1 of 1 HOUSE DOCKET, NO. 1117 FILED ON: 1/18/2023 HOUSE . . . . . . . . . . . . . . . No. 247 The Commonwealth of Massachusetts _________________ PRESENTED BY: Bruce J. Ayers _________________ To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General Court assembled: The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill: An Act regulating body art. _______________ PETITION OF: NAME:DISTRICT/ADDRESS :DATE ADDED:Bruce J. Ayers1st Norfolk1/18/2023 1 of 45 HOUSE DOCKET, NO. 1117 FILED ON: 1/18/2023 HOUSE . . . . . . . . . . . . . . . No. 247 By Representative Ayers of Quincy, a petition (accompanied by bill, House, No. 247) of Bruce J. Ayers for legislation to prohibit the practice of body piercing, so-called, unless licensed by the Department of Public Health. Consumer Protection and Professional Licensure. [SIMILAR MATTER FILED IN PREVIOUS SESSION SEE HOUSE, NO. 308 OF 2021-2022.] The Commonwealth of Massachusetts _______________ In the One Hundred and Ninety-Third General Court (2023-2024) _______________ An Act regulating body art. Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows: 1 SECTION 1. The General Laws are hereby amended by inserting after chapter 111N the 2following chapter:- 3 111O. Regulation of Body Art 4 Section 1. As used in this chapter, the following words shall have the following 5meanings: 6 "Aftercare instructions", written instructions, approved by the department, given to a 7person upon whom body art has been performed, specific to the body art procedure rendered or 8performed, concerning the proper care to be given to the area of the body upon which the body 9art has been performed and concerning the surrounding area of the body. 2 of 45 10 "Antiseptic", an agent that destroys disease-causing microorganisms on human skin or 11mucosa. 12 "Apprentice License", license authorized by the department to a person qualified to enter 13the body art practitioner license apprenticeship program. 14 "Autoclave", an apparatus for sterilization utilizing steam pressure at specific temperature 15over a designated period of time. 16 "Autoclaving", the process that results in the destruction of all forms of microbial life, 17including highly resistant bacterial spores, by the use of an autoclave for a minimum of 30 18minutes at 17 pounds of pressure PSI, at a temperature of 250 degrees Fahrenheit. 19 "Body art", the practice of physical body adornment, alteration or modification by means 20including, but not limited to, piercing, tattooing, branding, braiding, beading, implantation or 21scarring. 22 "Body art establishment", any facility that has been inspected and approved by the 23department for use in conducting of body art and for which a current permit is issued by the 24department in accordance with this chapter. 25 "Body piercing", the form of body art requiring or consisting of the puncturing or 26penetration of the skin or of a membrane of a person for the purpose of the temporary or 27permanent placement or insertion of jewelry or other adornment or device therein. 28 "Braiding", the form of body art requiring or consisting of the cutting of strips of skin of 29a person, which strips are then to be intertwined with one another and placed onto such person so 3 of 45 30as to cause or allow the incised and interwoven strips of skin to heal in such intertwined 31condition. 32 "Branding", the form of body art consisting of or requiring the inducement of a burn that 33results in the scarring of the skin of a person by means of the use of a heated instrument or 34object. 35 "Cleaning area", the area in a body art establishment used in the sterilization, sanitation 36or other cleaning of instruments or other equipment used for the practice of body art. 37 "Contaminated or contamination", the presence of or a reasonable possibility of the 38presence of blood, bodily fluids, infectious or potentially infectious matter on an inanimate 39object. 40 "Contaminated waste", any liquid or semi-liquid blood or other potentially infectious 41material; contaminated items that would release blood or other potentially infectious material in 42a liquid or semi-liquid state if compressed; items on which there is dried blood or other 43potentially infectious material and which are capable of releasing these materials during 44handling; sharps and any wastes containing blood or other potentially infectious materials, as 45defined in 29 CFR 1910:1030, 105 CMR 480.000 et seq, or in this chapter. 46 "Cosmetic tattooing", "permanent cosmetics", "micro pigment implantation" or "dermal 47pigmentation", the form of body art requiring the implantation of permanent pigment around the 48eyes, lips and cheeks of the face and hair imitation. 49 "Customer or client", a person upon whom one or more forms of body art is to be 50performed, and shall include a minor client. 4 of 45 51 "Customer waiting area", the area in a body art establishment for use and occupation by 52persons and clients prior to and after the conduct of body art. 53 "Department", the department of public health. 54 "Disinfect", the destruction of pathogenic microorganisms using a liquid chemical 55germicide. 56 "Disinfectant", liquid chemical germicide. 57 "Dermis", the deeper, thicker portion on the skin lying beneath the epidermis, including 58the subcutaneous layer. 59 "Ear piercing" the puncturing of the outer perimeter or lobe of the ear using a pre- 60sterilized single use stud and clasp ear piercing system following manufacturer instructions. 61 "Epidermis", the outer layer of skin which is composed of 4 recognizable layers of cells 62usually a total of about 0.1 mm thick. 63 "Equipment", all machinery, fixtures, containers, vessels, tools, devices, implements, 64furniture, display cases, storage units, sinks, and all other apparatus and appurtenances used in 65connection with the operation of a body art establishment. 66 "Exposure", an event whereby there is an eye, mouth or other mucous membrane, non- 67intact skin or parenteral contact with the blood or bodily fluids of another person or contact of an 68eye, mouth or other mucous membrane, non-intact skin or parenteral contact with other 69potentially infectious matter. 5 of 45 70 "Exposure control plan", a plan drafted by an operator pursuant to the requirements of the 71United States Occupational Safety and Health Administration to eliminate or minimize the 72potential for an exposure. 73 "Exposure incident report", a written report detailing the circumstances of an exposure. 74 "Germicide or germicidal solution", liquid chemical germicide. 75 "Hand sink", a sink supplied with hot and cold potable water under pressure used solely 76for washing hands, arms, or other portions of the body. 77 "Hot water", water which is heated to attain and maintain a temperature of between 110 78degrees and 130 degrees Fahrenheit. 79 "Infectious waste", contaminated waste. 80 “Ink”, “Dye” or “Pigment”, the metal or salt-based substance injected into the 81subcutaneous portion of the skin in the act or process of creating a tattoo. 82 "Instrument" or "Instrument used for body art", those hand pieces, needles, needle bars 83and other instruments that may come in contact with a client's body or possible exposure to 84bodily fluids during body art procedures. 85 "Instrument sink", a sink used exclusively for the cleaning of instruments. 86 "Instrument storage area", the area in a body art establishment used for the storage of 87linens, equipment and instruments used for body art. 6 of 45 88 "Invasive", a procedure causing entry into the body either by incision or by the insertion 89of an instrument into or through the skin or mucosa, or by any other means intended to puncture, 90break or compromise the skin or mucosa. 91 “Janitorial sink”, a sink of adequate size equipped with hot and cold water under pressure 92so as to permit the cleaning of the body art establishment and any equipment used for cleaning. 93 "Jewelry", any device or adornment inserted into a pierced or incised area or portion of 94the body. 95 "Light-colored", a light reflectance value of 70 per cent or greater. 96 "Liquid chemical germicide", a substance registered with the United States 97Environmental Protection Agency for use in the destruction of pathogenic microorganisms or an 98approximate 1:100 dilution of household chlorine bleach in clean water mixed fresh daily. 99 "Minor" or "minor client", a person of less that 18 years of age as of that person's last 100birth date. 101 "Mobile body art establishment", any trailer, truck, car, van, camper or other motorized 102or non-motorized vehicle, a shed, tent, movable structure, bar, home or other facility wherein, or 103concert, fair, party or other event whereat one desires to or actually does conduct body art 104procedures, excepting only a licensed body art establishment. 105 "Operator", any person alone or jointly with other persons who owns, controls, operates 106or manages a body art establishment. 107 "Parenteral", the invasion of the skin barrier or mucous membranes. 7 of 45 108 "Permit", a document issued by the department pursuant to this chapter authorizing the 109use of a facility for the conducting of body art. 110 "Physician", a person licensed by the commonwealth in accordance with section 2 of 111chapter 112. 112 "Practitioner", a person who has received a license to perform body art by the department 113pursuant to this chapter. 114 "Practitioner License", license issued by the department to a person qualified to engage in 115the practice of body art in accordance with this chapter. 116 "Procedure surface", any surface of an inanimate object that contacts an unclothed part of 117a person upon whom body art is to be performed. 118 "Prohibited forms of body art" means those forms of body art prohibited under this 119chapter and set forth in section 56. 120 "Sanitize", the process of reducing the number of microorganisms on a surface to a safe 121level using a liquid chemical germicide. 122 "Sanitizer", liquid chemical germicide. 123 "Scarification", a form of body art that requires the use of an instrument to cut a design 124into the skin to produce a scar. 125 "Sharps", any object (sterile or not) that may purposefully or accidentally cut or penetrate 126the skin or mucosa of a person including, but not limited to, needles, scalpel blades, razor blades 127and lancets. 8 of 45 128 "Sharp's container", a puncture-resistant, leak-proof container that can be closed for 129handling, storage, transportation or disposal and is labeled with the international biohazard 130symbol. 131 "Single-use", products or items that are intended for one-time, one-person use and are to 132be disposed of after such use including, but not limited to, cotton swabs or balls, tissues or paper 133products, paper or plastic cups, gauze and sanitary coverings, razors, piercing needles, scalpel 134blades, stencils, ink cups and protective gloves. 135 "Sterilization unit", a unit designed to and which is effective at killing all 136microorganisms, including bacterial spores and which is approved by the department for use for 137sterilization in a body art establishment. 138 "Sterilize", to effectively kill all microorganisms, including bacterial spores. 139 "Tattoo", the form of body art consisting of the injection of ink, dye or other medium to 140form or create an indelible mark, figure or decorative design in the subcutaneous portion of the 141skin. 142 "Tattooing", the act or process of creating a tattoo. 143 "Tattoo gun", an electric, vertically vibrating tool used for tattooing. 144 "Temporary body art establishment", mobile body art establishment. 145 "Three dimensional body art" or "Beading" or "Implantation", the form of body art 146consisting of or requiring the placement, injection or insertion of an object, device or other thing 147made of matters such as steel, titanium, rubber, latex, plastic, glass or other inert materials, 148beneath the surface of the skin of a person, not including body piercing. 9 of 45 149 "Ultrasonic cleaning unit", a unit approved by the department and physically large 150enough to fully submerge instruments in liquid, which unit removes all foreign matter from the 151instruments by means of high frequency oscillations transmitted through the contained liquid. 152 "Universal precautions" or "Standard precautions", the set of guidelines and controls, 153published by the Center for Disease Control as "guidelines for prevention of transmission of 154human immunodeficiency virus and hepatitis B virus to health-care and public-safety workers" 155in Morbidity and Mortality Weekly Report by the Center for Disease Control (CDC) June 23, 1561989, Vol. 38, NO. S-6, and as "recommendations for preventing transmission of human 157immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive 158procedures" in Morbidity and Mortality Weekly Report July 12, 1991, Vol. 40, No. RR-8, each 159as amended or updated. This method of infection control requires the employer and the employee 160to assume that all human blood and specified human body fluids are infectious for HIV, HBV 161and other blood pathogens. Precautions include hand washing, gloving, personal protective 162equipment, injury prevention, and proper handling and disposal of needles, other sharp 163instruments, and blood and body fluid contaminated products. 164 "Workstation", an area within a body art facility designated for use in the conducting of 165body art. 166 Section 2. (a) No person shall conduct any form of body art unless such person holds a 167valid practitioner license issued by the department pursuant to this chapter. 168 (b) No person shall establish a facility for the conduct of a business consisting of or 169including the performance of one or more forms of body art upon the person of another without a 10 of 45 170valid permit to operate such facility as a venue within which to conduct body art issued by the 171department in accordance with this chapter. 172 (c) The following persons are exempt from the provisions of this chapter: 173 (i) physicians who practice body art as a part of patient treatment; provided, however, 174that such body art is performed in a medically acceptable manner; and 175 (ii) individuals who pierce only the lobe of the ear with a pre-sterilized, single-use stud 176and clasp ear piercing system without the use of a so-called piercing gun. 177 (d) The requirements of this chapter to obtain a practitioner license and a body art facility 178permit are separate from and in addition to the requirements of section 5 of chapter 110. An 179applicant for a body art establishment permit shall comply with the requirements section 5 of 180chapter 110. Prior to the issuance of a body art establishment permit an applicant therefore shall 181demonstrate to the department compliance therewith by way of presentment to the department 182the original of the business certificate issued by the city clerk pursuant to section 5 of chapter 183110. 184 Section 3. (a) A person seeking registration under this chapter so as to obtain a 185practitioner license shall submit a completed application provided by the department and shall 186pay a fee of $250. A practitioner license shall be valid for no more than 1 year. The department 187may renew a practitioner license under this chapter and each applicant for such renewal shall pay 188a renewal fee of $250. All practitioner licenses shall expire on December 31 of the year of 189issuance. 11 of 45 190 (b) An applicant for a practitioner license shall demonstrate to the department his or her 191successful compliance with all training, disclosure, consent and educational requirements of this 192chapter relative to the form of body art for which such applicant seeks a practitioner license prior 193to the issuance or renewal of a practitioner license by the department. 194 (c) An applicant for a practitioner license shall provide to the department, and shall 195provide to the owner of any body art establishment in which the applicant intends to perform or 196in which he does perform body art, valid documentation of his hepatitis B virus (HBV) 197vaccination status stating: 198 (i) Certification of completed vaccination; 199 (ii) Laboratory evidence of immunity; 200 (iii) Documentation stating the vaccine is contraindicated for medical reasons. 201Contraindication requires a dated and signed licensed health care professional's statement 202specifying the name of the practitioner license applicant employee and that the vaccine cannot be 203given; or, 204 (iv) Certificate of vaccination declination of HBV, i.e. for medical or religious reasons as 205provided in section 15 of chapter 76. 206 Section 4. A body art practitioner shall maintain a high degree of personal cleanliness, 207conform to hygienic practices and wear clean clothes when conducting body art. If the clothes of 208a body art practitioner are or become contaminated, clean clothing shall be donned prior to 209commencement of any further body art. 12 of 45 210 Section 5. (a) Every applicant for a practitioner license or a renewal of a practitioner 211license, in order to be qualified for such license, shall provide to the department evidence of 212satisfaction of the following minimal training requirements: 213 (i) For a practitioner license enabling one to perform body piercing, the completion of a 214complete course in anatomy and physiology, (i.e. anatomy and physiology I and II) with a grade 215of C or better at a college accredited by the New England Association of Schools and Colleges, 216or comparable accrediting entity. This course work shall include instruction on the systems of the 217integumentary system (skin). 218 (ii) For a practitioner license that enables one to perform tattooing, branding and 219scarification, but not body piercing, the successful completion of a complete course in anatomy 220and physiology, (i.e. anatomy and physiology I and II) with a grade of C or better at a college 221accredited by the New England Association of Schools and Colleges, or comparable accrediting 222entity. This course work shall include instruction on the systems of the integumentary system. 223Such other course or program as the department shall deem appropriate and acceptable may be 224substituted for the course in anatomy and physiology otherwise required of an applicant for a 225practitioner license that enables one to perform tattooing, branding and scarification, but not 226body piercing. 227 (iii) For all body art practitioners, the successful completion of a course on prevention of 228disease transmission and blood borne pathogens taught by an instructor trained and sufficiently 229knowledgeable to teach this OSHA course. Such knowledge shall include the requirements of 29 230CFR 190.1030. 13 of 45 231 (iv) For all body art practitioners, current certification in American Red Cross basic first 232aid or its equivalent and advanced cardio-pulmonary resuscitation. 233 (v) Evidence satisfactory to the department of at least 2 years actual experience in the 234practice of performing body art of the kind for which the applicant seeks a practitioner license to 235perform, whether such experience was obtained within or outside of the commonwealth, or 236evidence of a completed apprenticeship program as approved by the commonwealth or the 237department, with instruction in the kind of body art for which the applicant seeks a practitioner 238license to perform. 239 (b) Any course taken by an applicant to fulfill the requirements set forth in this chapter 240concerning exposure control and blood borne pathogen training shall meet the requirements of 24129 CFR 1910.1030 et seq, as amended from time to time, and, at a minimum, shall provide 242instruction in the following subject matter: 243 (i) A general explanation of the epidemiology and symptoms of blood borne diseases and 244all communicable diseases potentially transmitted through body art; 245 (ii) An explanation of the modes of transmission of blood borne pathogens and other 246communicable diseases potentially transmitted through body art; 247 (iii) An explanation of the appropriate methods for recognizing tasks and other activities 248that may involve exposure to blood for the body art practitioner or the client or recipient; 249 (iv) An explanation of the use and limitations of methods that will prevent or reduce 250exposure to the body art practitioner and the client or recipient of blood borne pathogens and 251other communicable diseases; 14 of 45 252 253 (v) Information on different types, proper use, and removal of gloves and proper hand 254washing techniques; 255 (vi) Information on the proper selection and use of autoclaveants and antiseptics; 256 (vii) Information on the HBV vaccine, including information on its efficacy, safety, 257method of administration, and the benefits of vaccination against HBV; 258 (viii) An explanation of what constitutes an exposure incident, the risk of disease 259transmission following an exposure incident, and the options for post-exposure evaluation and 260follow-up if an exposure incident occurs involving blood borne pathogens; and, 261 (ix) An opportunity for interactive questions and answers with the instructor of the 262training session. 263 Upon conclusion of a course as describe above, an examination based on the information 264covered in the course shall be administered to each attendee of the course by the entity 265administering the course, with documentation of the results for each attendee provided to him or 266her. The practitioner license applicant shall provide the results of such examination to the 267department. 268 Section 6. An applicant for a practitioner license shall sign a statement provided by the 269department consenting to and agreeing to abide by all of the provisions of this chapter. 270 Section 7. (a) If an applicant for a practitioner license demonstrates compliance with 271clause (i) of subsection (a) of section 5 and all other provisions of this chapter, excepting only 272clause (ii) of subsection (a) of section 5, than the department is hereby authorized to issue a 15 of 45 273practitioner license pursuant to the provisions of this chapter which authorizes the applicant to 274conduct body art consisting only of body piercing. 275 (b) If an applicant for a practitioner license does not demonstrate compliance with clause 276(i) of subsection (a) of section 5, but does demonstrate compliance with clause (ii) of subsection 277(a) of section 5 and with all other provisions of this chapter, than the department is hereby 278authorized to issue a practitioner license pursuant to the provisions of this chapter that authorizes 279the applicant to conduct body art consisting only of tattooing, branding and scarification. 280 Section 8. (a) A body art practitioner shall only perform those forms of body art for 281which he or she holds a practitioner license issued by the department. 282 (b) A body art practitioner shall only conduct body art within a facility with a current 283body art establishment permit, and which establishment is in compliance with all provisions of 284this chapter. No body art practitioner shall conduct any form of body art in a mobile or 285temporary body art establishment or establish or operate a mobile or temporary body art 286establishment. 287 Section 9. A body art practitioner or an operator shall post in an area of the body art 288establishment accessible to the department and to clients the original of the current practitioner 289license of the body art practitioner. 290 Section 10. A body art practitioner shall not conduct any form of body art while under the 291influence of alcohol or drugs. 292 Section 11. A body art practitioner shall not: 293 (i) Tattoo a minor client; 16 of 45 294 (ii) Brand a minor client; 295 (iii) Scar or perform scarification upon a minor client; 296 (iv) Pierce the genitalia of a minor client; 297 (v) Pierce a client under 14 years of age with the exception of ear piercing; or 298 (vi) Perform or engage in any of the activities prohibited under section 56. 299 Section 12. A body art practitioner shall only conduct body art under sterile conditions. 300 Section 13. The skin of a body art practitioner shall be free of rash, any lesion or visible 301sign of infection. A body art practitioner shall not conduct any form of body art upon any area of 302a client that evidences the presence of any rash, lesion or visible sign of infection. 303 The skin area or mucosa of a client to receive any form of body art shall be free of rash, 304any lesion or from any visible sign of infection. 305 Section 14. (a)The department shall establish a practitioner license apprenticeship 306program requiring that all participants in such program adhere to and abide by all relevant 307provisions of this chapter excepting only section 5. 308 (b) As a minimum requirement of the practitioner license apprenticeship program 309established by the department, the department shall require that each participant in such program 310shall be required to complete the requirements in clauses (i) through (iv) of subsection (a) of 311section 5 and subsection (b) of section 5 prior to a participant in such program conducting any 312form of body art upon a client or the person of another. 17 of 45 313 (c) The department is hereby authorized to issue an apprentice license to participants in 314the practitioner license apprenticeship program provided each such participant qualifies for the 315same pursuant to the provisions of this chapter and the practitioner license apprenticeship 316program. 317 (d) Before a person acting under an apprentice license conducts any form of body art 318upon a client, that client shall be advised that the person to conduct such body art is in fact an 319apprentice and is acting only under an apprentice license. 320 (e) Before a person acting under an apprentice license conducts any form of body art 321upon a client, such person shall obtain the client's written consent. This written consent shall be 322physically affixed to the application and consent form for body art required pursuant to section 32315 and such written consent shall be maintained therewith. 324 Section 15. Every client shall complete an application and consent form approved by the 325department prior to having any body art performed upon or to their body. 326 Every application and consent form shall contain a minimum of the following: 327 (i) General information regarding body art, including, at a minimum, the following 328statements: 329 (a) Tattoos should be considered permanent; and 330 (b) The removal of tattoos and scars would require surgery or other medical procedure 331that may result in scarring or additional scarring of the skin; 332 (ii) Information as to the side effects of body art, including, but not limited to, 333hypertrophic scarring, possible adverse reaction to ink, dye or pigment, possible change in color 18 of 45 334of ink, dye or pigment over time, a decreased ability of physician to locate skin melanoma in 335regions concealed by tattoos, brands, scars and other forms of body art, possible nerve damage, 336febrile illness, tetanus, systemic infection, and keloid formation; 337 (iii) Client information, including the name, type of body art being performed, age and 338valid identification; provided, however, that in the case of a minor client, the parent's or legal 339guardian's name, proof of parentage or legal guardianship through a copy of a birth certificate or 340court order of guardianship respectively, or a notarized document signed by the parent or legal 341guardian attesting to the parent's or legal guardian's relationship to the minor client, and the 342consent to the conduct of the contemplated body art upon the minor client; 343 (iv) Instructions requiring the client to adhere to the exposure control plan as such plan 344relates to the client's conduct in the body art establishment; 345 (v) The address and phone number of the department and instructions for the client, or in 346the case of a minor client, the minor client and his or her parent or legal guardian, to contact the 347department with any questions or concerns regarding safety, sanitization or sterilization 348procedures; 349 (vi) The name of the body art practitioner who is to conduct the body art upon the client 350or minor client and that practitioner's department registration number; 351 (vii) The manufacturer codes, if any, the identity of the manufacturer, and lot numbers of 352any ink, dye or pigment to be used in the body art; 353 (viii) Signature of client; provided, however, that in the case of a minor client, a parent or 354legal guardian shall sign the consent form in the presence of the body art practitioner; 19 of 45 355 (ix) The signature of body art practitioner; 356 (x) The date of all signatures; and, 357 (xi) The date of the body art procedure, including a daily estimate of progress for the 358conduct of body art requiring multiple days to complete. 359 Section 16. (a) A client shall inform the body art practitioner of any known chronic 360medical or communicable conditions, including, but not limited to diabetes; history of 361hemophilia or bleeding; history of skin disease, skin lesions or skin sensitivities to soap, 362disinfectants, etc.; history of allergies or adverse reactions to pigments or dyes or other skin 363sensitivities; history of epilepsy, seizures, fainting or narcolepsy; the taking of medications such 364as aspirin or other anticoagulants, which thin the blood or interfere with blood clotting; or a 365history of or suspicion of adverse reaction to latex or products containing latex. 366 (b) A client shall inform the body art practitioner of a known pregnancy or possibility of 367pregnancy. 368 (c) The body art practitioner shall require the client to sign a release form confirming that 369the above information was obtained or attempted to be obtained and the client refused to disclose 370the same. 371 Section 17. No person shall receive any form of body art activity who is under the 372influence of drugs or alcohol. 373 Section 18. All clients shall obtain, read and follow aftercare instructions appropriate for 374the form of body art conducted upon such person. 20 of 45 375 Aftercare Instructions shall be approved by the department and shall include, at a 376minimum the following: 377 (i) Responsibilities and proper care following the procedure; 378 (ii) Restrictions, if any, upon the client; 379 (iii) Signs and symptoms of infection; and, 380 (iv) Instructions to contact a physician if possible signs of infection occur. 381 Section 19. (a) No minor client shall receive a tattoo, be branded, be scarred, or have his 382or her genitalia pierced. 383 (b) No body art practitioner shall pierce the genitalia of a minor child. 384 (c) No client under fourteen years of age shall be pierced with the sole exception of ear 385piercing. 386 Section 20. A person seeking registration under this chapter so as to obtain a body art 387establishment permit shall submit a completed application provided by the department and shall 388pay a fee of $250. A body art establishment permit shall be valid for no more than one year. The 389department may renew a body art establishment permit under this chapter and each applicant for 390such renewal shall pay to the a renewal fee of $250. All body art establishment permits shall 391expire on December 31 of the year of issuance. 392 Section 21. The operation of a body art establishment or the conduct of any body art 393under a practitioner license therein shall not occur before 9:00 a.m. nor after 9:00 p.m. Sunday 394through Thursday and nor before 9:00 a.m. nor after 10:00 p.m. on Friday and Saturday. 21 of 45 395 Section 22. Every operator or applicant for a body art establishment permit shall submit 396to the department scaled plans and specifications of the proposed facility wherein any body art is 397intended to be conducted demonstrating the compliance of the facility with this chapter. The 398department may require an on-sight inspection of the proposed facility to determine and ensure 399compliance with the requirements of this chapter prior to the issuance by the department of a 400body art establishment permit pursuant to this chapter. 401 Section 23. (a) Each body art establishment shall have at least 1 workstation. 402 (b) Every workstation shall have a minimum of 60 square feet. 403 (c) The area within each workstation shall be completely screened from view from any 404person outside such workstation. 405 (d) A workstation shall be used for no other purpose. 406 (e) Each workstation shall be separated from any other area of the body art facility, 407including other workstations within such body art facility, by a wall or other solid barrier 408extending from the floor to a minimum height of 8 feet. 409 (f) A workstation shall be maintained in a clean and sterile condition. 410 Section 24. (a) Every body art establishment shall have therein a cleaning area. Every 411cleaning area shall have an area for the placement and use of an autoclave or other sterilization 412unit located or positioned so as to be a minimum of 36 inches from a required ultrasonic cleaning 413unit. 414 (b) Every body art establishment shall have therein an instrument storage area exclusive 415of the cleaning area. The instrument storage area shall be equipped with cabinets for the storage 22 of 45 416of all instruments and equipment. The required cabinets shall be located a sufficient distance 417from the cleaning area so as to prevent contamination of the instruments and equipment stored 418therein. 419 (c) Every body art establishment shall have therein a customer waiting area exclusive of 420and separate from any workstation, instrument storage area or cleaning area. 421 Section 25. Every workstation, instrument storage area, toilet room, and cleaning area 422shall be constructed and maintained as follows so as to provide a durable, smooth, nonabsorbent 423and washable surface: 424 (i) Floors shall be constructed of commercially rated continuous sheet vinyl, smooth 425sealed cement, ceramic tile with sealed grout, or other similar materials approved by the 426department and shall be maintained in good repair free of any holes or cracks; 427 (ii) Walls shall be covered with a semi-gloss or gloss enamel paint, or constructed of 428fiberglass reinforced panel, ceramic tile with sealed grout or other similar materials approved by 429the department and shall be maintained in good repair free of any holes or cracks; 430 (iii) Ceilings shall be covered with semi-gloss or gloss enamel paint, or approved 431commercially rated panels or tiles and maintained in good repair free of any holes, cracks or 432falling matter. 433 All such floors, walls and ceilings shall be light-colored. 434 Section 26. All electrical wiring shall be installed and maintained in accordance with 435state and local wiring codes. 23 of 45 436 All electrical outlets in all workstations and cleaning areas shall be equipped with 437approved ground fault protected receptacles. 438 Section 27. Every workstation shall be well ventilated and have a minimum light service 439maintained at all times during the conducting of body art at an equivalent of not less than 20 foot 440candles as measured 36 inches above the floor, except that a minimum of 100 foot candles shall 441be provided on the area of the client's body subject to the conduct of body art, in any area where 442instruments or sharps are assembled, and all cleaning areas. 443 Every workstation, cleaning area and every area in a body art establishment where linens, 444instruments, sharps or other equipment are exposed, sanitized or sterilized shall be equipped 445exclusively with readily cleanable light fixtures with light bulbs, lenses or globes made of 446shatterproof material. 447 Section 28. (a) All plumbing and plumbing fixtures shall be installed in compliance with 448local plumbing codes. 449 (b) To the extent permitted by applicable federal, state and local laws, all liquid wastes 450shall be discharged through the plumbing system into the public sewerage system or into a 451department-approved private sewage disposal system. 452 (c) An adequate pressurized potable water supply shall be provided to every body art 453establishment. 454 (d) The public water supply entering a body art establishment shall be protected by a 455testable, reduced pressure back flow preventor installed in accordance with 142 CMR 248, as 456amended from time to time. 24 of 45 457 Section 29. (a) Every body art establishment shall provide toilet rooms with adequate 458lighting and ventilation to the outside for use by employees and clients, which shall be available 459to clients during business hours. The number and construction of toilet rooms shall be in 460accordance with local building and plumbing codes. Every water closet or toilet stall shall be 461enclosed and have a well-fitting, self-closing door. An adequate supply of toilet tissue shall be 462provided in a permanently installed dispenser in each water closet or toilet stall. Toilet rooms 463shall not be used for the storage of instruments or other supplies used for body art. 464 (b) A body art establishment permanently located within a retail shopping center, or 465similar setting housing multiple operations within 1 enclosed structure having shared entrance 466and exit points, shall not be required to provide a separate toilet room within such body art 467establishment if department-approved toilet facilities are located in the retail shopping center 468within 300 feet of the body art establishment so as to be readily accessible to any client or body 469art practitioner. 470 (c) A hand sink shall be provided within or adjacent to any toilet room and in each 471workstation. Every hand sink shall be equipped with an adequate supply of hot and cold water 472under pressure with fixtures to allow for washing of hands, liquid hand cleanser, single-use 473sanitary towels in devices for dispensing, and a waste container of washable construction. A 474hand sink shall not be used as a janitorial sink. 475 (d) At least 1 janitorial sink shall be provided in every body art establishment for use in 476cleaning the body art establishment and proper disposal of liquid wastes in accordance with all 477applicable federal, state and local laws. 25 of 45 478 (e) Every cleaning area shall have an instrument sink. Every instrument sink shall be of 479adequate size and equipped with hot and cold water under pressure so as to permit the cleaning 480of instruments. 481 (f) Every toilet room, all plumbing and all plumbing fixtures shall be kept clean, fully 482operative, and in good repair. 483 Section 30. Each operator shall create, update as needed, and comply with an exposure 484control plan. 485 The exposure control plan for a body art establishment shall be submitted by the operator 486to the department for review so as to meet all of the requirements of OSHA regulations, to 487include, but not limited to 29 CFR 1910.1030 et seq, as amended from time to time. 488 A copy of the body art establishment's exposure control plan shall be maintained at the 489body art establishment at all times and shall be made available to the department upon request. 490 Section 31. A body art establishment shall be required to have a telephone in good 491working order and easily accessible to all employees and clients during all hours of operation for 492the purpose of contacting police, fire or emergency medical assistance or ambulance services in 493the event of an emergency or perceived emergency. A legible sign shall be posted at or adjacent 494to the telephone indicating the correct emergency telephone numbers and the number of the 495department. 496 Section 32. No operator shall permit the use of a body art establishment: 497 (i) For the sale of food or beverages, whether to be consumed at the body art 498establishment or off-site; 26 of 45 499 (ii) As a barbershop or hair salon; 500 (iii) As a nail salon; 501 (iv) As a bar, with or without a license for the sale of alcoholic beverages; 502 (v) As a bowling alley; 503 (vi) For human habitation; 504 (vii) As a tanning salon; 505 (viii) As a massage parlor; or 506 (ix) For any other use which, in the opinion of the department, may cause the 507contamination of instruments, equipment, a procedure surface or workstation. 508 Section 33. If an applicant for a body art establishment permit demonstrates to the 509department compliance with this chapter, the department is hereby authorized to issue a body art 510establishment permit pursuant to the provisions of this chapter. 511 Section 34. The operator of a body art establishment shall post in an area of the body art 512establishment accessible to the department and to clients the original of the current body art 513establishment permit issued by the department. 514 Section 35. No person affected with boils, infected wounds, open sores, abrasions, 515weeping dermatological lesions or acute respiratory infection shall work in any area of, or in any 516capacity in, a body art establishment which would create a likelihood that that person could 517contaminate equipment, instruments, supplies, procedure surfaces, workstations or other 27 of 45 518otherwise compromise or could reasonably be expected to compromise the sterility of the body 519art establishment with body substances or pathogenic organisms. 520 Section 36. The procedure surface and the surface of all furniture and counter tops 521located in a workstation, instrument storage area and cleaning area shall be made of materials 522that are, or shall be treated so as to be, smooth, non-absorbent, non-porous, easily cleanable and 523able to withstand repeated cleaning and disinfecting. Such surfaces shall be maintained in a good 524condition free from holes and cracks. 525 Section 37. (a) Every body art establishment shall have at a minimum the following: 526 (i) One or more ultrasonic cleaning units sold for cleaning purposes under approval of the 527United States Food and Drug Administration. Every ultrasonic cleaning unit shall be clearly 528labeled "biohazardous" and shall be installed or placed in the cleaning area at a minimum 529distance of 36 inches from the required autoclave or other sterilization unit. 530 (ii) One or more autoclave or other sterilization unit sold for medical sterilization 531purposes under approval of the United States Food and Drug Administration; and, 532 (b) Every operator and body art practitioner shall be knowledgeable in the required 533washing, cleaning and sterilization procedures including the proper operation of the ultrasonic 534cleaning unit and autoclave or other sterilization unit. 535 Section 38. Every workstation shall have a foot-operated, covered, cleanable, waste 536receptacle for disposal of trash and other debris. 537 Every workstation shall have an approved sharps container exclusively used for the 538disposal of contaminated waste. 28 of 45 539 Section 39. (a) Every body art establishment or body art practitioner shall maintain an 540adequate supply of reusable, launderable linens or single-use linens, such as drapes, lap cloths 541and aprons, to be used in conducting body art. 542 (b) If used in body art, rotary pens, also known as cosmetic machines, shall have 543detachable, disposable, sterile combo couplers and shall have detachable, disposable casings or 544casings designed and manufactured to be easily cleaned and sterilized. 545 (c) All inks, dyes and pigments used to alter the color of skin in the conduct of body art 546shall be specifically manufactured for such purpose, approved, properly labeled as to its 547ingredients, manufacturer and lot number in accordance with applicable United States Food and 548Drug Administration requirements, and shall not be contaminated or adulterated. The mixing of 549such inks, dyes or pigments or the dilution of the same with potable sterile water is acceptable, 550unless prohibited or not recommended by the product manufacturer. 551 Inks, dyes and pigments prepared by or at the direction of a body art practitioner for use 552in body art shall be made exclusively of non-toxic and non-contaminated ingredients approved 553by the department or the United States Food and Drug Administration. 554 (d) Equipment, instruments and supplies intended for single-use shall not be used more 555that one time. 556 Section 40. Jewelry shall be sterilized, free from polishing compounds, free from nicks, 557scratches, burrs or irregular surface conditions. Jewelry of 16 gage girth or thicker shall not have 558raised external threads or threading. Jewelry shall be in good condition, designed and 559manufactured for insertion into the intended body part of the client. 29 of 45 560 The use of previously worn jewelry or jewelry brought into the body art establishment by 561the client or another is prohibited. 562 Only jewelry manufactured of surgical implant stainless steel of American Society for 563Testing and Material Standards grade F138, surgical implant solid 14K or 18K white or yellow 564gold, niobium, surgical implant titanium of Ti6A4V ELI, American Society for Testing and 565Material Standards F-136-98, platinum or other materials considered by the department to be 566equally bio-compatible and capable of adequate cleaning and sterilization shall be inserted into a 567client. 568 Section 41. No operator, body art practitioner or other person shall utilize or have 569available in a body art establishment any: 570 (i) Instruments or materials, such as styptic pencils or devices, alum, or any similar 571material, used to check the flow of blood; 572 (ii) Liquid sterilants for the attempted sterilization of any re-usable instrument or 573component; 574 (iii) Rotary pens that are designed or manufactured with a sponge type material at the 575opening of the chamber for the purpose of prohibiting the backflow of pigment and body fluid 576into the machine; 577 (iv) Multiple-use instruments or components that are designed in such a manner that 578restrict or prevent proper washing, cleaning or sterilization; 579 (v) Drugs, chemicals or agents that require a licensed medical practitioner's authorization 580for use, application or dispensation; 30 of 45 581 (vi) Suturing kits or suturing devices, scalpels, cauterizing tools or devices, or other tools, 582devices or instruments used for or in conjunction with any prohibited body art, and not otherwise 583properly used for any allowed body art; 584 (vii) Piercing needles or piercing tapers for the sale or use by one not a body art 585practitioner; or 586 (viii) Needles used in the practice of play piercing. 587 Section 42. No body art practitioner shall conduct any form of body art upon an animal. 588 No animal, except one actually serving as any guide animal, signal animal or service 589animal accompanied by a totally or partially blind person or deaf person or a person whose 590hearing is impaired or handicapped person, shall be allowed in a body art establishment. 591 Section 43. No person shall smoke, or otherwise use any form of tobacco, eat or drink at 592or in a workstation, instrument storage area or cleaning area. Only in the case of medical need 593may fluids be consumed by a client. 594 Section 44. (a) Except as set forth in these regulations, no operator, body art practitioner 595or other person shall deliberately expose any client or person to disease or illness or otherwise 596knowingly contaminate any instrument or area in a body art establishment without then 597sterilizing the instrument or area. 598 (b) An exposure incident report shall be completed by the close of the business day 599during which an exposure has or might have taken place by the involved or knowledgeable body 600art practitioner for every exposure incident occurring in the conduct of any body art. Each 601exposure incident report shall contain: 31 of 45 602 (i) A copy of the application and consent form for body art completed by any client or 603minor client involved in the exposure incident; 604 (ii) A full description of the exposure incident, including the portion of the body involved 605therein; 606 (iii) The name or description of any instrument or other equipment implicated; 607 (iv) A copy of the practitioner license of the involved body art practitioner. 608 (v) Date and time of exposure; 609 (vi) A copy of any medical history released to the body art establishment or body art 610practitioner; and 611 (vii) Information regarding any recommendation to refer to a physician or waiver to 612consult a physician by persons involved. 613 Section 45. (a) Every operator shall have and retain at the body art establishment for 614inspection by the department the following information for the time period specified below, to be 615updated as needed to remain current: 616 (i) One copy of the exposure control plan for the body art establishment submitted to the 617department; 618 (ii) Employment records covering the last 3 years of operation that indicate the 619employee’s name, home address, home phone number, identification photograph, state 620identification card number, physical description as detailed on state identification card, date of 621birth, types of body art procedures conducted, dates of employment at the body art 32 of 45 622establishment, body art practitioner registration number, hepatitis B vaccination status or 623declination notification; 624 (iii) Body art practitioner independent operator records for the last 3 years that indicate 625the operator’s name, home address, phone number, state identification card number, physical 626description as detailed on state identification card, date of birth, types of body art procedures 627conducted, dates operating at the body art establishment, body art practitioner registration 628number, hepatitis B vaccination status or declination notification; 629 (iv) Client records for the last 2 years, which shall include copies of all application and 630consent forms for body art; 631 (v) Waste hauler manifests for contaminated waste transport and disposal over the last 3 632years; 633 (vi) Documentation for the last 3 years to verify training of exposure control plan to all 634employees and body art practitioner independent operators conducting body art at such 635establishment; 636 (vii) Commercial biological monitoring spore system test results for the last 3 years; and 637 (viii) At least 1 copy of the most current version of the text of this chapter and any state 638regulations concerning the practice of body art. 639 (b) Every operator shall have and permanently retain at the body art establishment for 640inspection by the department all exposure incident reports. The disposal or destruction of these 641reports is prohibited. 33 of 45 642 Section 46. Every area of a body art establishment shall be kept in good repair, clean and 643free of all vermin and maintained so as to prevent contamination of clients and other persons. 644 All instruments, equipment and procedure surfaces used for body art, including, but not 645limited to, devices, containers, cabinets, storage compartments, chairs, tables, counters, and 646dispensers shall be maintained clean, fully operative, and in good repair and free from 647contamination. 648 All instruments manufactured for performing any specific body art shall be so designated, 649used and approved, and shall not be modified, adulterated, contaminated or improperly used. 650Instruments used for body piercing shall be constructed of stainless surgical-grade steel, and 651designed and manufactured for such use. 652 Section 47.(a) Every contaminated reusable instrument or component thereof, including, 653but not limited to, needles, needle bars, needle tubes, needle caps, body piercing tubes, rotary 654pens, and coil machines, shall be immersed in water or other approved liquid solution in the 655cleaning area until cleaned and sterilized. 656 (b) Prior to sterilization, every such instrument shall be thoroughly washed by scrubbing 657with an appropriate disinfectant and hot water in accordance with manufacturer's instructions so 658as to remove contamination and foreign matter. 659 (c) Upon completion of the washing process as set forth in subsection (b), every such 660instrument shall be cleaned using an ultrasonic cleaning unit in accordance with manufacturer's 661instructions. 34 of 45 662 (d) Upon completion of the cleaning process as set forth in subsection (c), every such 663instrument shall be packaged into procedure set-up packages with color change indicators 664designed to indicate complete sterilization thereof, initials of the person responsible for 665sterilizing the instruments and date of such sterilization. Instruments may be packaged 666individually or with other instruments to the extent permitted under the package manufacturer's 667instructions. 668 (e) Upon completion of the packaging process as set forth in subsection (d), every such 669instrument shall be properly sterilized by properly autoclaving in an approved autoclave or 670sterilized in another type of sterilization unit according to manufacturer's instructions. 671 (f) If a package becomes wet, is opened or is otherwise compromised so as to allow the 672possible contamination of the contents of the package, any instrument therein shall be deemed 673contaminated and shall again be washed, cleaned, packaged and sterilized as indicated above 674prior to use. 675 (g) Sterilized instruments shall be stored in a dry, clean cabinet or tightly covered 676container. Cabinets and containers designated for the storage of sterilized instruments shall be 677used for that purpose exclusively. 678 (h) Every sterilized package shall be deemed expired 6 months after the date of 679sterilization. Every instrument therein shall again be washed, cleaned, packaged and sterilized 680consistent with the provisions of this section prior to use. 681 (i) Liquid sterilants shall not be used for the sterilization of any reusable instrument. 35 of 45 682 Section 48. (a) All instruments shall be stored in the instrument storage area in a manner 683so as to prevent contamination. Identical instruments shall be exclusively stored together, unless 684intermingled storage with different instruments does not represent a hazard as determined by the 685department. 686 (b) All germicides, disinfectants, chemicals, and cleansers shall be used according to the 687manufacturer's requirements, used only for the purpose approved and intended by the 688manufacturer and properly labeled and stored so as to prevent contamination and hazard. 689 (c) Clean linen shall be stored in a manner so as to prevent contamination. Containers 690used for the storage of such linen shall be clearly labeled as to the contents and used for no other 691purpose. Linens that have become soiled or contaminated shall be disposed of, or not be used, 692until properly laundered. Contaminated linen shall be labeled, handled, stored, transported, and 693laundered or disposed of so as to prevent hazard in a manner approved by the department. 694 Any other protective clothing, garment or cloth items worn during or used during in body 695art and intended for reuse shall be mechanically washed with detergent and dried after each use. 696The items shall be stored in a clean, dry manner and protected from contamination until used. 697Should such items become contaminated directly or indirectly with bodily fluids, the items shall 698be washed in accordance with standards applicable to hospitals and medical care facilities, at a 699temperature of 160 degrees Fahrenheit or a temperature of 120 degrees Fahrenheit with the use 700of chlorine disinfectant. 701 (d) All storage containers, cabinets, shelves and other storage areas in the instrument 702storage area shall be properly labeled as to their contents, including, but not limited to, 703identification of contaminated or soiled contents as appropriate. 36 of 45 704 Section 49. Every ultrasonic cleaning unit and autoclave or sterilization unit shall be used 705and maintained according to manufacturer's specifications. Each ultrasonic cleaning unit, 706autoclave or other sterilization unit shall be emptied and thoroughly cleaned and disinfected at 707least once each day that the unit is used. 708 Every autoclave or sterilization unit shall be tested with a commercial biological 709monitoring spore system test in a manner and frequency consistent with the manufacturer's 710instructions, but no less than once every week, to monitor the efficacy of the eradication of all 711living organisms, including spores, by the autoclave or other sterilization unit. 712 Biological monitoring spore system testing of the autoclave or other sterilization unit 713shall be performed by an independent commercial testing laboratory contracted by the operator 714or body art practitioner. A provision shall be included in the contact between the operator or 715body art practitioner with the commercial testing laboratory requiring the commercial testing 716facility to notify the department of any failure of the autoclave or other sterilization unit to 717eradicate all living organisms, including spores. 718 Section 50. All waste shall be removed from the body art establishment on a daily basis 719and placed in an approved secured receptacle for pickup and removal. 720 All contaminated waste in solid form and sharps, shall be disposed of through use of an 721approved waste hauler in accordance with all applicable state and federal and local laws. The 722frequency of disposal shall be determined by the department, but shall be no less than every 30 723days. 724 Section 51. (a) The conduct of body art shall occur only upon a client or minor client in a 725workstation under sterile conditions. 37 of 45 726 Only the client, a the parent or legal guardian of a minor client, the guide or service 727animal of a client, the body art practitioner conducting the body art and an assistant or apprentice 728to the body art practitioner, with the express permission of the client, shall be permitted in the 729workstation during the conduct of body art. 730 (b) All surfaces in a workstation which come in contact with a client or which become 731contaminated or which may reasonably have become contaminated shall be cleaned with water 732and soap or other appropriate cleaning compound immediately following the conduct of body art 733upon a client. 734 The workstation, including, but not limited to the client's chair, table, tray, procedure 735surface and similar surfaces shall be thoroughly sanitized with an approved disinfectant 736immediately before and immediately after the conduct of body art upon a client. 737 (c) A body art practitioner shall clean his or her hands and forearms thoroughly by 738washing with antibacterial soap and warm water and promptly dry the same with single-use 739paper towels or like material prior to conducting any body art. 740 A body art practitioner shall wear new, clean, single-use examination gloves while 741assembling all instruments and other supplies intended for use in the conduct of body art and 742during the conduct of body art upon a client. New, clean, single-use non-latex examination 743gloves shall be used during the preparation for and the conduct of any body art upon a client with 744a known or a suspected latex allergy. 745 If an examination glove is pierced, torn or contaminated through contact with any part of 746the client not subject to the conduct of body art or such other surface so as to present the 747possibility of contamination, any person other than the client, or otherwise exposed to an 38 of 45 748unsanitary or non-sterile surface, both gloves shall be promptly removed and discarded into an 749appropriate waste receptacle. The body art practitioner shall don new gloves before proceeding 750with the conduct of body art. 751 If the gloves of a body art practitioner are removed at any time during assembly of 752instruments or supplies, or the conduct of body art, the body art practitioner shall clean his or her 753hands and don new gloves in accordance with this section. 754 The use of single-use examination gloves does not preclude or substitute for the above 755hand washing requirement. 756 (d) Every body art practitioner shall use linens, properly cleaned in accordance with these 757regulations, or new single-use drapes, lap cloths, and aprons for each element of body art 758conducted upon a client. 759 Every substance used in the conduct of body art shall be dispensed from containers so as 760to prevent contamination or the possibility of contamination of the unused portion. Immediately 761before tattooing a client, a sufficient quantity of the ink, dye or pigment to be used shall be 762transferred from its original bottle or container into sterile, single-use disposable cups, caps or 763containers. 764 Upon sanitization of the workstation, the instrument tray shall be covered with an 765uncontaminated single-use paper towel, tray cover or similar material. 766 Every instrument required for the conduct of body art upon a client shall be placed and 767arranged on the instrument tray in a manner so as to prevent contamination of sterilized 39 of 45 768instruments. All sterilized instruments shall remain in sterile packages until opened in front of 769the client. 770 Sharps containers shall be easily accessible to the body art practitioner and located as 771close as is feasible to the immediate area where the sharps will be used. 772 (e) All instruments used in the conduct of body art shall be without contamination, and 773shall be properly cleaned, sanitized and sterilized in accordance with this chapter. 774 All instruments and other equipment or supplies used in the conduct of body art that are 775designed or intended for single-use shall only be used once. 776 All sharps shall be properly disposed of immediately following use in a sharps container. 777 All product applied to the skin, including body art stencils, shall be single-use and shall 778be used only once. 779 Products used in the application of body art stencils shall be dispensed and applied to the 780area of the client upon which the body art is to be performed with sterile gauze or other sterile 781applicator so as to prevent contamination of the container and contents of the product in use. The 782gause or other applicator shall be used only once. 783 Only single-use disposable razors shall be used in the conducting of body art and such 784single-use disposable razors shall not be used more than one time. 785 Section 52. Disposable items such as gloves, wipes, cotton balls, Q-tips, water cups, rinse 786cups that are used alone or in an ultrasonic cleaning unit, drapes, lap cloths, aprons and other 787single-use items that have come into contact with any person, client, workstation, instrument 788trays, counters, towels or linens used for the conduct of body art, or have otherwise become 40 of 45 789contaminated shall be promptly discarded during or upon completion of the conduct of body art 790into an appropriate waste receptacle in accordance with this chapter. 791 Section 53. The following shall be deemed to be multiple body art procedures on a single 792client, each requiring proper washing, cleaning, sanitization and sterilization of instruments, 793workstations and other equipment and areas as set forth under these regulations: 794 (i) Creating 2 or more tattoos on different areas of the body of a single client; 795 (ii) The use of more than one needle or scalpel during the conduct of body art upon a 796single client; or 797 (iii) Creating one tattoo and the use of one needle or scalpel on a single client. 798 Section 54. Cosmetic tattooing, permanent cosmetics, micro pigment implantation or 799dermal pigmentation, are all prohibited unless performed by a medical doctor licensed by the 800commonwealth or such other person that receives a license, permit or registration by the 801commonwealth specifically to perform such activities. 802 If a person obtains such a license, permit or registration from the commonwealth, such 803person may conduct such body art provided all requirements of this chapter are complied with, 804excepting only subsection (a) of section 2. 805 Section 55. The use of a piercing gun is prohibited at all times. 806 Section 56. The following body art practices are prohibited: 807 (i) Piercing of the uvula, tracheal area, neck, ankle, gums, webbed area of the hand or 808foot, lingual frenum, clitoris, anus, or eyelid; 41 of 45 809 (ii) Piercing between the ribs or vertebrae; 810 (iii) Any form of chest or deep muscle piercings, excluding piercing of a nipple; 811 (iv) The form of body piercing known as pocketing; 812 (v) Piercing or skewering of a testicle; 813 (vi) Deep piercing of the penis or trans-penis piercing in any area from the corona glandis 814to the pubic bone; 815 (vii) Piercing through the scrotum, deep piercing of the scrotum or trans-scrotal piercing; 816 (viii) Deep piercing of the vagina, including but not limited to triangles; 817 (ix) Cutting, splitting or other bifurcation of the tongue unless performed by a medical 818doctor licensed by the commonwealth; 819 (x) Braiding of the skin unless performed by a medical doctor licensed by the 820commonwealth; 821 (xi) Three dimensional body art, including beading and implantation unless performed by 822a medical doctor licensed by the commonwealth; 823 (xii) Filing, shaping or the intentional fracturing or extraction of a tooth unless performed 824by a dentist licensed by the commonwealth; 825 (xiii) Cutting, notching, sculpting or other modification of cartilage unless performed by 826a doctor licensed by the commonwealth; 42 of 45 827 (xiv) The intentional amputation of any part of the body unless performed by a doctor 828licensed by the commonwealth; 829 (xv) The modification of the genitalia by means of sub-incision, bifurcation, castration, 830male or female nullification or other surgical means unless performed by a doctor licensed by the 831commonwealth; or 832 (xvi) The introduction of saline solution or other liquid or semi-liquid substance into the 833body of another for the purposed of causing a modification of the body unless performed by a 834medical doctor licensed by the commonwealth. 835 Section 57. (a) Variance may be granted from a particular section or provision of this 836chapter by the department with respect to a particular case only when, in the sole opinion of the 837department: 838 (i) The enforcement of the subject section or provision would do manifest injustice; and 839 (ii) The applicant for a practitioner license or body art establishment permit, as the case 840may be, has proved to the satisfaction of the department that the same degree of protection 841required under this chapter can be achieved without the strict application or enforcement of the 842subject section or provision. 843 (b) Every request for a variance pursuant shall be made in writing to the department and 844shall state the specific section, subsection or provision from which variance is sought. 845 Every variance granted by the department shall be in writing and the original of the 846variance document shall be posted, in the case of a variance relating to a practitioner license, 847with the posting of the practitioner license as required by section 9 and in the case of a variance 43 of 45 848relating to a body art establishment permit, with the posting of the body art establishment permit 849as required by section 34. 850 A copy or duplicate original of all variance documents issued by the department shall be 851held on file in an office of the department. 852 A variance document issued by the department shall contain information so as to 853reasonably inform the public of the nature of the variance, the need therefore, the specific section 854or provision of this chapter from which variance was granted and the name of the subject body 855art practitioner or body art establishment. 856 Information advising as to whether the subject variance is unlimited in time or duration or 857has a fixed expiration date shall be detailed in all variance documents issued by the department. 858 (c) Any variance granted by the department may be subject to such qualification, 859expiration, revocation, modification or suspension as the department shall deem appropriate. 860 Section 58. A practitioner license shall be suspended by the department immediately 861upon written notice of such suspension to the subject body art practitioner when, in the sole 862discretion of the department, the department has reason to believe that, due to a condition or 863practice of the body art practitioner, an imminent threat to the public health or welfare exists. 864 When the condition or practice believed to cause such threat to the public health or 865welfare is abated or corrected to the satisfaction of the department, the department may terminate 866the suspension of the practitioner license of the subject body art practitioner and reinstate the 867same upon written notice to the body art practitioner and the practitioner license of such body art 44 of 45 868practitioner shall remain in full force and effect until the expiration of the same or until a 869subsequent suspension, termination, revocation or modification thereof. 870 In all other instances of a violation of this chapter by a body art practitioner, the 871department shall serve upon the subject body art practitioner written order of notice detailing the 872condition, event or practice determined by the department to be in violation of this chapter and 873such written order of notice shall instruct the body art practitioner that he or she shall have 5 874business days to abate or correct such condition, event or practice to the satisfaction of the 875department. 876 Should a body art practitioner, subject to an order of notice pursuant to this section fail to 877abate or correct the condition, event or practice which is the subject of an order of notice, or to 878otherwise comply with an order of notice, the department may suspend, terminate, revoke or 879modify the license held by such body art practitioner. 880 Section 59. A body art establishment permit shall be suspended by the department 881immediately upon written notice of such suspension to the subject operator when, in the sole 882discretion of the department, due to a condition of or practice in the body art establishment, the 883department has reason to believe that an imminent threat to the public health and or welfare 884exists. 885 When the condition or practice believed to cause such threat to the public health and or 886welfare is abated or corrected to the satisfaction of the department, the department may terminate 887the suspension of the body art establishment permit of the subject operator and reinstate the same 888upon written notice to the subject operator and the body art establishment permit of such body art 45 of 45 889establishment shall remain in full force and effect until the expiration of the same or until a 890subsequent suspension, termination, revocation or modification thereof. 891 In all other instances of a violation of this chapter by an operator or in a body art 892establishment, the department shall serve upon the subject operator written order of notice 893detailing the condition, event or practice determined by the department to be in violation of this 894chapter and such order of notice shall instruct the operator that he or she shall have 5 business 895days to abate or correct such condition, event or practice to the satisfaction of the department. 896 Should an operator, subject to an order of notice pursuant to this section fail to abate or 897correct the condition, event or practice which is the subject of an order of notice, or to otherwise 898comply with an order of notice, the department may suspend, terminate, revoke or modify the 899body art establishment permit held by such operator. 900 Section 60. (a) Whoever violates any provision of this chapter may be penalized by 901indictment or on a criminal complaint brought in the district court. 902 The fine for a violation of any provision of this chapter shall be no less than $300 per 903offense. Each day that a violation continues shall be deemed to be a separate offense. 904 (b) Whoever violates any provision of this chapter, may be penalized by a non-criminal 905disposition as provided in section 21D of chapter 40. 906 Section 61. The department shall promulgate any rules, regulations or standards 907necessary to implement this chapter.