New Canadian Study on the Use of Tattoo Equipment in the Treatment of Skin Conditions

The National Post has recently published an article on a groundbreaking new study.  Anny Fortin, a Canadian biochemist at McGill has researching the use of tattoo equipment to administer treatment for skin conditions.

“The just-published research found evidence that tattooing could greatly improve treatment for cutaneous leishmaniasis, a parasite that leaves millions of people worldwide with disfiguring, and often emotionally devastating, facial sores. It affects mainly developing countries, but even Canadian soldiers returning from Afghanistan have contracted the illness.

The technology, though, could eventually have application in treating skin cancer, psoriasis and other ailments, speculates the scientist behind the project.”

A tattooing machine can target Leishmania cells just below the surface of the sore, depositing the drug — instead of ink — into the bottom of the little holes it creates, far less painfully than a hypodermic needle.

Read the full article here.

You can also access the scholarly research article here.

A Message to Toronto Tattoo Artists, Industry Professionals and Others

Dear Tattoo Shop Owner / Operator:

As you may or may not be aware, the City of Toronto is about to enact legislation regarding the operation of Personal Service Settings (PSS), which include but are not limited to, tattoo and piercing establishments, nail salons and electrolysis clinics. The legislation proposes to

a) license all PSS where there is a risk of infectious disease transmission;
b) require a public health inspection prior to the opening of all new PSS operations;
c) require PSS operators of premises where there is the risk of infectious disease transmission to post inspection results;
d) require PSS to comply with the Medical Officer of Health’s infection and control recommendations; and,
e) require infection prevention and control training for PSS operators (developed by the Ministry of Health and Long-Term Care).

As Tattoo Artists, we of course wish to work with the cooperation and endorsment of our local health authorities, for the benefit of our clients, for the health and safety of the general public and for the ongoing growth and recognition of tattooing as an art form. The proposed legislation, however well intentioned, raises some serious concerns within our community for a number of reasons. The first of these is the issue of licensing. Initially, Toronto Public Health stated that the sole purpose of licensing was to allow health inspectors to identify the location of tattoo shops and to ensure that they were inspected on a timely, regular basis. An online poll conducted on behalf of Toronto Public Health as part of their stakeholder consultation process however, indicates that the issuing of a license and license renewal will be contingent on compliance with health inspection recommendations. Licensing will be administered by Municipal Licensing and Standards, an entirely different branch of municipal government, which may be empowered to enact other, as yet undisclosed controls of the licensing process. It is imperitive that we, as a community, insist that licenses shall be issued unconditionally, and used only to identify the location of tattoo establishments for inspection purposes. It is our position that there is no such thing as a license to create art.

With regard to the proposal that PSS operators post inspection results we are generally in agreement. It is our understanding however, that the intended model will be based on the existing “DineSafe” program, which issues green (pass) yellow (conditional) or red (fail) postings. A yellow, or conditional pass sign displayed would be a literal kiss of death for any tattoo establishment. It has been our experience over the past few years that health inspections have been conducted by individuals who, by the nature of the questions they ask, often indicate that they know little or nothing about the tattooing process. There has been little or no communication from Toronto Public Health with regard to newly added protocols or inspection requirements, and a number of us have noted a wide range of inconsistancy in the enforcment and understanding of existing regulations on the part of health inspectors. All of these factors, combined with apparently ever increasing inspection criteria almost guarantee conditional or yellow passes. It is our position therefore, that inspection result postings be limited to pass or fail, and that the criteria for these designations be limited to critical issues where the health and safety of the client is reasonably at risk. (improper sterilization, lack of barrier control, improper skin prep, unsanitary conditions, etc.)

The requirement to comply with the Medical Officer of Health’s infection prevention and control recommendations seems, at face value to be a logical and reasonable proposition, and most of us already unquestioningly abide with existing regulations or recommendations. What is problematic with this proposal is that there is no limit placed in the proposed legislation as to what these recommendations may be in the future, essentially giving Toronto Public Health absolute, unfettered control over virtually every aspect of our operations not already controlled by the previously mentioned Municipal Licensing and Standards Dept. If this legislation is passed in its current form, we will not be permitted to question or dispute anything Toronto Public Health demands we do, regardless of how ridiculous or unnecessary simply because “it’s the law.” For this reason, we propose that the legislation be amended to read “require PSS operators to comply with the Medical Officer of Health’s infection prevention and control recommendations where there is a reasonable and demonstrable risk to the health and safety of the client or of the spread of communicable disease.” This will allow us, as operators and artists, to have some input over the imposition of regulations that may not be critical to the interest of client safety, but are more focused on theoretical possibilities rather than realistic probabilities, or the protection of health units from potential liability.

Most of us, as artists, simply wish to be left in peace to continue our work and focus on what we do best. It is an unfortunate side effect of the growth of our chosen art form and the proliferation of tattoo shops throughout the GTA and for that matter throughout the world, that legitimate concerns over safety and regulation will be raised by various levels of government. It is important at this stage to demand involvement in whatever regulatory process unfolds, or we will have no voice in determining our future.

Please contact us at: torontotattoo@gmail.com

Mycobacterium Skin Infections Found in Black and Grey Wash Ink in the U.S

A rash of mycobacterium skin infections has been investigated by the CDC and the FDA in the U.S. The bacterium was found in black and grey wash ink in a few regions in the United States. (Reference).

The OTA has compiled a few things to avoid in general:

  • Don’t premix your own black and grey wash, mix it fresh in the cap or use commercial premixed inks. Only use the appropriate mixing solution to dilute your ink in bottles.
  • AVOID USING TAP WATER, although many would argue in large cities like Toronto the tap water contains less bacteria than expensive bottled water. That may or may not be true in Toronto, it is surely less reliable in smaller towns.
  • The OTA suggests using steam distilled water or RO (reverse osmosis) for wash cups and wash bottles instead of tap water.
  • You can buy premixed black/grey wash or mixing solution for black/grey wash from most ink manufacturers.

We have compiled a very thorough and informative article about water.

Here are some useful links.

Outbreak of Mycobacterium chelonae Infection Associated with Tattoo Ink:
http://www.nejm.org/doi/full/10.1056/NEJMoa1205114

Tattoo Ink-Related Infections – Awareness, Diagnosis, Reporting, and Prevention – NEJM:
http://www.nejm.org/doi/full/10.1056/NEJMp1206063

Wound irrigation is the steady flow of a solution across an open wound surface to achieve wound hydration, to remove deeper debris, and to assist with the visual examination. The irrigation solution is meant to remove cellular debris and surface pathogens contained in wound exudates or residue from topically applied wound care products. Compared to swabbing or bathing, wound irrigation is considered to be the most consistently effective method of wound cleansing.

Normal wound healing is characterized by 3 interrelated phases: inflammatory, proliferative or fibroplastic, and remodeling. In normal wound healing, infectious microorganisms, foreign debris, and necrotic tissue are removed from the wound during the inflammatory phase due to vascular and cellular responses to trauma. However, weaknesses in the body’s inflammatory response can cause deficits in its ability to overpower surface microorganisms. This can lead to delayed angiogenesis and granulation tissue formation, as well as infection. Contaminating microorganisms can upset collagen synthesis and modify matrix metalloproteinases, leading to anoxia and impeding neutrophil and macrophage function.

Combined with debridement, irrigation is a critical step in facilitating progression from the inflammatory to proliferative phase of wound healing by removing debris that can impede the healing process. When performed properly, wound irrigation can aid in wound healing from the inside tissue layers outward to the skin surface. It may also help prevent premature surface healing over an abscess pocket or infected tract. The goal of irrigation is to clean the wound while avoiding trauma to wound bed and minimizing risk of driving bacteria further into the wound bed.

Key considerations – Selecting an irrigation solution

Choosing an appropriate solution is a critical step in wound irrigation. Solutions intended for topical use include topical cleansers, antibiotics, antifungals, antiseptics and anesthetics. Ideally, an irrigant should be isotonic, nonhemolytic, nontoxic, transparent, easy to sterilize, and inexpensive. Unfortunately, such a solution does not yet exist. Current literature generally favors use of normal saline. Many antiseptics and antibiotics have been employed, but the ideal additive is the subject of debate. Cytotoxicity of the solution should certainly be considered. In particular, antiseptic solutions, such as povidone-iodine, chlorhexidine, and hydrogen peroxide, may be toxic to tissues and may negatively influence acute wound healing. Some conventional topical irrigants are discussed below.

Normal saline

Normal saline is isotonic and the most commonly used wound irrigation solution due to safety(lowest toxicity) and physiologic factors. A disadvantage is that it does not cleanse dirty, necrotic wounds as effectively as other solutions. Similar wound infection rates have been reported with potable tap water versus saline in adult and pediatric populations.[3, 4] It is important to note the date of opening a saline container, as bacterial growth in saline may be present within 24 hours of opening the container.

Sterile water

Prepared by distillation, sterile water is nonpyrogenic and contains no antimicrobial or bacteriostatic agents or added buffers. It is often used in irrigation, particularly in developing countries, as a less expensive alternative to isotonic saline. Sterile water is hypotonic and may cause hemolysis and will be readily absorbed by the tissues during surgical procedures; therefore, its use under such conditions is not recommended. Water toxicity may result when excess volumes are used.

Potable water

Potable water is recommended in the event that normal saline or sterile water are not available. Its use is particularly attractive in austere environments. In fact, a few studies have shown potable water to be as effective at reducing bacterial counts as normal saline.

Commercial wound cleansers

Commercial wound cleansers are increasingly used in irrigation. Detergent irrigation is meant to remove, rather than kill, bacteria and has seen promising results in animal models of the complex contaminated musculoskeletal wound. Due to the surfactant content in cleansers, less force is required to remove bacteria and cellular debris. Thus, cleansers may be best suited for wounds with adherent cellular debris or in dirty or necrotic wounds. Trigger sprays can help direct the cleanser more effectively and safely. Cleansers typically contain preservatives to slow growth of bacteria, molds, and fungi, and extend product shelf life.

Key considerations – Selecting method of solution delivery to the wound

The ideal irrigation technique and pressure required for optimal outcome are still undetermined in the literature. Equipment used for irrigation includes bulb syringes, piston syringes, pressure canisters, whirlpool agitator, whirlpool hose sprayer, irrigation fluid in plastic containers with a pour cap or nozzle, and pulsed lavage (e.g, jet lavage, mechanical lavage, pulsatile lavage, mechanical irrigation, high-pressure irrigation).

Continuous irrigation is the uninterrupted stream of irrigant to the wound’s surface. Pulsed irrigation is the intermittent or interrupted pressurized delivery of an irrigant, typically measured by the number of pulses per second. Power-pulsed lavage is a wound irrigation system that uses an electrically powered pump system to deliver a high volume of irrigation solution under pressure. Outcomes of pulsed versus continuous pressure appear to be similar.

Advantages of pressurized canisters compared to traditional methods of irrigation include speed, simplicity and cost-effectiveness. Semirigid ampoules and pressurized canisters also allow practitioners to irrigate wounds without the risk of needle-stick injuries. Disadvantages include the reliability of canisters and difficulties in warming contents to consistent ambient temperature.

Are sterile water and sterile distilled water the same?

No. Distilled water has had all chemicals and minerals removed, usually by steaming and re-condensation. Sterile water has been treated, usually heat treated, to destroy pathogens (any living organisms). So, you can sterilize distilled water, but not all distilled water is sterile. manufacturing criteria do NOT require that regular distilled water be packaged to prevent contamination.

Water sold as sterile water must be packaged to avoid contamination. On the other hand, water full of minerals can be sterilized; the minerals are still present. So if you want mineral free, organism free water, you need sterile distilled; if just mineral free, distilled.

Sterile or Sterilized Water – Water that meets the requirements under “Sterility Tests” in the United States Pharmacopeia.

Distilled Water – Water that is demineralized by distillation and complies with the requirements for purified water set forth in the United States Pharmacopeia

DM water - Water that is demineralized by distillation, deionization, or reverse osmosis and complies with the requirements for purified water set forth in the United States Pharmacopeia

Information on Purified and Distilled Water

Purified water is water that is mechanically filtered or processed to be cleaned for consumption. Distilled water and deionized (DI) water have been the most common forms of purified water, but water can also be purified by other processes including reverse osmosiscarbon filtrationmicrofiltrationultrafiltrationultraviolet oxidation, or electrodialysis. In recent decades, a combination of the above processes have come into use to produce water of such high purity that its trace contaminants are measured in parts per billion (ppb) or parts per trillion (ppt). Purified water has many uses, largely in science and engineering laboratories and industries, and is produced in a range of purities.

Purified water in colloquial English can also refer to water which has been treated (“rendered potable”) to neutralize, but not necessarily remove contaminants considered harmful to humans or animals.

Distilled water is produced by a process of distillation and has an electrical conductivity of not more than 10 µS/cm and total dissolved solids of less than 10 mg/litre.

Distillation involves boiling the water and then condensing the vapour into a clean container, leaving solid contaminants behind. Distillation produces very pure water. A white or yellowish mineral scale is left in the distillation apparatus, which requires regular cleaning.

Distillation alone does not guarantee the absence of bacteria in drinking water unless containers are also sterilized. For many procedures more economical alternatives are available such as deionized water and, is used in place of distilled water Purification methods

Double distillation
Double-distilled water (abbreviated “ddH2O”, “Bidest. water” or “DDW”) is prepared by double distillation of water. Historically, it was the de facto standard for highly purified laboratory water for biochemistry and, by the method of trace analysis until combination methods of purification became widespread.

Deionization
Deionized water, also known as demineralized water[2] (DI water, DIW or de-ionized water), is water that has had its mineral ions removed, such as cations from sodiumcalcium,iron, and copper, and anions such as chloride and sulfate. Deionization is a chemical process which uses specially manufactured ion-exchange resins which exchange hydrogen ion and hydroxide ion for dissolved minerals, which then recombine to form water. Because the majority of water impurities are dissolved salts, deionization produces a high purity water that is generally similar to distilled water, and this process is quick and without scale buildup.

However, deionization does not significantly remove uncharged organic molecules, viruses or bacteria, except by incidental trapping in the resin. Specially made strong base anion resins can remove Gram-negative bacteria. Deionization can be done continuously and inexpensively using electrodeionization.

Electrodeionization (EDI) is usually considered a water treatment technology that utilizes an electrode to ionize water molecules and separate dissolved ions (impurities) from water. It differs from other water purification technologies in that it is done without the use of chemical treatments and is usually a tertiary treatment to reverse osmosis (RO)

Applications
An important application for electrodeionization is the production of pure water and ultrapure water. In EDI, the purifying compartments and sometimes the concentrating compartments of the electrodialysis stack are filled with ion exchange resin. When fed with low TDS feed (e.g., feed purified by RO), the product can reach very high purity levels (e.g., 18 Megohms/cm[1]). The ion exchange resins act to retain the ions, allowing these to be transported across the ion exchange membranes. The main usage of EDI technology such as that supplied by Ionpure and SnowPure are in electronics, pharmaceutical, and power generation applications.

Other processes
Other processes are also used to purify water, including reverse osmosiscarbon filtration, microporous filtration, ultrafiltration, ultraviolet oxidation, or electrodialysis. These are used in place of, or in addition to the processes listed above. Processes rendering water potable but not necessarily closer to being pure H2O / hydroxide + hydronium ions include use of dilute sodium hypochlorite, mixed-oxidants (electro-catalyzed H2O + NaCl), and iodine; See discussion regarding potable water treatments under “Health effects” below.

Purified water is suitable for many applications, including autoclaves, hand-pieces, laboratory testing, laser cutting, and automotive use.[3] Purification removes contaminants which may interfere with processes, or leave residues upon evaporation. Although water is generally considered to be a good electrical conductor—for example domestic electrical systems are considered particularly hazardous to people if they may be in contact with wet surfaces—pure water is a poor conductor. Conductivity of sea-water is typically 5 S/m,[4]drinking water is typically in the range of 5-50 mS/m, while highly purified water can be as low as 5.5 μS/m, a ratio of about 1,000,000:1,000:1.

Laboratory use
Technical standards on water quality have been established by a number of professional organizations, including the American Chemical Society (ACS), ASTM International, the U.S. National Committee for Clinical Laboratory Standards (NCCLS) which is now CLSI, and the U.S. Pharmacopeia (USP). The ASTM, NCCLS, and ISO 3696 or theInternational Organization for Standardization classify purified water into Grade 1–3 or Types I–IV depending upon the level of purity. These organizations have similar, although not identical, parameters for highly purified water.

Regardless of which organization’s water quality norm is used, even Type I water may require further purification depending upon the specific laboratory application. For example, water that is being used for molecular-biology experiments needs to be DNase or RNase-free, which requires special additional treatment or functional testing. Water for microbiology experiments needs to be completely sterile, which is usually accomplished by autoclaving. Water used to analyze trace metals may require elimination of trace metals to a standard beyond that of the Type I water norm.

Non-laboratory uses

Distilled or deionized water is commonly used to top up lead-acid batteries used in cars and trucks and for other applications. The presence of foreign ions commonly found in tap water will drastically shorten the lifespan of a lead-acid battery.

Using deionised or distilled water in appliances which evaporate water, such as steam irons and humidifiers, can reduce the build-up of mineral scale, which shortens appliance life. Some appliance manufacturers say that deionised water is no longer necessary.[9][10]

Purified water is used in freshwater and marine aquariums. Since it does not contain impurities such as copper and chlorine, it helps to keeps fish free from diseases, and avoids the build-up of algae on aquarium plants due to its lack of phosphate and silicate. Deionized water should be re-mineralized before use in aquaria, since it lacks many macro- and micro-nutrients needed by plants and fish.

Distilled water can be used in PC watercooling systems and Laser Marking Systems. The lack of impurity in the water means that the system stays clean and prevents a build up of bacteria and algae.

Distilled or purified water is used in humidors to reduce cigars from collecting bacteriamold, and contaminants. And to prevent residue from forming on the humidifier material.

Health effects of drinking purified water

Distillation removes all minerals from water, and the membrane methods of reverse osmosis and nanofiltration remove most, or virtually all, minerals. This results in demineralized water which has not been proven to be healthier than drinking water.[citation needed] The World Health Organization investigated the health effects of demineralized water in 1980, and its experiments in humans found that demineralized water increased diuresis and the elimination of electrolytes, with decreased serum potassium concentration. Magnesium, calcium and other nutrients in water can help to protect against nutritional deficiency. Demineralized water may also increase the risk from toxic metals because it more readily absorbs them, and because the presence of calcium and magnesium in water can prevent absorption of lead and cadmium. Recommendations for magnesium have been put at a minimum of 10 mg/L with 20–30 mg/L optimum; for calcium a 20 mg/L minimum and a 40–80 mg/L optimum, and a total water hardness (adding magnesium and calcium) of 2–4 mmol/L. At water hardness above 5 mmol/L, higher incidence of gallstones, kidney stones, urinary stones, arthrosis, and arthropathies have been observed. For fluoride the concentration recommended for dental health is 0.5–1.0 mg/L, with a maximum guideline value of 1.5 mg/L to avoid

Water filtration devices are becoming increasingly common in households. Most of these devices do not distill water, though there continues to be an increase in consumer-oriented water distillers and reverse osmosis machines being sold and used.

Municipal water supplies often add or have trace impurities at levels which are regulated to be safe for consumption. Much of these additional impurities, such as volatile organic compoundsfluoride, and an estimated 75,000+ other chemical compounds[17][18][19] are not removed through conventional filtration; however, distillation and reverse osmosis eliminate nearly all of these impurities.

The drinking of purified water as a replacement of drinking water has been both advocated and discouraged for health reasons. Purified water lacks minerals and ions such as calcium that play key roles in biological functions such as in nervous system homeostasis, and are normally found in potable water. The lack of naturally-occurring minerals in distilled water has raised some concerns. The Journal of General Internal Medicine[20] published a study on the mineral contents of different waters available in the US.

The study found that “drinking water sources available to North Americans may contain high levels of calciummagnesium, and sodium and may provide clinically important portions of the recommended dietary intake of these minerals”. It encouraged people to “check the mineral content of their drinking water, whether tap or bottled, and choose water most appropriate for their needs”. Since distilled water is devoid of minerals, supplemental mineral intake through diet is needed to maintain proper health.

The consumption of “hard” water (water with minerals) is associated with beneficial cardiovascular effects. As noted in the American Journal of Epidemiology, consumption of hard drinking water is negatively correlated with atherosclerotic heart disease.[21]

You can consult Health Canada’s Website at www.hc-sc.gc.ca/ewh-semt/water-eau/index_e.html which describes activities related to Canadian drinking water quality.

You can check the Web site of NSF International at www.nsf.org for information about health-based performance standard related to drinking water treatment units. NSF also lists certified systems.

The Canadian Water Quality Association is an industry source of information for drinking water treatment units, and can be found at www.cwqa.com.

A Call to Arms

Hello there fellow tattooist and/or shop owner,

This letter is a bit of a call to arms. The Ontario Tattoo Association (OTA) has been formed with the intention of working with the various municipal governments (in co-operation and with vigilance) on proposed licensing systems for tattooing.  The initial push has been in the GTA, but this concerns artists from all over the province, as it is just a matter of time before similar proposals pop up in the majority of municipalities.  We all recognize that normally tattooists are fiercely independent.  The way that the OTA looks at it, is that there is strength in numbers.  If we, the tattooists affected, want to have our voice heard then it should be strong, large and unified.  We have already started to work alongside Toronto Public Health in a co-operative but steadfast way; agreeing where we agree, and strongly disagreeing when we do not.

We urge you to check out the OTA and check this website regularly for updates on how this licensing proposal is progressing.

Here you will find a mission statement for the organization, an open letter to the industry outlining the proposed legislation regarding the operation of Personal Service Settings, a long list of public health standards and guides on infection control, and a list of members within the association.  We invite you to join that list.

We are changing up the website in order to serve the community better. Let’s face it, this takes time, resources and money. We are looking for individuals that can donate their skills in website/social media, promotion, fundraising, writing articles, volunteers, persons with medical accreditation of any kind, to help the cause.  At the moment the website is in the beginning stages so please overlook its lack of pizazz. Currently the  webspace has been sponsored by Tattoos.com.

Thank you for your time and input,

The Greater Toronto Tattoo Association
www.torontotattoo.com
The Ontario Tattoo Association
www.ontariotattoo.com