Hepatitis C: An In-Depth Guide
Safer tattooing & piercing
When the setting and equipment are not sterile, getting body art puts a person at risk for hepatitis C. Blood carrying the virus can be present on unsterile items and because body art usually involves the breaking of skin, there is a chance for blood-to-blood contact. The hepatitis C virus can live outside of the body for long periods of time and blood does not have to be visible on the equipment to spread an infection.
Infection Control Procedures and Professional Settings
Tattoo and body piercing studios are not always inspected by public health departments. Studios should be inspected and public health units should try to visit them at least once a year, but some piercing and tattoo businesses fall through the cracks and are missed. For safer body art, it’s important to find an artist who:
- has a good reputation
- has lots of experience (and portfolio) in their particular field
- has an inspection certificate from the local public health department
- has an autoclave and autoclave spore-test calendar
- follows infection control procedures to prevent the spread of hepatitis C and HIV
Infection control procedures to prevent the spread of hepatitis C and HIV include:
- New sterile needles every time – Sharing needles can transmit infections like Hep C. Reusing needles makes them dull and the piercing or tattoo will hurt more.
- New latex or vinyl gloves every time – Gloves should be changed every time they touch anything besides the sterile equipment and spot where the tattoo or piercing will be. This includes changing gloves after cleaning and prepping the work area and again after cleaning and prepping the site on the body.
- New ink and ink pots – With tattoos, ink and ink pots can transmit Hep C if they are reused. A good artist knows that disposable cups can be filled with just the right amount of ink. They are an inexpensive and effective way to prevent the spread of disease.
- New support equipment – Corks, razors, markers, swabs, cotton, dental bibs (for mouth piercings), stencil paper and other supplies should only be used once per person and then disposed of.
- Autoclave for metal equipment – Clamps, tongs and other metal equipment must be sterilized. Some places also buy new single-use needles in bulk and must use the autoclave to sterilize them before use. The best way is in a steam-heat autoclave and a spore-test calendar should be visible to certify that the autoclave is working.
- Cleaning the site – The artist should use an alcohol swab followed by a topical surgical disinfectant to clean the area, working from the centre outwards.
- Work area – The work surface and area should be clean, disinfected and non-porous so it doesn’t hold any fluids or infectious disease agents.
- Stainless steel – Initial jewellery should be sterilized stainless steel or titanium and should not be changed until the piercing is fully healed.
- Choosing a site on the body – The tattoo artist or piercer should have experience and skills that match the desired procedure, as different areas of the body require different skills to tattoo or pierce.
- Providing aftercare instructions – Preventing infection goes beyond the procedure in the studio and involves educating clients on aftercare instructions so they can prevent infections themselves once they leave the studio.
Piercing or tattooing in non-professional settings increases the risk of both blood-borne illnesses (like hepatitis C) and skin infections.
Piercing needles are hollow and cause a surgical cut to create an appropriate space in the skin for the jewellery, while safety pins or sewing needles just push the flesh out of the way and are more likely to scar. Proper needles are not very expensive and can sometimes be obtained through needle exchange programs. Buying piercing kits online is not as safe because it’s difficult to know if the equipment is sterile.
Non-professional tattooing is a strong part of certain cultures. While this includes prison, it is not limited to that setting; the number of tattoos done in basements, backyards and other non-studio spaces is growing. This can be accompanied by a number of challenges for infection control, including:
- reused equipment and shared ink (there is often no autoclave for sterilizing metal equipment and metal equipment cannot be sterilized using an oven, a microwave oven or boiling water)
- a workspace that is difficult to sterilize
- less-than-adequate disposal of sharps and other equipment that could cause accidental exposure to Hep C
- drugs and alcohol, which, if taken before getting a tattoo, reduce inhibitions and increase bleeding
- a lack of awareness around aftercare
- often, the quality of work is different and can be compromised if the job is rushed
Getting a tattoo or piercing in non-professional settings increases the risk of getting hepatitis C, HIV and other infections. Following infection control procedures wherever possible may help reduce this risk. Some strategies for doing this are:
- bringing one’s own sterile equipment and not sharing it
- if alcohol or drugs are around, waiting until after the art is finished to take them
- disposing of needles and other equipment into a sharps container or other bottle with a tight-fitting lid (such as a bleach bottle or pop bottle) immediately after the work is done
Tattoo artists should provide aftercare instructions. These will usually involve the following points:
- Leave the bandage on for four to six hours after getting the tattoo. Once the tattoo has stopped bleeding, the bandage can be gently removed after hands are washed. If it sticks, wet it with warm water.
- Wash hands, then wash the tattoo with the fingers and mild soap, rinse and pat dry.
- If using healing ointments (vitamin A and D or vitamin E), put a thin layer on the tattoo twice a day for two days. Some studios provide this ointment for their clients.
- Apply a non-scented body lotion (Lubriderm) when the tattoo becomes dry and flaky. Some scabbing and peeling will occur. Do not pick or scratch or you risk scarring, infections and losing ink.
- Keep clothing clean and loose around the fresh tattoo.
- Stay out of pools, lakes, hot tubs and direct sunlight until fully healed, about 10 to 14 days.
- If infected, use a non-corticoid cream-based topical antibiotic twice a day for 10 days. Have it looked at by a professional.
- Apply sunscreen when healed to protect the skin and prevent the colour from fading.
Signs of Skin Infections
Skin infections can wreck piercings and lead to excessive build-up of scar tissue; they can also ruin a tattoo's look and texture. If a piercing or tattoo looks red, swollen, blistered, oozes pus or hurts for longer than the standard healing time, it may not be healing properly and could be infected. It should be looked at right away by a doctor or at a clinic.
People with new piercings are advised to follow the aftercare instructions provided by their piercer. They generally include the following points:
- Wash hands with soap and water before cleaning the piercing and jewellery. Wash the piercing twice a day for the first two weeks with mild soap and then once a day after that.
- Do not expose any fresh piercing to the saliva or body fluids of other people until healing is complete. This will help prevent major skin infections, sexually transmitted infections (STIs), Hep C and HIV.
A piercing is an open wound and needs time to heal or it could become infected. As an open wound it also is a place where Hep C or HIV could enter the body. For example, a new genital piercing can bleed during sex making it easier to transmit Hep C or HIV. These aftercare instructions are meant to help people stay healthy and apply to piercings that involve the skin on the outside of the body, like ears, nose, nipples or belly button.
- Remove any crusty build-up with cotton swabs and warm water.
- Use non-scented soap and warm water to clean the holes and jewellery. Once the jewellery is soapy, gently move it back and forth in the hole to clean the inside. Rinse the jewellery and piercing using the same technique to remove all the soap, and then pat dry.
- If a piercing is in contact with clothing, make sure the clothing is clean and loose.
- Avoid bathtubs, hot tubs, lakes and pools while healing.
- Over-cleaning will dry out a new piercing.
- If a piercing gets infected, have it looked at by a doctor. Apply cream-based Polysporin twice a day after cleaning to help with minor infections. Put the cream on the jewellery and rotate in. Do not use a medicated cream unless you have an infection.
These instructions apply to piercings that involve the inside of the mouth, like tongue piercings.
- For the first two weeks, rinse with salt water or a non-alcohol-based mouthwash for 60 seconds every time you eat or drink.
- Avoid smoking, spicy foods, active yeast, beer, and alcohol for the first week.
- Antibacterial mouth rinse can help with healing or mild infections. Signs of infection are long-term or excessive swelling, yellow or green coating of the tongue, pus, localized hardness or bumps, and bleeding.
- Suck on ice cubes to reduce swelling.
- Brush your teeth and tongue twice a day as part of your regular oral hygiene.
For piercings that are both external and oral (labret or lip) follow both exterior and oral aftercare instructions.