105 CMR 124.000 is adopted under the authority of MGL c. 111, § 6.
The purpose of these regulations is to set forth regulations for the
Walpole Board of Health, acting under the authority conferred by MGL c. 111,
§ 31, seek to enact regulations governing the practice of body art.
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 surrounding area.
These instructions will include information about when to seek medical treatment,
if necessary.
BOARD OF HEALTH or BOARD
The Board of Health which has jurisdiction in the community in which
a body art establishment is located including the Board or officer having
like powers and duties in towns where there is no Board of Health.
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 or not for profit.
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
Puncturing or penetration of the skin of a person with presterilized
single-use needles and the insertion of presterilized 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 presterilized
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 semiliquid blood or other potentially infectious materials;
contaminated items that would release blood or other potentially infectious
materials in a liquid or semiliquid 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 wastes containing
blood and other potentially infectious materials, as defined in 29 Code of
Federal Regulations Part 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 in 105 CMR 480.000:
Storage and Disposal of Infectious or Physically dangerous Medical or Biological
Waste, State Sanitary Code, Chapter VIII.
DEPARTMENT
The Department of Public Health or its authorized representatives.
DISINFECTANT
A product registered as a disinfectant by the US 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 presterilized single-use
stud-and-clasp ear-piercing system following 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 110° F. to 130°
F.
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 bodily fluids during
body art procedures.
INVASIVE
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 14k or 18k white
or yellow gold, niobium, titanium, or platinum; or a 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 lessee
of the owner or as an independent contractor, but is not a body art practitioner.
PERMIT
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. 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 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 objects (sterile or contaminated) that may purposefully or accidentally
cut or penetrate the skin or mucosa, including, but not limited to, needle
devices, lancets, scalpel blades, razor blades, and broken glass.
SHARPS CONTAINER
A puncture-resistant, leak-proof container that can be closed for
handling, storage, transportation, and disposal and that is labeled with the
International Biohazard Symbol.
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.
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.
UNIVERSAL PRECAUTIONS
A set of guidelines and controls, published by the Centers for Disease
Control and Prevention (CDC), as "Guidelines for Prevention of Transmission
of Human Immunodeficiency Virus and Hepatitis B Virus to Health-Care and Public-Safety
Workers" in Morbidity and Mortality Weekly Report (MMWR), June 23, 1989, Vol.
38 No. S-6, and as "Recommendations for Preventing Transmission of Human Immunodeficiency
Virus and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures"
in MMWR, July 12, 1991, Vol. 40, No. RR-8. This method of infection control
requires the employer and the 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.
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 of 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
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 readily accessible within the body art establishment. One hand-sink shall
serve no more than three 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 waste receptacle shall be provided
in each operator area and each toilet room. Receptacles in the operator 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 must conform
to the manufacturers directions for use and applicable US Food and Drug Administration
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.
(12) 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.
B. Information to be kept on file. The following information
shall be kept on file on the premises of a body art establishment and available
for inspection by the Board:
(1) Employee information.
(a) Full names and exact duties;
(f) Identification photos of all body art practitioners;
(g) Establishment information;
(j) Owner's name and address;
(2) A complete description of all body art procedures performed.
(3) An inventory of all instruments and body jewelry, all
sharps, and all inks used for any and all body art procedures, including names
of manufacturers and serial or lot numbers, if applicable. Invoices or orders
shall satisfy this requirement.
(4) A copy of these regulations.
C. 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.
D. Each body art practitioner must be a minimum of 18 years
of age.
E. Each practitioner shall perform all body art procedures
in accordance with Universal Precautions set forth by the US Centers for Disease
Control and Prevention.
F. Smoking, eating, or drinking is prohibited in the area
where body art is performed.
G. Operators/practitioners shall refuse service to any person
who, in the opinion of the operator/practitioner, is under the influence of
alcohol or drugs.
H. 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
must thoroughly wash their hands in hot running water with liquid soap, then
rinse hands and dry with disposable paper towel. This shall be done as often
as necessary to remove contaminants.
I. In performing body art procedures, the practitioner shall
wear disposable single-use gloves. Gloves must 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 does not preclude or substitute for hand-washing procedures as part
of a good personnel hygiene program.
J. If, while performing a body art procedure, the practitioner's glove is pierced, torn, or otherwise contaminated, the procedure delineated in Subsection
I 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 a new sterilized instrument or item before the procedure resumes.
K. Contaminated waste, as defined in this code, that may
release liquid blood or body fluids when compressed or may release dried blood
or body fluids when handled must be placed in an approved "red" bag marked
with the International Biohazard Symbol. It must then be disposed in accordance
with 105 CMR 480.00: Storage and Disposal of Infectious or Physically Dangerous
Medical or Biological Waste, State Sanitary Code, Chapter VIII, or, at a minimum,
in compliance with 29 CFR Part 1910.1030, "Occupational Exposure to 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 does not 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 Part 1910.1030.
L. 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. Any skin or mucosa surface to receive a body art procedure
shall be free of rash or any visible infection.
N. The skin of the practitioner shall be free of rash or
infection. No person or operator 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 that person could contaminate body art equipment,
supplies, or working surfaces with body substances or pathogenic organisms.
O. Proof shall be provided upon request of the Board that
all practitioners have either completed or were offered and declined, in writing,
the hepatitis B vaccination series. This offering should be included as a
preemployment 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 operator or practitioner
to the Board which issued the permit 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 body art establishment shall keep a record of all persons who have
had body art procedures performed. The record shall include the name, date
of birth, and address of the client, the date of the procedure, the name of
the practitioner who performed the procedure(s), type and location of procedure
performed, and signature of client, and, if the client is a minor, proof of
parental or guardian presence and consent. Such records shall be retained
for a minimum of three years and shall be available to the Board upon request.
The Board and the body art establishment shall keep such records confidential.
Body art establishments shall submit a scale drawing and floor plan
of the proposed establishment for a plan review by the Board, as part of the
permit application process.
A. Establishment permit.
(1) No person, firm, partnership, joint venture, association,
business trust, corporation or organized group of persons may operate a body
art establishment except with a body art establishment permit from the Board.
(2) Any person operating a body art establishment shall obtain
an annual permit from the Board. The Board shall set a reasonable fee for
such permit.
(3) A permit for a body art establishment shall not be transferable
from one place or person to another.
(4) A current body art establishment permit shall be posted
in a prominent and conspicuous area where clients may readily observe it.
(5) The holder of a body art establishment permit must only
hire practitioners who have complied with the practitioner permit requirements
of this code.
B. Body art practitioner permit.
(1) No person shall practice body art procedures without
first obtaining an operator permit from the Board. The Board shall set a reasonable
fee for such permits.
(2) The practitioner permit shall be valid from the date
of issuance and shall automatically expire in two years from the date of issuance
unless revoked sooner by the Board.
C. Application for a practitioner permit shall include:
(7) Place(s) of employment as a practitioner;
(8) Training and/or experience;
(9) Proof of attendance at a bloodborne pathogen training
program (or equivalent), given or approved by the Board.
(a) The applicant shall provide documentation of attendance
and completion of courses approved by the Board, or completion of an examination,
on the following subjects:
[2] Skin diseases, disorders and conditions (including diabetes).
[3] Infectious disease control, including waste disposal,
hand-washing, techniques, sterilization equipment operation and methods, and
sanitization/disinfection/sterilization methods and techniques.
(b) Examples of courses approved by the Board include courses
such as "Preventing Disease Transmission" (American Red Cross) and "Bloodborne
Pathogen Training" (US OSHA). Training/courses provided by professional body
art organizations or associations or by equipment manufacturers may also be
submitted to the Board for approval.
D. No permit shall be issued unless, following reasonable
investigation by the Board, the body art establishment or practitioner has
demonstrated compliance with the provisions of this section and all other
provisions of these regulations.
E. All permits shall be conditioned upon continued compliance
with the provisions of this section as well as all applicable provisions of
these regulations.
F. All permits shall be posted in a prominent and conspicuous
area where clients may readily observe them.
The Board may summarily suspend a permit pending a final hearing on
the merits on the question of revocation if, based on the evidence before
it, the Board determines that an establishment and/or a 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.
The Board shall refer to the appropriate District Attorney, the Attorney
General, or other appropriate law enforcement agency any incidents of unauthorized
practice of body art that come to its attention.
If any rule or provision contained herein is found to be unconstitutional
or invalid by a court of competent jurisdiction, the validity of the remaining
rules and provisions will not be so affected.