June 2, 1993

MEMORANDUM TO:                LINDA R. ANKU
                             REGIONAL ADMINISTRATOR

FROM:                         ROGER A. CLARK, DIRECTOR                            
                             DIRECTORATE OF COMPLIANCE PROGRAMS

SUBJECT:                      Coverage of Ear Piercing by 29 CFR 1910.1030

This is in response to your request for an interpretation of 29 CFR 1910.1030, "Occupational Exposure to Bloodborne Pathogens." Specifically, you requested clarification regarding whether employees who perform ear piercing are covered under the bloodborne pathogens standard. You also suggested that a possible alternative would be to approach ear piercers as we do designated first-aiders, with the idea that any contact with blood would be considered collateral duty.

The collateral duty approach is not appropriate in this situation; if there is contact with blood, the contact would be a direct result of the employee's main job duty (ear piercing), and not a function separate from the employee's job.

The bloodborne pathogens standard applies to all occupational exposure to blood or other potentially infectious materials. Occupational exposure is defined as reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties. It is the employer's responsibility to determine which, if any, employees have occupational exposure. This determination must be made without taking into account the use of personal protective equipment.

The manufacturers of the Inverness and Studex ear piercing systems assert that their systems are designed to minimize tissue disruption, thereby minimizing or eliminating the presence of blood during the piercing procedure. Further, both systems use a set of plastic capsules, one half which encapsulates one pair of studs, and the other half, a pair of backings. This means that the piercing gun itself never touches the ear, and that the employee's hand never needs to touch the earrings, the piercing apparatus of the gun, or the immediate piercing site. There may be other systems on the market with similar features.

While the employee's hand never need touch the immediate piercing site, according to the Inverness Ear Piercing Training Manual, the employee is to "gently pull earlobe forward to free earring back" once the piercing procedure is completed. Also, the manual states, "Should the earring capsule fail to retract from the ear after piercing, simply flick the plastic cartridge that surrounds the earring back with your finger. This will free the earring." Lastly, after piercing, the manual instructs that "The earring fit may be adjusted by holding the earring and gently turning the earring back until it clicks into the groove on the earring post." This employee hand contact with the customer's ear near the actual piercing site may nullify the benefits that features preventing hand contact provide, depending on the amount of blood present when the piercing is performed.

The main issue, then, is to determine whether or not blood is present at all during the ear piercing procedure. According to Gregory Lane of Inverness in his letter of February 26 to Jim Johnston (copy attached), Inverness has retained the U.S. Testing Company, Inc. to perform testing that "will confirm the presence or absence of a reasonable risk of exposure." In the absence of their final results, we have reviewed the survey of 02-26, performed by Paul Mann of Inverness (copy attached). Based on its results, and provided the independent testing company's tests reflect the same results, we would agree with Inverness and Piercing Pagoda in that it appears as though during a normal ear piercing procedure using this type of equipment, exposure to blood or other potentially infectious material is not reasonably anticipated. However, some employees reported the presence of one drop of blood when an earring was removed from a customer's ear due to a misfire. If the employee removes the earring, there would be occupational exposure.

Some stores have addressed this problem by having the customer remove the earring. This practice seems to be an effective administrative control for eliminating the exposure to the employee during this part of the procedure. Other stores have approached the earring removal problem by having the customer return the next day for earring removal by the employee. According to Mr. Mann, this practice "will greatly reduce the occurrence of bleeding." If it cannot be said that this practice will eliminate the occurrence of bleeding, OSHA cannot accept it as an administrative control which will eliminate the bloodborne pathogens hazard.

However, the question of disinfection after removal remains. If blood is present after the earring is removed, is it the employee's responsibility to disinfect the ear? If so, the employee would still have occupational exposure. As an alternative, the customer can be instructed to put pressure on the site with an alcohol wipe or cotton ball which the customer would then discard. Such a procedure prevents employee hand contact with blood.

There are additional considerations: Does any part of either capsule come in contact with the ear? Is contamination of these capsules possible? According to the training manual, the instrument is to be prepared for the second earlobe by "removing and inverting both capsules." How are the capsules removed from the gun? An employee who removes contaminated capsules must be covered by the standard.

Another issue to consider is that body parts other than the ears may also be pierced. How prevalent is bleeding when a nose, navel, or other body part is pierced? The ear and nose may lend themselves more easily to piercing without employee hand contact due to the narrow width of skin and tissue being pierced. However, an area which is thicker or flatter may require a pinching technique to be used by the employee to insert the skin into the piercing apparatus. This hand contact could create occupational exposure, depending on the piercing method.

Lastly, there may be piercing systems on the market which could, as opposed to the systems described in the beginning of this memo, result in exposure to blood during the normal piercing procedure. Those employees using such a system would be covered under the standard.

In summary, although we do not feel that an employee performing a normal ear piercing with the use of a device that does not result in bleeding and which prevents hand contact with the piercing site necessarily has occupational exposure, many questions still exist. The final determination of coverage must take into account all factors pertaining to use of piercing devices at a particular worksite. This must include an evaluation through direct observation of employee work practices as well as an evaluation of the equipment or device being used.