S T E R I L E  T E C H N I Q U E

Information provided by Jeff Martin & Brian Skellie

Practical application of sterile technique does not mean that everything in the room is sterile, this is a common misconception, using sterile technique with integrity does mean reducing the amount of microbial contamination from 100% to 1-8%. (An attainable minimum.)

Sterile technique is not more expensive than other methods, on a whole most studios spend less. With healing times reduced systematically from 6-12 months to 30-90 days for all piercings, changing jewelry becomes less formidable. Complications, swelling and infection are greatly reduced. Any time there is a break in the skin, sterile technique should be employed e.g. changing jewelry on an unhealed piercing.

Sterile technique is not one set in stone method, this is a guideline for establishing your own individual technique. The methods described, may at first seem difficult or unattainable, but these methods are most assuredly easier than current "industry standard" techniques. (As of 03/2003 just over twenty individuals we have worked with, to our knowledge, are consistently practicing appropriate sterile technique, please speak up if you are using this method) Glove usage can be reduced from 3 - 8 pairs, to 3 pairs. Gloves can even be effectively sterilized in an autoclave. (powderless nitrile or latex) Having a controlled air flow in the piercing room is a plus, the cleanest air should be traveling over the client/sterile field first, then the piercer, and then out the exhaust vent. Airborne contamination is the second most common cause for infection, break in field is the first. Airborne contaminants could cause infection, break in sterile field or lack thereof could result in transmission of client to client bloodborne disease, such as HCV (Hepatitis C). This exponentiates the risk to the piercer.

Definitions:

• Sterile: Absence of viable microbes
• Sterile field: area in which no viable microbes exist
• Unsterile: has not been appropriately sterilized, has come in contact with an item that is no longer considered sterile, has entered a field that is not sterile, or has exceeded its shelf life .
• Shelf-life: length of time that an item that has been sterilized and packaged is considered to still be sterile if the package is unopened for up to one month.
• Sterile technique starts after the client has been marked and prepped for the piercing, clean exam gloves may be used for the preparation of the client for piercing.
• Contaminated: an item, surface or field that has come in contact with anything that is not sterile e.g. broken packaging

Techniques:

• Use only sterile materials in a sterile field
• A sterile towel, or the inside of the equipment package may be used to create a sterile field
• Any wet surface will be contaminated as liquid carries contaminants through, "strike through".
• Packages placed on a clean surface are contaminated on the outside, but the inside of the sterilized package may be used as a sterile field.
• If working with others in a sterile field never face the back of another; back to back or front to front is acceptable
• Keep sterile gloved hands above waist level; do not let hands hang below waist.
• Face, eye, mouth protection in the form of goggles, masks, face shields should be used to protect yourself to avoid the possibility of body fluid splatter.
• Edges of any container are unsterile.
• We accept the level of contamination from the air, but not from an unsterile object or field.
• Never remove and then replace any item in the field e.g. picking up a tool then setting it back down, the field is now contaminated.
• Assume the outside of the single use tube/pack is unsterile. Do not touch any part of the tube including the tip. The contents of the tube can sometimes be squeezed onto a dressing before sterile gloves are donned. (Remember that if the field becomes moistened, it becomes contaminated. If you use lubricants, they must be put on a impervious plastic or metal surface as a barrier e.g. the sterile inside plastic of the equipment packaging.)
• The inside of a sterile package remains so if peeled open properly. It is safer to open the package all the way to avoid reaching over an unsterile area of the package, but the longer the package is open, the more contamination from the air occurs.
• Masks must be worn to limit the amount of biological material from a persons breath, from getting into the client's tissue, and contaminating the field.
• Remove all dangling earrings, bracelets, necklaces; it is advisable to remove wristwatches, bracelets and rings before handwashing and donning sterile gloves.

Handwashing:

• Resident skin microbes, while not generally pathogenic, will cause infection when deposited into client's tissue
• Microbes may also be transmitted from clients to piercer.

Handwashing vs. scrubbing:

Handwashing is a vigorous and brief rubbing of hand surfaces together with lathered hands, followed by rinsing with flowing water. Scrubbing is a specific sequence of cleaning required to enter a sterile field that also requires a mask.

Proper handwashing technique avoids touching the sink with the hands. It is preferable to have water controls and soap dispensers that use knee or foot controls. If not available, use clean paper towels to touch faucet controls. Proper handwashing may be followed by drying with paper towels, but contact with outside of towel dispenser must be avoided.

Turn on faucet with clean paper towel

Operate soap control with foot control or use clean paper towel

Wash interdigitally for 30 seconds

Rinse thoroughly under flowing water, but do not make contact with faucet or sink

If contact made, handwashing must be re-started

Allow water to run toward elbows; do not allow water from arm to run down to hands

Dry with clean paper towels and then turn off water with paper towels

Handwashing is to be done before and after contact with each client

Disposable soap containers are preferred over refillable containers unless sterilized between refills; bar soap should not be used

Avoid being splashed at the sink

Gloving: further instructions linked

Inside of package is sterile

Peel package open and be sure all other needed packages are open before gloving and hands will not need to go outside of sterile field

Pull inside package open using folded over part of wrapper in the center. Avoid touching the inner surface of this wrapper. Pull hard enough to keep wrapper open. Wrapper will re-close if not pulled far enough

Inside of gloves are considered unsterile; hands may touch insides of gloves, but not the outside. Outside of one glove may touch outside of the other but not skin or inside of glove

Reach carefully, sliding one hand into glove. With the other hand, pull on the inside surface of glove until fingers are in. Do not try to pull first glove all of the way on, do not try to adjust glove!

With gloved hand scoop underneath fold in remaining glove so that the gloved hand makes contact with the outside of the remaining glove

Place remaining hand into glove and pull all of the way on with gloved hand, only touching outside of glove

Then touching only outside surfaces of gloves, perform final adjustments.

When gloves are removed, the outsides of the gloves should only touch the outside of the other glove, not the skin; carefully pull gloves off inside out so that hands only contact inside surface of gloves

Wash hands as soon as possible after gloves are removed. Do not write notes, restock supplies, pick your nose, etc. before doing so