Are you using sterile gloves for body piercing procedures?
If you are not, using an Aseptic Non Touch Technique with sterile engineering controls to prevent client contamination is an alternative that you can use now with equipment that you already have.
- The burden of proof
Fitness for purpose: Sterile gloves, be they exam or surgical are designed and tested to prevent contamination of a wound. Non-sterile gloves are designed and tested to protect the wearer from the patient. No proof in our industry other than anecdote refutes that. Sterile gloves fulfill the need for a desired outcome.
- Views on sterile gloves
- An Assessment of the Endotoxin Contents of Natural Rubber Latex Medical Gloves
- The Point has had a few submissions and editorial responses that bear re-reading
[with my notes]
Why All Responsible Piercers Must Use Them
The hands are the major source of pathogen transmission in medical procedures. Doctors didn’t even wash their hands as an infection control measure until 1847, when Ignaz Semmelweiss showed that the incidence of pleural sepsis in a Vienna maternity ward could be reduced from 18.7% to 1.27%, if doctors simply washed their hands in chloride of lime between performing post-mortem examinations and attending women in childbirth.
At first, his methods were met with contempt and ridicule by the established medical community. It wasn’t until 1861, when Joseph Lister used Louis Pasteur’s discovery of microbial infection to develop a method of antisepsis in surgery, that the medical profession began to pay proper attention to handwashing. Lister’s method reduced the death rate in surgery by over 50%, but gloves weren’t adopted by medical practitioners until the turn of the century.
Even though hand washing has long been recognized as the greatest disease prevention, doctors still don’t follow this practice responsibly. A recent study of the intensive care unit of the Royal Children’s Hospital, Melbourne, Australia, showed that only 4.3% of doctors complied with the standard of handwashing before and after coming into contact with a patient.
Even if hands are washed properly, there are still remaining pathogens which can cause infections. This is why gloves were adopted for surgery—they provide a more effective barrier against transmission. The closest analogy I can find to performing a piercing in medical procedure is the insertion of a catheter [indwelling , urethral, etc] into a patient. All the nursing manuals that I have examined say that the procedure must be carried out using aseptic technique, using sterile gloves.
Aseptic or “sterile” technique is a method developed to diminish the spread of potential pathogens to a bare minimum. There are strict principles governing the methods of aseptic technique; objects which are only clean (not sterile) are regarded as potentially contaminated by pathogens, because only sterilization can completely remove all pathogens. If a clean object comes into contact with a sterile object, both must be regarded as contaminated.
Even clean gloves must be regarded as contaminated, because they are exposed to the air, and therefore airborne pathogens. Because of the way they packed, they cannot be donned in an aseptic manner—they’re all pushed in together and can’t be pulled out without touching the exterior of the gloves. This means that any pathogens remaining on the piercer’s hands after washing are transferred to the exterior of the gloves, and onto the jewelry, tools, needles, and skin of the customer. This means that any pathogens on the gloves will be given direct access to the wound.
It can be taken for granted that responsible piercers sterilize their needles, instruments, and jewelry, and use sterile dressing trays to work from. Therefore, the only remaining part of the process which stops the method from conforming to aseptic technique. As all other parts of the process used for piercing are sterile, sterile gloves must be used, and donned using aseptic technique.
Sterile gloves come individually sterilized and wrapped. They must be opened in a specific manner, and donned so that the hands don’t touch the exterior of the gloves, for them to be regarded as sterile. All good nursing training manuals describe the methods for donning sterile gloves using aseptic technique. Any responsible piercer must be aware of and use these methods.
Some people might ask, “what of the added expense?” As sterile gloves cost between $1 and $2 a pair don’t think there is any excuse for not using them. They are the last and most vital component in the aseptic method, and their use should be compulsory for any responsible piercer.
The Piercing Temple
(ed: I feel it necessary to make a few comments on this article. In doing so, I am not at all implying that sterile gloves are an invalid option. If you find the funds and means to use sterile gloves in your piercing studio, then by all means, please do so. However, I disagree that the use of sterile gloves is compulsory for piercers. [Sterile gloves or ANTT are required to maintain sterility of the jewelry until it leaves your studio, when it becomes the client’s responsibility.]
Cheyenne draws an analogy between piercing and insertion of catheters; I am assuming urethral catheters. [indwelling (venous) catheter is common, and directly related to needle asepsis and ANTT or sterile gloves] The urethra is a sterile vacuum, and a direct path to the delicate and infection-prone bladder. Of course the most sterile materials would be used in this procedure. By contrast, let’s take a realistic look at body piercing:
The piercee enters the studio, covered with city dust, sweat, and dirty clothes. The immaculately clean studio, equipped with an air cleaner, hopefully prevents him/her from adding significantly to the pathogen load in the air, and the piercer watches all piercees carefully to prevent any cross-contamination, but each individual piercee is walking germ ball, if you’ll pardon the expression.
In the room, the piercer thoroughly disinfects the area to be pierced, and uses sterile instruments and jewelry. We all know what happens next: [a sterile bandage should be applied] the piercee gropes at the jewelry, says, “I love it! Thanks!” and then proceeds to put his or her dirty clothes back on and walk back out into the city streets. The jewelry will have already rotated matter into the fresh piercing several times before the piercee has even left the studio. [use a sterile bandage and barbell if possible to avoid this] While we as professional piercers do our very best to minimize incidents of transmission, we aren’t in “sterile” operating room conditions, and can’t expect to maintain absolute control over our environment where piercees are involved.
My greatest concern with sterile gloves is their potential for abuse due to the inaccurate name. [the name is accurate, since they were sterilized] “Sterile” gloves aren’t any more or less sterile than “clean” gloves once they’re in the open air of your studio, [this is false] but I have heard of tattooists, piercers, and even doctors touching things left and right without changing their gloves. Why not? Because the gloves are magically “sterile!” [this is a straw man, and spurious]
Cheyenne very correctly states that there is a right and wrong way to put on a pair of gloves. That method should be used irregardless [sic] of the type of gloves being donned. Assuming that clean gloves are stored properly (in a stainless steel or heavy plastic container with no-hand access, protected from air, moisture, light, and heat), and used appropriately, I feel that they are equivalent to sterile gloves for our purposes. [nonsterile and sterile gloves are not cleaned, handled, packaged, nor stored the same way by the manufacturer, as seen in the video that follows]
As for the cost of sterile gloves: most piercers / know use anywhere from three to six pairs of gloves for a single piercing. If sterile gloves are being used to prevent cross-contamination of clean items to sterile items, then it follows logically that sterile gloves should be used throughout the procedure, not just for the piercing itself. That adds up to $2 per piercing using nonsterile gloves, and $12 per piercing using sterile gloves.
[nonsterile gloves are used for clean steps, and only one pair of sterile gloves is required for handling the sterilized items such as jewelry and needle for a procedure: still under a dollar] Adding in all the other costs of disposable piercing equipment, my guess is that few piercees would want to pay the much higher piercing fee, and may end up at a less expensive hack shop instead. [safer body piercing costs a fraction more, and clients are willing to pay. Not every person will be your client, but the ones who are, care about safety]
I repeat that I’m not at all against the use of sterile gloves, or any other innovation that makes piercing safer, cleaner, or easier for the piercee. But it’s important not to forget that most “piercers” still wear no gloves at all, and that enforceable regulation should be kept to minimum health and safety standards, with an emphasis on cross-contamination awareness. Mandating what amount to academic fine points [were the gloves that handle the jewelry sterilized or not?] is simply not realistic at this time in piercing’s growth. I’d be interested to hear what others have to say on this debate. Any takers? [it is realistic, and was in practice when this article was published in a significant number of studios, including Piercing Experience]
San Francisco, CA
Sterile Gloves & Digressions
I would like to start of by stating how good it is to see these discussions occurring.
I agree that sterile gloves are the best way to go, however I do not think they should be mandatory. [nonsterile gloves can be used to hold the handles of sterile instruments when trained to practice ANTT] I do not agree with some of the comments by both Cheyenne and Michaela.
First off, the cost, you can get sterile gloves for $0.70 a pair. If you pay more you are being robbed.
Secondly, one can use the sterile field which the glove package provides to lay your instruments on without touching the instruments. This means you need only use 1 pair of sterile gloves per piercing. An increase of only $0.70 per piercing.
Thirdly, although the gloves are being exposed to the air in the piercing room, they should only be exposed for 10 minutes, not 2 days like regular gloves. If we go through the trouble of using sterile needles, clamps, jewelry, Q-tips, and toothpicks, why not our gloves? I think that this is the best way to go. As I stated earlier I don’t think that it should be mandatory, but at least discussed and aired for piercers, so they can make their own choice.
When I mentioned sterilizing the jewelry I did NOT mean a 10 minute soak! I mean individually packaged and sterilized jewelry. If the needle which is only in the body for a few seconds must be sterilized, why not then the jewelry? Yes people are going to stick their dirty nasty hands all over their fresh piercing, but it is the piercee’s dirty nasty hands, not the hands of the manufacturer, the packaging boy, the counter person, and maybe even the piercer. How many times a week does a manufacturer cut his/her hands while making jewelry?!?
c/o Primeval Body
Los Angeles, CA
(Ed. note: Thank you for your comments! I feel I must clarify a few points.
* I do support the use of sterile gloves when possible. I do not think they are necessary and I do not think it is realistic or even worthwhile to make sterile gloves mandatory. [personal incredulity: if it seems that one can get away without sterilizing their equipment or jewelry, that does not make a persuasive argument]
*I maintain that several pair of gloves must be used for each piercing. When you touch the piercee with the Betadine, your gloves now carry bacteria from their previously unwashed skin. They should be changed before marking. [sterile swabsticks with handles provide for ANTT practice] During marking it is almost inevitable that you will touch a part of the piercee not cleaned by Betadine, and many piercers will also be touching a reusable, albeit disinfected, pen. [reuse of marking implements is not safe, cleaning should be performed prior to marking, followed by a final painting of sterile antiseptic] The gloves should be changed prior to piercing. After piercing the gloves may have touched the contaminated tray or sharps container, and should be changed if the piercer returns to the piercee. While breaking down the setup and disinfecting the room, no fewer than 3 other pairs of gloves will be necessary to avoid contamination of the room. None of these glove changes will be affected either way by creating sterile room setup packets. This is about basic cross- contamination. [sterile gloves are needed only for handling the other sterilized items, nonsterile gloves for all other preparations and room cleaning]
* Air, according to many physicians, is technically considered sterile. All gloves, tissues, and other disposable supplies sold in the United States are gamma-ray sterilized prior to being sold. [this is a myth, only items marked as sterilized with documentation] Until the box is opened, the contents are sterile. Once opened, I and most other piercers easily go through a box or more of gloves each day. Assuming that that box is stored properly and handled to avoid cross-contamination, these gloves will not be any less “sterile” than a pair of sterile gloves. [false, these gloves were not sterilized]
* My primary concern is that doctors, piercers, and others using “sterile” gloves will assume that the “sterile” condition of their gloves relieves them of the responsibility to avoid cross-contamination. I have seen this occur. [straw man and false dilemma: adequate training for asepsis is required whether ANTT or sterile gloves or a combination are used]
*The APP suggests at least a bulk sterilization of all jewelry when it arrives at a shop. This is, however, a minimum requirement, and assumes that bulk-sterilized jewelry will be stored away from display stock, and handled only with gloves or hemostats after sterilization. In this case, a 10 minute disinfectant soak in Madacide would certainly be adequate to remove any minimal matter that was present on the jewelry. [The APP does not currently allow this inadequate infection control practice, based on false and misleading opinions] It is far preferable, however, to individually sterilize each item and store jewelry in individual sterile packets until ready to use. [sterilization is required]
More on Sterile Gloves
Whenever the subject of sterile gloves comes up in this forum, it is usually shot down according to the price difference between sterile and non sterile latex exam gloves. The difference can be made up for by preparing sterile gloves in your own studio. Latex gloves, folded with the cuff over the body of the glove, CAN be run through an autoclave—it is only necessary to change the settings to run at 260° for 10-15 minutes. [see further discussion on the could and should of glove sterilization here]
The gloves are unaffected by the dry cycle, although powdered gloves can become sticky— powder congeals in the fingertips. The powder must be removed from the gloves before using on a client. We utilize a sterile hand wipe impregnated with synergistic alcohol com pounds (eg Discide or Madacide). [this might damage the glove, distilled or DI water would be more appropriate] It’s better to use non powdered gloves, though.
As it has been stated, sterile gloves are not magical. The true advantage to using sterile gloves only becomes evident when paired with proper technique. The use of sterile gloves is irrelevant without a strong understanding of cross-contamination.
Procedures for sterile gloves
- Wash and dry hands. Don mask if required.
- Masks prevent the introduction of contaminants from or to mouth.
Masks should be on or off, not dangling around the neck. Dangling masks allow bacteria which has been filtered into the mask to dry and become airborne. Masks should be donned and removed by touching the strings only to reduce cross-contamination. Masks should be changed between clients, or if they become moist.
- Perform 3 to 10 minute handwash. Remove rings, watches, jewelry, nail polish— sources that can harbor bacteria.
- Wet hands and arms from elbows to fingertips under flowing water. It is preferable to use sinks with side or foot pedal. Clean from least to most dirty.
- Place antibacterial soap on hands and rub vigorously for 5 to 30 seconds; use disposable scrub brush gently. Do not abrade skin. Create friction to remove microorganisms. Use warm water—it has lower surface tension than cold. Soap lowers surface tension of water and emulsifies oils.
- Scrub all skin areas: joints, finger nails, between fingers.
- Rinse hands from fingers to elbows. Wash from cleanest to least clean areas.
- Dry hands with sterile towel moving from fingers to wrist. Dry hands from cleanest to least clean areas.
- Turn off faucet with foot pedal or towel. Prevent the recontamination of hands.
- Masks prevent the introduction of contaminants from or to mouth.
- Don exam gloves to set up tray. Open prep/marking materials.
- Re-glove with exam gloves.
- Prep/mark until satisfactory.
- Dispose of prep setup (encapsulating within the gloves worn.)
- Re-glove with exam gloves. Open sterile packaging.
- Open packages outer flap away from you. Prevent reaching over exposed sterile materials.
- Use inside of package to form sterile field.
- Remove and discard exam gloves as well as any excess packaging. Prevent field contamination.
- Don sterile gloves.
- Do not touch body of glove. Pick up one glove by cuff and slip fingers of other hand into glove. Pull glove over hand. Place gloved hand inside remaining glove. Slide hand into glove and pull cuff over hand and wrist. As always, do not touch skin, hair, or clothing with gloved hands.
- Pull gloves securely over fingers and adjust fit using one gloved hand to fix the other.
- After gloving, move to equipment and begin piercing.
Possible advantages to using sterile gloves
- Less noticeable swelling of piercings due to contaminants.
- Decreased incidence of contact dermatitis from glove powder (surgical grade talc or corn starch, impregnated with latex proteins)
Possible disadvantages to using sterile gloves
- Extra time spent preparing packages for sterilization (up to ten minutes per day)
- Cost (up to 20 cents extra per package) [alternately a slightly higher cost to purchase sterile gloves, without the time cost]
- Package 2 pairs per bag
- Wrap each pair in paper barrier
— Jeff Martin/[Raquel] René Martin Outreach Coordinator
Rites of Ascension/Obscurities
From The Point #13
in the studio
A few options you can use to improve the quality of the piercing experience… Many of these options may sound familiar, as they are widely employed.
Make your own sterile gloves
You can use a light inner wrap for glove sterilization in an ordinary autoclave according to manufacturer’s instructions. You can use open gloving technique. Nothing unsterilized may touch their outer surfaces after sterilization or else they must be discarded and a new pair of sterile gloves must be donned to complete the procedure.
Packaging for sterilization— all or nothing
You can include jewelry, gloves, gauze, and needles as well as instruments in one wrap instead of separate wraps.