We have had a number of enquiries from technicians about which types of face masks are most suitable for use by the majority of Cosmetic Tattooists and requests for our opinion if the transparent mouth shields (partial shields) that have recently found their way into the market place are suitable PPE for skin penetration / cosmetic tattooing services, hopefully this publication will clarify the situation.

The Standards

In December 2015, Standards Australia published AS 4381: 2015¹ which is an updated version of the standard for single-use face masks for use in health care, the new standard is intended to harmonise with the North American standard ASTM F2100-11 and European standard (EN) 14683. Products which are supplied in Australia need to comply with AS 4381: 2015 if they purport to provide the protections described within the standard.

Level of Protection

Manufacturers of surgical face masks may describe their products as having Level 1-3 protection depending on the Bacterial Filtration Efficiency (BFE), Particulate Filtration (PF), Differential Pressure (DP), and Fluid Resistance (FR). Broadly speaking we can describe the 3 levels as per the following;

Level 1 - BFE ≥ 95% (0.1μm), DP < 4.0 mm H2O/cm2, PF (N/A), FR 80mm Hg
e.g. For general purpose procedures, where the wearer is not at risk of blood or bodily fluid droplet or splash.

Level 2 - BFE ≥ 98% (0.1μm), DP < 5.0 mm H2O/cm2, PF (N/A), FR 120mm Hg
e.g. For procedures where minimal blood droplet exposure may possibly occur.

Level 3 - BFE ≥ 98% (0.1μm), DP < 5.0 mm H2O/cm2, PF (N/A), FR 160mm Hg
Procedures where there is a risk of blood or bodily fluid splash.

Over time the use of a surgical facemask by healthcare workers has changed focus away from protection of the patient and towards the protection of the healthcare staff ^2,3, depending on the type the modern use of surgical face marks may help to protect both the cosmetic tattoo technician and the client from a number of risks, the examples below illustrate how different types of risk can be managed with different levels of mask protection;

• Risk of transmission of minor respiratory infections from the client to the technician - e.g. Level 1 Mask.
• Risk of minor respiratory infections from the technician to the client - e.g. Level 2 Mask (higher Differential Pressure for coughing/sneezing etc).
• Risk of transmission BBCD from client to technician via minimal blood droplet exposure (adequate for most cosmetic tattoo services) - e.g. Level 2 Mask (higher Bacterial Filtration Efficiency and Fluid Resistance).
• Risk of transmission BBCD from client to technician via minimal blood splash exposure (cosmetic tattoo services with some machine types e.g. coils⁴) - e.g. Level 3 Mask (higher Fluid Resistance).

You can see from the above that the protection provided by the use of surgical face masks is largely dependant upon the filtration capacity and fluid resistance of the mask and the selection of protection level is dependant on the type of procedure and risk assessment of the procedure.

Frequently Asked Questions

Q: Are transparent mouth shields a suitable alternative to disposable surgical face masks for cosmetic tattoo services?

A: We do not recommend the use of Transparent Mouth Shield's (TMS) in place of disposable surgical face masks for the following reasons;

1. Most TMS products that we have encountered appear to focus on the fashionability, comfort, anti-fog and ease of use characteristics rather than the primary purpose of a surgical mask i.e. bacterial filtration and fluid resistance.
2. We have not seen a TMS product that states it is in compliance with AS 4381: 2015.
3. We have not seen any TMS product that has approvals or exemptions from the Therapeutic Goods Administration.
4. Most TMS products are promoting re-use (increases risk of fomite mediated cross contamination).
5. We have seen no credible evidence that a TMS product affords the same level of protection as a surgical face mask that is compliant with AS 4381: 2015.

Not Compliant with AS 4381: 2015

NB. Transparent mouth shield's should not be confused / compared with with full face shields which are sometimes used in high risk procedures in conjunction with Level 3 surgical face masks.

Q: What type of mask do the experts in disease control recommend?

A: The closest occupation where expert disease control advice is available for the use of personal protective equipment is from within the health care sector, cosmetic tattoo services have similar risks as the risks to health care workers during wound care and skin penetration procedures. The USA Centers for Disease Control and Prevention provide the following succinct information for the selection and use of face masks;

CDC: "Masks should fully cover the nose and mouth and prevent fluid penetration. Masks should fit snugly over the nose and mouth. For this reason, masks that have a flexible nose piece and can be secured to the head with string ties or elastic are preferable."

Incorrect Use of a Face Mask

Incorrect Use Defeats the Purpose of Use

Q: Which type of mask is most suitable for cosmetic tattoo services?

A: This depends on the type of equipment being used, in most circumstances a Level 2 Mask is probably adequate but some equipment may expose the technician to greater risk of splashes of blood and bodily fluids in which case a Level 3 mask or N95 respirator (if aerosol particles are suspected). Regardless of your assessment of the risk for your procedures and the Level of mask that you chose it is important that the mask complies with AS 4381: 2015

References