Health hazard evaluation report: HETA 99-0265-2830, Venus & Mars, Orlando, Florida; and HETA-2000-0013-2830, Body Piercing by Bink, Tallahassee, Florida.
In June 1999 and October 1999, the National Institute for Occupational Safety and Health (NIOSH) received health hazard evaluation (HHE) requests from Venus and Mars in Orlando, Florida, and Body Piercing by Bink in Tallahassee, Florida, respectively. The management requests concerned potential occupational exposures to bloodborne pathogens during body piercing procedures. Both requests were prompted by the passage of a new rule (Chapter 64E-19 of the Florida Administrative Code) which requires the Florida Department of Health (DOH) to regulate body piercing salons. In response to the HHE requests, NIOSH investigators conducted a site visit at Venus and Mars on August 10-11, 1999, and at Body Piercing by Bink on January 7-8, 2000. NIOSH investigators observed the assembly of instruments, jewelry, and supplies used during the piercing procedure, the preparation of the piercing area, the piercing itself, the disposal of the piercing needle in a sharps container, the disinfection of contaminated surfaces, and the sterilization of reusable instruments. The use of personal protective equipment (PPE) was observed for the activities noted above, as well as general housekeeping procedures. Written policies and programs were evaluated when present, and informal interviews were conducted with the HHE requesters and their employees. The observed practices in both piercing studios were compared to the requirements outlined in the new Florida ruling to identify any potential inconsistencies or areas in need of improvement. This evaluation was limited to areas relating to occupational health. To gain a better understanding of the factors which prompted the regulating of body piercing studios in the State of Florida, NIOSH investigators met with the authors of the ruling in Tallahassee, Florida, on January 7, 2000. Additionally, implementation strategies for the new rule were discussed including the training of the DOH inspectors. The primary hazard noted during the piercing process was the potential for needlesticks to occur. According to anecdotal information, the most likely time for occurrence of needlesticks among piercers is when the unprotected needle is exiting the piercing site. It is unclear whether a cork provides protection against a needlestick, since piercers reported the cork may crack as the needle is pushing through it. The use of a cork during piercings was not required at either studio and appeared to be solely dependent on the preference and training of the piercer. In both facilities, the sharps containers were located behind the piercing chair. Because the sharps container was not within reach of the piercer, used needles were placed back on the tray. Picking up contaminated needles from the tray to discard them in the sharps container posed an unnecessary risk to the piercer. In addition, an inconvenient location forced the piercer to make unnecessary movements while holding the needle. Additional risks were observed regarding exposures through the potential cross-contamination of instruments and surfaces. At the time of the site visit at Venus and Mars, genital piercings were being performed in the same room where contaminated instruments were being cleaned in a sonicator. Reportedly, this practice has since been discontinued. At Body Piercing by Bink, all piercings were done within six feet of the sonicator. A great number of disinfectants can be used for cleaning surfaces and instruments used during the piercing procedures, including alcohol, chlorine and chlorine compounds, formaldehyde, glutaraldehyde, hydrogen peroxide, iodophors, phenolics, and quaternary ammonium compounds. Latex gloves were used while handling these chemicals at both facilities. Neither of the body piercers at Venus & Mars had been vaccinated against Hepatitis B virus (HBV), and an exposure control program, as required by the Occupational Safety and Health Administration (OSHA), had not been prepared for either of the facilities. NIOSH investigators concluded that the body piercers at both facilities were at risk for exposure to bloodborne pathogens due to the potential for needlestick injuries. Also, although certain practices can reduce the number of viable organisms potentially aerosolized from a sonicator, there is the potential for the deposition of infectious droplets onto surfaces, equipment and personnel located in the near vicinity. Recommendations for minimizing exposures and complying with OSHA’s Bloodborne Pathogen Standard are provided in this report.