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Thread: The importance of saline solution and how to make it, plus Aseptic Technique 101

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    Default The importance of saline solution and how to make it, plus Aseptic Technique 101

    Why Saline Solution is important and how to make it properly

    What is saline? The best saline solution is called "Normal Saline" and is used in medicine as an intavenous infusion and for cleaning wounds. As a nurse I probably get through twenty litres of it on a quiet day. Most piercing enthusiasts make their own "sea salt soak", and I would bet that 99.9% of them get it wrong and seriously slow down the healing process. Knowledge is power, and if you know why it's important to get it right, you will make the effort and reap the benefits in faster healing times.

    One of the properties of normal Normal Saline that distinguishes is from water is that it is isotonic. Isotonic solutions have equal osmotic pressure to the interior of your body cells, and that is hugely important for healing; in plain English, it means that the same levels of salts and other electrolytes are inside your cells as are in the same volume of the isotonic solution.

    Why does it matter that your Sea Salt Soaks (SSS) are isotonic? The usual approach that people take to making a SSS is to whack a dirty great big scoop of salt into a glass of warm water. DON'T DO IT! If you do, the water from inside your nice new healing cells gets drawn out into the SSS and those cells subsequently shrivel up and die. Similarly, if you put too little salt in your SSS, the water gets drawn into your nice new healing cells and they explode and die. Seriously. They actually explode. This equalising of osmotic pressures by fluid transfer is why drinking sea water can kill you and why your fingers go wrinkly when you're in the bath too long, by the way.

    So how do you make a Sea Salt Soak properly?

    First of all, use the right salt. TABLE SALT WILL NOT DO! It contains Iodine and anti-caking agents which are terrible for wound healing because they dry eveything out - wounds heal faster in a slightly moist (but not wet) environment. The only salt you should be using is pure sea salt with no other additives. Malden Sea Salt is one option, but there are other brands.

    Secondly, get your measurements right: Normal saline is 0.9% concentration. Water weighs 1g per 1ml, so it's pretty easy to figure out that we need to use 9 grams of sea salt per litre of water. If you don't have accurate enough scales, that's about one large, heaped teaspoon of salt per litre of water.

    Thirdly, the water should be as pure and sterile as possible. You can acheive this by pouring it through a filter jug with a Carbon filter (such as a Britta filter jug) to remove heavy metals such as chlorine which are added to tap water in the treatment process, and then bringing it to boiling point and allowing it to cool. Add the salt while the water is still warm and it will disolve better.

    So now you know why it is important that your SSS should be the right concentration and how to do it properly. You're welcome, needle fans!

    So you're getting a piercing and you're switched on enough to avoid Claire's Accesories and seek advice in an online forum of piercers and pierced from around the world. Kudos. You're doing well so far.

    Aseptic Technique 101

    What I want to walk you through here is basic aseptic technique - the things your piercer should be doing while piercing you to make sure that if you get an infection it's your own damned fault and nothing to do with him/her!

    Let's talk germs. Specifically, let's talk about Methacylin Resistant Staphylococcus Aureus, otherwise known as MRSA (and also as Apocalyptic Megabug of Death that will Kill Us All, if you read the Daily Mail). The truth about MRSA is that it's NOT a "hospital superbug". It's a particular strain (actually, it's several different strains by now) of a bacteria called Staphylococcus Aureus which is present in normal skin flora - which is to say that everybody is covered in the stuff. We all have billions upon billions of microbes living on our skin. Mostly, they are harmless. Around half of the population of the UK is colonised with an MRSA strain of Stapholococcus Aureus, and most of them will never know it. It's only a problem when it gets inside your skin - at which point it can do this:

    That's a grade two pressure area infected with MRSA, for anybody who's interested in that sort of thing.

    Many bugs are not killed by boiling or chemicals. Some of them are not even destroyed by high doses of Gamma radiation (for example the prions which cause CJD, the human equivalent of mad-cow disease). Stapholococcus Aureus, though, can be destroyed by alcohol. Which means your piercer should be cleaning the area he/she's about to pierce with.... Survey says.... STERETS!

    They'll remove any MRSA in the surrounding area and prevent the needle from pushing it under the skin - and that, my friends, is a GOOD thing. Your piercer should also be alcohol gelling their hands before and after every client contact, and more importantly washing them with antimicrobial soap following an approved seven-point handwashing technique, like this one:

    Don't be afraid to ask to see them do it - You're paying for their time, after all.

    Now let's talk about gloves. There is a toss-up about whether sterile gloves are required or if normal medical examination gloves (which are not sterile) should be used. The bottom line is, will they be in direct contact with your skin after it's pierced or with any surface that's going to go through your skin? If yes, sterile is the way to go. They cost 16 for 50 pairs of lilac Nitrile - thats 32p a pair. Not exactly bank breaking, even if you do what I do and double glove.

    Not everybody does it, but here's a useful tip: Put two pairs of gloves on, do all the prep work such as cleaning the area, then pull off the top pair and presto-changeo you're sterile again for the piercing without the fiddle of putting sterile gloves on again. Which you do like this, by the way:

    One thing: that nurse is using latex gloves - your piercer should ask if you have a latex alergy and use nitrile or vinyl gloves instead if you do. I know many tattooists and piercers who routinely avoid latex and only use nitrile because latex is such a potent allergen and you don't always know if you're allergic to it. It's never used in operating theatres anymore for the exact same reason - they are latex free zones.

    Remember also that people who walk around wearing the gloves are what we in the medical trade call "morons". You glove up at the last minute to avoid absent mindedly picking stuff up and touching things and so accidentally contaminating yourself. I see other nurses do this all the time and it drives me nuts.

    Let's talk tools a second.

    Surgical markers for marking out your piercing: Them puppies are single-use disposable items. You haven't gone to all this trouble keeping somewhere aseptic only to dab bacteria between customers with a pen right on their piercing sites, right?

    Clamps. You want to see clamps come from a sealed, sterile packet or straight out of an autoclave. This is totally non-negotiable. I've seen piercers with bundles of clamps in a jar on their table, not even covered up, and I've walked out. I'm fortunate enough to have been vaccinated against Hepatitis B, but I still don't want to take that kind of risk thank you very much! You should be reasonably confident that your piercer has autoclaved the jewellery too - again, don't be afraid to ask.

    Needles. Bit obvious, I know, but these are single-use disposable items that come in sealed, sterile packs and which should be disposed of in a proper sharps bin after use. The sharps bin sounds like a trivial detail but it isn't; it's a legal requirement, and it's an expensive one. If a piercer isn't prepared to pay what it costs to dispose of their sharps properly, my first question is: What else have they skimped on?

    So there we go! How to be confident that the only thing in your new hole is a chunk of Titanium. Once again, needle fans - you're welcome.
    Last edited by Chumley; 10-18-2010 at 03:55 PM.

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