All About Masks

By Misty Forsberg, Empire Body Arts

Version française, cliquez ici.

Friday May 15, 2020

As studios begin to reopen, one hurdle that our industry will face is how to protect ourselves, our employees, and our clients from transmitting the COVID-19 virus to and from one another. Although our industry has the benefit of largely being aware of basic precautions and usage of personal protective equipment, we have generally only viewed these protections as a barrier between us and bloodborne pathogens and as a method of infection control within the wounds we create. 

Now, we must also take into consideration methods to reduce the risks of viral transmission in our studios as well. I will begin by saying that information is being released daily. The information here is based on studies that I was able to find, and they are listed below. For every study currently available, there seems to be another that refutes the same findings. This is only intended to provide some basic information that helps to aid in making the best choices for you and your studio. It is up to each of us to review new information as it becomes available, and use that to adapt to this new situation. 

*A quick note on filtration. Many of the masks and filters that are available or discussed in studies are tested at their ability to filter at 0.3 microns. This does not mean that they are unable to filter smaller particles. Rather, 0.3 microns is a standard of testing as it has been shown to be the most difficult size to filter, and therefore a weak point. Particles larger and smaller than this size have been shown to be easier for filtration. You can read and in depth study of that here:

https://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/20170005166.pdf

or an easier to digest breakdown of that information here:

https://smartairfilters.com/en/blog/what-is-pm0-3-why-important/

The second is from a company which produces filters, and obviously biased toward selling a product. However, it is much easier to read through. 

In order to look at protection, we first have to decide what we are protecting ourselves from. How is COVID-19 transmitted?

The CDC, WHO, and other health agencies have stated that the COVID-19 virus is to be largely transmitted through droplets exiting the nose or mouth when sneezing, coughing, or speaking. These droplets, although incredibly small, tend to settle more quickly due to their size and gravity, which somewhat limits the range they will travel. 

However, there are several studies that are not only finding evidence of smaller aerosolized particles containing the COVID-19 virus, but also finding that those particles can be transported through moving air from room to room. These small particles are of a size which can remain suspended for an extended amount of time in the air. They also seem to be produced even in the absence of coughing or sneezing, such as from talking or breathing, and viral loads have been shown to have some of their highest counts just prior to and at the onset of symptoms. These particles have been shown to settle on personal items of the individuals infected, with one study testing the items within infected patients' rooms showing, “Overall, 76.5% of all personal items sampled were determined to be positive for SARS-CoV-2 by 25 PCR.” **PCR (polymerase chain reaction) refers to the method of testing. Positive results indicate viral genetic material of the Coronavirus (SARS-CoV-2) on material tested.

https://www.medrxiv.org/content/medrxiv/early/2020/03/26/2020.03.23.20039446.1.full.pdf

https://www.nejm.org/doi/full/10.1056/NEJMc2004973

Surfaces:

Understandably, our clients are not living within our piercing or tattoo room for the extended amount of time that these patients were. However, it is important to keep in mind that the items a client brings with them (purse, cell phone, jacket, etc) potentially could be carriers of the virus if the client is an asymptomatic carrier. It might be beneficial to have a designated wipeable area to place these items within your room or studio, and to ask clients not to place personal items on the counters or surfaces elsewhere throughout the studio. 

Likewise, limiting the access to shared seating such a waiting areas or disinfecting those areas between clients could prove useful to minimizing client to client transfer of the virus, should an asymptomatic client pass through your studio. 

Also worth considering with this study is that any of our personal items that are in an environment with clients in and out can potentially be contaminated. We should at very least keep the thought in the back of our minds that laptops, purses, keys, etc brought into the studio that return home with us could potentially transport the virus with us if not disinfected. 

Droplets and aerosolized particles

This area is the bigger piece of the puzzle. For the sake of looking at the most realistic approaches, I am going to assume that many of us do not have access to N95 masks due to supply shortages and the requests of the medical community that they be reserved for use within the medical field. With that, we are mostly limited to two options: basic medical masks or homemade cloth masks of various materials. The latter of which our clients are very likely to be wearing when they come to our studios. 

Many studies looking at the effectiveness of homemade and surgical masks test only the ability to protect the wearer, and only with a perfect seal on the testing device. In reality, outside of a fitted N95 mask, surgical and homemade masks tend to have small air gaps around the sides of the face and possibly at the sides of the nose when not made with an adjustable bridge. In one study, which was one of the few I found that attempted to replicate air gaps in masks (which is more realistic to most masks that are not a fitted N95), mask filtration for both surgical and homemade masks was shown to drop around 60% if there are gaps present. Although this isn't great news, it did find that surgical masks without gaps filtered around 75-99% of particles, and with gaps about 45-55% of particles depending on size. 

With homemade masks, material changes the efficacy of the mask greatly. Many studies seem to be showing that high thread count cotton is superior to lower count fabric choices, and combinations that 'sandwich' a layer of material with higher static electricity (such as silk, chiffon, or flannel) between layers of high thread count cotton performed the best. The results from a poorly fitting mask were similar. For example, a cotton/silk combination showed 94-98% filtration without gaps, but only 32-37% filtration with gaps. Many studies also seem to agree that lower thread count cotton and other loosely woven materials tend to be fairly ineffective at filtration of particles. Although much of our protocol and PPE usage might be difficult for us to share with our clients in an easy to understand manner, mask fit and material selection could be one area we can consider discussing with them that helps protect our studio, as well as offering a bit of information that could be useful outside of that as well. Along with that, client information that addresses not touching or adjusting your mask, especially while in the studio, could be beneficial as well. 

*The gap used is ∼1% of the active mask surface area, created by drilling holes in the testing tube around where the material was fitted to replicate gaps along the face. 

https://pubs.acs.org/doi/10.1021/acsnano.0c03252

Although the numbers vary greatly between studies, the information seems to agree with the recommendations that homemade masks should be a back up plan if surgical masks are unavailable. One interesting finding was that the addition of a nylon stocking over surgical or homemade masks showed, “The addition of a nylon stocking overlayer improved the removal efficiency for all loose-fitting masks, including commercial medical-type masks, by 15 to 50 percentage points and also decreased the time-based standard deviation (indicating more consistent particle removal)”. 

In surgical masks, this changed the filtration rate in their study from around 60% without the nylon stocking to around 85% with it. This change is likely due to the stocking creating a better seal over the mask, which could be an accessible addition for practitioners, with homemade or surgical masks. However, consideration of contamination will have to be taken when removing a stocking (as pictured below from this study) over the head for cleaning. Or, it could simply be cut away and disposed of each time. 

https://www.medrxiv.org/content/10.1101/2020.04.17.20069567v3.full.pdf

Our routines in mask changes will likely be adapted to this new environment as well. Where before, many likely changed masks between clients, in an environment where we are wearing masks throughout the entire studio rather than for only the potential of contamination directly during a procedure, now studios will need to address protocols on when mask changes happen and how. Wearing masks for longer amounts of time means taking into account that humid masks will have lower filtration capabilities, and mask changes will need to include a routine such as “handwashing – mask removal – handwashing – mask replacement”. 

An easy visual to see all of this through is the World Health Organizations “Chain of Transmission”.



Our goal is to look at this cycle of points of contraction and transmission and find where we can make a break in it. Any break in the cycle stops it. In an environment where there is no 100% break available, outside of isolation, we have to focus on where and how to bring the odds down as far as possible. 

No one mask, air filter, or other device on its own breaks the cycle. One agreement between virtually all studies is that hand hygiene, PPE selection, proper donning and removal of PPE, and a well planned protocol to bring everything together is key to more effective protection. 

Progressive Mentorship will continue to post information as this moves forward, but as always, we appreciate your input and feedback on news, developments, or questions. 

- Misty Forsberg




Post COVID-19 Body Art Pandemic Response Plan

Friday, May 8, 2020

We hope you’re all doing well as we can only imagine everyone’s mind is working overtime trying to navigate through this difficult time, and struggling to find answers regarding post COVID-19 protocols in the body art community. 

Hopefully the following will provide you some guidance for Tattoo Artists and Piercers moving forward. We’ve gathered some resources and put them together to form a suggested:

 “Body Art Pandemic Response Plan” 

We're still in the recording process of building an online, educational video series for studio owners and employees across Canada. These online seminars will include industry specific Infection Prevention and Control guidelines including studio set up, workplace set up and clean up, cross contamination, disinfection and sterilization, skin preparation, aftercare, troubleshooting, working safe within your workplace, proper use of PPE, hand washing and Bloodborne Pathogens training and COVID-19. 

We invite you to reach out to us for any further questions or insight. Please this information to anyone working within the body art community that may benefit from this information. 

Thank you, 

Jesse Villemaire & Efix Roy

705-242-6621

info@progressivementorship.com




Covid-19 Update

Wednesday, March 18, 2020

Wow, it’s crazy how much can change in a short period of time. We can only imagine how this COVID19 situation is affecting all of you, and as small business owners ourselves, our thoughts are with all of you through this tough time.

Unfortunately, due to the rapidly evolving changes and guidelines related to travel and gatherings in public places, we have made the decision to postpone upcoming Progressive Mentorship seminars. At this time, we are postponing all of our classes until the situation has become under control.

We will be in contact with you in the near future when we set new dates for the rescheduled seminars. If you’ve pre-paid for a seminar, your payment will be automatically transferred to the new date. If you can’t attend the new scheduled date, a full refund will be issued. 

If you have any further questions, please let us know. 

Stay safe and keep washing your hands!

Jesse Villemaire & Efix Roy

705-242-6621

info@progressivementorship.com




Health Canada warns about use of Gentian Violet

Friday, June 14, 2019

The following information was just forwarded to us from Ontario Public Health. This will result in products containing gentian violet becoming more difficult to find from our suppliers. It’ll be interesting to see how this will play out with markers, stencil paper etc. 

For piercers looking for an alternative method on how to mark the skin, we’d suggest using the back of the needle and put a little pressure dot on the skin prior to piercing. It only takes a few seconds to leave an imprint and doesn’t cause any discomfort for the client. It might be a technique you’d like to get used to just in case you can’t find a substitute. 

For tattoo artists using transfer paper, most will also contain crystallized gentian violet. There is red transfer paper but all we can find from S8tattoo is that it is a “proprietary blend of inks and waxes” which basically means they don’t have to tell you what it’s made of.

As always with news releases and public education, we have to look at how the public will perceive this information. Even if the amounts of gentian and the way we are using it are low risk, if the words “gentian violet” become associated with “cancer” there will be people less than comfortable having those products used on them.

More info HERE




New Ontario Infection Prevention and Control PSS guidelines

Thursday, November 29, 2018

Public Health Ontario has released the latest Infection Prevention and Control guidelines for Public Service Settings.  This document is to compliment the PSS regulations released earlier in the year.  Follow the link below to download your own copy. 

Keep an eye open for Progressive Mentorship offering IPAC and BBP seminars in your area to keep you and your staff up to date with our industry specific training seminars.  We also offer private in studio training.  Please contact us for rates and available upcoming dates.

According to the new guidelines: 

"Every PSS operator is to undertake any health and safety training related to PSS operation and maintenance, including training in relevant practices that can prevent or reduce the risk of disease transmission at the setting if required by the public health unit. [Chapter 2.4]" 

We look forward to seeing you in the near future!  






New Tattoo and Piercing Regulations 2018

Friday, April 27, 2018

Ontario has just released the new Personal Service Settings regulations that will go into effect July 1st 2018.  If you’ve taken a Progressive Mentorship seminar in the past you’ll probably not be too surprised with what you read in the link below.  Many of us practitioners are forward thinking and welcome change that’ll better the body art community.  

One addition that I see was implemented is the required industry specific continued education.  Many of you have taken our Progressive Mentorship seminars in the past and I hope you agree that it’s been beneficial for the well being of your clients and yourself.  We’ve all known of practitioners and studios that would benefit from our educational classes and now they may be required to attend in order to keep up themselves and their clients safer. 

“13. Every operator of a personal service setting shall undertake any health and safety training related to personal service setting operation and maintenance, including training in relevant practices that can prevent or reduce the risk of disease transmission at the setting if required by a medical officer of health or public health inspector to do so.”

Click HERE to review and download the upcoming regulations.  




What Regulations?

Friday, July 7, 2017

Last year I learned that Public Health Ontario (PHO) had a project on the go of revising the outdated “2009 Infection Prevention and Control Best Practices for Public Service Settings” in Ontario.  I was approached by a local public health inspector about potentially reviewing the draft and asking for my feedback.  As a piercer, studio owner and an instructor within the body art community, I happily obliged hoping that I may join other practitioners in playing a key part on reviewing the potential guidelines and implementing changes if needed.  As there are 36 separate regions across Ontario, each region following these guidelines, I was under the impression that numerous tattoo artists and piercers were partaking in this new development within each region.  I eventually learned this was not the case.  

When I actually learned of the project, it had already been completed and the rough draft was in the hands of 36 different regions.  Each region was asked to provide any minor revisions and to submit them to Public Health Ontario within a specific deadline.  I met up with a local public health inspector at this time and provider her my feedback.  Between the three piercers in my area, and her input, we submitted 16 pages of potential changes to be revised.  These changes could be anything from removing outdated information, re-wording, re-defining, challenging them to do more research in certain areas.  

All 36 regions had the opportunity to provide their revisions and concerns and I looked forward to hearing about the next step…but I heard nothing.  I thought many of us respectful tattooers and piercers would have been contacted considering it was a large revision for the Public Service Settings.  I’ve since learned that I haven’t been able to find any other practitioner that has spoken directly with Public Health Ontario in regards to these matters.  

After the revisions were submitted to Public Health Ontario in the Fall of 2016, no one, including many regional public health inspectors, have heard of anything since.  However the rumours have started within our industry that new regulations are about to be enforced.  This struck me as odd since I haven’t heard of anything yet and I decided to investigate a little.

I was recently invited to the Durham region Public Health Unit to present a class on “Guidance within the Body Art Community”.  Through my discussions with many public health units, the need for their updated information within our industry is long overdue.  For the first time ever they were looking for a class dedicated to helping them understand our industry/community more now than they have in the past.  I was excited to build a class using  Progressive Mentorship as a platform to hopefully present some much needed information to inspectors to help make our inspections a lot less frustrating for both parties.  They admit that they’re nervous and intimated to walk into our studios with the limited knowledge that they have about the body art world and I was on the mission to help them, so in turn, they can help us.  

The class was a success with 60 inspectors showing up representing over 7 different regions.  Representatives from Public Health Ontario even showed up, as well as one individual from the Ministry of Health Ontario.  It was quite a turn out and I now had a platform to voice some of my concerns about these apparent new regulations that no one has even seen or heard of within our own industry.  

On our lunch break I started questioning the numerous people in the crowd about their roles within Public Health.  It took awhile but I was finally introduced to the rep from the Ministry of Health.  She had recently taken on this new role and has yet to see the draft or revisions.  It seems as though whoever had started this project the previous year has recently moved on to a different department leaving a lot of unfinished work in the hands of new people.  This was the common thread amongst many of the people I spoke too.  Public Health Ontario had admitted they have seen the revisions however they’re not close to finishing the project anytime soon.  In my opinion it seemed as though no one was ready to take the blame, or take on the challenge of moving forward.  Many of the regional inspectors voiced their frustrations as well since they base their inspections off of these guidelines and many regions are doing things a lot different.  All they want is a unified document that all inspectors could adopt and follow.  

Where does that leave us, the tattoo artists, the piercers, the business owners, trying to read the minds of the Ontario government of how we should conduct our business?  How come we weren't involved more?  Why didn’t any of us know these new guidelines were even being considered?  Why are there 36 regions with just as little knowledge about this completed project as we are?  

I encourage you to reach out to your local public health unit and ask them to stand up to their superiors.  Ask them to question the next steps on how to get us all on the same page.  It’s about working together and not allowing the Ministry to just implement guidelines without even talking to the industry they're writing about.   Where is the respect?  Why were we not informed and brought into meetings to discuss potential changes about our own industry?  You'd think they would want our input right? 

I strongly believe in “Conversation vs. Confrontation”.  With the right conversations we can move forward in the right direction.  Many practitioners admit there must be some sort of guidelines within our industry before our clients or ourselves get hurt.  It’s about learning together and starting a conversation.  Let’s try and reach to those inspectors that want to see a positive change and try to connect, build trust, build relationships.  In the meantime I’ll update anyone if I hear of any movement from the Ministry or Public Health Ontario.  




Canadian Institute of Public Health Inspectors

Monday, October 3, 2016

Today myself and Efix Roy were invited to speak at the Canadian Institute of Public Health Inspectors (CIPHI) conference to discuss the health and safety of body modification.  We were honoured to be guest speakers and we made some really great contacts throughout Canada.  We look forward to offering our educational seminars to future Public Health Inspectors and creating a relationship between practitioners and inspectors.  Working together to build a safe future for body art practitioners and collectors is the direction we're heading.  Thanks for the invite :)

Jesse and Efix presenting at the 77th Annual Canadian Institute of Public Health Inspectors Conference.

Thanks for the generous gift of local wine from Henry of Pelham...one of my favorites too!

Jesse decided to play "tourist" while visiting the area and captured the sun setting before the storm.