[HISTORY: Adopted by the Board of Health of the Town of Middleton 1-10-2001. Amendments noted where applicable.]
A. 
The Board of Health, Town of Middleton, Massachusetts, acting under the authority of MGL c. 111, § 31, has adopted the following regulation. The effective date shall be December 12, 2000.
B. 
Rationale. Town of Middleton is promulgating rules and regulations which provide minimum requirements to be met by persons performing body piercing upon any individual and for any establishment where body piercing is performed. These requirements shall include, but not be limited to, general sanitation of premises where body piercing is to be performed and the use of presterilized, disposable equipment. These rules and regulations are necessary to protect the public health by preventing disease, specifically including but not limited to transmission of Hepatitis B and/or Human Immunodeficiency Virus (HIV/AIDS).
C. 
These rules and regulations shall establish procedures for permitting of all persons performing body piercing; requirements for training courses in disease prevention, anatomy and physiology; for regular inspections of premises where body piercing is performed; and for revocation of the permit of any person or establishment deemed in violation of the rules and regulations. An annual, nontransferable permit fee set by the Town of Middleton shall be paid by any person or establishment permitted under these rules.
As used in this chapter, the following terms shall have the meanings indicated:
ANTIBACTERIAL SOLUTION
Any solution used to retard the growth of bacteria, approved for application to human skin as indicated on the product label.
BOARD OF HEALTH PERMIT FOR BODY PIERCING
Written BOH permit to engage in the work of body piercing.
BODY MODIFICATION
Altering of the shape or structure of human body parts.
BODY PIERCER
Any person who performs piercing of any part of the body other than the earlobe which is pierced by use of an appropriate piercing device.
BODY PIERCING
Any method of inserting a needle into the body, other than in the earlobe, to place jewelry in the perforation produced by the needle. Establishments and/or individuals involved in the piercing of earlobes (only) must comply with relevant OSHA requirements.
BOH
The Board of Health.
GERMICIDAL SOLUTION
Any solution which destroys germs and is so labeled.
MINOR
Any person under the age of 18.
OPERATOR
Any person who owns, controls, operates, conducts or manages any piercing establishment, whether actually performing the work of piercing or not.
PIERCING STUDIO/SALON
Any room or space where piercing is practiced or where the business of piercing is conducted.
SANITIZATION
The cleaning process that provides sufficient concentration of chemicals to reduce the bacteria count, including pathogens, to a safe level on equipment. Sterilization not sanitization should be the goal.
SCARRING
Cutting of the skin with a scalpel or other sharp instrument. This procedure is banned.
SKIN IMPLANTS
Introduction of metal or other materials under the skin.
STERILIZATION
A. 
A process which kills all bacteria or spores on an object.
B. 
The process of holding items in an autoclave for 30 minutes, at 20 pounds pressure, at a temperature of 275° F., after the autoclave has reached the proper temperature and pressure, not from a cold start.
No tattooing is allowed in the Town of Middleton, Massachusetts, until regulations have been adopted by the Board of Health or the State Department of Public Health.
A. 
No minors shall receive body piercing, unless accompanied by a parent or legal guardian who has signed a consent form allowing the procedure.
B. 
No piercing of animals shall be allowed in piercing studios.
C. 
Pre-procedural consultation to discuss body piercing and the health risks associated with it shall be required with each client. An informed consent shall be signed by each client. Clients shall be given a copy of the consent form and a copy shall be kept on file by the establishment. Clients with medical conditions such as hemophilia, which may be exacerbated by piercing procedures, shall be advised to first consult with their private physicians. Inquiries must be made as to whether or not a client is taking blood thinning medication.
D. 
The Board of Health shall be allowed to review consent forms during regular inspections.
E. 
Clients who are under the influence of alcohol or other drugs shall not receive any body modifications.
F. 
Body modification technicians shall not perform body modification while under the influence of any substance which may impair their judgment or ability to safely practice modification.
G. 
Piercing of genitalia is prohibited.
H. 
Oral piercing is limited to the tongue, lips, and facial areas. Internal piercings, such as on the uvula, are not allowed.
I. 
Clients must receive verbal and written instructions on post-procedure care and on the signs and symptoms of infection. Such instructions shall be available to the Board of Health during inspection.
J. 
Infections and adverse reactions of any kind shall be reported to the Middleton Board of Health within 24 hours and the client referred to a physician for an examination.
K. 
The skin to be affected shall first be washed with soap and water.
L. 
Environmental Protection Agency (EPA) approved disinfectants must be used to disinfect the surface of the skin in the area to be pierced, prior to piercing.
M. 
Body piercers who receive needle stick injuries and/or any potential exposure to blood-borne pathogens on the job shall follow OSHA laws on the reporting and follow-up on needle stick injuries. OSHA guidelines shall be posted in the employee area (Code of Federal Regulations, 29 CFR 1910.1030-f).
N. 
Sharps are needles and other tool heads used in body piercing.
O. 
All piercing studios shall offer free Hepatitis vaccination series to their employees as required by OSHA regulations.
P. 
Used piercing equipment shall be safely collected in biohazard-labeled rigid sharps disposable containers and disposed of as a biohazard.
Q. 
Body piercing will only be allowed in a commercial establishment.
R. 
Failure to comply with any of the above regulations may result in immediate revocation of permit.
A. 
No person shall perform body piercing or body modification, display a sign or in any other way advertise or claim to be a body modification technician unless that person holds a valid BOH permit.
B. 
An applicant for a permit shall pay a fee of $40 established by the Town of Middleton with an annual renewal fee of $40 and shall show to the satisfaction of the BOH that the technician applicant has:
(1) 
Complied with the BOH minimal training requirements for body piercers, set out in § 277-6.
(2) 
Provided evidence in the form of a driver's license/state identification card that the applicant is not less than 18 years of age.
(3) 
Provided the BOH with a current photograph.
(4) 
Signed a written agreement to adhere to all regulations regarding body piercing and modification.
C. 
The permit must be conspicuously posted at all times in the establishment.
D. 
Body modification technicians shall wear white or light-colored clothing suitable for the task.
E. 
A written policy on infection control for the establishment and technicians shall be submitted to the BOH.
F. 
The applicants shall submit a permit application to the BOH on the form provided.
G. 
The procedures of branding, scarring, implants and appendage splitting are prohibited.
A. 
Body modification technicians must show evidence of the following:
(1) 
Successful completion of basic training in first aid and CPR, as well as recertification classes with up-to-date certification.
(2) 
Successful completion of an OSHA course on prevention of disease transmission and blood-borne pathogens.
(3) 
Completion with a passing grade of a basic human anatomy and physiology course. The school must be accredited. Transcripts are to be required.
B. 
Body modification technicians must present evidence of a least one year of apprenticeship under the supervision of a trained, experienced professional piercer.
C. 
A medical exam with a statement that the technician is free of communicable diseases is required.
A. 
No person shall operate a body modification establishment unless the BOH issues a permit to that person to operate the establishment.
B. 
In addition to the body modification technician's fee, each establishment shall pay a fee of $40, with an annual renewal fee of $40, to operate the establishment.
C. 
Facilities shall be located in accordance with zoning regulations and requirements.
(1) 
The salon or studio design, furniture, lighting, plumbing, water, ventilation, solid waste disposal and sewerage must be in accordance with local ordinances.
(2) 
With the exception of service animals (i.e., guide dogs), no animals shall be allowed on the premises.
(3) 
The floors, walls, ceilings, light fixtures, decorative materials, and similar equipment attached to the walls or ceilings shall be kept clean and in good repair.
(4) 
Adequate ventilation (such as air conditioning, etc.) shall be used to keep the air dry and circulating.
(5) 
All floors, walls and ceilings shall be of light color.
(6) 
Convenient, clean, sanitary toilet and hand-washing facilities shall be made accessible to customers and employees. A hand-washing sign shall be posted in the bathroom, next to the sink. The plumbing fixtures and toilet room shall be in good repair. Single-use hand towels shall be provided. Mechanical air dryers are not recommended.
(7) 
Piercing studios shall be equipped with appropriate sterilizing equipment (i.e., a working steam autoclave). Autoclaves must be spore tested twice a month by independent laboratories to ensure that they are working adequately. Written records of testing shall be maintained for inspection.
(8) 
Piercing studios shall be equipped with appropriate cleansing equipment (i.e., a working ultrasonic cleaner).
(9) 
Piercing guns should be used on soft tissue only (ear lobes), not through cartilage.
(10) 
Working surfaces likely to be in contact with body fluids must be scrubable and nonabsorbent
D. 
Work area.
(1) 
Each body modification studio shall have a separate work area for each technician, not used for any other purpose.
(2) 
No client shall be pierced at any other location in the studio other than the work area.
(3) 
No clients shall be allowed to perform their own piercing/insertions.
(4) 
Hallways or corridors shall not be used as work areas.
(5) 
The floors, chairs and tabletops where body piercing equipment and body piercing work is done shall be easily cleanable and nonporous. Carpeting is not permitted in work areas.
(6) 
The work area should be well lit, with at least 50 footcandles of light measured at the height of the work table.
(7) 
Piercing rooms shall be equipped with sinks and basins with hot and cold running water. Such sink shall be used for no other purpose except hand-washing and piercing procedures.
(8) 
A covered waste receptacle with disposable liner bags shall be located in the work area.
(9) 
No person shall smoke, consume any food or drink in the work area.
(10) 
There shall be a hand-wash sink for every body technician in the same work space. A slop sink shall not be located in any work space.
A. 
Sanitary procedures. Before any procedure, technicians shall:
(1) 
Complete all business transactions, i.e., jewelry selection and paperwork.
(2) 
Obtain signed consent forms and provide a copy to the client.
B. 
Regarding jewelry.
(1) 
Appropriate jewelry is made of implant grade, high-quality surgical, stainless steel (316LVM series), solid 14K niobium, titanium or platinum. Appropriate jewelry has no nicks, scratches, or irregular surfaces which may endanger the body tissue or promote infection.
(2) 
Ear studs or earring wire must not be used on other body parts.
C. 
Hand-washing procedures. Before working on each patron, every technician shall:
(1) 
Inspect hands for small cuts and abrasions.
(2) 
Refrain from body piercing or handling equipment if he has open sores, weeping dermatitis or lesions on hands or arms until the condition has cleared.
(3) 
Refrain from body piercing until the condition has cleared, if he has a cold, flu or other communicable disease.
(4) 
Wash hands, wrists and up to the elbows with antibacterial solution.
(5) 
Dry hands thoroughly with single-use disposable towel, such as a paper towel.
(6) 
Wear medical-grade latex, vinyl, or hypoallergenic gloves.
D. 
Salons are prohibited from selling piercing equipment, such as clamps or needles, etc.
A. 
Body modification technicians shall set up equipment in front of the client.
B. 
Packages containing sterile equipment will be opened in front of the client.
C. 
No reused jewelry shall be utilized. Jewelry surfaces must be sterile.
D. 
All jewelry must be for single use, on only one person, and shall not be reused on other clients.
E. 
All needles used in piercing must be presterilized, used on only one person, in one sitting, for single piercing, and immediately disposed of in a medical sharps container.
F. 
Piercers shall use presterilized disposable equipment when possible. For equipment that is not disposable, such as surgical steel forceps, autoclaving and ultrasonic cleaning are required.
A. 
Body piercers shall:
(1) 
Put on fresh gloves for each procedure.
(2) 
Operate in such a manner so as to avoid recontamination of surfaces previously worked on.
(3) 
Discard disposable items and remove them from the work area
(4) 
Remove plastic barrier film (if used) and disinfect surface areas, drawer pulls, cabinetry, telephones, lamps, chairs, sinks, tables, chairs, floor area, and any other surfaces that may have become contaminated.
(5) 
Dispose of single-use lap cloths after each use.
(6) 
Remove and discard gloves and wash hands.
(7) 
Discard any materials used in the procedure, such as gloves, gauze and other non-sharp-disposal material in biohazardous waste bags after each client.
B. 
All reusable equipment, such as marking pen, shall be nonporous and disinfected after each use. Nonspray wipes for surfaces and liquids for soaking jewelry are preferred over spray disinfectants, which may disperse pathogens into the air.
C. 
Iodine, bacitracin, and other antiseptics shall be applied with single-use applicators. Applicators that have touched a client once may not be used to retrieve antiseptics, iodine, etc., from containers.
D. 
For removal of contamination on instruments (i.e., jewelry, forceps, pliers), cleansing with an ultrasonic cleaner followed by a steam autoclave is required.
E. 
Steam autoclave must be used on all equipment that may come in contact with the client or the jewelry (i.e., receiving tubes, rubber bands, insertion tapers, forceps, files, gauge wheels, pliers, etc.). Equipment shall be bagged, dated and sealed and then stored in a nonporous, dark, dry, cool place, such as a medical credenza. Autoclaves shall be spore tested by independent laboratories at least twice a month. Instruments shall be sterilized. Sterilization time shall begin at the time that the instruments reach the correct temperature.
A. 
Proper disposal of hazardous and biological waste is mandatory. All used needles must be stored in medical-grade sharps containers and disposed of by a professional environmental company licensed by the state.
B. 
Any other supplies or material that is contaminated with blood or other body fluids shall be double-bagged in red hazardous waste bags and also removed by an environmental company licensed by the state to remove biological waste.
C. 
Uncontaminated disposable waste shall be placed in easily cleanable, sealed containers, with tight lids, to prevent leakage.
D. 
Waste containers shall be kept closed when not in use.
[1]
Editor's Note: See also Ch. 323, Solid Waste.
A. 
An annual permit application with a fee of $40 will be submitted by check to the Middleton Board of Health for each establishment.
B. 
An annual permit application along with a fee of $40 will be submitted by check to the Middleton Board of Health for each body piercer applicant with qualifications.
C. 
Each permit shall expire on December 31.
D. 
Proof of liability insurance coverage shall accompany all applications.
E. 
The salon must have a written contract for disposal of sharps and biohazards.
A. 
The body modification technician shall be suspended immediately upon notice to the holder (without a hearing) when the BOH has reason to believe that an imminent health hazard exists.
B. 
In all other instances of violation, the BOH shall serve the registrant a written notice specifying the violations and allow the establishment the opportunity to correct the problems.
C. 
If a registrant fails to comply with the BOH body piercing regulations, the BOH shall suspend the body modification establishment permit.
D. 
The establishment shall be notified in writing that the permit shall be suspended at the end of 10 days following the citing of the violations unless a request for a hearing is made to the BOH within the seven-day period.
E. 
Any person whose permit has been suspended may make a request in writing for reinstatement of the permit.
F. 
For serious or repeated violations or for interference with the BOH in the performance of its duties, or for persons found guilty of any crime related to body modification, the technician's permit may be permanently revoked after an opportunity for a hearing has been provided.
G. 
Any person who performs piercing without a permit will be penalized by a fine of $300 a day or brought before a court of proper jurisdiction.
H. 
Any person performing body modification on a minor without the written consent and the presence of a parent or legal guardian will be penalized by a fine of $300 per violation or brought before a court of proper jurisdiction. The fine will increase to $600 for a second offense. A third offense will result in loss of permit.
A. 
The Board of Health may vary the application of any provisions of any of these regulations with respect to any particular case when the Board of Health finds the enforcement thereof would do manifest injustice.
B. 
Every request for a variance shall be made in writing to the Board of Health and shall state the specific variance sought and the reason therefor.
C. 
Any variance granted must be in writing with a copy available to the public at all reasonable hours in the office of the (Town) Clerk and in the office of the Board of Health. Any variance granted must be posted on the premises in a prominent location for the duration that the variance is in effect.
If any section, paragraph, sentence, clause, phrase, or word of this regulation is declared invalid for any reason, that decision will not be applicable to the remaining portions of these regulations.