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Know the Risk: Transmission Through Tattoos & Piercings

Tattoos and piercings are a popular mode of self-expression. Oftentimes, they hold cultural and societal significance. Rarely are they thought about in relation to public health. In the United States, there are no federal regulations for tattoos or piercings apart from age restrictions. This means that tattoo and piercing parlors may have different sanitation and sterilization standards in accordance with how strictly a state chooses to manage the industry. For example, Nevada does not regulate tattoo or piercing shops, but New Jersey requires each shop to meet certain equipment sterilization and sanitation standards. Many people also decide to forgo a professional setting and receive body art from their friends, which can be especially dangerous. This lack of universal regulations and sanitation laws increases the risk of spreading bloodborne infections like hepatitis B.  

Image Courtesy of Unsplash

How Tattoos and Piercings Work: A tattoo is created by sharp needles repeatedly piercing the skin to embed ink into your body. While this ensures a permanent image, it also exposes your blood directly to the needle and anything that might remain on the needle from its previous usage. As hepatitis B is spread by direct blood contact, getting a tattoo poses a risk of infection if the equipment is not single use has not been properly sanitized, preferably using an autoclave. A fresh tattoo is an open wound, so it is important to properly bandage the area and keep it away from shared items that could potentially have blood on it, such as razors.

When you get a body part pierced, an artist typically uses a piercing gun with a very sharp needle that pokes a hole into the desired area and earrings or body jewelry are placed into the hole to make sure that the body tissue does not close. Earrings or body jewelry pose another possible risk of direct blood contact if they have been previously worn by another individual, so it is always best to use a new pair of earrings when getting pierced. In general, it is best to avoid sharing earrings and body jewelry. It is important to remember that hepatitis B often has no symptoms, so most people who are infected do not know that they have it. Safety precautions should be taken for everyone receiving a tattoo or piercing to prevent accidental transmission of the infection.

Do Your Research: Making a permanent decision can be difficult and the risk of contracting an infection can complicate matters; it is not something that you want to rush into it. Completing background research can narrow down your choices and help you feel more confident in your ultimate decision. Look at reviews of the shops and see what customers have said. If you see a review about a rash or an infection, it could be a sign that the establishment is not meeting basic safety standards. If you are in America, you can also check the state laws for body art and ask to see a parlor’s compliance certificates if they are not displayed. Don’t be afraid to ask questions! Ask to see the autoclave and ensure equipment bags are opened in front of you.

Image Courtesy of Unsplash

Although it may be tempting to have a friend or family member complete your body art in the comfort of a familiar setting, it also poses a higher risk for exposure to infections like hepatitis B. It is likely that such a setting does not have the proper tools, sterilization equipment, or training to clean the needles as they should be cleaned. Completing the hepatitis B vaccine series is strongly recommended for everyone, but especially to those who participate in activities with higher chances of blood exposure, such as getting body art in unregulated areas. After completing the vaccine series, most people are protected from hepatitis B for life, but other infections – like hepatitis C or HIV – still pose a risk.

If you need help identifying safe establishments, the Association for Professional Piercers is an international non-profit organization that allows you to search for shops in your area that meet certain health standards and answers any questions you may have about piercing. The Alliance for Professional Tattooists, Inc. is another international non-profit that can also help you find safe shops. Both have been approved by the Centers for Disease Control and Prevention (CDC). For more information from the CDC about hepatitis B or other bloodborne infections, click here.

What to look for in a Tattoo or Piercing Parlor:

  • Gloves – The artist should be wearing disposable gloves to keep the risk of contamination and blood exposure as low as possible. In addition, they should change their gloves each time they leave their work area or switch to a new client.
  • Disinfectant – Does the artist wipe down their work area when they are done with a client? Make sure that any area that they have set a tool on has been properly cleaned as well. The hepatitis B virus can survive on a surface for up to a week, so it is extremely important that any surface a tool comes into contact with has been sanitized.
  • Clean Equipment – Many tattoos and piercing shops have reusable needles and piercing guns. These objects are sharp and draw the clients’ blood, so they should always be thoroughly cleaned before being used again. If you notice that an artist works on one client and does not disinfect or change their tool before accepting a new client, there is an extremely high risk for blood exchange. Be sure to ask about the autoclave.
  • Certifications – Oftentimes, shops will have their certifications displayed on the wall. This shows that they have either been properly trained or are required to meet certain standards by law. Depending on the certification, this could mean that the shop is well-educated in preventing and knows how to properly sterilize their tools.

If you think you have been exposed to hepatitis B, it is important to get tested. Visit your doctor or local health clinic to get screened. To a find a place near you where you can get tested in the U.S., visit www.hepbunited.org.

If you have been diagnosed with chronic hepatitis B, our Physicians Directory*  can help you locate a liver specialist near you. The World Hepatitis Alliance can also help you find health care services and hepatitis B education in your country.

*Disclaimer

The Hepatitis B Foundation Liver Specialist Directory is intended for use by the public to assist in locating a liver specialist within a specific state or country. All data is self-reported and is not intended for use by organizations requiring credentialing verification. The HBF does not warrant the accuracy, completeness, timeliness, or appropriateness for a particular purpose of the information contained in the Liver Specialist Directory. The HBF does not endorse the individuals listed in the service, nor does HBF verify medical qualifications, licenses, practice areas or suitability of those listed. In no event shall the HBF be liable to you or anyone else for any decision made or action taken by you based upon the information provided in the service.

Note: This is not a physician referral service. The HBF cannot provide referrals to specific physicians nor advice on individual medical problems.

Be Your Own Advocate in the Medical Room

The hepatitis B virus (HBV) can be transmitted two ways: 1) through direct contact with blood and 2) infected body fluids. Some risks for direct blood contact are obvious, such as touching an open wound to another open wound or cleaning up someone’s blood without any protective gear. However, other methods of blood transmission are harder to catch. Common activities like sharing razors, earrings, or toothbrushes are simple, innocent actions, yet they all have the potential for blood exchange.

Medical and dental procedures are aspects of our lives that we might not think twice about. While beneficial to our health, they also carry the risk of exposure to another person’s blood. Surgeries, shots, and dental activities all use sharp objects that pierce the skin and draw blood.  If the tools are not properly sterilized, or cleaned, before they are used on a new patient, the blood that was on the equipment can be transferred to the next patient.

Image courtesy of Cook Services

How do I know if medical tools are sterile? Ask! It is your right to know if the equipment that will touch your body has been thoroughly cleaned. In a dentist office, the assistant might unwrap a package of tools in front of you; this typically means that the tools are either new or have been properly cleansed. In a medical setting, needles and surgical equipment might come in packaging as well. If you still are not certain, feel free to ask what the standard cleaning procedures are for the tools being used. The staff will be happy that you are taking your health into your hands!

Why is it important to have sterile tools?   Hepatitis B earned the nickname “silent infection” because there are often no symptoms. Those who have been infected may not take the necessary precautions simply because they do not know that they should. They may not even know they are infected! In many cases, medical and dental professionals are unaware when a patient has hepatitis B. Therefore, it is important to make sure that all equipment that is being reused has been sterilized. Although there are no global sterilization standards, many countries and medical facilities around the world – like hospitals, dental offices, and doctor offices – have disinfection guidelines and practices for their equipment.

Tips to Protect Yourself:

  1. Be your own advocate: Ask the dental hygienist, nurse, doctor, acupuncturist or person in charge of your procedure if the tools have been sterilized.
  2. Know where you go: Try to visit medical or dental facilities that you trust and that provide clean, safe environments for any procedures involving blood or body fluids.
  3. Get vaccinated: Hepatitis B is a vaccine preventable disease. After receiving all three doses, most people are protected for life! Check your immunization records to make sure that you have been vaccinated or ask your doctor or local clinic about the vaccine.
  4. Share with caution: Sharing or eating food prepared by someone with hepatitis B is safe, but any activities that may involve direct contact with blood carry a risk. A good guideline is to keep all personal hygiene items personal.

If you think you have been exposed to hepatitis B, it is important to get tested. Visit your doctor or local health clinic to get screened.

If you have been diagnosed with chronic hepatitis B, our Physicians Directory*  can help you locate a liver specialist near you. The World Hepatitis Alliance can also help you find health care services and hepatitis B education in your country.

*Disclaimer

The Hepatitis B Foundation Liver Specialist Directory is intended for use by the public to assist in locating a liver specialist within a specific state or country. All data is self-reported and is not intended for use by organizations requiring credentialing verification. The HBF does not warrant the accuracy, completeness, timeliness, or appropriateness for a particular purpose of the information contained in the Liver Specialist Directory. The HBF does not endorse the individuals listed in the service, nor does HBF verify medical qualifications, licenses, practice areas or suitability of those listed. In no event shall the HBF be liable to you or anyone else for any decision made or action taken by you based upon the information provided in the service. Note: This is not a physician referral service. The HBF cannot provide referrals to specific physicians nor advice on individual medical problems.

Hepatitis B Foundation Mini-Grantees 2016

At the Hepatitis B Foundation, we have many research and programs throughout the year. With the Association of Asian Pacific Community Health Organizations (AAPCHO), we co-founded and co-chair Hep B United, a national coalition dedicated to reducing the health disparities associated with hepatitis B by increasing awareness, screening, vaccination, and linkage to care for high-risk communities across the United States. The coalition works to reduce the impact of hepatitis B through prevention and education efforts, addressing perinatal transmission, improving screening and linkage to care, contributing to national surveillance data, and advocating on a national level.

Last year, the Hepatitis B Foundation offered mini-grants for one year to Hep B United coalition partners working on hepatitis B education, screening and linkage to care activities. These grants ranged between $5,000 to $10,000 each. The mini-grants were offered to enhance the capacity of Hep B United coalition partners to conduct HBV education, testing and linkage to care in their local Asian American, Native Hawaiian and Pacific Islander (AA & NHPI) communities to advance the hepatitis B priority areas of the U.S. Department of Health and Human Services’ National Viral Hepatitis Action Plan (VHAP).

Courtesy of CPACS

The 2016-17 project year offered grants to 9 coalition partners, which included Center for Pan Asian Community Services, Inc (CPACS), Hepatitis B Initiative-Minnesota (HBI-MN), Midwest Asian Health Association (MAHA), Hepatitis B Initiative-DC (HBI-DC), Asian Services in Action (ASIA), Asian American Community Services (AACS), Asian Pacific Health Foundation (APHF), and HOPE Clinic. Together, Hep B United coalition partners screened 4,649 people, educated and reached out to 11,884 people, and distributed 13,112 handouts. Some coalition partners were featured in  newspapers, on TV with 496,189 views, and in a social media video. Mini-grantees also participated in activities such as developing key partnerships in local communities, providing linkage to care, and conducting provider training. One coalition partner also screened the “Be About It” documentary.

For 2017-2018 mini-grants, six Hep B United coalition partners (listed below) were recently awarded mini-grants. We are excited to kick off these projects and look forward to their future endeavors and results.

·     Asian American Community Services (Columbus, OH) -AACS’ Live Healthy – Hep Free project will use the H+EAL model to increase HBV education and awareness and encourage testing by targeting high school students and their parents.

·       Asian Pacific Community in Action (Phoenix, AZ) – APCA will be organizing community town hall events in collaboration with the #justB campaign across Maricopa County to collect and share stories that promote increased awareness and proactive approaches to treatment for hepatitis B.

·       Asian Pacific Health Foundation (San Diego, CA) – APHF will be working to increase community knowledge and awareness of hepatitis B, determine gaps in knowledge, develop in-language education materials, and provide hepatitis B screening within high-risk communities throughout San Diego.

·       Asian Services in Action (Cleveland, OH) – ASIA will be using community health outreach workers to increase HBV education and screening, including outreach to AAPI businesses in Akron and Cleveland, OH.

·       Center for Pan Asian Community Services (Atlanta, GA) – CPACS’ project focuses on expanding their Atlanta-based hepatitis B coalition, increasing the number of Georgia AAPI community members who know their HBV status through community and provider education, and improving testing and linkage to care services throughout the city.

·       Philadelphia Department of Public Health (Philadelphia, PA) -The Perinatal Hepatitis B Prevention Program auxiliary project will create new education modules for prenatal and pediatric care and conduct on-site provider education sessions to improve knowledge and care for infected mothers.

The 2017-18 project period expanded its priorities to address perinatal transmission and education through storytelling efforts with the #JustB Storytelling Campaign in addition to screenings and linkage to care.   The overall success of the Hep B United mini-grants has been proven through the significant number of high-risk populations educated, screened and linked into appropriate care for hepatitis B.   We look forward to updating you further in the coming months as we continue to highlight the national work of the Hepatitis B Foundation and Hep B United partners around the U.S.