Over the course of our Sterilization Series, we've discussed all sterilization methods briefly, outlined the sterilization classes, and delved more deeply into those methods that are most appropriate for use in tattoo and piercing shops--primarily, sterilization by steam, heat and chemical bath. With this groundwork laid, we now turn our attention to proper implementation of the specific sterilization techniques used in and for tattoo and piercing shops. We'll discuss proper procedures for pre-sterilization cleaning of instruments, autoclaving tools and body jewelry, and sterilizing instruments in chemical baths, as well as proper handling of EO gas-sterilized disposables like piercing needles, tattoo needles and disposable tube-tip-grip units.
Pre-Sterilization Cleaning of Tattoo & Piercing Instruments
When following proper sterilization techniques, it's imperative for shop employees to pre-clean any tattoo and piercing instruments they plan to sterilize. The sterilization process is significantly more effective when dirt and debris have been removed from tattoo and piercing tools prior to sterilization.
To properly clean tattoo and piercing instruments before sterilizing them, you'll need the following supplies:
- Steel- and Nylon-Bristled Brushes for Scrubbing
- A Cleaning Product Like Sklar Kleen
- Latex or Nitrile Gloves
- Warm Water
- An Ultrasonic Cleaner
- Ultrasonic Cleaner Detergent Like Alconox
Don a fresh pair of gloves, get your tap water running warm, and then rinse your instruments in the warm water. If there's any debris caked onto your instruments, use an appropriate brush--like a steel-bristled brush or a brass-bristled brush on grooved metal tools--to scrub the instruments thoroughly and remove any dirt or debris clinging to them. Scrub until you've removed all residual matter (particularly blood or other organic matter and mineral deposits), and then do a final 30-second rinse before setting your instruments out on a sterile surface, such as a dental bib, and allow them to air dry.
Next, either spray your instruments with Sklar Kleen or a similar product or soak the instruments in the solution briefly. Scrub the cleaner-saturated tools with a softer-bristled brush, like a nylon brush, to work the cleaning product into all the crevices and remove any remaining dirt and debris from your tools.
Next, place your tools (in the open position) in an ultrasonic cleaner along with a detergent like Alconox. Run the machine for 10 minutes. This will ensure that any residual matter you either overlooked or couldn't see because of its microscopic nature is loosened and lifted off the instruments. Remove the tools from the ultrasonic cleaner at the end of the cycle, and let them air dry again.
Once your tools are dry, spray them with a lubricant like Sklar Lube Spray Instrument Cleaner. Allow them to air dry a final time. The well-cleaned, dry tools will then be ready to be sterilized.
Proper Technique for Autoclave Sterilization
After cleaning your tools, the ideal method for sterilizing them is via an autoclave. If your shop doesn't have an autoclave, skip this section and jump down to the Proper Technique for Chemical Bath Sterilization section. If you do have an autoclave in your shop, make sure it's functioning properly by periodically running a sterilization Class 5 integrating indicator test using a product like Propper’s Vapor Line® Steam Sterilization Integrators. A Propvper's test incorporates a biological indicator (BI), which checks for spores, as well as a triple-process indicator that ensures that steam, temperature and time are all working in harmony within your autoclave. This type of Class 5 test is one of the most thorough tests you can run to ensure that your autoclave is functioning properly and fully sterilizing all items run through it.
If your autoclave's in confirmed working order, you can now prep your instruments for sterilization. Package each instrument and any body jewelry you need to sterilize separately using sterilization pouches or nylon tubing. Make sure your instruments are in the open position before sealing the pouches.
As you seal up each package, label it with the name of the instrument inside, your name, and the date. Place the bagged instruments in the autoclave, laying them out carefully so that none of the packages are touching each other or any metal surface within the autoclave. If needed, you can put paper or cloth in between the packages and the machine. (If you use nylon tubing and the packages overlap at all, they may fuse together during the sterilization process. See our Sterilizing With Nylon Tubing article for additional tips for working with this product.)
Be sure not to overload the sterilizer, since overloading can reduce the effectiveness of the sterilization process and prevent items from drying properly at the end of the steam sterilization cycle. There should be a distance of at least 1" in between sterilization trays so that the pressurized steam can circulate properly.
Once everything is laid out properly within the autoclave, seal it and follow the autoclave manufacturer's instructions for running a sterilization cycle that's appropriate for the items being sterilized.
At the end of the autoclave cycle, let the pouches cool within the sterilizer for 5 to 10 minutes, and then remove your instruments in their sterilization pouches or tubing. Keep the pouches sealed until you need to use the enclosed tools. You should date any packages that you aren't using immediately, so you'll know at a glance when each one was sterilized. Those items you are using immediately should be laid out in a sterile field and opened at the appropriate time, just before use during the body modification process.
Ideally, to protect yourself in case any issues arise and a client accuses you of not properly sterilizing the equipment and/or body jewelry you used on them, you should keep a log book of sterilization cycles. Each line should include the initials of the person who ran the sterilizer, the date, the number of minutes the sterilization cycle ran, the maximum temperature reached during the sterilization process, and results such as those on the sterilization pouches' indicators.
If you work in a small shop that doesn't have an autoclave, you can use chemical baths to sterilize your reusable tattoo and piercing instruments as long as you carefully follow the appropriate procedure for this sterilization method. Since a chemical bath doesn't get locked down for a set time period the way an autoclave does during the sterilization process, it's very easy for people to make mistakes such as contaminating a bath by adding tools to it partway through a cleaning cycle or removing instruments prematurely. It's up to you to ensure that all of your tools are sterilized simultaneously and for the appropriate amount of time, if you choose to utilize this sterilization method.
The base of an effective chemical bath is a glutaraldehyde sterilant that makes for a high-level disinfectant soaking solution like Wavicide. Such solutions will kill all forms of microbial life except for large numbers of bacterial spores, according to OSHA.*
Due to the variety of negative health effects that glutaraldehyde has been found to induce--issues ranging from mild to severe asthma, breathing difficulties, respiratory irritation, and skin rashes--it's important to use Wavicide and other products containing glutaraldehyde with extreme caution. You have to protect yourself when you're pouring the solution into a soaking basin, agitating tools in the chemical bath, removing tools from the bath, rinsing your instruments, and disposing of the solution after completion of a cold sterilization cycle. Follow these precautions to the full extent possible whenever working with Wavicide or another glutaraldehyde-based solution:
- Only use a glutaraldehyde-based chemical bath in a large, open, well-ventilated area.
- Setup an emergency eyewash station in close proximity to the soaking basin.
- Wear nitrile gloves to protect your hands when working with glutaraldehyde-based solutions like Wavicide. (Latex gloves are not ideal for working with glutaraldehyde solutions, except where only incidental contact is expected.)
- Ideally, you should wear long pants, a long-sleeved shirt, and a cover-up (like a lab coat) when working with a chemical bath. At minimum, cover your forearms with disposable tattoo sleeves and put on a disposable black apron.
- If at all possible, keep your chemical bath under a ventilated fume hood. If you have a ventilation unit in your work space, keep it on throughout the sterilization process.
- Cover your mouth and nose with a face mask before uncapping the bottle of Wavicide and filling a soaking basin with it. Cover your eyes with splash-proof protective goggles or a full face shield.
- Before opening the bottle of solution, place all instruments to be sterilized in your soaking basin. Then, pour only enough solution over top to just cover your instruments. Do not add any instruments to the chemical bath after pouring glutaraldehyde-based solution into your soaking basin. Anything you forgot to include must be held until the next bath is prepped; otherwise, you risk contaminating the current bath and its contents.
- Set a timer for the amount of time required to sterilize your instruments, as specified on the solution's packaging. Vacate the area until the timer goes off. Do not remove the instruments prematurely. It's extremely important to wait until the specified amount of time has passed to ensure that your tools have been properly sterilized.
- At the end of the sterilization cycle, carefully remove your tools, rinsing them well with cold, sterile water as you transfer them to a sterile surface. If necessary, use a syringe to flush out areas of your instruments that can't be easily reached with a general rinse. You can use compressed air to dry the inner workings of your instruments, if desired. Just be sure to stay covered with protective gear from head to toe through the end of the instrument removal and drying process.
- Dispose of the used chemical bath appropriately, in accordance with local, state and federal regulations. Check with your local POTW (Publicly Owned Treatment Works) to find out if glutaraldehyde solutions can be flushed into the sanitary sewer system. Your POTW may require that the solution be neutralized first or disposed of another way. If your POTW allows disposal into the public sewer system, make sure to flush the solution down a drain along with copious amounts of cold water. Never dispose of glutaraldehyde via a septic system. It has to be diluted by other waste streams to be disposed of safely, which won't happen in a private septic system.
- Immediately clean up any spills that occur at any point in the process.
- Change clothes immediately if what you're wearing becomes contaminated with glutaraldehyde solution in any way.
- Follow the packaging's instructions for disposing of empty solution bottles.
- Designate a hazardous waste container in which you can place disposable aprons, tattoo sleeves, face masks, and other protective gear after completing a chemical bath cycle.
- Do not eat, drink or smoke anywhere that glutaraldehyde is used or stored.
For additional safety tips for working with glutaraldehyde-based solutions, read OSHA's guide, Best Practices for the Safe Use of Glutaraldehyde in Health Care.
Since you will be purchasing pre-sterilized disposables like tattoo needles, piercing needles and tattoo tubes, you don't have to worry about any aspect of the EO gas sterilization process itself. Sterilization will be conducted in a proper environment well before your tools make it to your distributor, let alone to you. However, you should check a few things before you use an EO gas-sterilized disposable of any sort:
- Make sure the EtO indicator on the porous paper through which the EO gas penetrated the blister pack is blue. That indicates a successful sterilization process.
- Make sure the package is still securely sealed.
- Check the expiration date on the packaging; the item inside will stay sterile through that date or until the package is opened, whichever comes first.
- Wait to open the package until you've reached the point in the body modification process where you're ready to use its contents.
- Immediately dispose of used sharps like tattoo and piercing needles and scalpel blades in an appropriate Sharps container. You should either have one mounted in a Sharps cabinet or sitting on a counter top in each workspace in your shop.
After performing a body modification, it's best to clean your tools immediately so that no organic matter like blood dries and cakes on them. You can clean them thoroughly immediately before sterilization, but a short rinse-and-brush after use will make shorter work of the full cleaning process later.
Always dispose of sterilization pouches, protective gear, sharps, and other sterilization-related debris in an appropriate manner, for both your safety and that of your clients.
A Final Note on Techniques & Safety
Please note that the most critical techniques for performing safe, effective sterilization via an autoclave and chemical bath have been detailed here, but this is not necessarily a comprehensive list of all safety precautions that you could possibly take when sterilizing tattoo and piercing tools and body jewelry. For instance, you do not have to wear a respirator when working with the low concentration of glutaraldehyde found in Wavicide, but if you already have respiratory issues and they're aggravated by working with the solution, you may want to consider purchasing a respirator as OSHA suggests in their Best Practices for the Safe Use of Glutaraldehyde in Health Care guide. Read over the materials to which we've linked in our References section to learn more about the potential health hazards of the sterilization methods recommended here and how you can best protect yourself.
More Information About Sterilization
Interested in learning more about the different sterilization methods, like sterilization by heat and steam? Want to know what the different sterilization classes mean? If so, check out these other articles from our Sterilization Series:
- Sterilization Methods
- Sterilization by Heat
- Sterilization by Steam
- Sterilization Classes
- Sterilization Alternatives for Small Shops