In regards to the hands of employees performing tattooing, cosmetic tattooing and body piercing- This constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not delineated within the original correspondence.

Paragraph (d)(2)(v) of the standard required employers to ensure employees wash their hands immediately or as soon as feasible after removal of gloves. There is no requirement in OSHA's bloodborne pathogens standard for employees to wash before donning gloves. However, as you indicate, washing hands will aid in preventing infection of a patient or customer in the event a glove is torn during invasive procedures. Nevertheless, the Occupational Safety and Heath Act of 1970 deals only with the safety and health of employees, not customers. However, the Act does not prohibit you from also instructing employees about precautions to protect customers.

In regards to the use of petroleum products in conjunction with latex gloves, as it applies to the practice of tattooing- This constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not delineated within the original correspondence.

The standard at 29 CFR 1910.1030 (d)(3) requires that "appropriate personal protective equipment" be used where there is "occupational exposure," i.e., reasonably anticipated contact with blood or other potentially infectious materials (OPIM). Personal protective equipment, like gloves, is "appropriate" only if it does not permit blood or OPIM to pass through to or reach the employee's clothing or skin, eyes, mouth or other mucous membranes under normal conditions of use and for the duration of the time when the protective equipment will be used. During the rule making process, it was brought to OSHA's attention that significant deterioration of latex gloves was noted when exposed to petroleum-based lubricants. (See 56 Federal Register 6419, December 6, 1991.) The OSHA instruction for the enforcement of the standard (CPL 2-2.69) also noted that petroleum-based hand creams can adversely affect glove integrity. Based on the text of the standard and this information, it is OSHA's position that if latex gloves are used, employees must not apply petroleum-based products to their own or others skin, if contact with blood or other potentially infectious materials (OPIM) could be reasonably anticipated.

To assure adequate protection for their employees, employers must choose either non-petroleum=based lubricants which will not compromise the integrity of the gloves, or gloves which will not be affected by the petroleum-based products being used. If employers wish to continue the use of petroleum-based products, then nitrile or synthetic gloves would be a much safer choice. Also, employers choosing to change their lubricant to one that is non-petroleum-based will need to consult with the manufacturer to ensure its product is compatible with the gloves being used.

Scenario: Instead of disposing of the single-use sharp device into a regulated sharps container immediately upon completion of the tattoo procedure, it is not uncommon for many tattoo artists to re-sterilize the entire device in order to break off the needle configuration so that they may re-use the bar itself. This procedure requires the "breaking, bending, or shearing" of a sharp, which is expressly prohibited by OSHA. The justification for this practice is generally related to lower cost, when the cost of a single needle bar averages between $.01 and $.30 cents. It is our opinion that the re-processing of the used needle configuration denotes reusability, however, terminal sterilization is not ensured.

Question: How does the Bloodborne Pathogens Standard apply to this practice?

Response: The scope and application of the Bloodborne Pathogens Standard is dependent on reasonably anticipated occupational exposure to blood and other potentially infectious materials (OPIM). Since tattooing and piercing generate blood, workers in this industry would fall under the scope of the standard.

Proper implementation of a bloodborne pathogens exposure control plan, infection control procedures, and standard precautions protect not only workers from potential exposure, but clients, as well. The standard requires the use of engineering and work practice controls to eliminate or minimize employee exposure to blood and OPIM. Where occupational exposure remains after the institution of these controls, personal protective equipment must also be used.

Understandably, engineering controls for tattoo needles may not be commercially available., therefore the use of proper and safe work practices carries a higher level of importance. Safe work practices would include the immediate disposal of contaminated needles into an appropriate regulated waste container. Bending, recapping, breaking, and/or shearing contaminated needles required additional manual manipulation, which poses a greater risk of injury. If safer needle devices do become available, an employer must evaluate, select, and implement appropriate devices, based on employee feedback.

Therefore, it is OSHA's position that in the tattooing and piercing industry, proper work practices must be followed, including the immediate disposal and proper containerization of single-use contaminated needles. An employer must also ensure the use of appropriate personal protective equipment (e.g., gloves, gowns) depending on the types of exposures that may be anticipated (e.g., splashes, splatters, drips). Again, employees with occupational exposure to blood, identified by an employer's exposure determination (29 CFR 1910.1030 (c)(2)) must be afforded full coverage of the standard, including, but not limited to: the hepatitis B virus vaccination, post-exposure evaluation and follow-up, and appropriate housekeeping and decontamination procedures.

Scenario: When performing a body piercing, the needle goes through the tissue at the piercing site and directly into the end of a sterile cork. The corks is then removed to allow for removal of the piercing forceps and insertion of the body jewelry. The cork is replaced on the tip of the needle after removal from the tissue during the jewelry transfer.

Question: Would removal and replacement of the cork onto the contaminated needle be considered recapping under paragraph (d)(2)(vii) of the standard:

Response: The Bloodborne Pathogens Standard requires the use of engineering and work practice controls [29 CFR 1910.1030 (d)(2)(i)]. When an employee has exposure to a contaminated sharp and engineering controls (e.g., sharps with engineered safety features) are not available, hazard control is primarily gained through the implementation of work practices. In order to best protect an employee from an injury with a contaminated needle, minimal manipulation of the needle serves as means of control. Also, paragraph 29 CFR 1910.1030 (d)(4)(iii)(A)(1) requires the disposal of contaminated sharps in proper sharps containers immediately or as soon as feasible.

Furthermore, 29 CFR 1910.1030 (d)(2)(vii) states,

(A) Contaminated needles and other contaminated sharps shall not be bent, recapped or removed unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical or dental procedure.

(B) Such bending, recapping or needle removal must be accomplished through the use of a mechanical device of a one-handed technique.

Therefore, corking a contaminated needle would be allowed only if no alternative was feasible. As you explain, the cork itself is put in place in order to protect the employee performing the piercing from being stuck with the contaminated end of the piercing needle as the jewelry is pulled through the body. In this case, there may be no alternative and corking the contaminated needle may be necessary. In an OSHA inspection the compliance officer would review the exposure control plan for written justification for the recapping supported by reliable evidence. Any permissible recapping must be performed by some method other than the traditional two-handed procedure (e.g., by means of a mechanical device or forceps).

Scenario: A "freehand" piercing technique is one where the practitioner uses his or her hands as the piercing instrument instead of piercing forceps. In this procedure, the practitioner's fingers are placed in close proximity to the cutting edge of the needle as it exits the piercing site.

Question: Does OSHA view the practice of "freehand" piercing without the use of forceps and a receiving tool (cork or tube) as safe for the practitioner performing the procedure?

Response: The practice of "freehand" piercing without the use of forceps or other available engineering and work practice controls to prevent contact with the used end of the piercing needle violates 29 CFR 1910.1030(d)(2)(i), an important provision of the bloodborne pathogens standard which requires that engineering and work practice controls shall be used to eliminate or minimize employee exposure.

In a previously published letter of interpretation, OSHA wrote:

"When an employee has exposure to a contaminated sharp and engineering controls (e.g., sharps with engineered safety features) are not available, hazard control is primarily gained through the implementation of work practices. In order to best protect an employee from an injury with a contaminated needle, minimal manipulation of the needle serves as men's of control."

OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. These letters constitute OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information.