(Revised 22.03.17)
Preparation of premises:
The floor should be swept clean. Walls, floor, and tables in the piercing and aftercare area should be covered with plastic. The plastic should be secured with duct tape.
The handicap toilet on the ground floor should be marked as “Hand washing station for the crew” and be equipped with hand soap and paper towels.
The floor under the suspension points will be covered with dance mats secured with duct tape. Single use plastic on the floor will be used only for suspensions with high potential for bleeding.
Use of gloves:
Gloves must be used for “clean” procedures such as; tearing off paper towels, handling sterile equipment, piercing set-up, disinfection of unbroken skin, and marking of skin. Gloves must always be used for procedures where there is a risk of coming in contact with bio-hazardous matter such as: disinfection of broken skin (e.g., after shaving); piercing; cleaning of used piercing implements; disinfection of surfaces after piercing; aftercare of wounds; rigging and de-rigging; disinfection of used rigging equipment; disinfection and sealing of biohazard containers; and handling of all kinds of waste.
Hand washing:
Hands should be washed before and after every procedure.
Correct hand washing:
- Rinse hands and wrist in warm water.
- Apply one pump of hand soap.
- Lather and rub all surfaces of hands and forearms including between fingers, under and around fingernails for a minimum of 20 seconds.
- Rinse thoroughly with plenty of running warm water, keeping fingers pointed downwards.
- Pat dry with paper towels.
- Use paper towel or elbow to turn off water.
Disinfection:
Skin is disinfected with undiluted PurKlenz. The scrub should be thoroughly massaged into the skin for 30 seconds, and wiped from inside out in circular motion with sterile gauze.
Surfaces are disinfected with Optim wipes or Tri-Gene.
- Contact time for Bio hazard spillage: Tri-Gene: 30 minutes, Optim: 1 minute.
- Contact time for ‘clean’ surface: Tri-Gene: 10 minutes, Optim: 1 minute.
Note: Tri-Gene comes as a concentrate and should be diluted 1:10.
Hands are disinfected with Alcogel. The gel should be applied liberally and rubbed on both side of the hands, between fingers and around wrists. Should be left until it evaporates. Alcogel is not a substitute for hand washing.
Procedure in case of biohazard spillage on floors and furniture:
The contamination should be cleaned off with Optim wipes and the area should be disinfected with fresh Optim wipes and guarded during recommended contact time (1 minute)
Suspension points with single use plastic tarps: The entire piece of plastic should be discarded.
Procedure in case of biohazard spillage (on person):
On skin: The area should be washed thoroughly with hot water and hand soap for at least 30 seconds. Rinse thoroughly with lots of running water. Care should be taken to not contaminate sink and faucet. Ask for assistance if necessary. Disinfect sink with Optim after use.
In eyes: Rinse thoroughly with saline solution or running water for 10 minutes.
On clothing: Remove clothing in a manner that avoids infectious material getting in contact with skin or mucous membrane. Discard or seal in plastic bag marked “biohazard”.
Sorting and handling of waste:
Waste is sorted in six categories:
“Clean” waste (Non-contaminated waste such as gauze from unbroken skin disinfection, sterile wrapping, and gloves used for set-up, skin disinfection and marking):
- This waste is collected in black garbage bags and discarded in municipal general trash dumpsters.
Contaminated waste (Waste that has been in contact with bio-hazardous matter: gauze from broken skin disinfection, gloves, bibs, sterile wrapping and plastic sheets used in piercing; gloves, paper, gauze and rope used in rigging; gloves, apron, arm protection, mask, plastic and paper sheet, gauze and bandages used in aftercare):
- This waste is collected in yellow plastic containers marked with biohazard symbols that will be picked up and incinerated by Franzefoss. After sealing the lid, always disinfect the outside of the container.
Sharp waste (Toothpicks used for marking, needles used for piercing, razors, suture needles):
- These items are collected in small, round yellow plastic containers with red lids (“sharps box”). When the event is over the containers will be sealed and discarded in a big yellow container for bio-hazardous waste.
Paper and carton for recycling (Unused paper towels, paper wrapping, cartons).
This waste is collected in carton boxes and is discarded in municipal paper trash dumpsters.
Plastic (Contaminated plastic coming off the floor and plastic in general):
This waste is collected in blue bags for recycling.
Biodegradable (Food, peels, napkins, and other biodegradable waste):
This material is collected in green bags for recycling.
Storage and handling of sterile equipment:
Sterile equipment (needles, hooks, gauze, suture kits, skin staples and toothpicks) are pre-sterilized and packed in designated containers. These containers should be stored on top of the supplies table and should under no circumstances be put on the floor. Always wear clean gloves when handling the sterile packs.
Preparation for piercing:
Always don face mask and wash hands with soap before preparing for a new procedure. The bed should be covered with a plastic sheet. A plastic coated dental bib should be placed on the piercing tray, and the sterile packs should be placed on top of the bib. The person’s skin should be disinfected with PurKlenz for a minimum of 30 seconds and then wiped with clean gauze from the center outwards in circular motion of the disinfected area. The sterile pack with toothpicks should then be opened and a drop of Gentian Violet should be dropped inside of the plastic side of the packet or on a glove. A fresh pair of gloves should be donned for marking the piercing placements on the person’s skin. The toothpicks should be discarded in a yellow and red sharps box. The sterile packs containing the needles and hooks should be opened after marking to minimize airborne contamination. Needles and hooks should not be placed directly on the bib, the inside of the sterile wrapping should be used as a sterile field.
Piercing:
Always use fresh gloves for piercing. The use of a mask is mandatory and should be changed for each procedure. Only the sterile equipment that will be used for the piercing (sterile gauze, needles and hooks), and disinfected skin may be touched. If one touches any other surfaces during the course of the procedure, the gloves must be changed. The needle should be discarded in the sharps box immediately after the piercing. Under no circumstances should the needle be placed back on the piercing set-up area. Sharps containers should be taped/fixed to both sides of massage table for easy access.
Clean-up after piercing:
The dental bib, sterile wrapping, and plastic sheet should be discarded in the yellow container for bio-hazardous waste. The tray and the bed should be disinfected with Tri-Gene, and each marked with a ‘Disinfected’ sign. Hands should be disinfected with Alcogel or washed with soap.
Structural rigging:
An industrial span set (sling), set in a choke should be used for the top anchor of the structural rigging. If placed around an I-beam, this should be padded to avoid abrasion. The top pulley/block should be connected to the span set with an auto-locking carabiner. Screw lock carabiners should always be placed so the lock screws upwards to open, and only below the lower pulley/block. Always check that knots are properly tied and shackles tightened. Shackles should be finger tight, not with the use of tools.
Double-checking of structural rigging:
S/he who installs the structural rigging connects a red tag at the top (if the span set does not have a red tag installed). The rigging should then be checked by another rigger and marked with a green tag after it has been inspected and verified. Make sure the tags are connected in such a way that they are visible from the ground, and that they will not become entangled in the rigging. If you see a point missing a green tag; it should be checked. All points should be checked before the start of every new day during the event.
Suspension rigging:
Clean rig line should be burned off with a torch, not cut, in appropriate length and threaded onto the rig. When the rigging requires unknown lengths of rope, the spool must be kept away from potential contamination and the rig off of the floor. The rope should be connected to the hooks with shackles. The gloves are considered contaminated once the hooks have been touched, regardless of visible blood. One should avoid touching the rig after the hooks have been connected to the rope. Never touch the main rope or any other equipment with contaminated gloves. Always wear gloves when adjusting the rig line. All knots and shackles must be double-checked. For two-point suspensions the rig line should always be tied off at the rig, never to the hooks.
Containing bleeding during the suspension:
Each suspendee should have a designated “bio person” in charge of containing bleeding during the suspension. The bio person must wear gloves and be equipped with sterile gauze for wiping. In suspensions involving more than one suspendee, each suspendee must have his/her own bio person to avoid cross contamination. Running blood should be wiped from the bottom and towards the hook. Avoid wiping closer than 1 cm from the hook. Extra attention must be paid at touch down! When the suspension is over, the bio person will escort the suspendee to the aftercare area. In case of excessive bleeding aftercare should be performed on the spot.
De-rigging:
When the suspension is over, the shackles between hooks and rope should be removed first. The used shackles should be disposed of in large yellow and red sharps container marked “shackles”.
The rope should be cut as close to the rig as possible, and discarded in a biohazard waste container.
The rig should be disinfected with Optim and marked with a ‘Disinfected’ sign. The floor should be inspected for blood splatter.
Aftercare:
Both the “Clean Hands” and “Dirty Person” person to perform aftercare should wash hands before the procedure.
Complete Personal Protection Equipment (PPE) is mandatory when hooks are removed and air is massaged out from under the skin: apron, mask with eye protection, plastic sleeves, and a double set of gloves should be donned. The bed/chair must be covered with plastic and paper sheet.
Aftercare should be given by at least one person in PPE (“Dirty Person”), and one assistant (“Clean Hands”).
The Clean Hands should first lay out a dental bib to use as a working surface, then don a pair of gloves and open a pack of sterile gauze and place it onto the suspendee, or bed, without touching him/her. Then s/he should lay out the dry supplies that will be needed for the procedure (sterile gauze and bandages) onto the bib. After the supplies are ready for use, the clean person should prepare some Optim wipes for cleaning hooks.
The hooks are removed by the Dirty Person, and handed to the Clean Hands to be wiped clean with Optim before they are put in a container for contaminated equipment.
Note: each hook type has its designated container!
When all hooks are wiped and put away, the clean person will remove his/her contaminated gloves, disinfect their hands with alcogel, and don one glove. After this, the clean person should not touch anything contaminated, but deliver clean items to the Dirty Person. Care should be taken that the Dirty Person does not contaminate the clean person.
The gloved hand should be used to touch things that might get in contact with the suspendee’s wounds, i.e., open gauze and open bandages.
The un-gloved hand should be used to touch bottles and the outside of packets, such as sterile gauze and bandages. If the clean person needs to use the gloved hand to open packets, a new glove must be donned to handle the clean object.
Sterile gauze should be placed over the holes when the air is massaged out to avoid blood splatter. The skin needs to be cleaned thoroughly with gauze and Hydrogen Peroxide, and left to dry before the wounds are bandaged. The Dirty Person should remove their outer set of gloves so as to have clean gloves for bandaging.
The remaining PPE should be removed in a manner that minimizes the risk of cross-contamination: first the apron, the sleeves, and finally the inner pair of gloves. The mask should be removed only by touching the strings at the back of the head. The bed should be disinfected with Tri-Gene on a paper towel or Optim wipes, and marked with a ‘Disinfected’ sign.
All people involved in aftercare must wash hands after the procedure!
Handling of contaminated equipment:
The containers with contaminated equipment should be sealed, placed in a cardboard box marked “Bio Hazard”, and safely transported to a piercing shop where they will be cleaned, disinfected, run in ultra sonic, rinsed, bulk sterilized in an autoclave, inspected, and then be packed in sterilization pouches and sterilized in an autoclave. The sterile equipment will then be stored in designated containers.
Needlestick procedure:
- Remain calm!
- Let the people around you know what’s happened, have someone take over your position if necessary.
- Ask for assistance.
- Carefully remove gloves, making sure to avoid blood spillage.
- Wash the area thoroughly with soap for a minimum of 1 minute.
- Disinfect sink and faucet with Optim after use.
- Discuss the probability of blood borne pathogen infection with other involved party; consider seeking immediate medical attention to minimize risk of infection.
- Check blood for infection ASAP, and then again after 3 and 6 months.