I 2003 JAG wrote a summary interpretation for my colleagues who were questioning a website recommending an instrument processing method that seemed unusual and unsafe. Egenhet med denna metod var att tatuering och piercing utrustning skulle vara autoklav [fuktig värme] processed före rengöring.

Sammanfattningen

After researching the Unimax System and exploring the supposed benefits, I propose a safer solution for tattooists [och piercers] would be to use pre-sterilized disposable [utrustning, som] rören och pre-sterilized nål-staplar, 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 denna metod].

Den huvudsakliga fel i systemet:

[Systemet föreslår att] equipment only needs rinsing or wiping off with disinfectant cloth before heat is applied.

• Sköljning försvagar men tar inte bort proteinerna som, 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 gång sköljas och torkas, equipment that is allowed to dry and have heat applied at the end of the work day compounds the difficulty of removing [koagulerat] proteiner.

Common bench top autoclaves are only capable of sterilizing clean or new equipment that does not have any sort of cavity, porositet, 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 (värmebeständig endotoxins) kokas on and into scratched surfaces on tools, särskilt rör.

Protein och bläck rester inuti tatuering tips

Protein och bläck rester inuti tatuering tube

Protein och bläck rester inuti tatuering grepp

För piercing, Detsamma gäller, though new jewelry and equipment all can be sterilized in a type B vacuum or type S positive pressure flush process autoclave, som beskrivs i det bifogade dokumentet.

Min personliga åsikt:

[JAG] 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 Wrote:

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 från Piercing erfarenhet Wrote:

Du kan verkligen inte håller med dessa slutsatser. Dock, 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, oberoende forskare, and health regulatory authorities. Specific examples of the inadequacies of the provided counter arguments will be provided in a point for point format.

Wes Wrote:

Lokaler och slutsatserna har tolkats nedan följt av en vederläggning.

Argumentet # 1

A. Endotoxin förstörelse, inactivation or removal is the criteria for demonstrating the efficacy (tillförlitlighet) av en.

B. Endotoxins tas inte bort med hjälp av gravitation deplacement sterilisatorer.

Ingående: Hur allvarlig förskjutningen sterilisatorer är inte tillförlitliga.

Motargument # 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, Premiss A är falskt, therefore the conclusion is not proved by the argument.

Ben wrote:

Denna tolkning av argumentet är, i bästa fall, an unintentional misrepresentation. Vid någon punkt är 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. Viktigare, 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 täcker denna utvärderingsprocess]

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: borttagning av endotoxins [före sterilisering] is a functional component of those parameters.

Frågan om primära betydelse, dock, 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 Förenade kungariket.

Wes Wrote:

Argumentet # 2

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

B.Clean eller ny utrustning: endotoxin gratis.

C. Used tattoo and piercing equipment contain endotoxins.

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

Motargument # 2

Clean means relatively free of gross contamination that would interfere with the sterilizing process. Det är en fråga om grad, not an absolute. Clean does not mean the absence of endotoxins. Premiss A är falskt, 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 wrote:

Parsningen av Argument #2 vore mer korrekt:

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 Wrote:

Argumentet # 3

A. Bench top autoclaves cannot sterilize the inside of tubes, hollow spaces, porositet heller håligheter.

B. Tattoo tubes have hollow spaces inside of tubes.

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

Vederläggning argument # 3

Steam penetrates and reaches every available area providing massive heat transfer, inklusive håligheter, 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. Slutsatsen är falskt.

Ben Wrote:

Denna sammanfattning representerar ett missförstånd av mekanik en ånga steriliserats. Ånga används som en metod för att leverera värme energi till ytor skall steriliseras. Pressurization av ångan är nödvändiga att nå en temperatur vid vilken den kan effektivt Sterilisera ytor. I en passiv luft deplacement, de pressurization på avdelningen förskjuter passivt luften. Någonstans att luften kan svällas (ett vulkanutbrott, gångjärn, eller tube), luften själv är högtryck på ett sådant sätt att ånga inte tillförlitligt penetrera det. Torr luft inte effektivt sterilisera ytor vid samma temperatur som ånga gör.

Denna fråga är helt enkelt inte öppen för debatt: Det är en klinisk faktum och, i många fall, rättslig förordning. Den [En13060] MDA kategorisering av bänk topp Steam sterilisering utrustning tydligt stater som skriver N utrustning (passiv luft deplacement) är inte lämplig för sterilisering instrument med gångjärn, rör eller lumen, sprickor, sprickor, andra ytdefekter, porösa ytor (inklusive gasbinda), eller förpackade varor. Detta undantag omfattar nära alla objekt som används i tatuering och piercing fältet.

Wes Wrote:

Argumentet # 4

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

B. Tattoo and piercing should use the safest method.

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

Vederläggning argument # 4

Om en ny och en används objekt är steril är både säkra. Being ”nya” innebär inte att det är säkrare. Premise A is false and does not support the conclusion that disposable tools are safer.

Ben Wrote:

Using the equipment and methods commonly used in the reprocessing of tatuering och piercing instrument, 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 vederläggning bygger på den felaktiga förutsättningen att instrument kan vara lämpligt upparbetas på ett kostnadseffektivt sätt med tillförlitlig resultat. Detta begrepp har upprepade gånger och konsekvent besegrats i kliniska prövningar och medicinsk forskning under de senaste tre årtiondena. Detta är, sorgligt att säga, en typisk representation av contemporaneousness av medicinska kunskaper i gemenskapens organ konst: standarder som reviderades i den 60′s är i allmänhet tros vara aktuella kunskaper när, Självklart, de ’ t. Sterilisering normer och praxis har reviderats grundligt eftersom passiv deplacement ånga sterilisering var vanligt på sjukhus inställningar, särskilt under de senaste åren med ökad medvetenhet om hivinfektioner och genotypen patogena beteenden och uthållighet.

Wes Wrote:

Tack för att ge mig möjlighet att svara dessa invändningar.

Ben Wrote:

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

Slutsatser

1. Sterilisering bör vara säkrare för nya, oförorenad, ordentligt rengjorda objekt än upparbetat objekt.
2. Om upparbetning är anställd, Det bör göras enligt bevis baserade vetenskapliga rekommendationer.

MER INFORMATION

• CDC riktlinje för desinfektion och sterilisering i sjukvårdsinrättningar, 2008
• En kort historia om sterilisering
• Arbeta med en Statim autoklav

Jag ’ m intresserade av att veta om dina tankar om detta ämne. Kommentera nedan för att fortsätta denna diskussion.