In the first of a two-part series, NSF-International award winner Annabel Caine talks to Nick Warburton about the UK body piercing industry and why raising health and safety standards is so important

It is 15 months since the Environmental Health Journal first reported on the potential health hazards of body piercing (EHJ, October 1999, page 316). Its popularity is far from on the wane as images of attractive, pierced, young pop stars, models and actors flood the popular media. However, while concern about the health implications of this trade has led to a flurry of research in recent years, it is questionable as to whether this has prompted local authorities to take any real action with regard to regulating this potentially dangerous activity.

If you were considering having a body piercing, you would not have to look very far. Permanent body piercing parlours are located on many high streets, and mobile units can often be found at festivals and rock concerts. Neither is the cost beyond the reach of most consumers, notably fashion-conscious young adults. Considering the potential health hazards relating to this industry, it is perhaps surprising that under present legislation, only ear piercing is subject to legal controls on a nation-wide basis. Cosmetic piercing, such as navel, eyebrow and tongue remain unregulated, except in London, where practitioners are covered by the London Local Authorities Act 1991.

For EHOs like Annabel Caine, who works at East Herts DC, the main method of control is the Local Government (Miscellaneous Provisions) Act 1982, which only allows local authorities to impose conditions on tattooing, acupuncture, ear piercing and electrolysis. Last September, Annabel won an NSF-International Award for her research proposal on body piercing. As part of her research, she is investigating suitable training for operatives in the UK and standards to assist regulators in judging the competence of piercers. In May, she plans to travel to the US for a four-week sabbatical to compare and contrast the American and British systems.

She says that her interest in the subject stems from a complaint received on an underage piercing. "I was interested to find out what other local authorities were doing and whether the police got involved because it could be assault of a minor," she says. The interest sparked by the case led her to attend a seminar last year and the ideas she came away with prompted her to propose a study on the subject. When Annabel approached her chief officer about applying for the NSF-sponsored sabbatical, they both agreed that body piercing would be a topical issue to cover. Before she travels to the US, Annabel will spend a day with an operative in a London borough to see how the body piercer's service is arranged and how it is regulated and enforced by the local authority.

In fact, inconsistency among local authorities remains one of the main stumbling blocks to cracking down on poor practice in the industry. This is partially due to the fact that there are no national guidelines with which to assess practices and no recognised qualifications for operatives. Annabel also argues that the inconsistency in standards stems from a lack of research and training among local authorities. EHOs only deal with cases when they do inspections and often are not qualified to identify incorrect procedures.

From her research, Annabel cites examples of bad practice, such as operatives not using autoclaves to sterilise equipment prior to use or reusing needles. She also claims that customers are putting their health at risk by agreeing to treatment which is not safe: "There is a piece of skin under your tongue which holds the muscle down and if that stretches to the end of the tongue, you should not have your tongue pierced. However, what a lot of operatives are doing is piercing to either side and they shouldn't be doing that."

Professor Norman D Noah, from the Department of Public Health and Epidemiology recently sent all local authorities guidance on correct piercing procedures and other related matters, including information on proper healing methods, the use of autoclaves, and how to prevent the transmission of infections. Annabel believes such guidance is invaluable as "it helps EHOs to look out for specific things when doing inspections."

Annabel has formulated her own guidelines (using Dr Noah's advice and information she gathered from the seminar) for new operatives in East Herts DC. Her notes lay down basic principles that operatives must consider when establishing a service, and advise them on the regulating bodies they are required to contact and any legal matters they must observe. One area that she is particularly concerned about, which has not been properly documented, is the wide-scale use of anaesthetics. She says: "I went to see someone recently and he had xylocaine on the premises and he wouldn't tell me where he got it from. It is a prescription-only medicine and should only be administered by someone who knows what they are doing."
She is aware however, that operatives may not always be at fault and cites a case last January in which a 39-year old woman died of septicaemia of the blood following her 118th piercing. "She was pierced properly and had been given the necessary information, but doctor's evidence at the inquest suggested a lack of treatment to the wounds caused the infection."

Annabel thinks that the body piercing community is generally supportive towards improvements and is "in favour of a regulatory system and some clarification of standards that would assist with public safety."
The fact remains however, that the wide-scale availability of inappropriate training courses and educational aids has the potential to increase health risks. "What really worries me is that nobody has really looked at operative training," argues Annabel. "I'd like to focus on how well-trained people should be." At present, would-be-operatives can purchase training videos (bought over the Internet) and attend a short training course (which can cost up to £5000), after which many will consider themselves to be suitably qualified.

From her initial research on the US system, Annabel believes that certain practices should be encouraged here. The Georgia-based Association of Professional Piercers (APP), the only governing body in the world, recommends a 12-month training course and has set standard guidelines for operatives. Although there is no legal requirement for operatives to follow these guidelines, they would, if adopted, encourage consistency nation-wide.

Later this year, Annabel will look at how some US states regulate the body piercing industry and what enforcement measures are implemented for bad practices. EHJ will report on her findings and see whether anything can be learnt from the American experience.

The Barbour Index and the CIEH currently run a consultation web site, which offers a code of practice on a range of treatments.
The site can be found at:
www.safetypeople.co.uk/consult.htm

The APP's web site can be accessed at: www.safepiercing.com/