Is Your Professional Tattoo Artist Protecting You Against Infections?

A client receiving a tattoo. Were proper practices taken to prevent infections?

(Adobe Stock)

The art of tattooing involves making thousands of tiny pricks to inject ink into the dermis. Tattooing can place tattooists and clients at risk of exposure to bloodborne pathogens due to contact with infected blood. Infection control knowledge and practices are critical in preventing diseases associated with tattooing.

Three in 10 (30%) Americans have at least 1 tattoo. Body ink is considered one of the oldest forms of art, with evidence of tattoos dating back to 3000 BCE. Creating walking art is a unique talent, but it can pose a risk to the individuals on either side of the needle—the tattoo artist and the customer.

Tattooing creates openings in the skin, and these pricks can introduce bloodborne viruses into the body, such as human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus. Organisms can also contaminate equipment such as tattoo machines and inks. Therefore, cleaning, disinfection, sterilization, after-care, and safe needle practices are imperative for tattoo artists.

Great art must first start with a clean work environment and equipment.

“Make sure that when you are getting a professional tattoo, it's done by [individuals] who know what they're doing, that they sterilize their instruments ahead of time, that they use clean tattoo pigment, that they clean the surface of the skin before doing that because if they don't do that, the most common source of infection is nonsterile, uncleaned instruments used to introduce the pigment,” Bernard Cohen, MD, told Infection Control Today® (ICT®) in an exclusive interview. Cohen has over 40 years of experience as a pediatric dermatologist, holding positions as professor of pediatrics and dermatology at Johns Hopkins University School of Medicine and currently as director of the Advocacy Committee for the American Academy of Pediatrics Section on Pediatric Dermatology.

Cohen said that the individual receiving the tattoo might not see signs of infection immediately. It may take up to 12 to 24 hours or even a few days. “You may develop a fever as a sign of infection. You may develop pus draining from the lesions from the areas where the pigment was poked into the skin. You might develop lymphadenopathy or swollen lymph glands up the stream if you had [a tattoo] on your arm. You may find it in your armpit or your neck crease for lymph nodes upstream from that area. The skin may feel warm, and it's going to hurt.”

Great art must first start with a clean work environment and equipment. Before disinfection and sterilization, tattooists must clean and remove organic or inorganic matter from their workstations. Organic and inorganic material includes blood, pus, dirt, or mucus. Disinfection and sterilization can only occur after having first achieved cleaning. After cleaning, tattoo artists should disinfect and sterilize their environment (chairs, tables, lamps, armrests) and equipment (tattoo machines and guns). Use disinfectants tested and labeled to kill bloodborne pathogens and other potentially infectious materials. Lastly, once cleaned manually or by an ultrasonic cleaner, place items in an autoclave to sterilize. Only place items that can be autoclaved in the machine. Sterilization machines should be regularly tested and serviced.

All disposable items should be appropriately discarded after use and before the next customer arrives at the workstation. Needles and other sharps, such as razors, should be discarded in a biohazardous sharps container. Professional tattooists should discard these items immediately after use to reduce their risk of a sharps injury. Other single-use items should also be discarded immediately, such as gloves, ink, and ointment. Tattoo artists should only use sterile needles and inks and open these when they are about to be used. Any unused opened sterile needles and inks should be discarded because there is no manner to guarantee sterility once packaging has been opened and compromised. Tattooists should use sterile water to dilute inks and rinsing equipment during tattooing. There have been reports of tattoo-associated non-tuberculosis Mycobacterial (NTM) skin infections due to nonsterile water use.

While tattooing, artists should be mindful of where their sharps are at all times. The client should inform the tattoo artist if they intend to reposition or move to prevent any unintentional movements of the needles.

Upon completion of the tattoo, tattoo artists should appropriately clean the affected skin of their client, apply an antimicrobial ointment, and wrap it to prevent the introduction of bacteria. Tattoo artists should provide their clients with instructions on caring for their tattoo until it is healed. Aftercare instructions include cleaning requirements and avoiding swimming in pools and hot tubs before the skin has healed. Aftercare is primarily the client's responsibility, but tattoo artists should educate all clients, even clients who have previously tattooed.

Hand hygiene is also imperative in the body art industry. Tattooists must wash their hands before and after tattooing to prevent the spread of viruses and bacteria. Artists should wear gloves while working with clients and equipment. Before wearing and removing gloves, hands must be washed. Gloves can prevent skin infections in tattoo artists, such as methicillin-resistant Staphylococcus aureus (MRSA), from occurring due to frequent skin-to-skin contact.

Tattoo artists should follow universal precautions are all times to prevent the spread of disease. It is recommended for tattoo artists have updated vaccines, including the hepatitis B virus vaccination. Occupational Safety and Health Administration (OSHA) has helpful education for tattoo artists to learn how to prevent infections. Prior to being inked, clients should ensure the tattoo establishment has a valid license issued by the health department and that their artist follows the necessary steps to prevent the transmission of pathogens.