allow for client reactions. A piercer
should take responsibility for the error and correct it to
suit the clients needs and preferences.
If the client is displeased with the results or you determine the piercing may not heal successfully due to
an inaccuracy in placement, it should be removed and
re-pierced, either immediately or at a later date. If you
have made a mistake, it is appropriate to offer additional
services free of charge. If the client has experienced
undue discomfort it may be reasonable to offer an additional discount, free piercing, or jewelry.

DETERMINING APPROPRIATENESS OF A PIERCING

Sometimes it is inappropriate to perform even the most
standard piercing. A piercer should politely refuse to
perform a piercing that could be dangerous, ill suited,
unsuccessful, or for which they are not trained. It is
helpful to have an educated and piercing friendly phy43

sician to contact when clients do not have a physician

that they are comfortable consulting.
The following examples for which a second and/or
medical opinion may be needed before proceeding:
There is an obvious skin or tissue abnormality that
may include but is not limited to rashes, lumps,
bumps, scars, lesions, swellings, uid, tenderness,
moles, freckles, and/or abrasions;
The client is or has impending plans to become
pregnant and wishes to get a nipple, navel, or other
piercing. (It is advisable to refrain from piercing
during pregnancy to allow the body to focus on the
important, complex, and demanding task that it is
handling already. Additionally, if the client was to
faint it could result in serious consequences to the
unborn child.);
The client wants to pierce irregular or surgically-altered anatomy;
The client is unsuited due to occupational, recreational, or environmental factors;
The client requests piercings that are frequently
unsuccessful (commonly rejected by the body),
particularly when the client is uneducated about or
unwilling to accept responsibility for the risks of such
piercings;
The client has a heart murmur, diabetes, hemophilia,
autoimmune disorder, or other medical condition(s)
that may negatively inuence the piercing procedure
or healing process;
The client has a heart condition such as Mitral Valve
Prolapse that requires prophylactic antibiotic treatment before dental and other procedures. In these
cases the client must consult a physician prior to any
procedure. Medication may be required to avoid lifethreatening complications.

APPROPRIATE PLACEMENT
For thousands of years, tribal people around the world
have made similar choices in piercing placements.
This is not because of a lack of creativity, but because
of long-term experience with the superior stability of
certain anatomy. As piercing has resurfaced in the
globalized community, new information on anatomy,
jewelry, and asepsis have made possible some piercing
placements not previously considered.

receiving tubes, others use special hand positioning

that allows for freehand piercing. Most will combine
knowledge of various techniques, use of tools, and
hand placements in the way that works best for them
in each individual piercing situation.
The most fundamental aspects for the evolution of a
piercers personal style are proper training, continued
education, and an open mind. While it is important to
continue observing other piercers and learning throughout your career, new procedures and techniques should
not be undertaken merely for the sake of innovation or
emulation. To ensure client and piercer safety, piercers should be thoroughly trained and well skilled in
the basic procedures before attempting more difcult
methods.
When trying new techniques or experimenting with
new styles, it is essential to research all aspects of the
procedures. Elicit multiple opinions about differences
in piercee comfort, sterility, efciency, ease of healing,
jewelry type, placement, risks and benets, etc. Talk to
piercers who use alternate techniques as well as those
who choose not to, and nd out why. Also ask clients
what they prefer and why, and take their responses
seriously. We do what we do for them.
After obtaining as much information as possible,
you can make an informed decision. You may also
nd you change back after time, or that you begin to
alternate between techniques depending on individual
circumstances.
All piercing placements, old or new, should be decided by anatomical suitability and overall safety. Piercing
placements that are new should not be invented for
the sake of personal aggrandizement or novelty.
Of course, no eld progresses without cautious experimentation. Any trials should be a matter of personal
consideration and not involve the general public. It is
neither safe nor professional to use paying customers
to test techniques or placement theories. Experimental
piercings should not be introduced to the paying public
or the press until they have proven to be successful
and safe for a sufcient percentage of individuals over
a reasonable amount of time.
Piercing liability insurance providers may refuse
to cover experimental piercing placements and local
regulations may prohibit certain variations. For more
information, contact your insurance provider and/or
health department directly.

TECHNIQUES

OFF-SITE PIERCING

Techniques vary considerably from piercer to piercer.

Some will utilize tools such as forceps and needle

Piercing at music festivals, nightclubs, conventions

and street fairs may seem like a creative way to build

44

clientele. Guest piercing at other studios may seem

like fun. However, these situations may create pitfalls
for a piercer seeking to maintain appropriate hygiene
standards, ethics, and reputation.
When piercing in a public space, club or festival, the
most obvious concern is control of ones space. How
will you maintain a sanitary environment in a smoky
club lled with sweating bodies and alcohol? It can
be difcult to distinguish between inebriated and sober
clientele and false identication is common. Conditions are often conductive neither to hygienic piercing
practices nor to the safety and cleanliness of a fresh
piercing. How will you keep new piercees from imbibing afterwards and heading to the packed dance oor?
Can they avoid smoking and drinking after a tongue
piercing?
In such places, piercing can take on a freak-show
element that is distasteful to most professional piercers.
Additionally, peer pressure, lack of private consultation, and the thrill of the show may push some clients
to make decisions they would not otherwise make and
may regret. While this is not technically your problem,
you are the one creating the opportunity, and are
charged with running a professional and ethical business. Many piercers avoid public piercing altogether
and this is a valid option.
Wherever you decide to work, the setup needs to
be no less hygienic than your business studio. This
means nonporous ooring, a fully enclosed piercing
room, stainless steel trays, an autoclave, Sharps
containers, and observance of all hygienic practices
required in a studio. If you are unable or unwilling to
make the investments of time, money, and research
to assemble and move a full piercing studio, it is inappropriate for you to be piercing off-site. Additionally,
many cities now have regulations limiting or prohibiting
mobile piercing studios, or requiring temporary licenses
and inspections. Check with local health departments
before you set up shop.

COMPETITIVENESS
The rapid rise of popularity in piercing has led to an
increased competitiveness between piercers. In some
cities, two or more piercing studios operate on one
block. Competing studios often have different levels
of health and safety awareness and may be inclined
to share these details with clientele. It is easy to become frustrated and engage in negative interactions
with competitors, especially if you feel that you are the
more informed, conscientious piercer, or when they are
bad-mouthing you.

Good piercers should strive to maintain a genuinely

professional demeanor with all other piercers, including competitors. This can facilitate the exchange of
information and enhance progress for the industry and
all parties involved. Although it takes some careful
wording, try to nd ways to educate clientele and the
public about health concerns without making accusations against another shop. Even when another shop
insists on behaving badly, maintaining a professional
public attitude speaks well of your experience and
condence, and will earn your clients respect.
It is very important to remember that anything you
say about a competitor can be held against you in the
event of a libel or slander lawsuit -- even if it is true.
You could instead show concern for your clients health
and safety by giving out a checklist of things to look
for at any piercing studio, including your own. You
can educate the wider community by putting this in a
print ad.
A brochure with such a checklist is available from
the APP. It is entitled Picking Your Piercer and can
be ordered directly from the APP website at: www.
safepiercing.org. The Piercees Bill of Rights poster,
also available on the site, further advises clients on
how to choose and interact with a piercer.

PAPERWORK & BUSINESS

DOCUMENTATION
Professional piercers should obtain and keep on le
a release/consent form for every service performed
within the studio, including piercings, stretchings, and
insertions. This should be done regardless of whether
it is required by legislation and/or your insurance.
The consent form should state that the client requested the piercing (i.e. you did not pierce him/her
without consent) and you informed the client about how
to properly care for the piercing. While release forms
do not prevent legal action, they do provide evidence
that you have made an effort to educate your client and
to operate a legitimate business.
The release form should also contain records of the
following information from the client:
Valid photo identication number and type (state issued drivers license or ID card);
Passport or Military identication. Many shops photocopy this onto the release form;
Date of birth;
Allergies, particularly to latex, iodine (if used) or any products routinely used in your studio during a piercing;
45

 That client has not consumed alcoholic beverages

or other intoxicants within the last 24 hours;

Acknowledgment of having eaten within the last 2

hours.

Information on recent intake of any medications such

as blood thinners, aspirin, ibupron, or other NSAIDs
(see Glossary for details);

Note: Clients should eat a healthy meal before being

pierced to minimize dizziness, nausea or fainting.
Rened sugar such as soda or sweets can increase
the risk of these low blood sugar/vasovagal reactions;

Disclosure of whether the client is under the care of

a physician for any condition that might affect the
procedure or healing process;

Diabetes, hemophilia, or other medical condition(s)

Sample release form:

To induce _________ (company or piercers name) to pierce my __________ (name of piercing/anatomical region of piercing) and in consideration of doing so, I hereby release _________ (company or
piercers name) from all manner of liabilities, claims, actions, and demands, in law or in equity, which I
or my heirs might have now or hereafter by reason of complying with my request to be pierced.
I have provided accurate information on any medical conditions I may have that could affect the outcome
of this procedure. These include, but are not limited to, allergies (such as iodine, latex and metals),
diabetes, anemia, hemophilia, high/low blood pressure, heart disease (including any condition that may
require prophylactic antibiotics), swelling, rash, lumps or discoloration of the area to be pierced, and
any immunosuppressive disorder.
I have provided information on any medications I am currently taking, and on any piercings, tattoos,
surgeries or serious illnesses or injuries I have experienced in the past 90 days.
I certify that I am not pregnant or nursing.

To ensure proper healing of my piercing, I agree to follow the written aftercare guidelines until healing
is complete.
I understand that this type of piercing usually takes _______ (healing time) or longer to heal.
I recognize that the suggestions and aftercare given to me by _________ employees or agents are based
upon their experience in this eld and current industry standards. Employees of __________ are not
doctors, and their suggestions, whether written or verbal, stated or implied, are not meant to be taken
as medical advice. In the event of a serious medical concern I should see my physician.
I have signed this release on ________ (date).

I declare under penalty of perjury that the above is correct.

________________ (Signature of Client)

The signature of the client must be at the end of this statement, not prior to it.
46

that may affect the piercing procedure or healing (if

inquiry is allowed by law);
Any other information required by state or local authorities or insurance provider.
The wording above is only a generally applicable
suggestion. In certain states it is not legal to ask
about some aspects of a clients medical history on a
release form (e.g. Hepatitis, STDs, or HIV status); in
other states it is a requirement. Check your local laws
for compliance.
Piercing-specic liability insurance providers may require you to use one of their release forms with slightly
different wording. Legally suitable wording will also
vary by state and even by country, so it is advisable to
consult an attorney when drafting release forms. Check
and uphold your local laws.
The APP nds it prudent to store all client paperwork
indenitely, and many area regulations have specic
minimum requirements for retaining release forms (e.g.
three years). Again, check your local laws for specics
in your area.
Additional details should be added to release forms
for the following circumstances:
Piercings of minors
Piercings done off-site (at clinics, conventions, etc.)
Insertion of a clients own jewelry. (Note: Some local
laws prohibit the insertion of used and/or non-sterile
jewelry. Please see sections on Sterilization, Disinfection and Appropriate Jewelry for more information.)

MINORS

is important to remember that as professionals we

are responsible for our own actions and cannot try to
compensate for how people choose to treat or raise
their children, or how other piercers work. The best
course of action is to provide parents with all pertinent
information about health and safety, including the risks
of the procedures, the best possible aftercare and
jewelry, and how to nd a hygienic practitioner if they
must pierce their child. While we cannot change others
actions, or change our own to accommodate theirs, we
can help them make educated decisions.
With consent and release from a parent or legal
guardian, minors of an appropriate age may be eligible
for piercing, depending on circumstances, studio policy
and local laws.
The APP suggests that only the following piercings
be considered for minors:
Ear lobe or Cartilage
Navel
Oral/Facial
Nostril
Eyebrow
Other piercings are either potentially dangerous,
unethical to perform, or problematic to heal on minors
whose bodies are still growing and changing.
Under no circumstances is it acceptable, nor is it ever
appropriate, for a piercer to perform a piercing on the
nipples or genitals of an individual under 18 years of
age. This is ethically unconscionable and may even
be deemed sexual assault in a court of law. Parents or
legal guardians who consent to this type of piercing for
a minor in their care may also be charged with sexual
misconduct by some courts.

Laws regarding the piercing of minors vary by location.

In the United States, the legal age of consent or legal
responsibility is usually 18 years of age. Until then a
minors body is the legal responsibility of his or her
parent or legal guardian. Additionally, any contract
(such as a release form) signed by a minor is not legally
binding unless it is also signed by the person legally
responsible for her/him. For these reasons, signicant
caution is required when piercing minors, even on the
earlobes.

For any piercing of a minor, a parent or legal guardian

must be present to sign a consent form. State-issued
photo identication is required from the legal guardian,
and a bona de form of identication from the minor
(drivers license or state photo ID; birth certicate plus
school yearbook). In the event the parent has a different last name and/or address from the child, documentation is needed to prove the relationship (for example:
divorce or remarriage certicate; custodial or adoption
papers; birth certicate).

A child who cannot comprehend the procedure and

consequences cannot consent and should not be
pierced under any circumstances. Particularly with
infants and toddlers, the body and immune system are
still developing (this includes ear lobes), and a baby is
obviously unable to care for a piercing.

A unique single exception would be an emancipated

and/or married minor who presents positive proof of
their legal emancipation and/or marriage. In certain
states such minors are considered adults for legal and
practical purposes. Check local legislation regarding
emancipated/married minors.

Some piercers agree to pierce babies or children,

thinking to save them from the ear-piercing gun. It

A valid business practice is to simply refuse to pierce

anyone under the age of 18. Many studios follow this
47

policy. It is wise to check with an attorney in your

state to clarify the letter of the law when deciding your
studios policy on this matter. Once you have developed a policy that is comfortable and works well, be
consistent.
Photos displaying genital piercings may be considered pornographic in the hands of a minor. If minors
are allowed in the studio, having two separate, welllabeled portfolios available for display is advisable. In
this case you may also need to remove any explicit
pictures from the walls. Explicit conversations (verbal
or online) about genital piercings are also inadvisable.
If your shop has a website or responds to email, be
aware that photos and some information may be viewed
by minors or by clients in areas where such material is
illegal. Posting a warning and self-selecting statement
of age may minimize your liability. For example:

a menace to him/herself and his/her clients. Even if

he/she does not appear inebriated at work, a piercer
who is addicted to alcohol or drug is a serious potential
hazard. A counterperson who is under the inuence
likewise represents both a liability and an extremely
poor consumer relations statement.
Piercers should agree to pierce only sober, consenting clients who appear to be in full possession of their
mental and physical facilities. Piercing a client who is
not in a sober and sane condition raises serious ethical
questions. First, an inebriated or medicated individual
is not legally able to give informed consent. Any consent obtained under such conditions is not a binding
contract and may put the piercer at risk. Further, once
sober the client may regret the decision made under
altered consciousness.

By clicking here I verify that I am over 18 and

take full responsibility for viewing this site and
its contents.

Even for a skilled and focused piercer, it is dangerous

to work on a client who is under the inuence of drugs
or alcohol because:

Again, check with your lawyer for locally appropriate

wording and laws.

She/he may bleed more heavily, faint and/or vomit;

The piercing room must be under your control at all

times. You are responsible for the health and safety
of everyone in your studio and must set personal and
shop policy accordingly. While it is often helpful for a
client to have a friend in the piercing room for moral
support, many piercers limit the number of observers
to one or two, and verbally explain to observers where
to stand and how to act. Many piercers do not allow
small children or others who cannot/will not behave
appropriately in the piercing room.
In forming your own policy, keep in mind that piercing
is both a technical, hygienic procedure and a personally
meaningful experience. Try to nd a way to work that
respects both the integrity of your technique and the
emotional needs of your client. If you do allow guests
in the piercing room, be aware that they may become
light-headed during the piercing. A low, stable folding chair can keep them out of your set-up area and
minimize fainting mishaps.

She/he may not be able to communicate vital information to the piercer or follow important instructions
from the piercer;
She/he may move suddenly, endangering the piercer
and her/himself;
She/he may become belligerent, physically or verbally inappropriate, emotional, dishonest or unmanageable;
She/he may later have inaccurate recollections of the
piercing encounter, thus putting the piercers reputation and legal integrity at risk.

DRUGS AND ALCOHOL

While it may be tempting to take the money of those

who have had a drink to get up their courage, it is
ultimately a bad decision for you and for your client.
Furthermore, accepting clientele who are under the
inuence contributes to public perception of the piercing industry as immoral, unsafe, and irresponsible.
Few passersby will believe your studio practices high
standards of hygiene if they see drunk and/or disorderly
people in or around the shop.

Being under the inuence of drugs and/or alcohol is

never appropriate for either party involved in a piercing
procedure. A piercer must be focused, in control, and
able to deal with unforeseen complications. Furthermore, he/she is responsible for the safety and health
of everyone in the piercing studio. Any piercer who
feels it is acceptable to work under the inuence of
drugs or alcohol is reprehensible, unprofessional, and

Allowing clients to get pierced after drinking or taking drugs also validates the idea that piercing pain is
beyond normal tolerance and denies clients the opportunity to fully engage in their piercing experience.
Getting and healing a piercing requires being aware of
and responsible for ones body. Therefore, a piercee
who is not ready to get a piercing done while sober is
not ready to get a piercing.

48

COMPLIANCE AND TRAINING

OCCUPATIONAL SAFETY AND
HEALTH ADMINISTRATION
(OSHA) COMPLIANCE

3. An explanation of the modes of transmission of

bloodborne diseases

OSHA is a federal agency that monitors and regulates

worker safety for all businesses with one or more employees. Whether or not piercing-specic legislation
has passed in your area, OSHA has explicit requirements that directly relate to piercing. They apply even
if you have only one employee.

5. An explanation of the appropriate methods for recognizing tasks and other activities that may involve
exposure to blood and other potentially infectious
materials

Since federal and state regulations may apply, it is

important to inquire about the most relevant information for your area. To comply with OSHA requirements,
piercing studios with one or more employees must meet
these standards:
Listing of standard operating procedures, detailing:
Exposure Control
Exposure Control Plan
Exposure Determination
Methods of Compliance
Observation of Universal Precautions for
Bloodborne Pathogens
Engineering and Work Practice Controls
Personal Protective Equipment
Housekeeping
Regulated biohazard waste disposal
Communication of hazards to employees, written and
verbal (Hazard Communication Plan)
Employer-provided Hepatitis B vaccine or declination
(on le)
Record keeping/documentation
Accurate reporting of all exposure incidents
Appropriate information and training
OSHA requires that any employee who has the risk
of occupational exposure to blood or other potentially
infectious materials receive training at the time of initial
assignment, and at least annually thereafter. Training
must cover the following topics:
1. An accessible copy of the regulatory text (see appendix) and an explanation of its contents
2. A general explanation of the epidemiology and
symptoms of bloodborne disease

4. An explanation of the employers Exposure Control

Plan and the means by which the employee can
obtain a copy of the written plan

6. An explanation of the use and limitations of methods that will prevent or reduce exposure including
appropriate engineering controls, work practices,
and personal protective equipment
7. Information on the types, proper use location, removal, handling, decontamination, and disposal of
personal protective equipment
8. An explanation of the basis for selection of personal
protective equipment
9. Information on the Hepatitis B vaccine, including
information on its efcacy, safety, method of administration, the benets of being vaccinated, and
that the vaccine and vaccination will be offered free
of charge to employees covered by the standard
10. Information on the appropriate actions to take and
the persons to contact in an emergency involving
blood or other potentially infectious materials
11. An explanation of the procedure to follow and actions to take if an exposure incident occurs including the method of reporting the incident and the
medical follow-up that will be made available
12. Information on the post-exposure evaluation ad
follow-up that the employer is required to provide
for the employee following an exposure incident
13. An explanation of the signs, labels, and/or colorcoding required
14. An opportunity for interactive questions and answers with the person conducting the training
session during and after training session.

PIERCER TRAINING
The APP does not have any ofcial requirements in this
particular area, since there are many different ways to
develop prociency in piercing. Some piercers learn
to pierce by trial and error, by observation of a video,
studying a magazine, and/or by attending a seminar or
training class. However, this approach alone is limited
49

in that each of these methods provides incomplete or

inadequate training.
It is widely agreed that an apprenticeship under a
qualied professional piercer is the best way to most
thoroughly and scrupulously learn the art of piercing.
Even the most reputable training seminars including
lectures on anatomy, safety, hygiene, technique, and
hands-on piercing experience will not fully train you to
be a piercer.
A seminar that lasts only a few days or even several
weeks cannot possibly provide enough exposure to
the variety of anatomy or piercing or practice for you
to be a qualied piercer without additional training.
Regardless of any certicates they may provide, you
will not be a skilled piercer ready to work independently
in the eld from a piercing seminar alone. However,
seminars can be a wonderful foundation or addition to
a formal apprenticeship.

What is an Apprenticeship?
An apprenticeship is dened as a specic period of
guided progress through the basic, intermediate, and
advanced levels of piercer training.
Before undertaking an apprenticeship, you should
consider the following:
What is your motivation for wanting to become a
piercer? If you are hoping for quick money, a hip and
easy job, or stable, guaranteed, lifelong employment,
think again.
As should be obvious from reading this manual,
pursuing a professional piercing career is a long-term,
labor intensive and costly endeavor. In the past few
years, a proliferation of studios and piercers combined
with a slowdown in the economy has resulted in a
shrinking job market. Even if you undertake a high
quality apprenticeship, there is no guarantee of future
or continuous employment.

Spend a minimum of three months as a full-time

trainee, learning sterilization, disinfection, cross-contamination avoidance, and other health and safety
issues before piercing.
Train in performing insertions and stretching existing piercings before beginning to pierce. This is a
valuable opportunity to practice smooth aseptic technique, skin prep, tool/jewelry handling and bedside
manner with little risk.
Spend a minimum of six months to a year in full-time
supervised training as an apprentice before achieving
the title of piercer. The location, client volume, and
standards of the training studio will help to determine
the necessary duration of an apprenticeship.
Observe all procedures before attempting them, and
attempt a new procedure only with close supervision
by a senior/training piercer.
Acquire an understanding of human anatomy as it
relates to performing and handling piercing. This
is crucial. Formal classroom training in anatomy
is extremely helpful for comprehending the internal
anatomy. Variations in external anatomy can only be
learned through time and experience with hundreds
of clients. Some states have drafted legislation
requiring courses in anatomy and/or physiology be
taken in order to be licensed for piercing.
Perform new piercings in order of relative difculty,
depending on client availability, mutual comfort level,
and individual anatomical considerations. The apprentice should start with simpler procedures and
progress to more advanced piercings over time. After
sufcient experience is achieved and prociency is
demonstrated, the apprentice may begin to perform the more difcult or advanced piercings at the
supervisors discretion.

Apprentice Training

During an apprenticeship, the novice piercer should

do the following:

Before taking an apprentice, please consider the

following:

Locate a suitable apprenticeship in a reputable studio

under a well-respected, highly skilled, and experienced professional.

Do you possess the necessary qualications, skill

and experience, patience, communication skills,
ethics, organization, commitment, time and teaching
ability?

Attend an industry specic bloodborne pathogens

training class, such as that given by OSHA, the Red
Cross, or National Safety Council.
Attend a First Aid/CPR class, such as that given by
the Red Cross or YMCA.
Learn customer service, appropriate jewelry quality
and selection, bedside manner, aftercare procedures,
and troubleshooting.
50

What is your motivation for taking an apprentice?

Is it for prot? To train your own staff for long-term
employment? Ego gratication?
What will happen to the apprentice after training? Will
he/she be hired on in your own studio? Will he/she
open a studio down the block from you or work for
your competitors?

 Will he/she be able to nd employment in the already

saturated piercing eld at all?
If your motivation is to ll a job vacancy, job boards
and the APP conference are less expensive and
faster means of locating qualied piercers who are
already trained.

immediate access to a supervisor and/or a network of

experienced piercers who can answer questions and
offer assistance as need arises is appropriate during
this phase. A Piercer should still have a trainer or
peer observe and assess his/her piercings from time
to time.

If you plan to train an apprentice, note the following:

Senior or Training Piercer

An apprentice will probably interpret your methodology and techniques as the right way to pierce. If you
are producing the next generation of professionals,
be sure to pass on current and correct information.

A Senior Piercer has been piecing full time for four or

more years and behaves in a manner betting a role
model at all times. S/he is modest but in possession
of a vast body of experience and information. A Senior
Piercer continues to actively seek out new information,
constructive criticism, and ideas from others. A Senior
Piercer is an educator, willing to share knowledge by
networking, writing, or training.

Choose your apprentices carefully because your

reputation will continue to be affected by their actions
as they practice piercing for years to come.
The APP does not specically monitor the way piercers
train their apprentices. However, the following criteria
are suggested for piercers offering apprenticeships:
Compliance with appropriate state and local regulations, including business and piercing-specic licensing;
A senior or training piercer with at least four years of
full-time piercing experience
Liability insurance coverage for the studio, and for
the senior/training piercer and/or apprentice
Apprentices should not charge the public full price
for a supervised piercing. A small materials fee or a
half price fee is more appropriate and professional

Master Piercer
This is an honorary title and should never be self-appointed. Unfortunately, over the past few years it has
been abused to the extent of near meaninglessness.
A Master Piercer is an individual with more than ve
years of full time piercing experience, who has been
acknowledged by the piercing community for a substantial contribution to the eld of piercing. S/he is
comfortable enough with his/her abilities that s/he has
no need to rely on the title, and so ironically, rarely
claims it. The prociency that makes one a Master
Piercer requires constant diligence and a relentless
pursuit of excellence.

If an apprentice is an employee, he or she should

receive wages in accordance with federal and state
requirements

CONTINUING EDUCATION

TITLES

Piercing is not a static skill. To maintain ones abilities

it is crucial to acquire continuing education throughout
ones career.

Establishing standard job titles related to levels of piercing expertise is difcult because misunderstanding and
abuse of titles is widespread. The denitions commonly
used in the piercing industry are as follows:

Apprentice
During the rst year of training, all individuals are
considered to be apprentices. During this time, the
individual is learning basic concepts and skills that set
a rm foundation for the future.

Piercer
A Piercer is an individual who has pierced full time
for a minimum of one year and can condently and
accurately perform most common piercings. Having

Piercing seminars and conferences are not just for

novices. A true professional will seek out training, not
only for new information, but also for the much-needed
review of old facts, principles, and practices. Industry
recognized advanced piercing seminars will offer intensive hands-on, supervised training featuring the most
current information and techniques.
Established National and International Conferences
present classes on current techniques, aftercare, jewelry materials and other technical and theoretical details
of piercing. These are unparalleled events for skills
training, networking, job opportunities, and sharing of
knowledge amongst piercers.
OSHA requires that employees with an occupational
risk of exposure to bloodborne pathogens receive an51

nual training regarding risk management. There are a

number of educating agencies from which to choose,
but few actually relate this course work information
to the piercing environment. Choose a class that will
provide relevant application of this knowledge and
that offers information such as prevention of disease
transmission, infection control, and sterilization training
in the piercing studio.
First Aid, CPR, and any advanced emergency training
should be kept current.
Massage schools are another available resource for
piercers to learn about grounding, touch, and bedside
manner.
Community colleges are a good place to nd inexpensive college-level anatomy and physiology courses.
There are many ne anatomy texts, CD-ROMS, and
videos on the subject of the human body, particularly in
medical and university bookstores. Numerous websites
also contain relevant information and resources.

52

EMERGENCIES
BEING PREPARED IN THE
STUDIO
All piercing shops should have at least one rst aid kit
that is well stocked, familiar and available to all staff,
and that is used for emergencies only.
At a minimum, the kit should contain;

Antiseptic ointment
Gloves
Plastic Bags
Triangular Bandage
Blanket (emergency type)
Candy, glucose tablets
Scissors and Tweezers
Hand Cleaner
Small Flashlight with extra batteries
Band Aids (assorted sizes)
CPR mask
Cold Packs
Adhesive Tape
Gauze pads (2x2 & 4x4 )
Roller Bandage
Roller Gauze (1 and 2 are good sizes)

Each of the piercing stations or rooms should also

be emergency equipped. These kits should contain at
least the following;
Small ashlight /extra batteries
Band Aids
CPR mask
Cold pack
Hard sugar candy and/or packed orange juice, or
glucose tablets

or, Are you diabetic? can provide information that is

important to know.
Asking a person, Are you HIV positive? is a violation
of the right to privacy and in most states is prohibited
by law. In a professionally run shop, OSHA safety
standards will be observed and Standard Precautions
employed. Therefore, information gained by the answer
would have absolutely no bearing on the procedure
provided to that customer.

NEEDLESTICK ACCIDENTS
One of the risks faced by professional piercers is the
possibility of an accidental exposure to blood or other
potentially infectious materials (OPIM). This could
happen by a needlestick with a contaminated piercing
needle or exposure through splashing, spraying, or
other contact with contaminated materials, objects, or
surfaces.
Every action in a piercing procedure should be deliberate and intended to minimize the risk of a needle
accident. A professional piercer who remains focused,
alert and in control of the environment will greatly minimize the possibility of this event.
To reduce the likelihood of a needlestick incident:
Dispose of used needles in Sharps containers immediately
Know the location of all needles at all times. Once
removed from the sterile package and used, never
set down or lose sight of the needle.
Dont clutter your tray. Dispose of any necessary
gauze, paper products, and packaging before piercing

Some emergencies in the piercing studio can be

avoided by being prepared. The piercing release form
can provide relevant information about the health of
the customer that can alert the piercer to potential
problems. Knowing how to respond appropriately is
important if a customer faints or a diabetic suffers an
insulin reaction (see Special Circumstances section).
Knowing beforehand that a particular client may be
prone to such occurrences can help you plan ahead.

Dont rush when using, handling, or disposing of

needles. Focus on your actions.

While the release form cannot be used to gather

information about the health status of a customer if
the question is a violation of the persons right to privacy, questions such as, Are you prone to fainting?

Do not pierce if you are ill, tired or if you have not

eaten for a prolonged period of time. Be at your
best, awake, and aware; your clients deserve
nothing less.

Be consistent with your tray set up. If you are using

needles and insertion tapers in the same procedure,
keep them separate and know where everything is
at all times.
Remain in control and do not pierce clients who are
overly nervous or not prepared for the piercing.

53

 Examine all other equipment such as tools, corks,

gloves, and rubber bands. Flaws and failure of these
to perform as intended can lead to needle sticks.
If there is any possibility that an unused needle has
become contaminated, it must be immediately disposed of into the Sharps container.
If the used needle is corked, do not remove the cork
before disposal unless it is necessary. If re-corking
is necessary, federal regulations require the use of
mechanical implements such as hemostats or forceps.
Always replace Sharps containers when they have
been lled to the full line.
Never remove anything from a Sharps container.
To reduce the likelihood of other exposure incidents:
Do not reach into contaminated instrument trays.
Items should be removed mechanically or by the
procedure outlined in your studios exposure control
plan.
Use caution when handling contaminated sharps
such as scissors or insertion tapers.
When tools are scrubbed manually, they should be
completely submerged under water to prevent unnecessary splashing and spraying.
If contaminated tools are presoaked in a disinfecting
solution, this must be done in the biohazard/sterilization room (as opposed to the piercing room) to
prevent spills and splashes that could occur when
transporting the soaking container from one room to
another.
If the ultrasonic unit that you are using does not have
a built-in draining system, this must be dumped slowly
and steadily to avoid spills and splashes.
By observing the precautions listed above and having
a clearly written Exposure Control Plan that is specic to
your studio, much can be done to minimize the fear and
uncertainty that often follows an exposure incident.

You may or may not feel that it is appropriate to ask

about a clients health status, particularly regarding
Hepatitis and HIV. Depending on the laws in your area,
you may be treading on very dangerous legal ground
by asking someone to disclose, in whatever manner,
their status regarding HIV and other communicable
diseases. In some states, it is illegal to ask.
Immediately le your OSHAs Occupational PostExposure report and follow your studios Exposure
Control Plan. These are established with your health
and safety in mind.
You must seek immediate medical attention, especially if your client has disclosed that they are HIV
positive or if you have good reason to suspect that they
may be. It is important to know that there is an HIV prophylaxis available that could prevent HIV infection, but
this must be done within the rst 24-48 hours. While this
treatment has severe negative side effects (said to be
comparable to chemotherapy), it is an important option
for those who have been exposed to HIV or the blood
of somebody who is at high risk for HIV infection.
If you are not already vaccinated, you may sign up
for a ten day series of Hepatitis B shots that may help
protect you from the disease. A medical professional
can help you determine if this is an appropriate treatment for you.
Blood testing done shortly after the needlestick injury
occurred is also suggested. Although immediate testing
will not indicate if disease was transmitted through the
needlestick injury, it will provide a baseline to compare
future testing to. If the employee is unsure if they would
like to have their blood immediately tested, it is also important to know that their blood can be drawn and saved
for later testing, if they become inclined to do so.
Mentally review the accident. Think about the events
leading up to the exposure and what could be done
different. Learn from your mistake and take additional
precautions when in a similar situation in the future.

If, despite all cautions being observed, a needlestick

occurs:

BLEEDING

Secure the needle to prevent additional sticks. If

necessary, call a co-worker to nish the procedure.

Most piercings do not bleed much, if at all, but the

possibility always exists. It is good practice to remind
clients that any break in the skin can bleed, and that
piercings are no exception. If the client is made aware
in advance that the possibility of bleeding exists, they
are much less likely to be concerned or anxious if it
should happen.

Wash the area for several minutes with antimicrobial

or antibacterial liquid soap.
Rinse and bandage the wound.
Remain calm. Take some time to calm down before
returning to the procedure room if you have a coworker standing in for you.
54

The client who has recently ingested alcohol, aspirin,

caffeine or certain prescription drugs is more likely to

bleed, sometimes profusely. Inform clients to avoid

these blood-thinning agents if at all possible. Piercers
should prepare themselves and their client for the possibility of additional bleeding when a piercee has these
agents in his/her system.
Some piercings such as Prince Alberts and eyebrows
are located in more vascular areas so they are more
apt to bleed.
Using a needle of a gauge larger than the jewelry
may result in excess bleeding. To minimize bleeding
and client discomfort, use a larger needle only when
necessary.
Removing jewelry from a fresh piercing may produce
copious bleeding. In an emergency, it may be best not
to remove the jewelry; let the emergency room handle
the situation.
When you anticipate bleeding, have sterile gauze
pads ready. To stop bleeding, apply rm pressure for
two minutes. Dispose of all used gauze pads containing blood in biohazard waste. A small disposable ice
pack can be applied to help minimize swelling and
bleeding.
Apply ice to stop bleeding in an oral piercing. For a
tongue piercing, have the client gently suck on small
cubes, chipped ice, or shaved ice. The amount of blood
may seem greater when mixed with saliva.
Cautery (styptic) pencils and similar products are not
appropriate for use on puncture wounds such as piercings. Additionally, they can be very painful.
It is unprofessional to release a client with an actively
bleeding piercing. Be sure that bleeding has essentially
ceased and that the area is reasonably clean before
the client leaves.
It is illegal for a piercer to stitch or attach tissue. If a
client is bleeding profusely and you cannot stop it with
pressure, the client must be taken to the hospital.

Emergency Bleeding
Piercers are not to treat bleeding emergencies, so
the client should be brought to the emergency room
immediately.
Examples of emergency bleeding are:
Profuse bleeding that does not stop after several
minutes of pressure, particularly from oral, surfaceto surface or genital piercings, excluding the normal
bleeding of a Prince Albert or apadravya
Signicant bleeding that persists several days after
the piercing excluding the normal bleeding of a Prince
Albert or apadravya.

FAINTING
It can happen occasionally that a customer will pass
out or faint before, during, or after a piercing. For some
people, even the lling out paperwork at the counter and
picking out jewelry results in their feeling faint.
Answers to a question on the release form regarding
whether a client has a history of fainting can be very
helpful to the piercer in preparing for that possibility.
It is important to understand why some people lose
consciousness (pass out). A common misconception
is that low blood-sugar levels are the only cause of
this reaction.
Fainting is frequently caused by a loss of blood ow
to the brain. Most often this is a response triggered by
the Pneumogastric or vagus nerve, called a vasovagal
response. The occurrence of fainting is more likely if
the client has consumed excessive caffeine, or certain
prescription drugs. Also, if the client has not eaten a
meal within 4 hours and the stomach is empty; if the
weather is very hot and/or humid, if the client stands
up too soon after being pierced, the client has not slept
well, has a high anxiety level, or any combination of
the above.
A client may faint or become light headed at any time.
It could happen while browsing at the front counter, being marked for the piercing, during the actual piercing
or several minutes after the piercing.
Beware that a clients companion may also faint!
Keep watch on all people who come into your business and maintain control of the environment so that
a fainting person will not surprise you.
Observant employees and piercers can often spot
a person who is having trouble. Symptoms that are
frequently seen are:

Pale complexion
Headache or blurred vision
White or blue lips
Crying
Nausea
Trembling
Inability to concentrate, irritability or confusion
Excessive perspiration
Drowsiness, dizziness, or lack of coordination

Whether it is the client or an onlooker experiencing

the difculty, the course of action should be the same.
If the person is not in a supine (feet elevated above the
heart) position, place them in such a posture.
55

Or, if they are seated, bend them forward, so the

head is between the knees. Continue to talk to them,
reassure them, and offer cool water, candy, juice, and/
or glucose tablets. A cold compress on the forehead,
wrists and/or back of the neck may help. An actual loss
of consciousness can often be prevented with these
measures.
If the client does pass out do not give them any sort
of inhalants such as ammonia. These are considered a
last resort. That is, they are only to be used if the person remains unconscious for more than two minutes,
which is rare.
DO NOT attempt to put anything in their mouth.
Move away any object that may cause injury to the
person. Some shaking or twitching is not unusual with
fainting.
Most often the person will come to within a few
seconds. However, a few seconds can seem extraordinarily long, so it is important that you remain calm
and aware. It is possible that they can still hear you,
although they may be unable to respond. Attempt to
achieve communication by saying their name calmly,
and not too loudly.
People are often very confused when regaining consciousness and may not know who you are or where
they are, or what has taken place. Let them know where
they are and what has happened. Do not let them jump
up and leave the building. Although this is a very common reaction, it is ill advised. People are sometimes
ashamed that they have fainted and therefore want to
leave immediately
Turn off or dim bright lights in the room. The application of an ice pack to the forehead or back of the neck
and/or a cool drink of water can be helpful in reducing
the sense of being too warm. Have the person lie quietly
for a few minutes.
As they begin to feel better, rst have them sit up
for a few minutes. Several minutes later you may allow them to stand up. If at any point they begin to feel
unstable or unwell, have them lie down again. Stay with
the person as long as necessary, and call for assistance
from a co-worker if needed.
If this should happen during a piercing, rst, secure
the needle. It may be acceptable to attend to the piercee and nish the jewelry insertion later. If the presence
of the needle may endanger you or the client, as with a
tongue or lip piercing, immediately remove the needle
and deal with the situation at hand.
It may not be wise to proceed with the piercing even
when the customer is fully recovered. Discuss these
56

concerns with the customer and if necessary, suggest

they make the appointment for another day.
Emotional disturbances or panic attacks can often
take on the appearance of a serious physical condition.
It is important in these instances not to draw undue
attention to the situation. Such episodes are often
humiliating for the client. A quiet place to sit, a drink
of cool water, and a self-administered dose of whatever medication has been prescribed for the condition
(where applicable) is generally all that is necessary to
resolve the situation.

LOSS OF CONSCIOUSNESS
Special Circumstances
The types of client reactions most often handled in a
piercing studio are in no way life-threatening. There are,
however, certain circumstances in which the symptoms
discussed above including a loss of consciousness may
be the result of a more serious physical condition.
The knowledge gained through the required First
Aid/CPR courses will increase the piercers awareness
of appropriate steps to take in an emergency, and
thereby increase the condence level of the individual
should an emergency occur. The following are a few
potentially more serious conditions about which all
piercers should be aware:
Diabetes is not an infectious disease. It is a condition that has to do with the bodys inability to effectively
produce insulin in response to blood sugar. Some
diabetics can control their diabetes by diet and others
require medication.
Insulin reactions occur when the blood sugar level
is too low. This could be caused by nervous or emotional tension, strenuous exercise, too little food or a
delayed meal. Consumption of food will raise blood
sugar levels.
Customers should be asked to record on the release
form whether they have eaten within the previous 4
hours. Should the symptoms (listed under the Fainting section above) appear, it is critical that the diabetic
receive immediate assistance. If no treatment is given,
this becomes a life-threatening event.
Most diabetics are aware of their blood sugar levels
and will ask for assistance when needed. Provide the
customer with some form of sugar. This can be fruit
juice, several pieces of candy, sugar, or soda pop
(not diet). Improvement should be seen within about
10 minutes. If the condition does not improve, call
Emergency Medical Services (EMS).

Heart disease aficts an estimated 70 million Americans. Of the nearly one million deaths annually attributed to cardiovascular disease, more than half result
from heart attacks. A person is just as likely to suffer
a heart attack in your studio as anywhere else. CPR
training courses outline the proper procedures for a
person suspected of suffering from a heart attack.
Seizures involve convulsions and intense shaking of
the body with aggressive, jerky outward movements.
This is much more serious than simply passing out and
you should call 911. The affected party may also urinate, defecate, or vomit. This is uncommon, but natural.
Maintain professionalism and try not to make the client
feel embarrassed about such an occurrence. Seizures
may be caused by an acute or chronic condition. One
chronic condition is known as epilepsy. Epilepsy is usually controlled with medication. Still, some people with
epilepsy may have seizures from time to time. Just as
with someone who has merely fainted, make the area
safe for the client, removing any nearby objects that
may cause injury. Place a thin protective cushion or
article of clothing under the head and try to turn them
onto their side. DO NOT attempt to hold or restrain the
person or place anything in his/her mouth. Again, CPR
/First Aid courses will outline in detail the proper steps
to take if this occurs.

57

AFTERWARD
Merely reading this manual has not in any way endowed you or anyone else with the ability to pierce or provided
the knowledge to do so safely. If you plan to offer piercing services, it is your professional and ethical responsibility
to seek out a highly skilled, experienced professional piercer and undertake an apprenticeship. Only after extensive hands-on training and expert supervision will you be able to provide high quality professional services.
This manual has attempted to provide details of acceptable safety and hygiene standards, and appropriate
piercing practices. Reputable piercers will work diligently to meet all relevant documented procedures and to
uphold the standards described within this manual. There are equivalent methods, products and equipment that
may be acceptable, if they meet the criteria of minimal customer discomfort, maximum safety and zero risk of
cross-contamination.
Meeting all of these standards is not quick and easy; it takes a great deal of time, effort and money to create a safe working environment with all required equipment and supplies, training and preparation. A piercer
who upholds all of the standards described herein should feel very proud to be a reputable, respectable and
responsible piercer. If you can honestly say you do everything appropriately as described in this manual, you
should pat yourself on the back and congratulate yourself! Keep up the good work and also keep up with new
information as it becomes available. There is always more to learn.
The industry is continuing to develop and mature. The APP is always acquiring new information, so it is likely
that no matter how often we update this manual, some of the information contained within has already become
obsolete. Whether you are a professional piercer, a serious piercing enthusiast, a piercing-friendly medical
professional, a public health ofcial or a concerned legislator, it is your responsibility to keep up with the latest
techniques, products and other piercing information.
Readers are encouraged to contact the APP by email at secretary@safepiercing.org or visit our website at
www.safepiercing.org with any suggestions, comments, criticism or contributions.

58

GLOSSARY OF TERMS
Acute: Short term or temporary; often severe but
quickly resolved.
AIDS: Acquired Immunodeficiency Syndrome, a
disease that may result from HIV infection causing
breakdown of the immune system.
Airborne: Capable of being transmitted by air particles.
Anaphylaxis: A hypersensitive (allergenic reaction)
state of the body to a foreign protein or drug. Latex,
iodine and other chemicals commonly found in the
piercing studio can cause this reaction. Reactions
are sudden in onset and can include increased irritability, cyanosis, convulsions, unconsciousness and
even death. Death generally occurs due to spasms
of the bronchioles in the lungs.
Anesthetic: A drug or other agent used to produce
insensibility to pain or touch. Most anesthetics are
available by prescription only and are not legal for
piercers to use on clients. Many can cause complications in the piercing procedure.
Anesthetic, Injectable: A drug or other agent applied
subdermally by use of a syringe or other injection
device. Only trained, licensed medical professionals are legally qualied to administer this class of
prescription-only anesthetics.
Anesthetic, Topical: A drug or other agent applied
to the surface of the skin with the intent of providing
relief from pain. Topical anesthetics include ice, ethyl
chloride (spray freeze), EMLA and the xylocaine
family of topical creams and ointments. Most topical
anesthetics are available only by prescription and
most are not intended for use in or near puncture
wounds. These can irritate skin and complicate
piercing procedures and should not be used.
Antibacterial: Destroying or suppressing the growth
or reproduction of bacteria.
Antibiotic: A chemical substance produced by a living organism that has the capacity to destroy and/or
suppress the growth of other microorganisms.
Antibodies: Infection-ghting proteins released by
white blood cells.
Antigen: A substance that causes antibody formation.
Antimicrobial: Capable of killing or suppressing the
growth of microorganisms.

Asepsis: A condition free from germs.

Autoclave: A strong steel vessel used for sterilization
of equipment and materials at high temperature and
under pressure.
Bacillus: (Plural Bacilli); A genus of bacteria belonging
to the family Bacillaceae, and including the organisms
that cause dysentery, cholera and conjunctivitis.
Bacteria: Minute unicellular microorganisms with both
plant and animal characteristics. Also known as germs
or microbes. The primary types are cocci, spirilla and bacilli. Bacterial diseases include pneumonia, staph infections, tetanus, tuberculosis, syphilis, and diphtheria.
Bacteriocidal/Bactericidal: Capable of destroying
bacteria.
Bloodborne Pathogen: A pathogenic microorganism
that is present in human blood and can cause disease
in humans.
Body Substance Isolation: An infection control strategy that considers all body substances as potentially
infectious.
Broad Spectrum: A wide range of microorganisms.
Cartilage: A type of dense connective tissue consisting
of cells embedded in a substance or matrix. Cartilage
has no nerve or blood supply of its own. There are
several types of cartilage:
Articular: Hyaline cartilage covering the articular surfaces of the bones.
Costal: Cartilage connecting the true ribs and sternum.
Hyaline: Flexible and slightly elastic; ne connective
tissue found in the septum and nostrils, larynx and
trachea.
Elastic: A rigid network of yellow fibers that give
strength and shape to the external ear and the auditory tube.
Chemical Sterilization: See Sterilization, Chemical.
Chronic: Long-term, protracted, ever-present or returning. Often indicates an incurable medical condition
or illness.
Coccus: (Plural: Cocci). A type of bacteria that is
spherical or ovoid in form. Many are pathogenic,
causing diseases such as scarlet fever, pneumonia
and meningitis.
59

Cold Sterilization: See Sterilization, Cold.

Contamination: The presence or the reasonable
anticipated presence of blood or other potentially
infectious materials on an item or surface.
Contaminated Sharps: Any contaminated object that
can penetrate the skin, including but not limited to
needles, snip wires and broken glass.
Cross-Contamination: The act of spreading pathogenic organisms from one item or surface to another.
Cyanosis: A disordered condition of the circulatory
system from inadequate oxygen in the blood, resulting in a bluish color to the skin.
Disease Transmission: The passage of a disease
to a person.
Disinfect: To free from pathogenic organisms, or to
prevent pathogens from reproducing.
Decontamination: The use of physical or chemical
means to remove, inactivate or destroy bloodborne
pathogens on a surface or item to the extent that
they are no longer capable of transmitting pathogens.
The item is thus rendered safe for handling, use or
disposal.
Direct-Contact Transmission: The transmission of
a disease by touching an infected persons body
uids.
Disease: Disturbed or abnormal structure or physiological action in the living organism as a whole, or in any
of its parts. Literally, the lack of ease.
Edema: A swelling caused by excess uid in the intercellular spaces. Edema can be caused by a chemical reaction, an infection, stress to the area, (as in
improper piercing technique) or other causes.
Engineering Controls: Physical controls such as
sharps disposal containers that isolate or remove the
bloodborne pathogen from the workplace.
Epithelial Tissue: A membranous tissue consisting
of one or more layers of compactly joined cells of
various types and sizes
Exposure Control Plan: A systematized protocol
created by an employer to protect employees from
infection by identifying jobs that require employee
training, protective equipment, and immunizations.
Exposure Determination: The identication and documentation of job classications in which occupational
exposure to blood can occur.
Exposure Incident: A specic mucous, non-intact skin
60

or parenteral contact with blood or other potentially

infectious materials that results from the performance
of an employees duties.
Fascia: A brous membrane covering, supporting and
separating muscles. Fascia also unites the skin with
underlying tissue.
Fungal: Any inflammatory condition caused by a
fungus.
Fungicidal: That which is capable of killing fungi.
Gamma Radiation Sterilization: See Sterilization,
Gamma Ray.
Germicidal: That which is capable of killing germs.
Handwashing Facility: An area dedicated to handwashing that provides an adequate supply of running
potable water, soap and single-use towels.
HBV: Hepatitis B Virus. HBV is one of the viruses
that cause illness directly affecting the liver and is a
bloodborne pathogen.
HCV: Hepatitis C Virus. HCV is one strain of the
Hepatitis Virus formerly referred to as non-A-non-B
Hepatitis.
HEPA: High Efciency Particulate Air (lter) used to
improve air quality and reduce the quantity of airborne
contaminants.
Hepatitis: A disease that causes swelling, soreness,
and loss of normal function of the liver. Symptoms
include weakness, fatigue, anorexia, nausea, abdominal pain, fever, jaundice and headache.
HIV: Human Immunodeciency Virus is a virus that
infects immune system blood cells in humans and
renders them less effective in preventing disease.
Immune: Resistant to infectious disease.
Immune System: The bodys group of natural responses for ghting disease.
Immunization: A process or procedure by which resistance to infection is produced in people.
Indirect-Contact Transmission: The transmission
of a disease from one host to another through a
contaminated object.
Inert: Devoid of active properties.
Indicator: Indicators are paper or tape strips impregnated with a chemical that changes color when exposed to heat and steam in an autoclave. They are
often found on autoclave tape, autoclave pouches,
and strips, but are not limited to these items. Activated indicator marks are useful for identifying packages and articles which have been exposed to the

physical conditions of an autoclave cycle, but they

not prove sterilization.

agents are powerful enough to kill a broad range of

organisms.

Integrator: Integrators are strips or devices used in

pouches and/or autoclave chambers that prove the
conditions for sterilization were met. They are similar
to indicators, except that they change color when they
have been exposed to the ideal combination of steam,
pressure, heat and timing.

Steam Sterilization: See Sterilization, Steam.

Jaundice: A yellow discoloration of the skin, mucous

membranes, and/or whites of the eyes, characteristic of the later stages of Hepatitis or other liver
disease.

Sterilization, Cold: Killing organisms by long-term

immersion in a liquid sterilant solution (usually 24
- 72 hours).

Microorganism: A bacteria, virus, or other microscopic

organism that may enter the body. Microorganisms
that cause infection or disease are called germs.
Mucous Membrane: Any one of the four types of thin
sheets of tissue that cover various parts of the body,
such as the lining of the mouth or nose.
Mucus: The clear secretion of the mucous membranes.
Non-Intact skin: Skin that has a break in the surface.
It includes but is not limited to abrasions, cuts, hangnails, paper cuts and burns.
NSAIDs: Nonsteroidal anti-inammatory medications
such as ibuprofen.
Occupational Exposure: Reasonable anticipated
exposure to potentially infectious material that may
result from the performance of an employees duties.
Occupational Safety & Health Administration
(OSHA): The federal agency responsible for the
development, administration and enforcement of
employment-related health and safety regulations.
Opportunistic Infection: An infection that strikes a
person with a weakened immune system.
Pre-Cleaning: The act of soaking or otherwise disinfecting a contaminated tool prior to actual sterilization.
Pre-cleaning is not a substitute for cleaning tools in
an ultrasonic machine.
Spore Test: A biological monitoring process in which
a third party laboratory culturing service is engaged
to monitor spore growth on media processed in a
studios autoclave. The service provides documentation that serves as a tangible record and legal
document proving a studios ability to achieve proper
sterilization.

Sterilization: The complete elimination of all microbial

life. If an object is sterile, nothing lives on its surfaces.
As the air around us is teeming with organisms, nothing that has been in contact with air is considered
sterile.

Sterilization, Chemical: Sterilization by exposure to

Ethylene Oxide (EO) gas.
Sterilization, Gamma Ray: An effective, very rapid
method of sterilization by means of exposure to
gamma radiation.
Sterilization, Steam: Sterilization by means of exposure to high pressure, superheated steam. The
most common, efcient sterilization method for most
piercers. This is also known as hospital or autoclave
sterilization.
Sterilization, Liquid: See Sterilization, Cold.
Thermal Death Time: The amount of time required to
kill a given organism at a given temperature, measured in minutes. Generally, the higher the temperature, the shorter the thermal death time. Minimum
TDT for most autoclaves and a majority of organisms
is 15 minutes at 270 F.
Tuberculocidal: A very strong agent capable of destroying hardy TB spores.
Virucidal: Capable of killing viruses.
Virus: An ultra-microscopic microorganism that is
parasitic within living cells. Many viruses can cause
disease in humans. A virus cannot grow or reproduce
apart from a living cell. It invades living cells and
uses their chemical machinery to keep itself alive
and to replicate itself. It may reproduce with delity
or with errors (mutations). This ability to mutate is
responsible for the ability of some viruses to change
slightly in each infected person, making treatment
more difcult.

Sporicidal: Kills mold and other spores. Spores, especially TB, are generally very hard to kill, so sporicidal
61

62

UNDERSTANDING MATERIAL SAFETY DATA

SHEETS (MSDS)
According to OSHA standards, MSDS must be
kept on le for all chemicals used within the studio.
This includes everything from window/glass cleaner
and hard surface disinfectants to skin prep products and soaps used for hand washing and more.
Copies of MSDSs for all potentially hazardous chemicals to which employees may be exposed must be readily available to all employees during each work shift.

hazardous components is a trade secret, this will be

indicated in lieu of identifying the component. Suppliers of such products must still provide health hazard
data on the MSDS and additional information to safety
professionals who have a veriable need to know.

CHEMICAL PRODUCT
INFORMATION

This section is divided into two parts. The rst part

describes the materials appearance and gives an
overview of the most signicant immediate concerns
for emergency personnel.

This section provides the name, address, and telephone

number of the company that produced the product, the
MSDSs date of issue, and the name of the material.
The name of the material on the MSDS must be spelled
exactly as it is on the container you received. In addition, you will nd the following information:
Product Name
Commercial or marketing name
Synonym
Approved chemical name and/or synonyms
Chemical Family
Group of chemicals with related physical and chemical properties
Formula: Chemical formula, if applicable; i.e., the
conventional scientic denition for a material
CAS Number
Number assigned to chemicals or materials by the
Chemical Abstracts Service (CAS)
Composition of Ingredients
This section lists the products individual hazardous chemicals and their relative percentages. The
materials corresponding CAS Number must also be
listed. All ingredients that meet the OSHA Hazard Communication standard criteria of a hazardous ingredient
must be identied here.
Manufacturers may also choose to list active ingredients, signicant ingredients regulated under other
Federal, state, or local regulations, or a complete ingredient disclosure, including nonhazardous components.
Complex mixtures recognized as single substances
may be listed as single components. If any of the

HAZARDOUS IDENTIFICATION
INFORMATION

The second part provides information on the potential

adverse health effects and symptoms associated with
exposure to the material, its components, or known by
products. In addition, this section lists all of the routes
of entry pertinent to this material. Acute (short-term)
and chronic (long-term) health effects, symptoms of
exposure, and medical conditions aggravated by exposure must be stated. If the material is carcinogenic,
that fact must be stated.

First Aid Measures

This section describes medical and rst aid treatments
for accidental exposure by route of exposure (i.e. inhalation, skin, eye, ingestion). Any known antidotes
that may be administered by a layperson or specially
trained personnel will be indicated here.

Fire Fighting Measures

This section provides basic re ghting guidance for
trained re ghters, emergency responders, employees, and occupational health and safety professionals.
It describes the ammable and explosive properties of
the material, the proper extinguishing materials, and the
precautions and procedures to safely and effectively
ght the re.

Accidental Release Measures

This section provides spill, and leak procedures, and
response procedures for emergency responders and
environmental professionals. It describes evacuation
procedures, and other emergency advice to protect
the health and safety of the responders and the environment.
63

Handling and Storage Information

This section provides safe handling and storage
information for employees, occupational health and
safety professionals, and employers. General handling
precautions and practices are described to prevent
release of hazardous substances to the environment
and overexposure during contact with the material, and
also to minimize continued contact after handling.
In addition, this section explains necessary storage
conditions to avoid damage to containers, contact with
incompatible materials and subsequent dangerous
reactions, evaporation or decomposition of the stored
material, or ammable and explosive atmospheres in
the storage area.

Exposure Controls/Personal Protection

This section discusses methods intended for occupational health and safety professionals and employers
for reducing worker exposure to hazardous materials.
Exposure controls include engineering controls such
as ventilation and special process conditions (e.g.
isolation, enclosure), or administrative controls (e.g.
training, labeling, warning devices).
This section also provides guidance on personal protective equipment (PPE) including respirators, safety
glasses, goggles, gloves, aprons, and boots.

Physical and Chemical Properties

This section lists physical data, including a materials
boiling point, solubility in water, viscosity, specic gravity, melting point, evaporation rate, molecular weight,
appearance and odor. These properties can help in
predicting how the material will act and react so that
you can determine safe handling procedures and select
appropriate personal protective equipment.

Stability and Reactivity Information

This section lists materials and circumstances that
could be hazardous when combined with the material
covered by the MSDS. This section provides information on chemical incompatibilities, conditions to avoid,
decomposition products, and the materials stability.

Toxicology Information
This section provides information on toxicity testing of
the material and/or its components. The information
in this section is intended for medical professionals,
occupational health and safety professionals, and
toxicologists.

Ecological Information
This section assists you in evaluating the effect a
chemical may have if its released into the environment.
64

It may also be useful in evaluating waste treatment

practices.

Disposal Considerations
This section provides proper disposal information for
environmental professionals or individuals responsible
for waste management activities. Information may
include special disposal methods or limitations per Federal, state, or local regulations, and waste management
options, such as recycling or reclamation. It may also
include RCRA waste classications and EPA waste
identication numbers and descriptions.

Transport Information
This section provides shipping classication information
for the employer, distributor, emergency responders,
and transport/shipping departments. If regulated,
shipping information includes U.S. Department of
Transportation (DOT) hazardous materials description/
proper shipping name, hazard class, and identication
numbers (UN or NA numbers).

Regulatory Information
This section provides regulatory information for employers and regulatory compliance personnel. U.S. Federal
regulations such as OSHA, TSCA, SARA, CERCLA,
and CWA are addressed. Reportable quantities (RQ)
for spills or discharges and threshold planning quantities (TPQ) for hazardous materials stored at facilities
are listed.

Other Information
This section provides a location for additional information, such as a list of references, keys/legends, or
preparation and revision indicators. Hazard ratings
dening the acute health, ammability, and reactivity
hazards of a material may also be included.

APPENDIX A
FULL TEXT OF BLOODBORNE
PATHOGENS STANDARD
1910.1030
(a) Scope and Application. This section applies
to all occupational exposure to blood or other potentially infectious materials as dened by paragraph (b)
of this section.

ignated representative.
Engineering Controls means controls (e.g., sharps
disposal containers, self-sheathing needles, safer
medical devices, such as sharps with engineered
sharps injury protections and needleless systems)
that isolate or remove the bloodborne pathogens
hazard from the workplace.

following shall apply:

Exposure Incident means a specic eye, mouth, other

mucous membrane, non-intact skin, or parenteral
contact with blood or other potentially infectious
materials that results from the performance of an
employees duties.

Assistant Secretary means the Assistant Secretary

of Labor for Occupational Safety and Health, or designated representative.

Handwashing Facilities means a facility providing an

adequate supply of running potable water, soap and
single use towels or hot air drying machines.

Blood means human blood, human blood components,

and products made from human blood.

Licensed Healthcare Professional is a person whose

legally permitted scope of practice allows him or her
to independently perform the activities required by
paragraph (f) Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up.

(b) Denitions. For purposes of this section, the

Bloodborne Pathogens means pathogenic microorganisms that are present in human blood and can
cause disease in humans. These pathogens include,
but are not limited to hepatitis B virus (HBV) and human immunodeciency virus (HIV).
Clinical Laboratory means a workplace where diagnostic or other screening procedures are performed
on blood or other potentially infectious materials.
Contaminated means the presence or the reasonably
anticipated presence of blood or other potentially
infectious materials on an item or surface.
Contaminated Laundry means laundry which has
been soiled with blood or other potentially infectious
materials or may contain sharps.
Contaminated Sharps means any contaminated
object that can penetrate the skin including, but not
limited to, needles, scalpels, broken glass, broken
capillary tubes, and exposed ends of dental wires.
Decontamination means the use of physical or
chemical means to remove, inactivate, or destroy
bloodborne pathogens on a surface or item to the
point where they are no longer capable of transmitting infectious particles and the surface or item is
rendered safe for handling, use, or disposal.
Director means the Director of the National Institute
for Occupational Safety and Health, U.S.
Department of Health and Human Services, or des-

HBV means hepatitis B virus.

HIV means human immunodeciency virus, experimental animals infected with HIV or HBV.
Needleless Systems means a device that does not
use needles for (1) the collection of bodily uids
or withdrawal of body uids after initial venous or
arterial access is established; (2) the administration
of medication or uids; or (3) any other procedure
involving the potential for occupational exposure to
bloodborne pathogens due to percutaneous injuries
from contaminated sharps.
Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral
contact with blood or other potentially infectious
materials that may result from the performance of
an employees duties.
Other Potentially Infectious Materials means (1)
The following human body uids: semen, vaginal
secretions, cerebrospinal uid, synovial uid, pleural
uid, pericardial uid, peritoneal uid, amniotic uid,
saliva in dental procedures, any body uid that is
visibly contaminated with blood, and all body uids
in situations where it is difcult or impossible to differentiate between body uids; (2) Any unxed tissue or organ (other than intact skin) from a human
65

(living or dead); and (3) HIV-containing cell or tissue

cultures, organ cultures, and HIV- or HBV-containing
culture medium or other solutions; and blood, organs,
or other tissues from experimental animals infected
with HIV or HBV.
Parenteral means piercing mucous membranes or the
skin barrier through such events as needlesticks,
human bites, cuts, and abrasions.
Personal Protective Equipment is specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g.,
uniforms, pants, shirts or blouses) not intended to
function as protection against a hazard are not considered to be personal protective equipment.
Production Facility means a facility engaged in industrial-scale, large-volume or high concentration
production of HIV or HBV.
Regulated Waste means liquid or semiliquid blood or
other potentially infectious materials; contaminated
items that would release blood or other potentially
infectious materials in a liquid or semiliquid state if
compressed; items that are caked with dried blood
or other potentially infectious materials and are capable of releasing these materials during handling;
contaminated sharps; and pathological and microbiological wastes containing blood or other potentially
infectious materials.
Research Laboratory means a laboratory producing
or using research-laboratory-scale amounts of HIV
or HBV. Research laboratories may produce high
concentrations of HIV or HBV but not in the volume
found in production facilities.
Sharps with Engineered Sharps Injury Protections
means a non-needle sharp or a needle device used
for withdrawing body uids, accessing a vein or artery, or administering medications or other uids, with
a built-in safety feature or mechanism that effectively
reduces the risk of an exposure incident.
Source Individual means any individual, living or dead,
whose blood or other potentially infectious materials
may be a source of occupational exposure to the
employee. Examples include, but are not limited to,
hospital and clinic patients; clients in institutions for
the developmentally disabled; trauma victims; clients
of drug and alcohol treatment facilities; residents
of hospices and nursing homes; human remains;
and individuals who donate or sell blood or blood
components.
Sterilize means the use of a physical or chemical procedure to destroy all microbial life including highly
66

resistant bacterial endospores.

Universal Precautions is an approach to infection
control. According to the concept of Universal Precautions, all human blood and certain human body
uids are treated as if known to be infectious for HIV,
HBV, and other bloodborne pathogens.
Work Practice Controls means controls that reduce
the likelihood of exposure by altering the manner in
which a task is performed (e.g., prohibiting recapping
of needles by a two-handed technique).

(c) Exposure Control

(c)(1) Exposure Control Plan.
(c)(1)(i) Each employer having an employee(s) with
occupational exposure as dened by paragraph (b) of
this section shall establish a written Exposure Control
Plan designed to eliminate or minimize employee
exposure.
(c)(1)(ii) The Exposure Control Plan shall contain at
least the following elements:
(c)(1)(ii)(A) The exposure determination required by
paragraph (c)(2),
(c)(1)(ii)(B) The schedule and method of implementation for paragraphs (d) Methods of Compliance, (e)
HIV and HBV Research Laboratories and Production
Facilities, (f) Hepatitis B Vaccination and Post-Exposure Evaluation and Follow-up, (g) Communication of
Hazards to Employees, and (h) Recordkeeping, of this
standard, and
(c)(1)(ii)(C) The procedure for the evaluation of
circumstances surrounding exposure incidents as required by paragraph (f)(3)(i) of this standard.
(c)(1)(iii) Each employer shall ensure that a copy of
the Exposure Control Plan is accessible to employees
in accordance with 29 CFR 1910.1020(e).
(c)(1)(iv) The Exposure Control Plan shall be reviewed and updated at least annually and whenever
necessary to reect new or modied tasks and procedures which affect occupational exposure and to reect
new or revised employee positions with occupational
exposure. The review and update of such plans shall
also:
(c)(1)(iv)(A) reflect changes in technology that
eliminate or reduce exposure to bloodborne pathogens; and
(c)(1)(iv)(B) document annually consideration and
implementation of appropriate commercially available
and effective safer medical devices designed to elimi-

nate or minimize occupational exposure.

(c)(1)(v) An employer, who is required to establish
an Exposure Control Plan shall solicit input from nonmanagerial employees responsible for direct patient
care who are potentially exposed to injuries from
contaminated sharps in the identication, evaluation,
and selection of effective engineering and work practice controls and shall document the solicitation in the
Exposure Control Plan.
(c)(1)(vi) The Exposure Control Plan shall be made
available to the Assistant Secretary and the Director
upon request for examination and copying.
(c)(2) Exposure Determination.

(d)(2)(iii) Employers shall provide handwashing facilities which are readily accessible to employees.
(d)(2)(iv) When provision of handwashing facilities
is not feasible, the employer shall provide either an
appropriate antiseptic hand cleanser in conjunction
with clean cloth/paper towels or antiseptic towelettes.
When antiseptic hand cleansers or towelettes are used,
hands shall be washed with soap and running water
as soon as feasible.
(d)(2)(v) Employers shall ensure that employees
wash their hands immediately or as soon as feasible
after removal of gloves or other personal protective
equipment.

(c)(2)(i) Each employer who has an employee(s)

with occupational exposure as dened by paragraph
(b) of this section shall prepare an exposure determination. This exposure determination shall contain the
following:

(d)(2)(vi) Employers shall ensure that employees

wash hands and any other skin with soap and water, or
ush mucous membranes with water immediately or as
soon as feasible following contact of such body areas
with blood or other potentially infectious materials.

(c)(2)(i)(A) A list of all job classications in which all

employees in those job classications have occupational exposure;

(d)(2)(vii) Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed
except as noted in paragraphs (d)(2)(vii)(A) and
(d)(2)(vii)(B) below. Shearing or breaking of contaminated needles is prohibited.

(c)(2)(i)(B) A list of job classications in which some

employees have occupational exposure, and(c)(2)(i)(C)
A list of all tasks and procedures or groups of closely
related task and procedures in which occupational exposure occurs and that are performed by employees in
job classications listed in accordance with the provisions of paragraph (c)(2)(i)(B) of this standard.

(d)(2)(vii)(A) Contaminated needles and other

contaminated sharps shall not be bent, recapped or
removed unless the employer can demonstrate that no
alternative is feasible or that such action is required by
a specic medical or dental procedure.

(c)(2)(ii) This exposure determination shall be made

without regard to the use of personal protective equipment.

(d)(2)(vii)(B) Such bending, recapping or needle

removal must be accomplished through the use of a
mechanical device or a one-handed technique.

(d) Methods of Compliance

(d)(2)(viii) Immediately or as soon as possible after

use, contaminated reusable sharps shall be placed
in appropriate containers until properly reprocessed.
These containers shall be:

(d)(1) General. Universal precautions shall be observed to prevent contact with blood or other potentially
infectious materials. Under circumstances in which
differentiation between body uid types is difcult or
impossible, all body uids shall be considered potentially infectious materials.
(d)(2) Engineering and Work Practice Controls.
(d)(2)(i) Engineering and work practice controls shall
be used to eliminate or minimize employee exposure.
Where occupational exposure remains after institution
of these controls, personal protective equipment shall
also be used.
(d)(2)(ii) Engineering controls shall be examined and
maintained or replaced on a regular schedule to ensure
their effectiveness.

(d)(2)(viii)(A) puncture resistant;

(d)(2)(viii)(B) labeled or color-coded in accordance
with this standard;
(d)(2)(viii)(C) leakproof on the sides and bottom;
and
(d)(2)(viii)(D) in accordance with the requirements set
forth in paragraph (d)(4)(ii)(E) for reusable sharps
(d)(2)(ix) Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are
prohibited in work areas where there is a reasonable
likelihood of occupational exposure.
(d)(2)(x) Food and drink shall not be kept in refrigerators, freezers, shelves, cabinets or on countertops or
67

benchtops where blood or other potentially infectious

materials are present.
(d)(2)(xi) All procedures involving blood or other potentially infectious materials shall be performed in such
a manner as to minimize splashing, spraying, spattering, and generation of droplets of these substances.
(d)(2)(xii) Mouth pipetting/suctioning of blood or other
potentially infectious materials is prohibited.
(d)(2)(xiii) Specimens of blood or other potentially
infectious materials shall be placed in a container which
prevents leakage during collection, handling, processing, storage, transport, or shipping.
(d)(2)(xiii)(A) The container for storage, transport,
or shipping shall be labeled or color-coded according
to paragraph (g)(1)(i) and closed prior to being stored,
transported, or shipped. When a facility utilizes Universal Precautions in the handling of all specimens, the
labeling/color-coding of specimens is not necessary
provided containers are recognizable as containing
specimens. This exemption only applies while such
specimens/containers remain within the facility. Labeling or color-coding in accordance with paragraph
(g)(1)(i) is required when such specimens/containers
leave the facility.
(d)(2)(xiii)(B) If outside contamination of the primary
container occurs, the primary container shall be placed
within a second container which prevents leakage during handling, processing, storage, transport, or shipping
and is labeled or color-coded according to the requirements of this standard.
(d)(2)(xiii)(C) If the specimen could puncture the primary container, the primary container shall be placed
within a secondary container which is puncture-resistant in addition to the above characteristics.
(d)(2)(xiv) Equipment which may become contaminated with blood or other potentially infectious materials shall be examined prior to servicing or shipping
and shall be decontaminated as necessary, unless
the employer can demonstrate that decontamination
of such equipment or portions of such equipment is
not feasible.
(d)(2)(xiv)(A) A readily observable label in accordance with paragraph (g)(1)(i)(H) shall be attached
to the equipment stating which portions remain contaminated.
(d)(2)(xiv)(B) The employer shall ensure that this
information is conveyed to all affected employees, the
servicing representative, and/or the manufacturer, as
appropriate, prior to handling, servicing, or shipping so
that appropriate precautions will be taken.
68

(d)(3) Personal Protective Equipment (d)(3)(i) Provision. When there is occupational exposure, the employer shall provide, at no cost to the
employee, appropriate personal protective equipment
such as, but not limited to, gloves, gowns, laboratory
coats, face shields or masks and eye protection, and
mouthpieces, resuscitation bags, pocket masks, or
other ventilation devices. Personal protective equipment will be considered appropriate only if it does not
permit blood or other potentially infectious materials to
pass through to or reach the employees work clothes,
street clothes, undergarments, skin, eyes, mouth, or
other mucous membranes under normal conditions of
use and for the duration of time which the protective
equipment will be used.(d)(3)(ii) Use. The employer
shall ensure that the employee uses appropriate personal protective equipment unless the employer shows
that the employee temporarily and briey declined to
use personal protective equipment when, under rare
and extraordinary circumstances, it was the employees
professional judgment that in the specic instance
its use would have prevented the delivery of health
care or public safety services or would have posed
an increased hazard to the safety of the worker or coworker. When the employee makes this judgement, the
circumstances shall be investigated and documented in
order to determine whether changes can be instituted
to prevent such occurrences in the future.
(d)(3)(iii) Accessibility. The employer shall ensure
that appropriate personal protective equipment in the
appropriate sizes is readily accessible at the worksite
or is issued to employees. Hypoallergenic gloves, glove
liners, powderless gloves, or other similar alternatives
shall be readily accessible to those employees who are
allergic to the gloves normally provided.
(d)(3)(iv) Cleaning, Laundering, and Disposal. The
employer shall clean, launder, and dispose of personal
protective equipment required by paragraphs (d) and
(e) of this standard, at no cost to the employee.
(d)(3)(v) Repair and Replacement. The employer
shall repair or replace personal protective equipment
as needed to maintain its effectiveness, at no cost to
the employee.
(d)(3)(vi) If a garment(s) is penetrated by blood or
other potentially infectious materials, the garment(s)
shall be removed immediately or as soon as feasible.
(d)(3)(vii) All personal protective equipment shall be
removed prior to leaving the work area.
(d)(3)(viii) When personal protective equipment is removed it shall be placed in an appropriately designated

area or container for storage, washing, decontamination or disposal.

(d)(3)(ix) Gloves. Gloves shall be worn when it can
be reasonably anticipated that the employee may have
hand contact with blood, other potentially infectious
materials, mucous membranes, and non-intact skin;
when performing vascular access procedures except as
specied in paragraph (d)(3)(ix)(D); and when handling
or touching contaminated items or surfaces.
(d)(3)(ix)(A) Disposable (single use) gloves such as
surgical or examination gloves, shall be replaced as
soon as practical when contaminated or as soon as
feasible if they are torn, punctured, or when their ability
to function as a barrier is compromised.
(d)(3)(ix)(B) Disposable (single use) gloves shall not
be washed or decontaminated for re-use.
(d)(3)(ix)(C) Utility gloves may be decontaminated for
re-use if the integrity of the glove is not compromised.
However, they must be discarded if they are cracked,
peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier
is compromised.
(d)(3)(ix)(D) If an employer in a volunteer blood donation center judges that routine gloving for all phlebotomies is not necessary then the employer shall:
(d)(3)(ix)(D)(1) Periodically reevaluate this policy;
(d)(3)(ix)(D)(2) Make gloves available to all employees who wish to use them for phlebotomy;
(d)(3)(ix)(D)(3) Not discourage the use of gloves for
phlebotomy; and
(d)(3)(ix)(D)(4) Require that gloves be used for phlebotomy in the following circumstances:
(d)(3)(ix)(D)(4)(i) When the employee has cuts,
scratches, or other breaks in his or her skin;
(d)(3)(ix)(D)(4)(ii) When the employee judges that
hand contamination with blood may occur, for example,
when performing phlebotomy on an uncooperative
source individual; and
(d)(3)(ix)(D)(4)(iii) When the employee is receiving
training in phlebotomy.
(d)(3)(ix)(D)(4)(ii) When the employee judges that
hand contamination with blood may occur, for example,
when performing phlebotomy on an uncooperative
source individual; and
(d)(3)(ix)(D)(4)(iii) When the employee is receiving
training in phlebotomy.
(d)(3)(x) Masks, Eye Protection, and Face Shields.

Masks in combination with eye protection devices,

such as goggles or glasses with solid side shields,
or chin-length face shields, shall be worn whenever
splashes, spray, spatter, or droplets of blood or other
potentially infectious materials may be generated and
eye, nose, or mouth contamination can be reasonably
anticipated.
(d)(3)(xi) Gowns, Aprons, and Other Protective Body
Clothing. Appropriate protective clothing such as, but
not limited to, gowns, aprons, lab coats, clinic jackets,
or similar outer garments shall be worn in occupational
exposure situations. The type and characteristics will
depend upon the task and degree of exposure anticipated.
(d)(3)(xii) Surgical caps or hoods and/or shoe covers or boots shall be worn in instances when gross
contamination can reasonably be anticipated (e.g.,
autopsies, orthopaedic surgery).
(d)(4) Housekeeping (d)(4)(i) General. Employers shall ensure that the
worksite is maintained in a clean and sanitary condition. The employer shall determine and implement an
appropriate written schedule for cleaning and method
of decontamination based upon the location within
the facility, type of surface to be cleaned, type of soil
present, and tasks or procedures being performed in
the area.
(d)(4)(ii) All equipment and environmental and working surfaces shall be cleaned and decontaminated
after contact with blood or other potentially infectious
materials.
(d)(4)(ii)(A) Contaminated work surfaces shall be
decontaminated with an appropriate disinfectant after
completion of procedures; immediately or as soon as
feasible when surfaces are overtly contaminated or
after any spill of blood or other potentially infectious
materials; and at the end of the work shift if the surface may have become contaminated since the last
cleaning.
(d)(4)(ii)(B) Protective coverings, such as plastic
wrap, aluminum foil, or imperviously-backed absorbent
paper used to cover equipment and environmental
surfaces, shall be removed and replaced as soon as
feasible when they become overtly contaminated or
at the end of the workshift if they may have become
contaminated during the shift.
(d)(4)(ii)(C) All bins, pails, cans, and similar receptacles intended for reuse which have a reasonable
likelihood for becoming contaminated with blood or
other potentially infectious materials shall be inspected
69

and decontaminated on a regularly scheduled basis and

cleaned and decontaminated immediately or as soon
as feasible upon visible contamination.
(d)(4)(ii)(D) Broken glassware which may be contaminated shall not be picked up directly with the hands.
It shall be cleaned up using mechanical means, such
as a brush and dust pan, tongs, or forceps.(d)(4)(ii)(E)
Reusable sharps that are contaminated with blood or
other potentially infectious materials shall not be stored
or processed in a manner that requires employees to
reach by hand into the containers where these sharps
have been placed.
(d)(4)(iii) Regulated Waste
(d)(4)(iii)(A) Contaminated Sharps Discarding and
Containment.
(d)(4)(iii)(A)(1) Contaminated sharps shall be discarded immediately or as soon as feasible in containers that are:
(d)(4)(iii)(A)(1)(i) Closable;
(d)(4)(iii)(A)(1)(ii) Puncture resistant;
(d)(4)(iii)(A)(1)(iii) Leakproof on sides and bottom;
and
(d)(4)(iii)(A)(1)(iv) Labeled or color-coded in accordance with paragraph (g)(1)(i) of this standard.
(d)(4)(iii)(A)(2) During use, containers for contaminated sharps shall be:
(d)(4)(iii)(A)(2)(i) Easily accessible to personnel and
located as close as is feasible to the immediate area
where sharps are used or can be reasonably anticipated to be found (e.g., laundries);
(d)(4)(iii)(A)(2)(ii) Maintained upright throughout
use; and
(d)(4)(iii)(A)(2)(iii) Replaced routinely and not be allowed to overll.

(d)(4)(iii)(A)(3)(ii)(C) Labeled or color-coded according to paragraph (g)(1)(i) of this standard.

(d)(4)(iii)(A)(4) Reusable containers shall not be
opened, emptied, or cleaned manually or in any other
manner which would expose employees to the risk of
percutaneous injury.
(d)(4)(iii)(B) Other Regulated Waste Containment (d)(4)(iii)(B)(1) Regulated waste shall be placed in
containers which are:
(d)(4)(iii)(B)(1)(i) Closable;
(d)(4)(iii)(B)(1)(ii) Constructed to contain all contents
and prevent leakage of uids during handling, storage,
transport or shipping;
(d)(4)(iii)(B)(1)(iii) Labeled or color-coded in accordance with paragraph (g)(1)(i) this standard; and
(d)(4)(iii)(B)(1)(iv) Closed prior to removal to prevent
spillage or protrusion of contents during handling, storage, transport, or shipping.(d)(4)(iii)(B)(2) If outside
contamination of the regulated waste container occurs,
it shall be placed in a second container. The second
container shall be:
(d)(4)(iii)(B)(2)(i) Closable;
(d)(4)(iii)(B)(2)(ii) Constructed to contain all contents
and prevent leakage of uids during handling, storage,
transport or shipping;
(d)(4)(iii)(B)(2)(iii) Labeled or color-coded in accordance with paragraph (g)(1)(i) of this standard; and
(d)(4)(iii)(B)(2)(iv) Closed prior to removal to prevent
spillage or protrusion of contents during handling, storage, transport, or shipping.
(d)(4)(iii)(C) Disposal of all regulated waste shall be
in accordance with applicable regulations of the United
States, States and Territories, and political subdivisions
of States and Territories.

(d)(4)(iii)(A)(3) When moving containers of contaminated sharps from the area of use, the containers
shall be:

(d)(4)(iv)(A) Contaminated laundry shall be handled

as little as possible with a minimum of agitation.

(d)(4)(iii)(A)(3)(i) Closed immediately prior to removal

or replacement to prevent spillage or protrusion of contents during handling, storage, transport, or shipping;

(d)(4)(iv)(A)(1) Contaminated laundry shall be bagged

or containerized at the location where it was used and
shall not be sorted or rinsed in the location of use.

(d)(4)(iii)(A)(3)(ii) Placed in a secondary container if

leakage is possible. The second container shall be:

(d)(4)(iv)(A)(2) Contaminated laundry shall be placed

and transported in bags or containers labeled or colorcoded in accordance with paragraph (g)(1)(i) of this
standard. When a facility utilizes Universal Precautions
in the handling of all soiled laundry, alternative labeling
or color-coding is sufcient if it permits all employees
to recognize the containers as requiring compliance

(d)(4)(iii)(A)(3)(ii)(A) Closable;
(d)(4)(iii)(A)(3)(ii)(B) Constructed to contain all contents and prevent leakage during handling, storage,
transport, or shipping; and
70

(d)(4)(iv) Laundry.

with Universal Precautions.

(d)(4)(iv)(A)(3) Whenever contaminated laundry is
wet and presents a reasonable likelihood of soakthrough of or leakage from the bag or container, the
laundry shall be placed and transported in bags or
containers which prevent soak-through and/or leakage
of uids to the exterior.
(d)(4)(iv)(B) The employer shall ensure that employees who have contact with contaminated laundry
wear protective gloves and other appropriate personal
protective equipment.
(d)(4)(iv)(C) When a facility ships contaminated laundry off-site to a second facility which does not utilize
Universal Precautions in the handling of all laundry, the
facility generating the contaminated laundry must place
such laundry in bags or containers which are labeled or
color-coded in accordance with paragraph (g)(1)(i).

(e) HIV and HBV Research Laboratories

and Production Facilities.
(e)(1) This paragraph applies to research laboratories
and production facilities engaged in the culture, production, concentration, experimentation, and manipulation
of HIV and HBV. It does not apply to clinical or diagnostic laboratories engaged solely in the analysis of
blood, tissues, or organs. These requirements apply in
addition to the other requirements of the standard.
(e)(2) Research laboratories and production facilities
shall meet the following criteria:
(e)(2)(i) Standard Microbiological Practices. All
regulated waste shall either be incinerated or decontaminated by a method such as autoclaving known to
effectively destroy bloodborne pathogens.
(e)(2)(ii) Special Practices.
(e)(2)(ii)(A) Laboratory doors shall be kept closed
when work involving HIV or HBV is in progress.
(e)(2)(ii)(B) Contaminated materials that are to be
decontaminated at a site away from the work area
shall be placed in a durable, leakproof, labeled or colorcoded container that is closed before being removed
from the work area.
(e)(2)(ii)(C) Access to the work area shall be limited
to authorized persons. Written policies and procedures
shall be established whereby only persons who have
been advised of the potential biohazard, who meet any
specic entry requirements, and who comply with all
entry and exit procedures shall be allowed to enter the
work areas and animal rooms.

(e)(2)(ii)(D) When other potentially infectious materials or infected animals are present in the work area or
containment module, a hazard warning sign incorporating the universal biohazard symbol shall be posted on
all access doors. The hazard warning sign shall comply
with paragraph (g)(1)(ii) of this standard.
(e)(2)(ii)(E) All activities involving other potentially
infectious materials shall be conducted in biological
safety cabinets or other physical-containment devices
within the containment module. No work with these
other potentially infectious materials shall be conducted
on the open bench.
(e)(2)(ii)(F) Laboratory coats, gowns, smocks, uniforms, or other appropriate protective clothing shall be
used in the work area and animal rooms. Protective
clothing shall not be worn outside of the work area and
shall be decontaminated before being laundered.
(e)(2)(ii)(G) Special care shall be taken to avoid
skin contact with other potentially infectious materials.
Gloves shall be worn when handling infected animals
and when making hand contact with other potentially
infectious materials is unavoidable.
(e)(2)(ii)(H) Before disposal all waste from work areas and from animal rooms shall either be incinerated
or decontaminated by a method such as autoclaving
known to effectively destroy bloodborne pathogens.
(e)(2)(ii)(I) Vacuum lines shall be protected with liquid
disinfectant traps and high-efciency particulate air
(HEPA) lters or lters of equivalent or superior efciency and which are checked routinely and maintained
or replaced as necessary.
(e)(2)(ii)(J) Hypodermic needles and syringes shall be
used only for parenteral injection and aspiration of uids
from laboratory animals and diaphragm bottles. Only
needle-locking syringes or disposable syringe-needle
units (i.e., the needle is integral to the syringe) shall be
used for the injection or aspiration of other potentially
infectious materials. Extreme caution shall be used
when handling needles and syringes. A needle shall
not be bent, sheared, replaced in the sheath or guard,
or removed from the syringe following use. The needle
and syringe shall be promptly placed in a punctureresistant container and autoclaved or decontaminated
before reuse or disposal.
(e)(2)(ii)(K) All spills shall be immediately contained
and cleaned up by appropriate professional staff or
others properly trained and equipped to work with potentially concentrated infectious materials.
(e)(2)(ii)(L) A spill or accident that results in an exposure incident shall be immediately reported to the labo71

ratory director or other responsible person.(e)(2)(ii)(M)

A biosafety manual shall be prepared or adopted and
periodically reviewed and updated at least annually or
more often if necessary. Personnel shall be advised of
potential hazards, shall be required to read instructions
on practices and procedures, and shall be required to
follow them.
(e)(2)(iii) Containment Equipment.
(e)(2)(iii)(A) Certied biological safety cabinets (Class
I, II, or III) or other appropriate combinations of personal
protection or physical containment devices, such as
special protective clothing, respirators, centrifuge safety
cups, sealed centrifuge rotors, and containment caging
for animals, shall be used for all activities with other
potentially infectious materials that pose a threat of
exposure to droplets, splashes, spills, or aerosols.
(e)(2)(iii)(B) Biological safety cabinets shall be certied when installed, whenever they are moved and at
least annually.
(e)(3) HIV and HBV research laboratories shall meet
the following criteria:
(e)(3)(i) Each laboratory shall contain a facility for
hand washing and an eye wash facility which is readily
available within the work area.
(e)(3)(ii) An autoclave for decontamination of regulated waste shall be available.
(e)(4) HIV and HBV production facilities shall meet
the following criteria:
(e)(4)(i) The work areas shall be separated from areas that are open to unrestricted trafc ow within the
building. Passage through two sets of doors shall be
the basic requirement for entry into the work area from
access corridors or other contiguous areas. Physical
separation of the high-containment work area from
access corridors or other areas or activities may also
be provided by a double-doored clothes-change room
(showers may be included), airlock, or other access
facility that requires passing through two sets of doors
before entering the work area.
(e)(4)(ii) The surfaces of doors, walls, oors and
ceilings in the work area shall be water resistant so
that they can be easily cleaned. Penetrations in these
surfaces shall be sealed or capable of being sealed to
facilitate decontamination.
(e)(4)(iii) Each work area shall contain a sink for
washing hands and a readily available eye wash facility. The sink shall be foot, elbow, or automatically
operated and shall be located near the exit door of the
work area.
72

(e)(4)(iv) Access doors to the work area or containment module shall be self-closing.
(e)(4)(v) An autoclave for decontamination of regulated waste shall be available within or as near as
possible to the work area.
(e)(4)(vi) A ducted exhaust-air ventilation system
shall be provided. This system shall create directional
airow that draws air into the work area through the
entry area. The exhaust air shall not be recirculated to
any other area of the building, shall be discharged to
the outside, and shall be dispersed away from occupied
areas and air intakes. The proper direction of the airow
shall be veried (i.e., into the work area).
(e)(5) Training Requirements. Additional training
requirements for employees in HIV and HBV research
laboratories and HIV and HBV production facilities are
specied in paragraph (g)(2)(ix).

(f) Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up

(f)(1) General.(f)(1)(i) The employer shall make available the hepatitis B vaccine and vaccination series to
all employees who have occupational exposure, and
post-exposure evaluation and follow-up to all employees who have had an exposure incident.
(f)(1)(ii) The employer shall ensure that all medical
evaluations and procedures including the hepatitis B
vaccine and vaccination series and post-exposure
evaluation and follow-up, including prophylaxis, are:
(f)(1)(ii)(A) Made available at no cost to the employee;
(f)(1)(ii)(B) Made available to the employee at a
reasonable time and place;
(f)(1)(ii)(C) Performed by or under the supervision of
a licensed physician or by or under the supervision of
another licensed healthcare professional; and
(f)(1)(ii)(D) Provided according to recommendations
of the U.S. Public Health Service current at the time
these evaluations and procedures take place, except
as specied by this paragraph (f).
(f)(1)(iii) The employer shall ensure that all laboratory
tests are conducted by an accredited laboratory at no
cost to the employee.
(f)(2) Hepatitis B Vaccination.
(f)(2)(i) Hepatitis B vaccination shall be made available
after the employee has received the training required

in paragraph (g)(2)(vii)(I) and within 10 working days

of initial assignment to all employees who have occupational exposure unless the employee has previously
received the complete hepatitis B vaccination series,
antibody testing has revealed that the employee is
immune, or the vaccine is contraindicated for medical
reasons.
(f)(2)(ii) The employer shall not make participation
in a prescreening program a prerequisite for receiving
hepatitis B vaccination.
(f)(2)(iii) If the employee initially declines hepatitis B
vaccination but at a later date while still covered under
the standard decides to accept the vaccination, the
employer shall make available hepatitis B vaccination
at that time.
(f)(2)(iv) The employer shall assure that employees
who decline to accept hepatitis B vaccination offered
by the employer sign the statement in Appendix A.
(f)(2)(v) If a routine booster dose(s) of hepatitis B vaccine is recommended by the U.S. Public Health Service
at a future date, such booster dose(s) shall be made
available in accordance with section (f)(1)(ii).
(f)(3) Post-exposure Evaluation and Follow-up. Following a report of an exposure incident, the employer
shall make immediately available to the exposed employee a condential medical evaluation and follow-up,
including at least the following elements:
(f)(3)(i) Documentation of the route(s) of exposure,
and the circumstances under which the exposure incident occurred;
(f)(3)(ii) Identification and documentation of the
source individual, unless the employer can establish
that identication is infeasible or prohibited by state or
local law;
(f)(3)(ii)(A) The source individuals blood shall be
tested as soon as feasible and after consent is obtained
in order to determine HBV and HIV infectivity. If consent
is not obtained, the employer shall establish that legally
required consent cannot be obtained. When the source
individuals consent is not required by law, the source
individuals blood, if available, shall be tested and the
results documented.
(f)(3)(ii)(B) When the source individual is already
known to be infected with HBV or HIV, testing for the
source individuals known HBV or HIV status need
not be repeated.(f)(3)(ii)(C) Results of the source
individuals testing shall be made available to the exposed employee, and the employee shall be informed
of applicable laws and regulations concerning disclo-

sure of the identity and infectious status of the source

individual.
(f)(3)(iii) Collection and testing of blood for HBV and
HIV serological status;
(f)(3)(iii)(A) The exposed employees blood shall be
collected as soon as feasible and tested after consent
is obtained.
(f)(3)(iii)(B) If the employee consents to baseline
blood collection, but does not give consent at that time
for HIV serologic testing, the sample shall be preserved
for at least 90 days. If, within 90 days of the exposure
incident, the employee elects to have the baseline
sample tested, such testing shall be done as soon as
feasible.
(f)(3)(iv) Post-exposure prophylaxis, when medically
indicated, as recommended by the U.S. Public Health
Service;
(f)(3)(v) Counseling; and
(f)(3)(vi) Evaluation of reported illnesses.
(f)(4) Information Provided to the Healthcare Professional.
(f)(4)(i) The employer shall ensure that the healthcare
professional responsible for the employees Hepatitis B
vaccination is provided a copy of this regulation.
(f)(4)(ii) The employer shall ensure that the healthcare
professional evaluating an employee after an exposure
incident is provided the following information:
(f)(4)(ii)(A) A copy of this regulation;
(f)(4)(ii)(B) A description of the exposed employees
duties as they relate to the exposure incident;
(f)(4)(ii)(C) Documentation of the route(s) of exposure
and circumstances under which exposure occurred;
(f)(4)(ii)(D) Results of the source individuals blood
testing, if available; and
(f)(4)(ii)(E) All medical records relevant to the appropriate treatment of the employee including vaccination status which are the employers responsibility
to maintain.
(f)(5) Healthcare Professionals Written Opinion.
The employer shall obtain and provide the employee
with a copy of the evaluating healthcare professionals
written opinion within 15 days of the completion of the
evaluation.
(f)(5)(i) The healthcare professionals written opinion
for Hepatitis B vaccination shall be limited to whether
Hepatitis B vaccination is indicated for an employee,
and if the employee has received such vaccination.
73

(f)(5)(ii) The healthcare professionals written opinion

for post-exposure evaluation and follow-up shall be
limited to the following information:
(f)(5)(ii)(A) That the employee has been informed of
the results of the evaluation; and

shall also state which portions of the equipment remain

contaminated.
(g)(1)(i)(I) Regulated waste that has been decontaminated need not be labeled or color-coded.
(g)(1)(ii) Signs.

(f)(5)(ii)(B) That the employee has been told about

any medical conditions resulting from exposure to blood
or other potentially infectious materials which require
further evaluation or treatment.

(g)(1)(ii)(A) The employer shall post signs at the

entrance to work areas specied in paragraph (e), HIV
and HBV Research Laboratory and Production Facilities, which shall bear the following legend:

(f)(5)(iii) All other ndings or diagnoses shall remain

condential and shall not be included in the written
report.

(Name of the Infectious Agent) (Special requirements

for entering the area) (name, telephone number of the
laboratory director or other responsible person.)

(f)(6) Medical Recordkeeping. Medical records

required by this standard shall be maintained in accordance with paragraph (h)(1) of this section.

(g)(1)(ii)(B) These signs shall be uorescent orangered or predominantly so, with lettering and symbols in
a contrasting color.

(g) Communication of Hazards to Employees

(g)(1) Labels and Signs -(g)(1)(i) Labels.
(g)(1)(i)(A) Warning labels shall be afxed to containers of regulated waste, refrigerators and freezers
containing blood or other potentially infectious material;
and other containers used to store, transport or ship
blood or other potentially infectious materials, except
as provided in paragraph (g)(1)(i)(E), (F) and (G).
(g)(1)(i)(B) Labels required by this section shall include the following legend:
(g)(1)(i)(C) These labels shall be uorescent orange
or orange-red or predominantly so, with lettering and
symbols in a contrasting color.
(g)(1)(i)(D) Labels shall be affixed as close as
feasible to the container by string, wire, adhesive, or
other method that prevents their loss or unintentional
removal.
(g)(1)(i)(E) Red bags or red containers may be substituted for labels.
(g)(1)(i)(F) Containers of blood, blood components,
or blood products that are labeled as to their contents
and have been released for transfusion or other clinical use are exempted from the labeling requirements
of paragraph (g).
(g)(1)(i)(G) Individual containers of blood or other
potentially infectious materials that are placed in a
labeled container during storage, transport, shipment
or disposal are exempted from the labeling requirement.
(g)(1)(i)(H) Labels required for contaminated equipment shall be in accordance with this paragraph and
74

(g)(2) Information and Training.

(g)(2)(i) Employers shall ensure that all employees
with occupational exposure participate in a training
program which must be provided at no cost to the
employee and during working hours.
(g)(2)(ii) Training shall be provided as follows:
(g)(2)(ii)(A) At the time of initial assignment to tasks
where occupational exposure may take place;
(g)(2)(ii)(B) Within 90 days after the effective date of
the standard; and
(g)(2)(ii)(C) At least annually thereafter.
(g)(2)(iii) For employees who have received training
on bloodborne pathogens in the year preceding the effective date of the standard, only training with respect to
the provisions of the standard which were not included
need be provided.
(g)(2)(iv) Annual training for all employees shall be
provided within one year of their previous training.
(g)(2)(v) Employers shall provide additional training when changes such as modication of tasks or
procedures or institution of new tasks or procedures
affect the employees occupational exposure. The additional training may be limited to addressing the new
exposures created.
(g)(2)(vi) Material appropriate in content and vocabulary to educational level, literacy, and language
of employees shall be used.
(g)(2)(vii) The training program shall contain at a
minimum the following elements:
(g)(2)(vii)(A) An accessible copy of the regulatory text
of this standard and an explanation of its contents;

(g)(2)(vii)(B) A general explanation of the epidemiology and symptoms of bloodborne diseases;

(g)(2)(vii)(C) An explanation of the modes of transmission of bloodborne pathogens;
(g)(2)(vii)(D) An explanation of the employers exposure control plan and the means by which the employee
can obtain a copy of the written plan;
(g)(2)(vii)(E) An explanation of the appropriate
methods for recognizing tasks and other activities that
may involve exposure to blood and other potentially
infectious materials;

lowing initial training in addition to the above training

requirements.(g)(2)(ix)(A) The employer shall assure
that employees demonstrate prociency in standard
microbiological practices and techniques and in the
practices and operations specic to the facility before
being allowed to work with HIV or HBV.
(g)(2)(ix)(B) The employer shall assure that employees have prior experience in the handling of human
pathogens or tissue cultures before working with HIV
or HBV.

(g)(2)(vii)(G) Information on the types, proper use,

location, removal, handling, decontamination and disposal of personal protective equipment;

(g)(2)(ix)(C) The employer shall provide a training

program to employees who have no prior experience
in handling human pathogens. Initial work activities
shall not include the handling of infectious agents. A
progression of work activities shall be assigned as
techniques are learned and prociency is developed.
The employer shall assure that employees participate
in work activities involving infectious agents only after
prociency has been demonstrated.

(g)(2)(vii)(H) An explanation of the basis for selection

of personal protective equipment;

(h) Recordkeeping

(g)(2)(vii)(F) An explanation of the use and limitations

of methods that will prevent or reduce exposure including appropriate engineering controls, work practices,
and personal protective equipment;

(g)(2)(vii)(I) Information on the hepatitis B vaccine,

including information on its efcacy, safety, method of
administration, the benets of being vaccinated, and
that the vaccine and vaccination will be offered free
of charge;
(g)(2)(vii)(J) Information on the appropriate actions to
take and persons to contact in an emergency involving
blood or other potentially infectious materials;
(g)(2)(vii)(K) An explanation of the procedure to follow
if an exposure incident occurs, including the method
of reporting the incident and the medical follow-up that
will be made available;
(g)(2)(vii)(L) Information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident;
(g)(2)(vii)(M) An explanation of the signs and labels
and/or color coding required by paragraph (g)(1); and
(g)(2)(vii)(N) An opportunity for interactive questions
and answers with the person conducting the training
session.
(g)(2)(viii) The person conducting the training shall
be knowledgeable in the subject matter covered by the
elements contained in the training program as it relates
to the workplace that the training will address.
(g)(2)(ix) Additional Initial Training for Employees in
HIV and HBV Laboratories and Production Facilities.
Employees in HIV or HBV research laboratories and
HIV or HBV production facilities shall receive the fol-

(h)(1) Medical Records.

(h)(1)(i) The employer shall establish and maintain an
accurate record for each employee with occupational
exposure, in accordance with 29 CFR 1910.1020.
(h)(1)(ii) This record shall include:
(h)(1)(ii)(A) The name and social security number of
the employee;
(h)(1)(ii)(B) A copy of the employees hepatitis B vaccination status including the dates of all the hepatitis
B vaccinations and any medical records relative to the
employees ability to receive vaccination as required
by paragraph (f)(2);
(h)(1)(ii)(C) A copy of all results of examinations,
medical testing, and follow-up procedures as required
by paragraph (f)(3);
(h)(1)(ii)(D) The employers copy of the healthcare
professionals written opinion as required by paragraph
(f)(5); and
(h)(1)(ii)(E) A copy of the information provided to
the healthcare professional as required by paragraphs
(f)(4)(ii)(B)(C) and (D).
(h)(1)(iii) Condentiality. The employer shall ensure
that employee medical records required by paragraph
(h)(1) are:
(h)(1)(iii)(A) Kept condential; and
(h)(1)(iii)(B) Not disclosed or reported without the
75

employees express written consent to any person

within or outside the workplace except as required by
this section or as may be required by law.
(h)(1)(iv) The employer shall maintain the records
required by paragraph (h) for at least the duration of
employment plus 30 years in accordance with 29 CFR
1910.1020.
(h)(2) Training Records.
(h)(2)(i) Training records shall include the following
information:
(h)(2)(i)(A) The dates of the training sessions;
(h)(2)(i)(B) The contents or a summary of the training sessions;

a sharps injury log for the recording of percutaneous

injuries from contaminated sharps. The information in
the sharps injury log shall be recorded and maintained
in such manner as to protect the condentiality of the
injured employee. The sharps injury log shall contain,
at a minimum:
(h)(5)(i)(A) the type and brand of device involved in
the incident,
(h)(5)(i)(B) the department or work area where the
exposure incident occurred, and
(h)(5)(i)(C) an explanation of how the incident occurred.

(h)(2)(i)(C) The names and qualications of persons

conducting the training; and

(h)(5)(ii) The requirement to establish and maintain

a sharps injury log shall apply to any employer who is
required to maintain a log of occupational injuries and
illnesses under 29 CFR 1904.

(h)(2)(i)(D) The names and job titles of all persons

attending the training sessions.

(h)(5)(iii) The sharps injury log shall be maintained

for the period required by 29 CFR 1904.6.

(h)(2)(ii) Training records shall be maintained for 3

years from the date on which the training occurred.
(h)(3) Availability.(h)(3)(i) The employer shall ensure that all records required to be maintained by this
section shall be made available upon request to the
Assistant Secretary and the Director for examination
and copying.
(h)(3)(ii) Employee training records required by
this paragraph shall be provided upon request for
examination and copying to employees, to employee
representatives, to the Director, and to the Assistant
Secretary.
(h)(3)(iii) Employee medical records required by this
paragraph shall be provided upon request for examination and copying to the subject employee, to anyone
having written consent of the subject employee, to the
Director, and to the Assistant Secretary in accordance
with 29 CFR 1910.1020.
(h)(4) Transfer of Records.
(h)(4)(i) The employer shall comply with the requirements involving transfer of records set forth in 29 CFR
1910.1020(h).
(h)(4)(ii) If the employer ceases to do business and
there is no successor employer to receive and retain
the records for the prescribed period, the employer shall
notify the Director, at least three months prior to their
disposal and transmit them to the Director, if required by
the Director to do so, within that three month period.
(h)(5) Sharps Injury Log.
(h)(5)(i) The employer shall establish and maintain
76

(i) Dates
(i)(1) Effective Date. The standard shall become effective on March 6, 1992.
(i)(2) The Exposure Control Plan required by paragraph (c) of this section shall be completed on or before
May 5, 1992.
(i)(3) Paragraph (g)(2) Information and Training and
(h) Recordkeeping shall take effect on or before June
4, 1992.
(i)(4) paragraphs (d)(2) Engineering and Work Practice Controls, (d)(3) Personal Protective Equipment,
(d)(4) Housekeeping, (e) HIV and HBV Research
Laboratories and Production Facilities, (f) Hepatitis B
Vaccination and Post-Exposure Evaluation and Follow-up, and (g)(1) Labels and Signs, shall take effect
July 6, 1992.

APPENDIX B
HEPATITIS B VACCINE
DECLINATION (MANDATORY)
I understand that due to my occupational exposure to blood or other potentially infectious materials I may be
at risk of acquiring Hepatitis B Virus (HBV) infection. I have been given the opportunity to be vaccinated with
Hepatitis B vaccine, at no charge to myself. However, I decline the Hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If in the
future I continue to have occupational exposure to blood or other potentially infectious materials and I want to
be vaccinated with Hepatitis B vaccine, I can receive the vaccination series at no charge to me.
Employee Signature __________________________________
Date ______________________________________________
Employer Signature __________________________________
Date ______________________________________________

77

78

APPENDIX C

APPLICATIONS FOR MEMBERSHIP

MEMBERSHIP TYPES AND ELIGIBILITY CRITERIA:
Professional Business Member* Works full time as a piercer and has more than one year of professional
experience. Must meet both personal and environmental membership criteria.
Professional Member at Large* Pierces part time or periodically at more than one studio and has been a
professional business member for more than three years. Must meet personal and environmental membership
criteria at all studios.
Associate Member* Has less than one year of professional experience, or is a non-piercer working in a piercing establishment. If working as a piercer, personal and environmental criteria must be met. If working as a
non-piercer, environmental criteria must be met. Associate membership will be valid only in a studio currently
employing at least one professional business member.
Corporate Associate Member An entity or individual working in a eld or providing a service that is associated
with the application of body piercing. Examples of Corporate Associate Members are jewelry manufacturers,
medical suppliers, insurers, educators, etc. Applicants must contact the current Secretary for a list of criteria.
Patron Member An individual who supports the APP and its goals but is not actively involved in the body piercing industry. This membership may not be used for the promotion of any form of piercing services, jewelry sales
or web services. Dues are the only requirement for this membership.
*International Member A subdivision of memberships for piercers or non-piercers working in the piercing industry outside of the United States of America. International personal criteria differs slightly from the standard
to accommodate for classes and training available, among other continental differences.

MEMBERSHIP DUES:
Professional Business Member & Professional Member At Large

$150.00 ($50.00 annual renewal)

Associate Member

$100.00 ($50.00 annual renewal)

Corporate Associate Member

$200.00 ($200.00 annual renewal)

Patron

$50.00 ($50.00 annual renewal)

Dues are billed upon acceptance. DO NOT SEND them with your application; DO SEND a non-refundable $25.00
processing fee per video. One video is required per studio.
The Association of Professional Piercers
Attn: Secretary
2132 A Central Ave SE #285
Albuquerque, NM 87106
If you have any questions about your application, the current Secretary can be reached at
secretary@safepiercing.org, or call 1-888-888-1APP or 1-505-242-2144.
PLEASE ALLOW 6-8 WEEKS FOR PROCESSING
03/05

79

APPLICATION FOR PATRON MEMBERSHIP

A patron member is someone not actively involved in the body piercing industry, but supports the APP and its
goals. This membership may not be used for the promotion of any form of piercing services, jewelry or web
services. Dues are the only requirement for this type of membership.
Patron membership dues are $50 ($50 annual renewal).
Please submit completed application to:
The Association of Professional Piercers
Attn: Secretary
2132 A Central Ave SE #285
Albuquerque, NM 87106
If you have any questions about your application, the current Secretary can be reached at
secretary@safepiercing.org, or call 1-888-888-1APP or 1-505-242-2144.

Name _________________________________________________________________________________
Name of Business (if applicable)____________________________________________________________
Address_______________________________________________________________________________
City, State, Zip__________________________________________________________________________
Phone________________________________________ Fax_____________________________________
Email_________________________________________________________________________________

Signature of Applicant ______________________________________________ Date ________________

By my signature above I certify that I have read and I agree to the terms of this application.

PLEASE ALLOW 6-8 WEEKS FOR PROCESSING

04/05

80

CORPORATE ASSOCIATE MEMBERSHIP APPLICATION

Corporate Associate Member Is an entity or individual working in a eld or providing a service that is associated
with the application of body piercing. Examples of Corporate Associate Members are jewelry manufacturers,
medical suppliers, insurers, educators, etc.
Corporate Associate Membership dues are $200.00 ($200.00 annual renewal).
Dues are billed upon acceptance. DO NOT SEND them with your application.
Please submit completed application to:
The Association of Professional Piercers
Attn: Secretary
2132 A Central Ave SE #285
Albuquerque, NM 87106
If you have any questions about your application, the current Secretary can be reached at
secretary@safepiercing.org, or call 1-888-888-1APP or 1-505-242-2144.

Name of Company______________________________________________________________________
Name of Contact ________________________________________________________________________
Company Address_______________________________________________________________________
City, State, Zip__________________________________________________________________________
Phone________________________________________ Fax_____________________________________
Website _______________________________________________________________________________
Email__________________________________________________________________________________
Would you like your email address on our website? qYes qNo
Please include the following documentation:
q

A completed copy of this application form.

Letter of intent, requesting membership and outlining in what way your company is relevant to body piercing.

Business documentation: business license or other items verifying the company or group as an entity.

Signed logo usage agreement. (The term license in this agreement refers only to the use of the logo, your
company may not claim to be APP licensed).

continued
81

CORPORATE ASSOCIATE MEMBERSHIP APPLICATION CONT.

THE FOLLOWING CRITERIA MUST BE INCLUDED FOR WHOLESALE JEWELRY DISTRIBUTORS:
q

Catalog or brochure.

Mill specs for all gauges of steel and Titanium wire, balls, and bar.

MSDS sheets for Gold and Niobium.

Samples, disassembled, of the following:

3 14 gauge 1/2 steel captive bead rings w/steel balls

3 14 gauge 1/2 titanium captive bead rings w/titanium balls
3 12 gauge steel barbells
3 12 gauge titanium barbells
Independent metal testing may be conducted by the APP at any time to verify provided documentation. This will
be at your expense, approximate cost is $300- $500.
THE FOLLOWING CRITERIA MUST BE INCLUDED FOR AFTERCARE PRODUCT DISTRIBUTORS:
q

MSDS sheets for all aftercare products being distributed.

Results of extensive clinical studies performed by one or more independent laboratory or other documentation
may be requested.
THE FOLLOWING CRITERIA MUST BE INCLUDED FOR EDUCATORS:
q

Qualications of the class instructor(s).

A copy of the class curriculum.

Copies of all handouts, workbooks or materials given to class participants.

A voided copy of any certicates or awards given upon course completion*.

*Certicates distributed for piercer training must state the number of hours or days the course took to complete,
and that completion of the course does not claim that the participant is certied or licensed to pierce.
OTHER INDUSTRY SPECIFIC CRITERIA MAY BE REQUESTED ON AN INDIVIDUAL BASIS.

Signature of Applicant ______________________________________________ Date ________________

By my signature above I certify that I have read and I agree to the terms of this application.

04/05

82

PROFESSIONAL BUSINESS/ASSOCIATE MEMBERSHIP APPLICATION

Type of APP Membership desired (please check one):
q
q

Professional Business Member

Associate Member Piercer

q
q

Professional Business Member at Large

Associate Member- Non Piercer

Name of Applicant________________________________________________________________________
Studio & Address_________________________________________________________________________
City__________________________________________ Country __________________________________
Studio Phone___________________________________ Fax _____________________________________
Home Address___________________________________________________________________________
Phone_________________________________________ Website _________________________________
qYes qNo Would you like your email address on our website? Email_______________________________

THE FOLLOWING PERSONAL CRITERIA MUST BE INCLUDED FOR EACH PIERCER APPLYING:
q

A completed copy of this application form.

A completed questionnaire, preferably typewritten.

A copy of current CPR certication or equivalent training.

A copy of current First Aid certication or equivalent training.

A copy of current Bloodborne Pathogen Training Certicate or equivalent training (to be renewed annually regardless
of expiration date).

Signed Health and Safety Agreement.

Signed Logo Usage Agreement

Proof of how long piercer has been piercing professionally. A notarized statement,* dated business document, or newspaper article are examples of appropriate proof.

*If a notarized statement is submitted as proof, it must come from a party other than the applicant.

THE FOLLOWING ENVIRONMENTAL CRITERIA MUST BE INCLUDED UNLESS ENVIRONMENTAL

CRITERIA HAS BEEN SUBMITTED WITHIN THE LAST YEAR**:
q

A walk through 360 degree video of applicants entire studio including store front, foyer, piercing room(s), biohazard
area, sterilization area, restroom, inside all drawers, closets, and all other spaces. Narration is appreciated.

$25 processing fee per video. One video is required per studio. VHS or DVD (region 1) are the preferred video formats.
Other video formats may require additional time to process and any fees incurred for video transferring will be charged
to applicants. Please contact the current Secretary for more information.
Photograph of all applicants autoclaves with make, model and serial number printed on the back of photo Autoclaves
should be medical grade with a dry cycle.
Copy of two most recent spore test results from all autoclaves in use.
Copies of all release forms in use at applicants studio.
Copies of all aftercare information distributed at applicants studio.
Copy of studios business license.
Business card.
One or more samples of applicants advertising.

q
q
q
q
q
q
q

**Any and all materials should be updated voluntarily by the member if signicant changes are made in the environment, advertising, equipment, aftercare etc. These updates to the members
le should be done at the time any changes are made.
As an Applicant to the Association of Professional Piercers (APP), I understand that my video tape (and other materials) becomes the property of the APP. I hereby release the APP and/or its
legal representatives and assigns, the irrevocable and unrestricted right to use these materials for education, training, and for any other purpose and in any manner and medium. I hereby release
the APP and its legal representatives and assigns from all claims and liability relating to said tapes and materials.

Signature of Applicant ______________________________________________ Date ________________

By my signature above I certify that I have read and I agree to the terms of this application.

83

WALK THROUGH 360 VIDEO CRITERIA

Revised 03/2005
The purpose of submitting a walk through 360 video with your membership application is to help us determine the level of health and safety
awareness in your studio. We look for the criteria on this list, and also note anything that may be a potential hazard to clients or staff. Items
that are required for membership have been labeled as such. Other items are strong suggestions that are not required for membership of
themselves, however the studio that lacks several of these may not be operating at the level that is desired of APP members.

FRONT COUNTER/DISPLAY AREA

q

REQUIRED FOR MEMBERSHIP: The counter surface should be glass, metal, or other non-porous surface
that can be disinfected several times each day.

Gloves and disposable products to prevent cross-contamination should be kept at the front counter area.

BIOHAZARD/STERILIZATION ROOM(S)
q

REQUIRED FOR MEMBERSHIP: A completely separate and enclosed biohazard room for processing used implements,
jewelry and supplies is crucial to your health and safety and that of your clients.

REQUIRED FOR MEMBERSHIP: All ooring in the piercing room/s and biohazard room must be non-porous and easily
disinfected.

REQUIRED FOR MEMBERSHIP: There must be clear delineation between clean and dirty areas. Biohazard areas
should be labeled as such. The ultrasonic unit and the sink used for rinsing contaminated tools should be positioned as
far away from sterilizer as possible to reduce the risk of contaminating freshly autoclaved items. If space is a problem,
one solution would be to install a Plexiglas barrier to divide clean and dirty areas.

There should be at a minimum one ultrasonic cleaner to process contaminated items. Failure to remove debris from
instruments or jewelry prior to sterilization can negatively affect the efcacy of the autoclave. The Center for Disease
Control considers manual scrubbing of instruments to be an act that will actually increase the likelihood of exposure,
due to pathogens on the equipment becoming airborne. Many studios have a second ultrasonic cleaning unit used only
to process new jewelry.

An air purier or separate ventilation for this space is strongly suggested.

Hand washing should never take place at the contaminated sink.

PUBLIC/EMPLOYEE RESTROOM
q

REQUIRED FOR MEMBERSHIP: No sterilization equipment may be housed in the public restroom.

The restroom used by employees should have liquid soap in a pump or wall-mounted dispenser and a paper towel
dispenser with easy, one-handed access.

PIERCING ROOM
q

REQUIRED FOR MEMBERSHIP: A completely separate enclosed piercing room with walls and door(s) is a required.
No other services such as tattooing, hair styling, or retail sales should take place within this room.

REQUIRED FOR MEMBERSHIP: All ooring in the piercing room/s must be non-porous and easily disinfected.

REQUIRED FOR MEMBERSHIP: All surfaces in the piercing room that could potentially be contaminated during a
procedure must be non-porous to allow for proper cleaning. This includes piercing table, mat and base, shelving, and
counters.

REQUIRED FOR MEMBERSHIP: Pre-sterilized piercing implements should be kept in enclosed and non- porous containers, drawers or cabinets.

It is strongly suggested that there be clearly visible delineation between clean and dirty areas. The Sharps container
and contaminated-tools tray should not be close to sterilized piercing implements and supplies. One solution would
be to install a labeled biohazard shelf above the trashcan for the contaminated materials, thereby establishing a single
contamination area in the room.

Used piercing implements should be kept in a lidded, non-porous tray or container that is marked Biohazard.

84

The Sharps container should be secure to avoid accidental spillage. In the United States, NIOSH suggests that the
Sharps container be mounted with the opening 56 from the oor and OSHA requires that operators have reasonable
access to it. Additionally, the Sharps container should be located such that it can be easily utilized by the piercer in all
phases of a procedure without putting clients or observers at risk.

All biohazardous waste containers should be marked as Biohazard, be lidded and have foot operation. It is appropriate
to label your other lidded trashcans Do Not Touch. These should be placed in low or no trafc areas to avoid accidental
exposure.

A HEPA air lter or other air purication system located in the piercing room is extremely benecial, especially if other
services are offered within the studio.

As many surfaces as possible in the piercing room should be non-porous. All pictures, posters, and wall hangings should
be framed.

As many products as possible should be sterile and single use. This includes the marking implement.

All packaged equipment, sundry jars, or other materials and equipment used during a piercing should be handled
only with clean freshly gloved hands.

EMPLOYEE HAND-WASHING AREA

q

REQUIRED FOR MEMBERSHIP: Reasonable access to a sink used for hand-washing is mandatory. In-room prep
sinks are preferable.

Optimally, the sink used for pre and post-piercing hand-washing should operate via a hands-free method.

Wall-mounted or pump liquid soap dispensers and paper towel dispensers should have easy, one-handed access. This
will greatly reduce the likelihood of cross-contamination.

85

HEALTH AND SAFETY AGREEMENT

The APP requires a signed agreement on record from each individual member. Violation of these basic, critical
health and safety requirements is grounds for immediate revocation of membership. Please initial each numbered
line as indicated to show that you have read and fully understand each point.
1.____ I agree not to use ear-piercing guns in my studio due to the impossibility of properly sterilizing the equipment and the inappropriateness of ear piercing gun jewelry.
2.____ I agree that all needles will be pre-sterilized, used on one person only in one sitting, and will be immediately disposed of in a medical sharps container.
3.____ I agree that all forceps, tubes, etc. will be pre-sterilized. If they are not used immediately, they will be
stored in sterile bags and used on only one person in one sitting. After one such use, instruments will be appropriately decontaminated and then sterilized in an autoclave.
4.____ I agree that as many supplies as possible including corks, rubber bands, toothpicks etc., should be individually packaged and pre-sterilized in an autoclave and disposed of immediately after a single use. Skin prep
products will be properly dispensed if acceptable based on the product or individually packaged and disposed
of immediately after use.
5.____ I agree that a new pair of medical-grade (sterile and/or non-sterile) will be donned appropriately and
worn for every procedure and that gloves will be changed frequently, and whenever there is the slightest chance
for cross-contamination.
6.____ I agree that the room used for piercings will be an enclosed room and used exclusively for piercing and
jewelry insertion. This room must also be kept separate from the sterilization area. Piercing room, biohazard
room, bathrooms and other common areas, will be kept scrupulously clean and shall be disinfected frequently. All
surfaces shall be non-porous, allowing them to be cleaned with an FDA-approved disinfectant solution throughout
the day and whenever cross- contamination might occur.
7.____ I agree that all jewelry for initial piercings will be autoclaved prior to insertion.
8.____ I will use only appropriate jewelry in initial piercings. Appropriate jewelry is made of implant certied
stainless steel that is ASTM F-138 compliant or ISO 5832-1 compliant, implant certied titanium (Ti6Al4V ELI)
that is ASTM F-136 compliant or ISO 5832-3 compliant, solid 14 karat or higher white or yellow gold, Niobium
(Nb), solid platinum, or a dense low-porosity plastic such as Tygon or PTFE. Threaded jewelry for initial piercings must have internal tapping (no threads on posts) starting from 16 gauge. Jewelry must be free of nicks,
scratches, burrs, and polishing compounds. Ring ends should be rounded.
9.____ I agree that it is important to be open, available and not under the inuence of legal or illegal substances
which might compromise my abilities. I agree to maintain my certication in First Aid/ CPR, and Bloodborne
Pathogen training. I agree to meet or exceed all health, safety and legal standards as required by my state and
local authorities. I understand that it is important not to misrepresent myself, my abilities, or my standards in
any way. I agree to consider all new health and safety suggestions, as they become known to me and to make
appropriate changes in my technique as applicable. I agree that it is the moral, ethical, and professional responsibility of all piercers to continue to seek out, absorb and share health and safety information relevant to the craft
throughout my career. I also agree to adhere to the APP logo specication and guidelines.
Name (please print): __________________________________________
Studio Name: _______________________________________________
Signature_____________________________________________

Date _____________________

Witness______________________________________________

Date _____________________

86

A PIERCEE'S BILL OF RIGHTS

EVERY PERSON BEING PIERCED HAS THE RIGHT:
UPDATED AFTERCARE BROCHURES

1. To be pierced in a hygienic environment by a clean, conscientious, sober piercer wearing a fresh pair of disposable medical examination gloves.

Newly reformatted with additions reflecting new trends and

frequently asked questions from Piercers and Piercees
alike.

2. To be pierced with a brand new, completely sterilized single-use needle that is immediately disposed of in a
medical Sharps container after use on one piercing.

NEW AFTERCARE:
Clear concise instructions on cleaning
"Less is more" message
More information on jewelry issues
Facial piercings now covered in Oral Aftercare instructions
NEW FORMAT/DESIGNS:
Cohesive appearance of all APP brochures
Eye-catching and aesthetically pleasing
Professional image to support APP standards

The new brochures are available for sale on the APP web site
(www.safepiercing.org) for $20 per 100, postage paid.

MARK YOUR CALENDARS!

3. To be touched only with freshly sterilized and appropriate implements, properly used and disposed of or re-sterilized (where appropriate) in an autoclave prior to use on anyone else.

The annual APP Conference and Exposition takes place every

year in beautiful Las Vegas, Nevada.

4. To know that piercing guns are NEVER appropriate, and are often dangerous when used on anything
-- including earlobes.

There are classes offered in everything from piercing technique to

marketing, current industry legislation to accounting, studio setup to aftercare. There is something for everyone, from the first
time attendee to the long term shop owner, with classes geared
specifically for health care professionals.
The exposition includes venders from all segments of the body
piercing industry from the United States and abroad. Thousands
of items are available at the years largest gathering of manufacturers and distributors directly targeting the body piercing market.

Subjects include:
Aftercare Guidelines for Facial and Body Piercing*
Aftercare Guidelines for Oral Piercing*
Picking Your Piercer*
Troubleshooting for You and Your Healthcare Professional
(with jewelry removal tips and hints)
Oral Piercing Risks and Safety Measures

5. To the peace of mind that comes from knowing that their piercer knows and practices the very highest standards of sterilization and hygiene.
6. To a have a knowledgeable piercer evaluate and discuss appropriate piercings and jewelry for her/his individual anatomy and lifestyle.
7. To be fully informed of all risks and possible complications involved in his/her piercing choice before making
any decisions.
8. To seek and receive a second opinion either from another piercer within the studio or from another studio.
9. To have initial piercings fitted with jewelry of appropriate size, material, design, and construction to best promote healing. Gold-plated, gold-filled or sterling silver jewelry is never appropriate for any new or unhealed
piercing.
10. To see pictures, be given a tour of the piercing studio, and to have all questions fully and politely answered
before making or following through on any decision.

*Available in Spanish

11. To be fully informed about proper aftercare, both verbally and in writing, and to have continuing access to the
piercer for assistance throughout the healing process.
12. To be treated with respect, sensitivity and knowledge regardless of gender, sexual orientation, race, religion,
ethnicity, ability, health status or piercing choice.
13. To change her/his mind, halt the procedure and leave at any point if the situation seems uncomfortable
or improper.
FREE SAMPLES AVAILABLE UPON REQUEST
Order by fax or phone (888) 888-1APP
or visit our website: www.safepiercing.org

For updates about the conference please visit:

www.safepiercing.org
or call (505) 242-2144 or (888) 888-1APP

THE ASSOCIATION OF PROFESSIONAL PIERCERS

PROCEDURE MANUAL U.S. EDITION