I 2003 JEG wrote a summary interpretation for my colleagues who were questioning a website recommending an instrument processing method that seemed unusual and unsafe. Ejendommelighed ved denne metode var at tatovering og piercing udstyr ville være autoklaven [fugtig varme] forarbejdes før rengøring.

Resuméet

After researching the Unimax System and exploring the supposed benefits, I propose a safer solution for tattooists [og piercers] would be to use pre-sterilized disposable [udstyr, såsom] rør og pre-sterilized nål-barer, eliminating the need for a studio autoclave and the labor expense and risk for cleanup.

This appears on the surface very much a thoughtful and logical approach. The available scientific literature agrees with some of it in principle, particularly the statement though there are flaws based on several dangerous misconceptions. Cleaning contaminated tools is not possible for tattoo and piercing shops [med denne metode].

Den største fejl i systemet:

[Systemet foreslår, at] equipment only needs rinsing or wiping off with disinfectant cloth before heat is applied.

• Skylning dæmper men fjerner ikke proteiner, particularly after a long or messy procedure.
• Wiping tools with disinfectant leaves a chemical residue as well as the proteins which is corrosive to instruments and the autoclave itself.
• En gang skylles eller udslettet, equipment that is allowed to dry and have heat applied at the end of the work day compounds the difficulty of removing [koagulerede] proteiner.

Common bench top autoclaves are only capable of sterilizing clean or new equipment that does not have any sort of cavity, porøsitet, hollow spaces or tubes. En passiv, type N gravity displacement sterilizer as shown and described in the Unimax system is not physically capable of cleaning the inner surfaces of the tattoo tubes reliably.

Proteiner (varmebestandig endotoksiner) er kogt on and into scratched surfaces on tools, især rør.

Protein og blæk restkoncentrationer inde tatovering tip

Protein og blæk restkoncentrationer inde tatovering røret

Protein og blæk restkoncentrationer inde tatovering greb

For piercing, det samme gælder, though new jewelry and equipment all can be sterilized in a type B vacuum or type S positive pressure flush process autoclave, som beskrevet i det vedhæftede dokument.

Min personlige mening:

[JEG] don’t bother trying to reuse anything, the evidence has shown that no piercing or tattoo equipment can be reused reliably.

Rebuttal and discusson

Wes Woods skrev:

I disagree with the conclusions that tattoo and piercing should dispose of used contaminated equipment instead of re-processing them for re-use.

Ben Carruth, min kollega fra Piercing oplevelse skrev:

Du kan ganske vist frit uenig med disse konklusioner. Dog, in order for that disagreement to have weight above and beyond a personal opinion, the argument must be refuted with the degree of care and precision with which it was made, which in this case means logically cogent presentation of principles and contextually appropriate citation of reference and research materials provided by international health agencies, uafhængige forskere, and health regulatory authorities. Specific examples of the inadequacies of the provided counter arguments will be provided in a point for point format.

Wes skrev:

Lokaler og konklusioner er parset nedenfor efterfulgt af en indsigelse.

Argumentet # 1

En. Endotoxin destruktion, inactivation or removal is the criteria for demonstrating the efficacy (pålidelighed) af en sterilisationsproces.

B. Endotoksiner fjernes ikke ved hjælp af tyngdekraften deplacement autoklaver.

Konklusion: Grovhed deplacement autoklaver er ikke pålidelige.

Lejlighed Argument # 1

Inaktivering af Sporedannelse, Stearothermophilus, is the most widely accepted test for the efficacy of autoclave sterilization accepted by the CDC and OSHA not the removal or destruction of endotoxins. Depyrogenation is not a required level for an item to be considered sterile for medical tools and equipment. Argumentet # 1, Forudsætning A er falsk, therefore the conclusion is not proved by the argument.

Ben skrev:

Denne fortolkning af argumentet er, i bedste fald, an unintentional misrepresentation. På intet tidspunkt er Endotoxin presence directly equated with the testing criteria for effective operation. The elimination of Endotoxins is a functional requirement of the terminal decontamination and sterilization process, as active endotoxin presence represents a potentially severe health risk. Endnu vigtigere, the survival of endotoxin due to inappropriate processing indicates that more durable pathogens are potentially present: pyrogens and prions being of particular concern. [ASTM F748 dækker denne evalueringsprocessen]

Spore testing is the most widely accepted means of determining the efficacy of sterilization equipment to perform within its defined parameters. Spore tests are conducted to make sure that the equipment is operating up to its defined parameters: fjernelse af endotoksiner [forud for Sterilisation] is a functional component of those parameters.

Udstedelse af primær betydning, dog, is that which lies beyond the capabilities of the equipment in question. There is not a benchtop steam sterilization system in existence that has been rated for reliable destruction of pathogenic prions or blood-shielded enveloped viral Hepatitis C when used with methods that do not adequately remove soil such as the Unimax system. The capabilities of differing sterilization systems are closely and carefully defined, and it is the responsibility of the practitioner to use the equipment as it was designed to be used. The specific capabilities of a particular device must be assessed by a regulatory authority, Sådan som de [FDA eller] MDA i Det Forenede Kongerige.

Wes skrev:

Argumentet # 2

En. Bench top autoclaves can only sterilize clean or new equipment.

B.Clean eller nyt udstyr betyder endotoxin frie.

C. Used tattoo and piercing equipment contain endotoxins.

Konklusion: Used tattoo and piercing equipment cannot be sterilized using a bench-top sterilizer.

Lejlighed Argument # 2

Clean means relatively free of gross contamination that would interfere with the sterilizing process. Det er et spørgsmål om grader, not an absolute. Clean does not mean the absence of endotoxins. Forudsætning A er falsk, and premise B is false. Premise C is false unless there is some study that demonstrates that endotoxins are likely to be present. The conclusion is false because sterilization is measured by spore testing not endotoxin indicators.

Ben skrev:

Parsing af Argument #2 mere ville passende være:

En. Bench top steam sterilization equipment can only [effektivt] sterilize clean or new equipment.
B. Clean equipment is that equipment which is free of protein deposit, bioburden, or any other biological or chemical material which will impede delivery of thermal energy or presents a potential health risk in and of itself.
C. Used tattoo and piercing equipment has been contaminated with human blood on other potential infectious materials in such a fashion that has been clinically proven to harbor culturable pathogens. A study in the U.K. demonstrated that after processing including a tunnel washer and several hydro sonic processes, a tattoo tube still retained enough active biological material to successfully culture it. Repeated cleansing processes failed to remove this material.

Sterilization equipment is tested to see if it performs according to it’s designed parameters by regular spore testing. These tests do not indicate its ability to perform beyond its designed parameters.

Wes skrev:

Argumentet # 3

En. Bench top autoclaves cannot sterilize the inside of tubes, hollow spaces, porøsitet heller hulrummet.

B. Tattoo tubes have hollow spaces inside of tubes.

Konklusion: Tattoo tubes cannot be sterilized using bench top autoclaves.

Indsigelse til Argument # 3

Steam penetrates and reaches every available area providing massive heat transfer, herunder hulrummet, inside tubes and everywhere air reaches. Because the entire object is raised to the sterilizing temperature everything is sterile. Premise A is false and the conclusion is not proved. Konklusionen er falsk.

Ben skrev:

Dette resumé repræsenterer en misforståelse af mekanikken i et dampbad sterilisering. Damp bruges som en metode til levering af termisk energi til overfladerne, steriliseres. Trykpåvirkning af dampen er nødvendig at nå frem til en temperatur, hvormed det kan effektivt steriliseres overflader. I en passiv luft deplacement proces, den trykpåvirkning af salen passivt reaktionsmiljøet forskyder luften. Overalt, luften kan blive fanget (en sprække, hængsel, eller Metro), luften selv er Pressurised på en sådan måde, at damp ikke pålideligt trænge det. Tør luft effektivt ikke steriliseres overflader ved samme temperatur, damp er.

Denne sag er simpelthen ikke åben for debat: Det er en klinisk kendsgerning og, i mange tilfælde, juridiske forordning. Den [En13060] MDA kategorisering af bænken top damp sterilisation udstyr klart stater, skriver N udstyr (passiv luft forskydning) er ikke egnet til sterilisering af instrumenter med hængsler, rør eller lumen, revner, revner, andre overflade defekter, porøse overflader (herunder gaze), eller emballerede varer. Denne udelukkelse dækker nær hver vare, der bruges i tatovering og piercing felt organ.

Wes skrev:

Argumentet # 4

En. Disposing of used equipment is safer than sterilizing used equipment.

B. Tattoo and piercing should use the safest method.

Konklusion: Tattoo and Piercing should dispose of all used equipment.

Indsigelse til Argument # 4

Hvis en ny og en brugt vare er begge steril de er både som sikker. Being ”nye” indebærer ikke, at det er sikrere. Premise A is false and does not support the conclusion that disposable tools are safer.

Ben skrev:

Using the equipment and methods commonly used in the reprocessing of tatovering og piercing instrumenter, a used item will never be sterile again. A passive displacement steam sterilization process won’t sterilize the surface and the protein and biological payload cannot be removed with an adequate degree of certainty. A brief examination of the approach used by the medical community will reveal much: even with multi million dollar sterilization facilities and a large highly educated staff, most instruments that come in contact with human blood are disposed of. Those instruments that are reprocessed are of extremely high cost or are those that do not come into contact with broken skin. Din lejlighed er baseret på den falske forudsætning, at instrumenter kan være passende oparbejdes på en omkostningseffektiv måde med pålidelige resultater. Dette begreb har været gentagne gange og konsekvent besejrede i kliniske og medicinske forskning i de sidste tre årtier. Dette er, trist at sige, en typisk repræsentation af contemporaneousness af medicinsk viden i Fællesskabets organ kunst: standarder, der blev revideret i de 60′s er generelt menes at være aktuelle viden når, Selvfølgelig, de ’ t. Sterilisation normer og praksis er blevet grundigt revideret da passiv deplacement damp sterilisation var fælles i hospitalet indstillinger, især i de seneste år med stigende bevidsthed om retroviral og prion patogene funktionsmåder og udholdenhed.

Wes skrev:

Tak for at give mig mulighed for at besvare disse indsigelser.

Ben skrev:

And thank you for giving me the opportunity to address these common misconceptions about sterilization and basic safety precautions.

Konklusioner

1. Sterilisation skal være sikrere for nye, jævn vejoverflade, korrekt rengøres elementer end genbehandlet elementer.
2. Hvis oparbejdning er ansat, det skal ske efter evidensbaseret videnskabelige anbefalinger.

YDERLIGERE OPLYSNINGER

• CDC retningslinje for desinfektion og sterilisation i sundhedssektoren faciliteter, 2008
• En kort historie om sterilisation
• Arbejde med en Statim autoklave

Jeg ’ m interesseret i at vide om dine tanker om dette emne. Please comment nedenfor til at fortsætte denne diskussion.