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Guidelines for Hand Hygiene

Hand-Washing Photo In hospitals and other healthcare facilities, harmful pathogens are most often transmitted to patients via the contaminated hands of healthcare workers, so it's a logical assumption that the same would be true in other professions that involve close physical contact and bloodborne pathogens, like tattooing and piercing. The Institute for Health Care Improvement reports that hand hygiene--which includes hand-washing with soap and water or use of alcohol-based, waterless hand rubs--has long been considered one of the most important control measures for preventing infections in health care environments. That statement is corroborated by the Center for Disease Control (CDC) website, which provides Guidelines for Hand Hygiene in Health Care Settings that tattoo and piercing shops are expected to follow, too. As a tattoo or piercing artist or shop owner, it's important to familiarize yourself with the CDC's hand hygiene guidelines and make sure they're practiced to the letter in your shop to minimize the spread of infectious diseases and protect your clients, your employees and yourself both physically and legally.


A Brief History of Hand Hygiene

In our modern society, we tend to take good hand hygiene for granted. Our elders have been telling us our whole lives to wash our hands before meals and after going to the bathroom for our own personal hygiene. We see signs in health care facilities, restaurants, and even gas station bathrooms telling employees to wash their hands properly before returning to work. Everyone in the civilized world seems to understand the importance of clean hands, and we expect that people will wash their hands regularly, particularly after going to the bathroom and before handling food. The value of proper hand hygiene hasn't always been known even to medical professionals, though, and it's still a foreign concept to many in underdeveloped areas like third world countries.

The CDC's website says that the idea of washing one's hands with an antiseptic agent most likely first came about in the early 19th century. It was around that time that a "French pharmacist demonstrated that solutions containing chlorides of lime or soda could eradicate the foul odors associated with human corpses and that such solutions could be used as disinfectants and antiseptics." It took another 20+ years for people to realize that not using a proper antiseptic agent to wash one's hands, particularly after coming in contact with cadavers, was behind the rampant spread of puerperal fever being transmitted to patients by healthcare personnel. That knowledge still did little to change healthcare workers' actions at that time, though.

In 1961, the U. S. Public Health Service made a training film for healthcare workers recommending that they wash their hands with soap and water for 1-2 minutes before and after coming in physical contact with patients. The need for an antiseptic agent like alcohol was deemed less important than hand-washing with plain soap and water; it was only recommended in emergencies and in areas where sinks were unavailable.

The CDC first published hand-washing guidelines for healthcare professionals in 1975. Up until the mid 1980s, those guidelines recommended using "non-antimicrobial soap between the majority of patient contacts and washing with antimicrobial soap before and after performing invasive procedures or caring for patients at high risk." They also only recommended using waterless, alcohol-based solutions to cleanse the hands when sinks were unavailable.

It wasn't until 1995 that any organization went into more detail about using alcohol-based hand rubs as part of their hand hygiene guidelines. At that time, the Association for Professionals in Infection Control (APIC) published hand-washing guidelines that were similar to the CDC's, but that also supported the use of alcohol-based hand rubs in more clinical settings than anyone else had previously recommended. Right around that time, HICPAC (the Healthcare Infection Control Practices Advisory Committee) "recommended that either antimicrobial soap or a waterless antiseptic agent be used for cleaning hands upon leaving the rooms of patients with multidrug-resistant pathogens (e.g., vancomycin-resistant enterococci [VRE] and methicillin-resistant Staphylococcus aureus [MRSA])." HICPAC's guidelines also recommended hand-washing and use of hand antiseptics for routine patient care. Their guidelines have since been adopted by the majority of U.S. hospitals, but individual healthcare workers follow the rules a lot less often than they should.

Recently a Hand Hygiene Task Force comprised of members of APIC, HICPAC, the Society for Healthcare Epidemiology of America (SHEA), and the Infectious Diseases Society of America (IDSA) was setup to re-evaluate hand hygiene practices in healthcare facilities. They're conducting their review based on recent developments in the field and working on updated "guidelines designed to improve hand-hygiene practices in health-care facilities."


What You Need to Know About Skin & Bacteria

Human skin is fraught with bacteria, with different parts of the body harboring higher bacterial counts than others. Total bacterial counts found on the hands tend to be higher than on any other part of the body, which makes sense considering that we use our hands to do everything from feeding ourselves to cleaning up after going to the bathroom and a million other things in between.

There are two general types of bacteria that tattoo and piercing artists need to concern themselves with: transient flora and resident flora. Transient flora take root in the superficial layers of the skin and can be picked up by touching clients and contaminated surfaces in a work space. Latex & Nitrile Gloves | Surgical Gloves for Tattoo & Piercing Artists Transient flora can usually be eradicated with routine hand-washing. Resident flora, on the other hand, attach to deeper layers of the skin and are harder to remove. They're more likely to cause staph infections and other more serious health issues compared to the infections that transient flora are most likely to cause.

Since bacteria are found all over our bodies, you can't assume that you can safely touch, say, a client's head or back and come away with no bacteria transferred to your hands. The type of bacteria you pick up in such areas may not be as severe as what you could pick up from touching an open wound or a client's hands, but there's a chance you'll still come away with something undesirable on your hands. If you don't properly cleanse your hands and change gloves frequently throughout the body modification process, you could then transfer that harmful bacteria to another client or be negatively impacted by it yourself. Because some bacteria are transient while others are resident in nature, you can't assume that simply washing your hands with plain soap and water will rid you of all bacteria you'll come in contact with during the body modification process. That's why the CDC and the other organizations referenced above provide such detailed hand hygiene guidelines and encourage all healthcare workers and body modification artists to follow them.


Hand Hygiene Basics From the CDC

Proper hand hygiene is one of the most significant ways to prevent the spread of infectious diseases. The CDC recommends performing proper hand hygiene at these intervals:

  • before physical contact with a client;
  • after contact with blood, bodily fluids or contaminated surfaces, even if you've been wearing gloves;
  • before invasive procedures like tattooing, piercing, inserting implants like dermal anchors, and performing scarification; and,
  • after removing gloves, since wearing gloves alone isn't enough to stop the transmission of pathogens in a tattoo & piercing shop.

Proper hand hygiene involves washing your hands and applying alcohol-based hand sanitizers in specific ways. The CDC offers downloadable How to Wash Your Hands and How to Hand Rub posters that you can post above hand-washing sinks and hand sanitizer stations in your tattoo and piercing studio. We've summarized these instructions below for your convenience.

In addition to their free downloadable posters, the CDC offers an interactive online course for hand hygiene that you and your employees can take to ensure that everyone in your tattoo and piercing shop engages in proper hand hygiene protocols.

How to Wash Your Hands Properly

  1. Wet your hands with water. Leave the water running until you get to step #11.
  2. Apply enough soap to cover all surfaces of your hands.
  3. Rub your hands palm-to-palm in a circular motion.Paper Towels
  4. Rub your right palm over the back of your left hand, interlacing your fingers as you rub up and down, and then repeat with your left palm over the back of your right hand.
  5. Rub your hands together palm-to-palm with your fingers interlaced, in an up-and-down motion.
  6. Interlock your fingertips while one palm is up and the other is down, and rub in an up-and-down motion that massages soap thoroughly into your fingertips.
  7. Grasp your left thumb with your right hand, rub in a rotational manner, and then do the same to your right thumb/web area.
  8. Clasp the fingers of your right hand together, use them to scrub your left palm in a circular pattern, and then repeat using your left fingers to scrub your right palm.
  9. Rinse your hands thoroughly with warm water.
  10. Dry your hands thoroughly with a single-use paper towel.
  11. Use the paper towel to turn off the faucet, so your clean hands don't come in contact with the knobs, and then throw away the paper towel.
  12. From start to finish, the whole process should take between 40 and 60 seconds. At that point, your hands will be safe.

How to Properly Apply Alcohol-Based Hand Sanitizer

  1. Apply a palm-full of hand sanitizer in a cupped hand (enough to cover all surfaces of your hands).
  2. Rub your hands together palm-to-palm.
  3. Rub your right palm over the back of your left hand, interlacing your fingers as you rub up and down, and then repeat with your left palm over the back of your right hand.

  4. Rub your hands together palm-to-palm with your fingers interlaced, in an up-and-down motion.

  5. Interlock your fingers while one palm is up and the other is down, and rub in an up-and-down motion that massages the hand sanitizer thoroughly into your fingertips.

  6. Grasp your left thumb with your right hand, rub in a rotational manner, and then do the same to your right thumb/web area.

  7. Clasp the fingers of your right hand together, use them to scrub your left palm in a circular pattern, and then repeat using your left fingers to scrub your right palm.

  8. Once your hands are dry, which takes about 20-30 seconds of rubbing in hand sanitizer, your hands will be safe.


The Efficacy of Different Soaps & Alcohol-Based Hand Sanitizers

There are plain soaps, antibacterial/antimicrobial soaps, alcohol-based hand sanitizers, and alcohol-free hand sanitizers. Plain soaps have little, if any, antimicrobial properties. Hands-Free Soap Dispenser for Preventing Cross-Contamination During Hand Washing However, washing your hands with plain soap will at least remove loosely-adherent transient flora. Since washing with plain soap won't remove pathogens, it can actually lead to an increase in bacterial counts on the skin if they're left to accumulate over successive hand-washings. It's much safer for everyone if you and your employees use antibacterial hand soap to wash your hands at the intervals recommended by the CDC above. It's also ideal to use a hands-free soap dispenser, to minimize the cross-contamination that may occur with pump bottles, squeeze bottles and bars of soap.

When your hands aren't visibly soiled, an alcohol-based hand sanitizer is a sufficient sterilant. Hand sanitizers containing between 60% and 95% alcohol are most effective. Although alcohol-based hand sanitizers may contain isopropanol, ethanol, n-propanol, or a combination of two of those ingredients, only those products containing isopropanol and ethanol are considered appropriate surgical-grade hand sanitizers in the U.S. They're known to effectively reduce bacterial counts on the hands and to slow the re-growth of bacteria. Hand sanitizers that also contain chlorhexidine, quaternary ammonium compounds, octenidine, or triclosan are better equipped to fight residual bacteria that may linger after cleaning your hands with an alcohol-based hand sanitizer.

If you've gotten blood or other proteinaceous materials on your hands or they're visibly soiled, alcohol-based hand sterilizers aren't powerful enough to remove all bacteria. In those cases, you'll need to wash your hands properly with an antibacterial soap. If you want to be extra thorough, you can follow proper hand-washing with the application of an appropriate alcohol-based hand sterilizer.


Medical-Grade Hand Soaps Available Through Painful Pleasures

In addition to the skin cleansers and other skin prep products we offer for prepping clients for body modifications in our Skin Prep & Skin Cleansers section and the Infectious Control Cleaners & Disinfectants we offer for sterilizing surfaces in your shop, we also carry several medical-grade disinfecting hand soap options for tattoo and piercing professionals. Here are a few of the options you may want to consider using in your shop to prevent the spread of infectious diseases:

Surgical-Grade Hand-Sanitizing Soaps

Microsan Rx Medical-Grade Soap Saniwash 8 oz. Pump Bottle of Chloroxylenol-Based Hand Soap PurKlenz Antibacterial Hand Soap
Microsan Rx Anti-Microbial Soap
Microsan Rx is a professional anti-microbial skin cleanser that effectively kills 99.999% of susceptible organisms in 30 seconds. This liquid soap disinfects & leaves skin feeling clean & moisturized. It contains no Triclosan or alcohol. Just use 1-2 pumps each time you wash your hands to reduce the spread of nosocomial infections like MRSA & VRE.
SaniWash Antibacterial Hand Soap
SaniWash contains 0.6% PCMX for antimicrobial action & aloe vera to moisturize your skin with each use. It aids in reducing the risk of cross-contamination while helping you meet APIC and OSHA hand-washing recommendations in your tattoo & piercing shop. It's available in 8 oz. bottles. Use 1-2 pumps each time you wash your hands.
PurKlenz Antiseptic Hand Soap
PurKlenz is a topical antiseptic skin cleanser that's both paraben-free & fragrance-free. Like SaniWash, it contains PCMX (Chloroxylenol) for its antimicrobial properties. PurKlenz lubricates & moisturizes the skin while disinfecting it, reduces odor-causing bacteria, & removes dirt, grease & oil. The pump bottle helps reduce cross-contamination, too.




CDC's Guideline for Hand Hygiene in Health Care Settings (All direct quotes in this article are from this online publication.)
CDC Website's Hand Hygiene Center
IHI Hand Hygiene PDF
Recommendations of the Healthcare Infection Control Practices Advisory Committee & the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force