,Welcome to The Point!

The information in this premiere issue wassubmitted by the following APP memberbusinesses (in alphabetical order): BodyManipulations, Gauntlet, Inc.. Nomad,Obscurities, Primeval Body, and VenusModern Body Arts. Feel free to contact themfor any additional information.

To subscribe to this newsletter fill out theform on page 11 and send it with your checkor money order for $20.00 to APP, 519 CastroSt., Box 120, San Francisco, CA 94114.

AIIOC-IATION OFPROFIIIIONALPIlaCIR/TM519 Castro street, Box 120San Francisco, CA 94114(415) 281-9648

pages will reflect updated health and safetyinformation, editorials and columns by doc-tors and people in the medical community,as well as contributions from professionalpiercers, helpful hints and the like.

Our price donation of ten dollars has beenrevised to twenty dollars a year as our for-mat has expanded to a quarterly publica-tion and increased circulation has becomeevident. Our hope is that this newsletter canmobilize and fund a widespread public ser-vice message campaign.

We wish to thank those companies andindividuals who have contributed their timeand energy, money and information, andbrought our profession closer together.

We look forward to hearing all voices inthe future. Welcome to The Point.

Body piercing as an ancient tradition hasfinally entered into mainstream culture, andtoday, there are professional piercing stu-dios who provide expert service under con-ditions which exceed hospital sterilizationprocedures.

America's leading studios - where staffsrange from 4 to over 40 - have collaboratedand consolidated health and safety infor-mation, techniques and ethics, and haveformed the APP. Our primary objectives areto disseminate information, educate thepublic, set the standards under which bodypiercing is safely exacted, and protect thepiercee.

In every major city, main streets are filledwith people out for a qUick buck. Hairsalons, clothing stores, head shops and thelike plague our profession. Improper train-ing and lack of sterilization under these con-ditions often leads to disaster. Hence, theneed for professional mobilization hasbecome obvious. The result of our efforts isover twenty years of cumulative experienceand information that will directly benefitour profession, and, most importantly, thepublic.

The Point is a quarterly publication whichwe intend to serve as a forum for informa- .tion; all contributions, are welcome. Its

2ETHICS -So many people are practicing piercing today

that it is inevitable that greed or insecurity hasled many to misrepresent themselves to theirclientele. Just what is a "professional" piercer,anyway? Clearly, health and safety issues are atop priority for the true professional. A lack ofego or defensiveness leads to a more available,honest piercer, who iswilling to learn new thingswithout embarrassment. Technical skill isacquired over a long period of time, but so,unfortunately, are ingrained bad habits. Whilethe qualities that define one as being truly pro-fessional may be difficult to define, it is mucheasier to define an unprofessional piercer.

Agiveaway sign of a non-professional is mis-representation of one's abilities. If you weredoing something well, it wouldn't be nearly asimportant for you to have some sort of fancy titleor long list of fabricated qualifications. You'dsimply do good work, and let your ability speakfor itself.

When a piercing establishment uses term intheir advertising such as "medically approved",or "medically trained", what does that mean? Itcan mean that one or all of the staff have takenfirst aid or CPR classes. Did one of the staff go to

April 13, 1994 The founders ofAPP: (standing I-r) IrwinKane (Gauntlet, Inc.), RaelynGallina, Vaughn (BodyManipulations), MichaelaGrey and Jim Ward (Gauntlet,Inc.), Melisa Kaye (BodyManipulations), RichardWhite (Primeval Body), JoannWyman (BodyManipulations), Elizabeth(Body Manipulations), DrewWard (Gauntlet, Inc.) -(kneeling I-r) BlakePerlingieri (Nomad), Kristian(Nomad).

nursing school for a time, or work as an EMT(ambulance attendant)? Such claims should notsimply be taken at face value. If they're makinga medically related claim, ask specifically whatthey mean. If it's "too good to be true", it prob-ably is. Medically-related training doesn't indi-cate skill as a piercer. Piercing is a very special-ized skill. It may, hopefully, indicate awarenessof sterility issues. Would you choose a tattooartist who is a retired nurse, and cannot drawanything more complex than a stick figure?

If piercing-related training is being offered,be sure to ask questions about the provider'saccreditation I What does the fee actually getyou? Anyone can offer training and make what-ever claims they want about their benefits.However, part of complying with applicablelaws requires the prOVider to be honest aboutwhat exactly you're getting for those hard-earned dollars. Laws which apply to takingmoney for training cover other important issuesas well. If they're not operating their "training"or "school" in compliance with applicable laws,what does that say about their integrity? Canthey be irresponsible about the training, yetremain safe and responsible about the piercingservices they prOVide?

for thorough, regular dusting and cleaning, itdoes seem to make a lot of sense in a piercingstudio. Check it out!

Call Honeywell Environmental Air Control, Inc.at 1-800-332-1110

MadacideThere's a new hard-surface diSinfectant on

the blockI Madacide is a synergistic compoundwith the active ingredients Isopropanol (15.3%)and Dowanol EB (4%). It is listed as bacterioci-dal, viruocidal, tubercuocidal and fungiocidal-that makes it a hospital level disinfectant.Disinfection time is ten minutes, and the prodl,lctmaintains full potency for 10 months after open-ing. Unlike gluteraldehydes and formaldehydes,both biohazardous and nonbiodegradable,Madacide requires no special disposal or venti-lation systems. It is furthermore non-toxic, non-corrosive, and non-irritating.

Madacide may be used as an ultrasonic flUid,and is available in premixed gallon bottles (sug-gested) and spray bottles (not suggested-theforce of the spray could send particles out intothe air). But the neatest thing about Madacide is'that it's also available as an antiseptic handfoam. It you can put the stuff directly on yourhands, I personally feel like it's the best thingyet for jewelry disinfection.

For more information, contact MadaMedical Products at ,-800- 526-6370.

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too thin can act just like a cheese cutter, tearing.its way right out of the body. Jewelry that's toothick can cause abscessing and keloiding,because the weight is cutting off oxygen sup-plies to the tissue. Jewelry too large in diameteris likely to get snagged on things, possibly tear-ing, while jewelry that's too small in diametercan keloid, or be sucked right into the body.Consider these factors when choosing an appro-priate piece of piercing jewelry.10.) Iagree that it is important to be open, avail-able, and not under the influence of legal or ille-gal substances which would compromise myabilities. Iwill seriously consider attending a oneday Red Cross First Aid/CPR instruction course. Iagree to meet or exceed all health, safety, andlegal standards as required by my state andlocal authorities. I understand that it is impor-tant not to misrepresent myself, my abilities, ormy standards in any way. Iagree to consider allnew health 0 safety suggestions as they becomeknown to me, and to make appropriate changesin my techniques as applicable. I agree that it isthe moral, ethical, and professional responsibil-ity of all piercers to continue to seek out, absorb,and share health 0 safety information relevant tothe craft throughout their career.

Since piercing is a very specialized profes-sion, it will be to thepiercer's advantage tostrive for certain personal qualities.

One aspect of this is the relationship betweenthe piercer and piercee. It's important toremember that an individual interested in apiercing will be in need of an open and comfort-able line of communication with their piercer.Every person that approaches a piercer has theright to know about the piercer's experience andtraining, details of how the piercing will be per-formed, details about sterile procedures, andhow to optimally care for their piercing. Sincethe piercee is putting an amount of trust in thepiercer, it is most ethical for the piercer to beavailable and honest before, during and afterthe actual piercing. In most cases, the piercer is

10

the most reliable (if not only) source of informa-tion regarding the piercing.

On a similar note, it's important for thepiercer to be in good health and to be free of anysubstances that would hinder their abilitieswhile piercing. Apiercer can also be preparedfor emergencies by regularly taking first aid/CPRtraining.

As a changing profession, piercing will fre-quently expose piercers to new options relevantto their craft. It is essential for piercers to listento these options and acknowledge whereimprovements can be made,

If a piercer is able to subscribe to these simpleethics, he will be most likely to have a qualitypiercing service that he can offer with integrity.

MEDICAL PRODUCTI PROCEDURE UPDATES

Air CleanersAnew appliance has recently come to our atten-tion: the Enviracaire portable air cleaner. It islikely that other brands are available, but checktheir specifications before buying. TheEnviracaire is equipped with a true HEPA (HighEfficiency Particulate Air) filter, the same filterused in hospitals and medical laboratories. Apaper-thin sheet made of tiny glass fibers catch-es all airborne particles measuring .3 microns orlarger- that's over 99.97% of what you'd findfloating around in the average room. This dras-tically reduces the amount of airborne pollen,animal hair and dander, BACTERIA, VIRUSES,general dust, asbestos, mites, and odors thatmight settle onto your clean surfaces.

The cleaner is listed as a class 2 medicaldevice, whatever that means. Enviracaire comesin 3sizes, to clean anywhere from a 9' x 12' spaceto a 20' x 22' space, up to nine times an hour.While this air cleaner is certainly no substitute

~verv person beiner pierced hos the rierht... to be pierced in a sc.rupulouslV hv~ienic. open environment. bV a dean.

conscientious piercer wearin~a fresh pair of disposable latex ~loves. to a sober. friendlv. calm. and knowled~eablepiercer. who will ~uide

them throu~htheir piere.in~experience with confidence and assurance. to the peace of mind which comes from knowin~that their piercer

knows and practices the verv hi~heststandards of sterilization andhv~iene.

to be pierced with a brand-new, completelV sterilized needle, which isimmediatelv disposed of in a medical shnrps container after use on thepiercee alone.

to be touched onlV with freshlv sterilized, appropriate implements,properlv used and disposed of or resterilized in an autodave prior to useon anvone else.

to know that ear-piere.in~~uns are NBVBR appropriate, and nre oftendan~erous,when used on anvthin~other than ear lobes.

to be fitted onlV withjewelrv which is appropriatelv sized. safe inmaterial. desi~n, and construction. and which best promotes healin~. --!

The Basic Ten -To begin this newsletter, we thought it would

be appropriate to clarify our position on healthf, safety. We have compiled a list of tenabsolutely minimum basic standards which webelieve all responsible piercers MUST follow toavoid disease transmission to themselves andtheir clientele. All information not included inthis basic list is optional. Other information isworthy of being considered, weighed, and dis-cussed, but these ten basic requirements areCRITICAL and must be implemented!! Please readeach of these and hopefully you too will agree:1.) Ear piercing guns are not adequately ster-i1izable. I agree that because of this, andbecause they can cause serious, permanentdamage to body parts other than earlobes, Iagree not to use ear piercing guns in my prac-tice.

We cannot stress this point enough! Althoughthe manufacturers of the guns claim that theproduct is hygienic, there is always the chanceof invisible blood or blood plasma microspraydue to the incredibly strong spring mechanism.The practice of swabbing the area with alcohol issimply inefficient, and serves only to push thecontaminants around on the skin. There is noway to autoclave these plastic guns, and theporosity and rough surface texture make excel-lent hiding places for bacteria.

The jewelry used in these guns is usually steel,plated with gold, and frequently underplatedwith nickel or copper. This can result in a metalreaction and infection for the piercee when thethin plating chips off. Furthermore, rather thanbeing pierced with a surgically sharp needle, thetissue is brutally torn by the blunt backing of theear stud. This is not an easier way to be pierced.

The style of jewelry is less than ideal for evenearlobes, but on other body parts, it can be dan-gerous, debilitating, and permanently scarring.It is not unlikely that the body part pierced withan ear stud may lose all nerve sensitivity. For allthese reasons, the APP is strictly opposed to the

4

use of ear piercing guns.2. ) I agree that all needles should be prester-ilized, used on one person, in one sitting ,andimmediately disposed of in a medical sharpscontainer.

One elemental aspect of responsible piercingis proper sterilization, use and disposal of theactual piercing needle. This is an aspect thatpiercers training in more experienced shops areusually made aware of on their first day, butmany people who are piercing out there may notbe aware of the risks that can come with reuse orimproper use of needles.

An autoclave is a helpful appliance for apiercer to have. For those who may not be famil-iar with this device, it's most widely used in themedical profession for sterilization of theirimplements. For piercers, it's mainly used toclean implements. tools, and jewelry. It's themost desirable form of sterilization for anythingelse that can fit into it (trays, containers), andthat can withstand this form of sterilization. Theautoclave works by using heat, pressure andmoisture to kill any living contaminants.

One small side note: The word "sterile," inmedical terms, also refers to the elimination ofairborne contaminants that are inconsequential(and impossible to avoid) for our purposes.Technically, once you open the autoclave, theoutsides of your packages are no longer sterile,and when you open the packages, their contentsare no longer sterile. For our purposes, if anyobject in question has only come into contactwith air, it is still as clean.

In order to insure that the piercing needleremains as clean as possible before the actualpiercing, it should be autoclaved individuallyand taken out of the closed package immediate-ly before use. A good package to contain thepiercing needle for sterilization is a "sterilizationtube," which is commercially available. This"tube" is actually a flat piece with a window onone side. and comes in a roll that can be cut intopieces of an appropriate size. Once the contentsare in the tube, it can be sealed with heat (a

Because everything you touch, includingdoorknobs, faucets, countertops, walls, andfloors, is a potential source of cross-contamina-tion, it is critical that these areas and surfaces beregularly cleaned with a bactericidal, viruocidalliquid such as bleach solution or one of the manyhard-surface disinfectants. This is especiallyimportant in a piercing studio, where there isalways the possibility of bloodborne contami-nants being present somehow. It is also veryimportant that piercing services not take placein the same room as hairstyling, tattooing, retailsales, or other services. The potential for cross-contamination is simply too great. Have a sepa-rate room for piercing.8.) I agree that all jewelry contaminated withonly airborne pathogens (not previously womor contaminated) should be disinfected with anon-hazardous hard-surface disinfectant suchas Madacide. I agree that all jewelry contami-nated or potentially contaminated withbloodbome pathogens (previously wom byanother person) should be autoclaved.

We don't know where jewelry has been. Wedon't know who's been wearing or handling it.We don't know what's on it. If you don't person-ally know that jewelry has never been worn orotherwise contaminated, treat it as potentiallycontaminated.

Jewelry that has never been worn doesn'thave any bloodborne pathogens on it. It may beadequately disinfected with Madacide (a non-hazardous synergistic hospital level disinfectioncompound) or other non-hazardous hard-sur-face disinfectant. Formalin (formaldehyde) and,recently, gluteraldehydes, have been classifiedas biohazardous material, requiring special dis-posal and ventilation. That's not somethingyou'd want to put into someone's bloodstream!The average disinfection time is between fiveand ten minutes.

Jewelry that has been worn only by the personwho is now having it installed may not be haz-ardous to them, but certainly poses a threat toanyone else. Disinfect this type of jewelry in a

disposable plastic relish cup, to avoid contami-nating your main supply.

Jewelry that has been worn by someone otherthan the piercee is contaminated with blood-borne pathogens, many of which won't be killedby a five-minute soak in disinfectant. Withoutexception, this type of jewelry MUST be sterilizedin an autoclave. There is NO other way to be surethat you aren't passing along potentially dead-ly diseases.

For further information, refer to thesterile/clean/contaminated chart centerfold.10.) I will only use appropriate jewelry inpiercings. Appropriate jewelry is made ofimplant grade, high-quality stainless steelhoo series), solid 14 k or 18 k gold, niobium,titanium, platinum, or a dense, low-porosityplastic such as monofilament nylon, acrylic,or lucite. Ear studs or other jewelry designedfor earlobe piercings are not appropriate jew-elry for other body parts. Appropriate jewelryhas no nicks, scratches, or irregular surfaceswhich might endanger the tissue.

What's the point of doing a clean, accuratepiercing, if the jewelry that you've chosen maysubject the piercee to rejection, metal reactions,infections, abscesses, tearing, swelling. keloid-ing, or worse? Choose your jewelry carefully.Jewelry made of metals other than those listedabove literally rot when they come into contactwith human bodily flUids.

Ear studs are not only ugly in other bodyparts, they're dangerous. The design allows forinadequate cleaning, easy tearing and snag-ging, and certain suffocation of pinched tissue.The thickness (16 to 20 gauge for most studs) isdangerously thin for the majority of piercings.And most are made of gold-plated aluminum orsterling silver, two highly reactive metal choices.

As regards thickness and diameter, differentbodies and different piercings call for differentjewelry. Aring that's the perfect size in an eye-brow can be downright dangerous in a navel, forexample. Use common sense.

Thinner isn't always "better" . Jewelry that's9

--

not least, one of the easiest and most economi-cal disinfectants on the market is a solution of90% water and 10% bleach.While some of themcan bring tools to complete sterility in as little as10 tOl2 hours, there is too much risk of not com-pletely killing all matter, and so this process isvastly inferior to autoclaving. Use this processonly for non-autoclavable materials.5.) I agree that as many supplies as possible,including corks, rubber bands, etc. should bepresterilized in an autoclave or cleaned withdisinfecting liquids, stored in a clean, closedcontainer, and disposed of immediately aftera single use.

Everything that might come in contact withthe area to be pierced should be as clean as pos-sible. While we can completely avoid transmis-sion of bloodborne pathogens by remainingalert for cross-contamination, we can unfortu-nately only reduce or limit the amount of air-borne contaminants.

Ways to minimize airborne pathogens includepresterilization of corks, hair clips, wooden,handled cotton swabs, or toothpicks, or pre-soaking of rubber bands (hard-surface disinfec-tants are much less likely to erode the rubberthan bleach) to remove all living matter. All sup-plies, whether or not they can be presterilized orprecleaned, should be handled only with a freshpair of gloves. Even freshly washed hands andclean gloves have airborne matter on them. All

. supplies should be kept in clean, closed con-tainers made of a nonporous material to allowfor easy sterilization or disinfection. Frequentexposure to air means frequent exposure toorganisms which might cause illness or infectionto your piercees. Since people's unwashed handsmay be contaminated with bloodborne matter,any accidental handling by bare hands will con-taminate your supplies. They should be thrownout, the container cleaned or sterilized, andnew, clean supplies should replace the old.

For further clarification on the matter, refer tothe sterile/clean/contaminated chart.6.) I agree that new pair of latex gloves (ster-

8

i1e or nonsterile) should be worn for everyprocedure, and gloves should be changedwhenever the slightest chance of cross-conta-mination might occur.

In this day and age it seems incredible that apiercer would fail to wear gloves, or fail tochange them between clients, and yet we hearstories of this time and time again! Obviously,this is a major health threat that piercers andpiercees need to be made aware of. Changingyour gloves between clients and when accessingor handling anything other than your client'sindividual set-up during the piercing will dras-tically lower the chance of contamination toyou, your client, the piercing room, and the restof your shop. Here are a few easy steps to stopthe risk of crosscontamination:

I. Wash your hands before and after the pierc-ing, using a disinfectant soap and warm water.

2. Always don gloves BEFORE you prep yourclient.

3. Always de-glove when accessing anythinganywhere in your shop other than your client'sindividual piercing set-up.

4. Always re-glove with a NEW pair of gloves.5. Never handle contaminated materials with-

out gloves.(needles, bloody refuse, forceps,etc.) This includes soiled equipment being pre-pared for sterilization.

AqUick note on sterile vs. Non-Sterile gloves:While most of us in the piercing industry usenon-sterile gloves, some prefer to use sterilegloves only. Keep in mind, however, that onceyou open a pair of sterile gloves and come incontact with anything preViously handled, theclient, and even the air in the room (with it's air-borne bacteria) they immediately become non-sterile.7.) Iagree that the room used for piercings, aswell as the bathroom and other commonareas, should be kept scrupulously clean anddisinfected frequently. All surfaces should benonporous, to allow them to be cleaned withbleach solution or other disinfecting liquidswhenever cross-contamination might occur.

household iron will work) or with autoclave tape(also commercially available). Generally, apiercer will have different sized needles, so someindication of the size (a small slip of paper)could also be contained in the package. Thispackage will also feature some sort of indicatorso it is clear that the package has been sterilized.

Once the package has been opened and theneedle has been used for a piercing, the needlehas been exposed to bloodborne pathogens, or"contaminated. If Use of this needle on anotherindividual at this point would expose them toanything that is in the other person's system,and the piercer would be responsible for a verysevere risk to the other person's well being.

Sterilization and re-use of this needle is a sus-pect practice. The piercing needle, having beencontaminated, can not be considered adequate-ly c1ean0d by an autoclave. Matter could betrapped on the interior or the needle, and a nee-dle will become dull with use. The small amountof money saved by reusing a needle is not worththe potential consequences.

The needle can be best disposed of in ahard, sealable container, such as a "medicalsharps disposal container" (commerciallyavail-able). This container should then be sterilizedand disposed of as hazardous waste.

Improper use and disposal of a piercing nee-dle is one of the most serious risks that piercercould impose on himself and his clientele. If apiercer is going to expose a piercing needle tobloodborne pathogens, knowledge of theresponsible course of action is essential.3.) I agree that all forceps, tubes, etc. arepresterilized, stored in sterile bags, and usedone one person, in one sitting. After one suchuse, they must be autoclaved.

Implements that may come in contact with apiercing (broken skin) must be as clean as pos-sible. For forceps, nostril tubes, and NRTs, thismeans sterilization (autoclave), secure packag-ing (sterilization bags or tubes), and storagedesigned to minimize contact with airbornepathogens. Moisture, air, and light can all com-

promise the sterility of the implements, so keepthem in a clean, dark, dry drawer. As soon as thebag is opened, airborne material begins toaccumulate on the implement, so only open apackage immediately prior to use.

After one use, bloodborne material is on theimplement, even if none is visible. It is notacceptable to use the same pair of forceps ontwo people, no matter what their relationship.Even if neither of the two had any transmittablediseases, every person has very different bacte-ria, and the result would, at the very least, beinfection.

For more information, see the clean/sterile/contaminated charts.4.) I agree that as many supplies as possible,including corks, rubber bands, etc. should bepresterilized in an autoclave or disinfectedwith liquids, stored in a clean, closed contain-er, and disposed of immediately after a singleuse.

All tools that come in contact with the skin orjewelry (especially jewelry just inserted in to afresh piercing) should be considered contami-nated. To disinfect tools that can not be auto-claved two things must be done. First, the sur-face must be free of greasy ointment and/or oilsfrom the skin that act as a barrier to non-solventdisinfectants; to do this, use a detergent soapand clean water or a common solvent such asisopropyl alcohol (only 70% strength is effectivefor our purposes). Soaps and alcohol should beused only as cleaning agents ; they are notantibacterial enough to combat many air-borne/bloodborne pathogens. Secondly, thetools must be disinfected. Avariety of productsare available from medical supply companiesthat work effectively on the hard surfaces oftools made of brass or steel, (soft or porous sur-faces like plastics are difficult to disinfect) thesesolutions use chemicals such as quaternaryammonium, synergistic compounds (Madacide)or glutaraldehyde (Cidex g Wavicide). Whenused properly, these products can effectivelydisinfect tools in about 10 to 20 minutes. Last but

5

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not least, one of the easiest and most economi-cal disinfectants on the market is a solution of90% water and 10% bleach.While some of themcan bring tools to complete sterility in as little as10 tOl2 hours, there is too much risk of not com-pletely killing all matter, and so this process isvastly inferior to autoclaving. Use this processonly for non-autoclavable materials.5.) I agree that as many supplies as possible,including corks, rubber bands, etc. should bepresterilized in an autoclave or cleaned withdisinfecting liquids, stored in a clean, closedcontainer, and disposed of immediately aftera single use.

Everything that might come in contact withthe area to be pierced should be as clean as pos-sible. While we can completely avoid transmis-sion of bloodborne pathogens by remainingalert for cross-contamination, we can unfortu-nately only reduce or limit the amount of air-borne contaminants.

Ways to minimize airborne pathogens includepresterilization of corks, hair clips, wooden,handled cotton swabs, or toothpicks, or pre-soaking of rubber bands (hard-surface disinfec-tants are much less likely to erode the rubberthan bleach) to remove all living matter. All sup-plies, whether or not they can be presterilized orprecleaned, should be handled only with a freshpair of gloves. Even freshly washed hands andclean gloves have airborne matter on them. All

. supplies should be kept in clean, closed con-tainers made of a nonporous material to allowfor easy sterilization or disinfection. Frequentexposure to air means frequent exposure toorganisms which might cause illness or infectionto your piercees. Since people's unwashed handsmay be contaminated with bloodborne matter,any accidental handling by bare hands will con-taminate your supplies. They should be thrownout, the container cleaned or sterilized, andnew, clean supplies should replace the old.

For further clarification on the matter, refer tothe sterile/clean/contaminated chart.6.) I agree that new pair of latex gloves (ster-

8

i1e or nonsterile) should be worn for everyprocedure, and gloves should be changedwhenever the slightest chance of cross-conta-mination might occur.

In this day and age it seems incredible that apiercer would fail to wear gloves, or fail tochange them between clients, and yet we hearstories of this time and time again! Obviously,this is a major health threat that piercers andpiercees need to be made aware of. Changingyour gloves between clients and when accessingor handling anything other than your client'sindividual set-up during the piercing will dras-tically lower the chance of contamination toyou, your client, the piercing room, and the restof your shop. Here are a few easy steps to stopthe risk of crosscontamination:

I. Wash your hands before and after the pierc-ing, using a disinfectant soap and warm water.

2. Always don gloves BEFORE you prep yourclient.

3. Always de-glove when accessing anythinganywhere in your shop other than your client'sindividual piercing set-up.

4. Always re-glove with a NEW pair of gloves.5. Never handle contaminated materials with-

out gloves.(needles, bloody refuse, forceps,etc.) This includes soiled equipment being pre-pared for sterilization.

AqUick note on sterile vs. Non-Sterile gloves:While most of us in the piercing industry usenon-sterile gloves, some prefer to use sterilegloves only. Keep in mind, however, that onceyou open a pair of sterile gloves and come incontact with anything preViously handled, theclient, and even the air in the room (with it's air-borne bacteria) they immediately become non-sterile.7.) Iagree that the room used for piercings, aswell as the bathroom and other commonareas, should be kept scrupulously clean anddisinfected frequently. All surfaces should benonporous, to allow them to be cleaned withbleach solution or other disinfecting liquidswhenever cross-contamination might occur.

household iron will work) or with autoclave tape(also commercially available). Generally, apiercer will have different sized needles, so someindication of the size (a small slip of paper)could also be contained in the package. Thispackage will also feature some sort of indicatorso it is clear that the package has been sterilized.

Once the package has been opened and theneedle has been used for a piercing, the needlehas been exposed to bloodborne pathogens, or"contaminated. If Use of this needle on anotherindividual at this point would expose them toanything that is in the other person's system,and the piercer would be responsible for a verysevere risk to the other person's well being.

Sterilization and re-use of this needle is a sus-pect practice. The piercing needle, having beencontaminated, can not be considered adequate-ly c1ean0d by an autoclave. Matter could betrapped on the interior or the needle, and a nee-dle will become dull with use. The small amountof money saved by reusing a needle is not worththe potential consequences.

The needle can be best disposed of in ahard, sealable container, such as a "medicalsharps disposal container" (commerciallyavail-able). This container should then be sterilizedand disposed of as hazardous waste.

Improper use and disposal of a piercing nee-dle is one of the most serious risks that piercercould impose on himself and his clientele. If apiercer is going to expose a piercing needle tobloodborne pathogens, knowledge of theresponsible course of action is essential.3.) I agree that all forceps, tubes, etc. arepresterilized, stored in sterile bags, and usedone one person, in one sitting. After one suchuse, they must be autoclaved.

Implements that may come in contact with apiercing (broken skin) must be as clean as pos-sible. For forceps, nostril tubes, and NRTs, thismeans sterilization (autoclave), secure packag-ing (sterilization bags or tubes), and storagedesigned to minimize contact with airbornepathogens. Moisture, air, and light can all com-

promise the sterility of the implements, so keepthem in a clean, dark, dry drawer. As soon as thebag is opened, airborne material begins toaccumulate on the implement, so only open apackage immediately prior to use.

After one use, bloodborne material is on theimplement, even if none is visible. It is notacceptable to use the same pair of forceps ontwo people, no matter what their relationship.Even if neither of the two had any transmittablediseases, every person has very different bacte-ria, and the result would, at the very least, beinfection.

For more information, see the clean/sterile/contaminated charts.4.) I agree that as many supplies as possible,including corks, rubber bands, etc. should bepresterilized in an autoclave or disinfectedwith liquids, stored in a clean, closed contain-er, and disposed of immediately after a singleuse.

All tools that come in contact with the skin orjewelry (especially jewelry just inserted in to afresh piercing) should be considered contami-nated. To disinfect tools that can not be auto-claved two things must be done. First, the sur-face must be free of greasy ointment and/or oilsfrom the skin that act as a barrier to non-solventdisinfectants; to do this, use a detergent soapand clean water or a common solvent such asisopropyl alcohol (only 70% strength is effectivefor our purposes). Soaps and alcohol should beused only as cleaning agents ; they are notantibacterial enough to combat many air-borne/bloodborne pathogens. Secondly, thetools must be disinfected. Avariety of productsare available from medical supply companiesthat work effectively on the hard surfaces oftools made of brass or steel, (soft or porous sur-faces like plastics are difficult to disinfect) thesesolutions use chemicals such as quaternaryammonium, synergistic compounds (Madacide)or glutaraldehyde (Cidex g Wavicide). Whenused properly, these products can effectivelydisinfect tools in about 10 to 20 minutes. Last but

5

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The Basic Ten -To begin this newsletter, we thought it would

be appropriate to clarify our position on healthf, safety. We have compiled a list of tenabsolutely minimum basic standards which webelieve all responsible piercers MUST follow toavoid disease transmission to themselves andtheir clientele. All information not included inthis basic list is optional. Other information isworthy of being considered, weighed, and dis-cussed, but these ten basic requirements areCRITICAL and must be implemented!! Please readeach of these and hopefully you too will agree:1.) Ear piercing guns are not adequately ster-i1izable. I agree that because of this, andbecause they can cause serious, permanentdamage to body parts other than earlobes, Iagree not to use ear piercing guns in my prac-tice.

We cannot stress this point enough! Althoughthe manufacturers of the guns claim that theproduct is hygienic, there is always the chanceof invisible blood or blood plasma microspraydue to the incredibly strong spring mechanism.The practice of swabbing the area with alcohol issimply inefficient, and serves only to push thecontaminants around on the skin. There is noway to autoclave these plastic guns, and theporosity and rough surface texture make excel-lent hiding places for bacteria.

The jewelry used in these guns is usually steel,plated with gold, and frequently underplatedwith nickel or copper. This can result in a metalreaction and infection for the piercee when thethin plating chips off. Furthermore, rather thanbeing pierced with a surgically sharp needle, thetissue is brutally torn by the blunt backing of theear stud. This is not an easier way to be pierced.

The style of jewelry is less than ideal for evenearlobes, but on other body parts, it can be dan-gerous, debilitating, and permanently scarring.It is not unlikely that the body part pierced withan ear stud may lose all nerve sensitivity. For allthese reasons, the APP is strictly opposed to the

4

use of ear piercing guns.2. ) I agree that all needles should be prester-ilized, used on one person, in one sitting ,andimmediately disposed of in a medical sharpscontainer.

One elemental aspect of responsible piercingis proper sterilization, use and disposal of theactual piercing needle. This is an aspect thatpiercers training in more experienced shops areusually made aware of on their first day, butmany people who are piercing out there may notbe aware of the risks that can come with reuse orimproper use of needles.

An autoclave is a helpful appliance for apiercer to have. For those who may not be famil-iar with this device, it's most widely used in themedical profession for sterilization of theirimplements. For piercers, it's mainly used toclean implements. tools, and jewelry. It's themost desirable form of sterilization for anythingelse that can fit into it (trays, containers), andthat can withstand this form of sterilization. Theautoclave works by using heat, pressure andmoisture to kill any living contaminants.

One small side note: The word "sterile," inmedical terms, also refers to the elimination ofairborne contaminants that are inconsequential(and impossible to avoid) for our purposes.Technically, once you open the autoclave, theoutsides of your packages are no longer sterile,and when you open the packages, their contentsare no longer sterile. For our purposes, if anyobject in question has only come into contactwith air, it is still as clean.

In order to insure that the piercing needleremains as clean as possible before the actualpiercing, it should be autoclaved individuallyand taken out of the closed package immediate-ly before use. A good package to contain thepiercing needle for sterilization is a "sterilizationtube," which is commercially available. This"tube" is actually a flat piece with a window onone side. and comes in a roll that can be cut intopieces of an appropriate size. Once the contentsare in the tube, it can be sealed with heat (a

Because everything you touch, includingdoorknobs, faucets, countertops, walls, andfloors, is a potential source of cross-contamina-tion, it is critical that these areas and surfaces beregularly cleaned with a bactericidal, viruocidalliquid such as bleach solution or one of the manyhard-surface disinfectants. This is especiallyimportant in a piercing studio, where there isalways the possibility of bloodborne contami-nants being present somehow. It is also veryimportant that piercing services not take placein the same room as hairstyling, tattooing, retailsales, or other services. The potential for cross-contamination is simply too great. Have a sepa-rate room for piercing.8.) I agree that all jewelry contaminated withonly airborne pathogens (not previously womor contaminated) should be disinfected with anon-hazardous hard-surface disinfectant suchas Madacide. I agree that all jewelry contami-nated or potentially contaminated withbloodbome pathogens (previously wom byanother person) should be autoclaved.

We don't know where jewelry has been. Wedon't know who's been wearing or handling it.We don't know what's on it. If you don't person-ally know that jewelry has never been worn orotherwise contaminated, treat it as potentiallycontaminated.

Jewelry that has never been worn doesn'thave any bloodborne pathogens on it. It may beadequately disinfected with Madacide (a non-hazardous synergistic hospital level disinfectioncompound) or other non-hazardous hard-sur-face disinfectant. Formalin (formaldehyde) and,recently, gluteraldehydes, have been classifiedas biohazardous material, requiring special dis-posal and ventilation. That's not somethingyou'd want to put into someone's bloodstream!The average disinfection time is between fiveand ten minutes.

Jewelry that has been worn only by the personwho is now having it installed may not be haz-ardous to them, but certainly poses a threat toanyone else. Disinfect this type of jewelry in a

disposable plastic relish cup, to avoid contami-nating your main supply.

Jewelry that has been worn by someone otherthan the piercee is contaminated with blood-borne pathogens, many of which won't be killedby a five-minute soak in disinfectant. Withoutexception, this type of jewelry MUST be sterilizedin an autoclave. There is NO other way to be surethat you aren't passing along potentially dead-ly diseases.

For further information, refer to thesterile/clean/contaminated chart centerfold.99.) I will only use appropriate jewelry inpiercings. Appropriate jewelry is made ofimplant grade, high-quality stainless steelhoo series), solid 14 k or 18 k gold, niobium,titanium, platinum, or a dense, low-porosityplastic such as monofilament nylon, acrylic,or lucite. Ear studs or other jewelry designedfor earlobe piercings are not appropriate jew-elry for other body parts. Appropriate jewelryhas no nicks, scratches, or irregular surfaceswhich might endanger the tissue.

What's the point of doing a clean, accuratepiercing, if the jewelry that you've chosen maysubject the piercee to rejection, metal reactions,infections, abscesses, tearing, swelling. keloid-ing, or worse? Choose your jewelry carefully.Jewelry made of metals other than those listedabove literally rot when they come into contactwith human bodily flUids.

Ear studs are not only ugly in other bodyparts, they're dangerous. The design allows forinadequate cleaning, easy tearing and snag-ging, and certain suffocation of pinched tissue.The thickness (16 to 20 gauge for most studs) isdangerously thin for the majority of piercings.And most are made of gold-plated aluminum orsterling silver, two highly reactive metal choices.

As regards thickness and diameter, differentbodies and different piercings call for differentjewelry. Aring that's the perfect size in an eye-brow can be downright dangerous in a navel, forexample. Use common sense.

Thinner isn't always "better" . Jewelry that's9

--

too thin can act just like a cheese cutter, tearing.its way right out of the body. Jewelry that's toothick can cause abscessing and keloiding,because the weight is cutting off oxygen sup-plies to the tissue. Jewelry too large in diameteris likely to get snagged on things, possibly tear-ing, while jewelry that's too small in diametercan keloid, or be sucked right into the body.Consider these factors when choosing an appro-priate piece of piercing jewelry.10.) Iagree that it is important to be open, avail-able, and not under the influence of legal or ille-gal substances which would compromise myabilities. Iwill seriously consider attending a oneday Red Cross First Aid/CPR instruction course. Iagree to meet or exceed all health, safety, andlegal standards as required by my state andlocal authorities. I understand that it is impor-tant not to misrepresent myself, my abilities, ormy standards in any way. Iagree to consider allnew health 0 safety suggestions as they becomeknown to me, and to make appropriate changesin my techniques as applicable. I agree that it isthe moral, ethical, and professional responsibil-ity of all piercers to continue to seek out, absorb,and share health 0 safety information relevant tothe craft throughout their career.

Since piercing is a very specialized profes-sion, it will be to thepiercer's advantage tostrive for certain personal qualities.

One aspect of this is the relationship betweenthe piercer and piercee. It's important toremember that an individual interested in apiercing will be in need of an open and comfort-able line of communication with their piercer.Every person that approaches a piercer has theright to know about the piercer's experience andtraining, details of how the piercing will be per-formed, details about sterile procedures, andhow to optimally care for their piercing. Sincethe piercee is putting an amount of trust in thepiercer, it is most ethical for the piercer to beavailable and honest before, during and afterthe actual piercing. In most cases, the piercer is

10

the most reliable (if not only) source of informa-tion regarding the piercing.

On a similar note, it's important for thepiercer to be in good health and to be free of anysubstances that would hinder their abilitieswhile piercing. Apiercer can also be preparedfor emergencies by regularly taking first aid/CPRtraining.

As a changing profession, piercing will fre-quently expose piercers to new options relevantto their craft. It is essential for piercers to listento these options and acknowledge whereimprovements can be made,

If a piercer is able to subscribe to these simpleethics, he will be most likely to have a qualitypiercing service that he can offer with integrity.

MEDICAL PRODUCTI PROCEDURE UPDATES

Air CleanersAnew appliance has recently come to our atten-tion: the Enviracaire portable air cleaner. It islikely that other brands are available, but checktheir specifications before buying. TheEnviracaire is equipped with a true HEPA (HighEfficiency Particulate Air) filter, the same filterused in hospitals and medical laboratories. Apaper-thin sheet made of tiny glass fibers catch-es all airborne particles measuring .3 microns orlarger- that's over 99.97% of what you'd findfloating around in the average room. This dras-tically reduces the amount of airborne pollen,animal hair and dander, BACTERIA, VIRUSES,general dust, asbestos, mites, and odors thatmight settle onto your clean surfaces.

The cleaner is listed as a class 2 medicaldevice, whatever that means. Enviracaire comesin 3sizes, to clean anywhere from a 9' x 12' spaceto a 20' x 22' space, up to nine times an hour.While this air cleaner is certainly no substitute

~verv person beiner pierced hos the rierht... to be pierced in a sc.rupulouslV hv~ienic. open environment. bV a dean.

conscientious piercer wearin~a fresh pair of disposable latex ~loves. to a sober. friendlv. calm. and knowled~eablepiercer. who will ~uide

them throu~htheir piere.in~experience with confidence and assurance. to the peace of mind which comes from knowin~that their piercer

knows and practices the verv hi~heststandards of sterilization andhv~iene.

to be pierced with a brand-new, completelV sterilized needle, which isimmediatelv disposed of in a medical shnrps container after use on thepiercee alone.

to be touched onlV with freshlv sterilized, appropriate implements,properlv used and disposed of or resterilized in an autodave prior to useon anvone else.

to know that ear-piere.in~~uns are NBVBR appropriate, and nre oftendan~erous,when used on anvthin~other than ear lobes.

to be fitted onlV withjewelrv which is appropriatelv sized. safe inmaterial. desi~n, and construction. and which best promotes healin~. --!

2ETHICS -So many people are practicing piercing today

that it is inevitable that greed or insecurity hasled many to misrepresent themselves to theirclientele. Just what is a "professional" piercer,anyway? Clearly, health and safety issues are atop priority for the true professional. A lack ofego or defensiveness leads to a more available,honest piercer, who iswilling to learn new thingswithout embarrassment. Technical skill isacquired over a long period of time, but so,unfortunately, are ingrained bad habits. Whilethe qualities that define one as being truly pro-fessional may be difficult to define, it is mucheasier to define an unprofessional piercer.

Agiveaway sign of a non-professional is mis-representation of one's abilities. If you weredoing something well, it wouldn't be nearly asimportant for you to have some sort of fancy titleor long list of fabricated qualifications. You'dsimply do good work, and let your ability speakfor itself.

When a piercing establishment uses term intheir advertising such as "medically approved",or "medically trained", what does that mean? Itcan mean that one or all of the staff have takenfirst aid or CPR classes. Did one of the staff go to

April 13, 1994 The founders ofAPP: (standing I-r) IrwinKane (Gauntlet, Inc.), RaelynGallina, Vaughn (BodyManipulations), MichaelaGrey and Jim Ward (Gauntlet,Inc.), Melisa Kaye (BodyManipulations), RichardWhite (Primeval Body), JoannWyman (BodyManipulations), Elizabeth(Body Manipulations), DrewWard (Gauntlet, Inc.) -(kneeling I-r) BlakePerlingieri (Nomad), Kristian(Nomad).

nursing school for a time, or work as an EMT(ambulance attendant)? Such claims should notsimply be taken at face value. If they're makinga medically related claim, ask specifically whatthey mean. If it's "too good to be true", it prob-ably is. Medically-related training doesn't indi-cate skill as a piercer. Piercing is a very special-ized skill. It may, hopefully, indicate awarenessof sterility issues. Would you choose a tattooartist who is a retired nurse, and cannot drawanything more complex than a stick figure?

If piercing-related training is being offered,be sure to ask questions about the provider'saccreditation I What does the fee actually getyou? Anyone can offer training and make what-ever claims they want about their benefits.However, part of complying with applicablelaws requires the prOVider to be honest aboutwhat exactly you're getting for those hard-earned dollars. Laws which apply to takingmoney for training cover other important issuesas well. If they're not operating their "training"or "school" in compliance with applicable laws,what does that say about their integrity? Canthey be irresponsible about the training, yetremain safe and responsible about the piercingservices they prOVide?

for thorough, regular dusting and cleaning, itdoes seem to make a lot of sense in a piercingstudio. Check it out!

Call Honeywell Environmental Air Control, Inc.at 1-800-332-1110

MadacideThere's a new hard-surface diSinfectant on

the blockI Madacide is a synergistic compoundwith the active ingredients Isopropanol (15.3%)and Dowanol EB (4%). It is listed as bacterioci-dal, viruocidal, tubercuocidal and fungiocidal-that makes it a hospital level disinfectant.Disinfection time is ten minutes, and the prodl,lctmaintains full potency for 10 months after open-ing. Unlike gluteraldehydes and formaldehydes,both biohazardous and nonbiodegradable,Madacide requires no special disposal or venti-lation systems. It is furthermore non-toxic, non-corrosive, and non-irritating.

Madacide may be used as an ultrasonic flUid,and is available in premixed gallon bottles (sug-gested) and spray bottles (not suggested-theforce of the spray could send particles out intothe air). But the neatest thing about Madacide is'that it's also available as an antiseptic handfoam. It you can put the stuff directly on yourhands, I personally feel like it's the best thingyet for jewelry disinfection.

For more information, contact MadaMedical Products at ,-800- 526-6370.

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,Welcome to The Point!

The information in this premiere issue wassubmitted by the following APP memberbusinesses (in alphabetical order): BodyManipulations, Gauntlet, Inc.. Nomad,Obscurities, Primeval Body, and VenusModern Body Arts. Feel free to contact themfor any additional information.

To subscribe to this newsletter fill out theform on page 11 and send it with your checkor money order for $20.00 to APP, 519 CastroSt., Box 120, San Francisco, CA 94114.

AIIOC-IATION OFPROFIIIIONALPIlaCIR/TM519 Castro street, Box 120San Francisco, CA 94114(415) 281-9648

pages will reflect updated health and safetyinformation, editorials and columns by doc-tors and people in the medical community,as well as contributions from professionalpiercers, helpful hints and the like.

Our price donation of ten dollars has beenrevised to twenty dollars a year as our for-mat has expanded to a quarterly publica-tion and increased circulation has becomeevident. Our hope is that this newsletter canmobilize and fund a widespread public ser-vice message campaign.

We wish to thank those companies andindividuals who have contributed their timeand energy, money and information, andbrought our profession closer together.

We look forward to hearing all voices inthe future. Welcome to The Point.

Body piercing as an ancient tradition hasfinally entered into mainstream culture, andtoday, there are professional piercing stu-dios who provide expert service under con-ditions which exceed hospital sterilizationprocedures.

America's leading studios - where staffsrange from 4 to over 40 - have collaboratedand consolidated health and safety infor-mation, techniques and ethics, and haveformed the APP. Our primary objectives areto disseminate information, educate thepublic, set the standards under which bodypiercing is safely exacted, and protect thepiercee.

In every major city, main streets are filledwith people out for a qUick buck. Hairsalons, clothing stores, head shops and thelike plague our profession. Improper train-ing and lack of sterilization under these con-ditions often leads to disaster. Hence, theneed for professional mobilization hasbecome obvious. The result of our efforts isover twenty years of cumulative experienceand information that will directly benefitour profession, and, most importantly, thepublic.

The Point is a quarterly publication whichwe intend to serve as a forum for informa- .tion; all contributions, are welcome. Its

Welcome to The Point!ETHICSA Piercee's Bill Of RightsThe Basic Ten1.) No Ear piercing guns2.) Needles3.) Presterilized Instruments4.) Presterilized single use supplies5.) Aseptic storage of supplies6.) New Gloves (sterile or nonsterile) should be worn for every procedure7.) Studio should be kept scrupulously clean8.) Jewelry decontamination and sterilization9.) I will only use appropriate jewelry10.) Ethics and continuing education

From Sterile to Clean to Contaminated ChartMedical Product / Procedure UpdatesAir CleanersMadacideBack Cover