The KY Conspiracy

Just the facts: Ointments (Bacitracin, Triple Antibiotic, etc.), versus water-based lubricants (KY, Surgilube, etc.):

1.) Water based lubricants: Benefits

A. Sterile

B. Individual single use packets

C. Hypoallergenic

D. Does not promote more resistant pathogens

E. No need to scrub tools after presoaking to remove residue — debatable point

F. Ultrasonic will be able to remove residue more easily

G. Prevents oil buildup on jewelry and piercing

H. Does not break down latex barriers (gloves)

2.) Ointment: Benefits

A. Sterile

B. Individual, single use packets

C. Allergic reactions/sensitivity extremely rare

D. Germicidal

E. Adequate wipe down, enzymatic or solvent presoak and mechanical scrubbing removes residue

F. Ultrasonic cleaning with immersion in enzymatic or solvent agent breaks down oil and removes microscopic residue 

G. Provides a barrier to rare bleeding

H. Does not cause latex breakdown in the short duration of the procedure

The enzymatic cleaning agents described are long chain fatty acid molecules v bond to oils, proteins, and gross soil, and pull them off surfaces during the presoak, mechanical, and ultrasonic scrubbing processes of decontamination prior to autoclaving. Alconox and most soaps (Allegedly some ophthalmic surgeons clean their tools with Joy [ed]) fit this description and work well.

The solvents described break apart molecular bonds dislodging and separating oils and ointment when used as a presoak and/or ultrasonic cleaning agent. Alcohol and Madacide (which is 15% alcohol) are examples of acceptable solvents.

Both lubricant types share common benefits A, B, and C. Sterility, a crucial point to any item inserted under the skin. Individual use packaging minimizes cross contamination. Negative reactions are exceedingly rare and confined to only the most sensitive individuals. Often reactive individuals will also be sensitive to other materials used in the procedure, and this information will be known if the piercer’s release form and pre-piercing questions are appropriately designed. Some people have reactions to compositions of both water-based and oil-based lubricants.

To address claims that antibiotic ointments cause bacteria of a more dangerous and resistant nature to develop, we must look closely at the time frame in which it would occur. It is accepted that piercees should not use antibiotic ointments as aftercare for the reasons described on the ointment’s packaging.

A piercing is a puncture wound and contraindicated for routine ointment application. The manufacturer’s label is a legal document and a guarantee that the product will perform as promised. Instructions direct use of varied amounts daily, for no more than five to ten days, stopping to seek medical attention should a reaction occur. For that period of five days or more the antibiotic effect is guaranteed effective with controllable and limited risk of resistance in the population of harmful microorganisms.

Used once, during a piercing, the level of risk is reduced exponentially, almost nullifying an already low risk. Weighing the initial and residual germicidal effects at the pierced site against the risk of significant growth of harmful pathogens, after a single use, shows the advantage of using antibiotic ointment over water based lubricants. It is maintained that should the ointment be applied as aftercare, the risk would indeed grow daily.

To address claim E, that manual cleaning as a step in the process of decontamination and sterilization could be reduced or skipped altogether is a fundamental issue. To remove gross soil and debris, and to break down ointment, either a washer/sterilizer (as used by hospitals or HYDRIM in a studio) or human hands provide the necessary mechanical friction to remove the soil. The tools are immersed in either an enzymatic cleansing agent or solvent after a presoak in disinfectant. The tools are scrubbed by either machine or by hand and brush. Without this step, the pathogens can and will remain in the crevices of tools, particularly tubes and the teeth of forceps. Regardless of ointment or water-based lubricant, this step is essential to prepare tools for ultrasonic cleaning and sterilization.

To address claim F, that ultrasonic waves will not remove the residue of ointments or other lubricants. It is essential to recognize the manufacturer’s instructions for ultrasonic cleaning. The assertion that instruments immersed in an ultrasonic device will not be cleaned of ointment is only correct when using no liquid agent other than water. A solution of enzymatic cleaning agent or solvent, used in accordance with the manufacturer’s directions will disperse residues of oil as well as hard-to-scrub microscopic debris.

Ultrasonic cavitation scrubs solid surfaces clean aided by chemical interaction. The high frequency vibration creates microscopic bubbles in instruments which implode, dislodging microorganisms and oils. Following tool processing by presoak, manual scrub, and ultrasonic action, instruments should be lubricated by soaking them in aqueous antimicrobial lubricant (i.e. surgical milk). This will prolong their operational life and also serve to keep corrosive antiseptics, body fluids, protein soil, skin debris, and oils like ointment from clinging to them in their next use after sterilization.

Claim G is not intrinsic as a disadvantage to ointment use. In the final clean down before the piercee leaves the studio, most lubricant residue will be washed off. Employing a cationic deter gent (benzalkonium chloride) to wipe clean the jewelry and pierced area, moving outward away from the center, will remove most residue. Any remaining residue inside or out will be absorbed by the body with a minimum of harmful results, or washed away during the first aftercare session.

Antibiotic ointments and their residue can provide advantages in the rare case when presented with unusual bleeding. Sterile application to cover the pierced area tends to swiftly stop blood flow and minimize the spread of bloodborne pathogens. This is the same working principle by which bleeding is staunched on broken skin surfaces during the process of tattooing. This barrier prevents further exposure risks and pro vides residual germicidal effects until washed away by soap and water.

Claim H is only a disadvantage in certain circumstances for ointment use. The swift aseptic installation of jewelry will not necessarily involve contact with ointment to gloved hands, depending on the barriers, tools, and amount of ointment used. If ointment contacts glove latex, gloves can easily be changed or carefully wiped, or the piercer can take the strong chance that the operation will be completed long before any latex breakdown occurs. Gloves such as SafeSkin can be worn to minimize that risk even further. Checking gloves for pinholes and wear and tear is a primary concern to the personal service worker in any case, to protect the wearer and piercee from each other’s pathogens.

In evaluation of the benefits of both ointments and water based lubricants, it is to the advantage of a piercing studio to keep both on hand. For the piercee who is reactive to antibiotic ointments but not water-based lubricants, the choice is clear. For the piercee who is sensitive to both, other lubricants are available, such as povidone iodine gel. For situations where a residual germicidal effect is desirable, or blood flow is to be staunched, the ointment is preferred. The potential for residue causing harmful levels of resistant pathogens after a single use is negligible.

The core of the issue is that both lubricants can do the job— causing a reduction in friction without contributing to contamination— and allergy to either is rare. Fundamentally, using one or the other cannot allow a piercer to avoid cleaning their tools manually. The residues left on instruments (skin, fluids, strong antiseptics, and more) absolutely MUST be presoaked and followed by a manual scrubbing to rough clean surfaces before finer particulate scrubbing by ultrasonic device action (microscopic cavitation). Effective cleaning agents must be employed at all stages of the process of decontamination and sterilization to fully destroy all pathogens.

Questioning piercees about allergies and medical history is every piercer’s responsibility. Thorough information is needed to make appropriate decisions about jewelry and procedure. Since human bodies do unexpected things before, during, and after piercings, what is most important is to gather, absorb, organize, and assimilate or adapt for a piercee’s own special circumstances. A plan of action will limit the potential for negative reactions from any source from start to finish. Safe piercing is the goal of this process.

Brian Skellie and Kevin Covella

Piercing Experience – Atlanta, GA