I always write notes down in my notebook, but I will copy some down here as well to make sure I remember it. Do NOT take my notes as education.


Guide

This is a main topic.

This is a sub topic.

This is a minor/sub sub topic.

This is a term.

This is an example.

This is for other information.

Glossary

Operator: this means the person who owns, operates, manages, or controls the body modification studio.

Personal service worker: this means an individual who works in the body modification studio.

Sterilization: any process that eliminates, removes, kills, or deactivates all forms of life and other biological agents. Methods: heat, chemicals, high pressure, irradiation, and filtration.

disinfection: antimicrobial agents that are applied to the surface of non-living objects to destroy microorganisms that are living on the object. Does not necessarily kill all microorganisms, especially resistant bacterial spore. Less effective than sterilization which is an extreme physical and/or chemical process that kills all types of life.

antisepsis: disinfection mild enough for living tissue.

sanitation: disinfection of eating utensils and fishes; mechanical or chemical; agents used must not alter properties of food.

cleaning: removal of soil/body secretions does not imply disinfection; often soap and H2O.

-cidal: suffix; means death; used to denote agents that kill various types of microbes e.g. germicide (kills microbes in general); bactericide viricide; sporidice; fungicide

-static: used to denote agents or procedures that stop microbial growth but do not kill, e.g. bacteriostatic, fungistatic

Safety Standards for Body and Ear Piercings

Equipment and Supplies

Make sure all your equipment is vegan!

Operational Requirements

Informed consent

Before conducting a piercing, you need to have the client sign a dated consent form acknowledging that they are:

Preparation and handling of instruments/equipments

Take all precautions to prevent contamination of the equipment and follow proper infection control practices.

Skin preparation

Post-treatment skin care

Waste disposal

All waste sharps, such as needles, must be placed in a puncture-resistant container with a tight-fitting lid. It must be disposed of in accordance with the Regional Health Authority's requirements.

Record keeping

The operator must maintain a daily record of the names and addresses of clients, the name of the piercer who performed the procedure, and store them for 2 years. This will assist in tracing infectious diseases if they occur.

Removal of jewelry

ONLY a physican should remove jewelry due to an infection!

Personal service worker - health and safety

Cleaning, Disinfection and Sterilization

Cleaning

Cleaning must be the first step before disinfection or sterilization or those processes will be ineffective.

Disinfection

How the item is used determines the classification and type of disinfectant needed.

Refer to chart in notebook for different levels of disinfectants. Refer to Appendix 1 in notebook for classification of items for disinfection.

Sterilization

Refer to chart in notebook for sterilization equipment and supplies.

Health Standards and Guidelines for Tattooing

What is Tattooing?

Tattooing is the process of puncturing the skin with a cluster of fine needles containing indelible dyes to achieve a permanent piece of art. The needles are dipped in ink and then inserted into the two uppermost layers of skin, the epidermis and the dermis. Modern tattoo machines use a needle that rapidly causes tiny puncture wounds at a rate of 50 to 3000 times per minute. The ink is inserted into the dermal layer at a depth of 1/64th to 1/16th of an inch. Any ink that was desposited into the epidermis is not permanent as the epidermis cells die and regenerate. Some estimates say 1 in 4 North Americans have at least one tattoo. Modern tattoo artists use the following steps:

Equipment and Supplies

Make sure all your equipment is vegan!

* Often not vegan, but have vegan alternatives

Operational Requirements

Informed consent

Before doing the tattoo, the tattoo artist should have the client sign a dated consent form acknowledging that they are:

Preperation and handling of instruments and equipments

All precautions must be taken to prevent contamination of the equipment and follow proper infection control practices.

Skin preparation

Pigments/dye

Pigments, especially black ones aren't vegan (which sucks since you want to do blackwork), but you can find vegan inks online.

Post-treatment skin care

Waste disposal

All waste sharps such as needles and razors must be placed in a puncture-resistant container with a tight-fitting lid and disposed in accordance with the Regional Health Authority's requirements.

Personal service worker - health and safety

Record keeping

The operator must maintain a daily record of names and addresses of clients, name of the tattoo artist, and store them for two years. This assists in tracing infectious diseases if they occur.

Removal of tattoos

ONLY a physician should remove a tattoo!

Cleaning, Disinfection, and Sterilization

Cleaning

Cleaning must occur as a first step before disinfection and sterilization or those processes will be ineffective.

Disinfection

How an item is used determines the classification and type of disinfectant needed.

Refer to chart in notebook for different levels of disinfectants. Refer to Appendix 1 in notebook for classification of items for disinfection.

Sterilization

Guide to tattoo aftercare

What to do

Keep it clean! After you carefully remove the protective coating or bandage that the tattoo artist applied, gently wash the tattoo with soap and cool or warm water.

Keep it moist! In the past, it was recommended you keep wounds dry. Now, doctors recommend you keep a wound moist to aid in healing. Studies have shown that wounds healing under moist conditions heal 50% faster than under dry conditions. Healing your tattoo under moist conditions protects the delicate tissue and encourages new cell growth.

Apply an ointment! Use an ointment that helps maintain your skin's natural moisture while protecting it. Look for ointments that contain petrolatum, white petrolatum, mineral oil, olive oil, or zinc oxide. Those ingredients form a protective barrier and help prevent infection. Of all those ingredients, petrolatum is the preferred choice of doctors because it reduces water loss in your skin by 99%. Petrolatum works well for tattoos because it stays on the epidermis and is not absorbed into the lower layers where the ink is.

Treat your pain and itchiness! Letting your tattoo remain painful and itchy is not only uncomfortable, but may lead to subconcious scratching or rubbing that will damage your skin/tattoo. Apply an ointment with ingredients that are scientifically proven to provide temporary relief from pain and itchiness. Do not use homeopathic "cures".

Eat and live well! The skin is the body's largest organ. A healthy diet and lifestyle greatly helps in the healing process.

What not to do

DON'T let your tattooed skin or scabs dry out! Dry skin slows the healing process.

DON'T scratch or rub your tattoo! Scratching and/or rubbing can cause further damage to your skin.

DON'T allow bandages to stick to the wound! Don't use a bandage at all unless your tattoo will be exposed to dirty environments. If a bandage or dressing becomes stuck on a wound, ripping it off can further damage your skin and prolong healing.

DON'T apply an antibiotic ointment unless it's infected! If you suspect infection, you should go to a doctor. Antibiotic ointments should only be used if you have an infection.

DON'T expose your tattoo to direct sunlight! Over time, UV rays can break down pigments and cause colour to fade. This can be avoided by applying sunscreen or covering the tattoo when out in the sun for long periods of time.

DON'T swim in chlorinated or salt water until healed! Swimming lets harmful bacteria and germs enter your tattoo, increasing the risk of infection.

What to expect

Without complications, tattoos heal within 2-3 weeks. During the healing process, you may experience:

When to seek medical attention

What causes your tattoo's appearance to change?

Tattoo removal

Laser therapies make tattoo removal possible, but it's difficult. It's expensive and may require multiple treatments to eliminate or even fade a tattoo. Yellows and purples are the hardest to remove. Complete removal is never guaranteed. Side effects include scarring, lightening or darkening of the skin, ink darkening, allergic reactions, and changes in the texture of your skin.

Information Book - Sterilization and Disinfection

Sterilization and Disinfection

Refer to disinfectants chart in notebook for summary of each disinfectant group.

Pick methods of decontamination based on:

Methods of sterilization

Sterilization = KILLS EVERYTHING

What needs to be sterile:

There are 3 methods.

  1. Incineration:
  2. Ethylene Oxide (ETO):
  3. Autoclave

Refer to sterilization fact sheet.

Setting up and maintaining a sterile field

Before a client comes in to get modified, pre-sterilize your tools and any corks or rubber bands you may need to use. Make sure there's a sufficient supply of sterile cotton balls, cotton swabs, piercing needles and other piercing supplies, scalpels/blades, cautery tools, and any other medical supplies you'll need. It's always important to have sterile cotton swabs and gauze in case your client bleeds excessively after a piercing.

Since piercings can cause some people a degree of shock, and it can be worsened by low blood sugar, ask your client if they've eaten recently. If they haven't, grab them a sugary snack and drink for them to have while you set up.

1. Wash your hands. Put on disposable gloves then lay everything you need out on a sterile dental bib. The dental bib will serve as your sterile field. Every thing you lay out on the dental bib should be pre-packaged or bottled and anything reusable should be cleaned and sterilized properly in an autoclave prior to use. Anything disposable like rubber bands, corks, toothpicks, and cotton swabs should either be pre-packaged or autoclaved before use. Surgical markers are okay to re-use only if they've been used on clean, intact skin that is not on the mouth or genitals.

2. Open the largest sterilization pouch on your tray, being careful not to touch the inside of the pouch. Open each of the other sterilization pouches without touching their contents; just lay the open pouches on the dental bib. Open the iodine and alcohol pad packets and set them on the bib. It's okay to touch the disinfecting wipes with gloved hands, but don't touch the contents of any other packages yet.

3. Once everything is laid out, including body jewelry, change your gloves and apply hand sanitizer to them. Now you're fine to touch the contents of any of the packages. Get everything ready.

4. Prepare the client's skin for the procedure by swabbing the area with an iodine pad. Right after, use an alcohol pad to remove the yellow iodine stain.

5. Use a surgical skin marker to make the marks. Don't touch anything on your sterile field after handling the marker as the marker is not longer sterile. If you're doing an oral or genital piercing, use a sterilized toothpick dipped in gentian violet ink instead. Dispose of the toothpick after you've made the marks.

6. Put on a new pair of gloves and apply hand sanitizer to them. Now, you can begin the procedure. Once you've put the starter jewelry in, control the bleeding with sterile cotton swabs and/or gauze. If the bleeding is excessive, use a paper towel to collect the blood, then apply a sterile cotton swab as the bleeding slows.

7. After the bleeding has stopped, go over aftercare instructions with your client. Dispose of needle(s) properly in a sharps container, then wrap the remaining contents of your tray into your gloves and dispose of them. Put on a new pair of gloves, and spray your tray with a hospital-grade hard surface disinfectant like Madacide or Wavacide. Let it sit for one minute, then wipe it up, and dispose of paper towels the same way you did with the tray's contents.

8. Wash up, and then you're ready to repeat this process.

Products and tools to stock

Cleaning your shop

1. Check your autoclave with a spore-testing kit periodically and make sure it's cleaned with an autoclave cleaner at the end of each day.

2. Put on gloves and wipe down counters, equipment, tattoo chairs, piercing beds, and other shop furniture people touch a lot, as well as equipment and machines outside of the shop, using either Madacide wipes or spray.

3. Properly prepare your piercing tools and tattoo grips.

4. Throughout the work day, keep your shop clean by sweeping and wiping down counters and chairs as needed. Ensure artists dispose of used needles properly in sharps containers. All disposables should be thrown away in a trash bag-lined trash can right after use. Tattoo artists can use Petrify tea bags or squeeze bottles to safely dispose of liquids. Petrify tea bags are also good for placing at the bottom of sharps containers to soak up excess fluid.

Pre-modification skin sterilization

You have to care for your own skin's cleanliness first, or else you'll just dirty the client's skin more. Wash your hands with antibacterial soap and follow up with hand sanitizer before putting on gloves.

Once you have gloves on, wash your client's skin with an antiseptic skin cleanser, like Green Soap, before tattooing. If you're doing a piercing, wipe your client's skin with alcohol pads, then prepare the area to be pierced with povidone-iodine swabs for at least 30 seconds. DO NOT use alcohol for tattoos as it doesn't pair well with tattoo inks and can carry the ink too deep.

Desirable properties of "ideal" disinfectant

Spaulding classification of items requiring disinfection/sterilization

  1. critical: items going into sterile area of body; must be sterile
  2. semi-critical: items going into or touching area of body that isn't sterile; no pathogens, but doesn't have to be sterile
  3. non-critical: items not going into body, but may touch body surface (beds, countertops); okay to have microbes, but don't want any that can be inhaled and cause infection

Resistance of microbes to disinfection

Levels of disinfectants

  1. low-level: kills vegetative bacteria and lipid viruses; everything else may survive
  2. intermediate-level: kills everything except maybe nonlipid viruses and bacterial spores
  3. high-level: kills everything if sufficient time; when disinfectant is washed off, items lose their sterility (high-level disinfectants are not classified with sterilization procedures)

Detergents and soaps

Alcohols (Ethanol and Isopropyl alcohol)

Chlorine-containing agents (bleach)

Refer to chart in notebook for Health Canada's strong bleach vs weak bleach chart.

Iodine, phenolics, and glutaraldehyde

Iodine (Iodophores):

Phenolic compounds:

Glutaraldehyde:

Peroxygens:

Safety and Equipment - Tattoo

Steps for cleaning and lubricating body mod tools

1. Gather all the tools you plan to clean and take them into your clean room.

2. Turn on your sink and let the water run until it's warm. Don't let it get hot.

3. Rinse instruments.

4. Soak instruments in a neutral pH(7) disinfectant for 10 minutes. Wavicide works well.

5. Use your ultrasonic cleaner to clean the instruments for 10 minutes. Make sure they're placed in the open and unlocked position.

6. Allow the instruments to air dry afer taking them out of the ultrasonic cleaner.

7. Spray any tools with moving parts with a surgical instrument lubricant.

8. Allow the tools to air dry after spraying them with a lubricant.

9. Place each instrument in a sterilization pouch or length of nylon tubing. Make sure the tools with moving parts are in the open and unlocked position. Seal the pouches and autoclave them. Do not remove the instruments from the sterilization pouches until right when you need to use them.

Tattoo grips, tips, and tubes

There are three primary styles of tattoo tips: round tips, diamond tips, and flat tips (which includes magnum tips). Different types of tattoo work and needle configurations call for specific tattoo tips. You'll probably need all of these tips at some point while you're tattooing, so it's best to keep a variety of tips on hand.

Diamond tattoo tips - Diamond tips are ideal for creating clean, thin, straight lines. The diamond tip cradles the needle and prevents it from wobbling, which makes it ideal for finer, delicate line work. They are better than round tips when working with single needles, 3's and 5 round liner needles, and round shader tattoo needles in particular. They also allow you to see your needle clearer than you can with round tips.

Round tattoo tips - Round tattoo tips are ideal for thicker line work, but they don't cradle the needle, so the tip may wobble a bit (especially when working around a curve). Round tattoo tips are better than diamond tips for accommodating larger needle configurations. You should use round tattoo tips with round liner needles, super tight round liner needles, extra super tight round liner needles, round shader needles, and textured round shader needles.

Flat tattoo tips - Flat tattoo tips are meant to be used with flat tattoo needle configurations. Flat tattoo tips are ideal for shading in geometric areas or creating avant-garde tattoos. Some experienced tattoo artists prefer to use flat tattoo tips for their linework, but they are experienced, so you should stick with diamond tips.

Magnum tattoo tips - Magnum tattoo tips are a type of flat tattoo tip, but they are wider than usual and can be paired with larger groupings of flat needles, magnum needles, or stacked magnum needles. They're great for filling in larger areas, blending, and shading. There's two styles of magnum tattoo tips: open-mouth and closed-mouth. Closed-mouth magnum tattoo tips have a box-shaped tip.

Cleaning reusable tattoo grips, tips, and tubes

Autoclavable tattoo grips, tips, and tubes have the benefit of saving you money over time, but unlike disposable ones, they require maintenance. Put on gloves and clean your tattoo grips, tips, and tubes well before autoclaving them in between uses. It's critical that you thoroughly clean your tools before autoclaving them, since dirty tools can damage the machine and bake debris into your instruments. You should clean the instruments by rinsing them under warm running water, giving them a scrub, and soaking them in Ultradose followed by Ink-out Tattoo Tube Cleaner. As an additional step or an alternative method, you can clean the tools in an ultrasonic cleaner with a suitable detergent like Alconox.

Pre-sterilization cleaning of tattoo and piercing instruments

Put on a fresh pair of gloves, run tap water warm, and then rinse your instruments in the warm running water. Use a brush on grooved metals and any debris that won't come off easily. After you thoroughly scrub what needs to be scrubbed, do a final 30-second rinse before setting the instruments on a sterile surface like a dental bib. Allow them to air dry.

Then, spray or soak your instruments with/in Sklar Kleen (or a similar product). Scrub the tools again with a soft-bristled brush, like a nylon brush, to work the cleaning product into all crevices. After you've done that, place the tools in their open and unlocked position in an ultrasonic cleaner. Run the ultrasonic cleaner with a detergent such as Alconox for 10 minutes. When 10 minutes have passes, remove the tools and let them air dry again.

Once they have dried, spray the tools with lubricant. Allow them to air dry one last final time, and then they're ready to be sterilized.

Proper technique for autoclave sterilization

Package all instruments and body jewelry you need to sterilize in seperate sterilization pouches or nylon tubing. Make sure tools with moving parts are placed in the open and unlocked position. Heat seal the packages. While sealing up the packages, label it with the name of the instrument inside, your name, and the date.

Place the packages into your autoclave, laying them out carefully so that none of them touch each other or any metal surface in the autoclave. You can put paper or cloth in between the packages and the machine if needed. Nylon tubings may fuse together if they overlap. Don't overload the autoclave since that can reduce effectiveness and interfere with the packages' drying after the cycle is done! There should be a distance of at least 1" in between the packages so the pressurized steam can circulate properly.

Follow the autoclave manufacturer's instructions for running a sterilization cycle appropriate for the items you're sterilizing. Once the cycle is done, let the pouches cool within the autoclave for 5 to 10 minutes before removing them. Keep a log book of sterilization cycles. Each line should include the initials of whoever ran the autoclave, the date, the number of minutes the cycle ran, the maximum temperature reached during the cycle, and results such as the sterilization pouches' indicators.

Safety and Equipment - Piercings

Ear piercing techniques

First things first, do NOT use a piercing gun! EVER! Hollow straight needles or threaded needles are what you should use for earlobe piercings, as they allow you to gently pull the jewelry through and provide cleaner fistulas that heal better.

Most people get their earlobes pierced at 20g-18g so they can wear standard-sized earrings, but 16g-12g may be more suitable for clients who want captive bead rings or labret studs. Like you, you have 16g captive bead rings. If a client asks for a larger gauge so they can wear plugs, tunnels, or other large gauge earrings, use either a larger-gauge needle or a dermal punch. A dermal punch should only be used if the client is okay with not being able to shrink the piercings down to a smaller size, as it's nearly impossible to do with a dermal punch. Unlike needles which part the skin, a dermal punch takes a small chunk of tissue out.

Ear cartilage is harder to piecer than the earlobes, so a needle pusher is helpful. Piercing corks are useful when performing cartilage piercings in tight places, like tragus piercings. Labret studs or micro bent barbells are recommended for tragus and anti-tragus piercings.

When performing industrial piercings, don't try to put the needle through both sites in one swift motion. Instead, after measuring the desired distance, mark the spots then pierce each hole seperately using seperate sterile needles for each piercing. Industrial bars are not good starter jewelry, so ask your client if they'd prefer wearing labret studs or captive bead rings while it heals. Once healed, it's much more comfortable to wear an industrial bar.

If a client mentions that they plan on stretching a cartilage piercing, let them know that it's lengthy process that is less successful than just starting with a larger-gauge needle or dermal punch to achieve the desired size from the start.

Eyebrow piercing techniques

Eyebrow piercings are surface piercings, meaning they have higher chances of migration and rejection. To reduce those chances, you need to place the piercing as deep as you can. Ideally, you should use a 16g-14g piercing needle and jewelry as larger gauge sizes also help reduce the chances of migration and rejection. If your client's facial structure and eyebrow tissue can accommodate it, 12g may be a good size, too.

First, try to find a placement that allows you to pinch a sufficient amount of skin around the eyebrow and mark the spots. You should pierce from the underside of the eyebrow up to avoid contact with the client's eye. If your client selects threaded eyebrow jewelry, use a threaded needle. If they don't, use a hollow needle instead.

Facial dermal piercing techniques

Facial dermal piercings can be done with either a small dermal punch or a piercing needle, but a needle is preferable if you want to avoid scarring.

Once you've pierced a hole, gently insert a dermal anchor. In order to minimize trauma to the surrounding tissue, you may want to use a 14g threaded taper to insert the anchor. Once the anchor is inserted, hold the anchor in place while you screw on the dermal top your client chose.

Cheek piercing techniques

Don't even attempt this until you're an experienced piercer. Seriously. Don't. Cheek piercings are incredibly easy to mess up. If you're not an experienced piercer, you can easily puncture your client's parotid ducts. The parotid ducts are responsible for saliva flow, and if damaged, saliva may permanently run down a person's cheeks and make them much more prone to infection. There's no way to repair them once they're damaged. They can only be cauterized to seal off the holes and stop external saliva flow, leaving scars.

Once you've identified the parotid ducts, you need to find a placement that gives the client the appearance of having dimples (or enhancing their dimples if they already have them) that's not too close to the parotid ducts. Mark the spots and make sure the client is happy with the placement before proceeding. Screw a cheek barbell on to the end of a threaded needle before gently inserting it in one cheek. You should insert the needle from the inside of the mouth, so that once you've pulled it through, the end of the jewelry will rest against your client's inner cheek. Unscrew the needle from the outside of the barbell and screw the decorative end on. Repeat on the other cheek using a new, sterile needle.

Nose piercing techniques

Bridge piercings are surface piercings. Like all other types of surface piercings, larger sizes are better, so use a 16g-14g threaded piercing needle and micro bent barbell. The jewelry should be long enough to accommodate any swelling that occurs, but not so long that it impairs vision. Again, like all other types of surface piercings, make sure to pinch the skin and place it as deeply as you can! You should also use a recieving tube to protect your client's eyes.

For nostril piercings, labret studs tend to be the best starter jewelry. Some clients may choose a small seamless or segmented ring, though. Either way, make sure the jewelry is long enough (or has a large enough diameter) to accommodate any swelling. Cleanse the area, mark the desired piercing spot, make sure the client is happy with the placement, and then apply an antiseptic to the area. Then you're ready to begin the piercing process. If you're using threaded jewelry, attach it to an 18g-16g threaded piercing needle. If inserting a nose ring, use a hollow piercing needle. You may prefer using a curved piercing needle to make it easier. Once the jewelry is in place, attach the top if you've inserted threaded jewelry, or close the gap in the ring if you inserted a nose hoop.

Rhino piercings are not common, but you may be asked to perform one eventually. They require piercing the soft tissue between the nostrils vertically. Gently pinch the tip of your client's nose to see how far back you can place the piercing. The top hole should rest towards the tip of their nose, slightly closer to the central cartilage than to the actual tip. Mark the spots and make sure your client is happy with their placement. Use a threaded piercing needle and a short straight barbell or micro bent barbell. It's recommended to pierce upwards instead of downwards. Once the jewelry is gently pulled through, unscrew the needle and attach the top ball.

Septum piercings can be tricky to get right. It's easy to pierce too low or too high, or in the cartilage. If you accidentally pierce your client's cartilage, it'll be incredibly painful for them and they'll have to wait until it heals to try again. You need to pierce through the "sweet spot", which is in between the top of the nostrils and the cartilage. Not everyone has a sweet spot. There are special forceps you should use to get the alignment right and guide your needle through. The type of needle you should use depends on what type of jewelry the client chooses.

Lip piercing techniques

Most lip piercings are done similarly to each other, with the exception of vertical labret, Dahlia, and lowbret piercings. Labret jewelry is the best type of starter jewelry for most upper and lower lip piercings. Because metal jewelry can damage the gums and teeth, you should recommend your client use BioPlast labret jewelry instead. BioPlast jewelry is autoclavable, hypoallergenic, soft, and flexible. If your client chooses the metal labret jewelry, use a threaded needle. If they choose BioPlast, use a hollow needle. Mark the spots, get your client's approval on the placement, do the proper skin preperation, and do the piercings. It's ideal to pierce from the inside of the mouth outwards. If you can't do that, use a recieving tube or piercing cork to avoid poking the client's mouth. If the space is tight but you still want to pierce from the inside out, you may want to use a curved or hooked needle instead.

The process for vertical labret piercings is simpler. You need a short straight barbell and a threaded piercing needle. You can use forceps if you'd like to hold your client's lip out while you do the piercing. Attach the barbell to the needle and pierce straight through the centre of their lower lip.

Lowbret piercings are trickier to perform since you have less space to maneuver. When selecting the placement, you have to look inside your client's mouth. Pinch their lower lip between your thumb and forefinger to mark the placement point for the lowbret. It should be slightly higher than where the gums meet their lip.

Dahlia (joker) piercings are likely to migrate out, so to minimize that risk, try to place them as far back as you can without coming into contact with the small flaps of skin that protrude inside the mouth behind the corners of the lips. Measure the distance/position of the piercing points carefully and ask for your client's approval. Use threaded or hollow piercing needles to perform Dahlia piercings. Pierce from the inside of the mouth outwards and gently pull the jewelry through until the back of the labret stud rests against the inside of the cheek. After that, attach the decorative end to the labret stud. Repeat the process on the other side.

Oral piercing techniques

There are three oral frenulum (web) piercings that all have fairly similar methods. Those piercings are the tongue web, smiley, and frowny piercings. Those are all surface piercings. The best jewelry to use for those are micro bent barbells, circular barbells, or captive bead rings, in that order. As with other surface piercings, using larger gauge sizes can reduce the chances of migration and rejection, but you have to do so within reason as oral frenulum tissue is delciate. You should stick with 18g-14g.

To perform an oral frenulum piercing, your client has to rinse their mouth well for 30-60 seconds with an antiseptic piercing rinse. If you're doing a lip frenulum piercing, you should use piercing forceps to hold the lip out, and pierce straight through as far abck as possible. If you're doing a tongue frenulum piercing, you should also use forceps to hold the tongue out and pierce as far back as possible. Depending on the jewelry your client chose, you can use either a threaded or hollow piercing needle.

Not everyone can get a tongue piercing. Most people have two obvious veins running down either side of the underside of the tongue. As long as there isn't a third vein in between, they can get a tongue piercing. You'll want to use forceps to get a good grasp on your client's tongue. Mark the top and bottom spots. Use a 14g tongue ring and threaded needle. When inserting the needle, be careful to not knick one of the major veins! After the jewelry is inserted, unscrew the needle and attach a top ball that's larger in diameter than the bottom ball and a good deal wider than the barbell. This ensures that the barbell doesn't sink and cause problems.

Web piercing techniques

Web piercings are placed in the connective tissue between various parts of the body, like the fingers and toes. Like all surface piercings, they're prone to migration and rejection, but are even more likely to reject than other surface piercings since they're typically on much-used parts of the body (hands and feet). 16g-14g labret studs are ideal for these piercings, but a short straight barbell can work as well.

Have your client spread their fingers or toes as much as they can, and then mark a spot towards the back-center of the web to be pierced. Perform proper skin preperation before piercing it with a threaded needle that has the jewelry attached. If you're using labret studs, pierce from the underside so you can easily unscrew the needle and replace it with the top.

Nipple piercing techniques

Nipple piercings tend to be very painful for people, so you should encourage the client to apply topical anesthetic 20-30 minutes before the piercing. The client can choose from 14g-16g straight barbells, bent barbells, circular barbells, or captive rings as their starter jewelry. Attach threaded jewelry to a threaded piercing needle, or insert threadless jewelry into a hollow straight needle. Your client can bring a friend that'll let them squeeze their hand, but if they're alone, hand them a stress ball or a tongue depressor to bite down on. Then, insert the first needle. As soon as the jewelry is pulled through, remove the needle, attach the end to the nipple ring, and start the second piercing right after with a seperate sterile needle and a fresh pair of gloves.

Belly button piercing techniques

Belly button piercings are placed 1/4" to 1/2" above the belly belly button, even if the client has an "outtie", so that the decorative end hangs over the top of the belly button cavity. Use 14g-12g belly button rings and either a straight or curved needle. Insert the needle and bring it out beneath the upper lip of the belly button cavity.

Surface and dermal piercing techniques

Getting lazy and I want to skip right to male genital piercings because I'm gay. Refer to notebook.

Female genital piercing techniques

Getting lazy and I want to skip right to male genital piercings because I'm gay. Refer to notebook.

Male genital piercing techniques

Dydoe piercings are placed at the top edge of the penis head, parallel to the penile shaft. Depending on the girth of his penis, a man can have more than one. These are surface piercings, so a heavier gauge threaded needle and short straight barbells are the best to use. Mark the point on the edge of the penis head where you plan to insert the jewelry, and then mark the exit point. Lay the needle against the penile shaft and push it through with a slight upward angle so it exits at your exit/second mark. Pull the jewelry through, unscrew the needle, and attach the opposing ball to the barbell. If you're doing a pair of dydoe piercings, repeat the same process with a new sterile needle. The pair should be slightly spaced apart, but centered on the penis head.

Ampallang piercings are incredibly painful as it goes horizontally through the penis head. To make sure there's enough room to accommodate swelling, choose a 10g-8g threaded needle and a straight barbell that's slightly larger than the width of the widest part of the penis head. Mark the left and right sides of the penis head, make sure they're level, attach one end of the straight barbell to the threaded needle, and pass the needle through the penis head fro one side to the other. Then unscrew the needle and screw on the opposing ball.

Apadravya piercings are also very painful. They're similar to ampallangs as they go through the penis head, but apadravyas are vertical instead of horizontal. They're pretty common despite how painful they are because they give great sexual benefits for the man's partner(s). You'll need a threaded needle and a long straight barbell. Attach one end of the barbell to the threaded needle and mark both the top and bottom centre of the penis head. Push the needle through the top mark and out the bottom mark, unscrew the needle from the jewelry, and replace it with the opposing ball.

If your client is uncircumsized, he can get a kuno piercing, which is a piercing on the upper rim of the foreskin. It needs to be performed while flaccid and you can get a good grip on the edge of his foreskin with forceps. Use a 16g-12g hollow needle to pierce straight through the foreskin a little below the edge of the rim. This is a surface piercing, so piercing too close to the top of the foreskin may cause it to migrate or reject. Follow the piercing needle with a seamless ring or other captive ring.

Frenum piercings are one of the least painful genital piercings for males, so it's more common. Like apadravya piercings, they're also very sexually stimulating for the man's partner(s). Frenum piercings are surface piercings placed horizontally along the penile shaft, typically along the bottom side. When placed on the top, they're called dorsal frenum piercings. When a single frenum is placed at the base of the underside of the penile shaft where it meets the scrotal sack, it's called a lorum piercing. Most men start with a frenum placed close to the head of the penile shaft, which allows him to wear a D-ring when healed. You need to attach a straight barbell to a threaded needle (a starter one long enough to accommodate swelling), pinch the skin up, and insert the needle horizontally across the penile shaft. Follow it with the barbell and unscrew the needle from the jewelry and replace it with the opposing ball.

Some men choose to add on more frenums to create a Jacob's Ladder. The same can be done with dorsal frenums.

Prince Albert piercings are also very popular. To perform a Prince Albert piercing, you need a 12g-8g hollow curved needle, a needle pusher, and either a bent barbell or a circular barbell or a captive bead ring. You puncture the underside of the penile shaft just below the penile head until you've penetrated the urethra. That's difficult, which is why a needle pusher is recommended. Once it's in the urethra, you can slowly turn the curved needle 'til it's pointing towads the urethral opening, and thread the jewelry through until it protrudes from the urethral opening. Attach the captive bead, or screw on the barbell balls, and then you're done. If your client asks for a reverse Prince Albert, it's the same process but from the top of the penile shaft instead of under.

A Prince Albert piercing is required to do a dolphin piercing. Place a second hole into the urethra from the underside of the penile shaft, roughly 5/8" below his Prince Albert. It is best to use a curved piercing needle as you'll be threading a bent barbell from the new hole into the Prince Albert hole. Screw on the opposing ball and the dolphin piercing will be complete.

Proper post-mod clean up procedures

Properly dispose of used supplies

Clean surfaces in your workspace

Once your workspace is clear of debris, put on a fresh pair of glovves and gather cleaning supplies. Start wiping down the surfaces in your workspace. You need a surface disinfectant like Cavicide or Madacide. They both kill all major fungi, bacteri, and viruses when applied for a long enough amount of time, which should be detailed on the cleaner's instructions. Apply it to your piercing table or tattoo chair, your work stool, countertops, and any stainless steel trays (yes, even the ones covered with dental bibs). If blood, ink, or anything else splattered on other surfaces such as the floor or cabinets, make sure to wipe those down, too.

Clean and sterilize reusable tools

  1. Gather up your tools and take them into your clean room. Put on fresh gloves.
  2. Turn on the faucet and let the water run warm. Rinse your tools under the warm running water and scrub off any debris with a suitable brush (steel and brass on metal and nylon on plastic).
  3. Soak your tools in a neutral pH(7) disinfecting cleaner for 10 minutes. Wavicide is a good choice.
  4. Put your tools in an ultrasonic cleaner with a suitable detergent like Alconox. Run the ultrasonic cleaner for 10 minutes and make sure you place the tools in the open and unlocked position.
  5. Remove the tools from the ultrasonic cleaner and allow them to air dry.
  6. Lubricate any tools with moving parts using a surgical instrument lubricant and allow them to air dry again.
  7. Package each instrument in either a sterilization pouch or length of nylon tubing. You may want to add an indicator to the bags to confirm the autoclave sterilized them. Heat seal the bags and place them in an autoclave.
  8. Run your autoclave then remove the sterilized tools. Leave them in their packages right until they're being used. Make sure you label the bags.
  9. Clean the autoclave with an appropriate autoclave cleaner. Also, periodically test the autoclave for spores.

Introduction to Microorganisms

Bacteria

Bacteria are tiny unicellular (single-celled) organisms typically surrounded by a rigid cell wall. They don't have an organized nucleus but can still carry out all the activities needed for growth and reproduction. Bacteria appear as one of three shapes, and those shapes help identify the bacterium.

Bacteria are found nearly everywhere there is moisture and nutrients. Many grow in or on humans and they are an essential part of humans' normal flora. However, there are many others that can cause infection.

The shapes bacteria can come in are called:

Cocci (plural), Coccus (singular): spherical or round cells

Rods or bacilli (plural), Bacillus (singular): rectangular-shaped boxes

Spiralla (plural), Spirillum (singular): curved rods, spiral-shaped rods, spiralla are rigid and have flagella, spirochetes are flexible

Gram reaction to bacteria

Bacteria can be divided into two groups on the basis of the Gram stain. The stain has been used for over a hundred years to stain bacteria and make them more visible when viewed under a microscope. Once the staining procedure is carried out, one group of bacteria appears as a dark bluish-black and are called Gram positive. All other bacteria appear as a pink or red colour and are called Gram negative.

The Gram reaction is important because it, and the shape of bateria, is the first step to identification. Using the Gram reaction and shape of cells, there's six groups:

The Gram reaction also determines the effectiveness of certain antibiotics and disinfectants.

Bacterial endospores

A small number of bacteria (a few Gram positive rods) are able to produce a special type of spore within their bacterial cell. These spores are called endospores to differentiate them from fungal spores borne on the ends of hyphae. Bacterial cells that don't contain endospores are often called vegetative cells. Even Gram positive rods that are able to form spores exist as vegetative cells when they are actively growing and multiplying. Sporulation seems to take place when certain nutrients are depleted. A layer of insulating material encloses one copy of the genetic material and a tiny amout of cytoplasm and the whole structure is covered with several compact layers of spore coat.

Endospores may remain dormant for days, months, and even years without nutrients or moisture. Many of the bacteria found in dust, cereals, grains, and soil exist as endospores. A viable endospore is an endospore that is able to germinate into a vegetative cell when moisture and nutrients are provided. One spore will germinate into one vegetative bacterium.

The significance of endospores in sterilization and disinfection:

Growth of bacteria

Almost all bacteria reproduce by a process called binary fission. The time it takes for binary fission to take place is the generation time. This is the time it takes for the population to double.

The generation time is not the same for all bacteria and is also affected by temperature and available nutrients. Rapidly growing bacteria, under ideal conditions, have a generation time of 15-30 minutes.

The generation time is related to the rate at which bacteria cause disease. The bacteria responsible for gas gangrene have a very short generation time, believed to be ~8 minutes. Once infection is established in human tissue, a whole limb can be destroyed in a day. The bacteria responsible for tuberculosis have a long generation time of 12-14 hours and may take weeks to produce disease.

Generation time also determines the amount of time required for bacteria to form visible growth on culture media. A colony is a visible mass of bacteria that develops on the surface of a solid culture medium after a period o time and represents all descendants of a single bacterial cell. The culture medium provides necessary nutrients for bacterial growth. Rapidly growing bacteria will form colonies within 24 hours.

Bacterial growth curve

Bacteria don't continue to grow at their maximum generation time forever. When bacteria are introduced into a new medium or environment, they go through four specific phases of growth. These phases make up the bacterial growth curve.

Lag phase is when bacterial cells are placed in a new environment. There is little to no increase in numbers in a short period of time. This time is necessary for the cells to adapt to the new environment. This page is usually a few hours long, but it may be much shorter or much longer in some situation. The lag phase for bacteria in food is ~2 hours. This allows food to be left out for that long without any worries of bacterial growth and food poisoning.

Log phase is a period of maximum growth of bacteria. All cells are dividing at a constant rate. Microbes continue to multiply at a logarithmic rate until supply of an essential nutrient has run out or toxic produts from microbial metabolism inhibit their growth. Fewer and fewer cells divide and then the transition into the next phase begins.

During the stationary phase, the number of live bacteria stays relatively constantly. Some cells die, but others divide to keep the number of live cells constant.

The death phase is when bacterial cells eventually begin to die, perishing in their own wastes, or unable to survive because of a lack of nutrients. The number of live cells decreases. In some cases, most of the bacteria die in a short period of time, but in other cases, they can linger for weeks, months, and even years. Bacteria that can survive the longest are those that form spores.

Growth curve related to infection

Growth curves are plotted using lab cultures, but the same sequence of events typically take place when microorganisms invade a host.

There are usually no disease symptoms for a period of time immediately following the introdution of miroorganisms to the host. This represents the incubation period of the disease and corresponds to the lag phase of the growth curve. This is followed by an onset of symptoms, which may be fever, sore throat, swollen lymph glands, vomiting, or diarrhea, depending on the infectious microbe involved.

This is the acute stage of the disease and corresponds to the log phase. With the assistance of a patient's defences and medial intervention, most recover. However, if it fails, the patient dies during this period of the disease.

Finally, the symptoms subside and recovery is on the way. This is the death phase (to the microorganism, not the host). The convalescent period of the disease covers the time needed for complete recovery. This length of time will vary with different diseases and infectious microorganisms ontinue to be shed during this period.

Viruses

Viruses are even smaller than bacteria and have very simple structure. They are unable to grow and reproduce on their own, and they must rely on living host cells to replicate the viral parts. Animal, plant, and bacterial cells all server as host cells for viruses.

A number of human diseases are caused by viruses. Influenza and colds are viral infections that affect everyone at one point. Some of the more serious infections include hepatitis, rabies, and AIDS.

Viral characteristics

Viruses are very different from bacteria. Two of the most distinguishing differences are:

Viruses possess a protein coat or capsid surrounding the nucleic acid. Some viruses also have an envelope, composed mainly of lipids, surrounding the coat, and others have spikes protruding from the lipid envelope. Lipid viruses are easier to kill with disinfectants.

Multiplication of viruses

In order for a virus to multiply in a host, it must attach to complemntary receptor sites on the surface of the host's calls. For the Adenovirus, the complementary sites are located on the epithelial cells of the respitory tract. The virus causing AIDS attaches to body cells that have CD4 receptor sites, especially specific white blood cells called lymphocytes.

Once they're attached, the virus is taken into the host cell by endocytosis, during which the cell's membrane folds inward, forming a vesicle containing the virus. As host cells attempt to destroy the contents of the vesicle, the outer protein coat is digested and the nucleic acid is released inside the host cell.

Then, the stage is set for replication of new viral material using the enzymes and metabolic pathways of host cells. The viral nucleic acid carries genetic coding for new viral material and directs the synthesis of viral parts. Most DNA viruses replicate DNA in the nucleus of the cell and proteins in the cytoplasm. The next step is assembly, where the proteins move to the nucleus and are joined with the DNA ready for movement out of the host cell. Lipids and other viral components, such as the envelope, may be added as the virus particle is released from the host cell.

Effects of viruses on host cells

1. Infection of a host cell usually kills host cell due to:

This may be destructive to the host if cells are vital for survival, as what sometimes happens with liver cells infected with hepatitis B.

2. A few viruses are able to alter the nucleic acid of the host cell in a way that the cell is transformed to a tumour cell. These viruses are called onogenic viruses. Hepatitis B is considered an oncogenic virus as it's linked to liver cancer.

3. Latent viral infections: Following the initial infection, the virus may remain in the body where it's non-infectious. It doesn't replicate nor does it cause disease. These particles can be reactivated to cause a second infection years later. For example, after intial acute infection, the herpes virus inhabits the host and causes no damage until activiated by stimuli like sunburn, fever, or stress, when it results in cold sores.

Control of viruses

Antibiotics have no effect on viral replication because antibiotics are directed against metabolic pathways of the bacterium. Since viruses have no metabolic activities of their own, antibiotics provide no antiviral activity. In addition, viruses lack a cell wall which is one typical target antibiotics use.

Many drugs that'd inhibit replication of viruses cannot be used because they'd destroy host cells. However, there are a few useful antiviral drugs. Ideally, antiviral agents target activities specific to the virus, like activity of DNA or RNA and assembly of components.

Acyclovir is well-known as a control measure for genital herpies, and zidovudine (ZDV) is useful in controlling the rate of replication of the AIDS virus.

Tamaflu is an antiviral that stops the Influenza virus from reproducing in the body. It's used in patients one year older or older who have symptoms for no more than two days. Tamaflu generally reduces the durations of symptoms by one and a half day if treatment is started early enough.

Each group of microorganism, when causing an infection, requires a different drug for treatment: protozoan treated with antiprotozoal drugs; fungal with antifungal drugs; bacterial with antibacterial drugs; viral with antiviral drugs.

Blood-borne Pathogens