Toolkit - Tattooing and body piercing guidance - Main contents - Lisburn & Castlereagh ...

 
Tattooing and
                body piercing
                  guidance

                Toolkit

Main contents
Tattooing and body piercing guidance

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   o  lki                 ACKNOWLEDGEMENTS
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FOREWORD
ENDORSING ORGANISATIONS
INTRODUCTION
USING THE GUIDANCE
TOOLKIT
ACKNOWLEDGEMENTS

                          Acknowledgements
                          These guidelines are extensively based on the Tattooing and Body Piercing Guidance: Toolkit
                          which was published by the Chartered Institute of Environmental Health (CIEH) London in 2013.
                          We acknowledge the contributions of the original authors and also those who contributed to the
                          production of this Northern Ireland version as set out below:

                          TATTOOING AND SKIN PIERCING WORKING GROUP MEMBERS

                          Chartered Institute of Environmental Health
                          Department of Health, Social Services and Public Safety (DHSSPS)

                          Public Health Agency
                          Health and Safety Liaison Group for Northern Ireland
                          Subgroup of the Chief Environmental Health Officers Group
                          (CEHOG)

                          January 2014

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Tattooing and body piercing guidance

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           FOREWORD                                      2     Appendix 03                                  42

  lki
   o       ENDORSING ORGANISATIONS                       3
                                                               Safe use and disposal of sharps
                                                               Appendix 04                                   43
To
           INTRODUCTION                               4–5      First Aid following a blood/body fluid exposure
           USING THE GUIDANCE TOOLKIT                    6     Appendix 05                               44
                                                               Protocol for cleaning up blood or a blood
           PART A                                              stained body fluid spill
            Section 01                           7 – 12
CONTENTS   Legislative background on tattooing and skin
           piercing activities
                                                               Appendix 06
                                                               Principles for good waste handling
                                                                                                            45

            Section 02a                                 13     Appenendix 07 Template protocol for
                                                                 environmental cleaning of premises
           Standard Principles of Infection Control
                                                               Appendix 08                                  46
            Section 02b                           14 – 15
                                                               Tattooing/body piercing consent form
           Principles of Infection Control – Hand hygiene
                                                               Appendix 09                                  48
            Section 02c                           16 – 18
                                                               Aftercare follow-up record sheet
           Principles of Infection Control – Personal
           protective equipment                                Appendix 10                            49
                                                               Decontamination requirements for equipment
            Section 02d                          19 – 21
                                                               used in tattooing and skin piercing
           Principles of Infection Control – Management
           of sharps and exposure to blood and body fluids     Appendix 11                             50
                                                               Equipment sterilization standard- self
            Section 02e                            22 – 23
                                                               assessment and decision making tool for
           Principles of Infection Control – Safe handling,
                                                               tattoo and body piercing practitioners
           storage and disposal of waste materials
                                                               Appendix 12                                  51
            Section 02f                                24
                                                               Equipment and body piercing jewellery
           Principles of Infection Control – Cleaning and
                                                               sterilization standard for tattooists and body
           disinfection of the environment
                                                               piercers
            Section 02g                                 25
                                                               Appendix 13                                  52
           References
                                                               Autoclave daily record sheet
            Section 03                             26 – 27
           Before and aftercare of a tattoo or body piercing   PART C
                                                               Leaflets to download and print out
           Section 04                              28 – 32
                                                               01 Tattoo aftercare                          53
           Decontamination
                                                               02 Ear and face piercing aftercare           54
            Section 05                             33 – 34     03 Oral piercing aftercare                   55
           Product quality of tattoo ink
                                                               04 Body and surface piercing aftercare       56
            Section 06                                  35     05 Genital piercing (female) aftercare       57
           Body piercing jewellery                             06 Genital piercing (male) aftercare         58
           Section 07                              36 – 37     07 Microdermal implants aftercare            59
           Governance                                          Poster to download
            Section 08                              38         How to handwash                              60
           Management of infectious disease incidents
           relating to tattooing and body piercing             PART D
                                                               Audit Tool to download                       61
           PART B
                                                               PART E
           Appendix 01                             40 – 41
                                                               Literature review to download                62
           Infection, its causes and sprad, including
           a glossary of infection-related terms
           Appendix 02                                  41
           Blood borne viruses

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Tattooing and body piercing guidance

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   o  lki                 FOREWORD
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FOREWORD
ENDORSING ORGANISATIONS
INTRODUCTION
USING THE GUIDANCE
                          GARY MC FARLANE                                    DR LORRAINE DOHERTY
TOOLKIT
                          Director, Chartered Institute of                   Assistant Director for Health Protection
                          Environmental Health Northern Ireland              Public Health Agency
                          Tattooing and body piercing have become            The tattooing and body piercing industry has
                          increasingly popular and fashionable. Ensuring     seen a period of growth in Northern Ireland in
                          practitioners follow safe working practices is     recent years.As such there is now an increased
                          important for protection of both clients and       need to ensure that those who are working
                          the practitioners themselves. This toolkit has     in this field are supported in delievering safe
                          been developed specifically for Northern           parctice.As an interactive document, this toolkit
                          Ireland following the publication of a similar     acts as a framework for good infection and
                          resource for England.In doing so we have           control practice which enables the user to access
                          collaborated and worked with the relevant NI       the sound evidence based guidance and to
                          agencies, notably the Department of Health         appropriately manage infection risk. I would
                          Social services and Public Safety (DHSSPS),        like to acknowledge the excellent collaborative
                          the Public Health Agency and the Health and        working of health protection colleagues from
                          Safety Liaison Group (HSLG), a subgroup of         PHA,PHE and CIEH and colleagues from the
                          the Chief Environmental Health Officers Group      tattooing industry that has resulted in the
                          (CEHOG). We hope that the resources will prove     publication of this invaluable tool. Its my
                          a practical tool for practitioners.                pleasure to endorse this guidance toolkit as a
                                                                             key resource for practitioners in the industry
                          PATRICIA ALLEN                                     which can only lead to better health outcomes
                          Assistant Director of Northern Group               for service users.
                          Systems Environmental Health
                          This guidance toolkit aims to influence
                                                                             NIGEL MC MAHON
                          tattooing and body piercing practices              Chief Environmental Health Officer
                          in Northern Ireland, in particular by the          Department of Health, Social Services &
                          promotion of evidence based prevention and         Public Safety
                          control measures. It provides easy access          Infection prevention and control is a
                          to key guidance and best practice, giving          paramount public health concern.The
                          practitioners and others a single authoritative    promotion of safe working practices is
                          source of information.By doing so it is hoped      important for practitioners, clients and public
                          that standards of safety and hygiene delivered     health professionals including environmental
                          across the range of tattooing and body             health staff. This reference guide attempts to
                          piercing practices will be consistently high for   bring all of the relevant information together
                          Northern Ireland consumers.                        in one place for the benefit of those involved
                                                                             in the industry, as well as for those that seek
                                                                             to advise and regulate it. The guide has been
                                                                             produced in partnership with a number of
                                                                             organisations and individuals and I would offer
                                                                             my thanks to all those involved. On behalf of
                                                                             the working group, I would also like to record
                                                                             our appreciation of the Chartered Institute
                                                                             of Environmental Health for carrying out the
                                                                             editing, web design and publication of the
                                                                             toolkit online.
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Tattooing and body piercing guidance

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   o  lki                 ENDORSING ORGANISATIONS
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FOREWORD                  CHARTERED INSTITUTE OF                             PHA is a multi-disciplinary, multi-professional
ENDORSING ORGANISATIONS
                          ENVIRONMENTAL HEALTH (CIEH)                        body with a strong regional and local presence.
                                                                             It has four key functions:
INTRODUCTION              The CIEH is a registered charity and the
USING THE GUIDANCE        professional voice for environmental health.       •   health and social wellbeing improvement;
TOOLKIT                   It sets standards, accredits courses and
                          qualifications for the education of members        •   health protection;
                          and other environmental health practitioners.
                                                                             •   public health support to commissioning
                          It provides information, evidence and policy
                                                                                 and policy development ;
                          advice to local and national government
                          and environmental and public health                •   HSC research and development
                          practitioners in the public and private sectors.
                          As an awarding body, the CIEH provides             The PHA also work to create better inter-
                          qualifications, events, and support materials on   sectoral working,including enchanced
                          topics relevant to health, wellbeing and safety    partnership arrangements with local
                          to develop workplace skills and best practice.     government, to tackle the underlying cause of
                                                                             poor health and reduce health inequalities.
                          THE DEPARTMENT OF HEALTH,
                          SOCIAL SERVICES AND PUBLIC                         NORTHERN IRELAND CHIEF
                          SAFETY (DHSSPS)                                    ENVIRONMENTAL HEALTH
                                                                             OFFICERS GROUP
                          DHSSPS was established by the Departments
                          (NI) Order 1999. It is the Department’s mission    The Northern Ireland Chief Environmental
                          to improve the health and social well-being of     Officers Group (CEHOG) was formed as a
                          the people of Northern Ireland.                    liaison body to provide a forum to unite the
                                                                             local government environmental health
                          The Department has three main business             service in Northern Ireland and to establish
                          responsibilities:                                  and maintain effective services partnerships
                                                                             with bodies having an influence upon health
                          •   Health and Social Care (HSC), which
                                                                             in NI communties. The fundamental remit is
                              includes policy and legislation for
                                                                             to aid the co-ordination and consistency of
                              hospitials, family practitioner services and
                                                                             environmental health services, to assist the
                              community health and personal social
                                                                             development of highly quality services and to
                              services:
                                                                             provide a consultative body with links to other
                          •   Public Health which covers policy,             agencies and departments to facilitate the
                              legislation and administrative action to       passage of advice on relevant policy matters.
                              promote and protect the health and well-
                                                                             Membership of this liaison body includes all
                              being of the population; and
                                                                             twenty six District Chief Environmental Health
                          •   Public Safety, which covers policy and         Officers, (or equivalent in title and function),
                              legislation for fire and rescue services.      the four Group Chief Environmental Health
                                                                             Officers and from outside local government,
                          THE PUBLIC HEALTH AGENCY                           the Chief Environmental Health Officer,
                          (PHA)                                              DHSSPS and the NI Director of the Chartered
                                                                             Institute of Environmental Health.
                          From its establishment in 2009, Public Health
                          Agency provides a renewed and enchanced
                          focus on public health and wellbeing by
                          bringing together a wide range of public health
 ➲ Main contents          functions under one organisation.
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Tattooing and body piercing guidance

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   o  lki                 INTRODUCTION
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FOREWORD                  This guidance toolkit has been prepared by a panel of health protection
ENDORSING ORGANISATIONS   and practitioner representatives. It comprises a consensus of expert advice
INTRODUCTION              which it is intended will provide an authoritative source of information.
USING THE GUIDANCE        Its contents are supported by extensive literature reviews (Part E).
TOOLKIT
                          The purpose of the guidance toolkit is to support local authority and other
                          regulatory officers in determining their requirements for effective control
                          of risk in these activities and to promote a consistent approach. Similarly, it
                          is intended to be of assistance to practitioners and businesses undertaking
                          these activities to support them in adopting acceptable standards of
                          practice. The use of this guidance toolkit will help to ensure the health and
                          safety of both clients and operators and that tattooing and skin piercing
                          practitioners will be operating in compliance with legal requirements.

                          BACKGROUND                                          Over the years a variety of legislation has
                                                                              been introduced, mainly for local adoption,
                          Tattooing and body piercing procedures have
                                                                              to encourage and support safe practice.
                          become more popular and fashionable in the
                                                                              Model byelaws have been made available,
                          United Kingdom (UK) as a whole, particularly
                                                                              but have not been accompanied by standard
                          in the last decade. The range of tattooing and
                                                                              requirements for compliance. As a response
                          body piercing procedures has also increased.
                                                                              to on-going concerns, a number of sets of
                          There are no published data on the prevalence
                                                                              local/regional guidelines have been developed
                          of tattoos in the general UK population. There
                                                                              by different agencies, often initiated by
                          are also no comprehensive data for the UK on
                                                                              environmental health or health protection
                          the prevalence of body piercing, but a small
                                                                              specialists (this guidance toolkit draws upon
                          study has estimated that the prevalence of
                                                                              some of the previously published material).
                          body piercing, other than of earlobes, in the
                                                                              However, there have been difficulties previously
                          general adult population in England was 10%
                                                                              in engaging practitioners in the development
                          (Bone A et al, 2008).
                                                                              of such guidelines and in securing adoption
                          There are known and well reported health risks      and wider implementation.
                          which can be attributed to these procedures,
                                                                              It is also recognised that there are no nationally
                          as well as associated legal issues. Improper
                                                                              recognised or accredited training courses,
                          and unhygienic practice may result in localised
                                                                              standards for practice, agreed knowledge and
                          skin infections at the site of the tattoo or
                                                                              skills frameworks or arrangements for monitoring
                          piercing. There is also the risk of transmission
                                                                              and reporting of professional competence.
                          of blood-borne viruses, for example Hepatitis
                                                                              The absence of accredited training and
                          B, Hepatitis C, Hepatitis D or HIV, which can
                                                                              competencies for tattooing and body piercing is
                          have more serious and long term health
                                                                              an area that needs to be addressed nationally
                          consequences. It is therefore important that
                                                                              and is outside the scope of this guidance. The
                          practitioners have safe working practices,
                                                                              working group has, however, been greatly
                          and particularly that good infection control
                                                                              assisted in the preparation of this guidance by
                          practices are followed at all times, so that both
                                                                              the Tattoo and Piercing Industry Union who are
                          clients and practitioners are protected.
                                                                              recognised as a professional body for tattoo and
                                                                              body piercing practitioners in the UK.
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Tattooing and body piercing guidance

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   o  lki                 INTRODUCTION (continued)
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FOREWORD                  DEVELOPMENT OF THE GUIDANCE
ENDORSING ORGANISATIONS
                          FOR NORTHERN IRELAND
INTRODUCTION              This guidance was developed in response to
USING THE GUIDANCE        concerns raised by tattoo and body piercing
TOOLKIT                   practitioners, as well as health protection
                          and environmental health specialists. These
                          concerns were particularly in regard to the
                          lack of robust and consistent guidance on
                          standards of hygiene and safety. This has
                          been leading to inconsistency in advice and
                          variations in standards of practice.
                          A multi-agency steering group was set up
                          comprising representatives from the Chartered
                          Institute of Environmental Health,Department
                          of Health and Social Services and Public Safety
                          (DHSSPS), Public Health Agency (PHA) and the
                          Health and Safety Liaison Group for Northern
                          Ireland (a subgroup of the Chief Environmental
                          Health Officers Group) and also individuals with
                          practical experience of working in this area as
                          expert advisors, practitioners or regulators.

                          The guidance is supported by extensive
                          documentary evidence of scientific knowledge,
                          reported research and published literature
                          encompassing expert advice and the opinions
                          and experience of practitioners of what works
                          at a practical level.

                          References
                          Bone A., Ncube F., Nichols T. & Noah ND. (2008)
                          Body piercing in England: a survey of piercing at
                          sites other than earlobe. BMJ; 336; 1426-1428.

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   o  lki                 USING THE GUIDANCE TOOLKIT
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FOREWORD                  The guidance has been written as a key point of reference for use nationally
ENDORSING ORGANISATIONS   by tattoo and body piercing practitioners who work in regulated premises,
INTRODUCTION              local authority officers in their regulatory role and health protection staff
USING THE GUIDANCE        who are asked to provide expert advice. The guidance does not cover mobile
TOOLKIT
                          operators or non-registered practitioners, although the risks encountered
THE AUDIT TOOL
                          in relation to their activities will be of equal or greater concern. It does not
PROVIDING FEEDBACK
                          address the risks associated with procedures other than those commonly
                          accepted as necessary for tattooing and the insertion of body jewellery,
                          although the procedures recommended for infection control are based upon
                          sound principles of infection control and will have wider application.

                          The material is arranged so as to be readily       No copyright is being claimed for the toolkit or
                          accessible as a web-based toolkit, organised       any of the material it contains and the authors
                          in a manner that reflects the tattoo and           encourage its wider distribution and use.
                          body piercing setting, and with supportive
                          documentation and literature that can be           In offering and using the advice contained in
                          downloaded and saved or printed in the             this guidance it must be clearly understood that:
                          manner that users prefer.                          • Legislation may change over time
                                                                               and the advice given is based on the
                          It is intended that the adoption of the
                                                                               information available at the time this
                          standards recommended in this guidance,
                                                                               toolkit was produced – it is not necessarily
                          particularly those relating to infection control
                                                                               comprehensive and is subject to revision in
                          and decontamination, will help to establish
                                                                               the light of further information.
                          standards for good practice. Governance is
                          promoted by the inclusion of template consent      • Only the courts can interpret legislation
                          forms, aftercare advice leaflets and a good          with any authority, and
                          practice infection control audit tool.             • This advice is not intended to be definitive
                                                                               legal guidance nor is it a substitute for the
                          THE AUDIT TOOL                                       relevant law and independent legal advice
                                                                               should be sought where appropriate.
                          This audit tool can be downloaded and used
                          as individual sections or as a complete tool.      PROVIDING FEEDBACK
                          It is intended to be used by tattoo and body
                          piercing practitioners, regulatory officers and    We hope you find the guidance useful. It is
                          health protection practitioners to generate        intended that the document wiil be revisited
                          evidence of the environment, practice and          and updated periodically. To that end feedback
                          procedures in meeting standards and whether        on your experience is positively encouraged.
                          practitioners are applying best practice and       Feedback can be sent to Gary Mc Farlane,
                          following guidance. The tool can be repeated       g.mcfarlane@cieh.org Director of The
                          to see if standards have been maintained or        Chartered Institute of Environmental Health
                          improved.                                          Northern Ireland.

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Tattooing and body piercing guidance

              t
   o    lki                      PART A
To

                     Legislative background on tattooing
          Section 01 and skin piercing activities
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SUMMARY                          SUMMARY                                              General controls
Specific controls                The use of legislation in this area of activity      The primary health and safety legislation in
General controls                 is primarily to ensure that infection control        Northern Ireland (NI) is the Health and Safety
Determining requirements         arrangements are adequate and effectively            at Work (Northern Ireland) Order 1978 (HSWO).
REGISTRATION AND                 carried out wherever tattooing and skin              It can be used to impose and enforce infection
BYELAW REQUIREMENTS IN                                                                control requirements in relation to all skin piercing
                                 piercing are carried out.
NORTHERN IRELAND                                                                      activities, including peripatetic practitioners who
HEALTH AND SAFETY AT             The primary means of enforcing infection             visit a client’s home. It allows for immediate
WORK (NI) ORDER 1978             control arrangements is by use of registration       prohibition of persons or activities that pose an
General duties                   and the observance of provisions contained           imminent risk to health or safety.
Risk assessment                  in byelaws.The registration and byelaw
Control of substances            provisions are largely concerned with setting        Determining requirements
    hazardous to health
                                 requirements for good standards by requiring         It is intended that this guidance will provide an
Management of contractors
                                 the maintenance of established hygiene               additional authoritative source of information
Enforcement                      controls in respect of premises, equipment,          to support local authorities in determining
AGE LIMITS AND CONSENT           procedures and practices. However, there             their requirements for effective control of risk
Tattooing                        are additional controls contained in primary         in these activities and adopting a consistent
Other skin piercing activities   legislation that do contain provisions for the       approach in the application of the legislation.
Acupuncture and electrolysis     immediate prohibition of activities or persons       Similarly, it will be of assistance to those
Consent                          or for the closure of premises where risk of         businesses and practitioners undertaking
USE OF LOCAL ANAESTHETIC         infection can be demonstrated.                       these activities to ensure that they are able
MEDICATION
                                                                                      to operate safely and comply with legal
                                 The legislation relating to tattooing and skin
                                                                                      requirements.
                                 piercing activities,can therefore be broadly split
                                 into two main areas:
                                 • Specific controls by registration of premises
                                   and people carrying out the activities, and
                                   associated byelaws, and
                                 • General controls of activities through primary
                                   legislation that is not specific to particular
                                   activities but applies to all of them.

                                 Specific controls
                                 Arrangements for registration will differ
                                 depending on the particular requirements of
                                 the local authority in whose area the business
                                 is located or the activity is being carried out.
                                 The majority of local authorities have adopted
                                 byelaws in respect of the standards for the
                                 maintenance of established hygiene controls
                                 in respect of premises, equipment, procedures
                                 and practices.

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Tattooing and body piercing guidance

              t
   o    lki                      PART A
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                     Legislative background on tattooing
          Section 01 and skin piercing activities (continued)
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SUMMARY                          REGISTRATION AND BYELAW                              Article 15 of the 1985 Order provides for
Specific controls                REQUIREMENTS IN NORTHERN                             offences and for non-custodial penalties
General controls                 IRELAND                                              (summary conviction and fine) for trading
Determining requirements                                                              without council and registration or breaching
                                 There are provisions in Part V of the The
REGISTRATION AND                                                                      council byelaws. The court may also order
                                 Local Government (Miscellaneous Provisions)
BYELAW REQUIREMENTS IN                                                                suspension of, or cancellation of registration
                                 Northern Ireland Order 1985 (LGMPO) for local
NORTHERN IRELAND                                                                      (whether of a person or premises) on
                                 authorities in NI to require the registration
HEALTH AND SAFETY AT                                                                  conviction. When cancellation of registration
                                 of persons carrying on the practices of
WORK (NI) ORDER 1978                                                                  happens, the court may order a fine, increased
                                 acupuncture, tattooing, ear piercing or
General duties                                                                        on a daily basis for late surrender of the
                                 electrolysis. These powers are adoptive, and
Risk assessment                                                                       cancelled registration certificate. There is also
                                 local authorities are able to choose which
Control of substances                                                                 an offence of not displaying a certificate of
    hazardous to health          of these practices would be required to be
                                                                                      registration or byelaws (in respect of which a
Management of contractors        registered in their area The Local Government
                                                                                      person is liable on summary conviction to a
Enforcement                      (Northern Ireland) Order 2005 added semi-
                                                                                      fine).
                                 permanent skin-colouring and cosmetic
AGE LIMITS AND CONSENT
                                 piercing to this list of activities for which        The penalties for offences are fines on the
Tattooing
                                 registration can be required.                        Standard Scale of Level 3 (currently £1000) for
Other skin piercing activities
Acupuncture and electrolysis
                                                                                      offences under Article 15(1),Article 15(2), and
                                 The Order allows for local authorities to
Consent                                                                               Level 1 (currently £200) for an offence under
                                 make byelaws, for the purpose of securing;
                                                                                      Article 15(9).
USE OF LOCAL ANAESTHETIC         the cleanliness and hygiene of premises,
MEDICATION                       practitioners and equipment. These measures          There are some exemptions from the
                                 are intended to increase health protection and       registration requirements. It does not apply to
                                 reduce the risk of transmission of blood borne       practices carried out by or under the supervision
                                 virus infections.                                    of a person who is registered as a medical
                                                                                      practitioner (a Doctor registered with the
                                 The local authority can request reasonable
                                                                                      General Medical Council) or for acupuncture
                                 information from applicants for registration.
                                                                                      by a dentist, or chartered physiotherapist, or
                                 This cannot include details concerning persons
                                                                                      a state registered physiotherapist, or a state
                                 whom the applicant has given treatments to,
                                                                                      registered chiropodist, or to premises under
                                 however, it could include evidence of training
                                                                                      their supervision.
                                 or competency for those being registered.
                                                                                      Local authority officers can be authorised to
                                 The registration is mandatory in that the
                                                                                      enter any premises where they have reason
                                 local authority must issue a registration if
                                                                                      to believe that an offence under Article 15
                                 the application has been properly made. A
                                                                                      is being committed there, but where entry is
                                 registration can only be refused where a person
                                                                                      refused the authority of a warrant issued by a
                                 has previously been convicted of an offence
                                                                                      Justice of the Peace has to be obtained.
                                 under Article 15 of the 1985 Order and the
                                 convicting magistrate suspended or cancelled         The Department of Health Social Services and
                                 the previous registration. A registration can only   Public Safety (DHSSPS) issued guidance on the
                                 be cancelled by a magistrate upon conviction         legal provisions relating to the regulation of
                                 of an offence, and this is instead of or in          cosmetic piercing and skin colouring businesses
                                 addition to a fine.                                  in 2005. The document also provides model
                                                                                      byelaws which local authorities could formally
                                                                                      adopt as well as guidance on the procedure for
                                                                                      the confirmation of byelaws by the DHSSPS.
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                                                                                      http://www.dhsspsni.gov.uk/bodypiercing-
              10                                                                      order.pdf
Tattooing and body piercing guidance

              t
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                     Legislative background on tattooing
          Section 01 and skin piercing activities (continued)
Click on text to view            HEALTH AND SAFETY AT WORK                            The Management of Health and Safety at
SUMMARY
                                 (NI) ORDER 1978                                      Work Regulations (Northern Ireland) 2000
                                                                                      requires all employers and self employed
Specific controls                The Health & Safety at Work (Northern
                                                                                      persons to:
General controls                 Ireland) Order 1978 (HSWO) applies to all
Determining requirements         persons engaged in tattooing and skin piercing       • Undertake a risk assessment of their
REGISTRATION AND                 activities for gain or reward. This includes           activities;
BYELAW REQUIREMENTS IN           peripatetic workers who carry out treatments         • Remove, where possible, that risk or;
NORTHERN IRELAND
                                 in the client’s home, although only the Health       • Where residual risk is unavoidable, to
HEALTH AND SAFETY AT             & Safety Executive for Northern Ireland have
WORK (NI) ORDER 1978
                                                                                        provide control measures to reduce it as
                                 powers in relation to peripatetic workers.             far as possible, including as a last resort,
General duties
Risk assessment                  It provides means of securing effective                provision of personal protective equipment;
Control of substances            infection control and the following areas are        • Provide training to staff and persons they
    hazardous to health          particularly applicable.                               use to undertake their business activities
Management of contractors                                                               (contractors) to ensure they understand the
Enforcement                      General duties                                         risks and the control measures.
AGE LIMITS AND CONSENT           Under Article 4 of the Order, all employers have     One of the risks that must be considered is
Tattooing                        a general duty of care to ensure the health,         that of possible complications relating to skin
Other skin piercing activities   safety and welfare of their employees. Under         piercing and tattooing. The practitioner must
Acupuncture and electrolysis     Article 5, both employers and self-employed          make sure that a fully ‘informed consent’
Consent                          persons have a general duty of care to ensure        procedure is adopted. This means gathering
USE OF LOCAL ANAESTHETIC         their activities do not expose them or the           information from the client about their health
MEDICATION                       general public to risks to their health or safety.   and suitability for the treatment, and giving
                                                                                      the client enough information about the
                                 Risk assessment                                      possible complications that could arise from the
                                 A risk assessment is the key step in protecting      treatment for them to make their own decision.
                                 workers and the public, as well as complying
                                 with the law. The risk assessment is a careful       Control of substances hazardous
                                 examination of what work activities could            to health
                                 cause harm to people and this then guides            The Control of Substances Hazardous to
                                 decisions about precautions that need to             Health Regulations (Northern Ireland)
                                 be taken, including infection prevention and         2003 (COSHH) requires that a specific risk
                                 control measures.                                    assessment is carried out by employers or self
                                                                                      employed persons who work with substances
                                 The HSE provides detailed advice on carrying
                                                                                      hazardous to health. Substances which are
                                 out risk assessments http://www.hse.gov.uk/
                                                                                      hazardous to health include biological agents.
                                 risk/risk-assessment.htm, including interactive
                                                                                      The hazards in this context are the organisms
                                 tools http://www.hse.gov.uk/risk/shop.htm and
                                                                                      which can cause communicable diseases
                                 other pieces of guidance http://www.hseni.gov.
                                                                                      could be transmitted from person to person by
                                 uk/..guidance/content-getting-started/content-
                                                                                      unhygienic practices.
                                 risk-assessment.htm
                                                                                      Therefore a specific risk assessment in respect
                                                                                      of infection control is necessary for all persons
                                                                                      undertaking tattooing and skin piercing activities.

                                                                                      Businesses employing less than 5 people do
                                                                                      not have to record the findings of this risk
                                                                                      assessment, however they still have to satisfy
  ➲ Main contents                                                                     regulatory officers that their risk assessment is
                                                                                      suitable and sufficient.
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Tattooing and body piercing guidance

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                     Legislative background on tattooing
          Section 01 and skin piercing activities (continued)
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SUMMARY                          Management of contractors                          AGE LIMITS AND CONSENT
Specific controls                The Management of Health and Safety at             The need for limits on age, and requirements
General controls                 Work Regulations (Northern Ireland) 2000           for consent, can be a controversial area
Determining requirements         (Regulations Sections 11, 12 & 13)                 because in many circumstances specific
REGISTRATION AND                 contains legal provisions which can be of          requirements have not been made in law.
BYELAW REQUIREMENTS IN           particular importance to the many tattooists       Consent is a complex area of law, and one that
NORTHERN IRELAND                 and cosmetic piercers who do not own the           is often misunderstood by the general public,
HEALTH AND SAFETY AT             premises which they operate from and are           and also by some skin piercing practitioners.
WORK (NI) ORDER 1978             not employed by the person who owns and/
General duties                   or manages the premises where they work. In        Tattooing
Risk assessment                  these cases, they are usually self-employed and    The Tattooing of Minors (Northern Ireland)
Control of substances            have some form of contract, formal or informal,
    hazardous to health                                                             Order 1979 imposes a statutory minimum age
                                 with the owner of the shop premises whereby        of 18 years for permanent tattooing (except
Management of contractors
                                 they pay the owner to allow them to work there.    when carried out for medical reasons by a duly
Enforcement
                                 In these circumstances the shop owner can be       qualified medical practitioner or by a person
AGE LIMITS AND CONSENT           said to be contracting out to the practitioner     working under their direction). The practitioner
Tattooing                        and in effect ‘endorsing’ their work’.             has a defence if they can show that they had
Other skin piercing activities
                                 These tattooists and piercers are therefore        good reason to believe that the person was
Acupuncture and electrolysis
Consent                          contractors undertaking the activities of the      over 18 years of age. The consent of a client
                                 business owner for them. This means that           under 18 is not a defence. The Police enforce this
USE OF LOCAL ANAESTHETIC
MEDICATION                       the premises owners cannot abdicate their          legislation and fines are up to £500.
                                 own general duties under the HSWO to the
                                                                                    Skin piercing activities
                                 individual practitioners. They have a duty to
                                 ensure that persons working on their premises      There is no statutory age of consent for cosmetic
                                 are competent and that they carry out their        piercing (cosmetic body piercing and ear
                                 work in a safe manner. The only way they           piercing). Cosmetic piercing of a minor is lawful
                                 can do this satisfactorily is to assess the        provided a valid consent is given. Furthermore the
                                 practitioners for themselves and monitor their     courts have held that a parents right to decide
                                 activities to ensure they have carried out their   on behalf of his and her child yields to the child’s
                                 own risk assessment, as they are required to       competence to make a decision, for example if
                                 do by law, and that they are following control     he or she is capable of understanding the nature
                                 measures they have identified. The business        of the act to be done (see below). Body piercing
                                 owner has the ultimate power to remove the         for sexual gratification is unlawful. Children under
                                 risk, by stopping particular contractors working   the age of 17 are not able to consent lawfully to
                                 at their premises.                                 a piercing that would be regarded as indecent
                                                                                    assault. Genital or nipple piercing performed on
                                 Enforcement                                        someone under the age of 17 might be regarded
                                 The requirements of HSWO are enforceable           as an indecent assault under sexual offences
                                 through improvement and prohibition notices.       legislation depending on the facts of the case.
                                 Improvement notices give a time limit for          Ear piercing and in some cultures nose piercing is
                                 compliance with requirements. Prohibition          generally considered acceptable when carried out
                                 notices can have the effect of immediately         on a minor, even below the age of five, provided
                                 stopping the operations of a business or the       that a parent or legal guardian gives consent and
                                 activities of a person where imminent risk is      is present whilst the procedure is carried out
                                 apparent. Failure to comply with HSWO may
  ➲ Main contents                result in court action.

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                     Legislative background on tattooing
          Section 01 and skin piercing activities (continued)
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SUMMARY                          Acupuncture and electrolysis                          Genital Mutilation Act 2003 states that certain
                                                                                       procedures in respect of female genitals are
Specific controls                When carried out properly these do not cause
                                                                                       illegal unless carried out for medical reasons.
General controls                 harm to the body, and leave no permanent
Determining requirements         markings. For this reason they are not likely to      The signing of a declaration and providing proof
REGISTRATION AND                 raise any concerns over common assault charges,       of age should be a fundamental part of the
BYELAW REQUIREMENTS IN           although practitioners should be aware of possible    client consultation process and practitioners
NORTHERN IRELAND                                                                       should always require that the client signs
                                 indecent assault complications (see below).
HEALTH AND SAFETY AT             Consent should still be obtained before treatment     a consent form prior to any work being
WORK (NI) ORDER 1978                                                                   commenced. However, the consent will only be
                                 takes place, and in the case of a minor this should
General duties                                                                         valid if the customer has been fully informed
                                 be obtained from the parents or legal guardians.
Risk assessment                                                                        as to the nature of the process, the likely effect
Control of substances            Other considerations                                  and potential problems involved. An example
    hazardous to health                                                                of a consent form is provided in Appendix 8.
Management of contractors        Semi-permanent skin-colouring, cosmetic piercing,     However, for practitioners own protection, it is
Enforcement                      beading, branding, scarring, cutting and other        recommended that any consent forms they use
                                 extreme forms of body modification do cause           are worded with the advice of a solicitor who is
AGE LIMITS AND CONSENT
                                 actual harm and generally leave permanent marks       familiar with this area of law.
Tattooing
                                 and can result in disfigurement. They can therefore
Other skin piercing activities
                                 be considered as assaults to the body, and so
                                                                                       USE OF LOCAL ANAESTHETIC
Acupuncture and electrolysis
                                 potentially subject to the legislation concerning
                                                                                       MEDICATION
Consent
                                 assault. This means that the question of age and      There is a range of topical local anaesthetic
USE OF LOCAL ANAESTHETIC
MEDICATION                       the client’s informed consent are very important      products for surface (skin) anaesthesia available
                                                                                       from community pharmacies (Pharmacy only (P)
                                 Consent                                               medicines), however none of these products are
                                                                                       licensed for local anaesthesia prior to tattoo or
                                 In the legal proceedings of R v Brown (1994)
                                                                                       body piercing.The client may wish to obtain a
                                 1 AC 212, the House of Lords ruled on appeal
                                                                                       topical local anaesthetic preparation prior to the
                                 that consent could not be a defence against
                                                                                       procedure; however responsibility for purchasing
                                 sections 20 and 47 of the Offences Against
                                                                                       and application of the product should remain
                                 the Person Act 1861 which deals with common
                                                                                       with the client. The client should be advised
                                 assaults. However, the law also recognises that
                                                                                       to read the Patient Information Leaflet which
                                 certain activities that give rise to ‘harm’ are
                                                                                       accompanies the product and should be aware
                                 lawful. This includes surgery, tattooing, ear
                                                                                       of the following:
                                 piercing and violent sports. The courts have
                                 also held that the law allows children under the      • Warnings, cautions and contraindications.
                                 age of 18 to consent to cosmetic body piercing        • Side effects.
                                 provided they are sufficiently mature to              • That they are using the licensed product for
                                 understand the nature of the request. This kind         an un-licensed indication.
                                 of assessment is clearly a subjective matter for
                                                                                       • Recommendations regarding
                                 the operator who will need to ensure that the
                                                                                         administration and application.
                                 client is provided with sufficient information to
                                 allow them to proceed in an informed way and          Alternatively, a qualified practitioner,
                                 without pressure.                                     e.g. doctor, may prescribe a topical local
                                                                                       anaesthetic product to be self-administered
                                 Under the Sexual Offences (Northern Ireland)          by the client, or can prescribe and administer
                                 Order 2008, girls and boys under the age of 16        a topical local anaesthetic product, in
                                 cannot legally give consent to intimate sexual        accordance with legal requirements of their
                                 contact under any circumstances, so piercing          professional registration.
                                 of nipples and genitalia (for girls) or genitalia
                                 (for boys) can be regarded as an assault              Local anaesthetic injections are prescription-only
  ➲ Main contents                offence. Evidence that such contact was for           medicines (POMs) therefore they can only be
                                 sexual gratification would be required in order       prescribed by a suitably qualified practitioner.
              13                 to constitute an indecent assault. The Female         Local anaesthetic injections are not licensed for
Tattooing and body piercing guidance

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                     Legislative background on tattooing
          Section 01 and skin piercing activities (continued)
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SUMMARY                          local anaesthesia prior to tattoo or body piercing.
                                 In addition they should not be administered
Specific controls
                                 parenterally unless adequate resuscitation
General controls
                                 equipment is available. Information on the
Determining requirements
                                 supply and administration of injectable medicines
REGISTRATION AND                 outside their licensed medicinal uses is available
BYELAW REQUIREMENTS IN
                                 from the Medicines and Healthcare Regulatory
NORTHERN IRELAND
                                 Agency (MHRA)2 and from the Nursing and
HEALTH AND SAFETY AT             Midwifery Council (NMC).
WORK (NI) ORDER 1978
General duties                   References
                                 1. British National Formulary (BNF) http://www.
Risk assessment                  medicinescomplete.com/mc/bnf/current/PHP8663-
Control of substances            local-anaesthesia.htm (accessed 22/4/2013)
    hazardous to health          2. MHRA; Frequently asked questions: Supply and
Management of contractors        administration of Botox®, Vistabel®, Dysport® and
Enforcement                      other injectable medicines outside their licensed
                                 medicinal uses such as in cosmetic procedures http://
AGE LIMITS AND CONSENT           www.mhra.gov.uk/Howweregulate/Medicines/
Tattooing                        Availabilityprescribingsellingandsupplyingof
                                 medicines/Frequentlyraisedissues/BotoxVistabel
Other skin piercing activities
                                 Dysportandotherinjectablemedicines
Acupuncture and electrolysis     incosmeticprocedures/index.htm (accessed
Consent                          22/4/2013)
USE OF LOCAL ANAESTHETIC         3. NMC; Remote prescribing and injectable cosmetic
MEDICATION                       medicinal products http://www.nmc-uk.org/Nurses-
                                 and-midwives/Regulation-in-practice/Regulation-in-
                                 Practice-Topics/Remote-prescribing-and-injectable-
                                 cosmetic-medicinal-products/ (accessed 22/4/2013)
                                 4.DHSSPSNI; Local Government (Northern Ireland)
                                 Order 2005 Regulation of Cosmetic Piercing and
                                 Skin-Colouring businesses Guidance on Artilce
                                 31 and Schedule 2 http://www.dhsspsni.gov.uk/
                                 bodypiercing-order.pdf
                                 (accessed on 20/08/14)

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        Section 02a Infection prevention and control
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SECTION 02A                    INTRODUCTION                                         Responsibilities
                                                                                    Under the HSWO, all employers should ensure
INTRODUCTION                   Infection, its causes and spread
Infection, its causes
                                                                                    that all their employees are appropriately trained
                               The causes and methods of spread of                  and proficient in the procedures necessary for
    and spread
                               infections that are likely to arise in connection    working safely. Employers and their employees
Factors in infection
    control practice
                               with tattooing and skin piercing, are well           are also responsible to ensure that any person
Responsibilities               understood.                                          on the premises is not placed at any avoidable
STANDARD PRINCIPLES OF         See Appendix 01– Infection, its causes               risk, as far as is reasonably practicable. They
INFECTION CONTROL                                                                   also have a responsibility to protect voluntary
                               and spread
Appendix 01 – Infection, its                                                        workers. Employers are also required by COSHH,
causes and spread              Unsafe or unhygienic practices by tattooing/         to review every procedure carried out by
SECTION 02B                    body piercing practitioners can lead to the          their employees which involves contact with
PRINCIPLES OF INFECTION        spread of infectious diseases that can affect        a substance hazardous to health, including
CONTROL – HAND HYGIENE         the health of the client as well as jeopardise       pathogenic micro-organisms. Specific guidance
SECTION 02C                    the health of the practitioner. Although some        is available from the Department of Health
                               bacterial or viral infections may be spread during   (Department of Health, 1998).
PRINCIPLES OF INFECTION
CONTROL – PERSONAL             procedures that do not involve skin penetration,
PROTECTIVE EQUIPMENT           it is the occupational risk of transmission of       STANDARD PRINCIPLES OF
SECTION 02D
                               infections such as blood-borne viruses (BBVs),       INFECTION CONTROL
                               such as hepatitis B, hepatitis C, hepatitis D and    This guidance is based upon standard principles
PRINCIPLES OF INFECTION
CONTROL – MANAGEMENT OF
                               HIV, which can arise and which are of primary        which are the basic level of infection control
SHARPS AND EXPOSURE TO         concern. Precautions to minimise the possibility     practice. Compliance with these standard
BLOOD AND BODY FLUIDS          of exposure to blood from an infected client         principles reduces the risk of transmission of
SECTION 02E                    or practitioner should be put in place by the        blood-borne and other pathogens.
                               adoption of safe practices and procedures. This
PRINCIPLES OF INFECTION
CONTROL – SAFE HANDLING,       should include immunisation against hepatitis B      Everyone providing treatments to clients
STORAGE AND DISPOSAL OF        (Department of Health, 2010a).                       should know about and be able to carry
WASTE MATERIALS                                                                     out these standard principles for infection
SECTION 02F                    Factors in infection control practice                prevention and control (National Institute for
PRINCIPLES OF INFECTION        The risk of transmission of infection can be         Health and Care Excellence 2012). To that end
CONTROL – CLEANING AND         minimised by:                                        they should have received training in:
DISINFECTION OF THE
ENVIRONMENT                    • Good cleanliness of the premises where the         • Hand hygiene and skin care.
                                 tattooing and/or body piercing is taking           • The use of personal protective equipment
SECTION 02G – REFERENCES
                                 place, and of the fixtures and fittings.             (PPE).
                               • Good personal hygiene of the practitioners.        • Sharps management and management of
                               • Correct cleaning and sterilization or                exposure to blood and body fluids.
                                 disposal of instruments, materials and             • Safe handling, storage and disposal of
                                 equipment processes in place.                        waste materials.
                                  It is therefore important that the safe           • Cleaning and disinfection of the
                                  working practices described in this                 environment.
                                  guidance are followed at all times in order
                                  to protect both the client and practitioner.

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       Section 02b Infection prevention and control
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SECTION 02A                     PRINCIPLES OF INFECTION                             As a gold standard for infection control
                                CONTROL – HAND HYGIENE                              purposes,it recommended that hand wash
INTRODUCTION
                                                                                    basins should:
STANDARD PRINCIPLES OF          Hand hygiene is a major component of the
INFECTION CONTROL               standard principles and one of the most             • Have elbow/foot-operated or non-touch
                                effective methods to prevent transmission             mixer taps.
SECTION 02B
                                of pathogens by reducing the number                 • Have wall-mounted cartridge soap
PRINCIPLES OF INFECTION
CONTROL – HAND HYGIENE          of microorganisms that may be present.                dispensers and paper towels available at
Hand washing facilities
                                The spread of infection from hands is well            each hand wash basin.
When to wash hands              recognised and the importance of compliance         • Not have a plug or overflow or be capable
What to use to wash hands       with hand hygiene practices is emphasised in          of taking a sink plug.
How to carry out hand washing   all national and international guidelines.
                                                                                    • Not have taps aligned to run directly into
Use of hand rubs
                                Hand washing facilities                               the drain aperture.
Hand care
Use of hand cream               Hand washing facilities should be adequate          • Have waterproof splashbacks.
Care of broken skin             and conveniently located in treatment areas.        • Have space allowed at the design stage for
Poster – How to handwash        Hand washing instructions should be clearly           the placement of waste bins next to the
SECTION 02C                     displayed at the hand wash basin, such as in          hand wash basin.
                                the form of a poster.
PRINCIPLES OF INFECTION                                                             When to wash hands
CONTROL – PERSONAL
                                See Poster – How to handwash                        • Before and after an intervention with
PROTECTIVE EQUIPMENT
                                Hand wash basins must be designated for that          each client.
SECTION 02D
                                purpose only and have a constant supply of hot      • After contact with any blood or body fluids.
PRINCIPLES OF INFECTION
CONTROL – MANAGEMENT OF         and cold running water, ideally delivered through   • Immediately after the removal of gloves.
SHARPS AND EXPOSURE TO          a mixer tap. Under no circumstances should          • After using a tissue or handkerchief.
BLOOD AND BODY FLUIDS           equipment be washed in hand wash basins.
                                                                                    • After smoking.
SECTION 02E
                                Liquid soap dispensers with single use              • After visiting the toilet.
PRINCIPLES OF INFECTION
                                liquid soap cartridges/bottles should be            • Before and after eating.
CONTROL – SAFE HANDLING,
STORAGE AND DISPOSAL OF         used, ideally wall-mounted, although free
                                                                                    • Immediately after any other activity or
WASTE MATERIALS                 standing dispensers would be considered
                                                                                      contact with a client’s surroundings that
SECTION 02F                     suitable. Disposable liquid soap cartridges are
                                                                                      could potentially result in hands becoming
                                recommended because they do not permit a
PRINCIPLES OF INFECTION                                                               contaminated.
CONTROL – CLEANING AND          topping-up process and this minimizes the risk
DISINFECTION OF THE             of contamination.                                   What to use for hand washing
ENVIRONMENT
                                Wall-mounted disposable paper towels should         For an ordinary hygienic hand wash, the
SECTION 02G – REFERENCES                                                            use of liquid soap is sufficient. Preparations
                                be next to the hand wash basins, and fully
                                stocked at the start of each working day to         containing antiseptics that have a residual
                                minimise or reduce the need to fill up within       effect on the skin surface are not required for
                                hours during which the premises is operational.     use in tattoo and body piercing settings.

                                A foot-operated pedal bin, of an appropriate
                                size, should be placed next to the hand wash
                                basin for disposal of paper towels.

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       Section 02b Infection prevention and control
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SECTION 02A                     How to carry out hand washing                        Use of hand rubs
INTRODUCTION                    There are three distinct and essential stages        Hand rubs containing alcohol based products
                                to handwashing (National Institute for Health        can enable practitioners to quickly and effectively
STANDARD PRINCIPLES OF
INFECTION CONTROL               and Care Excellence, 2012)                           clean their hands before and after contact with
                                                                                     clients. However, the use of a hand alcohol
SECTION 02B                     1. Preparation                                       rub/gel is not a substitute for using soap and
PRINCIPLES OF INFECTION            Before washing hands, all wrist and hand          water for hand washing e.g. when undertaking
CONTROL – HAND HYGIENE
                                   jewellery should be removed. Cuts and             tattooing and body piercing procedures (see
Hand washing facilities            abrasions must be covered with waterproof         above), and should not be used when the hands
When to wash hands
                                   dressings. Fingernails should be kept short,      are visibly soiled or potentially contaminated
What to use to wash hands
                                   clean and free from nail polish. Hands should     with body fluids (National Institute for Health
How to carry out hand washing
                                   be made wet by placing them under tepid           and Care Excellence, 2012). Hand rubs should
Use of hand rubs
                                   running water before applying liquid soap.        conform to the standard BS EN 1500. The hand
Hand care
Use of hand cream                                                                    rub solution must come into contact with all
                                2. Washing and rinsing                               surfaces of the hand; the hands must be rubbed
Care of broken skin
Poster – How to handwash
                                   The hand wash solution must come into             together paying particular attention to the tips of
                                   contact with all of the surfaces of the           the fingers, the thumbs and the areas between
SECTION 02C
                                   hand. The hands must be rubbed together           the fingers, until the solution has evaporated.
PRINCIPLES OF INFECTION            vigorously for a minimum of 10–15
CONTROL – PERSONAL
                                   seconds, paying particular attention to           Hand care
PROTECTIVE EQUIPMENT
                                   the tips of the fingers, the thumbs and the       Use of hand cream
SECTION 02D
                                   areas between the fingers. Hands should           A hand cream can be applied regularly to
PRINCIPLES OF INFECTION            be rinsed thoroughly.
CONTROL – MANAGEMENT OF                                                              protect skin from the drying effects of regular
SHARPS AND EXPOSURE TO                                                               hand decontamination (National Institute
                                3. Drying
BLOOD AND BODY FLUIDS                                                                for Health and Care Excellence, 2012). Each
SECTION 02E
                                   In a tattooing and body piercing setting,         practitioner should have their own supply and
                                   good quality disposable soft paper towels         a communal pot should not be used.
PRINCIPLES OF INFECTION
                                   would be considered the method of choice
CONTROL – SAFE HANDLING,                                                             Care of broken skin
STORAGE AND DISPOSAL OF            because communal towels are a source of
WASTE MATERIALS                    cross-contamination. Paper towels should          Unbroken skin is the best defence because it
SECTION 02F                        be stored in a wall-mounted dispenser             provides the perfect barrier against infection.
                                   next to the washbasin and thrown away             Small areas of broken or infected skin on
PRINCIPLES OF INFECTION
CONTROL – CLEANING AND             in a pedal operated waste bin. Hands              exposed parts of the practitioner’s body should
DISINFECTION OF THE                should not be used to lift the lid or they will   be covered with a waterproof dressing that
ENVIRONMENT                        become re-contaminated.                           completely covers the affected area.
SECTION 02G – REFERENCES

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        Section 02c Infection prevention and control
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SECTION 02A                    PRINCIPLES OF INFECTION                                 Types of protective clothing
                               CONTROL – PERSONAL                                      Work clothing
INTRODUCTION
                               PROTECTIVE EQUIPMENT                                    Practitioner clothing should be clean at all
STANDARD PRINCIPLES OF
INFECTION CONTROL              Personal protective equipment (PPE) should be           times, and professional in appearance. Work
SECTION 02B                    available to all practitioners and staff who may        clothing should be changed daily. Staff clothing
                               be at risk whilst working in the premises.              should not impede good hand washing,
PRINCIPLES OF INFECTION
CONTROL – HAND HYGIENE                                                                 therefore the wearing of short sleeved tops is
                               Assessment of risk                                      advocated (Department of Health, 2010b).
SECTION 02C
                               Regulation 3 of the Management of Health                Gloves
PRINCIPLES OF INFECTION
                               and Safety at Work Regulations (Northern
CONTROL – PERSONAL                                                                     COSHH requires employers to assess any
PROTECTIVE EQUIPMENT           Ireland) 2000 requires every employer to make
                                                                                       substances hazardous to health, including
Assessment of risk             a suitable and sufficient assessment of:
                                                                                       biohazards within blood and body fluids (such
Types of protective clothing   a) risks to the health and safety of their              as blood-borne viruses) and take steps to
Work clothing                     employees to which they are exposed                  reduce the risk of exposure.
Gloves                            whilst they are at work; and
− Glove choice                                                                         The use of gloves has two purposes:
                               b) risks to health and safety of persons not in their
− Synthetic materials
− Latex gloves
                                  employment arising out of or in connection           1. To protect the hands from becoming
− Sterile gloves
                                  with the conduct by them of their undertaking.          contaminated with dirt and microorganisms.
− Gloves used for cleaning     Therefore the selection of protective                   2. By changing gloves, to prevent transfer of
Aprons                         equipment must be based on an assessment                   microbes from one client to another.
Eye and face protection        of the risk of transmission of infection between
SECTION 02D                    the practitioner and client and vice versa:             Gloves must be worn when carrying out invasive
PRINCIPLES OF INFECTION
                                                                                       procedures, when in contact with sterile sites
CONTROL – MANAGEMENT OF        Anticipated Wear           Wear plastic Wear eye        and non-intact skin or mucous membranes, and
SHARPS AND EXPOSURE TO         level of    disposable     or fluid     and face        during all activities that have been assessed
BLOOD AND BODY FLUIDS          exposure    gloves         repellent    protection      as carrying a risk of exposure to blood, body
                                                          apron
SECTION 02E                                                                            fluids, secretions or excretions, or to sharp or
PRINCIPLES OF INFECTION        No                                                      contaminated instruments (National Institute
                               exposure                                                for Health and Care Excellence, 2012).
CONTROL – SAFE HANDLING,
                               to blood/
STORAGE AND DISPOSAL OF
                               body fluids
WASTE MATERIALS                                   X             X            X         The correct method for wearing and removing
                               anticipated
SECTION 02F                                                                            gloves can be found on the WHO Save Lives
                                                                                       website: (http://www.who.int/gpsc/5may/
PRINCIPLES OF INFECTION
CONTROL – CLEANING AND                                                                 Glove_Use_Information_Leaflet.pdf). Hands
DISINFECTION OF THE            Exposure                                                must be washed and dried thoroughly before
ENVIRONMENT                    to blood/                                               putting on disposable gloves.
                               body fluids
SECTION 02G – REFERENCES       anticipated
                                                 Yes           Yes           X         Gloves can tear or puncture visibly during use,
                               but low risk
                               of splashing                                            or leakage may occur through microscopic
                                                                                       holes. Hands may also become contaminated
                                                                                       as gloves are removed. Gloves therefore must
                               Exposure                                                not be seen as a substitute for good hand
                               to blood/                                               hygiene. Used gloves should be disposed of as
                               body fluids
                               anticipated
                                                                                       offensive waste (see waste section).
                               with high         Yes           Yes          Yes
                               risk of
  ➲ Main contents              splashing
                               to the face
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        Section 02c Infection prevention and control
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SECTION 02A                    Gloves are single-use items (National Institute      Nitrile
                               for Health and Care Excellence, 2012). This          • Provides an excellent biological barrier,
INTRODUCTION
                               means they must be put on immediately                  resistant to punctures and tears.
STANDARD PRINCIPLES OF         before an episode of client contact or
INFECTION CONTROL                                                                   • Comparable to latex in terms of barrier
                               procedure and removed as soon as the activity
                                                                                      performance.
SECTION 02B                    is completed, or when leaving the client for
PRINCIPLES OF INFECTION        any reason. Gloves must be changed between           • Is a good alternative for latex sensitive
CONTROL – HAND HYGIENE         different procedural activities for the same           individuals.
SECTION 02C                    client and between dealing with different            • Can be used where a latex free
PRINCIPLES OF INFECTION        clients, or removed if they become torn.               environment is necessary.
CONTROL – PERSONAL
                               Glove choice                                         • Is less elastic than latex but does shape to
PROTECTIVE EQUIPMENT                                                                  the wearer’s hand over time.
Assessment of risk             Gloves should be made available in a range of
                               sizes for use by different practitioners (National   • Can be used for handling certain chemicals
Types of protective clothing
                               Institute of Clinical Excellence, 2012).               (Infection Control Nurses Association, 2002).
Work clothing
Gloves                                                                              However, nitrile contains the same types of
                               All gloves used for direct client care must
− Glove choice                                                                      chemicals as latex in the manufacturing process
                               conform to current EU legislation (CE marked
− Synthetic materials                                                               and allergic reactions have been reported.
− Latex gloves
                               as for single use) and should be appropriate
                               for the task. Only PPE meeting the basic health      Polyisoprene and Neoprene
− Sterile gloves
− Gloves used for cleaning     and safety requirements of the EC Personal           • Offers effective protection against viral
Aprons                         Protective Equipment Directive requirements is         penetration.
Eye and face protection        entitled to carry a CE mark and be sold for use      • Has similar elasticity and physical
SECTION 02D                    in the EC (Health and Safety Executive, 2012a).        properties as latex.
                               Practitioners should therefore look for the CE
PRINCIPLES OF INFECTION                                                             • Is suitable for individuals sensitised to latex
CONTROL – MANAGEMENT OF        mark information on glove packs plus EN 374-
                                                                                      proteins.
SHARPS AND EXPOSURE TO         1:2003 or EN 374-2. These markings show the
BLOOD AND BODY FLUIDS          gloves are protective against chemicals and          • Can be used when a latex free environment
                               can resist microorganisms at a performance             is necessary (Infection Control Nurses
SECTION 02E
                               level 2 test in penetration tests. Although            Association, 2002).
PRINCIPLES OF INFECTION
CONTROL – SAFE HANDLING,       this cannot infer protection against viruses,        Vinyl
STORAGE AND DISPOSAL OF        because they are not used in the performance         • Is suitable for use in areas where there is a
WASTE MATERIALS                tests, in practice this is the highest level of        low biohazard risk.
SECTION 02F                    protection afforded against microorganisms
                                                                                    • Provides a good alternative for use when
PRINCIPLES OF INFECTION        (Health and Safety Executive, 2012a).
                                                                                      staff or clients are sensitised to latex.
CONTROL – CLEANING AND
                               Synthetic materials                                  • In lab tests shows increased permeability
DISINFECTION OF THE
ENVIRONMENT                    Neoprene and nitrile gloves are synthetic gloves       to blood borne viruses than latex.
SECTION 02G – REFERENCES       which have been shown to have comparable in-         • Possesses lower tensile strength than latex
                               use barrier performance to natural rubber latex        and breaks down more frequently.
                               gloves in laboratory and clinical studies.
                                                                                    • Is prone to leaking.
                                                                                    • Is inelastic and can be baggy to wear.
                                                                                    • Is inexpensive in comparison to synthetic
                                                                                      rubbers (Infection Control Nurses
                                                                                      Association, 2002).

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