Infections expose dangers of piercing.

Byline: Tim Christie The Register-Guard

Charles Bianchi, owner of a Eugene tattoo and piercing parlor, has two simple rules for prospective piercees:

Rule No. 1: "Never get pierced in a mall."

Rule No. 2: "Never trust anyone piercing with a gun."

If only Klamath Falls teens had followed Bianchi's advice back in 2000. They got pierced at a jewelry kiosk in the Jefferson Square Mall by piercers using a piercing gun. As many as 25 developed nasty ear infections in their upper ear cartilage that left some permanently disfigured.

The story of the outbreak was published this week in the Journal of the American Medical Association. Dr. William Keene, an epidemiologist with the state Department of Human Services, was the lead author.

Epidemiologists found that piercing through cartilage - such as the upper part of the ear - poses a greater danger for infection than piercing through the fleshy lobe. And they found that the Klamath Falls piercers were not well-versed in piercing technique and regulations, not to mention basic hygiene and infection control.

"They were just essentially clueless," Keene said. "This is not brain surgery, but it's an invasive procedure in its own way."

For one, they were using an open, spring-loaded piercing gun - that has since been banned by state regulators - to punch holes in the cartilage of the upper ear. At the time, the guns were approved for lobe piercings but not for cartilage piercings, and the shop, Kristi's Fashion Jewelry, had been cited previously for misusing such a gun.

Using the guns to punch a blunt stud through cartilage tissue is like using a baseball bat to punch a hole in a sheet of plywood, Keene said. It creates "a big ugly wound" that can take a long time to heal, leaving it more prone to infection.

The real problem arose, however, when at least one worker made a misguided effort to keep the equipment extra sterile. She would place the sterile ear stud into the sterilized piercing gun, then spritz it down with a spray bottle of alleged disinfectant.

Investigators found the disinfectant solution in the bottle was contaminated with a common, hardy germ known as Pseudomonas aeruginosa.

After checking the jewelry kiosk's records, investigators tracked down 118 people who had been pierced there in the previous 45 days. Seven were confirmed to be infected with Pseudomonas aeruginosa and 18 were suspected. Of the seven confirmed cases, four were hospitalized; several wound up with "significant disfigurement" of their upper ear.

Keene and his fellow investigators concluded that the upper ear is more prone to infection than the lobe. That's because cartilage doesn't get the same circulation as the fleshy lobe, so it won't get the same number of infection-fighting white blood cells, nor will it carry the same level of antibiotics to the wound.

The moral of the story, according to Keene: "Don't go to places where they're doing dumb stuff."

Also, even if you're pierced by a skilled professional who's a stickler for infection control, don't assume you're out of the woods when you get home. Many ear infections can occur a week or two after the piercing. The bug that infected the Klamath Falls teens is common, found in shower heads and under sinks.

"You hope you don't have the bad luck to go to the wrong shop, but even if you go to the right shop, most of the problem is in your own hands," Keene said.

His advice: Follow the after-care instructions carefully, keep the wound clean, "and keep your fingers crossed."

Since the outbreak, Oregon regulators banned the type of piercing gun used in Klamath Falls. They also required ear-piercers to be at least 18, and to be certified in basic first aid, blood-borne pathogens infection control, and post-piercing aftercare procedures.

Bianchi - known simply as Zev to friends - imposes even stricter rules in his shop, Primal Body Piercing at 509 E. 13th Ave. in Eugene. Would-be piercers are required to go through an apprenticeship under the head piercer that can last up to two years.

And piercing guns, like the kind they use at malls? Forget about it. True professionals use triple-beveled, hollow-core, surgical steel needles, which make for a cleaner incision, he said.

Zev, 24, is part of a subculture where piercing is not a passing fad but a way of life. He sports a pointy, bone-white septum plug in his nose and large black earrings in his lobes. His partially shaved head reveals tribal-inspired tattoos on the top and sides of his skull. He figures he's been pierced himself 30 to 40 times.

Noting that pop stars such as Britney Spears and Christina Aguilera have embraced their inner pin cushions, Zev said piercing is starting to come in out of the fringe.

"Piercing is definitely sliding more into mainstream culture," he said.