Ask Angel

Sterile Gloves

Elayne Angel,

I am writing for your perspective on something I’m struggling with. Some background: I am a proud member of the Association of Professional Piercers, and have been piercing for 16 years. I own a reputable piercing-only business and employ several other piercers. I consider myself an ethical professional and work to keep up my skills and knowledge.

So, the question I have is whether you think it is necessary to use sterile gloves? It feels like there is a kind of peer pressure going on now with an attitude that if we pierce with medical exam gloves (and not sterile gloves), we’re inferior. Or even hacks. I have some colleagues who autoclave gloves in their studios before use, but I am unsure of best practices. Is that recommended?

I am 100% confident that my staff and I are not causing any infections. I believe that our current methods are safe and I know that our clients have excellent results with our work. A little help here, please?

Thank you! J.


Dear J.,

There are plenty of strong opinions when it comes to the topic of sterile vs. non-sterile gloves for piercing. But no substantive research studies or definitive resource materials exist as this relates specifically to body piercing, so we have to extrapolate as best we can.

For the purposes of this discussion we must first discern whether we consider body piercing to be in the category of “surgery” or not. If I believed that body piercing was surgery, I would say that sterile gloves are indeed necessary. But it is my contention that piercing is not surgery. Fortunately, our legislators agree; otherwise we’d need to head to medical school—or seek new work. Body art laws now exist in all fifty US statesi, though less than a handful (couldn’t help myself) require sterile gloves: only Florida and South Carolina (ii).

Naturally, as an APP member with employees, it is non-negotiable that you adhere to all organization and OSHA guidelines, and any other state and local ordinances that apply. Beyond the obligatory minimums, we all need to find our own comfort levels for the supplemental measures we implement.

The APP’s stance on sterile gloves is posted on the website (iii):

The APP mission is to promote and uphold minimal standards of safety and hygiene. As such, it is our official position that aseptic technique performed with clean disposable gloves is appropriate and acceptable. The above applies, except where sterile gloves are mandated by local laws. If a piercer wishes to use sterile gloves, naturally they may do so. Non-sterile gloves are the minimum required for membership.

In reviewing related medical literature, I found the World Health Organization (WHO) glove pyramid(iv). According to their guidelines, sterile gloves are indicated for the following (bold emphasis added):

“Any surgical procedure; vaginal delivery; invasive radiological procedures; performing vascular access and procedures (central lines)….”

Examination gloves (non-sterile) are suggested for the tasks that are more similar to what piercers do:

“Contact with blood; contact with mucous membrane and with non-intact skin… IV insertion and removal; drawing blood; discontinuation of venous line; pelvic and vaginal examination….”

Recent research(v) was conducted comparing the two types of gloves in outpatient minor surgeries. These studies, including a randomized controlled trial(vi) and a meta-analysis(vii) of over 11,000 patients, revealed that postoperative surgical site infection rates are not higher when non-sterile gloves are worn for these procedures. And those actually were surgeries.

In looking at clinical practice, since the 1980s I’ve performed over 50,000 piercings using non-sterile medical exam gloves, and I’m equally confident about not causing infections. I didn’t even see them during the early days when our hygiene protocols were comparatively primitive.

The relevance of clinical practice or “historical and practical application” has long been recognized by the APP. It is the method by which niobium was deemed an appropriate jewelry material for wear in initial piercings. It was not through applicable scientific studies, which are unavailable, but by having a “history of documented compatibility with the human body.”

Based on this same principle, the APP jewelry standards for initial piercings(viii) were amended in 2017 to include rose gold in addition to “solid 14 karat or higher nickel and cadmium free yellow and white gold.” My own investigation had indicated this pretty-in-pink metal might not be safe to wear in fresh piercings due to the copper content. But industry usage and clinical practice appear to have shown otherwise. So, not everything considered acceptable in our field—including something as critical as the materials we put into fresh piercings—comes down to the results of systematic formal research. (Even so, I’ve decided to reserve rose gold for healed piercings to suit my own comfort level.)

Any piercer electing to perform in-house sterilization must follow manufacturers’ instructions for both the autoclave and the gloves. On that note, I scoured the web for such guidelines, and medical or scientific journals containing relevant information. The most detailed instructions I located were for reprocessing latex surgical gloves in Infection Prevention Guidelines for Healthcare Facilities with Limited Resources (2003)(ix). They issued a warning: “Higher temperatures and pressures are destructive to gloves.” And, “Immediately after autoclaving, gloves are extremely friable and tear easily. Gloves should not be used for 24 to 48 hours to allow their elasticity to return and to prevent tackiness (stickiness).” Apparently, nitrile doesn’t suffer from those issues, according to the one article that surfaced on that topic. It contains some interesting information but regarded rodent surgeries(x) so may not be entirely applicable.

Many autoclaves do have a rubber/plastics cycle, but unless your glove manufacturers advocate this treatment of their products, that may be a moot point. To find out, I contacted more than half a dozen producers, including those who supply exam gloves that are commonly used in our industry. None of the company representatives recommended autoclave sterilization of their gloves. The only written response I received was from the makers of MICROFLEX gloves. Not only are instructions for autoclaving their exam gloves unavailable, they flat-out advise against the practice:

Ansell(xi) does not recommend autoclaving gloves as it will compromise resistance of the gloves under high temperature conditions.”

So, unless we are able to locate and follow some other glove manufacturer’s directives for in-studio autoclaving, we shouldn’t really be doing it. If anyone does have such a guide (or other pertinent research) please share it with me; I would happily write a follow-up.

Ultimately, there is no level lower than a zero-incidence rate of infection. If your current process results in no infections whatsoever per 1000 piercings, for example, then adding more stringent measures is not going to improve results.

That said, I want to be clear that I am in no way against the use of sterile gloves. I am simply making the case that they have not shown to be essential for safe piercing procedures. If wearing them feels like the right choice for you, absolutely do so! Of course, it is necessary that they’re handled (autoclaved?) and donned correctly(xii) or their use is a meaningless gesture. My advice is to review the available information and make the decision that seems best for you and your practice.

References:

(i) http://www.ncsl.org/research/health/tattooing-and-body-piercing.aspx (Some regulate age restrictions, but not hygiene)
(ii) According to the APP Legislative Liaison as of February 2018
(iii) https://www.safepiercing.org/safe_piercing.php#sterilegloves (accessed 2/10/18)
(iv) http://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf
(v) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029541/#B2
(vi) https://www.ncbi.nlm.nih.gov/pubmed/25588441/
(vii) https://jamanetwork.com/journals/jamadermatology/fullarticle/2538523
(viii) https://www.safepiercing.org/jewelry_standards.php
(ix) http://pdf.usaid.gov/pdf_docs/Pnact433.pdf
(x) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4460945/
(xi) http://www.ansell.com/
(xii) https://opentextbc.ca/clinicalskills/chapter/sterile-gloving/

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