by Corinne Asch
Direct contact- occurs when microorganisms are transferred from one infected person directly to another person. For example, infected blood from one person enters a care giver’s body through an open cut.
Indirect contact- involves the transfer of an infectious agent through a contaminated object or person. For example, when a caregiver doesn’t wash hands in between caring for someone with infected body fluids and other patients. For example, parenteral contact with a needle stick.
Airborne transmission- occurs when droplets or small particles contain infectious agents that remain effective over time and distance in the air. Tuberculosis is a common disease spread this way. Blood borne pathogens are not typically spread this way.
Clients must provide “Informed Consent”
To provide informed consent, client must read an informed consent form that includes a description of the procedure, a description of what to expect after the procedure, a statement regarding the permanent nature of body art (in the case of microblading, the brow of this statement would be the length of time the pigment will last); a notice that tattoo inks, dyes and pigments have not been approved by the Federal Food and Drug Administration and the health consequences of using these products are unknown.
The informed consent form should also include a client health questionnaire to determine if the client is pregnant, has a history of herpes infections at the procedure site, diabetes, allergic reaction to latex or antibiotics, hemophilia or other bleeding disorder, cardiac valve disease, has a history of medication use, including prescribed antibiotics prior to dental or surgical procedures or has other risk factors for blood borne pathogen exposure. The client must also provide post-procedure instructions.
What can be done to control exposure to blood borne pathogens?
In order to reduce or eliminate the hazards of occupational exposure to blood borne pathogens, an employer must implement an exposure control plan for the worksite with details on employee protection measures. The plan must also describe how an employer will use engineering and work practice controls, personal protective clothing and equipment, employee training, medical surveillance, hepatitis-B vaccinations, and other provisions as required by OSHA’s Blood Borne Pathogens Standard.
If you are stuck by a needle or other sharp object or get blood in your eyes, nose, mouth, or on broken skin, immediately flood the exposed area with water and clean any wound with soap and water or a skin disinfectant. Report this immediately to your employer and seek immediate medical attention.
Requirements for Safe Performance of Body Art
Wash and dry hands before beginning a procedure
Put on a clean apron, bib, or lap pad and personal protective equipment appropriate to the task.
Put on clean, unused, disposable exam gloves just prior to the procedure and wear the gloves throughout the procedure. Wash hands and change gloves if contact occurs with surfaces other than the client’s skin or instruments used in the procedure or if glove is punctured or torn.
Apply antiseptic, antimicrobial, or microbicide to the client’s skin immediately prior to the procedure.
Use a single-use razor to shave client and dispose of the razor in the Sharps container.
Only single-use needles and needle bars may be used and must be disposed of in the Sharps container.
Any part of a tattooing machine that may be touched by a practitioner during the procedure shall be covered with a disposable plastic sheath that is discarded upon completion of the procedure.
Instruments other than the needles and needle bars that contact skin must be either be single use or be washed, disinfected, packaged, and sterilized after each procedure.
Only commercially manufactured inks, dyes, and pigments may be used and must be dispensed in a manner to prevent contamination of the storage container and remaining contents.
After the procedure, wash and disinfect instruments and decontaminate the workstation and procedure area.
No food, drink, tobacco product, or personal effects are permitted in the procedure area.
Animals, with the exception of service animals, are not permitted in the procedure area or decontamination- sterilization area.
Decontamination and Sterilization Requirements
Each instrument peel-packs must have an appropriate indicator.
Each sterilization load shall be monitored with a Class V integrator.
Sterilization units are to be loaded, operated, decontaminated, and maintained according to manufacturer specifications.
A written log of each sterilization cycle including date, contents, exposure time, temperature and the results of the Class V integrator must be retained on site for two years.
Sterilization packs must be inspected prior to storage and again prior to use.
Standard Precautions
Treat all body fluids from every person as potentially infectious. Follow the recommendations in the employer’s Blood Borne Pathogens Exposure Control Plan
An employer’s Blood Borne Pathogens Exposure Control Plan should include:
Various levels of risk of employees that may have occupational exposure
Training requirements
Work practice controls
Engineering controls
Procedure for an exposure incident
Use personal protective equipment
Gloves, CPR shields, masks, gowns, eye protection
Know where PPE is at your workplace
Know what PPE is available and how to use it
Make sure first-aid kits and emergency supplies include disposable gloves and CPR face shields or rescue masks
How to Reduce Your Risk
Do not eat, drink, smoke, apply cosmetics or handle contact lenses in areas where there is the possibility of exposure to BBP.
When emptying trash containers, do not use your hands to compress the trash in the bag. Lift and carry the trash bag away from your body.
Keep contaminated laundry separate from other laundry. Bag potentially contaminated laundry where it is used.
Use leak-proof bags for wet laundry. Transport in properly labeled bags.
The Needle stick Prevention Act requires appropriate, commercially available, and effectively safer medical devices designed to eliminate or minimize occupational exposure.
Needles and other sharps must be discarded in rigid, leak-proof, puncture-resistant containers.
Do not bend, shear, break or recap needles.
If you must recap, use the one-handed method.
Hazardous Disposal
Liquid or semi-liquid blood or other potentially infectious materials (OPIM).
Contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed.
Dispose of in a properly labeled biohazard container: either a red bag or container labeled in orange or orange-red with the Bio-Hazard symbol.
Properly labeled and bundled waste needs to be handled according to your facility’s disposal procedures.
Clean-up Procedure
Use a solution of 1part household bleach mixed with 9 parts water (a 1:10 solution).
Other commercial disinfectants registered with the EPA as effective against HIV/HBV may be used. Check the label.
Use Personal Protective Equipment.
If a Body Fluid Spill Kit is available, use according to manufacturer’s directions.
First, put on Personal Protective Equipment.
Remove visible material with absorbent towels.
If any sharp object or broken glass is visible, remove with tongs or dust pan and place in a rigid sealable container. Never use bare hands.
Spray disinfectant on contaminated area and let it stand for several minutes.
Once the area has been disinfected, dry area with absorbent towels and dispose of towels in regular trash.
Proper Glove Removal
Grip one glove near the cuff and peel it down until it comes off inside out
. Cup it in the palm of your gloved hand.
Place two fingers of your bare hand inside the cuff of the remaining glove.
Peel that glove down so that it also comes off inside out and over the first glove.
Properly dispose of the gloves.
Remember, only touch glove to glove and skin to skin.
Exposure Incident
An exposure incident is defined as a specific mucous membrane, broken skin, or puncture contact with blood or OPIM that results from the performance of an employee's duties.
If you think you’ve been exposed, decontaminate, report to supervisor, and seek medical treatment. An immediate confidential medical evaluation and follow-up needs to be conducted by a physician.
Complete forms as soon as possible after incident. Don’t delay medical treatment to fill out paperwork. Forms and continued action will proceed according to employer’s policies and procedures.
Sterile Water Use in Tattooing
The use of non-sterile water in tattooing activities has been associated with a number of waterborne skin infections caused by bacteria such as Legionella, Pseudomonas and Mycobacteria. These infections can result in severe illness and when left untreated, they may be fatal. Even mild infections can commonly result in skin scarring and damage to the tattoo. Water that is not sterile, including tap, bottled, “spring”, reverse osmosis filtered, and distilled water, may not be safe to cleanse the skin, rinse needles and to dilute inks that are injected into the skin.
The Center for Disease Control and Prevention recommend the use of sterile water when tattooing. Another safe option is the use of sterile saline solution. While there are no current regulations that require this practice, artists concerned with the health and safety of their customers have incorporated the use of sterile water or sterile saline for ink dilution, rinsing of needles, and rinsing of skin during their tattoo procedures.
The use of sterile water or sterile saline solution can help protect your customers from waterborne skin infections that can hurt their health and damage the body art you created for them.
Chapter 5
Getting to know the fitzpatricks
The Fitzpatrick Scale was developed in 1975 by Dr. Thomas Fitzpatrick, a Harvard University dermatologist. Our society has changed quite a bit since then. One of the challenges of skin typing is that we are becoming increasingly multiracial and multi-ethnic. Therefore, the color of our skin alone cannot determine reactivity to products.
For example, we typically associate sensitive skin with very fair, thin, delicate skin. But black skin can be sensitive too. What happens to skin if it is multiracial? It certainly makes it more challenging to correctly predict how skin will respond. Nevertheless, the Fitzpatrick Scale is still a useful tool for predicting how the skin will react to different pigments. The color of your skin is correlated with the amount of melanin in your skin. That can be vital information when figuring out how much modifier you will need to create the color you want.
The scale is divided into six different skin types. Check out the different indicators for each type to determine which category your skin falls into.
Type 1: Type 1 skin types have the least amount of melanin in the skin. You only burn and never tan. You have very pale skin with no visible undertones, and you have red or blond hair. You sometimes have freckles, and have blue or green eyes.
Type 2: Type 2 skin types are also very pale skinned with very little melanin; you only burn and never tan. You can sometimes have pink undertones and can have dark hair, although you almost always have blond or light brown hair. Your eye color ranges from light blue to dark green and hazel.
Type 3: As a type 3 skin type, you may burn at the beginning of the summer, but tan easily afterwards. Your medium to olive skin tone has more melanin than the previous 2 types. Your eyes are sometimes dark hazel, but mostly dark brown. Your hair is brown.
Type 4: Your medium-brown skin tans easily and rarely burns. You have dark hair and eyes.
Type 5: Type 5 skin tans very easily and seldom burns. Dark hair, dark eyes and dark skin are your characteristics.
Type 6: As the darkest skin type, you almost never burn and tan very easily. Your eyes are almost always dark and your hair is always dark.
What is skin undertone?
Your skin's undertone is not about how light or dark your skin is, rather it is the color that comes through from underneath the skin’s surface to affect the overall tonal quality. Whether you have light, medium or dark skin, your skin can have warm, cool, or neutral undertones. So how do you determine a client’s undertones?
Basically, this sums it up:
Cool: Hints of bluish, pink or a ruddy complexion.
Warm: Skin skews yellow, sallow, peachy or golden.
Neutral: Has no obvious overtones of pink or sallow skin, but rather the skin’s natural color is more evident.
1. Check Your Veins
Push your sleeves up right now and look at the veins on the inside of your wrist. Are they blue or green? If they look more blue, you likely have cool undertones. If the veins look greenish, you’re warm. It’s worth noting, warm girls, that your veins aren’t actually green—they look it because you’re seeing them through yellow-toned skin (yellow + blue = green.)
2. Eye and Hair Color
Your natural eye and hair colors can help figure out your coloring. Customarily, cool people have eyes that are blue, gray, or green and have blond, brown, or black hair with blue, silver, violet and ash undertones. Conversely, warm-toned women usually have brown, amber, or hazel eyes with strawberry blond, red, brown, or black hair. Their hair tends to have gold, red, orange, or yellow undertones.
3. The Sun’s Effects.
As the Fitzpatrick scale suggests, when you’re out in the sun, does your skin turn a golden-brown, or does it burn and turn pink first? If you fit into the former category, you’re warm-toned, while cool tones tend to burn (fair-skinned cool girls will simply burn, while medium-skinned cool-toned girls will burn then tan).
4. The White Cloth Test
Put a white cloth next to your bare face and observe what cast your skin takes on. Skin with warm undertones will appear yellowish, while skin with cool undertones will seem blueish or pinkish. If your test results are coming out mixed, you may, in fact have neutral undertones.
5. Do You Blush Easily?
If so, then you’re on the cool side.
6. Who Do You Identify With?
Think celebrities. Scarlett Johansson, Anne Hathaway, Lucy Liu, Demi Moore, Courtney Cox, Sandra Bullock, Jennifer Hudson, and Amanda Seyfried have cool undertones.
Nicole Kidman, Jennifer Lopez, Beyoncé, Jessica Alba, Kate Hudson, Diane Sawyer, and Kim Kardashian have warm undertones.
Chapter 6
Understanding Pigments
It would be nice if the color you choose is the color you end up with, but it also makes sense that the pigment or the color of the skin you're working on makes a contribution to the chosen color/s. Knowing your colors and modifiers and then learning how to use them on which skin tone is a whole class in itself.
If you use Li pigment, and many do, Teryn Darling and Mary Ritcherson give an excellent online course on color theory. Whatever line you decide to use, make sure they give strong educational support.
When selecting a pigment for your client, you must use your experience and fast forward in your mind the effect the client’s skin tone will have in relationship with the pigment you are putting in the skin.
Pigment color + skin tone = outcome color
The obvious question regarding pigments is why couldn’t we have colors that heal the same color as when it’s in the bottle, and the reason is, because we all have different skin undertones that effect the colors we use. This is why it’s important to know your Fitzpatrick scale and to get your color education from whichever line of pigments you choose.