March 2024. Published by the National Environmental Health Association (NEHA), www.neha.org.
BAMC Body Art Model Code
March 2024
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Background
In 1998, environmental health professionals and industry experts worked together to develop and release the first NEHA Body Art Model Code (BAMC): the only comprehensive model code that addresses current body art issues and public health risks. In the time since the original Code was released, body art has become much more accepted, diverse, and popular. To address the changes in the field, NEHA updated the 1998 BAMC and re-released it in the winter of 2019. After updating the BAMC in 2019, NEHA’s Body Art Committee (BAC) committed to triennial updates to ensure this vital resource remains relevant and scientifically defensible to best protect public health. Following through on that commitment, NEHA BAC members started the arduous process of updating the BAMC in the fall of 2021.
The enormous task of updating the BAMC was accomplished by a dedicated committee of regulators and industry professionals and supported by numerous associations, including the Alliance of Professional Tattooists, Association of Food and Drug Officials Body Art Committee, Association of Professional Piercers, and the Society of Permanent Cosmetic Professionals. NEHA would like to recognize these individuals and associations for their contributions. The BAMC is available for local and state agencies to use as a resource to develop, or update, their own body art codes.
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NEHA Body Art Model Code Committee Members
Abby Houghton, MPH Environmental Health Specialist II Weld County Department of Public Health and Environment Asani Samson Environmental Health Officer Ministry of Health and Child Care Alex Rosales Environmental Health Inspector Kenosha County Health Department
Heather Woods Environmental Health Specialist II Southern Nevada Health District Special Programs Jodi Jackson, REHS, MPH Registered Environmental Health Specialist Jefferson County Public Health Department John Johnson OSHA Authorized General Industry Trainer Association of Professional Piercers (APP)
John Misock Senior Regulatory Consultant Ceutical Laboratories, Inc.
Joseph “Austin” Addison DHSc, REHS, CHES Environmental Health Specialist IV NEHA Body Art Committee Regulatory Chair Georgia Department of Public Health Benjamin Shaw Tattoo Artist Alliance of Professional Tattooists Board Member Owner of Archetype Tattoo
iii Kate Shergold Permanent Cosmetic Professional Society of Permanent Cosmetic Professionals (SPCP) Past Executive Director
Katherine Martinez, REHS Sanitarian Specialist Kent County Health Department
Brian Everett Tattoo Artist
Kathy Hartman, REHS OSHA Authorized General Industry Trainer San Diego County Body Art Program Lead (retired) Body Art Training Group President Kira Flagstead, REHS/RS Environmental Health Services Yellowstone City-County Health Department dba RiverStone Health Kristina Wright Head of Growth and Expansion for Certified Tattoo Studios Assistant Director of The Tattoo Academy Laurel Arrigona Regulatory Affairs Specialist Association of Food and Drug Officials Body Art Committee Chair Body Art Education Alliance Chair
Brian Skellie Piercer Piercing Experience
Cathy Montie Tattoo Artist Founder & Owner of Cathy Montie Body Art Training Company OSHA Authorized Industry-Specific Trainer Christopher Adams, BS, LEHP Director of Environmental Health McDonough/Schuyler County Health Department Gretchen Quirk Water Quality Supervisor Marion County Public Health Department
NEHA Body Art Model Code Committee Members
Lindsey Strong, REHS Casper-Natrona County Health Department
Robin Hays Cosmetic Tattoo Artist Owner of About Face Inc. Society of Permanent Cosmetic Professionals Past Board Member
Maria Deaver Senior Registered Environmental Health Specialist Burlington County Health Department
Rufus Redsell, MPH Environmental Health Officer Runnymede Borough Council
Maria Vega Environmental Health Specialist
Matt Bavougian Body Art Compliance Onyx Piercing Studio
Selina Medina Body Art Alliance Compliance and Education Manager Body Art Alliance Regulatory Committee Member Owner of Bless Your Heart Tattoo Steve Joyner Body Art Professional NEHA Body Art Committee Industry Chair Body Art Compliance Co-Founder Body Art Alliance, Regulatory & Compliance Suzanne Fajgier, REHS, CPH, CP-FS, CFOI Principal Registered Environmental Health Specialist Burlington County Health Department Tyson Schaffert Tattoo artist Alliance of Professional Tattooists Representative and Board of Directors
Michelle Bilodeau, REHS, RS Environmental Health Program Coordinator Yolo County Environmental Health Michael Crea, R.S. Owner of Z-Edge Piercing Inc. Executive Director of Florida Environmental Health Association Body Art Industry Educator & Private Consultant
Mike Lopinsky, REHS Community Environmental Health Franklin County Public Health
Nancy Crow Publisher and Contributing Editor Cathy Montie Body Art Training Company Nathan M. Daily, RRT Senior Sanitarian Allegheny County Health Department Nicole Gibeau, RS Environmental Health Program Coordinator West Hartford-Bloomfield Health District
Vildana Tinjic, CP-FS, CPO, PCQI, HACCP certified, RN Senior Environmental Health Specialist Tattoo Program Lead Linn County Public Health Wendy Maurer, RS, REHS Coconino County Health & Human Services
Patrick McCloughen Alliance of Professional Tattooists National Tattoo Association CEO of Armadillo Re’s Tattoo
Contents
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Definitions Body Art Operator Requirements and Professional Standards 02 Jewelry Standards Specific Regulations for Specific Types of Body Art 04 03 Public Notification Requirements Facility Documentation Requirements 06 Informed Consent and Release Form 05
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08 07 12 11 10 18 17 16 15 13 14 09 19 20 21
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Disinfection and Sterilization Procedures
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Preparation and Care of the Procedure Site
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Requirements for Single-Use Items
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Regulated Waste
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Requirements for Premises
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License Requirements
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Prohibitions
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Enforcement
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Inspection
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Suspension
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Revocation
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Citations
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Department Personnel Competancy Requirements
PAGE 33
Interpretation and Severability
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1. Definitions
The terms used in this Code are defined as follows:
AFTERCARE means suggested 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. ANTISEPTIC means a product that is labeled as useful in preventing diseases caused by microorganisms present on the skin and/or mucosal surfaces of humans. This includes products meant to kill germs and/or labeled as “antiseptic,” “antimicrobial,” “antibacterial,” “microbicide,” or “germicide,” or other similar terms. ASEPTIC TECHNIQUE means a set of specific practices and procedures performed under controlled conditions with the goal of minimizing contamination by pathogens.
AUTHORIZED AGENT means an employee of the designated health department/district charged with the enforcement of this Code.
AUTOCLAVE means a piece of equipment that is intended to sterilize products by means of pressurized steam.
AUTOMATED INSTRUMENT WASHER means a mechanical washer designed specifically for the decontamination of instruments prior to sterilization.
BIOCOMPATIBLE means the ability of an object to be inserted into a person without eliciting any undesirable local or systemic effects in that person.
BIOHAZARDOUS WASTE means any solid or liquid waste that can present a threat of infection to humans, including body tissue, blood and bodily fluids, wastes that contain blood or other potentially infectious material (OPIM). This includes, but is not limited to, absorbent materials with blood, bodily fluids, or excretions/secretions; and other contaminated products used during a body art procedure. BLOODBORNE PATHOGEN means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).
BODY ART means body piercing, tattooing, branding, scarification, or cosmetic tattooing.
BODY ART ESTABLISHMENT means any place or premise, whether licensed or not, public or private, temporary or permanent, outside or inside, for profit or not, where the practices of body art are performed.
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BODY ARTIST means any person performing body art services, whether licensed or not.
BODY PIERCING means any method of piercing the skin or mucosa to place jewelry through the skin or mucosa. BRANDING means the process in which a mark or marks are burned into human skin tissue with the intention of leaving a permanent mark. CAS REGISTRY NUMBER also referred to as CASRN or CAS Number, means a unique numerical identifier assigned by the Chemical Abstracts Service (CAS) to every chemical substance described in the open scientific literature.
CHRONIC/REPEAT VIOLATIONS means a violation that has occurred three times within five inspections.
CLIENT means an individual upon whom a body artist performs a body art procedure.
CODE means this document, as amended, and any supporting documents specifically incorporated herein.
COMPLAINT OF INJURY FORM means a document used to file with the Department a notice of injury as a result of a body art procedure.
CONTAMINATED means the presence or the reasonably anticipated presence of blood or OPIM on an item or surface.
COSMETIC TATTOOING see TATTOOING
CRITICAL VIOLATIONS means those items that are likely to cause an imminent health hazard to the public and/or body artist.
CYCLE NUMBER means a unique number that corresponds to each individual autoclave cycle. This number is used as an identifier, sometimes known as a lot number. It may include the date as part of the number. DECONTAMINATION means the use of physical and/or chemical means to remove, inactivate, or destroy pathogens on a surface. A surface/item is decontaminated when there are no infectious particles, and then the surface/item is rendered safe for handling, use, or disposal.
DEPARTMENT means the agency (whether local, state, or federal) or its authorized representatives who have jurisdiction to promulgate, monitor, administer, and enforce regulations.
DISINFECTANT means a product that is tuberculocidal and registered by the U.S. Environmental Protection Agency (EPA), as indicated on the label for use in disinfection.
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DISINFECT means to destroy pathogenic and other kinds of microorganisms by physical and/or chemical means.
DIVIDER means a partition used to separate or delineate a workstation from other workstations, such as non-absorbent curtains, knee walls, or other hard partitions.
EAR PIERCING see BODY PIERCING
EAR-PIERCING GUN means a stud-and-clasp ear-piercing system.
ENZYMATIC CLEANING SOLUTION means a cleaner that relies on biological catalysts to remove proteins or biofilms from a surface.
EQUIPMENT means all machinery, containers, vessels, implements, storage areas, and sinks that are used in conjunction with the storage or application of body art, by a body artist, or used within the sterilization/decontamination and disinfection processes.
FACILITY see BODY ART ESTABLISHMENT
FURNISHINGS means all fixtures, furniture, and other objects within a body art establishment that are not integral to the structure of the physical establishment (e.g., walls, windows, doors) and are not used in the storage of body art equipment and instruments, application of body art, or its sterilization/ decontamination and disinfection processes. GLOVES means medical grade or exam grade, sterile or nonsterile, disposable, single-use, full-hand coverings worn for protection against disease transmission. GUARDIAN means a person lawfully invested with the power and charged with the obligation of taking care of managing the property and rights of a person who, because of age, understanding, or self-control, is considered incapable of administering his or her own affairs. HAND WASHING means the act of cleaning one’s hands for the purpose of removing dirt, soil, or microorganisms through the use of soap, warm water, and friction. HAND WASHING SINK means a sink equipped to provide water at a temperature of at least 38°C (100°F) through a mixing valve or combination faucet, used solely for washing hands, arms, or prosthetics.
IDENTIFICATION means a government-issued ID card with name, photo, and birthdate.
IMMINENT HEALTH HAZARD means a significant threat or danger to health that is considered to exist when there is evidence sufficient to show that a product, practice, circumstance, or event creates a situation that requires immediate correction.
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INDICATOR means a test or device designed to validate one or more of the following critical variables of an autoclave cycle: time, temperature, and steam/pressure. The three types of indicators are chemical, biological, and mechanical. CHEMICAL INDICATOR means a substance that undergoes a distinct observable change when conditions in its solution change while measuring the sterilization process. This could be a color change, precipitate formation, or bubble formation, in order to show a temperature change, or other measurable quality. BIOLOGICAL INDICATOR (BI) means a test system containing viable microorganisms (spores) providing a defined resistance to a specific sterilization process. A biological indicator provides information on whether necessary conditions were met to kill a specified number of microorganisms for a given sterilization process. MECHANICAL INDICATOR means a self-recording gauge used to verify the time, pressure and/ or temperature obtained during the sterilization process. INFORMED CONSENT AND RELEASE FORM means a form signed by a client prior to a body art procedure to confirm that they agree to the procedure and are aware of any risks that might be involved.
INITIAL PIERCING means a fresh or new body piercing.
INSPECTION means a careful examination, exploration, or evaluation of the body art establishment and the body artist by the Department in compliance with this Code. INSTRUMENTS/TOOLS/DEVICES/IMPLEMENTS USED FOR BODY ART means handpieces, needles, needle bars, tattoo machines, forceps, and other tools that could come in contact with a client’s body or could be exposed to bodily fluids during body art procedures. INTEGRATOR also referred to as Type 5 Integrator or an Integrating Indicator, means a device designed to validate all three of the following critical variables of an autoclave cycle: time, temperature, and steam under pressure.
JEWELRY means any biocompatible object that is worn through a body piercing.
LICENSE means written approval by the Department to operate a body art establishment or to perform body art. Approval is given in accordance with this Code and in addition to any other local, state, or federal requirements.
MAINTENANCE means repairs and upkeep of equipment as recommended by the manufacturer.
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MATERIAL CERTIFICATE means all documents intended to state the specifics of a material used for body jewelry. Names for these documents include but are not limited to Mill Certificates, Material Certificates, Metal Composition Sheets, Material Safety Data Sheets (MSDS), and Material Certification Sheets.
MICROBLADING see TATTOOING
MINOR means an individual under the age of eighteen (18) years.
MOBILE BODY ART ESTABLISHMENT/UNIT means a licensed mobile establishment or unit that is self-propelled or otherwise movable from place to place and operated by a licensed body artist who performs body art procedures.
MUCOSA see MUCOSAL SURFACE
MUCOSAL SURFACE means the moisture-secreting membrane lining of all body cavities or passages that communicate with the exterior, including but not limited to the nose, mouth, vulva, and urethra. MUNICIPAL SOLID WASTE means common trash or garbage that does not meet the definition of regulated waste. NONCRITICAL VIOLATIONS means those items are not likely to cause an imminent health danger to the public and/or the practitioner. OPERATOR means any person, whether permitted or not, who controls any interest in, operates, or manages a body art establishment and who is responsible for compliance with this Code, whether or not actually performing body art activities.
OTHER POTENTIALLY INFECTIOUS MATERIAL (OPIM) means:
1. The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; 2. Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and 3. HIV-containing cell or tissue cultures, organ cultures, HIV- or HBV-containing culture medium or other solutions, blood, organs, or other tissues from experimental animals infected with HIV, HVC, or HBV.
PERMANENT COSMETICS see TATTOOING
PERMIT see LICENSE
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PERSON means an individual, any form of business or social organization, or any other non- governmental legal entity, including but not limited to corporations, partnerships, limited liability companies, associations, trusts, or unincorporated organizations. PERSONNEL means employees, body artists, contracted body artists, and agents of the body art facility, whether or not actually performing body art activities. PHYSICIAN means a person licensed by the state to practice medicine in all its branches and may include other areas such as dentistry, osteopathy, or acupuncture, depending on the rules and regulations particular to that state.
PROCEDURE means the act of performing body art.
PROCEDURE AREA means a room, or portion of a room, or any surface of an inanimate object that is designated to be used only to perform body art.
PROCEDURE SITE means the area or location on the client’s body selected for the placement of body art.
PROPYLENE GAS means any gas that is labeled with a CAS Registry Number of 115-07-1 (this includes but is not limited to MAPP gas and methyl ethylene gas).
REGULATED WASTE means liquid or semi-liquid blood; items contaminated with blood or OPIM, and which would release these substances if compressed; items that are caked with dried blood or OPIM and are capable of releasing these materials during handling; and contaminated sharps containing blood or OPIM. REGULATED WASTE OPERATING PLAN means a document detailing policies and procedures regarding the containment, labeling, storage, and transport of biomedical waste, in addition to detailed training for personnel of the body art establishment. SAFETY DATA SHEET (SDS) means a document for any potentially harmful chemical that includes information such as the properties of each chemical; the physical hazards, health hazards, and environmental health hazards; protective measures; and safety precautions for handling, storing, and transporting the chemical. SDS is the current term for Material Safety Data Sheet (MSDS).
SCALP MICROPIGMENTATION (SMP) see TATTOOING
SCARIFICATION means the process in which a mark or marks are cut into human skin tissue with the intention of leaving a permanent mark.
SEMIPERMANENT MAKEUP see TATTOOING
SHARPS means any object that can purposely or accidentally cut or penetrate the skin or mucosa, including but not limited to presterilized, single-use needles; scalpel blades; and razor blades.
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SHARPS CONTAINER means a closable, puncture-resistant, leakproof (on sides and bottom) container made specifically to be a sharps container that can be closed for handling, storage, transportation, and disposal. A sharps container must be labeled with the international biohazard symbol. SINGLE-USE means 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 cotton balls, tissues or paper products, paper or plastic cups, gauze and sanitary coverings, razors, needles, scalpel blades, stencils, ink cups, and protective gloves.
SPORE TEST see INDICATOR – BIOLOGICAL INDICATOR
STANDARD OPERATING PROCEDURE (SOP) means an instructional document that describes all procedures and processes that are to be followed step-by-step, by each worker in a facility, so as to produce the exact same results safely no matter who performs routine operations.
STERILIZATION means a validated process used to render a product free from viable microorganisms.
STERILIZATION AREA or STERILIZATION ROOM means a room or enclosed area, set apart and used only to clean, decontaminate, and sterilize instruments. STERILIZATION LOG means a physical or digital recording of autoclave cycle number, as well as type of sterilizer and cycle used; the load identification number; the load contents; the exposure parameters (e.g., time and temperature); the operator’s name or initials; date and time; and the results of mechanical, chemical, and/or biological monitoring. STRIKE BRANDING means the process by which a mark is burned with heated metal into the tissue of a person. STERILE GLOVES means a medical-grade or exam-grade disposable, single-use covering for the hands worn for protection against disease transmission. Sterile gloves have been sterilized by the manufacturer or by following the sterilization protocol set forth by the glove manufacturer.
STERILE WATER means water that is purchased from the manufacturer sterile, in a single-use container.
STERILE means a state of being free from viable microorganisms.
TATTOO means the mark resulting from the act of tattooing.
TATTOOING means any act of placing ink or other pigment into or under the skin or mucosa by the use of needles or any other method used to puncture the skin, resulting in permanent or temporary colorization of the skin or mucosa. This includes all forms of cosmetic tattooing performed on the face or body.
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TEMPORARY BODY ART ESTABLISHMENT means any place or premise operating at a fixed location where a body artist performs body art procedures but does not have a permanent body art facility license (i.e., educational, trade show, convention, public or private events, performance, product demonstration, or aesthetic shows).
TEMPORARY BODY ARTIST LICENSE see LICENSE
THERMAL CAUTERY UNIT (TCU) means electrical equipment that provides direct or alternating current that is passed through a resistant metal wire electrode, generating heat used for branding.
TYPE 5 INDICATOR see INTEGRATOR
ULTRASONIC CLEANER or ULTRASONIC means equipment that removes debris by a process called cavitation, in which waves of acoustic energy are propagated in aqueous solutions to disrupt the bonds that hold particulate matter to surfaces. ULTRAVIOLET AIR PURIFIER means a machine designed to use short wave ultraviolet (UV-C) light to inactivate airborne pathogens and microorganisms.
VIOLATION means the act of violating or going against any section or subsection of this Code.
WORKSTATION means the area within a procedure area where a body artist performs body art. The workstation includes but is not limited to the client chair or table, counter, mayo stand, instrument tray, storage drawer, and practitioner’s chair.
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2. Body Art Operator Requirements and Professional Standards
2.1 Persons performing body art procedures or any other task or function in a body art facility must use aseptic techniques.
2.2 The body artist must be a minimum of 18 years of age.
2.3 It is unlawful for any person to perform body art procedures unless such procedures are performed in a body art establishment with a current applicable state, county, or city license, permit, and/or other regulatory requirements as required by the applicable jurisdiction. 2.4 The body artist must maintain hair, skin, and clothes that are free of visible particulate matter and debris. The body artist must keep fingernails short with smooth, filed edges to allow thorough cleaning and prevent glove tears. Body artists must not wear artificial fingernails or extenders and natural nail tips must be less than 1/8 inch long. Nail polish must be intact without chips or cracks and must be removed and/or reapplied every 7 days. 2.5 The body artist must be free of any open wound that cannot be covered, any infection, or other visible or communicable diseases that can be transmitted as a result of carrying out the body art procedure.
2.6 Wearing jewelry on fingers, hands, and wrists while performing a body art procedure is prohibited.
2.7 Before performing body art procedures, body artists must thoroughly wash their hands in a hand washing sink as specified under Section 12.5 and according to the hand washing procedure below. If a surrogate prosthetic device is being worn, manufacturer recommendations for washing shall be followed. 1. Remove all jewelry on fingers, hands, and wrists. 2. Turn on warm water, wet hands, and apply soap. 3. Rubbing your hands together, make a soapy lather. 4. Make sure you include all your fingers, wash between your fingers, thumbs, nails, cuticles, wrists, palm to palm, and the top of your hands per CDC hand washing guidelines. 5. Rinse your hands with your fingers pointed up toward the faucet and rinse down to your wrists. 6. Dry with a clean disposable towel. 7. Use a new clean disposable towel to turn off the handles of the sink. 2.8 Any item or instrument used for body art that is anticipated/known to be contaminated, not from the client, during the procedure shall be removed as soon as practical from the procedure area and, if necessary, replaced before the procedure resumes. Any item or instrument no longer necessary for the procedure should be removed as soon as practical.
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2.9 Eating or drinking by anyone is prohibited in the area where body art preparations or procedures are performed and any location where instruments or supplies are stored or cleaned. Exceptions must be made for the purpose of rendering first aid. 2.10 Any injury or complaint of injury, infections that required treatment by a licensed medical practitioner, or any communicable diseases resulting from the body art procedure that become known to the body artist must be reported by the body artist to the Department using a complaint of injury form within three business days of the body artist becoming aware of the complaint or condition. 2.11 Body artists shall report all adverse events relating to or suspected of being related to materials used during a body art procedure and its aftercare to the Department and MedWatch, including the name of the artist, client information, description of adverse events, and a complete description of materials involved with lot and/or batch codes if required to seek medical attention. This reporting will help identify outbreaks and identify products with manufacturing defects. A record of this reporting must be maintained with the complaint of injury form in client records.
3. Jewelry Standards
3.1 All jewelry used for initial piercings must meet the following standards: 1. Any and all materials that meet the American Society for Testing and Materials (ASTM) and/or the International Organization for Standardization (ISO) standards for implantation. Examples of these include but are not limited to:
1. steel that is ASTM F138 compliant or ISO 5832-1 compliant, 2. steel that is ISO 10993-6, 10993-10, and/or 10993-11 compliant, 3. unalloyed titanium that is ASTM F67 or ISO 5832-2 compliant,
4. alloyed titanium (Ti6Al4V ELI) that is ASTM F136 compliant or ISO 5832-3 compliant, 5. alloyed titanium (Ti6Al7Nb ELI) that is ASTM F1295 compliant or ISO 5832-11 compliant, and 6. any polymer or plastic material that is ISO 10993-6, 10993-10, and/or 10993- 11 compliant and/or meets the U.S. Pharmacopeia (USP) Class VI classification. This includes but is not limited to polytetrafluoroethylene (PTFE) that is ASTM F754 compliant. 2. Solid 14-karat or higher yellow, white, or rose gold that is nickel free and cadmium free. Gold jewelry used for initial piercing may not be: 1. plated, unless using materials approved by this standard over solid 14-karat or higher yellow, white, or rose gold that is nickel and cadmium free, 2. gold filled, or 3. gold overlay/vermeil. 3. Solid unalloyed or alloyed platinum that is nickel free and cadmium free.
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4. Unalloyed niobium (Nb) that is ASTM B392 compliant. This includes but is not limited to: 1. commercial grade 2 niobium and 2. commercial grade 4 niobium that contains 1% zirconium. 5. Glass that is lead free. This includes but is not limited to: 1. fused quartz, 2. borosilicate, and 3. soda-lime. 6. All threaded or press-fit jewelry must have internal tapping (no threads on exterior of posts and barbells). 7. For body jewelry purposes, surfaces and ends must be smooth, free of nicks, scratches, burrs, stamps, hallmarks, and polishing compounds. 8. Metals must have a consistent mirror finish on surfaces that frequently come in contact with tissue. 9. All jewelry used for initial piercing on people older than 12 years must be ASTM F2999 compliant. 10. All jewelry used for initial piercing on people 12 and younger must be ASTM F2923 compliant.
4. Specific Regulations for Specific Types of Body Art
4.1 Specific regulations for piercing 1. Clarification of other piercing instruments.
1. Individuals who perform piercings with ear-piercing guns; presterilized single-use, stud- and-clasp ear-piercing systems; or similar devices must adhere to this Code and meet the requirements of a body artist. 2. Use of ear-piercing guns is limited to the earlobe. 3. The body artist must wear sterile gloves when coming into contact with sterile instruments and while performing the procedure. 4. For rationale, see the NEHA policy statement on ear-piercing guns. 4.2 Specific regulations for tattooing/cosmetic tattooing 1. All inks and pigments must be specifically manufactured for performing body art procedures. 2 Only distilled water or sterile water may be used for the dilution of inks or pigments. Diluting with potable water is not acceptable. Such dilution must be single-use for the individual procedure. Immediately before a tattoo is applied, the quantity of the ink or pigment to be used must be transferred from the ink or pigment bottle and placed into single-use plastic cups or caps. 3. Upon completion of a tattoo, all single-use items and their contents must be discarded.
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4. For individuals performing microblading or manual procedures, once the needle grouping (blade) is attached to the handpiece it cannot be removed and must be fully disposed of into a sharps container whether or not used. 4.3 Specific regulations for branding 1. The client must be 18 years of age. Parental consent release forms do not apply. 2. The procedure area must have walls that extend to the ceiling and a closable door. 3. The procedure area must be equipped with an ultraviolet air purifier appropriately sized to the room based on the square footage and the manufacturer’s recommendations. 4. Any person present during the procedure, including all personnel and the client, must wear a mask rated as N-95 or higher. 5. Body artists must use the process of “strike branding” or use a thermal cautery unit (TCU). 6. Only nongalvanized metal may be used for “strike branding.” 7. Body artists should use only propylene gas to heat the metal for “strike branding.” 4.4 Specific regulations for scarification 1. The client must be 18 years of age. Parental consent release forms do not apply. 2. The body artist must wear disposable sleeves for personal protective equipment (PPE). 3. The procedure area must have walls that extend to the ceiling and a closable door. 4. The procedure area must be equipped with an ultraviolet air purifier appropriately sized to the room based on the square footage and the manufacturer’s recommendations. 5. The body artist must wear sterile gloves when coming into contact with sterile instruments during the procedure.
5. Public Notification Requirements
5.1 A current body art establishment license must be posted in a prominent and conspicuous area where it can be readily observed.
5.2 All body artist licenses must be posted in a prominent and conspicuous area where they can be readily observed. 5.3 Written public educational information and aftercare information that has been approved by the Department must be posted in a prominent and conspicuous area where it can be readily observed by clients. The written instructions must advise the client to consult a licensed physician if deemed necessary by the client and must contain the name, address, and phone number of the establishment.
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5.4 The facility license holder must publicly display the name, address, and phone number of the Department that has jurisdiction over the facility and the procedure for filing a complaint.
5.5 A copy of state body art requirements must be made available to the public upon request.
6. Facility Documentation Requirements
6.1 A body art facility operator must establish a written plan to eliminate or minimize personnel exposure to blood or OPIM; protect customers; safely handle, store, and dispose of regulated waste; disinfect and sterilize reusable tools and equipment; and reduce the risk of cross-contamination in the body art facility. 6.2 A body art facility operator must keep records of the facility’s operation and personnel. All records required by this Code must be kept in print or digital form. The requirements outlined in 6.3- 6.8 be kept on file on the premises of a body art facility, except as otherwise noted, and be available to the Department upon request.
6.3 Facility Information 1. Current operator’s name, address, and phone number 2. Facility name 3. Facility address 4. Facility phone number 5. Hours of operation 6. State, county, and city licenses 7. Aftercare information 8. Current local regulations for type of body art performed in the facility
6.4 Operational Records 1. All operational records required by this Code must be kept in print or digital for three years. All records must be held on the premises for one year but may be stored off the premises afterward. 2. Operational records, at a minimum, shall include: 1. Disinfection and sterilization instructions for instruments and surfaces 2. Record of instruments purchased pre-sterilized 3. Equipment information 1. Sterilization records 2. Equipment maintenance records 3. Procedure for responding to a positive spore test result
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4. Regulated Waste Operating Plan 5. Red bag letter 6. Regulated waste pickup receipts 7. Safety Data Sheets (SDS) 8. Exposure Control Plan as required in OSHA 1910.1030(b) 9. Jewelry documentation 1. Receipts for jewelry purchased for initial piercings 1. These receipts must list specifications for materials sold as designated in Section 3. 2. Metal composition sheets for gold 3. Composition sheets for other materials (glass, polymer, etc.) 4. Material certificate from jewelry suppliers for jewelry used for initial piercings 1. These material certificates must be updated from the supplier for each new lot of material. 2. These material certificates must include the: 1. name of purchaser of material, 2. name of seller of material, 3. date of material sales, 4. type of material purchased,
5. composition of material purchased, 6. quantity of material purchased, and 7. country of origin
6.5 Client Records 1. Client records required by this Code must be kept in print or digital format for three years and be available to the Department upon request. The files must be stored to prevent access from unauthorized personnel (e.g., a locked file cabinet, locked room, password-protected files). All records must be kept on the premises for one year but may be stored off the premises afterward. 2. Client records, at a minimum, shall include: 1. Customer informed consent and release form(s) 2. Risk notification 3. Any complaint of injury form 6.6 Personnel Records 1. Body art facilities shall keep all personnel records secure and confidential in the facility and be made available to the Department upon request. After one year, files for previous employees, contractors, or agents of the body art facility may be retained off-site for a minimum of three years past employment termination.
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2. Personnel records, at a minimum, shall include: 1. full name 2. job title 3. exact duties 4. date of employment 5. date of birth showing at least 18 years of age
6. primary residence address 7. contact phone number(s) 8. e-mail address 9. copy of government-issued photo ID
6.7 Personnel Training records 1. Training records shall be maintained for three years from the date on which the training occurred. 2. Training records, at a minimum, shall include: 1. trainee’s name 2. date(s) of the training session
3. contents or summary of persons conducting the training 4. names and job titles of all persons attending the sessions 5. trainer qualifications
6.8 Personnel Medical Records 1. Facility operators must maintain records for each worker with occupational exposure as required by 29 CFR 1910.1030 and the Department. 2. All medical records must be stored in a manner that prohibits access from unauthorized personnel (e.g., locked file cabinet, locked room, password-protected files) and must not be disclosed without the person’s express written consent to any person within or outside the facility except as may be required by law. 3. Medical records must be maintained for the length of time as dictated by 29 CFR 1910.1020.
7. Informed Consent and Release Form
7.1 In order for the body artist to perform body art on a client, a consent and release form(s) must be completed and stored in accordance with Section 6 of this Code. This may be done with a single form or multiple forms. The consent and release form(s) must be in written and/or digital format. A physical and/or digital copy of this form(s) must be offered to the client. The release form(s) must include at a minimum the following sections:
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1. A risk notification section that provides information detailing the risks and possible consequences of a body art procedure and must include (but is not limited to) the following statements: 1. “Body art can cause swelling, bruising, discomfort, bleeding, and pain.” 2. “Body art can cause allergic reactions.” 3. “Body art can cause irreversible changes to the human body.” 4. “Body art has a risk of infection.” 2. A client evaluation section that asks the following questions to evaluate the client’s condition for receiving body art. This section must include the following statement: Consult a physician prior to the procedure if you have any concerns about any of the questions below: 1. Have you eaten within the past 4 hours? 2. Are you under the influence of drugs or alcohol? 3. Have you ingested anticoagulants, antiplatelet drugs, or NSAIDS (aspirin, ibuprofen, etc.) in the last 24 hours? 4. Have you ingested any medication that can inhibit the ability to heal a skin wound? 5. Do you have any allergies or adverse reactions to dyes, pigments, latex, iodine, or other such products? 6. Do you have hemophilia, epilepsy, a history of seizure, fainting, narcolepsy, or other conditions that could interfere with the body art procedure? 7. Do you have a history of any diseases, including skin diseases, that might inhibit the healing of the body art procedure? 8. Do you have any communicable diseases that could be transferred to another person during the procedure? 9. Do you have diabetes, high blood pressure, heart condition, heart disease, or any other
conditions that could interfere with the body art procedure? 10. Are you or have you been pregnant within the last 3 months? 3. Client information: 1. name as it appears on government ID,
2. signature, 3. birthdate,
4. permanent address, 5. phone number, and 6. a copy of their state or federally issued photo ID with birthdate (i.e., driver’s license, state
ID, passport, immigration card, etc.). 7. Is the client 18 years of age or older?
7.2 Each body artist must record the following information about the body art procedures administered: 1. The following information about the body art procedure must be written down: 1. type of body art procedure,
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2. location on body, 3. design if applicable, 4. jewelry styles and sizes if applicable,
5. expiration date and batch and/or lot number of all sterilized instruments used during the body art procedure that corresponds with the sterilization log for those instruments and/or package/lot number that will be applied to or inserted under the skin, 6. expiration date, brand, color, batch and/or lot number of all inks, and pigments used in the body art procedure, 7. date and time of body art procedure, and
8. any complications that occurred during the body art procedure. 2. The following information from the body artist must be written down: 1. first and last name, and 2. signature.
7.3 An informed consent statement, including a signature obtained from the customer, must confirm at a minimum that the client:
1. is voluntarily obtaining services of their own free will and volition, 2. has had the opportunity to read and understand the document, 3. has the ability to ask questions about the procedure, and 4. has received and understands written and verbal aftercare.
7.4 Nothing in this section should be construed to require the body artist to perform a body art procedure upon a client.
7.5 The client must be offered a copy of the completed release form in written and/or digital format.
8. Disinfection and Sterilization Procedures
8.1 All surfaces used in the body art procedure must be smooth; free of nicks, cuts, and tears; easily cleanable; and nonporous. Surfaces must be cleaned and then disinfected with an EPA- registered tuberculocidal disinfectant prior to and after the body art procedure. 8.2 All surfaces of equipment and furnishings that come into contact with the body artist during a body art procedure must be covered with a protective, impermeable barrier. Barriers must be single-use and discarded after each client.
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8.3 All equipment used to clean and sterilize body art materials and reusable instruments must be suitable for their intended use. The equipment and devices must be used, cleaned, and maintained according to the manufacturer’s instructions. A copy of the manufacturer’s recommended procedures for the operation of the equipment must be available for inspection by the Department when available from the supplier. 8.4 When participating in any disinfection or sterilization procedures, individuals must wear personal protective equipment (PPE) that will provide adequate protection to exposure, or potential exposure, to blood and OPIM.
8.5 All reusable instruments are to be decontaminated and sterilized after each use in the sterilization room or sterilization area.
8.6 After being cleaned, all reusable instruments used for body art must be sterilized by one of the below methods: 1. Contained in sterilization packaging and subsequently sterilized, with the date and cycle number noted on packaging or indicator strips. 1. This information must match up with the sterilization log. 2. All sterilization packaging must have a color-changing chemical indicator. 2. Unwrapped and subsequently sterilized, stored, and sterilized again immediately prior to use. 3. Afterward, sterilized instruments must be stored in a cabinet, drawer, or tightly covered container reserved for the storage of sterilized instruments. 8.7 An autoclave, ultrasonic, and sterilization room or sterilization area is not required if the body art establishment uses only presterilized disposable instruments, presterilized body art materials, and presterilized supplies. 8.8 All instruments used for body art procedures must remain stored a) in sterile packages and marked with the cycle number until just prior to a body art procedure, or b) cleanly in containers and ready for sterilization immediately prior to the procedure. 8.9 Sterile instruments and body art materials must not be used if the package has been compromised. Sterile instruments and body art materials must not be used after the expiration date without first reprocessing and resterilizing. Body art instruments and materials must be disposed of in an appropriate container. 8.10 Each holder of a license to operate a body art establishment must demonstrate that the autoclave used is capable of attaining sterilization by weekly biological monitoring (spore testing). These tests must be verified by an independent laboratory. The license must not be issued or renewed until documentation of the autoclave’s ability to destroy spores is received by the Department. These test records should be retained for a minimum of three years. Records must be kept on the premises for a minimum of one year. All three years of records must be available to the Department upon request. The most recent test must be made available to the public upon request.
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8.11 The body art facility must follow the procedure outlined in 8.11.1-7 for responding to a positive spore test if the mechanical (e.g., time, temperature, pressure) and chemical (internal or external) indicators suggest that the autoclave is functioning properly. A single positive spore test result probably does not indicate autoclave malfunction. The autoclave should be removed from service, though, and sterilization operating procedures reviewed to determine if operator error could be responsible (CDC, 2016). 1. In the sterilization log, document procedures taken to remedy the situation. 2. Remove the autoclave from service and review sterilization procedures (e.g., work practices and use of mechanical and chemical indicators) to determine whether operator error could be responsible for the positive spore test. 3. Recall, to the extent possible, and reprocess all items processed since the last negative spore test in a separate autoclave that has negative spore test results. 4. Retest the autoclave by using spore tests, mechanical, and chemical indicators after correcting any identified procedural problems. 5. If the repeat spore test is negative, and mechanical and chemical indicators are within normal limits, put the autoclave back in service. 6. The following are required if the repeat spore test is positive: 1. Do not use the autoclave until it has been inspected or repaired and the exact reason for the positive test has been determined. This work should be done by a factory authorized service professional, who is certified to repair and maintain the specific autoclave that is being worked on. 2. An autoclave shall pass a spore test before being put back into service after repairing or relocating. 7. Maintain sterilization records (i.e., sterilization cycles, maintenance, and spore tests) in accordance with this Code.
9. Preparation and Care of the Procedure Site
9.1 Any surface of the skin or mucosa to receive a body art procedure must be intact and free from suspected abnormalities of the skin or mucosa such as, but not limited to, suspected rash, visible infection, sunburn, or moles. 9.2 Glove Usage 1. Prior to, during, and after a body art procedure, the body artist must wear gloves and use aseptic technique to ensure that the instruments and gloves are not contaminated. This includes but is not limited to: 1. when setting up the procedure area. This set up includes touching containers, ink bottles, barrier films, exteriors of sterile packaging, and while assembling tattoo machines and needles. 2. when prepping skin, applying stencils, or drawing designs on the skin.
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3. once the procedure is completed, cleaning, applying aftercare, or bandaging to the procedure site. 4. when tearing down and disinfecting the procedure area. 2. The body artist shall wear gloves when coming into contact with the client while preparing for or performing the procedure. The gloves shall be immediately discarded and the body artist’s hands must be washed after the completion of each procedure, and/or when gloves worn for procedures are torn, punctured, or otherwise compromised, or at any other time when necessary to prevent cross-contamination.
9.3 Before a body art procedure is performed, the procedure site must be prepped with an antiseptic in accordance with the manufacturer’s instructions.
9.4 If shaving is necessary, it must be done before skin prep, and a single-use disposable razor must be used. After use, razors must be placed immediately into a sharps container. 9.5 In the event of bleeding, all products used to stop the flow of blood or to absorb blood must be a sterile, single-use item that is disposed of immediately after use in appropriate covered containers.
9.6 Any single-use items that contact the client must meet the requirements outlined in Section 10.2.
9.7 Any products portioned out for the client must be discarded upon completion of the body art procedure.
10. Requirements for Single-Use Items
10.1 Single-use items must not be used on more than one client for any reason. After use, all single- use needles, razors, and other sharps must be immediately disposed of in approved sharps containers. See Section 11 for disposal procedures. 10.2 All products applied to the skin, including body art stencils, pens, markers, and any other items that are used to mark the skin, must be single-use and disposable. Products used in the application of stencils must be dispensed and applied on the area to be tattooed with a suitable clean, single-use product and used in a manner to prevent contamination of the original container and its contents. The clean, single-use product must be used only once and then discarded.
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