In the second of our four-part blog series on special procedures and infection control, Tattoo artist Dee Matthews takes us on a journey from WW2 to modern best practices.

When I was first asked about tattoo hygiene and safe practices I thought, “Easy. Our craft is all good!” However, an explosion of new tattoo studios, new equipment, YouTube apprenticeships, older tattooists not keeping up and the ready availability of tattoo equipment on the internet, have produced a divergent and incoherent set of ‘best practice’.

Each local authority has its guidelines, a love child of food hygiene practices and guidelines developed by BTAF 45 years ago, with inspections by EHOs that are trained not in tattooing, but food hygiene. 

Before BTAF, tattooing hygiene was a mixed bag of good intentions and borrowed ideas. Handmade needles were reused. Some sterilised by boiling, meths burner or chemicals, but not always. Grips and tips were treated the same. Sailor Jerry from Honolulu was, during WW2, one of the first tattooists to get hold of a medical autoclave for his needles. His sailor clients were causing infection havoc, no one fancied becoming blood brothers with the US Navy. 

Since 1975 most tattooists use a new sterile needle for each client - they should! Today’s hot topic is water and ink. Now we use distilled water in our wash cups and wash bottles, but clients go home and wash their new tattoos in tap water. Make of that what you will!  The most frequent infections that occur in modern licensed tattooing are not due to tattooing practices, but the result of poor care by the client after they get home. You’d be surprised and horrified at the wild and wacky things clients get up to with their new tattoos! 

Mistakes are made in professional studios, but new standard procedures will help to minimise them. However untrained tattooing in unsanitary conditions almost guarantees an infection.

So what is best practice for hygiene?

  • Lots of cleaning, using modern cleaning agents appropriate to the situation. A studio can never be sterile, but you can keep the bugs down.
  • Know the difference between cleaning, disinfection, and sterilisation, which is appropriate to each situation.
  • Barrier protection, this doesn’t eliminate risk but makes equipment cleaning easier.
  • Choose easy to clean modern tattoo equipment.
  • Buy good quality pigment tattoo ink, we have great ink making companies here in the UK.
  • Wash your hands AND forearms, don’t cross contaminate. Put your hair up and wear disposable gloves and aprons PPE.

These are common sense practices, but they don’t acknowledge the fact that modern tattooing equipment has changed and how we ‘clean and sterilise’ should move with the times too. Controversially, tattooists might want to consider giving up autoclaves, which are only as good as the operator and don’t deal with prions. Instead, for grips, we should consider new cold sterilisation fluids and wipes. The NHS uses these for class 2 medical devices. Combined with UV cabinets for equipment storage. For any equipment that runs along open skin we should use EO gas sterilised one use tips, cartridges and needles.  

However, modern doesn’t always mean better. Some modern inks have caused issues. Maybe here, we should return to tried and tested powder pigments that have been used safely for hundreds of years. Leaving chemical colours and artificial dyes and animal testing to the cosmetic companies!

Unfortunately, setting these standard practices is not enough. While some clients will be delighted with better standards, the rest want a cheap deal and don’t care who does their tattoos (see DIY Amazon tattoo kits for details). Making it illegal to own any tattooing equipment without a license, introducing standardised apprenticeships and regular refresher training is the only way to guarantee standards. Without the enforcement of licenses, studios who invest in high standards of safety will be priced out by those who disregard them.

So will tattooing survive regulation? It will with more cleaning, more disposables, sensible and judicious use of plastic barriers, going back to proven high quality pigment ink, better understanding what needs to be sterile and hopefully more support from the government for those who do good practice. Tattooing will always be that expression of our inner artistic self with a little danger and edge, just a bit safer and with a bit more common sense.