Tattooing, body piercing and other skin penetration - safe operation

If you are operating a tattooing, body piercing or other skin penetration business, you need to minimise the risk of spreading diseases, such as HIV, Hepatitis B and Hepatitis C, and infections to your customers. The requirements of the Public Health (Infection Control for Personal Appearance Services) Act 2003 and the Infection Control Guidelines for Personal Appearance Services apply. You must keep a copy of the Infection Control Guidelines for Personal Appearance Services at your premises.

What is tattooing and tattoo removal?

Tattooing is the process of puncturing the skin with a needle to introduce coloured pigment leaving a semi/permanent mark, including cosmetic enhancement (also called cosmetic tattooing, pigment implants, semi/permanent creations, permanent makeup or dermal pigmentation). Cosmetic enhancement involves the same method of application as tattooing and is, therefore, subject to the same controls and procedures.

Tattoo removal using skin penetration involves the use of tiny needles to inject liquid into the skin causing the tattoo pigment to move to the skin’s surface.

Infection control qualification

Each person who performs tattooing, body piercing and other skin penetration must hold a 'HLTINF005 - Maintain infection prevention for skin penetration treatments' qualification. This course is available from a number of registered training organisations, for more information visit training.gov.au. You need to provide copies of your employees statement of attainment to Council, before starting your business.

Personal hygiene

Handwashing is the most important measure in preventing the spread of infection. You must wash your hands:

  • before and after each client
  • before putting on and after removing gloves
  • before contact with instruments that penetrate the skin
  • after contact with blood or other body substances
  • after contact with used instruments and jewellery
  • after eating, smoking, going to the toilet
  • whenever hands are visibly soiled
  • in any other circumstance when infection risks are apparent.

You must not smoke while attending to a customer. You need to wear clean clothing and closed puncture-resistant footwear and cover all cuts and abrasions with adhesive water-resistant dressings.

Equipment

Needles and other equipment used for skin penetration must be sterile, disposable and single-use wherever possible.

If you choose to use re-useable needles or other skin penetration equipment (tube, nozzle, needle bar, barrel) ensure you clean and sterilise them prior to each use. Good quality stainless steel products are better for this purpose. Cosmetic tattooists must only use equipment that has single-use disposable parts which are incapable of allowing blood and body fluid to flow back into the device.

Needles

  • do not use hollow (hypodermic) needles for tattooing as skin damage will occur. Also, the needles cannot be effectively cleaned and sterilised
  • handle sterile needles with sterile forceps
  • if you accidentally touch a needle at any stage during the process, you must be replace it immediately with a sterile one
  • do not test needles for sharpness on the operator’s skin before use
  • check needles or equipment for defects by inspection or insertion into a sterile pad before use. Dispose of any needles that have burrs, hooks, damage or blunt points to prevent injury to clients.

Razors

  • use a disposable plastic safety razor on one client only
  • if you use a standard safety razor with a disposable blade, dispose of the blade after use on one client
  • traditional cutthroat razors are not recommended for use.

Dyes and solutions (not sterile)

  • tattooing inks, dyes, pigments or solutions used for one client must not be used for another client
  • dispense enough solution for one client into sterile disposable containers; discard container and left over solution upon completion
  • if you use non-disposable containers, ensure you clean and sterilise them prior to each use
  • store ink and solutions in a way that protects them from contamination
  • ensure water or other liquid used for mixing inks is free from contamination (i.e. use treated drinking water or ethyl alcohol).

Stencils

  • single-use stencils, screens or patterns are highly recommended
  • clean and disinfect all re-useable stencils, screens or patterns before re-use
  • fix stencil to client’s skin using clean soapy water (do not reuse this soapy water on another client)
  • do not reuse reusable applicators to apply stencils on another client (e.g. deodorant sticks)
  • use a sterile spatula or applicator to apply products like petroleum jelly to the skin
  • clean all implements and containers after use.

Cosmetic tattooing or micro-pigmentation machines

  • clean and sterilise machine or needle tips, needles and the machine barrel casing
  • wipe the casing covering the motor with a clean paper towel moistened with warm water and detergent and allow the casing to air dry after the tattooing procedure for each client is completed
  • change the disposable coverings or use clean linen for each client
  • open sterile equipment at the start of the procedure and either place equipment on a sterile surface/tray, or remove it directly from packaging as required
  • the skin around the site must be cleaned with a skin antiseptic prior to starting. For the area around the eyes, the site must be cleaned with warm water
  • shave the site using a single-use disposable safety razor where possible
  • wash hands, thoroughly pat dry and put on new single-use gloves
  • tattoo an outline of the design on the skin
  • tattoo the colour or shade of the outline on the skin
  • use pre-dispensed cleaning solution and single-use wipes to remove excess pigment or solution and blood from the tattoo/removal site and dispose of wipes into the clinical and related waste container
  • remove antiseptic cream from a single-use container and apply to the tattoo/removal site using a single-use spatula
  • cover site with a sterile dressing
  • remove gloves and wash and dry hands
  • change the needle assembly or hand piece after each client use.

Jewellery

  • sterile packaging must be opened just before piercing is to be performed
  • only sterile jewellery is to be inserted into the opening. Check that the jewellery material can be sterilised, e.g. surgical grade stainless steel, niobium, solid 14K or 18K white or yellow gold, titanium, platinum
  • only handle sterile jewellery with sterile gloves.

Post treatment

  • dispose of all used single-use items (other than sharps), such as gloves, applicators, ink caps, used tissues and wipes, into the infectious waste bin
  • remove the elastic bands and plastic coverings from the tattoo machine and dispose of them into the infectious waste bin
  • dismantle tubes, needles and needle bars from the tattoo machine and place them into a puncture-resistant container, which can be sterilised
  • clean the area and all equipment:
    • tattoo machine – first wipe with a clean dry cloth, then wipe with a clean cotton wool or a pad saturated with 70% w/w ethyl alcohol. Allow to dry naturally. Store hand piece in a clean puncture proof covered container
    • motor – use warm water and detergent on a moistened paper towel, then allow to dry
    • needle and needle bar - clean and sterilise before breaking the needle and disposing into a sharps waste container
  • clean all storage items, including containers and their lids
  • clean and sterilise or dispose of ink cap trays.

After care information

Provide your client with after-care information, including:

  • cleaning of site
  • infections and what to look for
  • general care instructions
  • healing times
  • demonstrate to the client how to care for the tattoo to prevent infection
  • see a general practitioner and advise the tattooist or operator if the wound becomes infected.

It is a good idea to provide information in writing and to check if the client understands it.

Record keeping

Record keeping

If your business conducts higher risk personal appearance services you must maintain the following records:

  • Client information:
    • name, address and date of birth of the client
    • date of the high risk personal appearance service procedure
    • site and type of high risk personal appearance service procedure
    • instruments used (including sterilising batch number)
    • name of the operator who provided the service/administered the procedure
  • staff immunisation: it is recommended that staff undergo follow-up serological testing after immunisation course is complete.
  • staff training and qualifications
  • needlestick injuries in the workplace
  • if cleaning reusable equipment using an autoclave:
    • sterilisation records:
      • date and cycle number
      • exposure time and temperature
      • list of items processed
      • most autoclaves can print records. If your autoclave does not have a printer or the printer breaks, you will need to use a chemical indicator (Class 4, 5 or 6) or manually record the results for every cycle (every 15-30 seconds depending on the type and cycle).
  • maintenance records of the autoclave: showing any repair or service based on manufacturer’s instructions.
  • validation certificates: provided by an on-site technician who must perform process validation annually and every time the autoclave is repaired or serviced. If you cannot find timely on-site technical support, you must use a chemical indicator (Class 5 or 6) or a process challenge device every cycle until the on-site technician can attend, validate and provide a certificate.

You can buy sterilisation record books; alternatively, you can make your own or use the templates:

Remember that some autoclave printouts may fade over time - check them regularly and photocopy, photograph or scan as necessary.

All records should be kept for at least 7 years - they are important as they protect you and your customers. You are accountable for customer safety; documentation can be used as a defence against complaints. For more information, read the Infection Control Guidelines for Personal Appearance Services.

Check your compliance

You can use the operator checklist to check your business's compliance and test your infection control knowledge using the operator knowledge assessment question and answer sheets: