Point 74: President’s Corner – Brian Skellie

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Brian Skellie working with asepsis

Brian Skellie headshot at 2014 APP conference by April BerardiBrian Skellie
APP President

Technology for infection prevention:

Why the introduction of more technological advances help to reduce cross contamination risks

The benefits of thousands of years of advancements in infection control are applied and built upon daily: a brief history of sterilization.

Charles Chamberland’s Autoclave (1880), the first steam sterilizer
Chamberland’s Autoclave (1880), the first steam sterilizer
Denis Papin’s digester (1680), the first pressure cooker.
Papin’s digester (1680), the first pressure cooker.

Chamberland’s Autoclave (1880), the first steam sterilizer patterned after Papin’s digester (1680), the first pressure cooker.

Asepsis is the most effective technological advancement for a purposeful reduction of microbes to an irreducible minimum. This begins with policy and training, and follows through with checklists, review, and reminders for implementation.

Primum non nocere = above all else we should do no harm.

Antonj van Leeuwenhoek’s microscope (1683)
Antonj van Leeuwenhoek’s microscope (1683)

Physics was the first step in decontamination, using thermal energy: fire and the effects of the sun. Advances have been made in E-beam and radiation, both ionizing and non-ionizing, for sterilization. As a result, new equipment and supplies are now available providing an almost infinite sterilization shelf life. Part of what was found useful from the sun, apart from drying, was the power of short wavelength ultraviolet light to disrupt the DNA of cells. This has been harnessed for disinfection of exposed environmental surfaces, air, and water, but this form of sterilization is not appropriate for initial piercing jewelry. Further study of properties of the sun have resulted in functional plasma etching and cleaning processes and H2O2 gas plasma sterilization. At some point, gadgets for disinfection of procedure rooms such as UV-C robots and hydrogen peroxide (H2O2) vapor foggers may have an application in scale for our trade.

Joseph Lister’s antiseptic sprayer (1867)
Joseph Lister’s antiseptic sprayer (1867)

Chemistry was the next big step in the fight against preventable iatrogenic infection with germicides, from chlorine solutions and carbolic acid to EO gas. Recognizing the potential for stopping infection transmission during procedures by thoroughly cleaning the worker’s hands and the subject site with a germicidal product was an enormous step that has become part of our established thinking. Materials themselves can be used to leverage the natural properties of copper (Cu+) and silver (Ag) that make touch and transfer surfaces inhospitable to microbes, and other embedded compounds have been developed for similar purposes. Some even work with nanotech surface treatments.

Instrument cleaning technology is constantly improving on the basic two fronts of physical action and chemical reaction. Advancements in products safe for the worker and environmentally friendly have brought forth alkaline or enzymatic detergent, or peracetic acid options.

surgical tools from the late 1800s
outmoded surgical equipment from the late 1800s

Consumables have long been a source of worker and client protection and potential oversight. Gloves and other Personal Protective Equipment (PPE) do create a barrier when used correctly, but do not take the place of adequate hand hygiene and application of asepsis. For further protection against exposure to environmental hazards, wearable vapor detectors can be used to alert the worker of chemical hazards from cleaning and disinfecting products. Essential detectors for sterilization or cleaning parameters should be used for validation of each process. Test Soils with protein detection for washing instruments, even manual cleaning should be tested, and Chemical and regular Biological Indicators for sterilization loads.

Cleaning appliances have made validation tests easier and more repeatable, with the availability of small automated instrument washers and medical and dental ultrasonic cleaners. Our last line of defense against cross contamination comes from our environmental air quality, which can be improved with air cleaners equipped with HEPA filtration and UV, thermal or plasma disinfection, and floor scrubbers to vacuum up the dust, wash and dry the floor automatically and robotically.

The health and safety of our clientele and personnel depend on adequate sterilization and disinfection. The advancements listed have changed the way we do our jobs and protect ourselves from risk. As we look towards the future it is impossible to know the impact further technological advancements will have, but they will undoubtedly continue to change how we practice our trade.

Point 74: From the Editor – Marina Pecorino

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The Point - Issue 74

Marina Pecorino headshotMarina Pecorino
Managing Editor of Content & Statistics

I initially struggled to come up with direction for this editorial, partly because I feel that I’m somewhat of an outsider. I’m connected to the industry, obviously, but for now, I live my days in corporate America. On an issue geared toward technology in the industry, my brain immediately jumped to marketing, as this was one of my primary business roles during my time as a piercer. Honestly though, I think the biggest impact technology has for me currently is allowing me to connect so easily with all of you.

Throughout my life, I’ve found it difficult to stay in touch with friends when there is physical distance; I have great intentions, but my follow through can be lacking. Social media allows communication with my distant friends to become seamlessly integrated into my day-to-day life. I can now feel connected and do my introverted “lurk and like” while allowing people I care about to do the same.

Recently, I was trying to explain to my partner how supportive and appreciative the volunteer family is, even though many of us have only met in person a handful of times, if that. We’re not a daily face to face interaction in each other’s lives, but we still feel like family. I believe this to be true throughout the body modification community, which is one of the things I love most about having chosen this path. In many ways, my continued involvement in the industry is made possible because of the technology we have at our disposal.

It amazes me to realize that, as a result of my involvement with this industry, I’ve developed friendships with awe-inspiring people all over the world. Unfortunately, the last year seems to have dealt a lot of hard blows to our community. Having friends that span the far reaches of the globe can be extremely tough when someone is going through a particularly hard experience, and all I want to do is give them a hug. Technology makes connecting over these vast distances a little less difficult and allows us to show our support, even when physical proximity isn’t possible.

I have to admit that this editorial started out as a quick comment in the APP volunteers group, while curled up in bed. I only got a few words in, when I suddenly realized that what I wanted to express is my appreciation for the chance to feel so close, despite being so far away. What started as a quick comment, ended up evolving into a rough draft for an editorial. It’s pretty incredible what you can create with technology.

Point 74: From the Editor – Kendra Jane B

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The Point - Issue 74 - cover

Kendra Jane headshotKendra Jane Berndt
Managing Editor of Content & Archives

We are in a world where we double tap dozens of times a day, use our smart devices to track the most minute details of our days, and start to sweat at the thought of no wifi. In a relatively short amount of time our industry has embraced technology. We as piercers know what an important role social media and technological advances have on our jobs. As someone that has been given the good fortune of being able to reach many of my peers on a regular basis; I want to take this opportunity to hopefully provide you all with for some food for thought. A few “rules” if you will to navigate the waters of the tech ocean we are all trying to stay afloat in.

To be engaged in ones work, ones passion to apply oneself fully and wholly is an amazing thing. This used to mean spending hours pouring over books, old letters, even microfiche, or (yikes) actually talking to people. The art of the spoken word is no longer what it was. The internet has made so much possible. With information a click away, one can fulfill every need and want for knowledge in seconds enabling our passions to ignite and take off. The flip side to this 24/7 access to internet anonymity (you can become someone you are not, omit the parts of your person at will, or remain completely anonymous) is that the rules of social engagement seem to be faltering; no tone or body language to accompany it. In this issue, you’ll find an article by Miro Hernandez explaining how to put your best foot forward while communicating online.

When I was younger my mom often told me if I had nothing nice to say I was to say nothing at all. As much as it may pain me, I have to admit my mom was right. This statement has saved feelings from being hurt, friendships from being ruined, and embarrassing things from happening. Inevitably, we all face some form of negative online criticism in our professional lives. Courtney Jane Maxwell has shared some tips to help you stay cool and collected when dealing with a bad review on a social media platform.

We live in a world where we are force fed the idea that more is better. I firmly and truly believe moderation is the key, not just when it comes to the donuts I eat or the coffee I drink, but very importantly in the social media I use. I choose to be choosey which means I do not use every type of new and fancy social media that pops up. I do not snap, tweet, and in fact I do not spend the same amount of time tumbling or booking that I used to. I have chosen the types of technology that work best for me and I make them work as effectively and efficiently as possible. This means that as much as technology has become part of every facet of my day to day life, it is not my life from day to day.

Read on to see how technological advances have helped to make our industry safer for clients and piercers alike; how the etiquette of more formal times in the past still have a place in our conversations on the internet today, and don’t forget to double tap and share this publication.

Point 74: From the Editor – Jim Ward

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The Point - Issue 74

Jim Ward headshotJim Ward
Art Director

One of the joys of having been a part of this industry since its beginning has been seeing the technological advances that have brought it to such an astounding degree of professionalism.

Young piercers have no idea what things were like when Gauntlet was born in 1975. For starters, imagine a world without the cell phone, personal computer, and the internet. As the old cigarette commercial said, “You’ve come a long way, baby.”

When I first began my piercing business, I had to use a pressure cooker to sterilize instruments, later graduating to ever more sophisticated autoclaves. With the advent of the Statim, you are now blessed not only with more reliable sterilization, but are able to accomplish it within mere minutes.

The first piercing needles were veterinary hypodermics with the syringe couplings cut off. We sterilized and reused them over and over while they became duller with every use and often had to be used with a needle pusher. Nowadays, you have access to disposable needles that are so sharp they pierce the toughest of tissue like butter.

Even though I made every effort to provide the highest quality body jewelry, in those early days we had little understanding as to which materials were most suitable for the purpose of piercing. The industry is now blessed with an abundance of jewelry choices produced to the most stringent of manufacturing standards.

Many of you are familiar with Gauntlet’s publication Piercing Fans International Quarterly (PFIQ). Thanks to the personal computer and the marvel of desktop publishing, I’ve been able to say goodbye to the typewriter, the T­square, the drafting board, and all the art supplies that were used for years to produce the magazine. With a few mouse clicks, design and layout has become a breeze.

Technology is here to stay, and will continue to benefit our profession. I only hope that one day human kindness and compassion will catch up.

On another subject, for the last several issues of The Point I have participated as one of the Managing Editors. With this issue my title changes and I become the publication’s Art Director. I will still be an occasional Contributing Editor, and while I’m busy doing the layout and design, I get to edit the editors.

Over time I also hope to be able to bring some fresh design ideas to these pages. Enjoy!

Point 73: A Parent’s Guide to Safe Piercing for Children’s Ears

3 Comments read Issue 73, Medical, Public Education, Science & Body Modifications, Sterilization
Child's ear piercing performed by Becky Dill at Cold Steel Piercing Photo by Danielle Greenwood
Child’s ear piercing performed by Becky Dill at Cold Steel Piercing
Photo by Danielle Greenwood

Proper technique, sterility, piercing placement, aftercare, jewelry material, and style are among the many important factors that go into a successful piercing. First, let’s look at the technique itself. Piercing guns use pressure to force a pointed object, the jewelry, through the skin. While these mechanisms may seem like a quick, easy, and convenient way of creating holes, they can have major drawbacks in terms of tissue damage, inappropriate jewelry designs, and sterility. These concerns have been documented in medical literature over the years and provide proof of these concerns.

Due to the dull nature of the jewelry used in piercing guns, more damage is caused to the tissue when compared to piercings done with quality piercing needles. The effects are similar to a blunt force trauma including significant pain, swelling, scarring, and an increased potential for complications. The gun then pinches the back of the jewelry in place snugly against the skin, allowing no way for the new wound to breathe and heal properly. The customer is often told to turn the jewelry, which only further pushes growing bacteria into the wound, increasing the risk of infection and delaying the healing process considerably.

Additionally, it has not been documented how often piercing guns malfunction. Some operators report that the earring adapter that holds the jewelry often will not release the earring, requiring its removal with pliers. These pliers, which contact contaminated jewelry immediately after it has passed through the client’s tissue, may be reused on multiple customers without full sterilization. Few, if any, gun piercing establishments possess the expensive sterilization equipment necessary for such a process. Occasionally the intense pressure and speed of the gun’s spring-loaded mechanism is not sufficient to force the blunt jewelry through the flesh. In these cases, the earring stud may become lodged part way through the client’s ear. The gun operator, who may not be trained to deal with this possibility, has two options. S/he can remove the jewelry and repierce the ear, risking contamination of the gun and surrounding environment by blood flow from the original wound. Alternately, the operator can attempt to manually force the stud through the client’s flesh, causing excessive trauma to the client and risking a needlestick-type injury for the operator.

Diagram showing the differences in the "cutting edge" of ear piercing studs used in piercing guns. The bottom silhouette is a single use hollow needle.
Diagram showing the differences in the “cutting edge” of ear piercing studs used in piercing guns. The bottom silhouette is a single use hollow needle. Reference: Ear piercing techniques and their effect on cartilage, a histologic study

There may also be a greater likelihood of more serious complications when cartilage or structural tissue such as noses are pierced using a piercing gun. This type of tissue (cartilage) has less blood supply than earlobe tissue and therefore a correspondingly longer healing time; this means that infection in this area can be more likely and more destructive.

Another common concern is sterilization and asepsis. Any kind of procedure which involves contact with blood or bodily fluids requires strict adherence to crosscontamination prevention.

As is now well known, the hepatitis virus can live for extended periods of time on inanimate surfaces, and could be harbored within a reusable piercing gun for several weeks or more. Hepatitis and common staph infections, which could be found on such surfaces, constitute a serious public health threat if they are introduced into even one reusable piercing gun. Considering the dozens of clients whose initial piercings may have direct contact with a single gun in one day, this is a cause for serious concern. Babies, young children, and others with immature or compromised immune systems may be at a higher risk.

Some will argue that the piercing gun never comes in contact directly with a customer’s skin, or is sterilized or disposed of after a single use. This might be true, but the gun operator’s hands do—if they touch the customer’s skin and then touch the gun, the gun is now contaminated. When the gun drives the stud through the flesh— whether or not the skin starts to bleed – there is no way of knowing whether or not tiny particles of blood have been dispersed into the air contaminating everything around it. Piercing guns are usually made with plastic and cannot be adequately cleaned and sterilized for reuse. A quick wipe with an antiseptic pad is not effective in removing disease-carrying blood. Although many manufacturers now make disposable options, these do not negate concerns regarding possible damage to tissue, jewlery quality, or inadequate staff training.

The Association of Professional Piercers does not support the use of piercing guns because the reusable versions can’t be sterilized using APP approved equipment, such as an autoclave. Without proper sterilization, the risk of spreading diseases such as Hepatitis and staph infections increase.

The Bottom Line: Professional piercers use a more modern approach to piercing that’s less traumatic, cleaner, and more likely to result in a smooth healing process.

The Point Issue 73 - Professionals dont use piercing guns

Point 73: Children’s Ear Piercing – Kendra Jane B

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Kendra Jane BerndtThe Point Issue 73 - Professionals dont use piercing guns
April Thomas
Julie Taylor

Most of us receive at least one phone a week— sometimes even a day—from a concerned parent wanting to know the best option to pierce their child’s lobes. We are frequently seeing that the safe piercing message is reaching the masses. However, we are still seeing many piercings done with piercing guns. Whether it is because they are unable to find the information in the places they are visiting or because they are intimidated to visit their local tattoo or piercing studio to have their questions answered, parents are using less than favorable methods to pierce their children’s lobes. Perhaps they are leery of taking their six or seven year old daughter or son into said studio because of things that have nothing to do with piercing, such as the music, a worry of profanity or inappropriate behaviour, etc.

Within this article, we have presented similar information in two forms. The first is intended for an audience with a more complete understanding of piercing industry jargon and intricacies. The second presentation has been simplified with our clients in mind. Our intention was to provide something that you are able to print and send home. You can choose which presentation is most appropriate for your target audience. Either way, we encourage you to share the link to this article and repost on every site that questions the safest way to pierce children’s ears.

What is the APP’s position on ear piercing guns?
It is the position of the Association of Professional Piercers that only sterile disposable equipment is suitable for body piercing, and that only materials which are certified as safe for internal implant should be placed inside a fresh or unhealed piercing. We consider any procedure that places vulnerable tissue in contact with either non-sterile equipment or jewelry that is not considered medically safe for long-term internal wear to be unsafe. Such procedures place the health of recipients at an unacceptable risk. For this reason, APP Members may not use reusable ear piercing guns for any type of piercing procedure.

Reusable ear piercing guns can put clients in direct contact with the blood and bodily fluids of previous clients.
Although they can become contaminated with bloodborne pathogens dozens of times in one day, ear piercing guns are often not sanitized in a medically recognized way. Plastic ear piercing guns cannot be autoclave sterilized and may not be sufficiently cleaned between use on multiple clients. Even if the antiseptic wipes used were able to kill all pathogens on contact, simply wiping the external surfaces of the gun with isopropyl alcohol or other antiseptics does not kill pathogens within the working parts of the gun. Blood from one client can become aerosolized, becoming airborne in microscopic particles, and contaminate the inside components of the gun. The next client’s tissue and jewelry may come into contact with these contaminated surfaces. This creates the possibility of transmitting bloodborne disease-causing microorganisms through such ear piercing, as many medical studies report.

The Point Issue 73 - childrens ear piercing Frankie PistoneAs is now well known, the Hepatitis virus can live for extended periods of time on inanimate surfaces, and could be harbored within a piercing gun for several weeks or more. Hepatitis and common staph infections, which could be found on such surfaces, constitute a serious public health threat if they are introduced into even one reusable piercing gun. Considering the dozens of clients whose initial piercings may have direct contact with a single gun in one day, this is a cause for serious concern. Babies, young children, and others with immature or compromised immune systems may be at higher risk.

Additionally, it has not been documented how often piercing guns malfunction. Some operators report that the earring adapter that holds the jewelry will often not release the earring, requiring its removal with pliers. These pliers, which contact contaminated jewelry immediately after it has passed through the client’s tissue, may be reused on multiple customers without full sterilization. Few, if any, gun piercing establishments possess the expensive sterilization equipment (steam autoclave or chemclave) necessary for such a process.

Piercing guns can cause significant tissue damage.
Though slightly pointy in appearance, most ear piercing studs are quite dull. Therefore, these instruments use excessive pressure over a larger surface area in order to force the metal shaft through the skin. The effect on the body is more like a crush injury than a piercing and causes similar tissue damage. Medically, this is referred to as “blunt force trauma.” At the least, it can result in significant pain and swelling for the client, but it also has the potential to cause scarring and increased incidence of auricular chondritis, a severe tissue disfigurement.

Occasionally the intense pressure and speed of the gun’s spring-loaded mechanism is not sufficient to force the blunt jewelry through the flesh. In these cases, the earring stud may become lodged part way through the client’s ear. The gun operator, who may not be trained to deal with this possibility, has two options. S/he can remove the jewelry and repierce the ear, risking contamination of the gun and surrounding environment with blood flow from the original wound. Alternately, the operator can attempt to manually force the stud through the client’s flesh, causing excessive trauma to the client and risking a needlestick-type injury for the operator. How often such gun malfunction occurs has not been documented by manufacturers, but some gun operators report that it is frequent.

When used on structural tissue such as cartilage, more serious complications such as auricular chondritis, shattered cartilage, and excessive scarring are common. Gun piercings can result in the separation of subcutaneous fascia from cartilage tissue, creating spaces in which fluids collect. This can lead to both temporary swelling and permanent lumps of tissue at or near the piercing site. These range from mildly annoying to grossly disfiguring, and some require surgery to correct. Incidence can be minimized by having the piercing performed with a sharp surgical needle, which slides smoothly through the tissue and causes less tissue separation. A trained piercer will also use a post-piercing pressure technique that minimizes hypertrophic scar formation.

Cartilage has less blood flow than lobe tissue and a correspondingly longer healing time. Therefore infections in this area are much more common and can be much more destructive. The use of non-sterile piercing equipment and insufficient aftercare has been associated with increased incidence of auricular chondritis, a severe and disfiguring infection in cartilage tissue. This can result in deformity and collapse of structural ear tissue, requiring antibiotic therapy and extensive reconstructive surgery to correct. Again, medical literature has documented many such cases and is available on request.

The Point Issue 73 - childrens ear piercing - Courtney MaxwellThe length and design of gun studs is inappropriate for healing piercings.
Ear piercing studs are too short for some earlobes and most cartilage. Initially, the pressure of the gun’s mechanism is sufficient to force the pieces to lock over the tissue. However, once they are locked on, the compressed tissue cannot return to its normal state. This constriction causes further irritation. At the least, the diminished air and blood circulation in the compressed tissue can lead to prolonged healing, minor complications, and scarring. More disturbingly, the pressure of such tight jewelry can result in additional swelling and impaction. Both piercers and medical personnel have seen stud gun jewelry completely embedded in ear lobes and cartilage (as well as navels, nostrils and lips), even when pierced “properly” with a gun. This may require the jewelry to be cut out surgically, particularly in cases where one or both sides of the gun stud have disappeared completely beneath the surface of the skin. Such risk is minimal when jewelry is custom fit to the anatomy of the client, and installed with a needle piercing technique which creates less trauma and swelling. Custom fit jewelry should allow sufficient room for swelling and can be downsized to fit snugly on healed tissue.

Jewelry that fits too closely also increases the risk of infection because it does not allow for thorough cleaning. During normal healing, body fluids containing cellular discharge and other products of the healing process are excreted from the piercing. But with inappropriate jewelry, they can become trapped around the fistula. The fluid coagulates, becoming sticky and trapping bacteria against the skin. Unless thoroughly and frequently removed, this becomes an invitation for secondary infection. The design of the “butterfly” clasp of most gun studs can exacerbate this problem. Again, these consequences can be avoided with implant-grade jewelry that is designed for ease of cleaning and long-term wear.

Not all piercing jewelry is safe for prolonged wear.
Most ear piercing studs are not made of materials certified by the FDA, ASTM, or ISO as safe for long term implant in the human body. Even when coated in nontoxic gold plating, materials from underlying alloys can leach into human tissue through corrosion, scratches and surface defects, causing cytotoxicity and allergic reaction. Since manufacturing a durable corrosionand defect-free coating for such studs is extremely difficult, medical literature considers only implant grade steel (ASTM F138) and titanium (ASTM F67 and ASTM F136) to be appropriate for piercing jewelry composition. Studs made of any other materials, including nonimplant grade steel (steel not batch certified as ASTM F138), should not be used, regardless of the presence of surface plating.

Misuse of ear piercing guns is extremely common.
Even though many manufacturers’ instructions and local regulations prohibit it, some gun operators do not stop at piercing only the lobes, and may pierce ear cartilage, nostrils, navels, eyebrows, tongues and other body parts with the ear stud guns. This is absolutely inappropriate and very dangerous.

Although gun piercing establishments usually train their operators, this training is not standardized and may amount to merely viewing a video, reading an instruction booklet, and/or practicing on cosmetic sponges or other employees. Allegations have been made that some establishments do not inform their employees of the serious risks involved in both performing and receiving gun piercings, and do not instruct staff on how to deal with situations such as client medical complications or gun malfunction. Indeed, surveys conducted in jewelry stores, beauty parlors, and mall kiosks in England and the US revealed that many employees had little knowledge of risks or risk management related to their procedure.

Considering that a large proportion of gun operators’ clientele are minors or young adults, it is not surprising that few gun piercing complications are reported to medical personnel. Many clients may have been pierced without the knowledge or consent of parents or guardians who provide healthcare access. Therefore, the majority of the infections, scarring and minor complications may go unreported and untreated. Furthermore, because of the ease of acquiring a gun piercing and the lack of awareness of risk, many consumers fail to associate their negative experiences with the piercing gun itself. They believe that, since it is quicker and easier to acquire a gun piercing than a manicure, gun piercing must be inherently risk-free. Often it is only when complications prove so severe as to require immediate medical attention that the connection is made and gun stud complications get reported to medical personnel.

Despite these pronounced risks associated with gun piercing, most areas allow gun operators to perform piercings without supervision. Recent legislation has begun to prohibit the use of guns on ear cartilage and other non-lobe locations, and the state of New Hampshire has made all non-sterile equipment illegal, but these changes are not yet nationwide. It is our hope that, with accurate and adequate information, consumers and the legislatures will understand and therefore reject the use of gun piercing in the interests of the public health.

References Cited:

Pediatric Emergency Care. 1999 June 15(3): 189-92.
Ear-piercing techniques as a cause of auricular chondritis.
More DR, Seidel JS, Bryan PA.

International Journal of Pediatric Otorhinolaryngology. 1990 March 19(1): 73-6.
Embedded earrings: a complication of the ear-piercing gun.
Muntz HR, Pa-C DJ, Asher BF.

Plastic and Reconstructive Surgery. 2003 February 111(2): 891-7; discussion 898.
Ear reconstruction after auricular chondritis secondary to ear piercing.
Margulis A, Bauer BS, Alizadeh K.

Contact Dermatitis. 1984 Jan; 10(1): 39-41.
Nickel release from ear piercing kits and earrings.
Fischer T, Fregert S, Gruvberger B, Rystedt I.

British Journal of Plastic Surgery. 2002 April 55(3): 194-7.
Piercing the upper ear: a simple infection, a difficult reconstruction.
Cicchetti S, Skillman J, Gault DT.

Scottish Medical Journal. 2001 February 46(1): 9-10.
The risks of ear piercing in children.
Macgregor DM.

American Journal of Infection Control. 2001 August 29(4): 271-4.
Body piercing as a risk factor for viral hepatitis: an integrative research review.
Hayes MO, Harkness GA.

Journal Laryngology and Otology. 2001 July 115(7): 519-21.
Ear deformity in children following high ear-piercing: current practice, consent issues and legislation.
Jervis PN, Clifton NJ, Woolford TJ.

Cutis. 1994 February 53(2): 82.
Embedded earrings.
Cohen HA, Nussinovitch M, Straussberg R.

Scandinavian Journal of Rheumatology. 2001; 30(5): 311.
Does mechanical insult to cartilage trigger relapsing polychondritis?
Alissa H, Kadanoff R, Adams E.

British Journal of Dermatology. 2002 April 146(4): 636-42.
Decrease in nickel sensitization in a Danish schoolgirl population with ears pierced after implementation of a nickel- exposure regulation.
Jensen CS, Lisby S, Baadsgaard O, Volund A, Menne T.

Toxicology In Vitro. 2000 Dec 14(6): 497-504.
Cytotoxicity due to corrosion of ear piercing studs.
Rogero SO, Higa OZ, Saiki M, Correa OV, Costa I.

Journal of the American Medical Association. 1974 March 11; 227(10): 1165.
Ear piercing and hepatitis. Nonsterile instruments for ear piercing and the subsequent onset of viral hepatitis.
Johnson CJ, Anderson H, Spearman J, Madson J.

Journal of the American Medical Association. 1969 March 24; 207(12): 2285.
Hepatitis from ear piercing.
Van Sciver AE.

Journal of the American Medical Association. 291.8 (2004): 981-985.
Outbreak of Pseudomonas aeruginosa infections caused by commercial piercing of upper ear cartilage.
Keene, William E, Amy C Markum, and Mansour Samadpour.

Point 73: BMXnet – Nicole Holmes

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Nicole Holmes
Blue Lotus Piercing, APP Member*

September 3 through 6 of this year, I was fortunate enough to attend my fourth BMX Conference, which was held in the small but beautiful city of Essen, Germany. The conference was coordinated by the charismatic Stefan Schomowski and his team of trusted helpers and volunteers. As much as I always enjoy this conference, I must admit that just visiting Essen is lovely too: scattered city water fountains, the shopping district, and great food. It is honestly the highlight of my piercing year. Each year I arrive earlier and leave a little later.

The venue for BMX is partly the reason I return year after year; the Unperfekthaus is truly a spectacle to behold. As an artist’s village nestled within the city, it really doesn’t disappoint. It is such an inspiration to sit for lunch, walk the corridors, or climb the stairs. Every wall is hand painted, covered in collage, or decorated with a sculpture of sorts. When this venue is full (on registration day, capacity is reached long before breakfast) the atmosphere becomes energized. With so many like-minded people gathering from around the world, BMX embodies a special sense of purpose and community.

I remember my first BMX in 2012. I didn’t know anyone there personally. I was sitting outside alone having coffee at the ungodly hour of 8:00am just because I was excited. The first person that sat by me grew to be the first of many conference friends. Each year BMX expands and there are new faces, new friends to be had. I find it so easy to talk to people during the event. This is another reason I keep attending.

I have attended many seminars, day events, and conventions, but none compare to BMX. There are no similar conferences or events where I live in the North of England. My last large scale, piercing specific event was the 2002 APP Conference & Exposition in Amsterdam. However, 2002 was more than a decade ago and so much has changed. There has been so much grown in the industry since then, I feel a comparison would be irrelevant.

What I can say with certainty is that BMX is not like anything I could have imagined. This year marked the 9th annual conference and it really demonstrated the team’s experience. From the smooth running operation of things to the flow from class to class, the grouping of the lectures was natural and it never felt rushed. Although I feel there was never enough time to visit the expo to do some shopping!

Classes covered topics such as hygiene in the studio, creating sacred space, earlobe reconstruction, and magnet removal. BMX is as it always has been, an umbrella of many topics, not solely piercing based subjects. Tattooing and other modifications are also covered. Many attendees expressed their fondness for this scope of subjects.

I personally feel I absorbed the most this year from the roundtables. These communal discussions based on topics such as “Ethics” led by Samppa Von Cyborg, covering the delicate issue of recording and posting video clips on the internet when you may unwittingly represent the whole industry. In another of this year’s fascinating roundtables, titled “Implantable Technology,” Tim Cannon brought his prototype silicone implant containing LED lights capable of being switched on and off by the users already-implanted magnet. There were even some attendees who were so passionate about the topics that they were willing to hold roundtables at all hours of the day or night. That is a perfect example of the freeform and flexible nature that is BMX.

After classes on both Friday and Saturday, there were striking and eclectic shows from Coco, Superfly, Squid O, and Pain Solution which enchanted the late night crowd with a manifestation of freakshow/sideshow entertainment. This was followed by the annual prize draw raffle.

Overall the whole adventure of BMX was undeniably a special triumph of our industry and community. After discussing this year’s efforts with many other attendees, both new and old, I feel the response was very heartwarming. Everyone that learned and loved at BMX promised to return the following year, myself included.

*Nicole Holmes is one of the newest APP Members in the UK.

Point 73: UKAPP, A Prelude – Ryan Ouellette

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RyanOuelletteRyan Ouellette
Precision Body Arts

In September of 2015 I traveled to Birmingham, England for the first seminars of the newly formed United Kingdom Association of Professional Piercers (UKAPP). When I got home and sat down to write about my experience I found myself thinking more about wider-reaching industry issues which affect not only the UK, but Europe as a whole. My intention was to give a little perspective as to why there are so few APP Members overseas compared here in North America. Once I started I discovered there was much more to the issue than I could properly cover in a single article, so I have decided to make this a two part piece. Hopefully it will give you an idea of the challenges European piercers face if they want to meet APP membership standards, and in turn hopefully it will show you just how impressive and hard working this group of piercers is.

I travel, what many would consider, a fair amount for a full time piercer. Not as much as some, but much more than others. I try to do as much of that travel outside of my home country (the United States) as possible. I like to see new countries and cities, and while I’m travelling I like to meet other piercers and learn how they practice our craft in their respective areas. When I meet piercers from Europe the conversation always ends up being about the APP. I hear quite a few issues voiced when the topic comes up, not necessarily with the organization, but more so in how our Members talk about other regions or parts of the world being “behind” when it comes to piercing. There is the perception that APP Members imply a piercer who does not use the best jewelry available is being unprofessional. I myself have even made the mistake of assuming “good piercing” is all about the jewelry. Now in an era of social media, these perceptions are more important than ever. Anyone can get nice jewelry, install it in a new or healed piercing, and take a picture. That does not make them a good piercer, or a true professional. In my opinion the sign of a professional is continuing to learn and evolve and to strive to give our clients the best work possible. That doesn’t mean you start out doing exactly what you want. For most piercers it is a struggle and you are constantly working towards a goal that, in turn as you progress, changes over time.

I have met piercers in almost a dozen different countries around the world and I see the same challenges that piercers in the US face: “my customers won’t pay X for good quality jewelry”, “my boss won’t invest in quality”, “there are no educational opportunities in my area”. These are all obstacles that a piercer can overcome with time, persistence, education, and a flexible budget. However, there is another aspect that I think US piercers take for granted: access to supplies. In the European Union (EU) and the United Kingdom (UK), piercers have an additional challenge. As an example, if you want to order Neometal, Anatometal, BVLA, or most other US made jewelry, not only do you have to deal with long wait times, but also increased shipping costs, delays with customs, and substantial import taxes. Canadian and Latin American piercers face these challenges as well, but to a lesser extent, due to their proximity to where most high end piercing supplies are manufactured. In England, if a piercer orders jewelry they have to pay approximately 20% extra to import it into their country, and that is on top of already significant international shipping costs. Imagine waiting even longer and paying even more. How many US piercers, barely keeping internally threaded and threadless jewelry in stock, would implode at that added challenge? There are almost no native companies manufacturing body jewelry in the EU or the UK at this time. Many have moved production to Asia to lessen costs. Those companies left manufacturing in the EU and UK offer little to no internally threaded jewelry, hand polishing, or products made from materials the Association of Professional Piercers would classify as acceptable for initial piercing.

Needles are another obstacle. How many American piercers are aware of the differences between “blade needles” or “cannulas”? There is a simple reason why; you would never need to. Any American piercer can buy needles made specifically for body piercing, in varying qualities. Again, in the EU and UK there is little to no access to what we would consider “piercing needles” without importing them. In most of Europe there are fewer restrictions on medical devices so it is very common for piercers to use medical catheter needles and biopsy punches to perform body piercings. They call what American piercers use a “blade” needle to distinguish it from the more common cannula needles they are using. Since they don’t have the same access to blade needles many of their techniques are built on a foundation of using the cannula sheath for jewelry transfers. If you are unfamiliar with a cannula it is a plastic sheath covering the needle that can slide off and be used as a catheter. If you have had IV fluids in your arm or hand at the hospital. That little tube going into your vein or artery is a cannula. The application is to pierce through the tissue, once the needle and sheath exit you can slide out the needle leaving the cannula in place. You can then insert jewelry (internal or external) into the sheath and back it through the piercing. In theory this covers external threading during insertion so many European and British piercers see it as negating the risk of using external threading. Whether is does or does not could be another whole article.¹

I hope by now you can see where the different mindsets come from between US and Europe counterparts. Imagine all those obstacles, and a piercer without those obstacles calling you lazy or sloppy because you do not have the means to overcome said obstacles. It would be frustrating, it might even make you apprehensive to strive to reach the goals that same piercer holds as being a minimum standard. One of the most common complaints I hear about the APP is that membership is geared almost entirely to piercers in the United States. While it is true that the vast majority of APP Members are operating in the US, I have met APP Members all over the world: Sweden, Norway, Denmark, Mexico, England, and more. If APP membership is not an easy goal to achieve in a specific region, another option to improve standards is to create a local organization such as the APTPI (Italy), LBP (Mexico, Central, and South America) and the newly formed UKAPP. The point of these other organizations is not to have lower standards, but to have standards geared towards their specific region. For instance, if jewelry concerns are not the main obstacle, the organization can instead focus on other safety issues such as sterilization, studio layout, and training.

Every Fall I travel to Essen, Germany to teach seminars at the BMXnet (Body Modification Exchange Network) Conference. I’ve met some fantastic piercers from all over Europe there. At the 2014 event I spent quite a while talking with a British piercer named Nici Holmes. We talked about many of the points mentioned above. Specifically, we discussed how it is very challenging to be a piercer who wants to offer quality, especially when the items that go into a “quality” piercing need to be imported from another continent. We talked about how many of the best piercers in the UK could not meet membership standards set forth by the Association of Professional Piercers. One of the concerns she voiced: most, if not all, of the jewelry that meets APP standard is based on ASTM material standards, which has led to some confusion as it previously stood for the AMERICAN Society for Testing and Materials.² The APP jewelry standards were revised in 2009 and currently include both ASTM and ISO designations. Much of Europe is moving away from allowing steel as an acceptable material for body jewelry due to nickel content, but at the same time Europe widely allows the use of G23 grade titanium, which is an industrial grade, rather than an implant grade material. G23 Ti has been used as an alternative to nickel containing alloys and its safety has not been addressed, as regulations focused on eliminating nickel as an allergen, not on validation of a material for safe healing and prolonged wear.

Nici talked about how she wanted to start a dialog with other British, Irish, and Scottish piercers to try to form a new group. At first I thought the intention was just to have some casual meetings and discuss industry issues. Apparently the idea caught on and soon after, with the help of a crowdfunding campaign, there was a new nonprofit formed to focus on safe body piercing in the United Kingdom. One of their first acts was to host a central meet. In the next issue of The Point I plan to elaborate on what was accomplished at their first meeting.

¹The plastic sheath is easily damaged which in turn can damage tissue. Also, the blade length is significantly shorter, limiting or preventing many of the bevel theories modern freehand piercers are so fond of.
²The ASTM has focused on international trade since the 1970’s. In 2001 it was rebranded as ASTM International, and is used globally in more than 140 countries.

Point 73: Beto Madrigal Award

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THE BETO MADRIGAL AWARD
presented to Ed Chavarria
at the LBP Gala
by Beto’s brother Ennio Madrigal
The Point Issue 73 - Beto Madrigal Award - LBP Gala 2015

Unfortunately Beto took his own life last year, Beto had a large role in the LBP and this new award akin to the APP’s Josh Prentice volunteer award was to recognize outstanding volunteer work and contributions to the piercing community.

Spanish Original:
Muy Feliz y agradecido con LBP… por seguir honrando la memoria y el aporte de mi hermano Beto …para con la industria del Body Piercing Latinoamericano … Para mí es un orgullo que hayan nombrado con el nombre Beto Madrigal el premio que entregarán año con año en la gala de Latinoamérica Body Piercing… Este año le correspondió a nuestro querido Eduardo Chavarria….recibir este importante reconocimiento por su entrega y compromiso para con la industria del Body Piercing. Felicidades mi queridísimo Ed…!!! Sé que Beto se encuentra feliz de que te entregaran …tan merecido reconocimiento..!!

Thank you, Luis Garcia, for an English Translation:

I am very happy and thankful to the LBP for continuing to honor the memory of my brother Beto and the support he gave the body piercing industry in Latin America. I am proud that they named the service award after my brother, Beto Madrigal, and that they will be presenting this award year after year at the LBP gala. This year the award was given to the beloved Eduardo Chavarria for his hard work and commitment, not only to the Latin American body piercing community, but the industry worldwide. Congratulations Ed. I know that Beto is happy that you were honored with this much deserved award.

The Point Issue 73 - Beto Madrigal Award presented to Ed Echavarria - LBP 2015