(Center for the Advancement of Health) -- A new study of tattooing and body piercing finds that many operators may be putting clients at risk of HIV and hepatitis B and C infection.

The study was limited to Australian establishments, and supports previous research finding a need for more infection-control education and compliance among "skin-penetration operators."

The investigators surveyed 874 owners and managers of shops offering skin-penetration services. Each person answered questions about their knowledge of and attitudes toward recommended practices for preventing blood-borne disease transmission and their attitudes toward local officials monitoring their compliance with the government's infection-control guidelines in the state of New South Wales, Australia.

Ninety-five percent of the skin penetration operators agreed that infection-control guidelines are needed. However, only half of the respondents said they followed the government's guidelines, and many were not knowledgeable about standard infection-control principles and practices.

The tattoo shop operators were more likely than body piercers, beauty therapists and hairdressers to be knowledgeable about infection control.

Additionally, more than half of the shop operators acknowledged that they needed to follow the guidelines more closely, but many operators said they face barriers to compliance. Barriers cited include a perception that infection-control practices like disinfection and sterilization are a "turnoff" for clients, their shops are too busy and it is hard to ensure that workers comply.

"Commercial premises practicing skin penetration, which involves the risk of blood-borne disease transmission, appear to lack knowledge of some essential infection-control principles and practices," write John H. Wiggers, Ph.D., and colleagues. The findings are published in the March-April issue of the American Journal of Health Behavior.

"These findings suggest that there is a considerable opportunity to increase infection-control compliance among skin-penetration operators," they conclude.

Although HIV and hepatitis B are more likely to be transmitted through sexual contact, the diseases can be transmitted through tattooing, ear piercing, barbershop shaving or manicurist services.