Infection control practices among tattooists and body piercers in Sydney, Australia Aurmporn Oberdorfer, MD, M MedSc (Clinical Epidemiology), PhD Candidate, a John H. Wiggers, PhD, a,b Jenny Bowman, PhD, c and Christophe Lecathelinais, DESS de Mathe ´matiques Applique ´es b Newcastle, Australia Background: Tattooing and body piercing have a long history, and both have become increasingly fashionableworldwide. There is an association between tattooing/body piercing and hepatitis B and C infections. Method: We undertook an observational study to examine the prevalence and predictors of infection control practices among tattooists and body piercers in Sydney, Australia. Within each premise, data were obtained from owners/mangers and nominated staff completion of a knowledge and attitudes questionnaire, owner/manager demonstration of key infection control procedures, and an inspection of the premises. Results: Consent to participate was obtained in 41 of 44 premises (93.2%). A low proportion of owners/managers and staff gave the correct answer for the purpose of disinfection (52.8%/26.9%) and sterilization (50%/53.8%). About one third of owners/managers (38.8%) and 56% of staff reported that their infection control compliance could be improved. Approximately one quarter of owners/managers reported that the frequency of inspections was inadequate. Even though the majority of demonstration and inspection items were complied with, deficiencies were observed concerning washing of hands, wearing of gloves, and sterilization procedures. Conclusion: There is a continuing need to improve infection control performance among tattooists and body piercers. The effectiveness of intervention approaches designed to achieve this should be explored. (Am J Infect Control 2003;31:447-56.) Even though tattooing and piercing have a long history, 1,2 both have recently become increasingly fashionable worldwide. 2-4 Since the 1960s, several hepatitis B virus outbreaks have been reported world- wide from nonsterile tattooing procedures. 5,6 Evidence also has shown an association between hepatitis C virus infections and both tattooing and body pierc- ing. 7-10 Given the high cost of bloodborne disease 11-13 and the risk of disease transmission through cosmetic skin- penetration practices, 9,10,14 many countries have in- troduced infection control regulations/standards to prevent disease transmission. 15-18 In Australia, all states have developed such regulations. 19 Despite the existence of such regulations, a number of studies have reported low levels of compliance with infection control regulations among nonmedical skin- penetration operators. 20-25 Little has been reported on the characteristics of operators who are least likely to comply. Hellard et al 26 noted greater compliance and knowledge among body piercing establishments that operated primarily as body piercers and tattooists compared with those that performed these services as nonprimary business activities. Raymond et al 27 reported that tattooists with more than 10 years experience, those not trained by health officials, and those working in smaller studios had poorer infection control knowledge scores. From the School of Medical Practice and Population Health, Faculty of Health, University of Newcastle a ; Hunter Centre for Health Advance- ment, Wallsend b ; School of Behavioural Science, Faculty of Science, University of Newcastle. c This project was funded by a grant from the National Health and Medical Research Council and the New South Wales Department of Health (AIDS/Infectious Diseases). It forms part of the doctoral studies of Aurmporn (Peninnah) Oberdorfer, who was supported by a Royal Thai Scholarship and Faculty of Medicine, Chiangmai University. Reprint requests: John Wiggers, PhD, Hunter Centre for Health Advancement, Locked Bag 10, Wallsend 2287, NSW, Australia. Copyright ª 2003 by the Association for Professionals in Infection Control and Epidemiology, Inc. 0196-6553/2003/$30.00 + 0 doi:10.1016/S0196-6553(03)00082-8 447