Tattoos and infections

I have an admission. I am tattooed. Twice. A small thing, but it’s pretty incredible at the visceral reactions I sometime receive when people find out. (They’re not in oft-seen areas under normal attire, but neither are they anywhere “naughty.”) I get head shakes and tongue-clucks from many of my elders; nose crinkles from folks of my own generation who simply think tattoos are unattractive (either on anyone, or on women specifically), or compliments from people who are inked themselves. I understand the range of reactions and hey, to each their own–I’m all for diversity of opinion. But what shouldn’t be compromised with the tattoo process is safety. The vast majority of tattoo studios and artists are very concerned about the safety of their clients, but there are always some bad apples to spoil the bunch. A new MMWR story shows one outcome of unsafe tattooing: serious infection.

In the new report, they summarize their investigation of six clusters of infections caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). 44 individuals (34 primary cases, 10 secondary cases) were affected between June 2004 and August 2005, receiving tattoos from 13 different artists in 3 states (including my home state of Ohio).

Luckily, most of the infections weren’t too serious, but 4 patients did develop bacteremia (bacteria in the bloodstream) and were hospitalized to be treated with IV antibiotics (vancomycin). When they looked at the pulsed-field gel electrophoresis (PFGE) patterns of a subset of the isolates, they were all found to be identical within each cluster, and matched a common CA-MRSA strain (USA300).

Not surprisingly, these could have been prevented; they cite “…use of nonsterile equipment and suboptimal infection-control practices…as potential causes of the infections.”

Although gloves were reportedly worn by all tattooists in four of the six clusters, adherence to other infection-control measures (e.g., changing gloves between clients and performing appropriate hand hygiene, skin antisepsis, and disinfection of equipment and surfaces) was not practiced…Five patients reported seeing lesions on the hands of tattooists that were consistent in description with MRSA skin infection, and one tattooist reported a pustule on his finger; however, no specimens from tattooists were cultured. All 13 primary patients in the first of the four Ohio clusters reported receiving their tattoos in public places (e.g., parks or private residences) from tattooists who used homemade tattooing equipment consisting of guitar-string tattoo needles and computer ink-jet printer cartridges for dye. The persons with secondary cases were exposed to persons with primary cases by direct contact because they were living in the same house or had close personal contact.

Not to be Ms. Obvious here, but a public service announcement: it’s not a brilliant idea to get permanent body art while sitting on a park bench, from a guy with lesions on their hands who uses a guitar string tattoo needle and takes his ink out of a printer cartridge.

Tattoos certainly aren’t for everyone. Some hate ‘em, some like them but the thought of a needle being repeatedly stuck in the skin isn’t all that appealing. But if you’re going to get one, do some research. Check out the studio. State laws vary as far as who oversees tattooing. As noted, “…under Ohio law, the operator of a tattoo establishment must ensure that tattooists follow standard infection-control procedures, are trained adequately, and have completed required first aid and bloodborne pathogen courses.” In Iowa, they’re under the Iowa Department of Health and must receive a permit and inspections, and are required to abide by the state’s defined tattoo procedures, but as far as I’m aware, they don’t have to take any kind of blood-borne pathogens training. Caveat emptor, but remember that it’s your body and your life you’re dealing with; not quite as easy as returning a malfunctioning TV.

Image from http://www.cdc.gov/mmwr/preview/mmwrhtml/figures/m524a3f.gif

Comments

  1. #1 Dave S.
    June 23, 2006

    Tara writes:

    I have an admission. I am tattooed. Twice. A small thing, but it’s pretty incredible at the visceral reactions I sometime receive when people find out. (They’re not in oft-seen areas under normal attire, but neither are they anywhere “naughty.”)

    Now we have to know what and where! I’m guessing flowers on the lower back and a unicorn on the left ankle.

    I don’t have any tats, but do have a couple nice scars.

  2. #2 BJN
    June 23, 2006

    What I don’t get about tats is how folks casually commit to an image that’s likely not very good art. Or worse it’s some lame logo. I’m an artist. I’ve seen some impressive tattoo art. But most of it is crap. I suppose fashion and modern tribalism play a bigger role in the tattoo trend than aesthetics.

    Admitting you have a couple of discrete tats is a little like admitting you secretly listen to Wayne Newton or you have a foot odor fetish. Everyone has their weird spot.

  3. #3 Blake Stacey
    June 23, 2006

    I don’t have any tattoos, but I have a lightning-bolt-shaped scar over my right eyebrow from a door that was closed in my face at the YMCA when I was about seven years old. Does that count?

  4. #4 Hank Barnes
    June 23, 2006

    Not to be a fuddy-duddy, but what happens to the tattoo when you reach Grandma status, say, in 2035 or so?

    When I was a kid tattoos were limited to military guys and bikers, but now everyone and their Momma has them.

    I have no opinion either way –but I am curious when the skin starts to get loose and wrinkly from old age, whether the tattoo causes any problems.

    HankB

    p.s. I was once stationed in Japan in the service, and we all got drunk and went to get tattoos, but I opted against getting one, much to the chagrin of my comrades.

  5. #5 Bill Thater
    June 23, 2006

    only 2?;-) i have several. and mine are more art than just tribal stuff. i was lucky and found n artest to do them who is lso a nurse. no infections at all.

  6. #6 wheatdogg
    June 23, 2006

    A local tat parlor here advertises “tattoos done while you wait.” Pretty clever slogan, I think.

    No tats on me, but I’m cool with other people having them. I have noticed an increasing trend among my students in the last several years. The small of the back, and either shoulderblade seem to be popular sites for the girls. (Don’t jump to conclusions here, folks. Our school has no dress code, so my seeing the tats is sometimes unavoidable.) Guys seem to be less forthcoming about theirs, perhaps because their locations are less, um, public, or because tattoos are now more a girl thing. (Comments from younger visitors?) The usual designs are elaborate swirly things. One girl had an Irish claddagh tatooed on her ankle, she being Irish-American.

    I have read about a grandmotherly type who had “Do not resuscitate” tattoed on her chest. More prosaic than dragons and boat anchors, but effective.

  7. #7 CK
    June 23, 2006

    I have a fair number of tattoos (though I’m working on only having one). However, I’ve never had a negative reaction to my tattoos. That said, though I have a fair number of them and they cover a substantial area, they’re all easily hidden with a t-shirt and a pair of shorts.

    That aside though, when it’s revealed that I am fairly thoroughly tattooed people are generally impressed, surprised, or otherwise respond well.

  8. #8 alphabitch
    June 23, 2006

    A young friend informs me that the small-of-the-back tattoos that all the girls are getting are called ‘tramp stamps.’ And yeah, you can usually see them pretty easily given what they wear nowadays.

    When I worked in orthopedics I noticed a lot of the old guys would look at each other’s tats and start asking questions about where/when they’d gotten them. It would usually start an epic WWII conversation. Every now & then we’d get a little old lady who’d been an army nurse or some such who had one. They didn’t seem troubled in the least by them. I like to picture a bunch of these elaborately tattooed kids some sixty years from now, sitting in the activity room at the nursing home between bingo and shuffleboard talking about their tats: “Yeah man, 1996, Lalapalooza, fuckin A!” & “Oh wow, Calvin & Hobbes — awesome!” etc.

  9. #9 David Harmon
    June 23, 2006

    Never mind “Grandma status” and wrinkles, as I understand it tattoos get all blurry and blue-black well before that point. (My stepfather has one like that from his Navy years, though admittedly he is a grandpa) When I see those tats across all those young girls’ backs, butts, etc., I imagine what they’ll look like when they’re my age. I doubt they’ll want to display them….

  10. #10 alphabitch
    June 23, 2006

    Well, I don’t think those of us without tats will be all that wild about showing a lot of skin when we’re little old ladies, either. I don’t think tattoos are any more (or less) unpleasant on little-old-lady skin than on little-old-man skin.

  11. #11 Brinstar
    June 23, 2006

    I read that getting them touched-up hurts more than getting it inked in the first instance. That kind of put me off…

  12. #12 David Harmon
    June 24, 2006

    Hey, I’ve seen plenty of seniors in bikinis. Forget “skin”, I figure they won’t want to show “stupid”! ;-)

  13. #13 Tara C. Smith
    June 26, 2006

    What I don’t get about tats is how folks casually commit to an image that’s likely not very good art. Or worse it’s some lame logo. I’m an artist. I’ve seen some impressive tattoo art. But most of it is crap.

    I agree. My first one is cutesy and while I still like it, artistically, yeah, it’s crap. My second was drawn by the artist, and IMO much, much better.

    Not to be a fuddy-duddy, but what happens to the tattoo when you reach Grandma status, say, in 2035 or so?

    Physically? They’re places that don’t wrinkle or sag that much, and again, that’s why they’re in places that are easily covered. If you’re asking if I’ll care what other people think of me as a senior citizen with tattoos, I can’t imagine my attitude will change much from my lack of concern about what people think of me as a 30-yr-old with tattoos.

    And as far as color, tattoo inks have greatly improved since my grandpa’s day. I got my first one 11 years ago and the only change is that the white ink is mostly gone (which they’d mentioned would happen, so no surprise there).

    A young friend informs me that the small-of-the-back tattoos that all the girls are getting are called ‘tramp stamps.’

    Saturday Night Live had a skit on that a few weeks ago, on soccer moms and their lower back tattoos. (Found it here).

  14. #14 KeithB
    June 26, 2006

    Last Time I gave blood, the Red Cross had changed the requirements so that folks who had been tatoo’d in certain states with fairly rigid controls, like California, were allowed to give blood.

  15. #15 William the Coroner
    June 27, 2006

    As a forensic pathologist, I’m quite interested in tattoos and body modification. I’ve found them to be quite helpful for purposes of identification. Kris Sperry of the Georgia Medical Examiner’s office has a very nice series of articles on tattoos. Not only Staph, but they’ve been associatied with syphilis, leprosy, TB, Hepatitis B, and others.

    BTW, a tattoo is cause for a one-year deferral for blood donation. KiethB is right, but having run a donor center I’d require a 12 year deferral after a tattoo to spare MY liability. Here’s the ARC rules:http://www.redcross.org/services/biomed/0,1082,0_557_,00.html

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