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Biosecurity knowledge and practices among tattooists: the nurse's contribution


Karen Silva de SousaI, Elizabeth Rose Costa Martins II, Cristiane Maria Amorim CostaIII, Thelma SpindolaIV, Raquel Conceição de Almeida RamosVI, Agatha Soares de BarrosV

I Nursing Student. Nursing Faculty of the Rio de Janeiro State University. Rio de Janeiro, Brazil. E-mail:
II Nurse. PhD in Nursing. Associate Professor of the Nursing Faculty of the Rio de Janeiro State University. Brazil. E-mail:
III Nurse. PhD in Nursing. Associate Professor of the Nursing Faculty of the Rio de Janeiro State University. Brazil. E-mail:
IV Nurse. PhD in Nursing. Associate Professor of the Nursing Faculty of the Rio de Janeiro State University. Brazil. E-mail:
V Nurse. Master student in Nursing. Nursing Faculty of the Rio de Janeiro State University. Rio de Janeiro, Brazil. E-mail:
VI Nursing Student. Nursing Faculty of the Rio de Janeiro State University. Brazil. Email





Introduction: the study object is tattooists' knowledge of the protective measures necessary to the practice of tattooing, when handling biological material. Objectives: to describe tattoo artists' knowledge of biosafety directed to the procedure characteristic of their profession and analyze the applicability of this knowledge to maintaining client health. Method: this qualitative, descriptive study of 10 tattooists from two studios in Rio de Janeiro used semi-structured interviews and direct observation of the procedure, from March to May 2016, then applying content analysis to the declarations. Results: care was restricted to disposal and non-reuse of sharps; the approach is artistic to the detriment of biosafety principles. Conclusion: this points to a new area of work for nurses, where standardization of work processes is needed.

Keywords: Exposure to biological agents; tattooing; personal protection; nursing.




The study had as object the knowledge that tattooists have about the protective measures for handling biological material, such as the use of personal protective equipment (PPE) and methods of disinfection and sterilization, necessary for the practice of tattooing involving loss of tissue integrity.

According to the National Health Surveillance Agency1, the act of tattooing should be performed with sterile instruments in a specific location, with separation between reception, procedure and materials processing. All that is not disposable should be cleaned, disinfected and/or sterilized1.

The practice of a safe technique requires that biosecurity measures be adopted for the protection of both the client and the professional. For the client, the use sterilized and/or cleaned and disinfected material is needed, as well as the observation of the routing protocol to health services and guidance on the procedure; for the professional, there should be a proper place, clean and with enough material to perform the procedures1.

The motivation of this study came from the concern of the authors with this theme, since tattooist professionals deal not only with the loss of skin continuity of the client, but often with large lesions and consequent blood fluids. With the advent of frequent discussions and campaigns against the spread of diseases transmitted by blood among other forms of transmission, some questions arise: Do these professionals have knowledge on biosafety? Do they adopt biosecurity practices in their professional activity, protecting the client and themselves?

Currently, we observe the spread of the practice of tattooing the body among the most different social groups. This practice may signal the need that subjects have to be singular at the sight of others, especially in a time when differences tend to be extinguished2.

Considering these questions and the intent to clarify the object of study, emerged as objectives: to describe the knowledge that professional tattoo artists have about the biosafety related to procedures that are typical of their profession and to analyze the applicability of this knowledge to maintain the integrity of the client's health.

The relevance of this study comes from the lack of research on this subject and the consequent scarce knowledge of health professionals regarding the association between biosecurity and tattoos. The incentive to scientific production on this topic may benefit professional tattooists, as well as customers, indicating the safest ways for these workers and for the users of their services.



Biosecurity is defined as "a set of actions to prevent, control, mitigate or eliminate risks inherent to activities that may interfere or compromise the quality of life, human health and the environment"3:15. Therefore, it is understood that biosecurity covers actions that, in the case of this study, will prevent and eliminate the risk of contamination through biological materials.

Tattoos consist of inserting pigmentation by physical means in the dermal or sub-epidermal layer with a permanent result. This involves breaking natural barriers and may bring biological risks for both, the customer whose barrier is being broken, and the professional who is at risk of entering in contact with biological agents of the client1. To be protected against these risks and to prevent damage to health, it is necessary to adopt biosafety measures in the field of tattoos.

The planning of security actions for workers' health should be performed by technicians trained to perform the diagnose of situations and creating goals and objectives, including the workers in the process, in all its phases, to avoid resistance and to make the exchange of knowledge more applicable in the practice and to identify national legislation and existing programs that may fit this theme4.

Tattooists are self-employed professionals without training in health. This suggests that training by a healthcare professional should be provided to help them to know how to deal with the risks and biosecurity. This is a new possibility of action for nursing.

Among the duties of nurses are analysis of working conditions and of unhealthy factors and risks. Highlight must be given to: drawing up plans and programs for the promotion and protection of workers' health; studying work accidents and occupational diseases or not; training professionals in relation to protective equipment required to work; conducting health education programs, seeking to share knowledge and encouraging healthy habits to prevent accidents5.



This was an exploratory and descriptive study with qualitative approach. The project was submitted to the Research Ethics Committee of the Rio de Janeiro State University and approved under Opinion number 1455310.

The scenarios of the study were two tattoo studios in the west of Rio de Janeiro, chosen at random. Participants totaled 10 tattoo artists, with at least one year working in the area, to ensure some professional experience. The number of subjects was defined according to the method of saturation of discursive data.

The ethical and legal aspects of the Standards for Research with Human beings6 were assured to participants, to maintain respect, dignity, autonomy and ensuring that any possible damage was avoided.

Study participants received the Informed Consent form and were told that the research did not offer any reward for participation because it was a voluntary study and that they could withdraw at any time, with no risk or punishment. Anonymity was guaranteed. Thus, respondents were identified with the letter T (tattooist) followed by the number of the order of participation in the study: T1, T2, T3 and so forth.

A semi-structured interview that was recorded in an attempt to grasp the knowledge of the participants of the study on biosecurity practices applied by them was used as data collection instrument. Another method used was direct observation of the procedures performed in these studios in order to observe whether the data that had been collected in the interviews were being applied in practice. Field notes were made, first reporting the actions and thoughts of the participants and subsequently carrying out reflections. Observations occurred before the interviews in order to avoid contaminating the data. Data collection was conducted from March to May 2016.

With regard to the processing of statements, the path chosen was the content analysis7, in three phases: pre-analysis, material exploration and treatment of results, inference and interpretation. The thematic units were built to meet each goal. Two categories emerged: knowledge of professional tattooists about biosafety and biosecurity practices in the process of tattooing.



To better characterize the participants, an analysis of their personal and professional attributes was made. The profile found out men aged between 25 and 40 years and with complete high school, but there were isolated cases of higher levels, always directed to the area of ​​art. Regarding the profession, participants revealed that they have worked in with tattoos for 2 to 20 years without any kind of curse in the area. All are involved in other forms of art

Category 1 - Knowledge of professional tattooists on biosafety

Knowledge on biosecurity is necessary in this profession, as the artist handles the client's skin integrity, due to the frequent extensive lesions which are also called tattoos shutdown. The healing of these lesions is of paramount importance for the health of the client and for the good result of the tattoo. Occupational exposure to potentially contaminated biological materials in workplaces represents a serious risk to professionals. The Human Immunodeficiency Virus (HIV), Hepatitis B and C, and infectious agents are more routinely involved in injuries with sharp and cutting objects 8. Disease transmission may happen through work tools, from the professional to the client, from the client to the professional, and between clients9. It can be observed in the testimonies of the participants that the knowledge about the professional practice is acquired empirically, without considering the risks involved:

[...] erring always with the friends, as always, tattooing friends and learning and evolving, evolving [...] (T10)

And yet, the scientific knowledge is something that is not proper to this activity because this is related to primitive and tribal issues, as brought up several times in the speech of participants.

[...] there is a concern for health safety, but the truth is that it is a tribal act [...] We take care to do this today, but the root of tattooing remains tribal. (T6)

That is, these professionals, due to lack of scientific knowledge, are subject to numerous errors with possible serious consequences until they make it right, because they use empirical knowledge, knowledge acquired through trial and error. This even slows down the advancement of the profession.

This lack of scientific knowledge is justified by the fact that this profession comes from the tribal culture which does not use the modern science to guide its practices. However, the risks to which these indigenous groups are subjected when using a practice that often generates extensive lesions and sometimes in critical areas should take into account 9,10. The lack of knowledge among tribal people in relation to biosecurity does not make them immune to the inherent risks of negligence in this procedure.

The fact that there are no professional bodies to standardize the profession of tattoo artists nor specific training or qualification for the development of these activities contributes to the situation9.

The informal exchange of knowledge was brought by the participants, evidenced in the following speech:

[...] this is so, we go on playing with techniques, absorbing with one and other, some know more, others know less and we go on gaining something with them [...] (T3)

The importance given to artistic aspects at the expense of aspects relating to protection of health was also exposed by respondents:

[...] it is of no help to practice and make tattoos without studying. It is not only about tattooing, it is the study of the composition, the skin, the body's anatomy, how it will look like, and think about how it will look in 5, 6 years. (T8)

The predominant learning model in this environment is the master/apprentice model where the one who has more experience passes knowledge to the other who is less experienced10. As it can be also seen, artistic aspects come first when it comes to tattooing11 and this fact was explicit in the statements of the participants. Even when talking about study, this deals with the study of art, design; when it comes to anatomy, it is thinking about how that picture will adapt to the body and if that will affect the art. The specific risks for each part of the body are not mentioned.

Still, tattooists have been considered artists whose raw material is the skin and their experience is purely artistic. Judgments related to lack of knowledge on health protection are, thus, not applicable. This happens because despite courses on tattoo art are available, these are taught by experienced tattooists who no experience with studies in health, with some rare exceptions.

There is some awareness of the existence of risk, but this is contradictory, because irresponsible acts were often pointed out as highlighted in the following statements:

[...] the tattoo, this is an irresponsible business [...] risk is there all the time. (T9)

But, curiously, it is difficult to describe these risks. Here is the statement:

The contact with person's blood and so, and this involves a lot of things [...] to be a good tattoo artist does not only involve a beautiful work, but also there is the thing of security in terms of ... asepsis, too, and everything. (T3)

Another situation evidenced in interviews brings the comparison between tattoos and other skin lesions, but each interviewee compares with a skin lesion of different complexities.

It is just the person take care... It is [...] when you take a point, when you are with a point on the leg, do you go to the beach? (T5)

[...] I usually say that for children and learners: 'if you scratch your skin in a rosebush or a barbed wire and pass ink there, you will get a tattoo trace on your skin'. (T1)

Taking into account the difference in severity of these injuries and the respective care, used as a reference, one may notice the lack of knowledge and even awareness of the real depth of the lesion caused by the tattoo, as well as lack of awareness of their risks.

Category 2 - Biosecurity practices in the process of tattooing

The second category deals with biosecurity practices adopted by the participants in the process of tattooing. Whereas in some cases there are certain difficulties to put in practice what has been learned in theory, we tried to associate the knowledge of the tattooists with what is actually applied in their daily lives; it was observed in the field that they use biosecurity, especially sterilization measures and the use of disposables, only aimed at protecting against cross-infection; all reports refer to the use of sterile instruments, such as the following speeches:

[...] now I'm more rested about biosafety because the materials have evolved significantly and is now almost everything is disposable. (T7)

At first, everything was made of surgical steel. We would brush it, put it in the autoclave. But then this evolution came, this whole commotion, now everything is disposable because this represents security for the customer, do you understand? (T6)

That is, they know the risks of infection incurred by the discontinuity of the skin, but do not have scientific knowledge, as stated in the previous category. In their speeches they focus only sterilization measures and emphasize the use of disposables. There was only one tattoo artist who highlighted measures aimed at improving the hygiene in the procedure:

[...] we use a worktop saver that is to absorb the ink and even the paper is covered with plastic underneath, it keeps the ink, it does not let the paint drip if I drop the bung. [...] I pass plastic in the spray bottle to avoid contact with secretion and for not having to discard the bottle; I just throw the plastic away after the procedure, plastic on the clip-cord that connecting the machine to the source [...] (T2)

A previous study confirms the use of personal protective equipment, as 50% of professionals said they wear disposable gloves for each client. However, situations where disposable glove were reused were still observed, and also, 27.5% used disposable mask, 7.5% used apron and 2.5% used rubber gloves for cleaning instruments9.

The lack of knowledge and lack of the habit are some of the main reasons for neglect of standard precautions as verified in a study. However, despite not knowing how to explain the risks and/or the necessary care, it was observed that tattooists make use of certain protective measures such as washing the skin with water and antiseptic soap before and after performing the tattoo; they always work with the hair pulled back, avoid touching anything but the skin being tattooed with the gloved hand; exchange gloves whenever there is need to stop the work or to search for some materials; discard sharp and cutting objects in appropriate locations, which are collected by the surveillance, however, they do not recognize such care as protective measures12.

Biosecurity comprises measures of protection for both, the client and the professional13. However, it was observed that the professionals care for the customer, but they do not explain the self-care and the risks to themselves. In their speeches is clear that, besides the concern with the client's health, they try to secure that the act is safe. It is noteworthy that care with hygiene is considered as reinforcement against the prejudice towards this profession 11, as a tattoo artist emphasizes:

In terms of safety for the customer, do you understand? Even when, sometimes, you explain that this is surgical steel, which is washed and put in the autoclave. Thus, [with disposable] the customer feels more satisfied [...] (T1)

It was observed that there are professionals who care about health protection, but others do not. It was noticed that emphasis was given to explaining that making tattoos has risks like any other profession and these lines made evident that there is a lack of standardization of compliance with biosecurity principles. This is because participants mentioned very frequently that every tattoo artist works in a different way.

Each tattooist works in a way, some have excessive care, and others have not almost any care. (T4)

This situation becomes important when it comes to a profession that deals with human health. It should not be only at the discretion of the conscience of each one. It is noticeable, also, that some basic principles such as the use of PPE for tattooing are being overlooked by some professionals, and this may bring risks to customers.

It was also noted that professionals are not committed with the applicability of biosafety norms. Occupational safety actions should include workers at all stages, even bringing discomfort and resistance from some. There are also professionals who somehow believe in the use of biosafety in their practice4.

What the law actually tries to insert in tattoo studios, today, does not allow, for example, that studios have pictures because the frames collect dust [...] It is not a frame, dust that will ... that will actually change the tattoo in the world. (T4)

You see, a Japanese person doing tattoos that [...] that is the fifth child of a family of tattoo artists and he will be told for no longer use the ink, something like this [...]. It's like going to a stonemason and tell him that he can no longer use the trowel with which he works, because now he has to use the new, made of plastic or titanium or kryptonite. Do you understand? (T2)

The issue of involving workers in the formulation of new work standards is easily compared to the nursing service. It is like a technician with a long time in the profession who throughout his career has held bladder catheters, for example, in a given way, and then the nurse comes and says that the procedure is wrong, but the nurse does not explain why nor demonstrates the correct way. This warning will only generate conflict and discomfort, because it does not value continuing education. In this context, it is evident the need for problem-based education that may encourage more and more professionals to keep their knowledge and practices updated.

Continuing education is a strategy that may encourage the adoption of preventive measures to reduce the number of accidents with biological material among workers14.

In nursing service, biosafety is also the subject of discussion. In this case, professionals recognize the importance of these measures for the prevention of infections and occupational accidents; however, despite the knowledge, they still demonstrate neutrality and adopt these measures during labor activity with partially, reporting difficulties faced in the work routine15. This points to the importance of further studies on the subject.

Among the limitations of the study, there was a small contingent of subjects and data collection happened in a single season and in only two studios, which does not invalidate the exploratory character of the research.



The knowledge of tattoo artists about protective measures at handling biological material necessary to the practice of tattooing, involving loss of tissue integrity, were discussed in this study. It was observed that the knowledge of these professionals on biosafety incipient, with emphasis only on the correct disposal and reuse of sharp and cutting objects.

Despite the difficulty to measure and explain the risk inherent to the practice of this profession, tattoo artists realize its existence, but the concern with the art is what prevails. At many moments was seen that each professional acts in different ways, empirically, without worrying about standards or biosecurity protocols, creating risks for both the client and for the professional. It is necessary to standardize the procedure, even to make this craft to become consolidated as a profession.

Biosecurity actions in the work of tattooing may point a new area of ​​activity for nursing, as, among the skills of nurses, health education and training personnel regarding occupational health protection stand out.



1.Agência Nacional de Vigilância Sanitária (Br). Referência técnica para o funcionamento dos serviços de tatuagem e piercing. Brasília (DF): ANVISA; 2009.

2.Macedo S, Paravidini JLL, Próchno CCSC. Corpo e marca: tatuagem como forma de subjetivação. RevMal-Estar Subj. 2014; 14(1): 152-61.

3.Ministério da Saúde (Br). Organização Pan-americana de Saúde. Biossegurança em saúde: prioridades e estratégias de ação. Brasília (DF): Editora MS; 2010.

4.Marcos PAM. NR 32 - Sistema de gestão da segurança e saúde no trabalho: gerenciamento de riscos em serviços de saúde. 2ªed. São Paulo: LTr; 2012.

5.Associação Nacional de Enfermagem do Trabalho - ANENT [internet]. Competências do enfermeiro do trabalho: atribuições do enfermeiro do trabalho. [cited 2016 June 1]. Available from:

6.Ministério da Saúde (Br). Conselho Nacional de Saúde. Resolução n° 466 de 12 de dezembro de 2012. Diretrizes e Normas Reguladoras de Pesquisa Envolvendo Seres Humanos. Brasília (DF): CNS; 2012.

7.Bardin L. Análise de conteúdo. São Paulo: Edições 70;2011.

8.Ministério da Saúde (Br). Secretaria de Vigilância em Saúde Departamento de Vigilância em Saúde Ambiental e Saúde do Trabalhador. Exposição a Materiais Biológicos: Saúde do Trabalhador Protocolos de Complexidade Diferenciada. Brasília (DF): Editora MS; 2011.

9.Diniz AF, Matté GR. Procedimentos de biossegurança adotados por profissionais de serviços de embelezamento. Saude soc. 2013;22(3):751-9.

10.Ferreira DJV. Artesãos da pele: aprendendo a ser tatuador [master thesis]. Fortaleza (CE): Universidade Federal do Ceará; 2012.

11.Ferreira VS. Os ofícios de marcar o corpo. A realização profissional de um projecto identitário. Sociologia, problemas e práticas. 2008;58 (3):71-108.

12.Neves HCC, Souza ACS, Medeiros M, Munari DB, Ribeiro LCM, Tipple AFV. Safety of nursing staff and determinants of adherence to personal protective equipment. Rev Latino-Am Enfermagem. 2011; 19 (2):354-61.

13.Ministério do Trabalho e Emprego (Br). Norma regulamentadora 32: Segurança e saúde no trabalho em serviços de saúde. Brasília (DF): MTE; 2005.

14.Costa LP, Santos PR, Lapa ATL, Spindola T. Acidentes de trabalho com enfermeiros de clínica médica envolvendo material biológico. Rev enferm UERJ. 2015; 23(3):355-61.

15.Valle ARMC, Moura MEB, Nunes BMVT, Figueiredo MLF. A biossegurança sob o olhar de enfermeiros. Rev enferm UERJ. 2012; 20(3):361-7.

Direitos autorais 2016 Karen Silva de Sousa, Elizabeth Rose Costa Martins, Cristiane Maria Amorim Costa, Thelma Spindola, Raquel Conceição de Almeida Ramos, Agatha Soares de Barros

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