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. Underlige av denne metoden var at tatovering og piercing utstyr ville være autoklav [fuktighet heten] processed før du rengjøring.

Sammendraget

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 [utstyr, eksempel] rør og pre-sterilisert 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 metoden].

Den største feilen i systemet:

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

• Skylling utvanner 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 tørket, equipment that is allowed to dry and have heat applied at the end of the work day compounds the difficulty of removing [koagulert] 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 endotoxins) er kokt on and into scratched surfaces on tools, spesielt rør.

Protein og blekk rester inne tatovering tips

Protein og blekk rester inne tatovering røret

Protein og blekk rester inne tatovering grep

For piercing, det samme gjelder, 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 vedlagte dokumentet.

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 erfaring skrev:

Du er absolutt ledig å være uenig med disse konklusjoner. Men, 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, uavhengige 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:

Lokalene og konklusjonene analyseres nedenfor etterfulgt av en innsigelsen.

Argumentet # 1

A. Endotoxin ødeleggelse, inactivation or removal is the criteria for demonstrating the efficacy (pålitelighet) av en sterilisering prosess.

B. Endotoxins fjernes ikke ved hjelp av tyngdekraften forskyvning autoklaver.

Konklusjon: Tyngdekraften forskyvning autoklaver er ikke pålitelig.

Innsigelsen argumentet # 1

Inaktivering av Spore, 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, Premisset A er USANN, therefore the conclusion is not proved by the argument.

Ben skrev:

Denne tolkningen av argumentet er, i beste fall, an unintentional misrepresentation. Ikke på noe punkt 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. Enda viktigere, 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 dekker denne evalueringsprosessen]

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: fjerning av endotoxins [før sterilisering] is a functional component of those parameters.

Problemet av primær betydning, imidlertid, 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, som den [FDA eller] MDA i Storbritannia.

Wes skrev:

Argumentet # 2

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

B.Clean eller nytt utstyr betyr endotoxin gratis.

C. Used tattoo and piercing equipment contain endotoxins.

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

Innsigelsen argumentet # 2

Clean means relatively free of gross contamination that would interfere with the sterilizing process. Det er et spørsmål om grad, not an absolute. Clean does not mean the absence of endotoxins. Premisset A er falske, 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:

Analyseringen av argumentet #2 mer ville hensiktsmessig være:

A. 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

A. Bench top autoclaves cannot sterilize the inside of tubes, hollow spaces, porøsitet eller hulrom.

B. Tattoo tubes have hollow spaces inside of tubes.

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

Innsigelsen til argumentet # 3

Steam penetrates and reaches every available area providing massive heat transfer, inkludert hulrom, 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. Konklusjonen er falske.

Ben skrev:

Dette sammendraget representerer en misforståelse av mekanikken i en steam steriliseringsprosessen. Steam er brukt som en metode for levering av termisk energi til overflaten skal steriliseres. Pressurization av damp er nødvendig å nå en temperatur som det kan effektivt sterilisere overflater. I en passiv luft forskyvning prosess, den Pressurization av kammeret fortrenger passivt luften. Hvor som helst som luften kan være fanget (en sprekk, hengsel, eller rør), luften i seg selv er Trykk på en slik måte at steam ikke pålitelig trenge det. Tørr luften ikke effektivt i henhold overflater ved samme temperatur som Steam gjør.

Denne saken er ikke bare åpen for debatt: Det er en klinisk faktisk og, i mange tilfeller, juridisk forskrift. Det [En13060] MDA kategorisering av benk toppen damp sterilisering utstyr klart stater skriver inn N-utstyr (passiv luft forskyvning) er ikke egnet for sterilisering instrumenter med hengsler, rør eller lumen, sprekker, sprekker, andre overflate mangler, porøse overflater (inkludert gasbind), eller pakket varer. Denne ekskluderingen dekker nær hvert element som brukes i tatovering og piercing feltet.

Wes skrev:

Argumentet # 4

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

B. Tattoo and piercing should use the safest method.

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

Innsigelsen til argumentet # 4

Hvis både en ny og en brukt elementet er sterilt de er begge som trygge. Being ”nye” innebærer ikke at det er tryggere. 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 innsigelsen er basert på the false premiss som instrumenter kan bli hensiktsmessig behandles på nytt på en kostnadseffektiv måte med pålitelig resultater. Dette begrepet har vært gjentatte ganger og konsekvent beseiret i kliniske forsøk og medisinsk forskning de siste tre tiårene. Dette er, trist å si, en typisk representasjon av contemporaneousness av medisinsk kunnskap i kroppen kunst samfunnet: standarder som ble revidert i den 60′s er vanligvis antatt å være gjeldende kunnskap når, selvfølgelig, de Aren ’ t. Sterilisering standarder og praksis har blitt grundig revidert siden passiv forskyvning dampsterilisering var vanlig i sykehus innstillinger, spesielt de siste årene med økende bevissthet om retroviral og prion patogene atferd og utholdenhet.

Wes skrev:

Takk for ga meg muligheten til å svare på disse innvendingene.

Ben skrev:

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

Konklusjoner

1. Sterilisering bør være tryggere for nye, forurenset, riktig renset elementer enn reprocessed elementer.
2. Hvis reprosessering er ansatt, det bør gjøres i henhold til evidensbasert vitenskapelige anbefalinger.

MER INFORMASJON

• CDC retningslinje for desinfeksjon og sterilisering i helsevesen fasiliteter, 2008
• En kort historie om sterilisering
• Arbeide med en Statim autoklav

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