Cleaning tubes and needle bars. Continuation

If a heat sealing system is not used, Red Fox bags, prelabeled for contents, can be substituted. However, they will not have the shelf life of the plastic bags, (1 year) and are not waterproof.
After autoclaving, remove the trash bag from the autoclave and dispose of it – it is now sterile. Place all bags in the clave and lock the door; start the cycle. 273° F, 15-17 PSI, for 30 minutes. At the end of the cool down cycle, remove the bad needle bars to the solder bench for destruction.
Heat the soldering iron and hold the needle end of the bar over the sharps box. Melt them off the bar, wipe the excess solder off the bar onto a wet towel and place it in the rebuild box.
The machine rack test tubes should be cleaned with a test tube brush and soapy water, rinsed under tap water, and rinsed again with distilled water. These tubes should be inverted and allowed to air dry before bagging and sterilizing them.
Though not required by regulation, the straight razor and bandage scissors can be cleansed, dried, bagged, and sterilized at the same time the bars and tubes go in; it’s just good practice.
Also remember, animals carry more bacteria and viruses than humans, some of which are transferable to man. To promote a sterile work environment it’s best to leave your pets at home.
A closing note of caution on the use of household bleach as a cleansing agent -never let it come in contact with ammonia, as chlorine gas will be liberated. This gas will KILL anything that breathes.  Bleach also corrodes aluminum.
Adhere to the laws of sterilization and you will be a survivor; fall short and you’ll be out of business.
To comply with current federal government regulations, regarding the sterilization of needle bars and tubes, we have obtained validation certificates from inde-pendant testing laboratories.
We have on file, quality assurance compliance reports verifmg that all of Spaulding & Rogers tubes and needle bars can be successfully sterilized using the autoclave or dry-clave sterilization methods described before on this tattoo site.

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CLEANING TUBES AND NEEDLE BARS ON TATTOO MACHINES

We have 2 types of cleaning here; one is for re-usable and the other is for disposable items. The process is the same except for packaging the items for the autoclave. After 30 minutes in the ultrasonic cleaner, cleaning needle bars and tubes is a snap. Simply brush off any debris with a denture brush and green soap or soap powder. Hold the needles in your left hand against your index finger for support (points away from you) and brush away from you, never towards yourself. Roll the bar over and clean the other side. Rinse the bar under running water and examine it with an eye loupe for damage (barbs, excessive wear, etc.).

If it can be re-used place it on a towel and clean its respective tube. There are several devices that make this easier. One is a pipe cleaner, others are nylon brushes and special denture brushes all available from good tattoo supply houses.

Cleaning, first use the brush, then bore swabs. The pipe cleaners are pulled through it like a bore brush then rinse. The nylon brushes enter through the back (open) end of tube – the special denture (with variable tips) do a great job from entering in from the needle end – then always rinse. See Figure 8.
Place it with its needle bar. Do the same for all remaining bars and tubes. If a needle bar cannot be re-used after the cleaning, drop it points first into a glass test tube. Using machine rack test tubes, push a cotton ball (not rayon) to the bottom of the tube and place the re-usable bar in its respective tube gently, points first, onto this cotton ball. Plug the open end with another cotton ball and place it in a plastic autoclave bag with a tag to identify it e.g. 3 needle liner, etc. Heat seal all of these bags and put a small piece of autoclave tape on the bag with the date on it. Plug the tube with the bad needles in it and seal it for autoclaving.

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After the tattoo

Place all machines used in a rack and set it in the ultrasonic cleaner for 30 minutes to be cleaned. Mix a 5.25% sodium hypochlorite solution and put on your plastic apron and rubber gloves. Fill 2 glass or stainless shallow pans with straight bleach (must be puncture proof) and begin to wipe down everything that was handled during the tattoo procedure (ink bottles, machine rack, transformer, clipper cord, sink faucet handles, table top, spray bottles, etc.). Turn off ultrasonic cleaner and break down machines. Remove needle bars and place them as a unit in one of the pans clearly marked “Sharps”. Pull the glass tubes from the machine rack and place them in the other pan marked “Glass Tubes”. Continue to clean the machines by throwing the rubber bands away and wiping each machine off with the bleach solution then place them in your drawer. Mop the floor and carry the 2 pans to the cleaning area. Wipe out the trash can and replace the liner. Staple the trash bag closed and autoclave it. Recover your table. Pour your bucket of used bleach solution down the drain, this is acceptable.

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Cautions before doing the tattoo sterilization

Never go into a stock bottle while working, but instead pour from it into the sterile one-use container being used: e.g. ink into small plastic cups or paper cups presterilized. Remove vaseline with a sterile tongue blade, etc.
Never touch your face, hair, or eyes while tattooing. If you have to, remove and throw away your gloves; wash your hands again before putting on another pair of gloves. Never smoke, eat, drink, or apply make-up in the tattoo room. Never blow water out of or off a tattoo machine. If the machine is dropped, put it out of service.
After the tattooing process is complete, clean the tattooed area with green soap and dry it. With a tongue blade, apply a heavy coat of Bacitracin ointment or triple antibiotic ointment to the area. Cover with a Telfa pad and either tape them in place using hypoallergenic tape (called Dermalite) or bandage with a conforming gauze called Kerlex. Another fine bandage is called Coban in that it sticks to itself and is elastic. Give the client a tattoo care card so he knows what to do and what not to do.
An example of a care instruction flyer for you to hand to your client would read like this:
1.            Remove the bandage in 2 hours.
2.           Wash the area with Ivory soap and cold water; be sure to wash off all of the small red spots.
3.            Blot dry. Air dry 10 minutes.
4.            Apply a thin layer of Bacitracin or triple antibiotic ointment like you are trying to push it in.
5.           Apply the ointment every 3 to 4 hours- keep it shiny.
6.            No salt water or chlorinated swimming pools until healed.
7.            No direct sunlight for 30 days.
8.            If it scabs, DO NOT PICK IT.
9.            Relieve the itch by slapping or scratch the area around it.
10.          Keep it covered with loose, clean clothing.

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Preparing de client for the tattoo sterilization

With a sterile straight razor (or disposable), remove all hair from the tattoo site including 1 and 1/2 inch beyond all borders. Wipe with sterile napkin (prepackaged, 50 or 100 each and autoclaved). Fold 2 more 4×4’s and repeat the green soap scrub, working from the center of the circle towards the outside, not going back to the center.

Dry the area again with a napkin, from the center in a circular fashion working outward. Fold 2 4×4’s and scrub again with 70% alcohol in the same circular fashion and dry once again in the same manner. Fold 2 4×4’s and apply a light coat of betadine solution to the area, again in the same circular motion. Unfold the remaining two 4×4’s so they are 4×8’s and cover the cleansed area until you are ready to set your stencil.
The above prep procedure is hospital recommended for suturing. It should be alright for tattooing. Believe me when I say your client will be impressed.
CAUTION. Ask the client if he/she has a history of allergic reaction to the use of iodine or iodine related products prior to the use of betadine.
During the tattoo, I throw the bloody napkins or paper towels into a waxed brown paper bag. When I am done, my apron, gloves, ink cups, and lap sheet go in there too. It is then stapled shut and autoclaved for disposal as common trash. If you use plastvc trash, can Iiners, they must be changed between clients and  placed seated mto a second bag that again is sealed and labeled as contaminated with human blood.

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The Tattooist. Prior to applying a tattoo

After your client has chosen a design tattoo and you have come to terms, accept the payment and fill him/her out a receipt. Have them sign a disclaimer (explained in a later chapter). Wash your hands using a good grade hospital approved soap (tincture of green soap, betadine) and a brush. Scrub, don’t just wash, up to the elbows paying close attention to the nails and skin folds at the finger joints, etc. Rinse under running water. Put on your latex gloves, proceed to the work area and assemble your machines. Place the assembled machines in a tube rack that contains a solution of Benz-all until needed.

PREPARING THE CLIENT
Pour a small sterile basin (1 qt.) about 1/2 full of sterile, distilled water (HOH). Remember to keep the inside of the cap pointing up when you remove it from the bottle. Recap the bottle and place it out of the way. Assemble what equipment will be used for the tattoo and replace the table cover over the remaiivmg.
Remove 12 4″x4″ gauze pads from a 2 qt. sterile, covered stainless can with a pair of pick up forceps (set in about 2″ of Benz-all) and place them on the table. These pads can be prepackaged in Kraft paper or a sealed plastic bag and autoclaved. Fold 2 4×4’s as shown in figure 3 and hold them as shown in figure 4 to form a scrubber.

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The Work Area and The Tattooist

The Work Area
The area where the actual tattooing is done has to be considered the “STERILE ZONE,” so never allow clients’ friends or onlookers beyond this obvious point. The decking should be covered with an elite grade of inlaid linoleum that does not have to be waxed. Wax and carpet in this area are forbidden, as bacteria thrive on and in both surfaces.
The worktable top should be covered with formica or high grade, non-porous Micarta, colored white. White shows dirt, dust, blood, ink, etc., more readily and sure looks good. A cover for the table and its contents can be made from a clear plastic or white #70 Denier nylon, coated with Scotchgard. This cover will protect the area from dust and dirt when not in use, and that area of the table that is not used when tattooing is in progress.

When you open the shop, put on a plastic apron and a good grade of commercial rubber gloves. Prepare a solution of Sodium hypochlorite 5.25% (1/4 cup of bleach to 1 gallon of water), and wipe down the table and chairs. Use the same solution on the floors, and re-cover your table. 70% alcohol is excellent to wipe down the table with, but it is also flammable. One may want to weigh its advantages against this disadvantage.
The work area should be well lighted at all times, even when you are closed, as bacteria like the dark. Utilize an air conditioner and a ceiling fan to not only cool, but dry the air and keep it circulating. Hot, dark spaces invite bacterial growth; a humid, stagnant area also adds molds and fungi.

The Tattooist
As we well know, bacteria love hair and the subaceous glands that lubricate it. If you wear a beard, it should be cropped short and your hair arranged in such a manner as not to compromise sterility. If you think it’s clean, have your doctor culture it for you. The results will shock you.
Keep your nails clean and cut short. They should be free of hangnails that can cut and puncture surgical gloves. Wear clean clothes and be fully clothed, e.g., shoes, pants, shirt. No rings or watches should be worn. The wearing of latex gloves (or vinyl) is MANDATORY while you are tattooing. A lap cloth of a disposable type is a good idea, as it should be changed between clients. If you have a skin disorder, such as an eczema on your hands, you are not to tattoo until it is resolved.

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Tattoos. How to Sterilize liquids.

If you sterilize liquids, use the “slow exhaust” or the inside of the clave will wear it! The clave will sterilize everything except some rubber items and most plastics. For tabletop models use only distilled water (HOH). Filters are supplied for floor models.
Clean the clave once a week according to manufacturer’s specs. If you don’t, the company rep will be only too glad to pick it up and refurbish it for you when it fails to operate. It will be gone 3 to 6 weeks and carry the National Debt when returned. Check it with a spore strip once a month, and keep a running record in a log book. Log all maintenance, it makes good sense.
Never stand over a clave when you open the door, as the residual, steam, when exiting upward, will burn you. If liquids are autoclaved, remove the bottle tops, jar tops, etc., and place them inverted on the tray or shelf of the clave. Remember to slow exhaust.

The Ultrasonic Cleaner
This machine in no way sterilizes, it is a cleaner only. If you use one once, you’ll buy it, as it’s simply indispensable. It will remove dried ink from tubes and needle bars quickly. It works on a unique process. A cleaning solution is added to the tank and the soiled article is suspended in it. The machine, when turned on, cleans with microwave energy. It forms small bubbles on the dirty surface and causes them to implode. This action pulls the dirt away from the surface leaving it clean.
The tank should be sanitized with a 10% bleach solution whenever it is emptied.

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Autoclave Sterilization

If your autoclave has automatic features, it was probably pre-set at the factory for 250° F. Utilizing a screwdriver and the instruction manual, increase the temperature to 273° F, or call a rep if you care not to do it yourself.
Some people are afraid of the clave exploding. This cannot happen as it has a safety release valve in back or on top which, when overloaded, will release the steam from the chamber.
Some autoclaves work on the locking-lug principle, very similar to a cannon breech or ship’s door. You turn the wheel to the right and the lugs engage a groove about 1/2″ behind the outer face ring. Others work on a bolt-stud closure with hand gripping tighteners.
When the steam enters the inner chamber and reaches about 5 psi, a popping sound is heard. This safety feature is the inside face of the door, which is convex, being moved by internal pressure to the concave, whereby the clave cannot be accidentally opened while in cycle, (see figure 2). This will also occur when the cycle is complete and the pressure falls below 5 psi.
The inside face will “pop” back to convex and the door can be opened.

When an autoclave is used it should be checked against a known indicator, such as heat and pressure sensitive tape, Red Fox bags, and other such items available from your supplier. If a doubt exists about an item’s sterility, it is not sterile.

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Bacterias, sterilization and tattoos.

Bacteria possess certain characteristics such as: some require oxygen to live, they are known as Aerobic. Those that do not are know as Anaerobic. There are bacteria that are called Thermostabile, which means that they are not easily altered or decomposed by heat… those that are Thermolabile are easily decomposed by heat.
You will also come across the term spore. A spore is a reproductive cell produced by plants and some protozoans – it is the asexual reproduction of many unicellular animals and plants. These spores possess thick walls enabling them to withstand unfavorable environmental conditions such as extreme heat.
Certain bacteria form spores but more in the nature of a defense mechanism than for reproduction. These spores are difficult to destroy because they are very resistant and require prolonged exposure to heat to destroy them.
So, as we see, some bacteria love heat, and if they are spore formers, high heat alone will not do the job, so dry heat is out.
Some sterilizers utilize boiling water and steam in an unsealed receptacle know as “flowing steam”… temperature 212° F (IOO C)… this is also inadequate. Boiling water alone is good for tea and coffee but useless against bacteria.
Exposing the article to heat and steam at intermittent intervals, called tyndal-ization… is another inadequate procedure.
How about sterilization by gas, e.g., ethylene oxide. Great, but too explosive. Or formaldehyde… again, great, but formaldehyde is trapped in a ruling right now linking it as a carcinogen (able to cause cancer); also too dangerous.
We are narrowed down to the autoclave, the instrument of choice, that kills not only bacteria, but also spores.
To autoclave properly, we must first understand the mechanics of the system. This employs a temperature of 273° F, with steam under pressure of 15-17 pounds per square inch (PSI) for 30 minutes (50 minutes from cold start) and a 15 minute cool down or drying period (the door can be open about 1″ during this period).

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