Body art is becoming prevalent and popular throughout the commonwealth;
and the 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; now, therefore the Board of Health of the
Town of Barnstable adopted these regulations for the practice of body art
in the Town of Barnstable as part of the mission to protect the health, safety,
and welfare of the public. These regulations are promulgated under the authority
granted to the Board of Health under Massachusetts General Law Chapter 111,
§ 31.
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.
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 a steam 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.
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.
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
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.
DEPARTMENT
The Department of Public Health or its authorized representatives.
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.
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.
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 110º to 130ºF.
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 similar facility.
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 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 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, 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. This term includes
all forms of cosmetic tattooing.
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, nonporous, 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 body art station 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 divider 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, and where instruments
and sharps are assembled.
(6) Light bulbs shall be shielded, coated, or otherwise shatter-resistant
in each body art station.
(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 minimum of one toilet room containing
a toilet and sink with running water. The toilet room shall be provided with
toilet paper, liquid hand soap and paper towels stored in a fixed dispenser.
(9) 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.
(10) 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.
(11) 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.
(12) 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.
(13) 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.
(14) 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.
(15) 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 480.000.
(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 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 caps. Upon completion
of the tattoo, these single-use cups or cups and their contents shall be discarded.
C. Sanitation and sterilization measures and procedures.
(1) Only sterilized disposable single-use-type needles shall
be used for body art.
(2) All other nondisposable instruments used for body art
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 operated in accordance with manufacturer's
instructions.
(3) After being cleaned, nondisposable instruments used for
body art shall be packed individually in sterilizer packs and subsequently
sterilized in a steam autoclave. 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.
(4) 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.
(5) 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.
(6) 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, locked cabinet or other tightly covered container
reserved for the storage of such instruments.
(7) Sterile instruments may not be used if the package has
been breached or after the expiration date without first repackaging and resterilizing.
(8) When assembling instruments used for body art procedures,
the operator shall wear 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 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, which shall be available from
the Public Health Division Office. 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 local Board
of Health that has jurisdiction and the procedure for filing a complaint.
(3) An emergency plan, including:
(a) A plan for 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; and
(g) A copy of these regulations.
(2) Employee information, which shall include:
(a) Full names and exact duties;
(d) Home /work phone numbers; and
(3) Client information, which shall include:
(e) Name of the practitioner who performed the procedure(s);
(f) Description of procedure(s) performed and the location
on the body;
(h) 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 and a copy of
the photographic identification of the client.
(4) Client information shall be kept confidential at all
times.
F. The establishment shall require and ensure that all body
art practitioners obtain hepatitis B vaccination series. Records documenting
compliance with this requirement shall be provided to the Board upon request.
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. Practitioners who use ear-piercing systems must conform
to the manufacturers directions for use, and to applicable U.S. 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 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 him or 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 §
307-6K.
E. 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 his or 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 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.
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 that 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 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, 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 480.000.
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. The written
instructions shall advise the client:
(1) On the proper cleansing of the area which received the
body art;
(2) To consult a health care provider for:
(a) Unexpected redness, tenderness or swelling at the site
of the body art procedure;
(c) Unexpected drainage at or from the site of the body art
procedure; or
(d) A fever within 24 hours of the body art procedure; and
(3) Of the address, and phone number of the establishment.
A copy shall be provided to the client. A model set of aftercare instructions
shall be made available by the Department.
L. Contaminated waste shall be stored, treated and disposed
in accordance with 105 CMR 480.000: Storage and Disposal of Infectious or
Physically Dangerous Medial or Biological Waster, 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
of body art.
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.