A comprehensive training manual for tattoo artists including hygiene & studio operation
• Who We Are, American Tattooing Institute
Body Art Specialist’s Code of Ethics
Chapter 1 Skin Anatomy and Physiology
Chapter 2 Procedures for Studios and Artists
• Consumer instructions
• Dyes or pigments
• Sterilization of needles
• Aftercare of tattoo
• Facilities and equipment
• Disposal of waste
Chapter 3 Bloodborne Pathogens – OSHA Summary
• Exposure plan
• Methods of compliance
• Hepatitis B vaccination
• Hazard communication
• Information and training
• Record Keeping
Chapter 4 OSHA Standards
• 29 CFR – 1910.1030
Chapter 5 Food and Drug Administration Fact Sheet
• Tattoos and permanent makeup
• Risks involved
• Common problems
• Removal techniques
• Temporary tattoos
• Reporting adverse reactions
Who We Are
Staff at the American Tattooing Institute (ATI) developed this program as an important educational resource for the tattoo professional. Regulations vary from state to state as to the qualifications of a state compliant tattoo artist. Because of this, we strongly suggest you contact your local regulatory office for a written list of licensing requirements in your state. A list of Health departments and their summarized regulations can be found in chapter 6 of this manual.
We realize that it is often difficult for busy tattoo artists to attend educational seminars in person. With our program, you’ll find tattooing education more affordable and accessible. Our training program is available online nationwide 24 hour a day, 7 days a week.
Many tattooing facilities operate with a minimum number of personnel, not to mention limited budgets. The American Tattooing Institute provides a cost effective solution to training by allowing owners and staff to complete crucial education in their spare time.
We have carefully selected the educational material available through this program. We are confident that the material we offer will help you develop a tattooing facility that is professional as well as profitable.
American Tattooing Institute is a division of ProEd Network. ProEd Network serves as an umbrella for continuing education, training programs, and educational services for other industries. Since 1997, staff at ATI has provided healthcare and service professionals with valuable, affordable and convenient education options.
Body Art Specialist’s Code of Ethics
• The body art specialist conducts himself or herself in a professional manner, responds to customer needs and supports colleagues and associates in providing quality customer service while following healthful standards.
• The body art specialist acts to advance the principal objective of the tattooing industry to provide services to clients with full respect for their overall well-being.
• The body art specialist practices healthful techniques founded upon theoretical knowledge and concepts, uses equipment and accessories consistent with the purpose for which they were designed and employs procedures and techniques appropriately while adhering to local, state, and federal guidelines.
• The body art specialist assesses situations; exercises care, discretion and judgment; assumes responsibility for professional decisions; and acts in the best interest of the client.
• The body art specialist uses equipment and accessories, employs techniques and procedures, and performs services in accordance with an accepted standard of practice while demonstrating high levels of expertise.
• The body art specialist continually strives to improve knowledge and skills by participating in continuing education and professional activities, sharing knowledge with colleagues and investigating new aspects of professional practice.
Skin Anatomy and Physiology
Although the skin is less complicated than most other organs, it is still one of the most architecturally advanced of all. It covers the entire body and accounts for about 7% of our total body weight, making it the largest organ. It has been estimated that every square centimeter of skin contains 70 cm of blood vessels, 55 cm of nerves, 100 sweat glands, 15 oil glands, 230 sensory receptors, and about 500,000 cells that are constantly dying and being replaced.
The skin, which varies in thickness from 1.5 to 4 mm or more in different regions of the body, has two distinct layers. The outer layer is the epidermis, a thick membranous tissue. Located below the epidermis is the dermis, a fibrous connective tissue. And, just below the dermis lies a fatty layer called the hypodermis. Although the hypodermis is usually not thought of as part of the skin or integumentary system, it shares some of the skins functions and will be discussed in this chapter.
The skin performs many functions, most but not all of are protective. It cushions and insulates the deeper body organs and protects the entire body from physical damage like bumps and cuts. The skin also offers helpful protection form harmful chemicals, thermal damage (heat and cold), and invading bacteria. The epidermis is waterproof, preventing unnecessary loss of water across the body surface. The skins rich abundance of blood flow and sweat glands regulate the loss of heat from the body, helping to control body temperature. The skin also acts as a mini-excretory system: Urea, salts, and water are lost as sweat. Skin also reduces ultraviolet (UV) rays from the sun, and its epidermal cells use these UV rays to synthesize vitamin D. Finally, the skin contains sensory organs called sensory receptors that are associated with nerve endings. By sensing touch, pressure, temperature, and pain, these receptors keep us aware of what is happening at the body surface. As this chapter describes the anatomy of the skin, we will explore its function in greater detail.
Just below the skin is the fatty layer of the hypodermis (“below the skin” in Greek). This layer is also called the subcutaneous layer (“below the skin” in Latin). It consists of both areolar and adipose connective tissue, although the adipose tissue normally dominates. Besides storing fat, the hypodermis anchors the skin to the underlying structures (mostly to muscles) and allows the skin to slide relatively freely over those structures. Sliding skin protects us by ensuring most blows just glance off our bodies. The hypodermis is also and insulator: Since fat is a poor conductor of heat, it helps prevent heat loss from the body. The hypodermis thickens distinctly when one
gains weight, but this thickening occurs in different body areas in the two sexes. In females, subcutaneous fat accumulates first in the thighs and breasts, whereas in males it first accumulates in the front abdominal area.
The dermis, the second major layer of the skin, is a strong, flexible connective tissue. The cells in the dermis are identical to those of any connective tissue in the body. The dermis binds the body together like a body stocking. Tattooing involves multiple punctures of the skin to instill pigment into the dermis.
The dermis is richly supplied with nerve fibers and blood vessels. The blood vessels of the dermis are so extensive that it can hold 5% of all blood in the body. When organs, such as exercising muscles, need more blood, the nervous system constricts the blood vessel located in the dermis. This shunts more blood into the general circulation, making it available to the muscles and other organs. On the other hand, the dermal blood vessels swell with warm blood on hot days, allowing heat to radiate from the body creating a cooling effect.
The collagen fibers of the dermis give skin its strength and resilience. Thus, many
jabs and scrapes usually do not penetrate the tough dermis. Furthermore, elastic fibers in
the dermis provides the skin with stretch and recoil properties.
The deeper part of the dermis is responsible for markings on our skin surface called flexure lines. These lines are easily observed as the deep skin creases on the palms. Flexure lines result from a continual folding of the skin, often over joints, where the dermis attaches tightly to underlying structures. Flexure lines are also visible on the wrists, soles of the feet, fingers, and toes.
The epidermis contains four distinct types of cells: keratinocytes, melanocytes, Merkel cells, and Langerhans cells. Keratinocytes are by far the most abundant cells of these, so we will discuss them first. We will discuss the other types of cells later as we examine the various layers of the epidermis.
The chief role of the keratinocytes is to produce keratin, a tough fibrous protein that gives the epidermis its protective properties. Tightly connected to one another by a large number of desmosomes, the keratinocytes arise in the deepest part of the epidermis from cells that undergo almost continuous mitosis, or cell division. As these cells are pushed toward the skin surface by the production of new cells beneath them, they manufacture the keratin that eventually fills their cytoplasm. The cytoplasm makes up the bulk of the cell and is located between the outer layer of the cell and the nucleus.
By the time the keratinocyte reaches the skin surface, they are dead, flat sacs completely filled with keratin. Millions of these dead cells rub off every day, giving us an entirely new epidermis every 30 to 45 days—the average time from “birth” of a keratinocyte to its final wearing away. In the normal healthy epidermis, the production of new cells balances the loss at the surface of the skin. Where the skin experiences friction, both cell production and keratin formation are accelerated.
Layers of the Epidermis
In thick skin, which covers the palms of the hand and soles of the feet, the thickened epidermis consists of five layers, or strata. In thin skin, which covers the rest of the body, only four strata are present.
1. Stratum Basale (Basal Layer)
The stratum basale, the deepest layer of the epidermis, is firmly attached to the dermis along a wavy borderline. Also called the germinating layer, this stratum consists of a single row of cells representing the youngest keratinocytes. These cells divide rapidly. Occasional Merkel cells are seen among the keratinocytes. Each semi-circular Merkel cell is closely associated with a disc-like sensory nerve ending and may serve as a receptor for touch.
Between 10 percent and 25 percent of the cells in the stratum basale are melanocytes (“melanin cells”). These make the dark skin pigment melanin. The spider-shaped melanocytes have many branching processes that reach and touch all of the keratinocytes in the basal layer. Melanin is made in membrane-lined granules and then transferred through the cell processes to nearby keratinocytes. Consequently, the basale keratinocytes contain more melanin than do the melanocytes themselves. The melanin granules accumulate on the surface of each keratinocyte, forming a shield of pigment over the nucleus. In Caucasians, the melanin disappears a short distance above the basal layer, where it is digested by lysosomes in the keratinocytes. In black skinned individuals, no such digestion occurs, so melanin occupies keratinocytes throughout the epidermis. Although black skinned individuals have darker melanin and more pigment in each melanocyte, they do not have more melanocytes in their skin. In all but the darkest people, melanin builds up in response to ultraviolet rays, the response that we know as suntanning.
2. Stratum Spinosum (Spiny Layer)
The stratum spinosum is several cell layers thick. Mitosis, or cell production through division, occurs here, but less frequently than in the basal layer. Under microscopic imaging, the keratinocytes in this layer have many spine-like extensions.
Scattered among the keratinocytes of the stratum spinosum are Langerhans cells. These star-shaped cells are particulate ingesting microphages that help activate the immune system.
3. Stratum Granulosum (Granular Layer)
The thin stratum granulosum consists of three to five layers of flattened kearatinocytes. These keratinocytes contribute to the formation of keratin in the upper layers of the epidermis. This keratin contains a waterproofing material that is secreted into the areas between the cells and is the major factor for slowing water loss from the epidermis. Further more, the external wall of the cells thicken, so that they become more resistant to destruction. You might say that the keratinocytes are “toughening up” to make the outer layers of the epidermis the strongest.
4. Stratum Lucida (Clear Layer)
The stratum lucid only occurs in thick skin, not thin skin. This layer consists of a few rows of flat dead keratinocytes. Electron microscopes show that its cells are identical to cells at the stratum corneum, the next layer.
5. Stratum Corneum (Horny Layer)
The most external part of the epidermis, the stratum corneum, is many cells thick. This layer is far thicker in thick skin than in thin skin. Its dead cells are flat sacs completely filled with keratin, because their nuclei and organelles were digested away by the lysosome enzymes upon cell death. Both the keratin and the thickened plasma membranes of the cells in the stratum corneum protect the skin against abrasion and penetration. It is amazing that a dead layer of cells can still perform such important functions.
The cells of the stratum corneum are referred to as horny cells. These cells are the dandruff shed from the scalp and the flakes that come off dry skin. The average person sheds about 40 pounds of these flakes in a lifetime. The common saying “Beauty is only skin deep” is especially interesting in the light of the fact that nearly everything we see when we look at someone is dead!
Three pigments contribute to skin color: melanin, carotene, and hemoglobin. Carotene is a yellow to orange pigment derived from certain plant products, such as carrots. It tends to accumulate in the stratum corneum of the epidermis and in fat tissue of the hypodermis. Color derived from carotene is most obvious in the palms and soles, where the stratum corneum is thickest.
The pink tone of Caucasian skin reflects the red color of oxygenated hemoglobin in the capillaries of the dermis. Since Caucasian skin contains little melanin, the epidermis is nearly transparent in untanned individuals and allows blood’s color to shoe\w through more predominantly.
Melanin, the most prominent pigment and is made from an amino acid called tyrosine. Melanin ranges in color from yellow to reddish to brown to black. Its production depends on an enzyme in melanocytes called tyrosinase. Freckles and pigmented moles are localized accumulations of melanin.
Procedures for Studios and Artists
Tattooing facility owners and operators have a responsibility to operate their facility under the structure of well-developed, up to date and principled procedures. It is important to note that if your state has specific regulations regarding the operation of a tattoo business, these regulations should be included in your procedural policies. The following list of recommended procedures, taken from several state requirements, is considered to be a general and responsible list of operating procedures. You should consult your states Health Department to see if a required guideline exists for you.
(a) Before working on each patron, the fingernails and hands of the tattoo artist shall be thoroughly washed and scrubbed with warm running water, antibacterial soap, and individual hand brush that is clean and in good repair, then air blown or dried by single use towel prior to beginning work on each person or when interrupted in the process.
(b) Disposable, latex examination gloves shall be worn during the tattooing process. Gloves shall be changed and properly disposed of each time there is an interruption in the application of the tattoo, the gloves become torn or punctured, or whenever their ability to function as a barrier is compromised.
(c) Each tattoo artist shall wear a clean outer garment, apron, smock, T-shirt, etc.
(d) Tattoo artists who are experiencing symptoms of diarrhea, vomiting, fever, rash, productive cough, jaundice or draining (or open) skin infections, boils, impetigo or scabies shall refrain from tattooing activities.
(e) Only sterilized or single use, disposable razors shall be used to shave the area to be tattooed.
(f) Before placing the design on the patron’s skin, the tattoo artist shall treat the skin area with an antibacterial solution.
(g) If an acetate stencil is used by a tattoo artist for transferring the design to the skin, it shall be thoroughly cleaned and rinsed in a germicidal solution for at least twenty (20) minutes and then dried with sterile gauze or dried in the air on a sanitized surface after each use.
(h) If a paper stencil is used by a tattoo artist for transferring the design to the skin, it shall be single use and disposable.
(i) If the design is drawn directly onto the skin, it shall be applied with a single use article only.
(j) A registered tattoo artist or certified tattoo business may set up at fairs, festivals, expositions or any location other than a tattoo studio with the written approval of the local health department for a period not to exceed fourteen (14) days.
(k) Cabinets for the storage of instruments, dyes, pigments, single use articles, carbon, and stencils shall be provided for each tattoo artist and shall be maintained in a sanitary manner, which protects them from contamination.
(l) Bulk single use articles shall be commercially packaged and handled to protect them from contamination. Storage of single use articles shall not be in a toilet room or vestibule of toilet rooms nor under nonpotable water lines or exposed sewer lines.
(m) The surface of all work tables and chairs or benches shall be constructed of material which is smooth, light- colored, nonabsorbent, corrosive-resistant, and easily sanitized.
(n) Work tables and chairs or benches shall be sanitized with a germicidal solution after each tattoo application.
(o) Existing tattoo studios on the effective date of this administrative regulation shall be exempt from the required color of the work table.
(p) All materials applied to the human skin shall be from single use articles or transferred from bulk containers to single use containers and shall be disposed of after each use.
(q) No pets, except working dogs, guide dogs or security dogs from a certified trainer, shall be permitted in the studio.
(a) For each patron, proper records of tattoos administered shall be maintained by the holder of a studio certificate.
(b) Records of each patron shall be prepared prior to any procedure being performed and shall include the patron’s name and signature, address and age, the date tattooed, the design of the tattoo, its location on the patron’s body, and the name of the tattoo artist who performed the work.
(c) Records shall be entered in ink or indelible pencil shall be available at a reasonable time for examination by the local health department in the district or county where the tattoo is performed. The signature of the patron shall be on the record.
(d) Before tattoo administration, there shall be a discussion conducted with the patron on the risks involved in the tattoo requested, and its possible complications, which shall be entered in the record.
(e) Records required by this administrative regulation shall be kept on file for five (5) years by the holder of the studio certification for the studio in which the tattoo was performed.
(a) Written consent for tattooing of minors shall be obtained from one (1) parent or guardian.
(b) Records of the written consents shall be kept on file for five (5) years by the holder of the studio certification for the tattoo studio in which the tattoo was performed.
(c) The person receiving the tattoo shall attest to the fact that they are not intoxicated or under the influence of drugs or alcohol.
(4) Consumer Instructions
(a) Printed instructions on the care of skin shall be given to each patron or customer after tattooing as a precaution to prevent infection.
(b) A copy of instructions shall be posted in a conspicuous place, clearly visible to the person being tattooed.
(5) Dyes or Pigments
(a) In preparing dyes or pigments to be used by a tattoo artist, only nontoxic sterile materials shall be used. Single-use or individual portions of dyes or pigments in clean, sterilized individual containers or single-use containers shall be used for each patron.
(b) After tattooing, the remaining unused dye or pigment in the single-use or individual containers shall be discarded along with the container.
(c) All dyes or pigments used in tattooing shall be from professional suppliers specifically providing dyes or pigments for the tattooing of human skin.
(6) Sterilization of Needles
(a) A set of individual, sterilized needles shall be used by a tattoo artist for each patron.
(b) To guard against a potential temptation to reuse single-service needles because of exhaustion of existing supplies, not less than twenty-four (24) sets per studio of sterilized needles and tubes shall be on hand for the entire day or night operation. Sterilized instruments shall be resterilized at intervals of no more than six (6) months from the date of the last sterilization.
(c) Used, nondisposable instruments shall be kept in a separate, puncture resistant container until brush scrubbed in hot water and soap, and then sterilized by autoclaving.
(d) If used instruments are ultrasoniced prior to being placed in the used instrument container, they shall be ultrasoniced, and then rinsed under running hot water prior to being placed in the used instrument container.
(e) The ultrasonic unit shall be sanitized with a germicidal solution daily.
(f) If used instruments are not ultrasoniced prior to being placed in the used instrument container, they shall be kept in a germicidal or soap solution until brush scrubbed in hot water and soap, and then sterilized by autoclaving.
(g) Nondisposable instruments including the needle tubes shall be sterilized and shall be handled as to prevent contamination. Instruments to be sterilized shall be sealed in bags specifically made for the purpose of autoclave sterilization, and include the date of sterilization. If nontransparent sterilization bags are utilized, the bag shall also list the contents.
(h) Autoclave sterilization bags, with a color code indicator which changes color upon proper steam sterilization shall be utilized during the autoclave sterilization process.
(i) Instruments shall be placed in the autoclave in such a manner as to allow live steam to circulate around them.
(j) No rusty, defective or faulty instruments shall be kept in the studio.
(7) Aftercare of Tattoo
(a) The completed tattoo shall be washed with a single-use towel saturated with an antibacterial solution.
(b) After drying, antibacterial solution shall be applied from a collapsible metal or plastic tube and the entire area covered with a single-use covering, which may, in turn, be covered with gauze and fastened to the site with adhesive tape.
Facilities and Equipment
(1) General physical environment.
(a) Tattoo studios shall have at least fifty (50) foot-candles of light measured at the height of the work table.
(b) Tattoo studios shall have adequate ventilation.
(c) Walls and ceilings shall be smooth and easily cleaned. Walls and ceilings shall be painted a light color.
(d) The floor of the tattoo work room shall be impervious material. The floor shall be swept and wet mopped daily. Floors, walls or ceilings shall not be swept or cleaned while tattooing is in operation.
(e) Convenient, clean, and sanitary toilet and hand washing facilities shall be made accessible to customers.
(f) The building and equipment shall be maintained in a state of good repair at all times. The studio premises shall be kept clean, neat, and free of litter and rubbish.
(2) Work room.
(a) Each tattoo studio shall have a separate work room not used for any other purpose.
(b) Work rooms shall not be used as a corridor for access to other rooms.
(c) Patrons or customers shall be tattooed only in the work room.
(d) Work rooms shall be equipped with hot and cold running water, and one (1) sink or basin per artist operating at the same time.
(e) Sinks and basins shall be for the exclusive use of the tattoo artists for washing their hands and preparing customers for tattooing.
(f) Sinks shall be equipped with foot, wrist, or single lever action controls, soap, a germicidal solution, single use towels, and individual hand brushes clean and in good repair for each tattoo artist.
(g) Plumbing shall be in compliance with the State or local Plumbing Code.
(h) No person shall consume any food or drink in the work room.
Disposal of Waste
The tattoo studio operators shall dispose of waste products in the following manner:
(1) Needles, scalpels, razors or other sharp instruments used for patient care procedures, shall be segregated from other wastes and placed in puncture resistant, closed containers immediately after use.
(2) Needles shall not be purposely bent or broken, or otherwise manipulated by hand.
(3) Containers of sharp wastes shall be sent to a facility where they are either incinerated or otherwise rendered nonhazardous.
(4) Disposable waste shall be placed in easily cleanable, closed containers provided with tight fitting lids, to prevent leakage or spillage.
(5) Waste containers shall be kept closed when not in use.
(6) Disposable waste shall be handled, stored, and disposed of to minimize direct exposure of personnel to waste materials.
(7) Disposable waste shall be sprayed with a ten (10) percent chlorine solution immediately following each tattoo application.
Bloodborne Pathogens – OSHA Summary
Due to its invasive nature, there is a potential for serious infection to occur during tattooing. The needles that are used to penetrate the skin at various sites on the body can become contaminated by blood or serum.
HIV (the virus which causes AIDS), Hepatitis B and Hepatitis C viruses are present in blood and spread by infected blood entering another person’s bloodstream. This can happen during tattooing, when needles used for penetrating the skin are contaminated with infected blood or serum and are not replaced before use on another person.
The person at risk may be the next client being treated with the contaminated instrument or you, if you accidentally penetrate your skin with the contaminated instrument. This is called a ‘needle-stick’ injury. Contact with infected blood, serum or contaminated instruments on open cuts, sores or broken skin can also lead to infection.
Blood or serum does not have to be visible on an instrument or needle for infection to be transmitted. It is important to note: all instruments that penetrate the skin of a person, including needles and attachments such as nozzles, needle bars and tubes, must be sterile.