HETA 99-0265-2830

Venus & Mars

Orlando, Florida

and

HETA 2000-0013-2830

Body Piercing by Bink

Tallahassee, Florida

____________

Angela M. Weber, MS

This Health Hazard Evaluation (HHE) report and any recommendations made herein are for the specific facility evaluated and may not be universally

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

Additional HHE reports are available at http://www.cdc.gov/niosh/hhe/reports

This Health Hazard Evaluation (HHE) report and any recommendations made herein are for the specific facility evaluated and may not be universally

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

Additional HHE reports are available at http://www.cdc.gov/niosh/hhe/reports

This Health Hazard Evaluation (HHE) report and any recommendations made herein are for the specific facility evaluated and may not be universally

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

Additional HHE reports are available at http://www.cdc.gov/niosh/hhe/reports
ii

PREFACE

The Hazard Evaluations and Technical Assistance Branch (HETAB) of the National Institute for

Occupational Safety and Health (NIOSH) conducts field investigations of possible health hazards in the

workplace. These investigations are conducted under the authority of Section 20(a)(6) of the Occupational

Safety and Health (OSHA) Act of 1970, 29 U.S.C. 669(a)(6) which authorizes the Secretary of Health and

Human Services, following a written request from any employer or authorized representative of employees,

to determine whether any substance normally found in the place of employment has potentially toxic effects

in such concentrations as used or found.

HETAB also provides, upon request, technical and consultative assistance to Federal, State, and local

agencies; labor; industry; and other groups or individuals to control occupational health hazards and to prevent

related trauma and disease. Mention of company names or products does not constitute endorsement by

NIOSH.

ACKNOWLEDGMENTS AND AVAILABILITY OF REPORT

This report was prepared by Angela Weber of the HETAB, Division of Surveillance, Hazard Evaluations and

Field Studies (DSHEFS). Field assistance was provided by Teresa Seitz at Venus & Mars and Sally Brown

at Body Piercing by Bink. Desktop publishing was performed by Patricia Lovell. Review and preparation

for printing were performed by Penny Arthur.

Copies of this report have been sent to employee and management representatives at Venus & Mars, Body

Piercing by Bink, and the OSHA Regional Office. This report is not copyrighted and may be freely

reproduced. Single copies will be available for a period of three years from the date of this report. To

expedite your request, include a self-addressed mailing label along with your written request to:

NIOSH Publications Office

4676 Columbia Parkway

Cincinnati, Ohio 45226

800-356-4674

After this time, copies may be purchased from the National Technical Information Service (NTIS) at

5825 Port Royal Road, Springfield, Virginia 22161. Information regarding the NTIS stock number may be

obtained from the NIOSH Publications Office at the Cincinnati address.

For the purpose of informing affected employees, copies of this report shall be

posted by the employer in a prominent place accessible to the employees for a

period of 30 calendar days.
iii

Highlights of the NIOSH Health Hazard Evaluation

Evaluation of Potential Bloodborne Pathogen 

Exposures Among Body Piercers

In response to requests from Venus and Mars and Body Piercing by Bink, NIOSH evaluated potential

occupational exposures to bloodborne pathogens during body piercing. 

What NIOSH Did

# We observed piercing activities and

decontamination procedures.

# We talked to piercers about their health and

safety concerns.

# We evaluated compliance with the

Occupational Safety and Health

Administration’s (OSHA) Bloodborne

Pathogen Standard.

# We asked about training received bypiercers.

What NIOSH Found

# Body piercers are at risk for infection with

bloodborne pathogens through needlesticks

and contact with contaminated surfaces.

# Bloodborne pathogen training had been

completed by the piercers.

# The wrong type of gloves was worn while

handling decontaminants.

# Studios did not have OSHA exposure control

programs in place. 

# Ventilation systems did not provide adequate

filtration and directional airflow.

What Studio Owners Can Do

# Provide separate areas for piercings, cleaning

instruments, and sterilization.

# Provide adequate ventilation and filtered air to

piercing areas.

# Provide foot-operated sinks and waste

receptacles.

# Provide easily accessible sharps containers.

# Develop exposure control and spill response

programs. 

# Offer HBV vaccinations to piercersat no cost.

# Provide appropriate gloves.

What Body Piercers Can Do

# Get HBV vaccination if not immune.

# Report needlesticks and spills immediately.

# Immediately discard used needles in sharps

containers.

# Limit the numberofcustomersinpiercing area.

# Wear industrial-grade gloves while using

decontaminants.

# Wear reduced protein, powder-free latex

gloves to reduce the risk of latex allergy.

# Avoid performing piercings when fatigued.

What To Do For More Information:

We encourage you to read the full report. If you

would like a copy, either ask your health and safety

representative to make you a copy or call

1-513/841-4252 and ask for HETA Report #

99-0256-2830 and 2000-0013-2830
v

Health Hazard Evaluation Report 99-0265-2830

Venus & Mars

Orlando, Florida

and

Health Hazard Evaluation Report 2000-0013-2830

Body Piercing by Bink 

Tallahassee, Florida

February 2001

Angela M. Weber, MS

SUMMARY

In June 1999 and October 1999, the National Institute for Occupational Safety and Health (NIOSH) received

health hazard evaluation (HHE) requests from Venus and Mars in Orlando, Florida, and Body Piercing by

Bink in Tallahassee, Florida, respectively. The management requests concerned potential occupational

exposures to bloodborne pathogens during body piercing procedures. Both requests were prompted by the

passage of a new rule (Chapter 64E-19 of the Florida Administrative Code) which requires the Florida

Department of Health (DOH) to regulate body piercing salons. In response to the HHE requests, NIOSH

investigators conducted a site visit at Venus and Mars on August 10-11, 1999, and at Body Piercing by Bink

on January 7-8, 2000. 

NIOSH investigators observed the assembly of instruments, jewelry, and supplies used during the piercing

procedure, the preparation of the piercing area, the piercing itself, the disposal of the piercing needle in a

sharps container, the disinfection of contaminated surfaces, and the sterilization of reusable instruments. The

use of personal protective equipment (PPE) was observed for the activities noted above, as well as general

housekeeping procedures. Written policies and programs were evaluated when present, and informal

interviews were conducted with the HHE requesters and their employees. 

The observed practices in both piercing studios were compared to the requirements outlined in the new Florida

ruling to identify any potential inconsistencies or areas in need of improvement. This evaluation was limited

to areas relating to occupational health. To gain a better understanding of the factors which prompted the

regulating of body piercing studios in the State of Florida, NIOSH investigators met with the authors of the

ruling in Tallahassee, Florida, on January 7, 2000. Additionally, implementation strategies for the new rule

were discussed including the training of the DOH inspectors. 

The primary hazard noted during the piercing process was the potential for needlesticks to occur. According

to anecdotal information, the most likely time for occurrence of needlesticks among piercers is when the

unprotected needle is exiting the piercing site. It is unclear whether a cork provides protection against a

needlestick, since piercers reported the cork may crack as the needle is pushing through it. The use of a cork

during piercings was not required at either studio and appeared to be solely dependent on the preference and

training of the piercer. 
vi

In both facilities, the sharps containers were located behind the piercing chair. Because the sharps container

was not within reach of the piercer, used needles were placed back on the tray. Picking up contaminated

needles from the tray to discard them in the sharps container posed an unnecessary risk to the piercer. In

addition, an inconvenient location forced the piercer to make unnecessary movements while holding the

needle. 

Additional risks were observed regarding exposures through the potential cross-contamination of instruments

and surfaces. At the time of the site visit at Venus and Mars, genital piercings were being performed in the

same room where contaminated instruments were being cleaned in a sonicator. Reportedly, this practice has

since been discontinued. At Body Piercing by Bink, all piercings were done within six feet of the sonicator.

A great number of disinfectants can be used for cleaning surfaces and instruments used during the piercing

procedures, including alcohol, chlorine and chlorine compounds, formaldehyde, glutaraldehyde, hydrogen

peroxide, iodophors, phenolics, and quaternary ammonium compounds. Latex gloves were used while

handling these chemicals at both facilities. 

Neither of the body piercers at Venus & Mars had been vaccinated against Hepatitis B virus (HBV), and

an exposure control program, as required by the Occupational Safety and Health Administration (OSHA),

had not been prepared for either of the facilities. 

NIOSH investigators concluded that the body piercers at both facilities were at risk for exposure

to bloodborne pathogens due to the potential for needlestick injuries. Also, although certain practices

can reduce the number of viable organisms potentially aerosolized from a sonicator, there is the

potential for the deposition of infectious droplets onto surfaces, equipment and personnel located in

the near vicinity. Recommendations for minimizing exposures and complying with OSHA’s

Bloodborne Pathogen Standard are provided in this report.

Keywords: SIC 7299 (Miscellaneous Personal Services, Not Elsewhere Classified), body piercing, bloodborne

pathogens, human immunodeficiency virus, HIV, hepatitis B, HBV, hepatitis C, HCV, needlestick injuries,

sharps.
TABLE OF CONTENTS

Preface ....................................................................... ii

Acknowledgments and Availability of Report ............................................. ii

HHE Supplement ............................................................... iii

Summary .................................................................... iv

Introduction ................................................................... 1

Background .................................................................... 1

History of Body Piercing ........................................................ 1

Piercing Procedure ............................................................ 1

Training Level of Piercers ....................................................... 1

Methods ...................................................................... 2

Evaluation Criteria ............................................................... 2

Bloodborne Pathogens Standard ................................................... 2

Written Exposure Control Plan ................................................. 2

Hazard Communication to Employees ............................................ 3

Preventive Measures ....................................................... 3

Engineering and Work Practice Controls .......................................... 3

Personal Protective Equipment (PPE) ............................................ 3

Procedures after an Exposure Incident ........................................... 3

Recordkeeping ............................................................ 3

Specific Bloodborne Pathogens ................................................... 3

Hepatitis B............................................................... 3

Hepatitis C .............................................................. 3

Human Immunodeficiency Virus (HIV) ........................................... 4

Regulation of Body Piercing Studios ................................................ 4

Chapter 64E-19, Florida Administrative Code ......................................... 4

Results ....................................................................... 5

Venus & Mars ............................................................... 5

Body Piercing by Bink ......................................................... 7

Discussion and Conclusions ........................................................ 8

Recommendations ............................................................... 9

References ................................................................... 11
Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830 Page 1

INTRODUCTION

In June 1999 and October 1999, the National

Institute for Occupational Safety and Health

(NIOSH) received health hazard evaluation

(HHE) requests from Venus and Mars in Orlando,

Florida, and Body Piercing by Bink in Tallahassee,

Florida, respectively. The owners’ requests

concerned potential occupational exposures to

bloodborne pathogens during body piercing

procedures. Both requests were prompted by the

passage of a new rule (Chapter 64E-19 of the

Florida Administrative Code) which requires the

Florida Department of Health (DOH) to regulate

body piercing salons. In response to the HHE

requests, NIOSH investigators conducted a site

visit at Venus and Mars on August 10-11, 1999,

and at Body Piercing by Bink on January 7-8,

2000. 

BACKGROUND

History of Body Piercing

Until recently, body piercing sites other than the

earlobe have been relatively rare in Western

culture. Body piercing is gaining widespread

popularity among both teens and adults from a

variety of occupations and social classes.

Although it may seem like a new fad, body

piercing has been popular in some cultures for

many years. Piercings have been done as a rite of

passage, to indicate social standing, and as a mark

of royalty.

1,2

 Roman centurions were said to have

pierced their nipples to hold their capes in place,

Mayans pierced their tongues for spiritual

purposes, and the Pharaohs of Egypt

ceremoniously had their navels pierced. Genital

piercings were, and still are, seen in areas around

the Indian Ocean and among peoples of the South

Pacific. Both sexes of English Royalty in the

Victorian Era had nipple and genital piercings.

One particular type of genital piercing was

supposedly worn by and named after Queen

Victoria’s husband, Prince Albert. 

Piercing Procedure

Body piercing is a quick procedure which is done

without local anesthesia. The type of piercing and

the location on the body determine the gauge of

the jewelry and the diameter of the rings or length

of the “barbell” to be placed through the skin or

mucosa. Piercing locations include the ears, nose,

lips, chin, tongue, eyebrows, nipples, navel, and

genitals. The types of jewelry range from small to

wide hoops to ear or barbell-type studs. Once the

jewelry is chosen, it is autoclaved for sterilization.

Most jewelry is made of surgical-grade stainless

steel, solid 14 or 18-karat gold, niobium, titanium,

platinum, low-porosity plastic, or silver. 

A single-use setup is used to perform the piercing.

The piercer cleanses the piercing area with a

topical antiseptic. Entrance and exit sites are

marked with a pen to provide a guide for the

needle, the skin is held taut by forceps, while the

piercing is made with a large-gauge (12-16-gauge)

hollow-bore needle. Some piercers prefer to place

a cork at the exiting site to catch the needle.

Jewelry is then attached to the needle and quickly

guided through the hole in a needle-and-thread

type fashion. A bead, metal ball, or disk is then

screwed on to the exiting side of the jewelry.

Since a small amount of bleeding usually occurs,

manual pressure is applied to the pierced area with

sterile gauze. The amount of blood depends on

the piercing location; the nose and genital areas

generally produce the most blood. 

Variations of this procedure may occur. In

piercing the tongue, a longer “barbell” is initially

used to allow for edema of the tongue. In the

Prince Albert penile piercing, the needle passes

through the urethra, where a receiving tube is used

to guide the needle. Receiving tubes are also used

for nose piercings, where they are placed in the

clients nostril. To stretch existing piercing site

openings so larger-diameter jewelry can be worn,

tapers are slowly passed through them. 

Training Level of Piercers

Body piercing is currently performed by

unlicenced personnel who have learned their trade

from colleagues, magazines, or videos.2 In the

absence of local or federal regulations, piercers
Page 2 Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830

may not have received training in anatomy,

infection control, or universal precautions. The

Association of Professional Piercers (APP)

recommends that an apprenticeship consisting of

at least one year be completed.3 Some of the

requirements listed for an apprenticeship include

attending an Occupational Safety and Health

Administration (OSHA) bloodborne pathogen

course; spending a minimum of three months fulltime as a trainee, learning sterilization and

disinfection and cross-contamination avoidance;

spending a minimum of six months to one year in

full-time supervised training before achieving the

title of piercer; and observing all procedures

before performing them. The APP has four

different piercing titles: apprentice/trainee, piercer,

senior or training piercer, and master piercer. The

designated title depends on the time the person has

been piercing. For example, an apprentice is

someone who has worked as a piercer for less

than a year, while a master piercer is an individual

with not less than five years of full-time piercing

experience.

METHODS

At both of the body piercing studios, NIOSH

investigators observed the assembly of

instruments, jewelry, and supplies used during the

piercing procedure, the preparation of the piercing

area, the piercing itself, the disposal of the piercing

needle in a sharps container, the disinfection of

contaminated surfaces, and the sterilization of

reusable instruments. The use of personal

protective equipment (PPE) was observed for the

activities noted above, as well as general

housekeeping procedures. Written policies and

programs were evaluated when present, and

informal interviews were conducted with the HHE

requesters and their employees. 

The observed practices in both piercing studios

were compared to the requirements outlined in the

new Florida ruling (discussed in the Background

section of this report) to identify any potential

inconsistencies or areas in need of improvement.

This evaluation was limited to those areas relating

to occupational health. To gain a better

understanding of the factors which prompted the

regulating of body piercing studios in the State of

Florida, NIOSH investigators met with the authors

of the ruling in Tallahassee, Florida on January 7,

2000. Additionally, implementation strategies for

the new rule were discussed, which included the

training of the DOH inspectors. 

EVALUATION CRITERIA

Bloodborne Pathogens

Standard

Bloodborne pathogens include, but are not limited

to, the hepatitis B virus (HBV); human

immunodeficiency virus (HIV), which causes

acquired immunodeficiency syndrome (AIDS);

hepatitis C virus (HCV); human T-lymphotrophic

virus Type 1; and pathogens causing malaria,

syphilis, babesiosis, brucellosis, leptospirosis,

arboviral infections, and viral hemorrhagic fever.

For the purposes of this report, attention will be

focused on the three most commonly transmitted

bloodborne viruses: HBV, HCV, and HIV. 

OSHA regulation on bloodborne pathogens, 29

CFR 1910.1030, took effect on March 6, 1992.4

The OSHA standard covers all employees who

may be reasonably anticipated to be occupationally

exposed to blood and other potential infectious

materials. The key requirements of the standard

are the determination of occupational exposure

and the implementation of appropriate control

measures and work practices to minimize these

exposures. The following section outlines the

major requirements of the bloodborne pathogens

standard.

Written Exposure Control Plan

• Identification of job classifications where

there is exposure to blood or other potentially

infectious materials.
Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830 Page 3

• Identification of protective measures currently

in effect at the facility.

• Establishment of procedures to evaluate the

circumstances of an exposure incident.

Hazard Communication to

Employees

• Implementation of employee training

programs, which should include information on

bloodborne pathogens, OSHA regulations, and

the employer’s exposure control program.

Preventive Measures

• Hepatitis B vaccination should be provided

within 10 working days of initial job

assignment at no cost to the employee.

• Application of the universal precautions

approach to infection control, which assumes

that the blood, body fluids, and tissues of all

persons are potentially infectious. 

Engineering and Work

Practice Controls

• Use of puncture-resistant, leak-proof

containers (color-coded red or labeled as a

biohazard) to discard or transport sharps and

other potentially infectious material.

• Use of work practice controls to reduce the

probability of exposure by altering the manner

in which the task is performed.

Personal Protective

Equipment (PPE)

• Use of gloves, face shields, face masks,

protective clothing and other PPE to reduce

workers’ risk of exposure.

Procedures after an Exposure

Incident

• Medical evaluations and follow-up are at no

cost to the individual.

• Employee must be immediately directed to a

healthcare professional who is available during

all working hours.

Recordkeeping

• A medical record must be established for

each employee with potential occupational

exposure. A copy of the employee’s hepatitis

B vaccination status should be included. The

record must be confidential, separate from

other personnel records, and maintained for 30

years after employment.

• Training records must be kept for three years.

Specific Bloodborne

Pathogens

Although there are a number of bloodborne

pathogens, as listed at the beginning of the section,

only the three most common in the United States

are discussed below.

Hepatitis B

One of the most infectious of all the known

bloodborne pathogens is HBV. Among healthcare

workers who have had needlestick injuries where

the patient has had HBV infection, up to 30%

have developed infection with this virus.5,6,7,8

Persons infected with HBV are at risk for chronic

liver disease (i.e., chronic active hepatitis,

cirrhosis, and primary hepatocellular carcinoma)

and can potentially infect others. An estimated

100-200 healthcare personnel have died annually

during the past decade because of the chronic

consequences of HBV infection (Centers for

Disease Control and Prevention [CDC],

unpublished data). A vaccine for HBV is

available, and the CDC recommends that workers

potentially exposed to blood or blood-contaminated

body fluids receive this vaccine.9

Hepatitis C
Page 4 Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830

HCV infection is the most common chronic

bloodborne infection in the United States.10 HCV

is most efficiently transmitted by large or repeated

percutaneous exposures to blood, such as through

the transfusion of blood or blood products from

infectious donors and sharing of contaminated

needles among injection drug users. The risk

factors for HCV transmission in the occupational

setting are not well-defined.11,12,13,14 During the

past decade, the annual number of newly acquired

HCV infections has ranged from an estimated

28,000 to 180,000.15 Of these, an estimated 2-4 %

occurred among healthcare personnel who were

occupationally exposed to blood.16

At least 85 % of persons with HCV infection

become chronically infected, while chronic liver

disease with persistently elevated liver enzymes

develops in about 67 % of those chronically

infected.10 These extraordinarily high rates of

chronic disease and persistent viremia in humans

indicate the absence of an effective neutralizing

immune response. 17,18 Although the efficacy of

post-exposure prophylaxis after occupational

exposure to HCV has been difficult to assess,

immune globulin does not appear to be effective in

preventing HCV infection.19

Even in the absenc e of available post-exposure

prophylaxis, individual worksites should establish

policies and procedures for follow-up after

percutaneous or mucosal exposure to anti-HCV

positive blood to address individual worker’s

concerns about their risk and outcome. Employers

should provide education to employees regarding

the prevention of hepatitis C in the occupational

setting,10 and such information should be routinely

updated to ensure accuracy.

Human Immunodeficiency

Virus (HIV)

Exposures to HIV can occur through needlesticks

or cuts from other sharp instruments contaminated

with an infected person’s blood or through contact

of the eye, nose, mouth, or skin with contaminated

blood. All exposures of this type should be

immediately evaluated by a healthcare provider. 

Most occupational exposures to HIV do not result

in infection. The risk of infection varies with the

type of exposure and factors such as the amount

of blood involved in the exposure, the amount of

virus in the blood, and whether treatment was

given after the exposure. Between 1985 and June

1999, cumulative totals of 55 documented cases

and 136 possible cases of occupational HIV

transmission to U.S. healthcare workers were

reported to the CDC.20 Needlesticks were

associated with 89% (49 out of 55) of the

documented transmissions. Of these, 44 involved

hollow-bore needles. There have been no

documented cases of HIV transmission due to an

exposure involving a small amount of blood on

intact skin. The risk may be higher if the skin is

damaged or if the contact involves a large area of

skin or is prolonged. 

Treatment is available after an occupational

exposure to HIV. Results from a small number of

studies suggest that the use of zidovudine (ZDV)

and other antiviral drugs after certain occupational

exposures may reduce the chance of HIV

infection after exposure.21 However, a healthcare

provider familiar with the risks of HIV infection

and the side effects of the drugs should be

consulted to determine whether post-exposure

treatment is appropriate.

Regulation of Body Piercing

Studios

Most body piercing studios in the United States

are not regulated. In 1998, Texas, Oregon, and

Wisconsin were the only states that specifically

regulated body piercing. According to the website

of APP, approximately 18 states are currently in

the process of enacting legislation to regulate body

piercing.22 

The APP is a nonprofit organization which was

formed in an attempt to initiate self-regulatory

policies for the body piercing industry.

23 The

association publishes a procedural manual which

provides safety suggestions, as well as a monthly

newsletter called “The Point.” In addition, the

APP holds an annual conference where safety

and health issues are discussed. To become a
Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830 Page 5

member of the APP, applicants must prove that

they have been piercing full-time for at least one

full year, that they are certified in First Aid/CPR,

and they use an autoclave for sterilization of

reusable instruments. Spore testing for the

autoclave must be submitted on a monthly basis.

There are currently over 100 members belonging

to the APP. At the time of the HHE requests, the

only two APP members from Florida, out of an

estimated 300 piercers in the state, were the

owners of the two piercing studios which

submitted the NIOSH HHE requests. The total

number of piercing studios in the United States is

unknown; therefore, an estimate of at-risk piercing

employees cannot be calculated. Since this

occupation is not closely monitored, the potential

for disease transmission among workers is

unknown. 

Chapter 64E-19, Florida

Administrative Code

The Florida ruling prescribes minimum sanitary

and safety requirements regarding the design,

operation, and maintenance of body piercing

studios and temporary establishments. The

primary focus of the standard is the prevention of

infections in those receiving the piercings, not

occupational risks to those performing the

piercings. Potential risks to recipients of piercings

include localized bacterial infections, tetanus, nonmenstrual toxic shock syndrome, viral hepatitis,

and HIV.

24,25,26,27,28,29,30,31,32 These infections

have been attributed to the use of contaminated

equipment and improper after-care by the client.

The sections of the standard which specifically

address occupational concerns of the piercers are

summarized below:

Requirements for Premises (64E-19.004):

This section contains requirements for

handwashing facilities within each body piercing

area, appropriate disposal of biohazardous waste;

cleaning and sterilization of instruments; and

prohibiting smoking, eating, and drinking in piercing

areas.

Requirements for Sterilizing Jewelry and

Instruments (64E-19.005): This section

recommends the use of sanitizers which are

tuberculocidal for surface cleaning.

Piercing Procedures (64E-19.006): This

section requires piercers to wear “disposable

sterile medical gloves” during procedures and to

wear protective eyewear if splashing is expected.

This section also states that the skin area to be

pierced must be “free of rash, infection or any

other visible disease condition.” 

Other Operations (64E-19.007): This section

requires the completion of training covering the

areas of safety, sanitation, and sterilization for the

prevention of infectious diseases. 

Although the ruling requires that injuries to a

customer’s body structure or function be reported

to the local health department, there is no

discussion for the need of reporting an

occupational exposure to bloodborne pathogens as

required by OSHA. 4 The Florida standard does

not cover ear piercings performed in beauty salons

or jewelry stores. 

RESULTS

Venus & Mars

Venus & Mars serves as a piercing studio, as well

as a clothing, shoe and music store.

Approximately 15 employees work at the

establishment, but only 2 employees actually

perform piercings. Approximately 100 piercings

are completed per week, depending on the time of

the year. The most common piercing sites are the

tongue and naval. Jewelry was displayed near the

entrance of the store in an enclosed case and was

kept separate from the stock jewelry. 

There were two areas in the facility which were

designated for piercing activities: a piercing room

and a decontamination/sterilization room. All

surfaces of the piercing room, including the walls,

floors, and procedure surfaces, were constructed

of smooth, non-absorbent and washable materials.

There was approximately 64 square feet of floor
Page 6 Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830

space which contained one piercing station. A

viewing window with blinds had been installed in

one of the walls so customers could observe the

piercings. This limited the number of people going

into the room, which may introduce additional

contaminants to the surrounding environment. The

room was in good physical condition and was well

lit. Smoking, eating, and drinking were not

allowed in the piercing areas. 

A large industrial-sized toolbox, located in the

piercing room, was used for storing individuallypackaged jewelry which had been sterilized. The

sharps container was bolted to the wall behind the

piercing chair. A handsink was located along the

same wall as a counter-top cabinet where supplies

were stored and instruments assembled in

preparation for piercings. Paper towels were

dispensed from a wall-mounted unit located above

the preparation area. A stainless steel rolling cart

with a tray holder was used for positioning the

forceps, jewelry, gloves, needle, and gauze used

during the piercings. The tray was wiped down

with a disinfectant before and after each use. 

During the site visit, NIOSH investigators

observed a labret piercing (through the skin

beneath the lip). After the client chose the type of

jewelry (a barbell with a flat disk for the interior of

the mouth and a ball on the other), the piercer

selected the same type from stock which had

already been sterilized. Pre-packaged, sterilized

jewelry has a shelf-life of 30 days; after this time,

it needs to be re-autoclaved. A pair of packaged,

sterilized latex gloves were worn by the piercer

during setup, which involved opening another

package of gloves. The packaging was opened to

cover the entire tray, with the inner portion

(sterilized side) facing up (Figure 1). Other

materials needed for the piercing included gauze;

a 14-gauge, hollow-bore disposable needle about

one and a half inches in length; marking dye and

applicator; and sterilized, packaged forceps, which

were unwrapped and placed on the tray. The

piercer cleaned the area of the face with a topical

antiseptic applied to gauze, while the client was

asked to use mouthwash antiseptic to cleanse the

inside of her mouth. Using a toothpick, the piercer

marked the location of the piercing with the dye

both inside the mouth and on the face. 

The additional pair of gloves on the tray were then

placed over the gloves already being worn. The

forceps were used to align the entrance and exit

markings of the piercing and tightened. The tips

of the forceps are looped, therefore, they provide

guidance for the needle, which passes through the

looped area (Figure 2). The needle (with the

attached barbell) was inserted from the outer skin

below the lip through the skin to the inside of the

mouth (Figure 3). The needle was removed and

a ball was screwed on to the end of the exterior

portion of the barbell. 

Pressure was applied to the pierced area with

sterile gauze to slow the bleeding (Figure 4),

followed by the application of an antiseptic. The

entire process took less than five minutes, with the

majority of time spent marking the piercing site.

Throughout the process, all materials and

instruments, including the needle, were placed

back on the tray. The amount of blood produced

by the piercing could be cleaned with two gauze

pads. According to the piercer, this amount of

blood is similar for all piercings except for the nose

and genital areas, which bleed more. After the

procedure was completed, the contaminated

needle was picked off the tray by hand and

disposed of in the sharps container. The bloodcontaminated gauze and gloves were discarded as

biohazardous waste, the forceps were taken to the

sterilization room, and all other materials were

thrown away as regular trash. Between clients,

the tray, chair, and countertop are sanitized with a

germicidal agent. The floor is mopped with a

diluted sodium hypochlorite (bleach) solution at

least once per day.

In addition to the piercing, NIOSH investigators

observed the stretching of an existing piercing.

Stretching is accomplished with the use of tapers

(Figure 5). Tapers are made of solid, surgicalgrade stainless steel and are reusable after they

have been autoclaved. A lubricant is used to

insert the taper slowly through the pierced area.

This was a much less invasive procedure

compared to a piercing. No visible blood was

seen, which is reportedly the case for most

circumstances. The same type of skin preparation

and clean-up was used for the stretching as was
Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830 Page 7

for the piercing; latex gloves were used throughout

the procedure. 

The decontamination/sterilization room was off

limits to clients, except for the performance of

genital piercings, which are rare. At the time of

the survey, genital piercings were performed in

this room because it offered more privacy than the

piercing room. Contaminated instruments were

brought to this room and soaked in an open tray in

either Cidex® or Wavicide.® The active

ingredient in both agents is glutaraldehyde. A

single pair of latex gloves is worn during the

handling of contaminated instruments. Once the

instruments have soaked in the decontaminant,

they are rinsed in the sink, and put in the sonicator

for 30 minutes. A lid is placed on the sonicator

while it is in use. The instruments are removed

from the sonicator and allowed to dry. After

drying, instruments are bagged and placed in the

autoclave. Both the clean-up of contaminated

equipment and the sterilization of equipment are

done in this room. A comprehensive set of

material safety data sheets (MSDSs) for the

chemicals used in the store and studio were kept

in a binder located in this room. 

The heating, ventilating, and air conditioning

(HVAC) system serving the store consisted of a

typical central forced-air residential unit. A lowefficiency filter was used in the unit, and a half

inch gap was found at the top of the filter frame;

this allows for the passage of unfiltered air through

the system. The system is serviced by an outside

contractor. The piercing room was under negative

pressure (air flowed from the hallway into the

room).

Neither of the body piercers had been vaccinated

against HBV, and an exposure control program, as

required by OSHA, had not been prepared for the

facility at the time of the site visit. A bloodborne

pathogens training course had been completed by

both piercers. 

Body Piercing by Bink

The Body Piercing by Bink piercing studio shared

space with a tattoo parlor. At the time of the site

visit, there were two piercers in the studio; one

piercer was the owner, and the other piercer was

completing her apprenticeship. Approximately

100 piercings are completed per week, with the

most common piercing site being the naval.

Jewelry is displayed in an enclosed, counter-top

viewing case. Display jewelry is kept separate

from the stock jewelry. 

The piercing area is located near the entrance of

the tattooing room. There is approximately 45

square feet of floor space in this area, which

contained one piercing station. The piercing area

is blocked off from the main reception area by a

curtain. All other surfaces of the piercing room,

including the floor and procedure surfaces, were

constructed of smooth, non-absorbent and

washable materials. The room was in good

physical condition and was well lit. Additional light

was provided by an adjustable lamp. Smoking,

eating, and drinking were not allowed in the

piercing area. 

Individually-packaged, sterilized jewelry was

stored in a credenza located in the piercing area.

The sharps container was located behind the

piercing chair. A handsink was located along the

same wall as the jewelry credenza, while paper

towels were dispensed from a wall-mounted unit

located above the sink. Additional piercing

supplies and instruments were assembled in the

credenza. A stainless steel rolling cart with a tray

holder was used for positioning the forceps,

jewelry, gloves, needle, and gauze used during the

piercings. The tray was wiped down with a

disinfectant before and after each use. The

sonicator and autoclave were also located in the

piercing area along the same wall as the credenza.

NIOSH investigators were able to observe

numerous piercings during the site visit, including

piercings in the eyebrow, nostril, naval, tongue, and

a female genital piercing. The same procedures

were followed as described for Venus & Mars,

except that corks were used during the piercings.

Corks can be used to support the tissue and

forceps during the piercing, and they potentially

offer protection against needlesticks. In addition,

a receiving tube was used during the nostril

piercing; forceps cannot be used for this body
Page 8 Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830

area. Prior to the piercing, the receiving tube was

placed inside the client’s nostril. The needle (with

the attached jewelry) was inserted from the outer

part of the nose through the skin to the inside of

the nose where it was pushed through the

receiving tube and out through the nostril. Nasal

jewelry has no further attachments inside the

nose. Instead, the portion of the jewelry inside the

nose is bent by the piercer to conform to the inside

of the nostril. There was significantly more blood

associated with this piercing compared to all

others that were observed on the day of the site

visit. 

Contaminated instruments were soaked in

MadaCide,® which has an alcohol-based active

ingredient. A single pair of latex gloves is worn

during the handling of contaminated instruments.

Once the instruments have soaked in the

decontaminant, they are rinsed in the sink, and put

in the sonicator for 30 minutes. A lid is placed on

the sonicator while it is in use. The instruments

are removed from the sonicator and allowed to

dry. After drying, instruments are bagged and

placed in the autoclave. A comprehensive set of

MSDSs for the chemicals used in the studio was

available. 

The HVAC unit was not accessed during the

NIOSH site visit. The same unit serviced both the

piercing studio and the tattoo parlor. Since the

piercing area did not have floor to ceiling walls,

there was no consistent directional airflow. 

Both of the body piercers had been vaccinated

against HBV. While a bloodborne pathogen

training course was completed by both of them, an

exposure control program, as required by OSHA,

had not been prepared for the facility at the time

of the site visit. 

DISCUSSION AND

CONCLUSIONS

The primary hazard noted during the piercing

process was the potential for needlesticks to

occur. NIOSH investigators concluded that the

body piercers at both facilities were at risk for

exposure to bloodborne pathogens due to the

potential for needlestick injuries. While there are

numerous publications on the risk of infections in

those receiving body piercings, there is relatively

little information available on the occupational risks

posed to body piercers. For instance, the number

of body piercers in the United States has never

been documented. Additionally, there is no

published data available regarding the number of

body piercers who have received needlesticks, or

how many of that group may have contracted an

infection with a bloodborne pathogen. The fact

that most, if not all, piercers have received

numerous piercings themselves, makes

determining the number of occupational

transmissions in this group of employees even

more difficult, since an infection could have

occurred while they were receiving a piercing. 

The risk of infection after a needlestick depends

on the pathogen, the immune status of the piercer,

the severity of the needlestick injury, and the

availability of appropriate post-exposure

prophylaxis.33 Healthcare workers (HCWs) are

the only group of employees where the risk of

infection due to needlesticks has been evaluated.

Among HCWs , the average transmission rate for

HIV, when the source is HIV-positive, is 0.3%

per injury.

34 The rate of HBV transmission to

susceptible HCWs, when the source is infectious,

ranges from 6% to 30%;9 while the average

transmission of HCV is 1.8% (range of 0% to 7%)

per injury when the source is infectious.10 While

HBV poses a high risk for infection, the hepatitis

B vaccine has been shown to be 90% effective in

preventing HBV infection.34 There is no vaccine

available for HIV and HCV, therefore, the only

protection against these agents, is to prevent the

needlestick from ever occurring.

It is unknown whether these rates of transmission

are similar among body piercers. The severity of

the needlesticks may be different among the two

groups. In body piercing, a relatively large needle

(14-gauge) is used; in the healthcare industry,

smaller needles tend to be used for the most

common procedures. Additionally, the force

applied to the needle during piercing is much

different (greater) than the force that is applied

when collecting blood or injecting a drug into a
Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830 Page 9

patient. The risk of transmission will also be

greatly influenced by the population served. It is

unknown, however, whether individuals seeking

body piercings have a higher rate of bloodborne

infections than the persons receiving healthcare.

Another potential route of transmission of

bloodborne pathogens is from an infected piercer

to a customer. Within the healthcare industry,

there have been reports of 20 clusters of HBV

transmission in which a total of 300 patients were

infected with HBV during an invasive procedure

conducted by an HBV-infected HCW.

35

According to data collected by CDC, certain

invasive surgical and dental procedures have been

linked to HBV transmission, and have been

identified as exposure-prone. The question is

whether or not body piercing would fall into an

exposure-prone category. Since the procedures

identified by CDC include manipulations which are

much more invasive than body piercing (i.e., digital

palpation of a needle tip in a body cavity,

simultaneous presence of the HCW’s fingers and

a needle in a poorly visualized anatomical site), it

can be concluded that body piercing would not be

considered exposure-prone. Therefore, there

would be no reason to restrict the practice of

piercers infected with a bloodborne pathogen

provided that the piercer complies with universal

precautions and appropriate procedures for

disinfection/sterilization.36

The implementation of engineering controls is one

of the primary methods used to eliminate an

occupational hazard. In the healthcare industry,

this has led to a drastic reduction in the number of

needlesticks by the introduction of better designed

needles.37 These devices, however, may not be

usable in the piercing industry, since the needles

must entirely pass through a body part. According

to anecdotal information, needlesticks among

piercers typically happen when the unprotected

needle is exiting the piercing site. It is unclear

whether or not a cork provides protection against

a needlestick, since the cork may reportedly crack

as the needle is pushing through it. The use of a

cork during piercings appears to be solely

dependent on the preference and training of the

piercer. Since this aspect of piercing has not been

widely studied, it is impossible at this time to make

a recommendation regarding the use of corks. 

In both facilities, the sharps containers were

located behind the piercing chair. Because the

sharps container was not within reach of the

piercer, used needles were placed back on the

tray. Picking up contaminated needles from the

tray to discard them in the sharps container is an

unnecessary handling step thus posing an

unnecessary risk to the piercer. In addition, an

inconvenient location of the sharps container

forces the piercer to make unnecessary

movements while holding the needle. 

Additional infection risks were observed regarding

exposures from the potential cross-contamination

of instruments and surfaces. It is important to

stress that the typical body piercing procedure

should not be considered a sterile procedure.

Even the instruments which are autoclaved can

become contaminated once their packaging is

open, since the surrounding environment is not

sterile. At the time of the site visit at Venus and

Mars, genital piercings were being performed in

the same room where contaminated instruments

were being cleaned in a sonicator. This practice

has since been discontinued. At Body Piercing by

Bink, all piercings were done within six feet of the

sonicator. Although certain practices can reduce

the number of viable organisms potentially

aerosolized from a sonicator (see

Recommendations section), there is the potential

for the deposition of infectious droplets onto

surfaces, equipment, and personnel located in the

near vicinity. 

A great number of disinfectants can be used for

cleaning surfaces and instruments used during the

piercing procedures, including alcohol, chlorine and

chlorine compounds, formaldehyde,

glutaraldehyde, hydrogen peroxide, iodophors,

phenolics, and quaternary ammonium compounds.

Occupational skin diseases among cleaning

personnel have been associated with the use of

several disinfectants such as formaldehyde,

glutaraldehyde, chlorine, and phenol. 36,37 The use

of latex gloves while handling these chemicals,

which was done at both facilities, does not offer

adequate protection to any of these compounds. 
Page 10 Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830

RECOMMENDATIONS

The following recommendations apply to both

facilities, and are offered to reduce employees’

exposures to potentially infectious agents during

body piercing activities and chemicals during

disinfection procedures.

1. Develop and implement all components

included in the OSHA Bloodborne Pathogen

Standard.4 The major components of the standard

include: following universal precautions,

appropriate use of PPE, housekeeping, use of

sharps containers, offering hepatis B vaccinations

to all employees, post-exposure management

including an exposure evaluation and follow-up,

bloodborne pathogen training, and record keeping.

2. Procedures should be modified to allow the

piercer to dispose of the needle as soon as

possible after use without needing to put the

needle down and pick it up again.38 This may

require that the sharps disposal container be

mounted on wheels to accommodate its movement

to the piercing station. Some manufactures

provide trays or holders to stabilize the sharps

container during this type of application. Pushing

the needle into a cork located on the tray is not

considered a safe alternative to immediate disposal

of needles. 

3. All piercers should be required to be up-todate on relevant immunizations according to

recommendations by the CDC Advisory

Committee on Immunization Practices.9

Currently, vaccination against tuberculosis is not

recommended in the United States (tuberculosis

[TB] vaccination is recommended by the APP3).

All non-immune piercers should be offered the

hepatitis B vaccination prior to performing any

piercings. One to two months after completion of

the 3-dose hepatitis B vaccination series,

employees should be tested for antibody to

hepatitis B surface antigen (anti-HBs).35 

4. Consideration should be given to the use of

improved needle designs (such as solid needles

instead of the currently used hollow-bore needles)

as they become available. This type of needle is

currently not available, and would have to be

designed to work in combination with the insertion

of jewelry. This would potentially reduce the

amount of blood a piercer is exposed to if they

were stuck, since the needle would not be full of

blood. Prior to using any new device, training

must be performed.

5. Immediately following an exposure to blood or

body fluids, or to objects potentially contaminated

with blood or body fluids, the following should

occur: areas of skin exposed to needlesticks and

cuts should be washed with soap and water; after

splashes to the nose, mouth, or skin, the area

should be flushed with water; and after splashes to

the eyes, the eyes should be irrigated with clean

water, saline, or sterile irrigants. There is no

evidence that the use of antiseptics for wound

care or the squeezing of the wound site further

reduces the risk for disease transmission.39 The

application of caustic agents such as bleach is not

recommended. All employee needlesticks, cuts

from other sharp objects, or splashes onto the skin,

eyes, nose, or mouth should be immediately

reported and evaluated by an appropriate

healthcare professional.

6. If permissible by law, an attempt should be

made to determine the infection status of the

customer if a needlestick or exposure to blood or

other body fluids occur. If their infectious status

is unknown, contact information should be

acquired including the customers name, address,

and telephone number. This information could be

passed on to the healthcare professional or the

health department providing follow-up.

 

7. Since environmental contamination is a

potential method of disease transmission,

appropriate cleaning and disinfecting of work

surfaces is necessary. “Appropriate

disinfectants” include a diluted bleach solution and

“EPA-registered tuberculocides” (list B). A list of

EPA-registered products are available from the

National Antimicrobial Information Network at

800-447-6349 or its website at

http://ace.orst.edu/info/nain/lists.htm. The

recommended manufacturer’s contact time should

be closely followed. At no time should a surface
Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830 Page 11

be prepared for another piercing prior to

appropriate decontamination contact time.

8. Appropriate gloves should be worn and

changed as needed. If latex gloves are used,

reduced protein, powder-free gloves should be

worn to protect workers from developing latex

allergy.

40 These gloves reduce exposures to latex

protein, although some symptoms may still occur.

“Hypoallergenic” latex gloves do not necessarily

reduce the risk of latex allergy; they are designed

to reduce reactions to chemical additives in the

latex which can cause allergic contact dermatitis.

Latex gloves do not, however, provide adequate

protection against disinfec tion agents, since the

chemicals may cause deterioration of the glove

material. Consideration should be given to using

vinyl or nitrile rubber gloves instead of latex.

Nitrile, for example, could safely be used with

most disinfectants including ethyl alcohol,

hydrogen peroxide, glutaraldehyde, and sodium

hypochlorite.41 If this were done, only one type of

glove would need to be purchased for both

piercing and decontamination activities. 

9. A spill response plan should be developed and

implemented. The response plan should be

included as an employee training requirement. All

spills of blood and blood-contaminated fluids

should be promptly cleaned using an EPAapproved germicide or a 1:100 solution of

household bleach while wearing appropriate

gloves. If visible materials are present, they

should be removed first with disposable towels. If

there are sharps present, they should be picked up

using forceps or other means which do not require

direct contact with the sharp or needle. The area

should then be decontaminated with the

appropriate germicide, and hands should be

washed immediately following the removal of

gloves. A biohazard waste container should be

available for the removal of contaminated items

from the site of the spill.

10. Procedures or equipment, such as the

sonicator, which have a high potential for

generating droplets should be operated within an

enclosed environment which passes its exhaust air

through a high-efficiency particulate air (HEPA)

filter.

42 Additional ways to minimize the

aerosolization of infectious droplets includes

operating the sonicator only when a manufacturerprovided lid is in place. The lid should be left on

for several minutes after the sonicator has finished

its cycle in order for the aerosols to settle.

Soaking the instruments for the recommended

contact time prior to the operation of the sonicator

may also reduce the number of viable organisms

in solution. While aerosolized bloodborne

pathogens do not typically pose an inhalation

hazard, cross-contamination could be an issue

when aerosols settle out on surfaces in the

piercing areas.

11. Piercings should not be performed in the same

room where contaminated instruments are cleaned

by sonication. In addition, sterilized materials

should not be kept in the same room where

contaminated materials are cleaned. 

12. The use of recirculating, portable HEPA

filtration units may be used in any of the piercing

areas, including the piercing room, the cleaning

room, or the sterilization room, where additional air

filtration could aid in lowering the airborne

bacterial and fungal loads. The placement and its

airflow capacity of the unit determines its ability to

effectively recirculate and filter the room air. 

13. Since the body piercing procedure is similar to

the activities which are conducted in a hospital

patient room, ventilation rates should comply with

those recommended by the American Society for

Heating, Refrigerating, and Air-Conditioning

Engineers (ASHRAE). In Standard 62-1999,

“Ventilation for Acceptable Indoor Air Quality,”

ASHRAE recommends an effective outside air

exchange rate of 25 cubic feet per minute (cfm)

per person for patient rooms in hospitals.43

Additionally, the piercing room should be kept

under positive pressure to prevent the migration of

air from an adjacent “dirtier” environment into the

piercing room. Rooms with floor to ceiling solid

walls are necessary to achieve controlled

directional air flow and air exchange rates. 

14. The current filtration is not adequate to

prevent dust accumulation in the ventilation
Page 12 Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830

1. Samantha S, Tweeten M, and Rickman LS

[1998]. Infectious complications of body piercing.

Clin. Infect. Dis. 26:735-40.

2. Armstrong ML, Ekmark E, and Brooks B

[1995]. Body piercing: promoting informed

decision making. J. of School of Nurs 11(2):20-

25.

3. APP [1998]. Ethics and Legalities. In: Grey

M, ed. Procedural Standards. Chamblee, GA: pp

47-55. 

4. CFR [1991]. 29 CFR 1910.1030 Bloodborne

pathogens standard. Code of Federal Regulations.

Washington, D.C.: U.S. Government Printing

Office, Office of the Federal Register.

5. Lymer UB, Schütz AA, Isaksson B [1997].

A descriptive study of blood exposure incidents

among healthcare workers in a University hospital

in Sweden. J Hosp Inf 35:223-35.

6. Polish LB, Tong MJ, Co RL, Coleman PJ,

Alter MJ [1993]. Risk factors for Hepatitis C

virus infection among health care personnel in a

community hospital. Am J Inf Cont 21(4):196-

200.

7. Caird A, Wann C [1995]. Are Irish general

practitioners minimizing infection risk from sharps?

 Irish Med Journal 88(4):133-4.

8. Kopfer AM, McGovern PM [1993].

Transmission of HIV via a needlestick injury:

practice recommendations and research

implications. AAOHN Journal 41(8):374-81.

9. CDC [1997]. Immunization of health-care

workers: recommendations of the Advisory

Committee on Immunization Practices (ACIP) and

the Hospital Infection Control Practices Advisory

Committee (HICPAC). MMWR 46(RR-18):1-42.

10. CDC [1998]. Recommendations for

prevention and control of hepatitis C virus (HCV)

infection and HCV-related chronic disease.

MMWR 47(RR-19):1-39.

systems. Filters with an ASHRAE dust spot

efficiency rating of 35 to 60 percent should be

used instead of the current filters, which are less

than 10 percent efficient. The most efficient

filters whose pressure drop the system can handle

should be used. A mechanical firm should be

consulted to determine the maximum filter

efficiency. At Venus & Mars, the filter should be

seated correctly in the filter frame of the HVAC

system to remove the gap which was present

during the site visit. 

15. Chemical indicator strips should be used on

every load which is autoclaved to ensure that the

appropriate temperature is reached during the

cycle. 

16. Ideally, wrist-action or foot pedal-operated

sinks should be used in the piercing areas to

reduce the potential for cross-contamination of

hands. Towel dispensers should not be located

over work areas where dripping water from wet

hands could contaminate clean instruments. 

17. Foot traffic in the piercing areas should be

kept to a minimum to reduce the amount of

contaminants tracked into the room. Piercing

areas should never be carpeted, since it cannot be

appropriately cleaned. Customers’ personal

belongings (i.e., purses, bags, etc.) should remain

outside of the piercing room. 

18. Markers, which are re-used between

customers for the marking of piercing sites, should

be discarded or cleaned between uses with an

appropriate disinfectant. 

19. Body piercing should be discouraged when

piercers are fatigued, since this could lead to

accidental needlesticks. 

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Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830 Page 15

Figure 3. Insertion of jewelry.

Figure 1. Tray Preparation

Figure 2. Area held with forceps.
Page 16 Health Hazard Evaluation Report No. 99-0265-2830 and 2000-0013-2830

Figure 5. Insertion of taper.

Figure 4. Applying pressure.