In the hot seat

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• In the hot seat

Mark Jones Microbiologist, CCDHB and Aotea
Pathology
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• In the hot seat

Mark Jones Microbiologist, CCDHB and Aotea
Pathology
Sterilisation or Disinfection in the Tattoo
Industry? - the bare bones!
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Case history 1

• November 1995
• Male Samoan, 38 years
• Extensive Samoan tattoos
• Course began 5 weeks earlier
• 2days/week for 4 weeks
• Every day for the last week
• Completed 7 days ago

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Case history 1

• Pain and swelling thighs 6 days
• Fever and rigors 3 days
• Nausea and vomiting 3 days
• Has been soaking tattoos with soap and cold water
• Temp 39.5
• Pulse 100
• Widespread cellulitis and pus

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Case history 1

• Admitted
• Wound swabs
• Pen and Fluclox

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Gram stain remember Micro 101??
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Culture
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Culture

• Streptococcus pyogenes
• Corynebacterium diphtheriae

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Case history 2

• 4 weeks later
• Male Samoan, 22 years
• Extensive tattoos
• Done in Samoa 3 weeks
• ago
• Fever and infection
• Came home
• Admitted
• Pen and Fluclox
• Gram and culture

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Gram
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Gram Culture

• Gp A Strep and Corynebacterium diphtheriae

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Two cases linked or coincidence?

• What happened next?
• Probably the same tattoist
• Traditional samoan tattoos (Tatau)
• Pigs tooth implements
• Dubious hygiene
• Ministry to meet with IC/ID/Micro input
• Skin Piercing Guidelines, 1989 1998

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All quiet until 2003
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So Dyed He DiedTattoo Man's Ordeal Ends in
Death

• Peta Leota-Tui threatened to end her marriage to
  stop her husband getting the backstreet cultural
  tattoos she believes killed him.  James Leota-Tui
  died in the intensive care unit at Middlemore
  Hospital this week from an infection, three days
  after abandoning his second attempt to complete a
  traditional Samoan body tattoo.  The dark tattoos
  covered his body from navel to knees and as a new
  matai, or head of his extended family, the
  29-year-old was determined to endure the same
  tattoo ritual his father had.
• An autopsy has been performed.  Police and public
  health officials are investigating the cause of
  death and charges may be laid.  The infection is
  understood to have involved the flesh-eating
  disease necrotising fasciitis, often caused by a
  strain of the streptococcal bug.  Tissue from Mr
  Leota-Tui, and the tattoo equipment used, is
  being tested for this and other bacteria.  The
  police are investigating under the Crimes Act,
  which requires that surgical procedures be
  performed with a reasonable standard of care. 
  Grey Lynn cultural tattooist Inia Taylor wants a
  crackdown on backstreet operators, who he says
  discredit his craft and endanger the health of
  their customers.  "I have heard some real horror
  stories.  I have travelled around the Pacific for
  years learning how to do traditional, cultural
  work.  Being clean as well doesn't make my
  tattoos any less cultural."

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Several cases in Wellington in 2006

• Contract between Hutt Valley DHB and Mark Jones
• Met with local traditional tattoists

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Early photos in Samoa
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Traditional tattoing
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Traditional tattoing
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Traditional pig tooth implements
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Locally produced instruments
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So, what should we recommend?