Chapter 1: Bloodborne Pathogens & Infection Control

Purpose

Establish non-negotiable safety standards to protect clients, artists, and staff from infection and injury. This chapter underpins every other skill in the curriculum.

Learning Objectives

By the end of this chapter, students will be able to:

1. Explain bloodborne pathogen risks (e.g., HBV, HCV, HIV) and routes of transmission (percutaneous injury, mucous membranes, non-intact skin).
2. Implement Standard (Universal) Precautions: treat all blood and body fluids as potentially infectious.
3. Choose and correctly use PPE (gloves, masks/respirators as indicated, protective eyewear/face shield during splash risk, protective clothing/aprons).
4. Perform hand hygiene correctly and at appropriate moments.
5. Set up and tear down a workstation without cross-contamination using appropriate barriers and aseptic technique.
6. Safely handle sharps and dispose of them in FDA-cleared sharps containers; manage exposure incidents and needle-stick injuries per an Exposure Control Plan.
7. Carry out environmental cleaning and disinfection using appropriate products and contact times; maintain sterilization/monitoring logs where applicable.
8. Identify contraindications and situations requiring deferral or medical referral.
9. Maintain required records (e.g., BBP training, vaccination declination/consent, sterilization logs, incident reports).

Note on scope: Local regulations may mandate BBP training, Hepatitis B vaccination availability, autoclave validation frequency, and required record retention. Always align your studio’s written policies with your jurisdiction.

Key Concepts & Terms

• Bloodborne pathogens (BBP): Disease-causing microorganisms in human blood (notably HBV, HCV, HIV).
• Standard Precautions: A set of infection-control practices applied to all clients, regardless of perceived infection status.
• Aseptic technique: Practices that prevent contamination by pathogens.
• Critical/Semicritical/Noncritical items: Classification guiding sterilization vs. high-level or intermediate-level disinfection (tattoo needles and tips are critical and must be sterile single-use or sterilized properly prior to contact).
• PPE: Personal protective equipment (e.g., gloves, masks, eyewear, gowns/aprons).
• Sharps: Needles, razor blades, and any item capable of puncture or laceration.
• Exposure Control Plan (ECP): Written plan describing BBP risk controls, training, vaccinations, and post-exposure procedures.
• Chain of infection: Pathogen → reservoir → portal of exit → mode of transmission → portal of entry → susceptible host. Infection control breaks one or more links.

Facility & Workflow Requirements (High-Level)

• Zoning: Separate clean area (storage, sterile items) from dirty area (used instruments), and from active procedure area. Avoid cross-traffic.
• Handwash station: Hands-free preferred; warm water, liquid soap, disposable towels. Alcohol rubs supplement but do not replace washing when soiled.
• Surfaces: Smooth, non-porous, easily cleanable. Minimize clutter.
• Ventilation & lighting: Adequate for procedure accuracy and safe chemical use.
• Waste handling: Biohazard containers for contaminated disposables; FDA-cleared sharps containers for sharps; regulated medical waste contracts where required.
• Records: Training certificates, sterilization logs, spore test (biological indicator) results if sterilizing, incident reports, SDS for chemicals, equipment maintenance logs.

Hand Hygiene (When & How)

When:

• Before donning gloves; after removing gloves.
• Before touching clean/sterile items; after touching contaminated items or surfaces.
• After contact with body fluids, even if gloves were worn.
• Before and after each client; after restroom use; after blowing nose, coughing, or sneezing.

How:

• Soap & water for at least 20 seconds, covering all surfaces (palms, dorsum, between fingers, thumbs, fingertips, wrists). Dry with single-use towel; use towel to turn off tap if not hands-free.
• Alcohol-based hand rub (≥60% ethanol or isopropanol) if hands are not visibly soiled; rub until dry.

Personal Protective Equipment (PPE)

• Gloves: Medical-grade disposable (nitrile commonly preferred). Change between tasks and clients; never wash or reuse. Replace immediately if torn or contaminated.
• Masks/Respirators: Use a surgical mask during routine tattooing to reduce droplet/splash risk; add eye protection or face shield during splash-prone tasks (e.g., cleaning). Respirators (e.g., N95) if indicated by local policy, airborne risks, or chemical use.
• Eye protection: Safety glasses or face shield when splash risk exists.
• Protective clothing: Fluid-resistant apron or gown if splash or spray is possible.
• Footwear: Closed-toe, non-porous or easily cleanable.

Workstation Setup (Aseptic Barrier Technique)

1. Pre-clean and disinfect all procedure surfaces with an appropriate EPA-registered hospital-grade disinfectant (US context) or equivalent; observe manufacturer contact time (the surface must remain visibly wet for the full time).
2. Hand hygiene → gloves.
3. Place barriers on all high-touch items: machine, clip cord, power supply controls, spray bottles, light handles, wash bottles, armrests, tray surfaces, and client chair controls.
4. Open sterile, single-use items (needles, cartridges, grips if single-use, razors, ink caps, ointment packets) immediately before the procedure; avoid touching sterile ends. If using reusable grips/tips, they must be sterilized and packaged; check indicators before opening at point of use.
5. Dispense inks into single-use ink caps; never return unused ink to the bottle. Do not touch bottle tips to caps or skin.
6. Keep clean/sterile items in the clean zone; used items in the contaminated zone. Maintain a clear visual boundary.

Preventing Cross-Contamination During Tattooing

• Glove discipline: Change gloves whenever moving between clean and contaminated tasks or after touching non-barriered items (phone, drawer, doorknob).
• Single-use only: Needles/cartridges and razors are single-use. Cartridges should include a backflow-preventing membrane to protect the machine/drive system.
• Bottles & sprayers: Barrier them; avoid touching client skin with tips; if contaminated, re-barrier or replace.
• Rinse cups: Single-use; discard after each client.
• Ointments: Use single-use packets or dispense with a sterile tongue depressor; never double-dip.
• Food/drink: Prohibited in procedure areas.

Sharps Safety

• Do not recap needles. If recapping is unavoidable for a specific protocol, use a one-handed scoop technique or a recapping device to avoid hand exposure.
• Immediate disposal: Place used needles/cartridges directly into a puncture-resistant, leak-proof, labeled sharps container located as close as possible to the point of use.
• Fill line: Do not overfill sharps containers; seal and replace at the designated fill mark.
• Transport & disposal: Follow local regulations for regulated medical waste.

Instrument Reprocessing (If Any Reusables Are Used)

Many modern studios use fully single-use workflows to minimize risk. If you use reusable tips/tubes/grips, you must have a validated reprocessing system.

1. Point-of-use pre-cleaning: Remove gross soil promptly; keep items moist if delayed.
2. Transport: Closed, labeled container to the decontamination area.
3. Cleaning: Manual cleaning with appropriate detergents and tools or ultrasonic cleaning per IFU; rinse thoroughly.
4. Inspection: Check for damage and cleanliness; discard compromised items.
5. Packaging: Wrap/package with chemical indicators (internal and external) per IFU.
6. Sterilization: Steam autoclave per device IFU. Parameters vary by load type and autoclave model; typical steam cycles include ~121 °C (250 °F) or higher, with time/pressure set by the manufacturer. Always follow your autoclave’s and instruments’ IFU.
7. Monitoring:
   • Mechanical (time, temp, pressure gauges) each cycle.
   • Chemical indicators each package every cycle.
   • Biological indicator (spore test) at the frequency required by your jurisdiction and autoclave manufacturer (commonly weekly or per defined interval).
8. Storage: Keep sterile packs dry, dated, intact; inspect indicators before opening at point of use.
9. Documentation: Keep sterilization logs and spore test results per regulatory retention periods.

Environmental Cleaning & Disinfection

• Between clients: Remove/discard barriers; dispose of contaminated disposables as biohazard. Clean visible soil, then disinfect all touch surfaces with an appropriate disinfectant, honoring contact time.
• Daily: Floors, sinks, chair bases, light stands; mop/clean with appropriate products.
• Spill management: Use gloves and, if splash risk, eye/face protection. Follow product IFU for blood/body fluid cleanup, including appropriate dilution where applicable. Dispose of cleanup materials as biohazard.

Exposure Control Plan (ECP) — Core Elements

• Risk assessment of tasks with potential exposure.
• Standard Precautions policy and PPE requirements.
• Hepatitis B vaccination offering (or documented declination) for employees where applicable.
• Training: Initial and periodic BBP training; documentation of competency.
• Sharps injury log and incident reporting workflow.
• Post-exposure evaluation: Immediate first aid, reporting, and referral to a qualified healthcare provider for risk assessment and potential post-exposure prophylaxis (PEP), per current medical guidelines.
• Housekeeping: Cleaning/disinfection procedures and schedules.
• Waste management: Segregation, labeling, storage, and disposal procedures.
• Recordkeeping: Training records, vaccination status/declination, sterilization logs, spore test reports, incident logs.
• Annual review: Update the ECP at least annually or after any incident.

Needle-Stick / Exposure Incident: Immediate Steps

1. Wound care: Wash needlestick injuries with soap and water; do not squeeze or “milk” the wound. For mucous membrane exposure, flush with copious water or saline. Do not use harsh chemicals on the wound.
2. Report immediately per your studio policy.
3. Document the incident (time, device, circumstances, client ID code).
4. Refer to a qualified healthcare provider promptly for evaluation of HBV/HCV/HIV risk and consideration of post-exposure prophylaxis (PEP) based on current medical guidance.
5. Follow-up testing and documentation as advised by the provider.

Client Screening, Contraindications & Deferrals (Non-diagnostic)

• Intake questionnaire and informed consent must include recent illness, skin conditions at site (infection, dermatitis), allergies (e.g., adhesives, latex, topical anesthetics), prior adverse reactions, bleeding/clotting disorders or anticoagulant use (may increase bleeding), diabetes or conditions affecting healing, immunocompromise, pregnancy/breastfeeding (often deferred), recent sunburn or tanning (defer), recent alcohol/drug use (impairs consent/bleeding), and keloid history.
• Deferrals/Referrals: Active infection, open wounds, sunburn, compromised decision-making, intoxication, or medical conditions that warrant physician clearance. When in doubt, do not proceed and recommend medical advice.

Pain, Comfort & Safety (Brief, full treatment in Chapter 5)

• Explain realistic pain expectations and breaks.
• Use positioning and skin stretch to reduce trauma.
• Avoid vasovagal triggers (client upright too long, dehydration); keep water and glucose snacks available if permissible. Have a basic first aid plan (as allowed by local regulations).

Documentation & Labeling

• Client file: Intake, informed consent, design approval, procedure notes (date, site, products/ink batches, needle configuration), aftercare provided, photos (with consent).
• Product tracking: Record ink brand, lot/batch, and expiry when feasible to support traceability.
• Equipment logs: Maintenance dates, sterilization cycles, spore test results.

Training Activities (Labs & Drills)

• Gloving and regloving drill: Timed practice of proper don/doff without contamination.
• Barriering relay: Correctly barrier a full workstation; instructor checks common miss-points (power knob, light handle, bottle necks).
• Sharps handling simulation: One-hand scoop with a capped demo device; disposal workflow to sharps container.
• Spill cleanup practical: Simulated blood spill cleanup using colored water; proper PPE and contact times.
• Instrument reprocessing mock-through (if applicable): From dirty to sterile, including indicators and logging (using training-only equipment and non-sterile test packs).

Knowledge Checks (Sample Questions)

1. List three times you must change gloves during a procedure.
2. Define “Standard Precautions.” How do they apply to every client?
3. What are the required steps after a needle-stick injury?
4. Which items must be sterile single-use vs. can be high-level disinfected vs. environmental-level disinfected? Give examples for each category.
5. Describe proper disposal methods for sharps and contaminated waste.

Skills Assessment Rubric (Chapter 1)

Pass criteria require “Meets” or better in all critical items.

Competency Does Not Meet Meets Exceeds Hand hygiene Inconsistent; misses key moments Completes at all required moments with correct technique Anticipates needs; models for peers PPE selection/use Incorrect or missing Correct selection and sequence; no contamination Proactively adjusts PPE for task changes Workstation barriering Misses high-touch points All critical points barriered; intact during session Adds redundant protection for complex setups Sharps handling Unsafe movements; recaps two-handed No recapping; immediate sharps disposal Coaches others; maintains exemplar sharps station Cleaning/disinfection Skips cleaning or contact time Cleans then disinfects; honors contact time Documents product, lot, and timing; spot-audits Documentation Incomplete or absent Complete logs and incident forms Anticipates audits; ensures traceability for inks/equipment

Common Pitfalls & How to Avoid Them

• Breaking clean/dirty workflow → Pre-plan movements; stage supplies; verbalize steps during training.
• Glove overconfidence → Gloves are not magic; change often and avoid touching non-barriered items.
• Ignoring contact times → Set a timer; surfaces must remain visibly wet.
• Improvised containers → Only use proper sharps containers/biohazard bags.
• Ambiguous responsibility → Assign roles for cleanup/sterilization and sign off in logs.

Chapter 1 Checklist (Instructor Sign-off)

• [ ] Passed BBP knowledge assessment.
• [ ] Demonstrated correct hand hygiene and PPE.
• [ ] Set up and broke down a workstation without cross-contamination.
• [ ] Executed sharps disposal correctly.
• [ ] Completed spill cleanup practical.
• [ ] Completed sterilization/logging practical (if applicable).
• [ ] Reviewed and signed the studio’s Exposure Control Plan.

Notes on Accuracy & Scope

• Infection control here aligns with widely accepted principles (e.g., OSHA BBP framework in the US, CDC Standard Precautions) and industry best practices. Exact legal requirements (e.g., spore test frequency, waste handling contracts, required signage) depend on your jurisdiction and the specific autoclave/equipment IFU—verify locally and follow manufacturer instructions.
• Medical topics in this curriculum are educational; they are not medical advice. When in doubt, defer procedures and advise clients to seek guidance from a licensed healthcare provider.