: when body piercing goes wrong Heather Insert name Lewis of presentation on Master Slide
Background November 2014 several cases of pseudomonas skin infection admitted to the Royal Gwent All cases had piercings at the same premises Sun Tattoo No other links between cases
Pseudomonas aeruginosa Widely found in the environment Can be spread: ~on the hands of those undertaking piercing/tattooing ~ via piercing/tattooing equipment Routine infection control practices can prevent infection
Pseudomonas infection
Pseudomonas infection
Pseudomonas infection
Pseudomonas infection 9 hospital admissions in total All needed incision and drainage 4 under GA, 5 under LA Some needed reconstructive surgery Minimum of 3 nights in hospital 3 cases were in hospital more than 10 nights
Sun Tattoo LA EHOs visited premises to look at body piercing practices Deficiencies in infection control identified Samples and swabs positive for pseudomonas aeruginosa Prohibition Notice (HASWA) served prohibiting body piercing Client forms taken by EHOs
Risk Assessment Confirmed transmission of pseudomonas bacteria Potential for transmission of other organisms Hepatitis virus is able to survive in a protected environment Unknown whether source of BBV Prevalence of BBVs in area Impossible to quantify an acceptable level of risk Knowing that you had infection was a benefit outweighing anxiety Effective treatment available Prevention of ongoing transmission Sought advice from UK advisory panel
Outcome of Risk Assessment Look back exercise needed: Exercise Seren To identify clients who underwent a procedure at Sun tattoo, Blue Voodoo & Flesh Wound To offer testing for BBVs to clients
Planning & Preparation Incident Management Team Initial records, more found...more found again Validating client list: the knowns and the unknowns Maintaining confidentiality until go live Preparation of communications materials Helplines: - ABUHB appointment line - PHW/NHS Direct
Results As at 30 th May 2015: 727 people tested at special nurse clinics 61% received letters 39% self presented 425 calls to PHW helpline Others tested at GP, GUM and Sexual Health Clinics No acute infection identified Positive press coverage Opportunity to shape the Public Health Bill
Age and sex distribution of cohort Under 13 yrs Female Male 13 yrs 14 yrs 15 yrs 16 yrs 17 yrs 18-25 yrs 25 yrs and over 350 250 150 50 50 150 250 350
Reported versus true age Age Difference between reported age and true age Reported age greater than true age Exact match Reported age less than true age >2 years 1-2 years <1 year <1 year 1-2 years > 2 years <13 0% 6% 38% 56% 0% 0% 0% 13 10% 10% 10% 70% 0% 0% 0% 14 13% 33% 8% 38% 4% 0% 4% 15 6% 15% 48% 29% 2% 0% 0% 16 8% 6% 12% 73% 1% 0% 0% 17 0% 29% 16% 52% 0% 3% 0% 18-25 1% 0% 3% 96% 0% 0% 0% >25 0% 0% 0% 97% 0% 0% 3% Total 4% 12% 17% 65% 1% 1% 1%
Proportion of individuals attending for a BBV screen reporting a body piercing at an intimate site (nipples and/or genitals) by age group % 0 5 10 15 20 25 30 Under 13 yrs 13 yrs 14 yrs age 15 yrs 16 yrs 17 yrs 18-25 yrs 25 yrs and over
The power of social media ABHB Webpage hits: 15,638 Facebook posts: 19,209 Twitter impressions: 51,112
12 charges; 3 contravening byelaws: equipment 5 H&S Regulations incl COSHH 4 General H&S duties Prosecution
Public Health Impact The premises: infection control, previous history, 2 for 1 offer, intimate piercings used to inform the PH Act Clients: false ages, many u16, ability to understand the risks?? Ongoing costs for LA whilst owners have legal aid to employ experts Cost of look back exercise
250,000 Around 8 full time EHOs for a year 16,666 Carbon monoxide alarms 5,000+ temperature probes 3,500 noise monitors 35 hip replacement operations When body piercing goes wrong: the price of looking good!
Thank you Diolch