1.1 Can I get infectious diseases from tattoo needles?

1.2 What to look for in a sanitary shop environment.

1.3 Can I get AIDS from tattooing?

1.4 Can my tattoos get infected?

1.5 How to look for sterilization

1.6 Are there any medical conditions that will preclude me from getting a tattoo?

1.7 What is the Alliance of Professional Tattooists?

1.8 Should I get a vaccination shot against hepatitis?

1.1 Can I get infectious diseases from tattoo needles?
There has been some concern recently regarding transmittable diseases (particularly Hepatitis-B and AIDS [HIV]) and tattoo shops. Just as in a dentist's office, as long as the area is strictly sanitized, your chances for infection will be greatly reduced.

Note: If you plan on getting lots of bodyart (pierces or tattoos), you should seriously consider getting immunized against Hepatitis-B. Hep-B is a much more serious concern than HIV as the virus is much more virulent and easier to catch.



1.2 What to look for in a sanitary shop environment.
The current popularity of tattooing and body piercing has also brought on an increase in potentially hazardous conditions. For this reason, I am posting the following guideline of what to look out for (in this situation, "artist" refers to both tattooists and piercers):

- Lighting: The area must be well-lit so the artist can see what s/he is doing.

- Counter and floor space should be lightly colored, preferably white so dirt shows up easier.

- The spray bottle the artist uses on your skin should be disinfected between customers, or some kind of protective film such as Saran Wrap should be used.

- Disposing needles: All needles must be either discarded after EACH use (or at least with each new customer), or autoclaved. Many body piercers operate out of small booths and may not have spent money for an autoclaver, in which they MUST dispose of each needle. NO EXCEPTIONS. Reusing piercing needles is equivalent to sharing IV drugs with strangers.

- Needles touching other things: The needles, once open from their sanitary packages, must not be placed on unsanitized surfaces. The piercer should NOT set the needle down on the table, or, heaven forbid, DROP THE NEEDLE ON THE FLOOR!!! If this happens, insist they open a new needle.

- Gloves: The artist must wash their hands prior to putting on their gloves, preferably with an antibacterial/antiseptic solution. Once they put their gloves on, they should not touch anything other than your skin, the needle, and the jewelry. They should not be filling out receipts beforehand, or answering the phone--unless these have been wiped clean beforehand.

- Is there a sink separate from the bathroom sink? -Does the artist use a disposable razor when shaving skin?

- The Speed Stick used as an ahesive for the tattoo pattern should not be directly applied to the skin, but applied first to a tissue which can then be used on the skin. -Autoclaves should be inspected regularly.

- Sterile materials should be stored in sealed containers away from things that could cause body fluids or ink to splash on them -The palate that holds the ink caps should be covered with Saran Wrap -After tattooing, the ink caps should be discarded and the ink not reused or poured back into the bottles

Be particularly wary of "outdoor fair booths." While many are run by caring, experienced artists, these booths allow fly-by-night operators to make some fast money and disappear. If you don't know the artist, spend time watching them work on others first. Are they reusing needles? Do they use needles that have dropped on the ground?



1.3 Can I get AIDS from tattooing?
IMPORTANT NOTE: This section refers to tattooing specifically, and not to other forms of bodyart. Some, such as piercing and cutting, require the breaking of the client's skin to a deeper level than what is achieved with a modern tattoo machine.

This section on AIDS & Tattooing has been contributed by Nick "Buccaneer" pirate@netcom.com Baban , who studied at the Univ. of Michigan School of Public Health, Dept. of Epidemiology. He spent the summer researching AIDS and IV drug use in NYC. "I'm not an expert, but I consider myself knowledgable. Any furthur questions about AIDS can be e-mailed to me."

Obviously there is some concern about AIDS and tattooing because when you get a tattoo, you bleed. But the mechanism of transmission needs to be better understood.

AIDS is transmitted by intimate contact with bodily fluids, blood and semen being the most comon. Intimate contact means that the fluid carrying the AIDS virus (HIV) enters into your system.

Injection drug users (IDUs) use hollow medical syringes and needles to inject drugs directly into their bloodstream. It is common practice to withdraw a little blood back into the syringe to delay the onset of the high. When needles are passed from IDU to IDU and reused without sterilization, some of that blood remains in the syringe and is passed on to the next user. If infected blood is passed, the recipient can become infected with HIV, which leads to AIDS.

Tattooing is VERY different from injecting drugs. The needles used in tattooing are not hollow. They do, however, travel back and forth through a hollow tube that acts as an ink reservoir. The tip of the tube is dipped into the ink, which draws a little into the tube. As the needle withdraws into the tube, it gets coated with ink. When it comes forward, it pierces your skin and deposits the ink. You then bleed a little through the needle hole. This happens several hundred times a second.

You are only at risk of infection if you come in contact with infected blood. Since it is only *your* skin that is being pierced during the tattooing process, only *your* blood is being exposed. This means that the only person at greater risk is the artist, because s/he is the only one coming in contact with someone else's (potentially infected) blood. This is why reputable (and sane) tattoo artist wears surgical gloves while working.

Another source of infection is through the use of infected tools. *This is why it is IMPERATIVE that you make sure your tattoo artist uses sterile equipment.* Needles and tubes need to be autoclaved before EACH AND EVERY time they are used. Ink should come from separate cups and not directly from the bottle. Any leftover ink should be disposed of and not reused under ANY circumstances.

The key to HIV transmission is *transfer of bodily fluids.* Evidence indicates that infection may require a (relatively) substantial ammount of fluid to be passed. A pin prick almost certainly won't do it. HIV is also a very fragile virus that cannot survive long outside the human body, and is very easy to kill via autoclaving. (I have heard of using bleach to sterilize needles. While bleach is an effective HIV killer, I'm not sure of the procedures for cleaning the equipment after bleach cleaning. As I personally have no desire to have bleach put under my skin, I go with autoclaving as the proper way to sterilize).

If your tattooer maintains sterile conditions and proceedures, there is almost no risk of infection. I say "almost" because any risk, no matter how miniscule, is still a risk and must be recognized. That said, I am the proud owner of a Jolly Roger tattoo on my right shoulder because I knew my tattooist and knew he had sterile conditions.



1.4 Can my tattoos get infected?
Not as long as you take care of your new tat. There is a section in the FAQ that covers healing methods in depth. Some people have trouble healing tattoos with colors they are allergic to. If it gets infected and refuses to heal after a few days of using a topical antibiotic, you may want to check with a doctor. Keep in mind this assumes you are a healthy individual without any condition that suppresses your immune system.



1.5 How to look for sterilization
Check out the shop thoroughly. Don't be lulled into a false sense of security by a clean look. If the needles are not disposed of after each person, then it MUST be "autoclaved." Autoclaving is a process that pressurizes the instruments and kills any virus or bacteria that might transmit viruses or bacteria. My dentist has two autoclavers--one gas and one steam--both pressurizing down to 250fsw. He also has spore samples that he autoclaves and sends to a pathology lab to make sure the machines are working.

Ask the artist how they clean their needles. If they don't say they autoclave, you are taking your risks. If they say they do, ask to see their machine. Note that in some states, autoclaving is required by law. Other common-sense types of things include throwing out the ink after each customer. Make sure the artists have small wells for each ink color that they dispense from a larger container, and that these are thrown out after work on you is done. Compare the conditions of the shop to that of your dentist--does the artist wear gloves? Are the areas sprayed clean?

According to the Navy Environmental Health Center Medical Corps in Norfolk, Virginia, each year, a few cases of Hep-B are reported in people who've gotten tattoos within the last two months, but they have not been able to trace the disease back to its source, nor attribute it directly to the tattoo.

Becky Fenton AS.RAF@forsythe.stanford.edu says: "I spoke with a disease infection specialist at Kaiser [Permanente--US West Coast health care system], and there have not been any incidents (as of 1990) of HIV being spread *to* a recipient of a tattoo. If you think about it, the tattooist is much more at risk, as s/he has to touch the customer's blood.

David Zinner dzinner@desire.wright.edu notes that a blanket statement regarding the use of autoclaves could be misleading. While an autoclave will kill the HIV virus, it is not because of the efficacy of the 'clave, but because of the weakness of that particular virus. Far more insidious is Hepatitis, which is more tenacious, and which a 'clave does not always kill. He has gotten all of his info from CDC, by the way.

The irony, he says, is that now virtually anyone can afford a 'clave, because many hospitals are selling them secondhand for a very good price, and switching either to disposables, or purchasing dry-heat or chemical sterilizers. Chemical is the best rated, and he says that his friend's business has increased because of the precautions he takes.

In response to David's well-founded concern, Dr. Milton Diamond diamond@hawaii.edu from the UH School of Medicine who has been researching sexuality for 30 years, says: Hepatitis is easier to transmit than HIV but all the bugs will be killed IF the autoclave is run properly (i.e., set hot enough & long enough). Some instruments can not, however, be autoclaved since they cant take the heat. These have to be sterilized with viracides, "bug"acides and so forth. In any case, here in the States, EVERYONE should be using disposable needles.

The chemical bath is only as effective as how fresh is it, how concentrated, what chemicals, how "dirty" or contaminated the instruments, how long in the bath, which particular bug is under attack, etc. It is not the device, autoclave or chemical bath, that is as important as the operator. There are many different bugs out there. HIV may be one of the most deadly and Hep among the more easily transmitted but many others have to be considered (including Chlamydia, the infection rate of which is 20%!) and "he who aims at one, hits one." "Mo betta aim fo dem all." If the artist or piercer is conscientious, reliable and knowledgeable, either device could serve. Again my general rule still stands: "EVERYONE should be using disposable needles."

Dr. Kai Kristensen tattoodoc@jps.net says: The needles that push the ink into the skin (below the epidermis or outer covering and into the mid-dermis or support structure under the epidermis) can transmit disease UNLESS STERILE TO BEGIN WITH. When they have been used on you, whatever bugs you carry in your blood can be transmitted to the next person. The most commonly transmitted disease by needlestick is Hepatitis B (and C). Clearly AIDS could be transmitted even though not documented yet to my knowledge.

The skin should be cleaned with antibacterial soap and water and scrubbing before the procedure to lessen the normal population of germs on the hide. Alcohol doesn't do much but tends to degrease and cool, so no harm but no substitute.

USE OF DISPOSABLE GLOVES: A conscientious, professional tattooist or piercer will often go through A DOZEN DISPOSABLE GLOVES on one client. Gloves SHOULD be changed every time they touch unsanitized items with their gloves. If you see that the artist does not change gloves after answering the phone, they are not being sanitary. Marginally acceptable is if they pick up the phone (or other objects, such as pencil) with a tissue. Optimally, they should use a new pair of gloves after each potential contamination.

1.6 Are there any medical conditions that will preclude me from getting a tattoo?
If you have hemophilia. There is even a case of a man who was HIV positive who got a tattoo--if you are HIV+ however, you will want to inform the artist, since it's the artist that is at more risk than you. [In the case of the HIV+ man, he was John Baldetta, a former nursing assistant at Harborview Medical Center in Seattle, who got a tat on his forearm that said "HIV Positive." He was suspended for three days without pay and told he could return if he covered up the tat. He refused and was subsequently fired, although he was not an RN and was not doing anything that would put patients at risk.]

However, it is best to let the artist know if you have ANY medical condition, such as diabetes or epilepsy, in case of an emergency.

If you have multiple allergies, you can always have the artist do a "patch test" on you with the colors you want prior to returning for a regular tattoo. This is similar to patch tests done for perms and hair coloring, and will help you determine if your body will react to some of the pigments.

Also, it is generally not considered a good idea to tattoo pregnant women.

1.7 What is the Alliance of Professional Tattooists?
This section was contributed by Pat Sinatra patstats@aol.com , a professional tattoo artist and vice president of the organization:

The Alliance of Professional Tattooists (APT), Inc. is a professional standards organization that was established in March 1992 and officially incorporated in June '92 as a non-profit organization (contributions, fees and educational materials are tax deductible.

Their activities:
- Continuing education to artists

- Offers accurate, up-to-date information about communicable diseases through seminars

- Is interested in preserving tattooing as an artform

- Monitors legislative activity to prevent over-regulation (controlled or banned)

- Believes in keeping the art of tattooing safe and legal through education, knowledge and awareness

- Offers reliable information to tattoo lovers about safe tattoo practices to ensure your health.
Headquartered in Maryland, its international membership has expanded from the US to Canada, Europe and other countries. They are currently establishing state chapters with state directors.

Their nine-hour seminar entitled, "Preventing Disease Transmission in Tattooing," is taught by APT secretary, Dr. Kris Sperry (Fulton County Medical Examiner, involved with tattooing for over 10 years). Designed in 1988 to educate health care workers (including tattooists) in the prevention of infection and the implementation of professional standards,the program was specifically redesigned in 1991-1992 for the needs of the tattooist and is the standard for APT members. Since the 1991 Bloodborne Pathogens Rule, APT, Inc. has designed this manual for tattooists.

PDTT is presented in various locations throughout the country at a one time fee of $125.00 (APT members) or $300.00 (non-members). This course is open to the Professional and Associate levels only. Members are required to complete this seminar within two years after initial application.

While we have noted that many individuals are promoting videos on this subject, OSHA (the US Occupational Safety & Health Association that regulates work-environment safety) says that an infection control program cannot be taught by video, but by an on-site knowledgable individual on site.

OSHA believes that the in-person interaction between instructor and student is vital to the education of this serious subject, and that individual questions regarding infection control, universal precautions, disease transmission, pathology, etc., must be answered by a knowledgeable, credible instructor such as Dr. Sperry.




1.8 Should I get a vaccination shot against hepatitis?
Without everyone worried about HIV transmission, it is easy to forget that hepatitis (specifically hep-B) is a much stronger and virulent virus to worry about. Fortunately, you *can* get protection against both hepatitis A and B! Check with your health insurance to see if it's covered--otherwise, you might have to shell out $200 or so for both. There are two shots (injected a month apart) for hep-A, and three shots (injected over the course of six months) for hep-B. You are strongly urged to get protected if you are planning to get tattoos *OR* pierces on a regular basis.

As a warning however, note that a very small percentage of individuals react negatively to Hepatitis B vaccines, and could actually become ill from the vaccines themselves. If you are contemplating getting vaccinated for Hep B, talk to your health care professional to weigh the risks against the benefits. Note: Not all health care professionals are apprised of the most current statistics on the adverse effects of Hep B vaccines.