Piercing of the skin code of practice

Get your customer's information first

Before you begin any service that may pierce the skin, there are things that you need to know about your customer.

Know age restrictions

• You must not carry out any commercial skin piercing service on any person under 16 years of age unless the parent or guardian gives written permission. This does not apply to tattooing.
• You must not carry out tattooing on any person under 18 years of age unless the parent or guardian gives written permission.

Get a consent from your customer

Any customer who wishes to undergo a commercial skin piercing service must complete and sign a written consent form.

Before you start the service, the customer must outline their medical history and let you know if they have or suspect they have:

• a communicable or skin disease
• haemophilia or are taking medications that thin the blood
• allergies or adverse reactions to dyes and pigments; or
• epilepsy or seizures.

You may decline to carry out any commercial service based on such information or agree to carry out the commercial service with appropriate conditions and safeguards.

Give advice on precautions

Before the start of any commercial skin piercing service, you must:

• advise the customer of the risks associated with the service and the potential for infection during and after the service
• give written advice, concerning precautions and after-care procedures that the customer should take.

Give aftercare instructions

Aftercare instructions should cover:

• wound cleaning
• drying and dressing
• avoidance of dirt
• chemicals, irritants and sunlight
• recognising signs of infection (pain, redness, swelling and heat)
• what to do
• specific instructions for mouth and genital piercings.

A medical practitioner should be consulted in the case of any complications.

Keep customer records

You must keep records of:

• a customer consent form for the procedure to be undertaken, listing any medical conditions and signed consent
• the names and addresses of any customer who undergoes any skin piercing service
• the date on which the skin piercing service was undertaken
• the nature of the skin piercing service
• the location on the body where the skin piercing service was undertaken.

You must keep your records secure and confidential for a minimum of two years and make them available to the council for inspection, on request.

Provide a safe service

First aid

At least one operator on the premises must hold a current St John’s or Red Cross First Aid Workplace Certificate or an approved equivalent.

Wash your hands and wear gloves

You must thoroughly wash your hands up to the wrist with soap/anti-bacterial cleansing agent before putting on single-use disposable gloves and commencing any skin piercing process.

To maintain a high level of cleanliness, use a clean nail-brush when necessary for the hands and nails and single-use paper towel or other approved hand-drying equipment to dry hands.

You must cover your hands with clean, single-use disposable gloves:

• before preparing the area for the skin piercing process
• before starting the skin piercing process
• after touching any object that has not been cleaned and sterilised, unless you use an effective sterile barrier.

Prepare skin for piercing

Before you start any skin piercing service, you must:

• evaluate the skin
• discuss any skin condition that may lead to skin irritation
• cleanse the customer’s skin by swabbing with an antiseptic, clean, single-use swab. Maintain product-specific contact time.

Instruments for piercing

You must use single use disposable instruments for piercing the skin or clean and sterilise your equipment following the procedures outlined below:

• Do not use marker pen or similar device to mark any mucous membrane of any customer.
• Instruments or similar articles with a hollow lumen must be single-use and disposable.
• You may use an instrument or similar article for piercing the skin on any customer if you take it out of a manufacturer's package in the presence of the customer if, and the package is in an:
• the package is undamaged or the manufacturer has affixed a label stating that the contents have been sterilised
• the contents, if steam sterilised, have been packaged according to standards AS/NZS 4187:2003            
• it has not been subjected to any contamination during storage.
• You must keep the instruments sterile.

After piercing the skin

After completing piercing the skin:

• immediately dispose of all single-use needles/razors in a dry puncture resistant container
• thoroughly clean, rinse and sterilise any reusable instrument, appliance or like article using prescribed sterilisation process [link to Sterilisation subheading]
• store the equipment in an appropriate manner, to maintain its sterility before use on any other customer or the same customer at a later time

All sharps containers and bio hazard waste bins must comply with standard AS/NZS 4031:1992, and all operators must demonstrate that they have made appropriate arrangements to dispose of sharps and bio hazard wastes.

Sterilise your equipment

You must display written instructions adjacent to every place on the premises where cleaning and/or sterilising of instruments is undertaken.

These instructions should clearly describe the processes to be followed to ensure compliance with sterilisation and ultrasonic cleaning:

• You must sterilise all instruments used for piercing the skin after each use, by thoroughly washing them in warm water and detergent or within an ultrasonic cleaner and exposing them to steam:
• Exposure to steam must occur within a steriliser (autoclave) under appropriate time, temperature and pressure parameters.
• Every steriliser (autoclave) must be fitted with time, temperature and pressure gauges.
• Each time you use the steriliser (autoclave), you must insert chemical indicator strips. If the chemical indicator / integrator fails to change colour, you must reprocess all of the load contents.
• During each use you must view the gauges to ensure that the correct times, temperatures and pressures are reached.
• You must record and note time, temperature and pressure readings after each usage.
• You must carry out regular spore testing and record the results.
• You must have the steriliser (autoclave) serviced every six months, or according to manufacturer’s instructions, and record the results. You must keep these records for a minimum of two years and make them available to the council for inspection, on request.
• You can also:
• thoroughly wash all instruments in warm water and detergent and expose them to dry heat for at least 60 minutes at 170 degrees Celsius
• thoroughly wash all instruments in cold water and detergent and then totally immerse them in a glass bead steriliser operating at 250 degrees Celsius for a minimum of 5 minutes
• thoroughly cleanse instruments by a method appropriate to the nature of the article concerned and then submit them to a process of sterilisation approved by the council. (Note: This may include ethylene oxide treatment and gamma irradiation)
• individually package all instruments or similar articles and mark them “sterile” or display a sterility indicator tape. The packaging must be intact and the items stored to preserve the sterility of the instruments.

Ultrasonic cleaners should comply with recognisable standards such as Australian Standard AS 2773.1:1998 and AS 2773.2:1999 as appropriate. The cleaning, disinfection and sterilising requirements within this code of practice are based on AS/NZS 4187:2003 standards.

Best practice: additional recommendations

Your protection

• Immunisation against Hepatitis B is highly recommended.
• A protective apron or garment is recommended where it is likely that the operator’s clothing may be contaminated by blood or bodily fluids.
• Wear eye protection / face shields when performing close-up procedures that may cause aerosols of blood or body fluids.

Accidents

Have written procedures for dealing with bleeding, sharps injuries and contact with blood and body fluids. The Ministry of Health ‘Guidelines for the Safe Piercing of Skin’ outlines procedures to deal with bleeding, sharp injuries and contact with blood or body fluids.

Cleaning

• Industry standard cleansers and detergents should be used. Alkaline detergents are much more effective at removing blood and fat than plain surfactant based detergents.
• Note that chlorine solutions may corrode metals. Gluteraldehyde and phenol are not recommended as disinfectants because of the health risks involved in their usage.
• To reduce the risk of cross contamination cleaning and decontamination activities should not take place at the same time as packaging and/or sterilisation activities.

Sterilisation

• Holding times must be adhered to for autoclaves. Bench top steam sterilisers without a drying cycle are only appropriate for the sterilisation of unwrapped items. Autoclaves should comply with a recognised national or international standard.
• Ultrasonic cleaners clean but do not disinfect instruments and equipment. They should be operated with the lid closed, and ideally in a separate work area that is well ventilated.
• Reusable equipment that is to be autoclaved should have chemical integrator/indicator tape or some other product on or within the packaging to identify when the equipment has been properly sterilised. This is to prevent non-sterile equipment being used by mistake. Please note that chemical integrator/indicator tape may not be UV stable, so should be stored in a cool, dry, dark place.