Body art is becoming prevalent and popular throughout the Commonwealth;
and knowledge and practice of universal precautions, sanitation, personal
hygiene, sterilization and aftercare requirements on the part of the
practitioner should be demonstrated to prevent the transmission of
disease or injury to the client and/or practitioner. Therefore, the
Board of Health of the Town of Greenfield passes these rules and regulations
for the practice of body art in the Town of Greenfield as part of
its mission to protect the public health, safety and welfare of the
public.
These regulations are promulgated under the authority granted
to the Board of Health under MGL c. 111, § 31.
As used in this article, 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, including information about when to seek medical
treatment, if necessary.
APPLICANT
Any person who applies to the Board of Health for either
a body art establishment permit or practitioner permit.
AUTOCLAVE
An apparatus for sterilization utilizing steam pressure at
a specific temperature over a period of time.
AUTOCLAVING
A process which results in the destruction of all forms of
microbial life, including highly resistant spores, by the use of an
autoclave for a minimum of 30 minutes at 20 pounds of pressure (PSI)
at a temperature of 270° F.
BOARD OF HEALTH or BOARD
The Board of Health that 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, such as implants
under the skin, which are prohibited.
BODY ART ESTABLISHMENT or ESTABLISHMENT
A location, place, or business 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 specifically identified individual who has been granted
a permit by the Board to perform body art in an establishment that
has been granted a permit by the Board.
BODY PIERCING
Puncturing or penetrating the skin of a client with presterilized
single-use needles and the insertion of presterilized jewelry or other
adornment into the opening. This definition excludes piercing of the
earlobe with a presterilized single-use stud-and-clasp system manufactured
exclusively for ear piercing.
BRAIDING
The cutting of strips of skin of a person, which strips are
then to be intertwined with one another and placed onto such person
so as to cause or allow the incised and interwoven strips of skin
to heal in such intertwined condition.
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.
CLEANING AREA
The area in a body art establishment used in the sterilization,
sanitation or other cleaning of instruments or other equipment used
for the practice of body art.
CLIENT
A member of the public who requests a body art procedure
at a body art establishment.
CONTAMINATED WASTE
Waste as defined in 105 CMR 480.000: Storage and Disposal
of Infectious or Physically Dangerous Medical or Biological Waste,
State Sanitary Code, Chapter VIII and/or 29 CFR Part 1910.1030. This
includes any liquid or semi-liquid blood or other potentially infectious
material; contaminated items that would release blood or other potentially
infectious material in a liquid or semi-liquid state if compressed;
items on which there is dried blood or other potentially infectious
material and which are capable of releasing these materials during
handling; sharps and any wastes containing blood or other potentially
infectious materials.
DISINFECTANT
A product registered as a disinfectant by the United States
Environmental Protection Agency (EPA).
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 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.
EXPOSURE
An event whereby there is an eye, mouth or other mucus membrane,
nonintact skin or parenteral contact with the blood or bodily fluids
of another person or contact of an eye, mouth or other mucous membrane,
nonintact skin or parenteral contact with other potentially infectious
matter.
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 any body art procedure.
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 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.
MOBILE BODY ART ESTABLISHMENT
Any trailer, truck, car, van, camper or other motorized or
nonmotorized vehicle, a shed, tent, movable structure, bar, home or
other facility wherein, or concert, fair, party or other event whereat
one desires to or actually does conduct body art procedures, excepting
only a licensed body art establishment.
OPERATOR
Any person who individually, or jointly or severally with
others, owns or controls an establishment, but is not a body art practitioner.
PERMIT
Board approval in writing to either 1) operate a body art
establishment or 2) operate as a body art practitioner within a body
art establishment. Board approval shall be granted solely for the
practice of body art pursuant to these regulations. Said permit is
exclusive of the establishment's compliance with other licensing or
permitting requirements that may exist within the community or political
subdivision 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 licensed as a qualified physician by the Board
of Registration in Medicine pursuant to MGL c. 112, § 2.
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.
SANITIZE
The application of a United States EPA-registered sanitizer
on a cleaned surface in accordance with the label instructions.
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 object, sterile or contaminated, that may intentionally
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, leakproof container that can be closed
for handling, storage, transportation, and disposal and that is labeled
with the International Biohazard Symbol.
SINGLE-USE ITEMS
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.
THREE-DIMENSIONAL "3D" BODY ART or BEADING or IMPLANTATION
The form of body art consisting of or requiring the placement,
injection or insertion of an object, device or other thing made of
matters such as steel, titanium, rubber, latex, plastic, glass or
other inert materials, beneath the surface of the skin of a person.
This term does not include "body piercing."
ULTRASONIC CLEANING UNIT
A unit approved by the Board, physically large enough to
fully submerge instruments in liquid, which removes all foreign matter
from the instruments by means of high-frequency oscillations transmitted
through the contained liquid.
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 (HIV) and Hepatitis
B Virus (HBV) 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) Walls, floors, ceilings, and procedure surfaces shall be smooth,
durable, 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) Solid partitions or walls extending from floor to ceiling shall separate
the establishment's space from any other 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) The establishment shall take all measures necessary to ensure against
the presence or breeding of insects, vermin, and rodents within the
establishment.
(4) Each operator area shall have a minimum of 45 square feet of floor
space for each practitioner. 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 a dividers 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, where
instruments and sharps are assembled and all cleaning areas.
(6) All electrical outlets in operator areas and cleaning areas shall
be equipped with approved ground fault (GFCI) protected receptacles.
(7) 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
stored in fixed dispensers shall be readily accessible within the
establishment. Each operator area shall have a hand sink.
(8) There shall be a sharps container in each operator area and each
cleaning area.
(9) There shall be a minimum of one toilet room containing a toilet and
sink. The toilet room shall be provided with toilet paper, liquid
hand soap and paper towels stored in a fixed dispenser. A body art
establishment permanently located within a retail shopping center,
or similar setting housing multiple operations within one enclosed
structure having shared entrance and exit points, shall not be required
to provide a separate toilet room within such body art establishment
if Board-approved toilet facilities are located in the retail shopping
center within 300 feet of the body art establishment so as to be readily
accessible to any client or practitioner.
(10)
The public water supply entering a body art establishment shall
be protected by a testable, reduced pressure backflow preventor installed
in accordance with 142 CMR 248, as amended from time to time.
(11)
At least one covered, foot-operated waste receptacle shall be
provided in each operator area and each toilet room. Receptacles in
the operator area shall be emptied daily. Solid waste shall be stored
in covered, leakproof, rodent-resistant containers and shall be removed
from the premises at least weekly.
(12)
At least one janitorial sink shall be provided in each body
art establishment for use in cleaning the establishment and proper
disposal of noncontaminated liquid wastes in accordance with all applicable
federal, state and local laws. Said sink shall be of adequate size
equipped with hot and cold running water under pressure and permit
the cleaning of the establishment and any equipment used for cleaning.
(13)
All instruments and supplies shall be stored in clean, dry,
and covered containers. Containers shall be kept in a secure area
specifically dedicated to the storage of all instruments and supplies.
(14)
The establishment shall have a cleaning area. Every cleaning
area shall have an area for the placement of an autoclave or other
sterilization unit located or positioned a minimum of 36 inches from
the required ultrasonic cleaning unit.
(15)
The establishment shall have a customer waiting area, exclusive
and separate from any workstation, instrument storage area, cleaning
area or any other area in the body art establishment used for body
art activity.
(16)
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.
(17)
Smoking, eating, or drinking is prohibited in the area where
body art is performed, with the exception of fluids being offered
to a client during or after a body art procedure.
B. Requirements for single-use items, including inks, dyes and pigments.
(1) Single-use items shall not be used on more than one client for any
reason. After use, all single-use sharps shall be immediately disposed
of in approved sharps containers pursuant to 105 CMR 480.
(2) All products applied to the skin, such as but not limited to body
art stencils, applicators, gauze and razors, shall be single-use and
disposable.
(3) Hollow-bore needles or needles with cannula shall not be reused.
(4) All inks, dyes, pigments, solid-core needles, and equipment shall
be specifically manufactured for performing body art procedures and
shall be used according to manufacturer's instructions.
(5) Inks, dyes or pigments may be mixed and may only be diluted with
water from an approved potable source. Immediately before a tattoo
is applied, the quantity of the dye to be used shall be transferred
from the dye bottle and placed into single-use paper cups or plastic
cups. Upon completion of the tattoo, these single-use cups or caps
and their contents shall be discarded.
C. Sanitation and sterilization measures and procedures.
(1) All nondisposable instruments used for body art, including all reusable
solid-core needles, pins and stylets, shall be cleaned thoroughly
after each use by scrubbing with an appropriate soap or disinfectant
solution and hot water, (to remove blood and tissue residue), and
shall be placed in an ultrasonic unit sold for cleaning purposes under
approval of the United States Food and Drug Administration and operated
in accordance with manufacturer's instructions.
(2) After being cleaned, all nondisposable instruments used for body
art shall be packed individually in sterilizer packs and subsequently
sterilized in a steam autoclave sold for medical sterilization purposes
under approval of the United States Food and Drug Administration.
All sterilizer packs shall contain either a sterilizer indicator or
internal temperature indicator. Sterilizer packs must be dated with
an expiration date not to exceed six months.
(3) The autoclave shall be used, cleaned, and maintained according to
manufacturer's instruction. A copy of the manufacturer's recommended
procedures for the operation of the autoclave must be available for
inspection by the Board. Autoclaves shall be located away from workstations
or areas frequented by the public.
(4) Each holder of a permit to operate a body art establishment shall
demonstrate that the autoclave used is capable of attaining sterilization
by monthly spore destruction tests. These tests shall be verified
through an independent laboratory. The permit shall not be issued
or renewed until documentation of the autoclave's ability to destroy
spores is received by the Board. These test records shall be retained
by the operator for a period of three years and made available to
the Board upon request.
(5) All instruments used for body art procedures shall remain stored
in sterile packages until just prior to the performance of a body
art procedure. After sterilization, the instruments used in body art
procedures shall be stored in a dry, clean cabinet or other tightly
covered container reserved for the storage of such instruments.
(6) Sterile instruments may not be used if the package has been breached
or after the expiration date without first repackaging and resterilizing.
(7) If the body art establishment uses only single-use, disposable instruments
and products, and uses sterile supplies, an autoclave shall not be
required.
(8) When assembling instruments used for body art procedures, the operator
shall wear sterile disposable medical gloves and use medically recognized
techniques to ensure that the instruments and gloves are not contaminated.
(9) Reusable cloth items shall be mechanically washed with detergent
and mechanically dried after each use. The cloth items shall be stored
in a dry, clean environment until used.
D. Posting requirements. The following shall be prominently displayed:
(1) A disclosure statement, a model of which shall be available from
the Board. A disclosure statement shall also be given to each client,
advising him/her of the risks and possible consequences of body art
procedures.
(2) The name, address and phone number of the Greenfield Board of Health
and the procedure for filing a complaint.
(3) An emergency plan, including:
(a)
A plan for the purpose of contacting police, fire or emergency
medical services in the event of an emergency;
(b)
A telephone in good working order shall be easily available
and accessible to all employees and clients during all hours of operation;
and
(c)
A sign at or adjacent to the telephone indicating the correct
emergency telephone numbers.
(4) An occupancy and use permit as issued by the local building official.
(5) A current establishment permit.
(6) Each practitioner's permit.
E. Establishment recordkeeping. The establishment shall maintain the
following records in a secure place for a minimum of three years,
and such records shall be made available to the Board upon request:
(1) Establishment information, which shall include:
(c)
Owner's name and address.
(d)
A complete description of all body art procedures performed.
(e)
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 packing slips shall satisfy this requirement.
(f)
Material Safety Data Sheets, when available, for each ink and
dye used by the establishment.
(g)
Copies of waste hauler manifests.
(h)
Copies of commercial biological monitoring tests.
(i)
Exposure incident reports (kept permanently).
(j)
A copy of these regulations.
(2) Employee information, which shall include:
(a)
Full legal name and exact duties;
(e)
Identification photograph;
(g)
Hepatitis B vaccination status or declination notification;
and
(3) Client information.
(a) Client information shall include:
[2]
Age and valid identification;
[5]
Name of the practitioner who performed the procedure(s);
[6]
Description of procedure(s) performed and the location on the
body;
[8]
If the client is a person under the age of 18, proof of parental
or guardian identification, presence and consent, including a copy
of the photographic identification of the parent or guardian.
(b)
Client information shall be kept confidential at all times.
(4) Exposure control plan. The establishment shall require that all body
art practitioners have either completed, or were offered and declined,
in writing, the Hepatitis B vaccination series. Records documenting
compliance with this requirement shall be provided to the Board upon
request.
F. No person shall establish or operate a mobile or temporary body art
establishment.
Practitioners are required to comply with the following minimum
health standards:
A. A practitioner shall perform all body art procedures in accordance
with Universal Precautions set forth by the United States Centers
for Disease Control and Prevention.
B. A practitioner shall refuse service to any person who may be under
the influence of alcohol or drugs.
C. Practitioners who use ear-piercing systems must conform to the manufacturer's
directions for use, and to applicable United States Food and Drug
Administration requirements. No practitioner shall use an ear-piercing
system on any part of the client's body other than the lobe of the
ear.
D. Health history and client informed consent. Prior to performing a
body art procedure on a client, the practitioner shall:
(1) Inform the client, verbally and in writing, that the following health
conditions will increase health risks associated with receiving a
body art procedure:
(b)
History of hemophilia (bleeding);
(c)
History of skin diseases, skin lesions, or skin sensitivities
to soaps, disinfectants, etc.;
(d)
History of allergies or adverse reactions to pigments, dyes,
or other sensitivities;
(e)
History of epilepsy, seizures, fainting, or narcolepsy;
(f)
Use of medications such as anticoagulants, which thin the blood
and/or interfere with blood clotting; and
(g)
Any other conditions such as hepatitis or HIV.
(2) Require that the client sign a form confirming that the above information was provided, that the client does not have a condition that prevents him/her from receiving body art, that the client consents to the performance of the body art procedure, and that the client has been given the aftercare instructions as required by Subsection
K of this section.
E. A practitioner shall maintain the highest degree of personal cleanliness,
conform to the best standard hygienic practices, and wear clean clothes
when performing body art procedures. Before performing body art procedures,
the practitioner must thoroughly wash his/her 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.
F. In performing body art procedures, a practitioner shall wear sterile disposable single-use gloves. Gloves shall be changed if they become pierced, torn, or otherwise 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 in accordance with Subsection
E before the next set of gloves is put on. 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 personal hygiene program.
G. The skin of the practitioner shall be free of rash or infection.
No 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 could contaminate body
art equipment, supplies, or working surfaces with body substances
or pathogenic organisms.
H. 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.
I. Preparation and care of a client's skin area must comply with the
following:
(1) Any skin or mucosa surface to receive a body art procedure shall
be free of rash or any visible infection.
(2) Before a body art procedure is performed, the immediate skin area
and the areas of skin surrounding where the body art procedure is
to be placed shall be washed with soap and water and an approved surgical
skin preparation, such as a five minute Betadine scrub. If shaving
is necessary, single-use disposable razors or safety razors with single-service
blades shall be used. Blades shall be discarded after each use, and
reusable holders shall be cleaned and autoclaved after use. Following
shaving, the skin and surrounding area shall be washed with soap and
water. The washing pad shall be discarded after a single use.
(3) In the event of bleeding, all products used to stop the bleeding
or to absorb blood shall be single-use, and discarded immediately
after use in appropriate covered containers, and disposed of in accordance
with 105 CMR 480.
J. Petroleum jellies, soaps, and other products used in the application
of stencils shall be dispensed and applied on the area to receive
a body art procedure with sterile gauze or other sterile applicator
to prevent contamination of the original container and its contents.
The applicator or gauze shall be used once and then discarded.
K. The practitioner shall provide each client with verbal and written
instructions on the aftercare of the body art site.
(1) The written instructions shall advise the client:
(a)
On the proper cleansing of the area which received the body
art;
(b)
To consult a health care provider for:
[1]
Unexpected redness, tenderness or swelling at the site of the
body art procedure;
[3]
Unexpected drainage at or from the site of the body art procedure;
or
[4]
A fever within 24 hours of the body art procedure; and
[5]
Of the address, and phone number of the establishment.
(2) A copy shall be provided to the client. A model set of aftercare
instructions shall be made available by the Board.
L. Contaminated waste shall be stored, treated and disposed of in accordance
with 105 CMR 480: Storage and Disposal of Infectious or Physically
Dangerous Medical or Biological Waste, State Sanitary Code, Chapter
VIII.
A written report of any injury, infection, complication or disease
as a result of a body art procedure, or complaint of injury, infection,
complication or disease, shall be forwarded by the operator to the
Board which issued the permit, with a copy to the 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 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,
Attorney General, or other law enforcement official any incidents
of unauthorized practice.
The fine for a violation of any provision of these rules and
regulations shall be $100 for the first offense. The establishment
permit shall be suspended for 30 days for a second offense. The establishment
permit shall be revoked for a third offense. Each day that a violation
continues shall be deemed to be a separate offense.
In accordance with MGL c. 40, § 21D, and Chapter
1, Article
III, of the Code of the Town of Greenfield, whoever violates any provision of these rules and regulations may be penalized by noncriminal disposition.