In recent years, many tattoo and piercing businesses have come under new regulations involving the sterilization of equipment used in their daily operations. These regulations generally outline requirements for routine spore testing of the autoclaves, record keeping, and cleaning and packaging of sterilized items. This article focuses primarily on the theory of proper autoclave sterilization and common spore testing issues.
The Center for Disease Control has recognized the risk associated with the re-use of tattoo and piercing equipment, primarily the potential transmission of tuberculosis, hepatitis-B, and HIV virus through the use of non-sterile needles and equipment. Legislation has been passed in many states already, and we can expect the remaining states to fall under some type of regulation over the next few years. Some business owners may feel these regulations requiring routine autoclave spore testing is another unnecessary and costly governmental burden. In reality, it should be recognized as a valuable tool to help legitimize the safety of tattooing and piercing, and in the long run help the publics perception of thetattoo and piercing artists businesses.
Most new and existing studios look to the internet to find an autoclave. There is constant trading on Ebay of used autoclaves, and several new businesses have arisen dealing with nothing but the purchase, repair, and re-sale of used autoclaves. The problem with this is the deteriorating condition of the autoclave. These units are used in one studio for awhile, sold and shipped to another, and so on. Over time, the temperature gauges, pressure gauges, seals, timers, switching valves, and heating elements deteriorate and lose accuracy. So how do you know your autoclave is really sterilizing?
Spore strip testing is currently the method of choice to determine if you are achieving complete sterilization. A spore strip test is a biological challenge to the sterilization cycle and unit. A spore strip is a small piece of filter paper that is impregnated with thousands of bacterial spores typically of the genus Bacillus or Geobacillus. The most common in use today are Bacillus atrophaeus for dry heat sterilization, and Geobacillus stearothermophilus for autoclave steam sterilization. Think of a spore as a bacterium encapsulated in a resistant shell. Steam must first penetrate this shell before it can come in contact with and destroy the bacterium. Spores are harder to destroy by steam sterilization than the disease causing organisms listed above. If you destroy all the spores in a sterilizer run, you can be assured you also destroyed any blood-related pathogens that may have been on the sterilized instruments.
Typically, a set of spore strips are purchased from an independent testing laboratory through a mail-in program. Each week or month, a spore strip is placed in the sterilizer with a typical load and ran through the sterilization cycle. When the cycle is complete, the spore strip is mailed back to the testing laboratory for further analyses. Some spore test kits include a control strip. This is the same as the spore strip that was placed in the sterilizer, but this one is not sterilized. It is left out on the counter. The control strip is part of a quality control system that validates that the spores were viable prior to being placed in the sterilizer. If you consider that spore strips are mailed throughout the United States and subjected to different temperature, pressures, and environmental conditions, there is a possibility that the spores could have been damaged in shipment. The control strip should always test positive for growth and verifies that the spores were viable prior to sterilization. Many businesses opt to not use a control strip to save on cost. It currently is not a requirement in most states to use a control strip. But that may change someday. If a control strip isnt used, most testing laboratories maintain a stock of spore strips of the same lot number they have mailed out and use them for positive controls with each days testing. This doesnt quite simulate the degree of quality assurance you get when a control strip is used at the business site, but helps. It also validates that the test media used by the testing laboratory supports growth and is satisfactory for use in testing.
So how do you ensure that you pass a spore test? Make sure your sterilizer is achieving a minimum 121°C (250°F) for a minimum of 30 minutes. If youre using a vertical pressure cooker type sterilizer, try and vent out the cold air as the unit is warming up by opening the valve on top. When it approaches operating temperature, close the valve and start your timer when 121°C is achieved. The temperature must remain at 121°C or higher for the full 30 minutes, so always start your timer once you have reached sterilizing temperature and pressure. Most horizontal type autoclaves, like the Tuttnauer, Pelton & Crane, and Napco units include automated chamber venting in their cycle, so manual venting usually isnt necessary with these types. Also make sure you dont overload the sterilizer and your items are labeled and packaged correctly. Make sure you dont have any obvious steam leaks.
What do you do if you fail a spore test? The first thing is quarantine and re-sterilize any items that were ran through the run that failed. This is easy to do if you keep records of your sterilizer runs and have properly packaged and labeled the items sterilized. Perform any routine preventative maintenance on the unit. Check the seals and run a few runs and observe the cycle for proper temperature, pressure, and time. One check highly recommended for any used autoclave or for recurring spore test failures is to compare the autoclave temperature gauge against a maximum recording NIST (National Institute of Standards and Technology) thermometer. This will ensure you are achieving the temperature indicated on the gauge. Weve found temperature gauges on used autoclaves to vary by as much as 20 percent. NIST thermometers are sometimes hard to find and expensive to purchase. They can be rented fairly inexpensively athttp://www.shop.sporestriptesting.com . Once you have verified that your unit is working properly and have done an inspection and preventative maintenance, perform another spore test and send it to the lab. Wait on a passing spore test report before you use the sterilizer again for daily operations.
The author of this article, Tymn Combest, has over thirty years experience in microbiology and sterilization science and is the owner of Enviro-Tech Laboratories, Inc. in San Angelo, Texas. For questions related to this article or for spore strip testing services, the laboratory can be contacted at http://www.sporestriptesting.com, or toll free at 1.800.944.1302.
