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, 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.
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 procedures 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.
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.
COSMETIC TATTOOING
Also known as permanent cosmetics, micropigment implantation
or dermal pigmentation; means the implantation of permanent pigment
around the eyes, lips and cheeks of the face and hair imitation.
DISINFECTANT
A product registered as a disinfectant by the U.S. 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.
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,
non-intact skin or parenteral contact with the blood or bodily fluids
of another person or contact of an eye, mouth or other mucous membrane,
non-intact 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.
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 operate 1) a body art
establishment or 2) 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 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 U.S. 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, leak-proof 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. This term includes all forms of cosmetic tattooing.
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.
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.
Physicians licensed in accordance with MGL c. 112, § 2
who perform body art procedures as part of patient treatment are exempt
from these regulations.
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 practitioner shall have a minimum of 45 square feet of floor
space. 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 partition, 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 practitioner 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 practitioner shall have a hand sink.
(8) There shall be a sharps container in each practitioner 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.
(10)
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. Solid waste shall
be stored in covered, leak-proof, rodent-resistant containers and
shall be removed from the premises at least weekly.
(11)
At least one janitorial sink shall be provided in each body
art establishment for use in cleaning the establishment and proper
disposal of non-contaminated 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.
(12)
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.
(13)
The establishment shall have a cleaning area.
(14)
Every cleaning area shall have an instrument sink used exclusively
for the cleaning of instruments. Every instrument sink shall be of
adequate size and equipped with hot and cold running water under pressure
so as to permit the cleaning of instruments used in body art activity.
(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 nonalcoholic 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 480.000.
(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 a 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 not be mixed. 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) If the body art establishment will only use sterile single-use, disposable
instruments and products.
(2) When assembling instruments used for body art procedures, the practitioner
shall wear sterile disposable medical gloves and use medically recognized
sterile techniques to ensure that the instruments and gloves are not
contaminated.
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 Board of Health.
(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)
A Material Safety Data Sheet, 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 Report (kept permanently);
(j)
A copy of these regulations.
(2) Employee information, which shall include:
(a)
Full legal names and exact duties;
(e)
Identification photograph;
(g)
Proof that all practitioners have either completed or were offered
and declined, in writing, the hepatitis B vaccination series;
(3) Client Information, which shall include:
(b)
Age and valid photo identification;
(e)
Name of the practitioner who performed the procedure(s);
(f)
Description of procedure(s) performed and the location on the
body;
(g)
A signed consent form.
Client information shall be kept confidential at all times.
(4) Exposure control plan. Each establishment shall create, update, and
comply with an Exposure Control Plan. The Plan shall be submitted
to the Board for review so as to meet all of the requirements of OSHA
regulations, to include, but not limited to, 29 CFR 1910.1030, OSHA
Bloodborne Pathogens Standards, et seq., as amended from time to time.
A copy of the Plan shall be maintained at the body art establishment
at all times and shall be made available 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 U.S. 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. 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 may 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
them from receiving body art, that the client consents to the performance
of the body art procedure and that the client has been given the required
aftercare instructions.
D. A practitioner shall maintain the highest degree of personal cleanliness,
conform to best standard 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 towels.
This shall be done as often as necessary to remove contaminants.
E. In performing body art procedures, a practitioner shall wear 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 handwashing procedures as part of a good personal hygiene program.
F. 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 that person could contaminate
body art equipment, supplies, or working surfaces with body substances
or pathogenic organisms.
G. 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 before the procedure resumes.
H. 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 body art procedure is to be
placed shall be washed with soap and water or an approved surgical
skin preparation. 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. 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 480.000.
I. 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.
J. 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
(c)
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.
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.
If any provision contained in the model regulations is deemed
invalid for any reason, it shall be severed and shall not affect the
validity of the remaining provisions.
The fine for a violation of any provision of these Rules and
Regulations shall be $100 per offense. Each day that a violation continues
shall be deemed to be a separate offense.
In accordance with MGL c. 40, § 21D and Town of Middleton
bylaws, whoever violates any provision of these Rules and Regulations
may be penalized by noncriminal disposition.
These rules and regulations shall be effective as of FEBRUARY
7, 2024.