Infection Controls Update
by David Vidra
This is the first in a series of articles which will deal with infection control issues in the modification industry i.e., tattooing and piercing.
Infection “control” is the process of preventing infection from occurring, not only to our clients but to ourselves, as practitioners. It is not enough to practice the learned routines of protection. You must know why you do what you do. Only then are you able to understand the process of infection control and practice it safely.
HAND WASHING: THE CRITICAL LINE OF DEFENSE
Gloves – The use of gloves does not eliminate the need for hand hygiene. Likewise, the use of good hand hygiene does not eliminate the need for gloves. Gloves reduce hand contamination by 70 to 80 percent, prevent cross-contamination and protect your clients and yourself from infection.
Hand Hygiene – One of the most important tools and protective devices we have is our skin. It is the largest organ of the body. If we do not provide it with proper care, it can have reactions to soaps we use and the gloves we wear.
Water should be tepid or lukewarm. Hot water will dry out the skin. Cold water will also cause damage and make the pores close, therefore not getting down where we need to be with hand washing.
Soaps – Antibacterial soaps are highly overused and can cause severe irritation to the skin. Presumed allergy or sensitivity to gloves may be from irritated skin due to over washing with antibacterial soap. Consider how many procedures you do in a day. Keep in mind rest room use and interruptions during the procedures. Chances are if you exclusively use antibacterial soap, you are using it in excess. There are resident and transient bacteria on the hands. With hand hygiene, you must realize the purpose of the soap is to suspend the bacteria. The friction from washing removes them, and the chemicals will reduce the number of bacteria present. If you are removing or killing off too many resident bacteria, you are using the product in excess.
Gels are just now being accepted in the health care community but only with good hand hygiene. They do not have any place in our industry. We have the time, and the proper environment for sound hand washing techniques. We don’t generally have so many procedures to do to that it warrants their use.
Nails – Nails are a huge consideration. The majority of hand bacteria can be found under and around the fingernails. No artificial nails should be worn and natural nails should be kept less than one quarter of an inch long. Nail polish chips and can harbor bacteria. Rings also trap bacteria underneath them. If you must wear one put it on a chain around your neck, not on your hands with gloves. Warm, moist, and dark places are perfect breeding grounds for bacterial growth.
Skin care – Use a cream to help condition the skin. It will minimize the occurrence of irritant contact dermatitis associated with hand washing and hand antiseptics. Protect your hands from the elements. Select your soaps wisely. Know when and how much of them to use. They all come with instructions, follow them.
How to wash your hands – You must get between the fingers (digits) and scrub, this is called inter digital washing. Clean under the nails top and wrists of the hands. Rinse in a downward manner. The length of time necessary is about 15-20 seconds. If you sing Happy Birthday to yourself, that is about the time needed.
Hand drying – When drying, pat the hands dry, don’t rub them. The rubbing causes friction which causes minor abrasions, and then we put on gloves. Now you see how the chemicals irritate us from the gloves.
The last step is the training. Have a complete training program so everyone in the studio will follow the same procedures.
Here is a sample written protocol for hand washing that can be adjusted for your specific needs:
Hand Washing Protocol
Hand washing is the first step in any infection control program. The surface of the hands and nails must be clean before any contact is made with clients. Abrasions, cuts, or lesions should be covered by a waterproof dressing. Consistency in hand-washing procedures is essential in reducing the risk of cross-contamination and the spread of infectious diseases.
When to wash hands:
- Upon arrival in the studio
- After working at the counter and/or handling money
- After using the toilet
- Before and after each procedure
- Before and after daily room set-up
- Before and after eating
- Whenever hands are dirty
- After smoking
- Before leaving the building
- Whenever there is doubt about cleanliness of hands
What to Wash Hands With:
Hands should be washed using the liquid, antibacterial soap provided in each of the procedure rooms, the sterilization areas and the restroom. Soap for hand washing should always come from a wall-mounted, pump dispenser. Bar soaps are unacceptable, as they can harbor different forms of bacteria and other microorganisms.
How to Wash Hands:
Turn on water if using hand operated paper towels. Turn on and off so as to prevent cross contamination.
Always wet hands with water then apply soap (follow manufacturers instructions).
Using soap provided for hand washing:
Rub hands vigorously during the washing process. Both the chemical action of the soap as well as the friction from the physical act of hand washing results in appropriate cleaning.
Hand washing should include the following actions:
- Washing palm-to-palm
- Washing palm over dorsum (top of hand)
- Washing palm-to-palm with fingers interlaced
- Washing tops of fingers and nail area
- Washing forearms to an area above where the cuffs of gloves stop
- Thoroughly rinse hands, with hands pointed downwards
Your hands are your most important tools and are the greatest at risk for you to contract a disease and to cause one.