Brian Skellie
APP President

The APP is always going to be a work in progress, since standards are ever changing with new evidence. Lauded among the guiding principles we maintain as safety standards for our membership is the practice of asepsis. We refer to many procedural acts as practice, as they are rarely ever perfect and require a profound theoretical understanding coupled with regular exercise and critical self observation for improvement. Asepsis requires the right combination of cleaning and sterilization with touching and not touching manual, instrumental and environmental surfaces for infection prevention and control (IPC).

We apply two types of asepsis to reduce or eliminate infection transmission: medical asepsis which emphasizes protection for the client and their environment is more concerned with cleanliness and prevention of the spread of the clients own organisms to other clients, while surgical asepsis which focuses on sterilization and maintaining sterility for items that will be introduced to a wound or piercing cavity or penetrate the skin, thus preventing the introduction of organisms to the client. Medical asepsis can be referred to as clean technique, and surgical asepsis as sterile technique. A thorough and effective means of surgical asepsis should be implemented for all body art procedures. [CE resource]

“Sterile technique is not one set-in-stone method, this is a guideline for establishing your own individual technique.” Nor is it advocating precautions beyond what our sort of minimally invasive ear piercing procedures require for antisepsis and sterility. For those who are curious to learn more about Maximum Sterile Barrier precautions, the CDC HICPAC describes further steps that can be taken for more seriously invasive punctures such as a central venous or arterial catheter. For body artists, an achievable version of surgical asepsis (sterile technique) maintains barriers such as sterile gloves, masks and eye protection, and removes obstacles likely to compromise these barriers such as hanging earrings and necklaces, long hair, rings and watches.

“I think that when you say ‘aseptic technique,’ a lot of people automatically think ‘operating room’ or ‘surgical procedure,’” explains Kathleen Meehan Arias, MS, CIC, president of the Association for Professionals in Infection Control and Epidemiology (APIC) and director of Arias Infection Control Consulting LLC. “That’s rightly so because that is where the bulk of it is. But whenever you are doing anything that bypasses the skin barrier, you should automatically think aseptic technique.” — Applying Aseptic Technique in all Clinical Settings

This outline of technique suggestions comes from the AORN, APIC and CDC standards and recommended practices as well as a number of textbook resources such as Asepsis, the Right Touch. Much of it needs very little interpretation for our purposes. Safety precautions should result in greater control of the procedure, clinical benefits, reduced harm, and limited liability for negligence.

Rationale: There exist standards for prevention of surgical site infection that apply to even minor invasive elective procedures, and piercing falls within this category by definition.

“When implemented, these guidelines should reduce the risk of disease transmission in the piercing environment, from piercee to piercer, and from piercee to piercee. Based on principles of infection control, the document delineates specific guidelines related to protective attire and barrier techniques; handwashing and care of hands; the use and care of sharp instruments and needles; sterilization or disinfection of instruments; cleaning and disinfection of environmental surfaces; disinfection and the decontamination room; single-use disposable items; the handling of previously worn piercing jewelry; disposal of waste materials; and implementation of recommendations.”— Piercing Experience adapted IPC standards from the CDC

My personal observation is that these policies have helped limit risk at my studio. They have been reviewed by legal counsel, qualified bioscientists, medical professionals, and university professors. That said, I’m sure that they could always use more input and adaptation. Body art safety is an ever-evolving field of interest.

One might say there is no single right way to pierce. Many variations are possible with an understanding and application of asepsis. We are an industry in which studios market based on their specialties, and for some that is participation in continuing education, gaining knowledge, and raising standards. Maintaining a positive tone one can show those as strengths without diminishing others. This is crucial to developing the bonds between us as fellow professionals. If you believe something you do has advantages, feel free to share that with your customers in a way that does not end up overly critical of our other colleagues.

It should be clear that these position statements in support of surgical asepsis are neither contradictory nor accusatory of others currently using APP minimum standards for medical asepsis according to our 2013 revised Procedure Manual. They build upon them as we are all encouraged to do as Members, employing additional precautions and elective limitations based on evidence and strong theoretical rationale. My preference is to demonstrate best practices as an educator instead of the minimums. If we all did no more than what was required, the industry would not be as interesting.

I believe that it is the responsibility of each of us to uphold the values we feel are important, and to continually advance our standards in order to achieve our goals. I do have romantic hopes that over time the industry will move in the direction of pure, validated, ethical materials and practices that are as harmless as possible. A predictable, consistent, safe, simple, and gentle piercing experience is attainable today and can be refined based on these principles and open communication among colleagues. The recommendations that I make in addition to APP minimums result from a continually researched process of elimination and adaptation, and they are freely shared for peer review. Please consider this a formal request for comments.