This chapter is adopted under the authority of MGL c. 111, § 31.
The purpose of this chapter is to protect the health, safety,
and welfare of the residents of, and the visitors to, the Town of
Eastham through the control of infection and the spread of diseases
including, but not limited to, hepatitis B virus (HBV), hepatitis
C virus (HCV) and human immunodeficiency virus (HIV). This chapter
protects the public health by prescribing minimal standards for the
practice of body art through general sanitation of the premises; proper
sterilization of all instruments and equipment; and requiring training
in the standard procedures for the prevention of disease transmission.
This will ensure that the practice of body art in the Town of Eastham
shall be conducted with the highest professional standards.
As used in this chapter, the following terms shall have the
meanings indicated:
AFTERCARE
Written instructions given to the client, specific to the
body art procedure(s) rendered, about caring for the body art and
the surrounding area. These instructions will include information
about when to seek medical treatment, if necessary.
BODY ART
The practice of physical body adornment by permitted establishments
and practitioners using, but not limited to, the following techniques:
body piercing, tattooing, cosmetic tattooing, branding, and scarification.
This definition does not include practices that are considered medical
procedures by the Board of Registration in Medicine in the commonwealth,
such as implants under the skin, which shall not be performed in a
body art establishment.
BODY ART ESTABLISHMENT or ESTABLISHMENT
A specified place or premises that has been granted a permit
by the Board, whether public or private, where the practices of body
art are performed, whether for profit or not.
BODY ART PRACTITIONER or PRACTITIONER
A specified person who has been granted a permit by the Board
to perform body art in a body art establishment that has been granted
a valid permit by the Board.
BODY PIERCING
The puncturing or penetration of the skin of a person with
pre-sterilized single-use needles and the insertion of pre-sterilized
jewelry or other adornment thereto in the opening. This definition
includes piercing of the outer perimeter of the ear, but does not
include piercing of the earlobe with pre-sterilized single-use stud-and-clasp
ear-piercing systems.
BRANDING
Inducing a pattern of scar tissue by use of a heated material
(usually metal) to the skin, making a serious burn, which eventually
becomes a scar.
CLIENT
Any person who has requested a body art procedure at a body
art establishment.
CONTAMINATED WASTE
Any liquid, or semi-liquid, blood or other potentially infectious
materials; contaminated items that would release blood or other potentially
infectious materials in a liquid or semi-liquid state if compressed;
items that are caked with dried blood or other potentially infectious
materials and are capable of releasing these materials during handling;
sharps and any waste containing blood and other potentially infectious
materials, as defined in 29 CFR 1910.1030 (latest edition), known
as "Occupational Exposure to Bloodborne Pathogens," or as defined
as "infectious or physically dangerous medical or biological waste"
in accordance with 105 CMR 480.000: Minimum Requirements for the Management
of Medical or Biological Waste (State Sanitary Code Chapter VIII).
DEPARTMENT
The Massachusetts Department of Public Health or its authorized
representatives.
DISINFECTANT
Any product registered as a disinfectant by the U.S. Environmental
Protection Agency.
DISINFECTION
The destruction of disease-causing microorganisms on inanimate
objects or surfaces, thereby rendering these objects safe for use
or handling.
EAR-PIERCING
The puncturing of the lobe of the ear with a pre-sterilized
single-use stud-and-clasp ear-piercing system following the manufacturer's
instructions.
EQUIPMENT
All machinery, including fixtures, containers, vessels, tools,
devices, implements, furniture, display and storage areas, sinks,
and all other apparatus and appurtenances used in connection with
the operation of a Body Art Establishment.
HAND SINK
A lavatory equipped with hot and cold running water under
pressure, used solely for washing hands, arms, or other portions of
the body.
HOT WATER
Water that attains and maintains a temperature of 110°
F. to 130° F. or 43° C. to 54° C.
INSTRUMENTS USED FOR BODY ART
Hand pieces, needles, needle bars, and other instruments
that may come in contact with a client's body or may be exposed
to body fluids during body art procedures.
INVASIVE
The entry into the client's body either by incision
or insertion of any instruments into or through the skin or mucosa,
or by any other means intended to puncture, break, or otherwise compromise
the skin or mucosa.
JEWELRY
Any personal ornament inserted into a newly pierced area,
which must be made of surgical implant-grade stainless steel; solid
fourteen-karat (14K) or eighteen-karat (18K) white or yellow gold,
niobium, titanium, or platinum; or dense, low-porosity plastic, which
is free of nicks, scratches, or irregular surfaces and has been properly
sterilized prior to use.
MINOR
Any person under the age of 18 years.
OPERATOR
Any person who alone, jointly, or severally with others,
owns, has care, charge, or control of any body art establishment as
agent or leasee of the owner or as an independent contractor, but
is not a body art practitioner.
PERMIT
A.
Approval in writing by the Board either:
(1)
To operate a body art establishment; or
(2)
To operate as a body art practitioner within a body art establishment.
B.
Approval is granted in accordance with 105 CMR 124.000 and is
separate from any other licensing requirement that may exist within
communities or political subdivisions comprising the Board's
jurisdiction.
PERSON
An individual; any form of business or social organization;
or any other nongovernmental legal entity including, but not limited
to, corporations, partnerships, limited-liability companies, associations,
trusts, or unincorporated organizations.
PHYSICIAN
An individual registered by the Board of Registration in
Medicine pursuant to MGL c. 112, § 2 as a qualified physician.
PROCEDURE SURFACE
Any surface of an inanimate object that contacts the client's
unclothed body during a body art procedure, skin preparation of the
area adjacent to and including the body art procedure, or any associated
work area which may require sanitizing.
SANITARY
Clean and free of agents of infection or disease.
SANITIZATION PROCEDURE
A process of reducing the numbers of microorganisms on cleaned
surfaces and equipment to a safe level as judged by public health
standards and which has been approved by the Department.
SANITIZED
Effective disinfectant treatment by a process using intermediate
disinfectants for enough time to reduce the bacteria count including
pathogens to a safe level on semi-critical or noncritical equipment.
SCARIFICATION
Altering the skin texture by cutting the skin and controlling
the body's healing process in order to produce wounds, which
result in permanently raised wheals or bumps known as keloids.
SHARPS
Any object (sterile or contaminated) that may purposefully
or accidentally cut or penetrate the skin or mucosa including, but
not limited to, needles, needle devices, lancets, scalpel blades,
razor blades, and broken glass.
SINGLE-USE
Products or items that are intended for one-time, one-person
use and are disposed of after use on each client, including, but not
limited to, cotton swabs or balls, tissues or paper products, paper
or plastic cups, gauze and sanitary coverings, razors, piercing needles,
scalpel blades, stencils, ink cups, and protective gloves.
STANDARD PRECAUTIONS
A set of guidelines and controls, published by the Centers
for Disease Control and Prevention (CDC). This method of infection
control requires the employer and employee to assume that all human
blood and specified human body fluids are infectious for HIV, HBV,
and other blood pathogens. Precautions include hand washing; gloving;
personal protective equipment; injury prevention; and proper handling
and disposal of needles, other sharp instruments, and blood and body
fluid contaminated products. For guidelines and controls see:
A.
Schillie S, Vellozzi C, Reingold A, et al. "Prevention of Hepatitis
B Virus Infection in the United States: Recommendations of the Advisory
Committee on Immunization Practices." MMWR Recomm Rep 2018;67(No.
RR-1):1-31. DOI: http://dx.doi.org/10.15585/mmwr.rr6701a1.
B.
Schillie S, Murphy, Sawyer M, et al. "CDC Guidance for Evaluating
Health-Care Personnel for Hepatitis B Virus Protection and for Administering
Postexposure Management." MMWR Recomm Rep 2013;62(No. RR-10):1-19.
C.
Kuhar D, Henderson D, Struble, K, et al. "Updated U.S. Public
Health Service guidelines for the management of occupational exposures
to HIV and recommendations for postexposure prophylaxis." MMWR 2005;
54(No.RR09); p. 1-17.
D.
CDC. "Recommendations for the prevention and control of hepatitis
C virus (HCV) infection and HCV-related chronic disease." MMWR 1998;
47(No. RR-19).
E.
CDC. "Updated U.S. Public Health Service Guidelines for the
Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations
for Postexposure Prophylaxis." MMWR 2001; 50(RR11); 1-42.
STERILIZE
The use of a physical or chemical procedure to destroy all
microbial life including highly resistant bacterial endospores.
TATTOO
The indelible mark, figure, or decorative design introduced
by insertion of dyes or pigments into or under the subcutaneous portion
of the skin.
TATTOOING
Any method of placing ink or other pigment into or under
the skin or mucosa by the aid of needles or any other instrument used
to puncture the skin, resulting in permanent coloration of the skin
or mucosa. This term includes all forms of cosmetic tattooing.
The chapter shall apply to any person who operates a body art
establishment or engages in the practice of body art as herein defined,
except:
A. Physicians licensed in accordance with MGL c. 112, § 2
who perform body art procedures as part of patient treatment; and
B. Individuals who pierce only the lobe of the ear with a pre-sterilized
single-use stud-and-clasp ear-piercing system.
Unless otherwise ordered or approved by the Board, each body
art establishment shall be constructed, operated, and maintained to
meet the following minimum requirements.
A. Physical plant.
(1) All walls, floors, ceilings, and procedure surfaces within the body
art establishment shall be smooth, free from open holes or cracks,
light-colored, washable, and in good repair. Walls, floors, and ceilings
shall be maintained in a clean condition. All procedure surfaces,
including client chairs/benches, shall be of such construction as
to be easily cleaned and sanitized after each client.
(2) All body art establishments shall be completely separated by solid
partitions, or by walls extending from floor to ceiling, from any
room used for human habitation; any food establishment or room where
food is prepared; any hair salon; any retail sales; or any other such
activity that may cause potential contamination of work surfaces.
(3) Effective measures shall be taken by the body art operator and/or
practitioner to protect against entrance into the establishment and
against the breeding or presence on the premises of insects, vermin,
and rodents. Insects, vermin, and rodents shall not be present in
any part of the establishment, its appurtenances, or appertaining
premises.
(4) There shall be a minimum of 45 square feet of floor space for each
practitioner in the establishment. Each establishment shall have an
area that may be screened from public view for clients requesting
privacy. Multiple body art stations shall be separated by dividers,
curtains, or partitions, at a minimum.
(5) The establishment shall be well-ventilated and provided with an artificial
light source equivalent to at least 20 footcandles three feet off
the floor, except that at least 100 footcandles shall be provided
at the level where the body art procedure is being performed, and
where instruments and sharps are assembled.
(6) A separate, readily accessible hand sink with hot and cold running
water, under pressure, preferably equipped with wrist- or foot-operated
controls and supplied with liquid soap and disposable paper towels,
shall be provided within the body art establishment. One hand sink
shall serve no more than three body art practitioners.
(7) There shall be a minimum of one lavatory, excluding any service sinks,
and one working toilet in a body art establishment.
(8) At least one covered, foot-operated waste receptacle shall be provided
in each practitioner area and each toilet room. Receptacles in the
practitioner area shall be emptied daily, and solid waste shall be
removed from the premises at least weekly. All refuse containers shall
be lidded, cleanable, and kept clean.
(9) All instruments and supplies shall be stored in clean, dry, and covered
containers.
(10)
Practitioners who use ear-piercing systems shall conform to
the manufacturer's directions for use and all applicable U.S.
Food and Drug Administration (FDA) requirements.
(11)
Reusable cloth items shall be mechanically washed with detergent
and dried after each use. The cloth items shall be stored in a dry,
clean environment until used.
B. No animals of any kind shall be allowed in a body art establishment
except service animals used by persons with disabilities (e.g., seeing
eye dogs). Fish aquariums shall be allowed in waiting rooms and nonprocedural
areas.
C. Information to be kept on file. The following information shall be
kept on file on the premises of a body art establishment and shall
be available for inspection by the Board:
(1) Employee information.
(a)
Full names and exact duties.
(e)
Home and work phone numbers.
(2) Establishment information.
(c)
Owner's name and address.
(3) A complete description of all body art procedures performed.
(4) Aftercare instructions for all body art procedures performed.
(5) An inventory of all instruments and body jewelry, all sharps, and
all inks used for any and all body art procedures, including the names
of the manufacturers and serial or lot numbers, if applicable. Invoices
or orders shall satisfy this requirement.
(6) A copy of the service agreement for the sterilizer.
(7) Copies of all signed and dated release forms.
D. It shall be unlawful for any person to perform body art procedures
unless such procedures are performed in a body art establishment with
a current permit.
E. Each body art practitioner shall be a minimum of 18 years of age.
F. Each body art practitioner shall perform all body art procedures
in accordance with standard precautions set forth by the U.S. Centers
for Disease Control and Prevention.
G. Smoking, eating, or drinking are prohibited in the area where body
art procedures are performed.
H. Operators and/or practitioners shall refuse service to any person
who, in the opinion of the operator and/or practitioner, is under
the influence of alcohol or drugs.
I. The practitioner shall maintain a high degree of personal cleanliness,
conform to hygienic practices, and wear clean clothes when performing
body art procedures. Before performing body art procedures, the practitioner
shall thoroughly wash their hands in hot running water with liquid
soap, then rinse hands and dry with disposable paper towels. This
shall be done as often as necessary to remove contaminants.
J. In performing body art procedures, the practitioner shall wear disposable
single-use gloves. Gloves shall be changed if they become contaminated
by contact with any unclean surfaces or objects or by contact with
a third person. The gloves shall be discarded, at a minimum, after
the completion of each procedure on an individual client, and hands
shall be washed before the next set of gloves is donned. Under no
circumstances shall a single pair of gloves be used on more than one
person. The use of disposable single-use gloves shall not preclude
or substitute for handwashing procedures as part of a good personal
hygiene program.
(1) If, while performing a body art procedure, the practitioner's glove is pierced, torn, or otherwise contaminated, the procedure delineated in Subsection
I above shall be repeated immediately. The contaminated gloves shall be immediately discarded and the hands washed thoroughly (see Subsection
I above) before a fresh pair of gloves is applied. Any item or instrument used for body art that is contaminated during the procedure shall be discarded and replaced immediately with a new disposable item or new sterilized instrument or item before the procedure resumes.
K. Contaminated waste, as defined in this chapter, that may release
liquid blood or body fluids when compressed or may release dried blood
or body fluids when handled shall be placed in an approved "red" bag
marked with the International Biohazard Symbol. It shall then be disposed
in accordance with 105 CMR 480.000: Minimum Requirements for the Management
of Medical or Biological Waste (State Sanitary Code Chapter VIII)
or, at a minimum, in compliance with 29 CFR 1910.1030, "Bloodborne
pathogens." Used sharps ready for disposal shall be disposed of in
approved sharps containers. Contaminated waste that does not release
liquid blood or body fluids when compressed or may release dried blood
or body fluids when handled may be placed in a covered receptacle
and disposed of through normal, approved disposal methods. Storage
of contaminated waste on site shall not exceed 30 days, as specified
in 29 CFR 1910.1030.
L. No practitioner shall perform any body art procedure upon a client
who appears to be under 25 years of age without the client presenting
a valid state-issued picture identification card or driver's
license with an appropriate photograph to confirm that the client
is 18 years of age or older. No practitioner shall perform any body
art procedure upon a client under the age of 18 years without the
presence, consent, and proper identification of a parent, legal custodial
parent, or legal guardian. Nothing in this section is intended to
require a practitioner to perform any body art procedure on a person
under 18 years of age regardless of parental or guardian consent.
M. The skin of the client shall be free of rash or visible infection.
No body art procedure shall be performed upon any client affected
with boils, infected wounds, open sores, abrasions, weeping dermatological
lesions, or acute respiratory infections.
N. The skin of the practitioner shall be free of rash or infection.
No person, operator, or practitioner affected with boils, infected
wounds, open sores, abrasions, weeping dermatological lesions, or
acute respiratory infection shall work in any area of a body art establishment
in any capacity in which there is a likelihood that the person, operator,
or practitioner could contaminate body art equipment, supplies, or
working surfaces with body substances or pathogenic organisms.
O. Proof shall be provided upon request by the Board that all practitioners
in a body art establishment have either completed or were offered
and declined, in writing, the Hepatitis B vaccination series. This
offering should be included as a pre-employment requirement.
A written report of any injury, infection complication, or disease
to a client as a result of a body art procedure, or complaint of injury,
infection complication, or disease, shall be forwarded by the owner
and/or practitioner to the Board and to the Department with a copy
to the complainant or injured client within five working days of its
occurrence or knowledge thereof. The report shall include:
A. The name of the affected client.
B. The name and location of the body art establishment involved.
C. The nature of the injury, infection complication, or disease.
D. The name and address of the affected client's health care provider,
if any.
E. Any other information considered relevant to the situation.
The Board may summarily suspend a permit pending a final hearing
on the merits of the question of revocation if, based upon the evidence
before it, the Board determines that an establishment and/or practitioner
is an immediate and serious threat to the public health, safety, or
welfare. The suspension of a permit shall take effect immediately
upon written notice of such suspension by the Board.
If any provision of this regulation is declared invalid by a
court of competent jurisdiction, such invalidity shall not affect
any remaining provisions of this regulation. Any part of these regulations
subsequently invalidated by a new state law or modification of an
existing state law shall automatically be brought into conformity
with the new or amended law and shall be deemed to be effective immediately.