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Self expression or threat of infection?
What's an IP to do about tattoos, piercings, flip-flops
By Patti Grant, RN, BSN, MS, CIC,
Infection Preventionist, Dallas, TX
Body art visible tattoos, nose/lip/eyebrow/tongue piercings or even the dreaded open-toe/heel shoe or sandal, can arouse surprising passion in health care. Over the years I've heard variations of the comments below, be they factual or not, invariably ending with: "Can't you do anything about this?"
Who wants to look at those ugly un-pedicured toes? Feet are dirty!
Surely a nose piercing is an infection control problem What's in the literature?
How can a pierced eyebrow, tongue, or lip not be an infection control issue?
Everybody knows getting a tattoo is a high risk for hepatitis ... what will the patient think?
At the other end of the spectrum are the owners of the tattoos, piercings, and sandals, passionately expressing their right to individuality, cultural and/or religious convictions. Similar to other controversial issues in health care there are two-sides to most topics and the science isn't always rock solid.
Can feet have fungal infection or an odor? Do tattoos and piercings offend? If so, who are the offended parties? Consider these potential nightmare discussions with staff after making any of the above personal expression topics strictly an infection prevention and control (IP&C) directive. I don't know about you, but some of these comeback statements contain a degree of logic and I'd be hard pressed to argue them solely based on science.
IP&C Rationale: Open toe/heel shoes are a safety hazard for falls and/or blood and body fluid exposures. Comeback: I don't take care of patients so why can't I wear sandals? My feet are attractive ... "I don't have a fungal infection ... We don't take care of patients with our feet ... I am more likely to slip on water or trip on that carpet."
IP&C Rationale: Tattoos are not permitted because of higher risk for bloodborne pathogen disease and/or broken skin barrier that increases risk for infection at work Comeback: "My tattoo artist is licensed by the state and follows good infection control ... Once my tattoo has healed my skin is just as intact as anybody's."
IP&C Rationale: Visible body piercings beyond the traditional ear-piercing are not acceptable because bacteria collect around the insertion sites and are difficult to clean. Comeback: "Since when do we care for patients with our eyebrows, nose, lips or tongues? As long as I don't have an active infection and I clean my hands right before patient care what does it matter what is pierced on me?"
And that's the way it is
Too often saying 'because that's the way it is' is not good enough unless it is reflective of the professionalism required by the health care facility. So what are your options as the infection preventionist? These matters can have infection prevention and control implications given the right circumstance; however, accept upfront that most of these topics should be grounded in corporate culture and/or administrative dress code, and not be pulled into a scientific-driven battle that may not prevail.
With rare exception most of these personal expression subjects are no different at a health care facility than wearing an inappropriate slogan tee-shirt, short-shorts/skirts, or dirty clothes with holes. So why are these topics treated differently and IP&C sought as the scape goat? They should not there is a time and place for most everything yet not in the workplace. Occupational Safety and Health Administration mandates aside, body art and open toe/heel shoes are rulings that belong in the dress code policy and not forbidden based on infection prevention rationale alone.
Even the strong recommendation for not using any form of artificial or nail extender and keeping nails short to enhance hand hygiene belongs with the house-wide dress code and should not reside only with the hand hygiene policy. IPs are not the nail police, but provide the science to help management to enforce compliance and are strong partners with administration. Save your sword to draw a line in the sand with a topic other than professional dress and personal expression. Appearance is subjective and should be addressed in human resource policies enforced by front-line management.