The bodysuit-piercing, the Anglo-Saxon term possessing no French equivalent means literally drilling physical (piercing) (bodysuit).
A. The bodysuit piercing, a potentially dangerous practice. Hepatitis B as hepatitis C, virus HIV-1, sepsis, toxic shock syndrom, endocarditis and tetanus is so many heavy infectious pathologies met and described in her(it) Literature when a search(research) for the complications suceptible to happen during the practice of the piercing is begun. The disorders(affections) previously quoted are only an extract of the wide range(fan) of infections so viral as bacterial, certain pulling(entailing) even the involvement(throw-in) of the vital forecast, being able to be contracted by the follower.
Non-infectious pathologies bound(connected) to the piercing would not know how to be ignored, the most common listed are the eczema of contact, due to the jewel or to the product of cutaneous decontamination, the scar chÈloÔde or the botryomycome and the tissular tears by tearing(wrench). Towards the nature of the intervention, the inspiration Medical at least, we shall understand easily that be leaked out mean assuming the risk of seeing infecting by any pathogenic germ, that it is about a virus, about a bacterium or still about a mushroom, as far as the integrity of the cutaneous barrier is not any more respected, leaving the general blood circulation in the grip of Any microbody. The visible cleanliness of a premises, the employment(use) of surgical gloves or the use of single-use needles, if they are as much indispensable as reassuring do not bring for all that the guarantee of the harmlessness of the operation. Indeed, a contagion of the various used instruments can occur without thatCustomer, devoid regrettably in the majority of the cases of culture medical, notices it. The driller can as for him, in spite of a wild will to make well, commit a fault of asepsis, no medical, bacteriological or infectious education distributed by a qualified professional of health not having been able to be followed given the absence of any diploma or formation(training) required(demanded) for the exercise of this profession. If it is normal that the medical world as well as the powers public worry about these establishments were well established, it is also justifiable to worry about the problem of the “wild” piercing. This term of wild piercing groups together(includes) the not unimportant percentage to see alarming of piercings practised during concerts, turnips and Other demonstrations(appearances) where little scrupulous individuals propose their services for a moderate sum, armed with unsuitable pistols and indÈsinfectables. The practised price lists(rates), of the order of fifty francs (four hundred francs on average in a lounge(show)) as well as the alcoholic atmosphere to see stunning allow these drillers of operetta to work on the chain(channel) without the slightest infectious concern(preoccupation), making of these customers of the victims it.
B. Gap in the law and bodysuit piercing.
The profession of driller, because it would be about a separate profession in the sights of the skills and the qualifications required for this exercise, is not recognized as such by the commercial register which classifies her(it) similarly to any storekeeper. The lounges(shows) of piercing are also considered at the moment by one Legal and legal point of view as any bottom of business were well established. They are governed as such by them even laws as a florist or as a trader of shoe, without having however the same responsibilities and the homework(duties) face to face of their clienteles. It is indeed easily understandable that the risks incurred by them Followers of these lounges(shows) are of a quite other nature that those incurred during a trade operation made in a more traditional said business. Nevertheless, the only legal barriers as for the exercise of this profession live in some rare articles relative to the protection of the persons of the code of the consumption and the commercial law.
C. Objectives of the study.
The increasing earnings(gains) of popularity of the Bodysuit-piercing seem to worry rightly the powers public which begin to arrest(dread) the consequences termede public health of a potentially dangerous practice by definition which, if it was Necessity to classify her(it), would be of medical order so much the resemblances with this domain are big. Resemblances both at the level of the indispensable preoperative anamnËse, of the operation in her even and of the postoperative follow-up, and at the level of the supposed assent free and lit by the patient. Almost absence of legal frame(executive) amounting to some articles of law insufficient borrowed(taken) from the commercial law and from the code of the consumption, added to the inexistance of diplomas or training courses(formations) introducing to the practice of the piercing, only ones(only) legal guarantors(guarantees) of one supposed skill(competence), oblige an urgent questioning of Modalities of this practice. The place(square) of the medicine and the doctor in particular is subject of a debate imposing the analysis of the ethical stakes. If it is evident that the doctor has a role to play in term of Public health, notably a duty of help(assistant) with a population potentially victim, it remains to define the precise limits of its function(office). One of the justifiable questions lifted(raised) is to know if the piercing has to be a purely medical act made by a competent doctor medically speaking but ignoring everything of the culture and the habits and customs of this world, at the risk of seeing extending the said piercing “savage”, or if necessary if he has to continue to be practised by one Drillers, the modalities allowing to make sure of their skills and the place(square) of the doctor in that case remaining to define. In the sight of the questioning lifted(raised) by this subject and proposed solutions, it is a question of keeping(guarding) in memory both fundamental ethical principles that are the principle of autonomy and the principle of charity in interest of all the parties, the customers first of all, the drillers, the doctors and the Public health.
METHOD 1. Selection of the studied population.
The studied population includes first of all the authentic followers of the piercing, namely the subjects having had the navel, the bosoms, the genitalia or the face Drilled, but also includes the individuals having had only the leaky earlobe. Although the psychological step(initiative) of these last ones is for a major part of them different real leaky and the way of proceeding (in the pistol) him(it) or also, it seemed indispensable to include them in the study and this for three reasons.
The first one(night) and nevertheless adult is that about is the site of perforing, it is a question of crossing(exceeding) the cutaneous barrier and of leaving opened this recently created wound. The second concerns the employment(use) of pistols. Indeed, we can notice that the same custom(usage) is made by these pistols (recognized as indÈsinfectables by all) by the jewelers, Usually authorized to drill ears, and by drillers “savages” practising their art in the chain(channel) during various popular gatherings. The last one of three reasons concerns the jewel in him even and the sentimentalities that it is necessary suceptible to provoke, the nose or the navel being not less subject to allergy no as the earlobe. If the literature abounds in case interesting the complications engendered by the drilling of the ear, the bibliographical references about the piercing are less common(current), the recent side of this phenomenon associated with the originality of the sites of perforing (often palling the patient to go to consult, so leaving his case unknown by the medical world) by being responsible mostly.
RESULTS(PROFITS) we shall see him(it) through statistical studies has nothing harmless and the second, the piercing in cleanly spoken. We shall distinguish from more two categories about the drilling of the ear, the lobe in cleanly spoken and the detached house(flag) of cartilaginous structure, this for histological and physiological reasons, the cartilage avasculaire being more subject to the infection.
1. Epidemiological study and piercing little finger.
The drilling of the ear, the lobe more particularly is a current(common) practice in our companies(societies) the origin of which coincides probably with the previous history of the man. It is source(spring) of uncountable complications infectious or not listed in Medline.
A. Statistical studies.
Cortese and Dickey led a study on 73 student nurses having had the leaky ears. She allowed to notice that 52 % of them, 38 subjects exactly knew one or several local complications following the drilling. These complications include the allergy (eczema of contact), the inflammation that is oedema and erythema The bleeding, the drainage not purulent, the local infection purulente, the cystic training courses(formations) and a traumatism by tearing(wrench). Study of Cortese and Dickey on 73 patients.
A study led in 1975 by Biggar and Haughie revealed that on 497 women, 138 of them is 34 % had complications further to a drilling of ear. Study of Biggar and Haughie on 138 patients.
The last listed study of group is to be put in Jay’s asset(Jay’s active person) which, over a period of five months, noticed twenty cases of complications due to this practice at going children from six to fourteen years. Twelve children knew an invagination of the buckle which came along for five of them of an infection. Four contracted one Infection in the site of perforing and three others underwent a traumatism by tearing(wrench). The last one twenty developed as for him a chÈloÔde scar. The treatment of some imposed the general anesthetic or still the administration of antibiotic (notably during an infection with Streptococcus of the group A-hÈmolytique).
A case of tuberculosis was described by Morgan at a 18-month-old child accompanied with fever and with a cervical tumefaction, it presented a hurt cro??qteuse hurt at the level of the earlobe. A glomÈrulonÈphrite post streptococcique by Ahmed-Jushuf and a toxic shock with Staphylococcus aureus producing were also put back Of toxin at a child neutropÈnique of six years by Mc Carthy, the operation had been made by means of a pistol. Finally, several cases of viral hepatitis (B and C) were detailed(retailed) (Van Sciver; Johnson; Castleman and McNelly), some having had a mortal exit.
C. Infections of the listener’s house.
Piercings crossing the cartilage of the ear are subject too to infection, the nature avasculaire of the cartilage facilitating the development of the infection, particularly when a pistol is used for the perforing. It was the case of two patients described by Staley, Anderson and Fitzgibbon. The 14-year-old first one(night) developed an abscess, Culture revealing afterward the presence of Pseudomonas aeruginosa and Staphylococcus coagulase negative. The culture of the second showed the presence of Pseudomonas aeruginosa only. In both cases, a deformation of the cartilage little finger remained following the cure. We can notice that Pseudomonas is frequently implied during the perforing of the cartilage little finger, so Turkeltaub and Habal described the case of a 22-year-old woman who having contracted a pointed chondrite to Pseudomonas aeruginosa had the major part of the cartilage little finger deleted(eliminated) further to its necrosis.
2. The complications of the piercing.
A. Not infectious complications The not infectious complications of the piercing in cleanly spoken result mainly from the nature of the jewel, due to its morphology and topography. Jones and Flyn put back the case of a paraphimosis at a 24-year-old man raising prince Albert, the exit was favorable following the reduction of the oedema there. Higgins put back the case of another prince Albert subject to complication, a break urÈtrale of the ventral side of the yard which is cured without the help(assistant) of a surgical operation.
Prince Albert and Paraphimosis.
Piercing lingual are sources(springs) too of numerous unwanted effects, Reichle and Dailey told the possibility of superior obstruction of air traffics consecutive to the rÈactionnel oedema to provoke by the perforing of the language(tongue). The lingual jewel is too cause of complications such as an embarrassment in the chewing and in The speech or still cracks or dental fractures. The risk of ingestion or inhalation is also present (18).
Other listed(counted) incidents are the traumatism by tearing(wrench) suceptible to happen about is the location(localization) of the jewel, the scar chÈloÔde or hypertrophique, the invagination of the jewel and the allergy in various metals that are the gold, the nickel or the money(silver) (16 ). The last listed(counted) not infectious complication Described the case of a patient carrier of a ring in the breast responsible for artefacts on the radio, for lack of having been able to remove him(it).
B. Infectious complications.
The cases were put back by infection further to the physical drilling, the ear outcasts are among six. The possible transmission of the virus HIV typical 1 was described by Pugatch, Mileno and Rich, the patient having presented a sÈroconversion following multiple acts of piercing. The perforing of the language(tongue), besides pulling(entailing) certain embarrassment in the speech in The chewing or in the breath, is suceptible to lead(infer) infectious complications. The case of a pÈricoronarite at a 22-year-old woman raising a bar(helm) across the language(tongue) was brought back(reported) by Scully and Chen, the cure having come true spontaneously in month. Another case interesting the language(tongue) was described by Perkins, Meisner and Harrison, it was about Ludwig’s pharyngitis with purulente inflammation of the gland sub-jaw at the level of the oral floor accompanied with a hypersiallorrhÈe, the treatment required the intubation and the mechanical ventilation(breakdown) of the patient. A case of tetanus at a 27-year-old woman who had drilled she(it) even Navel was described (26), she(it) is totally cured following a hospitalization of 10 days. Fiumara and Capek brought back(reported) for their part the case of an abscess of the breast developed following a piercing in the same region.
The last listed(counted) case is an endocarditis with Staphylococcus aureus which occurred following a nasal piercing. The patient divested initially of any cardiac deformations recovered incompletely following six
3. Recommendations and national and international laws.
The limits and the specific bans put by the French law towards the exercise of the profession of driller or the opening of a lounge(show) where is practised this kind(genre) of intervention are non-existent because this commercial activity is ignored at the moment texts of law. The only legal measures suceptible to carry(wear) damage in Lounges(Shows) in the doubtful practices live in some articles of the code of the consumption. The consultation of the commercial law allowed to arrest(dread) the limitations and the bans of which could be the object drillers as well as lounges(shows) of piercing. The right(law) of the consumption contains several articles which can interest the practice of the piercing as well as the commercial activity which she(it) implies. In the sights of the incurred dangers, the consumer protection appears to be the most important point, this last one living on two fundamental points that are the protection by the information and the protection by the quality of the product.
The protection by the information of the consumer has for purpose first to light(enlighten) its assent. The article L 113.3 of the code of the consumption foresees(plans) that the salesman of product or the service provider has to by marking, labeling, display(posting) or by quite other appropriate process, inform the consumer about the price(prize), the limitations Possible of the contractual liability and the particular conditions of the sale. The advertising(publicity) made by the service provider is also under the control of the law, the misleading advertising(publicity) being set up as penal malpractice by the article L 121.1 of the code of the consumption which foresees(plans) the ban on any advertising(publicity) containing under about Form whether it is assertions, indications or false natural presentations(displays) to be misled.
The protection by the quality of the product implies a general obligation(bond) of safety(security) put by the law of July 21st, 1983 and resumed(taken back) in articles L 221.1 and following ones of the code of the consumption. According to this article L 221.1, major when the service is synonymic of piercing, ” products and services owe, in normal conditions Of use or in the other reasonably predictable conditions by the professional, present the safety(security) which we can legally expect and not strike a blow at the health of the persons “. Furthermore, the protection of the victims was strengthened by the article 1386.1 of the civil code foreseeing(planning) that the producer is responsible of Damage caused by a defect of its product, this last one being considered as defective when he(it) does not offer the safety(security) which we can legally expect.
The commercial law teaches us that dependent limitations either of the quality of the person but the commercial activity she(it) even are possible and possible. These limitations take two forms, the first one(night) is the complete ban of activity whereas the second consists of a limitation of the same activity.
Certain commercial activities can be forbidden either because they are opposite in the law and order and in the good customs, or in a public purpose of health (However, he(it) is to note that these bans on activity put by the commercial law are mostly applied in the case of the commercial monopolies). Other activities Commercial are subjected on condition, either when the exercise of a commercial profession requires the obtaining of a diploma, or when a statement(declaration) with proper authorities (prefecture; city hall) or still the ownership of an ID card professional is required(demanded). Finally, certain activities are subjected to authorization, So allowing a state interventionism. These bans and limitations of commercial activity seem interesting because, even if he(it) is not made use of it at the moment, they could serve as track(runway) on second thought on the health control of the lounges(shows) of piercing.
Our neighbours of besides the Atlantic Ocean possess a relative advance on the European countries. Indeed, fourteen American states have a specific legislation as for the bodysuit piercing since 1994, even if they present quite a natural heterogeneousness ( 30 ). The Canadians are not in rest either in piercing because the web site Of the Ministry of Health of Canada propose since 1997 guidelines for the prevention and the fight ( wrestling ) against the infection in three types of services, the piercing being one of them. This methodology intended so much for the practitioners whom to the agents of the hygiene golden to the people in load(responsibility) of the anti-infective fight (wrestling ) would allow, yew she ( it ) applied Suitably, to reduce the risks of transmission of the infections. He(it) is to note however that the standards contents in these guidelines are present in informative title and that it is on no account about a rule ( 31 ). The Canadian Center of documentation on the HIV / AIDS of the Canadian association of public health has Elaborated for the Canadian Network of the Health ( RCS) of the recommendations ” to be how tattooed or drilled the skin in a security way? “. They clarify the various necessary and compulsory stages in hygiene ( 32 ).
The United States possess the another considerable advance on France because the professionals of the piercing grouped together(included) in association, the Association of Professionnal Piercers ( the APP) which spreads(diffuses) by means of internet all which is useful to know in piercing, so much at the legal, legal and different level according to them States, that at the hygienic and methodological level, even going as far as proposing a service of answers to the questions put on the piercing by the Internet users (33.
In France, it is the Doctor Bernard Accoyer, surgeon ENT and deputy RPR of his state, which the first one calls to Dominique Gillot, Secretary of State has the Health and in the social Action(Share), by a written question published in the official newspaper. Both major anxieties put by the bodysuit piercing are highlighted that are the problem of exercise Illegal of the medicine and the problem of the protection of the population against the infectious diseases within the framework of the politics(policy) of public health. The answer of Madam Secretary of State to the Health and to the social Action(Share) of this subject clarifies ” that a group of scientific experts of the Superior Advice(Council) of Health service of France ( CSHPF) has Summer seized to proceed to the evaluation of the infectious risk bound(connected) to the practice of the piercing to emit(utter) possibly recommendations to strengthen the sanitary safety(security) in this domain. The conclusions of these experts should allow to appreciate the necessity or not to regulate beyond the capacities(measures) of the code of the consumption.
DISCUSSION 1. Interpretation(performance) of the obtained results(profits).
The more and more popular practice of the bodysuit piercing comes along with its procession of complications in the variable severity. If a simple inflammation in the site of perforing or a sentimentality is common(current) currency(change), certain being life-threatening complications are to be regretted and seem disturbing in term of public health. We can note an inhomogÈnÈitÈ in the probability of development of a complication according to the chosen site of perforing. Staley, Fitzgibbon and Anderson underlines the fact that the drilling of the cartilage little finger, in spite of a strict asepsis increases the risk of infection, this due to the avasculaire nature of the cartilage forbidding the defences Immunizing the access to a zone potentially infected. Song and Wilson who told the case of an endocarditis with Staphylococcus Aureus following a nasal piercing denotes the fact that the natural colonization of the nasal pits by the same bacterium believes the risk of contracting an endocarditis further to a piercing in this region. The drilling of any mucous epithelium is more convenient to the development of a bactÈriÈmie or an endocarditis was the conclusion of these same authors. The case of the tetanus resulting from a piercing made advise by the authors ( 26 ) a vaccination as a precautionary measure against the tetanus above all act of piercing.If the unique(only) case of put back HIV 1 seems debatable in the sights of the multiple histories of the patient of type behavior at risk ( several protected homosexual connections), it means on no account that such a viral infection cannot arise. Pugatch, Mileno and Rich who put back this case of HIV concluded that one Transmission of this virus as well as any pathogenic micro-organism was possible, this implying the viruses ( HBV) as much as the bacteria (Staph Aureus, Clostridium tetani, strepto) and mushrooms.
2. Notion of assent, principle of autonomy and charity.
The contract linking(binding) the driller to his(her) customer is an oral contract implying the assent of the follower on the conditions which were exposed(explained) to him(her). To sign a discharge(dump) before the operation as it is practised in certain lounges(shows) mean on no account that the customer possesses all the elements of information indispensable to the good guide of sound Choice and it does not mean advantage that the customer considering itself hurt cannot have of legal appeals because this contract has no legal value. The tacit contract linking(binding) both parties will be considered as ethics that as far as the assent is free and lit(enlightened) and as far as the principles of autonomy and charity are respected. Character free and lit the assent appears as a major notion because directly bound(connected) to the principle of autonomy, the quality of the information carried(worn) in the leaky future is also a fundamental element of the ethical value of the operation.
That quality of information is directly dependent on the operator who should not only explain with the biggest clarity(brightness) the various indications, but also to make sure of the capacity of the subjects to understand(include) this information and so to allow them to give an authentic assent. One of the measures grip(taking) by lounges(shows)
Officials, or more exactly those were well established is to refuse the operation to the minor individuals and to those under the influence of alcohol or narcotics. The physical presence of the relatives(parents) will be required(demanded), a parental written authorization for the minor customers being judged for insufficient reason.
In the sights of the last observations, it seems essential that the status of the driller and the lounge(show) which he(it) possesses are to be rethought(to rethink), the first one who can not be considered as a storekeeper and the second as a commonplace business. Indeed, same articles of law which can not govern suitably the sale of a baguette and the transfixion pénienne..