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CODE OF PRACTICE FOR BODY PIERCING


Introduction




Throughout history people have used permanent and temporary adornment to enhance their appearance. The rationale for body piercing originates from ideas embedded in ancient cultures often as a mark of royalty or elitism.

Egyptian pharaohs underwent rights of passage by piercing their navels, Roman soldiers demonstrated their manhood by piercing their nipples and it is reported both sexes of Victorian royalty chose nipple and genital piercings.


In today’s society body piercing has become a main stream fashion item, rather than a fringe activity. The client age range appears to be 16 to the late 20’s, although clients up to the age of 60 have been reported.
Common sites for body piercing include ear lobe, pinna, tragus, inner helix, septum, nostril, eyebrow, lip, tongue, nipple, navel, clitoral hood, foreskin and other intimate piercings.
In line with current increases in interest local authorities have had increasing numbers of cases of infection/physical problems.

Guidelines For Body Piercing

Body piercing is potentially an extremely hazardous practice if performed badly.

It should only be practised by a competent, trained and experienced person at suitable premises. Persons under the age of 18 years should not undertake body piercing.
Novice piercers should have shadowed an experienced piercer for a suitable period of time and performed piercings under supervision.
This code of practice aims to offer guidance to body piercers regarding the practice of body piercing and outlines specific recommended hygienic procedures.
This code of practice is aimed at minimising the dangers associated with body piercing i.e. Hepatitis B and C, HIV transmission, bacterial sepsis and subsequent scarring.

Definition

"Body piercing is the practice of piercing parts of the human body into which jewellery is inserted."



Specific Guidelines





  1. Body piercing shall not be undertaken on any person under the age of 16 unless parental consent is given. Proof of age, preferably photo identification, should be sought if there is any uncertainty. A consent form must be completed by the client. (See appendix 1.)




  1. The operator shall discuss the client’s medical history and ask whether he/she has suffered from the following:




  • Heart disease/Heart condition

  • Eczema

  • Impetigo

  • Haemorrhaging

  • Seizures e.g. Epilepsy

  • Diabetes

  • HIV infection

  • Hepatitis A, B and C

  • Acne

  • Psoriasis

  • Cellulitis

  • Allergic responses – anaesthetics, adhesive plasters and jewellery metals

  • Genital warts – if relevant to piercing requested

  • Bulimia

If the client is currently suffering or has suffered from any of the above they should consult a G.P. before proceeding.




  1. A written record shall be taken of the client’s personal details e.g. name and address, medical history, date of the piercing and type of body piercing. Such records must be kept on the premises named in the registration certificate, for a period of at least 3 years.




  1. Ideally a notice shall be prominently displayed on the premises informing potential clients of the risks associated with body piercing including:




  • Blood poisoning (Septicaemia)

  • Localised severe swelling and trauma around the piercing site

  • Localised infection e.g. sepsis or urethritis

  • Scarring

  • Jewellery embedding

  • Allergic reaction to jewellery materials and antiseptics

  • Migration of jewellery.
Alternatively written information specifying the above can be given to each client.




  1. Both the operator and the client shall not be under the influence of drugs, alcohol or other substances




  1. All piercings must be undertaken in conditions of appropriate privacy




  1. To minimise the consequences of fainting, the client should be in a reclined position when piercing is carried out.


N.B. This is not appropriate for tongue piercing, as there is a risk of swallowing jewellery or the tongue itself.


  1. It is strongly recommended that body piercers are vaccinated for the Hepatitis B virus. Immunisation should not be regarded as a replacement for good hygiene standards. Anyone handling sharps is also advised to be up to date with their tetanus immunisation.




  1. There must be a first aid kit, which complies with the Health and Safety (First Aid) Regulations 1981, and the piercer should be adequately trained in first-aid.




  1. Prior to the treatment taking place the operator shall ‘surgical scrub’ with a suitable bactericidal soap and hot water (nails hands and elbows) dry with clean disposable paper towels and then wear disposable examination style gloves.

A good standard of operator personal hygiene is essential in controlling the risk of infection. Cuts and grazes should be covered prior to starting treatments. The operator’s nails should be clean and short.


Disposable examination style gloves should be worn during the piercing procedure and must be disposed of between clients. Fresh gloves must be used at the commencement of every new procedure. Latex allergies are becoming common with prolonged use of latex gloves and the use of vinyl and nitryl – based glove materials will avoid sensitisation. Gloves made from acceptable alternatives to latex must be appropriately CE marked for use with biological agents up to Hazard group 2 and must meet the appropriate British Standard.
11. The operator shall wear a gown, wrap or protective clothing that is clean and washable or a clean single use apron disposed of between clients.

12. If the piercing site is to be marked then this should be done with a fine indelible pen, prior to cleansing the piercing site with a pre-packed sterile antiseptic wipe.


13. The administering of local anaesthetic injections other than by a registered medical practitioner is an offence under the Medicines Act 1968. Lignocain – based cream/spray and Ametop gel are Pharmacy medicines (P). They can be legally used as topical anaesthetics by the purchaser. Ethyl Chloride a (P) issue drug should be avoided at the treated site. Resulting skin damage may increase the chance of infection at the treated site.
14. Needles must be pre-packed and pre-sterilised, and only used once before proper disposal in an approved sharps box. All needles and clinical waste must then be disposed of by a competent company/person. Sharps must be disposed off in an approved sharps container constructed to BS 7320/UN 3291 1990 and must be disposed of through a waste management company.
15. Hollow piercing needles should be a minimum of 1.2mm in diameter. To help reduce healing complications a needle over 2.5mm should not be used.
16. A hands away technique (e.g. using sterilised forceps) shall be used where practicable, to reduce the risk of skin and soft tissue infections and injury to the piercer. The piercing needle shall be held as far away from the tip as possible whilst affording adequate control of the needle.
17. The Female Genital Mutilation Act 2003 states that a person who "excise, infibulate or otherwise mutilates the whole or part of the labia majora or labia minora or clitoris of another person" is guilty of a criminal offence. Therefore piercing the female genitalia could be an offence and this must be borne in mind should such a piercing be requested.
Premises
18. The floor of the treatment room shall have a smooth impervious surface.
19. A wash hand basin constantly supplied with hot and cold running water must be adequately positioned close to the area. Soap and disposable towels must be available.
20. Suitable and sufficient lighting within the room is essential.
21. The bed/couch shall have a smooth impervious surface and be kept in good repair. It should be kept clean and washed with detergent and hot water regularly. Any bed/couch used in treatment shall be covered by a disposable paper sheet which is changed for each client.
22. A notice reading “No smoking and “No Eating or Drinking” shall be prominently displayed in the treatment area.
23. A copy of the registration certificate shall be displayed on the premises. A copy of the bylaws shall be prominently displayed on the premises.
Equipment
24. All surgical instruments in contact with broken skin and all jewellery that is to be inserted into the skin must be sterilised by an approved autoclave and stored in sterile conditions. (Autoclave with saturated steam at 134c for three minutes – see appendix 2.)
25. All equipment (e.g. Autoclaves/ultrasonic cleaners) shall be suitably maintained and inspected in accordance with the manufacturers guidelines and the Pressure Systems Safety Regulations 2000 (see appendix 2 for more information).

26. Jewellery shall be of a suitable grade; (i.e. surgical stainless steel, solid 14K or 18K gold, niobium, titanium and platinum) sterilised and kept in sterile conditions until inserted. (see appendix 3 for more information).


Aftercare
27. There shall be no attempt to increase the size of the piercing until it is completely healed. Such increases should be carried out gradually by the insertion of progressively larger gauge sterile jewellery. No subsequent tearing or bleeding should occur.
28. Clients shall be given verbal and written information regarding body piercing to include:

  • Normal bathing and showering is permitted but otherwise keep dry;

  • Clean hands before touching jewellery;

  • Turn jewellery when wound is not dry;

  • Do not cover wound closely, allow access to air;

  • Expected healing time of the wound;

  • Possible indications of complications;

  • Advice on how to deal with slight redness/swelling/pain;

  • Advise to return to the piercer or visit their GP if redness/swelling/pain continues to be experienced. (See appendix 4 for more aftercare information.)


General Considerations
29. Ear-piercing guns must not be used for other parts of the body, as the guns will become contaminated and could be the vehicle for infection to the ear, nose etc. of subsequent clients. The Local Authorities’ Environmental Health Department will be pleased to advise on how to obtain information on equipment suitable in specific applications.
Additional Advice
30. All genital piercing must be by appointment only. The client must be recommended to bring a friend to help ensure there is no misunderstanding or allegation of impropriety.
31. The body piercer must have public liability insurance cover.
32. Appendix 5 to this document includes information relating to different types of piercings
33. Appendix 6 to this document includes useful contact numbers.


Definitions

34. Cleaning - A process that physically removes contamination, including some micro organisms, but does not necessarily destroy a significant proportion of the micro organisms originally present. The reduction of microbial contamination cannot be defined and will depend on many factors including the efficiency of the cleaning process and the initial level of soiling present. Cleaning of equipment and work surfaces is best achieved using detergents compatible with the materials from which the equipment and work surfaces are made.


35. Disinfection – reduces the number of viable micro organisms but it may not necessarily inactivate all bacteria, fungi, viruses and spores. Disinfection does not achieve the same reduction in microbial contamination levels as sterilisation and it lacks the treatment quality assurance of steam sterilisation. The effectiveness of the disinfection process will be reduced if prior cleaning has not been performed.
36. Sterilisation – renders an object free from viable micro organisms including bacterial and fungal spores that may survive disinfection treatments. Use of UV light/glass bead sterilisers are not considered suitable for adequate sterilisation and should not be used.

APPENDIX 1 - BODY PIERCING CONSENT FORM

To be filled in block capitals correctly by persons wishing to be pierced


NAME …………………………………………………………………
ADDRESS …………………………………………………………………
…………………………………………………………………
TELEPHONE …………………………………………………………………
AGE …………………………………………………………………
This is to certify that I, the above named and undersigned, today gave my correct name, address and age when asked to do so by:-
NAME AND ADDRESS OF BODY PIERCING ESTABLISHMENT

To my knowledge I do not, and have not, suffered from any of the following:-







YES




NO

Heart Disease/Condition










Eczema










Impetigo










Haemorrhaging










Seizure eg Epilepsy










Diabetes










HIV Infection










Hepatitis A, B and C










Acne










Psoriasis










Cellulitis










Allergic Responses; anaesthetics, adhesive plasters and jewellery metals










Genital Warts; if relevant to piercing requested










Bulimia










If you are suffering or have suffered from any of the above, you should consult a GP before proceeding with the piercing.


I fully understand that I must be 16 years of age or over to be pierced or to attempt to obtain any body piercing. This is to certify that I, the above named and undersigned, do give my permission to be pierced and I am fully aware of the process involved and understand the importance of the daily aftercare procedure.
SIGNED …………………………………………………………………
DATE …………………………………………………………………

TYPE OF PIERCING


NAME OF PIERCER
I am under 16 years of age and accompanied by my parent/guardian
Parent/guardian signature
APPENDIX 2 - AUTOCLAVE INFORMATION

The Medicines and Healthcare Products Regulatory Agency (MHRA) has issued guidance stating that “high risk” equipment (e.g. equipment likely to increase the risk of infection, such as items used during the course of body piercing) can be defined as items that are in “close contact with a break in the skin” and therefore, sterilisation is essential. (see end of appendix 2 for further reading relating to sterilisation of equipment.) The MHRA recommends steam sterilisation at the highest temperature compatible with the equipment being processed.


The MHRA guidelines state that wherever possible it should be carried out by a hospital sterile services department that has the equipment and expertise to ensure that items are cleaned thoroughly and sterilised consistently. In the absence of hospital sterilisation facilities a properly functioning bench top steam steriliser may be used – but it must be suitable for the equipment that the user intends to process. (MHRA have provided guidance for the purchase of steam sterilisers. (see end of appendix 2 – further reading item 4)
STERILISATION OF EQUIPMENT:
Sterilisation of equipment can be accomplished using steam sterilisers or dry heat sterilisers although the former is preferred due to its high lethality. Cleaning of instruments is an essential pre- requisite of sterilisation. Used instruments and utensils must be thoroughly cleaned (either by hand washing in warm water «35°C) with detergent, or in an ultrasonic bath) remove any debris before being placed in the autoclave. Debris may harbour contaminating micro-organisms and may coagulate and become fixed onto the instrument or utensil protecting the organism from the sterilisation procedure.
TRAINING:
Operators of autoclaves should be fully instructed and properly trained in correct operating procedures and the purpose and function of controls and safety devices used with the equipment. They and their managers should be aware of the dangers of by-passing or interfering with safety devices or other malpractices. Manufacturers’ instruction and operating procedures should be readily available to operators and should be followed. Any malfunction or faulty equipment should be reported at once and remedial action taken.
STEAM STERILISERS:
Steam sterilisation is the preferred method for sterilising body piercing equipment because of the high lethality of the recommended cycle i.e. 134 degrees Celsius for three minutes. Many tattooists and body piercers use sterilisers, which are essentially modified pressure cookers that often operate at lower temperature and pressure but are satisfactory if validated. Acceptable sterilisation temperature/pressure relationships are identified in table 1 below.
Sterilisation temperature [oc]* 121 126 134
Maximum allowable temperature [oc] 124 129 137
Minimum holding time [min] 15 10 3
Table 1:- Acceptable sterilisation temperatures/pressure relationships

*The temperature setting of the controller will generally be a higher temperature within the sterilisation temperature bands.


Items to be sterilised in benchtop steam sterilisers should not be wrapped or placed in bags or pouches. Wrapping is not recommended because:

It may result in inadequate steam penetration and failure to sterilise the load;


It may prevent adequate drying of the load;
DRY HEAT STERILISERS
Dry heat sterilisers as their name suggests operate without steam or moisture and can be satisfactory, provided:
Equipment is periodically tested and validated and is properly maintained
Appropriate time/temperature combinations are achieved throughout the load. (see table below)
Interlocks prevent access to a load in the event of the cycle failing
Table 2:


Temperature (degrees Celsius)

Holding Time (minutes)

160-170

120


170-180

60


180-190

30


Table 2:- Sterilisation Temperature and Holding Times (for dry heat)
NOTE:
The holding time is the total cycle time and starts when every item in the load (not the air) has reached the sterilising temperatures. Hence the total cycle time includes the time for every item in the load time to reach sterilising temperature
(The time is dependant on the composition of the load, it also includes the holding and cooling times.)
GLASS BEAD STERILISERS:
Glass bead sterilisers are a particular type of dry heat steriliser intended to provide rapid sterilisation of instruments at the point of use. These are generally not recommended as they lack the appropriate controls and there is no assurance that they will sterilise the instruments. Glass bead sterilisers utilise high temperatures, which may cause damage to the instruments.
Irrespective of the equipment chosen regular testing and validation is essential to ensure sterilisation. Steam sterilisers must comply with the Pressure Systems Safety Regulations 2000. The overall intention of these regulations is to prevent risk of injury from stored energy as a result of failure of a pressure system or part of it.

Under these regulations all sterilisers containing pressure vessels are subject to periodic inspection by a competent person, according to a written scheme of inspection.


FURTHER ADVICE:
Specific advice on prevention of cross infection can be obtained from the Consultant in Communicable Disease Control on Tel: 271 1257 or the local community infection control team. Advice on sterilisers and sterilisation can be obtained from a Registered Authorised Person (sterilisers) [AP(s)]; a list of their names and contact details can be obtained from The Institute of Healthcare Engineers and Estates Management, 12 Abingdon House, Cumberland Business Park, Northumberland Road, Portsmouth PO5 1DS, Tel: 01705 823186.
FURTHER READING:
Relevant Medical Devices Agency (MHRA) Publications covering instrument cleaning, instrument re-use and sterilisation and other relevant Government publications.
1. Controls assurance in infection control: decontamination of medical devices HSC 1999/179 NHS Executive August 1999.
2. Single-use Medical Devices: Implications and Consequences of Re use DB2000 (04). MHRA August 2000.
3. Sterilisation, disinfection and cleaning of medical equipment: guidance on decontamination from the Microbiology Advisory Committee MHRA 1996 (sometimes referred to as “the MAC manual”)
4. The purchase, operation and maintenance of bench top steam sterilisers MDA DB 2002 (06) October 2002.
5. The validation and periodic testing of bench top vacuum steam sterilisers. DB9804 MHRA June 1998.
6. Guidance on the purchase, operation and maintenance of bench top vacuum steam sterilisers DB2000(05) MHRA October 2000.
7. The Dangerous Substances and Preparations (Nickel)(Safety) Regulations 2000.

http://www.legislation.hmso.gov.uk/si/si2000/20001668.htm
MHRA publications can be obtained from:

Medicines and Healthcare Products Regulatory Agency, Business Services, Level 9, Hannibal House, Elephant and Castle, London, SE1 6TQ


Copies of HSC 1999/179 can be obtained from the Department of Health, PO Box 777, London SE1 6XH, Fax 01623 724524 and from the DH website at: http://www.open.gov.uk/dph/coin.htm

APPENDIX 3 - BODY PIERCING JEWELLERY

The style of body piercing jewellery is distinct from traditional jewellery worn in the ear lobe such as studs and butterfly designs. Variations on the barbell and (captive) ring design are those most commonly seen in body piercing because these substantial shapes minimise the risk of embedding, tearing and migration. High quality jewellery is made with smooth surfaces and joins in order to reduce the risk of irritation or of harbouring infection.


Regulations on implantable jewellery have recently been amended as indicated below.
Statutory Instrument 2000 No 1668 (which implements the latest revision of EU Directive 94/27/EC (The Nickel Directive) are available in its entirety on-line. It states:
'Prohibitions on the supply of products containing nickel and its compounds –


(1)


No person shall supply any post assembly intended to be inserted into a pierced ear or other pierced part of the human body during epithelization of the wound caused by such piercing (whether or not it is a post assembly which is intended subsequently to be removed) if that post assembly contains nickel or a nickel compound, unless the post assembly is homogeneous and the concentration of nickel which it contains is less than 0.05do (expressed as mass of nickel to total mass).


(2)


No person shall supply any products intended to come into direct and prolonged contact with the skin, which contains nickel or a nickel compound if the rate of nickel release from the parts of the product coming into direct and prolonged contact with the skin is greater than 0.05ug/cm2/week, including any of the following products –





(a)


earrings;




(b)

necklaces, bracelets, chains, anklets and finger rings;





(c)


wrist-watch cases, watch straps and tighteners;




(d)


rivet buttons, tighteners, rivets, zippers and metal marks, contained in or intended to be used in garments.


(3)

(Paragraph (2) above shall not apply to any product that contains nickel and has a non-nickel coating to which paragraph (4) below applies.


(4)


Subject to paragraphs (5) and (6) below, no person shall supply any product listed in paragraph (2) (a) to (d) above or any other product intended to come into direct and prolonged contact with the skin which –





(a)

contains nickel or a nickel compound; and





(b)


has a non-nickel coating,





unless the non-nickel coating is sufficient to ensure that the rate of nickel release from the parts of the product coming into direct and prolonged contact with the skin will not exceed 0.5 ug/cm2/week for a period of at least two years of normal use of the product.


(5)


Nothing in paragraphs (1), (2) and (4) above shall prohibit the supply to the final consumer of any product which was placed on the market before 20th January 2000.


(6)


The test methods in BS EN 1810, BS EN 1811, BS EN 12472 shall be used in demonstrating the conformity of products referred to in paragraphs (1), (2) and (4) above of these Regulations.


(7)


The use of gold, although desirable for other forms of adornment, is avoided by many body piercers. Only solid 14 carat and 18 carat material is said to be pure enough for body piercing applications. The use of gold below 14 carat increases the chance of metal impurities that may cause allergic reactions. Jewellery that is much more than 18 carat is generally too soft and becomes easily pitted and scratched. This may, in turn, encourage infection to develop. Other metals and non-metal materials have been used safely in body piercing work providing they are free of nickel or other toxic metals. These include titanium, platinum, niobium (metals) and PTFE (also known as TeflonTM); the last being an inert non-metal sometimes used for sub-cutanerous implants.






Silver is not suitable for body piercing because it damages easily and may increase the chances of infection.



APPENDIX 4 - AFTER CARE GUIDELINES FOR BODY PIERCING

Clients are advised to follow the simple aftercare procedures outlined below:


A Normal Piercing:


  • May be tender, itchy, slightly red or bruised for a few weeks.

  • May bleed a little for the first few days.

  • May secrete a whitish-yellow fluid (plasma) which crusts on the jewellery; this is not pus.

  • May tighten around the jewellery as it heals, making turning somewhat difficult.


Cleaning/healing process:


  • Consult the pharmacist about gentle liquid antibacterial soaps containing triclosan, however, if you are sensitive to triclosan there are alternatives available.




  • Wash hands well before cleansing the piercing. First let the water help remove any crusted matter, then rotate a little antibacterial soap gently into the piercing for no more than two-three minutes, then rinse thoroughly while rotating jewellery. Do not allow residue to remain in the piercing.




  • Clean the piercing no more than twice a day. Cleaning more frequently may damage the delicate skin cells and cleaning less frequently may invite an infection. When cleaning is not in progress the piercing should be left alone.




  • With an oral piercing, after eating, smoking or putting anything in your mouth, rinse with antibacterial mouthwash at a dilution of 50%-75% to avoid damaging new skin cells. It is also necessary to disinfect the piercing, twice a day, with warm salt water or a mild antiseptic mouthwash.




  • Many piercees have found that vitamin C, multivitamins and Zinc supplement speed regeneration of tissue.




  • Hot compresses, with the optional addition of 1/4 teaspoon of salt per cup of clean water are strongly suggested for navel piercings. Avoid wearing belts, tight trousers or restrictive clothing for about 6 months – 1 year.




  • Genital piercees (male/female) can use a panty liner to absorb excess moisture and cushion the piercing. Avoid restrictive clothing; irritating clothing that limits oxygen flow to the area. Any sexual contact should be gentle and latex barriers should be used to protect the piercing from partner's body fluids.


Changing and Removing Jewellery:
Everyone heals at a different rate. The average healing times for piercings, provided they are cleaned twice daily and treated like new healing tissue, are shown below. It is important to remember that even after the initial healing period, the piercing will still need one full year or longer to completely heal. Always treat the piercing with care and gentleness.



  • Lip, labret: 6-8 weeks

  • Tongue: 4-6 weeks

  • Cheek 2-3 months

  • Naval 6 months to 2 full years

  • Nipple 2-3 months

  • Genitals 4-8 weeks

  • Nose 6-8 weeks

The piercing will not be completely healed for several years. Jewellery should not be changed during the initial healing period (often at least 6 months.) Clients should be advised to always wear the appropriate jewellery in the piercings, even when fully healed. The piercer should be contacted, for further advise, if removal of the jewellery is being considered on a temporary or permanent basis.


What to do in the case of Infection:
Infections are caused by contact with bacteria, fungi or other living pathogens. Piercing infections can usually be traced to one of the following activities:


  • Touching the piercing with unwashed hands

  • Oral contact with the piercing, including your own saliva

  • Contact with hair, cosmetics, oils, infrequently washed bedding or other agents

  • Going into a pool, hot tub, lake, ocean or other body of water.

The following are indications of infection:




  • Redness and swelling

  • A sensation of heat at the piercing site

  • Pain, especially throbbing or spreading pain

  • Unusual discharge. It may be yellowish, greenish or greyish.


While it is never inappropriate to contact the doctor, a visit to the piercer may be as beneficial. Do not remove the jewellery as this may aggravate the problem by closing off the drainage for the discharge matter. You might consult your doctor regarding the use of oral antibiotics.

APPENDIX 5 - TYPES OF PIERCINGS

SEPTUM

This piercing gives little or no trouble in healing, apart from a little tenderness if it pressed up from under the septum. The piercing really looks after its self and heals within 5 weeks. Once this piercing is well healed, it is one of the few piercings that can be left empty; although it may contract a little it doesn't seem to have the habit of closing up as some other piercings do. The piercing through the central part of the nose is done through the thin web of skin beneath the central nasal cartilage and is fitted with a 'U' shaped keeper, a short plastic bar almost undetectable until a ring or tusks are inserted. This piercing is predominated amongst inhabitants of India, Africa and Polynesia.



LABRET
The true labret is a central piercing through the lower part of the lip, about half an inch below the pink edge of the lip. Usually trouble-free, it takes about 5 weeks to heal, but may vary according to the thickness of lips, and there may be a little swelling for a day or two. It is difficult to find a stainless steel stud that is exactly the correct length; usually a flexible plastic stud with a disc on the inside of the mouth is used at the time of piercing which is adjustable. Once the piercing is healed, a steel, gold or jewelled stud can be fitted of the correct length. Labret piercings that are made to either side of the lip take a longer time to heal, due to more movement of the lips in that area. Labret piercing is seen amongst the people of certain South American tribes, Kenya, Zambezi and North Cameroon and have symbolic meanings. Some tribes enlarge the labret piercing to accommodate a large plug disc.
NIPPLE PIERCING:
It is said that Roman Centurions wore nipple rings as a sign of virility and courage and as a dress accessory to hold their short capes in place. Today it is a visual and sexual attraction. The placement is determined by the size and shape of the nipple, with correct placement being very important. The nipple should never be pierced with an ear piercing gun as the pins are too short, therefore pinching the nipple which may cause severe problems. Using a hollow needle, the piercing is normally made at the base of the nipple where it joins the aureola but often, with the male nipple especially, if they are very small the piercing is made just below (behind) the actual nipple, otherwise the piercing may be too close to the surface of the skin and could therefore reject. Nipples are usually pierced horizontally but can also be pierced vertically or diagonally. Vertical piercings tend to walk a little while healing so become slightly diagonal. It is extremely important to mark the position of this piercing before making the hole because some nipples tend to twist when they are cold / erect changing the appearance of the piercing when the nipple is warm / relaxed. It is also important that the person to be pierced is sitting up right, because the breasts can flop to the side or be a difference angle if the body is turned. A ball closure ring of

1 .5 mm thickness should be used 3/4 diameter being an average size. Alternatively a 1.5mm bar may be used but it is important that the length of the bar is enough to allow for expansion of the nipple, as slight swelling may occur and it naturally changes shape with different body temperature. Thinner or restricting jewellery should not be used as this can be extremely uncomfortable and will not heal well. The healing time is variable according to each person's body healing capacity, the average item taking approximately 8 weeks, although it has been known to take much longer. In some cases, although rare, it may take only 3 weeks.


FACIAL PIERCING
Earlobe, Rim and Tragus Piercing
Healing time for the earlobe is 3 to 6 weeks. Some other parts of the ear may take a little longer e.g. the upper rim. The most common method of ear piercing is with a gun, firing a stud through the ear, which is held in place with a butterfly fastener. The stud can be replaced by different jewellery after the piercing has healed.

The piercing can also be done by the hollow needle method and will have to be if you wish to wear a ring straight away, it may also be advisable for some of the more unusual placements and obscure positions. The latter method is a little more painful due to the fact that it is slower.


Nostril Piercing
Nostril piercing takes 6 to 8 weeks to heal. A stud, short barbell or ring can be fitted. It is unwise to remove the stud or ring too soon as the piercing tends to shrink quickly, thus making it difficult to re-insert the jewellery. A curved nose stud or spiral is often found to be more comfortable than a stud with a fastener.
NAVEL PIERCING
The navel piercing was a sign of royalty to the Ancient Egyptians and was sometimes denied to commoners; hence a deep navel was highly prized. It is still an advantage to have a well-shaped navel for the success of this piercing, which appears to be the most unpredictable of all. Many find problems with the long term establishment of this piercing which is influenced by a number of different factors, including the differing shape of the body e.g. the depth of the navel, the thickness of the skin, the position of the waistline (which differs between men and women,) and also the age of the person.

Restrictive clothing during the healing period and even afterwards has some bearing on it's success, for example wearing tight belts, girdles and skirt or trouser waistbands, according to the proximity of the navel. Many people experience, several months or even years after successful healing, that it will start to migrate, eventually working out. The choice of jewellery often depends on individual taste and comfort. During the healing period a curved barbell is possibly the best choice. An average healing time is difficult to determine. This piercing is still greatly sought after and admired, is purely visual and lends itself to imaginative and decorative effects.


TONGUE PIERCING
Barbell studs should be used for the initial piercing which should be at least 1/4 longer than the tongue is at its thickest. It is extremely important that the barbell used allows for swelling of the tongue after the piercing is made or it will cause problems and discomfort. In bad cases the ball ends may become embedded in the tongue

and will have to be removed. The barbell should remain loose for a week or so although it may look a little strange and needs to be replaced by a shorter barbell when the piercing is healed. Only then will the visual appearance be correct.




APPENDIX 6 - USEFUL INFORMATION SOURCES:

The Licensing Service

Sheffield City Council

Block C, Staniforth Road Depot

Staniforth Road

Sheffield, S9 3HD

Tel: 0114 2734264


Health Protection Service

Sheffield City Council

Environment & Regulatory Services

2-10 Carbrook Hall Road, Sheffield, S9 2 OB

Tel: (0114) 273 4653
Chartered Institute of Environmental Health

Body Art, Cosmetic Therapies and other Special Treatments

(Barbour Index)

Tel: 0207 928 6006

Fax: 0207 827 9930

E-mail:shop@cieh.net

ISBN 1-902423-80-1
Health and Safety Executive

Local Authority Circular 76/2

Health and safety issues related to body piercing, tattooing and scarification

www.hse.gov.uk


LONDON COMMUNICABLE DISEASE SURVEILLANCE PROJECT

Body Piercing Guidelines-

Insert No 3 dated 25th February 1995
Association of Professional Piercers (APP)

Procedural Standards -1998 Edition PO Box 1 6044

London NW1 8ZO

Telephone: 01 71 2678284


Prof. NORMAN D NOAH

Professor of Epidemiology and Public Health

London School of Hygiene and Tropical Medicine

Consultant Epidemiologist

PHLS Communicable Disease Surveillance Centre

Tel: 0208 200 6868 ex 3411

e-mail: Nnoah@phls.org.uk
Medicines and Healthcare Products Regulatory Agency (MHRA)

The Purchase, Operation and Maintenance of

Bench Top Steam Sterilisers.

The MHRA Ordering Department

Room 1207

Hannibal House

Elephant and Castle

London SE1 6TQ

Tel: 0207 972 8181

Fax: 0207 972 8205


PAULINE CLARKE

" The Eye of The Needle" Published by P Clark

ISBN 0952117509
Institute of Health Care Engineering and Estate Management,

2 Abingdon House, Cumberland Business Centre, Portsmouth, PO5 1DS.



Tel: 0239 282 3186.
Updated May 2007


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