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Comments on
Suffolk County New York
Presented by William Rafti
Research & Writing December 12, 2006
01.760 – Suffolk County Proposed Article 14 Opening remarks and cover letter This was to have been presented November 08, 2006 at Suffolk County Department of Health in Yapank by William Rafti. Unfortunately the public hearing was postponed.
This report was prepared by Westley Wood, President and owner of Unimax
Supply Company of New York City, founded in 1989, also owner of Sacred and
Bowery tattoo shops in Manhattan with the cooperation and at the bequest of
Suffolk County resident William Rafti, concerned citizen and founder of
Rafti Institute for the advancement of the body arts and safety. These comments are considered well reasoned, founded on evidence where available and deserving of consideration to make improvements to the Article. They are not presented as a consensus of opinion. The most important recommendation is to keep the focus on the danger posed by tattoo/piercing: blood borne pathogen exposure. It is commonly understood and explicitly stated by OSHA that tattoo/piercing fall under OSHA Blood Borne Pathogen Standards. These standards are promulgated to protect all occupations exposed to blood and are supported by recognized medical experts in the field. In addition, standards published by the CDC, FDA and EPA protect patients, clients and citizens. Provisions of Article 14 that are contrary to OSHA and CDC standards, or misunderstood, require justification that those deviations are correct and likely to reduce exposure to blood borne pathogens that will result in lower infection rates. If the Department wants to correct Article 14 it is necessary it should reflect relevant OSHA, CDC, FDA and EPA standards related to the type of situations found in body art shops: blood borne pathogens, not mold, not mildew, not e-coli or food contamination regulations. Efforts to prevent the spread of e-coli in food packaging have no justification within body art codes and are a waste of taxpayer money that will have no effect on exposure incidents. The reduction and minimizing of blood borne pathogen exposure should be the focus of the proposal and the regulations specifically targeted to food preparation should be deleted. It is reasonable for the body art community to ask the Department to provide evidence that these regulations are likely to reduce infection rates. It is reasonable to ask the department to include a re-evaluation after a period of time to see if the regulations will have reduced infection rates or perhaps the regulations can be reduced or eliminated. The CDC cites the US Supreme Court in the landmark "benzene" case that OSHA could not issue a standard without demonstrating a greater-than-expected risk of disease or injury (CDC-NIOSH Risk Assessment Methods). This ruling allowed risk assessment to determine significant risk and set the stage for CQI and evidence-based public health policy-making in other agencies. Since then the biggest champion calling for evidence based public health policy has been the Institute of Health. The first step in public health policy making, the Assessment Step is mandatory to determine if a problem exists at all. This essential assessment step, not carried out by local authorities allows agencies to base their body art rulings on feelings, intuition and anecdotal cases without and in some cases in spite of evidence to the contrary. The Commissioner is applauded because he asked the Board to conduct an assessment step. The Board though is to be criticized for the disregarded of his advice and fault their decision to substitute an internet search to support their positions instead of examining the health status of body art in the community to see what and if any problems emerge. Unfortunately people with no background in body art are faced with the task of preparing body art standards. As a result, faulty, unsupportable standards have filled the void copied from one faulty published standard to the next. There is no supporting evidence for any significant risk to the public and no evidence to justify so much of body art regulations, nor to justify the extravagant waste of taxpayer money. One example to save money is the effective and cost-savings of a complaint-driven Department. This works for New York City and can work here too. The people who make body art and work day after day, year after year learn things which no outside observer can know. For example, Article 14 doesn't reflect the decades of safe and effective tattoo establishment layout, but bans open area tattooing requiring the mandatory construction of private rooms for all procedures based on food preparation standards. No body art evidence other than the preference of some artists who want separate rooms for their own reasons is presented for this prohibition. This is a matter for individual owners to decide. It was a surprise to discover that most of Article 14 was actually food processing standards copied from Article 13 and re-labeled as body art standards. What is necessary to protect the food supply is not what is needed for human blood borne pathogen exposure from a tattoo/piercing. Under the mistaken assumption that what was good for food protection also applied to body art, nothing could be farther from the truth. This discovery highlights a significant inappropriateness to the Article. A provision copied from Article 13 prohibits having anything in a shop that is not directly related to the operation of the shop. That would be appropriate if we were packaging food but not for a body art shop. If applied logically and consistently it would have unintended consequences. One can imagine it would prevent bringing in a newspaper to be read with morning coffee, or a portable computer, or having a desk in the corner of an office, or even making non-business phone calls. These are necessary prohibitions while cooking food, but ridiculous applied to body art establishments. Another item. Contrary to body art wisdom and experience, Article 14 prohibits eating or drinking anything in the procedure room. Outsiders and others who have no background or understanding of body arts may not know, but we have learned that snacks and fluids are a necessary and effective tool to maintain the energy and safety of the client and the artist - which by the way is practiced in medical settings (intravenously) and sports events and tattoo/piercing the world over. Every body-artist and many clients know how important this practice is. The board did not know, even after 15 years of observation. A client died this year in a shop in Brooklyn because he got up from the chair to get some food, fainted, his head crashing into a glass showcase and died in the shop. Rules are being written without an intimate knowledge of the subject. When this was mentioned to an inspector he said if it were true he would have been told about it. Expert opinion for body art must include a conformance to expert health opinion and body art. Without it, being a body artist for 10, 15 or 25 years alone does not make a person an expert. For example, it was declared that Suffolk rules and inspections are the reason there are no health problems. The lack of epidemiological evidence to support this cause-and-effect claim actually supports the opposite. Dr. Benjamin Mojica, acting NYC Commissioner during legalization hearings in NYC said 40 years of tattooing did not produced any health problems. We know that health problems are rare in tattoo/piercing with or without regulations. This was the testimony of Dr. Mojica. You would think that illegal tattooing in NYC from 1960 to 1997 would be a hotbed of infection, but this was not the case. By the very nature of tattooing, it is hard enough just to get the ink in, much less spread disease. To transmit disease you really have to work at it. Practicing Universal Precautions, using new gloves and new needles is the emphasis that must be taught and practiced. The rest is basically fluff that has no effect on infection rates. A recent investigation by the CDC of several clusters of hepatitis C outbreaks implicated unlicensed tattooers not using gloves, tattooing in public parks, using guitar strings and printer toner for ink as the cause of those outbreaks. Lesions were reported on one tattooist's hands. Body Artists should be licensed and tested on how to protect themselves and their clients from blood borne pathogen exposure. To create an entire governmental apparatus with micro-management of the industry based on error is not reasonable. Another ridiculous example: contrary to tried and true practices the Article prohibits anyone: friends, relatives or loved ones being in the room during the procedure. This is so unnecessary and cruel we hope our participation at this time will bring body art experience and knowledge back into consideration. Body Arts are not medical procedures. No one is demanding that only licensed health care providers practice tattoo/piercing. So a tension develops for Tattoo/Piercing when regulations are crafted treating body arts as if on the one hand it's a food preparation facility and on the other hand it's open infection-prone surgery. Tattoo/Piercing needs to be considered in their own right. We make tattoos; we do piercing, not surgery and we don't package spinach. Trying to understand how these regulations got it so wrong we realized it was partly the hierarchical approach, writing regulations as a series of specific steps to cover as much ground as possible, to stipulate everything in as much detail as possible. To illustrate this, consider something as simple as record keeping. The Article requires records be kept in written form in a book solely for that purpose. OSHA and the CDC advise using a “performance approach” which accomplishes the same purpose, which is: records are to be kept, but leaves it up to the establishment to determine in what form they need to be kept. For example, they could be kept on a computer, as long as the records can be made available for inspection if needed. The old maxim about the forest for the trees applies. This hierarchical approach has a detrimental effect because it keeps body arts in a subservient parent-child relationship, unable to grow, never able to develop concepts that serve to guide body artists into applying principles to daily new situations. The regulations create body artists as dependent employees of the Department the same way having gasoline engines keeps us dependent on oil. The Department becomes the supervising employer. It needs to be noted that the NEHA code written a decade ago, used to support Article 14 is not tattoo/piercing authoritative, does not represent tattoo or piercing expert opinion, but in fact was a document never mentioned in public by the contributing writers who used their own opinions as evidence. It's an old trick having each person testify to the others' qualifications or members of the group setting up new organizations to add weight to their testimony. Their effort is viewed by some as an attempted take-over of the credentialing of the entire body art movement with them at the helm. There was a similar attempt to take control of NYC in 1996 but that was exposed and defeated. This publication does not deserve any more weight than any self-testimony presented without evidence. The contributing authors are not authorities in body art, not recognized as authorities and do not have the support of even a substantial number of the body art community. The same errors permeate that rule-book. A third surprise was that the writers were unfamiliar with OSHA Blood Borne Pathogens Standards, unaware of the FDA position on tattoo and inks, did not know the difference between antiseptics and hard surface disinfectants, requiring, in three places in the Article that only EPA hospital disinfectants be used on the skin. And without hesitation, the Article discards known, sound, published expert medical wound healing techniques in favor of ritual practices which delay healing, are not Best Practice for Continuous Quality Improvement and actually increase infection exposure. A practice that contradicts expert medical opinion should be investigated, not just accept because it is practiced by a few. A fourth concern centers on openness because supporting documents were not made available but had apparent restricted distribution. One of these documents, the only "study" cited more than once in meetings, that carried all the weight, the Pace Study, is flawed, distorted and transparently false. A summary critique of that is appended at the end of the comments. The only other source used, in defense of trying to prohibit genital piercings, was one out-of-context quote from the World Health Organization (WHO). The accusation was made that Suffolk Piercers were participating in female genital mutilation, which as defined by WHO is the removal of a young girl’s clitoris. This is a low blow. Together with their failure to follow the Commissioner's instructions this should disqualify those Board members from writing regulations. They deserve censure for their silent consent without knowing what it meant. A final area, the Article prevents the body art communities from developing into a professional society by usurping their basic ability to determine competency in the industry and attending to their own credentialing. Enforcing an apprenticeship program that has never been part of tattoo history or precedent, (Kate Hellenbrand's personal correspondence with WW) directly prevents the rise of a professional community in control of their own destiny. Competency has never been a matter of time, never dependent on apprenticeships but based on individual progress and dedication to the craft. There are no experts acknowledged by body arts, there are no qualifications that are universally accepted, no organizations recognized or supported by the body art world at this time, only pretenders to those titles because their business cards proclaim it. The Body Art Community has the need and the right to develop and learn to determine levels of competence of skill if they are ever able to say of themselves that they are a profession. Studying the regulations we came to realize that body arts, especially Tattoo as a historical movement, as a community with traditions and accumulated wisdom, as a living breathing participant – for the most part, stayed home, and except for only one shop owner and William Rafti never attended any meetings. Regulations were being written in absentia. Partly it can be surmised because the industry is not treated as able to regulate itself, meaning become professional, but kept as siblings under constant watch by their guardians. We hope this presentation and report will correct some of these shortcomings not only in Suffolk County but to counter the silent voice of body art across the country. The Department should not legislate to structure a child-parent existence for our industry. We hope these insights asking for evidence and fair play will wake the community of body artists to realize we must participate and cannot remain silent merely accepting the crumbs that fall from the master's table. We have the most envious record of safety of any activity on the planet and body artists have to tell the story.
Westley Wood
02.Suffolk-760-1402-Prohibitions updated 10-08-06, 10-20-2006, 10-30-06, 10-31-06 760-1402 Prohibitions 1.a. Applying any Body Art Procedure to the eyeball, the eyelid(s) or any surface within the orbit of the eye. Eyelid
Tattooing the eyelid is an established practice for permanent cosmetic
application for at least the last 15 years. Without evidence that the
procedure is causing harm or disease the current practice should not be
prohibited. b. Implants The medical use of implants is still under development and research in the medical community. It is common knowledge that only medically trained individuals with FDA approved implantable devices are allowed to implant. The body art community knows that medical licenses are needed to perform medical implants. Piercers do not engage in medical procedures. These procedures are known and accepted as illegal. Including this as a specific prohibition is not instructive not helpful nor will it serve as a deterrent to illegal practices. If the board wants to emphasize a "get tough" policy, that would be an enforcement issue unrelated to body art regulations. If a person is practicing medicine without a license, they are subject to those laws and regulations designed to prohibit practicing medicine without a license. This should not be part of the proposal.
c. Branding
d. Scarification
e. Mucosal or non-dermal tissue
This is the definition: according to WHO and all commentators: Female genital mutilation (FGM) is the term used to refer to the removal of part, or all, of the female genitalia. Cutting off the clitoris is the mildest form of female genital mutilation. The WHO report on Female Genital Mutilation did not imply that tattooing or piercing the genital area falls under the definition of FGM. The definition of FGM was ignored to allow justification for the prohibition. This kind of scholarship raises serious concern. In 1991, WHO recommended that the United Nations adopt the terminology "mutilation" to reinforce the idea that FGM is a violation of girls’ and women’s rights. It is usually done on girls under 10. More than 100 million women and girls worldwide are believed to have undergone genital cutting, the U.N. health agency said. Most Human rights organizations in the West, Africa, and Asia consider female genital cutting rituals a violation of women's human rights. Among these groups and governments, they are regarded as unacceptable and illegal forms of body modification and mutilation of those believed to be too young or otherwise unable to give informed consent. http://www.answers.com/topic/female-genital-mutilation. Female genital cutting (FGC) refers to amputation of any part of the female genitalia for cultural rather than medical reasons, not including genital modification of intersexuals or gender reassignment surgery. Failing to mention that tattooing and piercing do not fall under the definition of FGM, (amputation, removal of any part of a young girl's clitoris), trivializes FGM, shows such insensitivity by the Board to FGM and such a vile accusation against Suffolk County shops that the board, out of decency, should resign. f. Tattooing beneath the epidermal & dermal skin layers This reference is incomprehensible seeming to mean tattooing internal organs. This is a further example of circus bizarre ideas that must be removed. Who can understand what this means. g. Skin Braiding Another bizarre reference to an unknown procedure which has no standing as a body art procedure and must be removed. h. Bones Another seeming attempt to discredit the sobriety of the body art community that has no cause to be included. This is not considered a body art procedure. This list of prohibitions has no place within the Article.
i. Tongue-splitting In summary, Section 760-1402 should be removed entirely. An Article of this importance must be written by persons who have epidemiologic skills, knowledge of OSHA and CDC standards and an intimate knowledge of tattoo and piercing.
760-1403 Body
Artist Certification, Suffolk County, New York 03.Suffolk-760-1403 Body Artist Certification 760-1403 Body Artist Certification This exceeds the stated purpose of the Article, “to prevent communicable and non-communicable disease." It attempts to “regulate” the actual practice of tattoo and piercing, to set standards of competency, methods of training, apprenticeships and legal agreements. It is an intrusion into the affairs of tattoo and piercing and a restraint of known and common business practices without any benefit to prevent communicable and non-communicable disease.
760-1403 Body Artist Certification 1. No person except a duly licensed Health Professional (NYS Ed Law) shall perform body art procedures or act as a body artist unless such person has a Body Artist Certificate issued by the commissioner.
It is well
accepted that universal precautions, barrier protections and immunization
are necessary as instituted by Engineering Controls, Work Practices and
Personal Protective Equipment. To assure that body artists have the newest
most effective techniques and learning skills the Department will validate
their knowledge. The knowledge and practices necessary to assure health protection is irrespective of competency to apply a tattoo or pierce and as such the "certification" should be a license that the applicant has demonstrated a sufficient knowledge and understanding of the health issues and has a committed agreement to practice body arts safely irrespective of actually engaging in any tattooing or piercing. It should not be a certification that would imply competency or skill in the craft, which would mislead the public. The Department should not enter that arena.
2. An applicant's past history of non-compliance and/or the applicant's criminal record will be considered in evaluating whether the department will issue a body artist certificate. Previous convictions for criminal offenses shall be in accordance with NY Corrections Law Article 23-A. It is not clear what non-compliance means or how past criminal records will be considered or what NY Corrections Law Article 23-A says. Tattoo has a wide practice among the incarcerated and is one of the few opportunities the released have to enter working society and earn a living peacefully. Considerations need to be made and this item studied before approving something so vague and unknown.
3. An Applicant must be an adult to receive a Body Artist Certificate of any kind. Because the license should only serve to demonstrate proficiency and knowledge of health matters no justification is offered why 16 years should not be a reasonable age to begin thinking of a career. It has been pointed out that piercing especially could easily be a stepping-stone into other medical fields.
4. No holder of any Body Art Establishment permit issued under Section 1403 of this Article shall allow a body artist to practice in such shop unless such body artist is a holder of a valid Body Artist Certificate as issued under subdivision (1) of this section. In the case of an owner-operated establishment, the owner must be so certified.
The proposed section prohibits a long-standing tattoo practice and needs to be reversed. It is a recognized tradition of tattoo studios to participate in exchanges of artists both nationally and internationally. This important and expected part of the rites of passage for artists is also an expected rite of passage for shops to host them. It is alive and well throughout the known world wherever tattooing is allowed, practiced universally, establishes a rapport among tattooists and studios encouraging the development of a tattoo community across boundaries.
To invite
guests and then require them to prove they posses the knowledge and
expertise to work safely makes us look like some backwater gulag subject to
irrational demands of the dictators. Requiring invited guests to register
with the Health Department, undergo quizzes of their record and work
experience and examined like beginners and novices is not acceptable. The
disregard of tattoo traditions would give the appearance that Suffolk County
is run by bureaucrats who don't trust the studios they license. We expect
an active public health agency guided by modern evidence-based policies that
shows non-partisan respect for different community groups. There must be no impediment for non-resident visiting artists to tattoo on a temporary basis under the auspices and sponsorship of a legitimately registered Suffolk County shop or licensed tattoo artist without having to register the temporary worker with the Department of Health. The department is not showing confidence that licensed shops can practice proper safeguards. It reveals one of the fundamental flaws of the Article: its hierarchical rule making. The Department must embrace a better way, demonstrated by OSHA and CDC, which we think, should be emulated. For example, the Article requires soap, liquid or powder be used, whereas the CDC writes “Although hospitals have provided personnel with non-antimicrobial soaps in hopes of minimizing dermatitis, frequent use of such products may cause greater skin damage, dryness, and irritation than antiseptic preparations. One strategy for reducing the exposure of personnel to irritating soaps and detergents is to promote the use of alcohol-based hand rubs containing various emollients.” Guidelines for Hand Hygiene CDC.
In other words, the work practice is the important point, not enforcing the use of particular products or techniques to accomplish it. Another illustration, the Article prescribes brushes and nail files. The CDC writes
“Surgical hand-antisepsis protocols have required personnel to scrub with a brush. But this practice can damage the skin of personnel and result in increased shedding of bacteria from the hands.” OpCit.
What is not seen is the crucial establishment of work practices that leave the optional elements open for proper implementation to get the job done. The Article wants to oversee and micro-manage everything through more and more rules. Also notice that the protocols mentioned by the CDC are for the Surgical Team, not Hospital Care Workers. Body Artists are not engaged in open infection-prone surgery. Applying these scrubs to body artists cannot be justified. This is ruling over people rather than empowering them to make decisions. The debilitating effects of this hierarchical approach directly prevent the body art community from developing into a professional society.
5. Any person desiring to engage in body art procedures or act as a body artist shall submit an application for a body artist certificate to the commissioner along with (2) passport identification pictures, on a form prescribed by the department.
5. – Pertains to the form and method of applying for a license.
6. Each applicant shall be required to demonstrate by successfully passing the department's written examination and during subsequent inspections by a representative of the department, demonstrating knowledge of Universal Precautions, proper in-shop procedures, the requirements of this article and aseptic body art procedures designed to prevent infection(s) and the spread of communicable disease. Furthermore, to qualify for a body artist certificate of any type, the applicant may be required to successfully complete whatever course(s), training and/or educational programs the department has deemed relevant and necessary to the safe application of body art procedures and to protect the public health. These courses, when required, are to be set forth in Standards established by the Commissioner. 6. The first part, sentence one, requires an applicant to pass a written exam and then during multiple inspections be observed demonstrating Universal Precautions, shop procedures (not related to Universal Precautions), the requirements of this article and aseptic work practices (collectively this is the "practicals"). This is designed to appear diligent and it may sound good but The Article needs to enable artists to take responsibility, work independently and make judgments in real life circumstances. It actually keeps them dependent by focusing on enforcement. The second sentence is an invitation to any future overzealous department to discover many relevant courses and further certifications. Learning to work safely and follow Universal Precautions is not difficult. Understanding does not take hard work, discipline and guts. It's actually easy enough to be taught by a pamphlet, seeing a video and experiencing a practical demonstration. Making learning second nature comes with the doing. The certification is incomplete and distorted. First, the License should signify that the applicant understands and has the knowledge to practice safely. The second half of the equation is missing, which is not considered: an additional license, an employer license. Since we are responsible to follow OSHA blood-borne pathogen standards the Department should be a participant so that the structure can help enable that to happen. OSHA places considerable burdens on an employer that goes beyond the requirements of an employee and effectively makes the employer responsible that blood borne pathogen standards are being followed. This is the other half of the equation and covers a new area: responsibility. The Article incorrectly usurps the employer function mentioned by OSHA keeping body art in perpetual servitude hindering growth into a full fledge professional community. This should be a second license that will enable the employer to effectively assume responsibility for those in the shop and enable the employer to take responsibility for guest artists and learners. The regular license will acknowledge that applicants have rights to pursue work. The addition of "whatever courses, training and/or education programs" is a prescription for abuse. It is advantageous to limit the scope of power of the Department when reasonable. Without specific need included as "necessary to protect public health" it leaves additions up to the whim of any sitting Board without requiring consent of the governed or a method to redress unnecessary burdens. 7. The Commissioner may certify a body artist by reciprocal agreement with an outside agency or institution, if the body artist has successfully completed a course in infectious disease control approved by the Department. The "approved by the Department" phrase pops up often in this kind of context. The phrase is designed to cover-up the Department's desire to extend hierarchical rule-making control because if it were the intention for the Department to be assured that the course being cited by an applicant meets Suffolk standards how will it be done? It would take months of correspondence and study. It can't be done. These phrases are a cover-up and should be examined in every instance. Consequently this should be left off as is and perhaps give the applicant the test straight away. And, by examination of the individual's records and/or history of experience, training and education, has demonstrated acceptable knowledge of the requirements of this article to perform body art procedures. More and more is added to the list of requirements so that we now have a complete history of the applicant. The Article exceeds reasonable bounds and lacks compelling justification. 8. The body artist certificate shall not be transferable from one person to another. The Department's original copy of the body artist's certificate shall be prominently displayed to the public, at the body artist's workstation, in every establishment where the body artist practices. 9. A body artist certificate shall expire three (3) years from date of issuance. 10. A body artist's certificate or body artist apprentice certificate or transient body artist certificate may be revoked by the commissioner, after notice and an opportunity for a hearing, for failure of the certificate holder to comply with the requirements of this article or with any lawful notice or order issued pursuant thereto or failure to comply with any Federal, State or local law code or regulation. We are introduced to two more kinds of certificates; one for apprentices and one for transients. It is not acceptable that the Department gives themselves the authority to revoke a license for any infraction of any law, failure to comply with any code or any regulation without limit. This fuzzy writing authorizes the Department to act as the Police Department. Can the Department give themselves such authority? 11. Apprenticeship Procedure Apprenticeship training is a new phenomenon beginning sometime in the 90s and was never part of tattoo history or method of training. Training has always been either self-taught or done in a shop by a system of enforced slavery for a few years followed by many years of working in that shop. There was usually a written agreement which also prohibited working within hundreds of miles if the artist left the shop. Its purpose was to ensure the dedication of the person and prevent others from entering the business. The art of tattooing was a carefully guarded secret including knowledge of who made tattoo machines and equipment. For the Department to intentionally create this serf and master industry structure is not appropriate and will not diminish infection rates. 12. A Transient body artist must comply with all provisions of this article as pertains to performing body art procedures. a. A Transient body artist shall apply for a reciprocal body artist certificate in accordance with section 760-1403.5 of this article. Such reciprocal certificate will be issued for a period of time to be determined by the department and not to exceed three (3) years. This section seems to imply but does not say that if a person applies with 2 photos and a certificate from another jurisdiction they may be issued a transient certificate if the Department gives it to them. Temporary body artists should be allowed to work for the first 30 - 60 days under the sponsorship of a duly "employer-licensed" shop employer without obtaining a Health Proficiency License provided the owner or sponsoring artist has a Employer License and will be responsible that the body artist will work according to Suffolk County Standards: the artist possesses the requisite skills to protect the safety of the public. 13. At the time of this article's adoption, all tattoo/body piercing certificates already issued by the department will remain valid until their expiration dates. Renewal of these re-existing certificates will be done in accordance with this article without the requirement of apprenticeship. However, such renewing body artist(s) shall fulfill any specific educational and/or training requirements set forth in Standards established by the Commissioner. This section should be replaced with: At the time of the adoption of the Article all current certificated body artists will have 90 days after the current expiration date of their license to apply for the new license. All new body art workers wishing to work in Suffolk County must apply within 7 days of commencing working. (Penalties for non-compliance need to be spelled out and reviewed.) The "employer license" is new and will be required for all employers and sponsors.
Updated 10-19-2006 This entire section could be replaced with the "Employer's" license. 1. It shall be unlawful for any person to operate a body art establishment, temporary body art event or mobile body art establishment who does not have a valid permit issued under the provisions of this Article. Only a person who complies with the requirements of this Article shall be entitled to receive and retain such a permit. (Copied from 760-1303 Food establishment regulations. It is not clear why a Body Art Establishment Permit is needed other than this requirement. If a permit is needed to keep track of operations in the county then the Employer's license should automatically contain a corresponding permit. 2. It shall be unlawful for any person(s) to perform body art procedures at a temporary body art event unless that even possesses a valid Temporary Body Art Establishment Permit. Really, the only thing that the Department should require is notice of the temporary event, not permitting. 3. The Commissioner may at her/his discretion issue a Temporary Body Art Establishment permit for a special event not to exceed (14) days. The permit holder for the temporary body art establishment and the certified body artist(s) associated with the event must comply with all requirements of this article.
To operate a
business based upon "discretionary" power revocable at will without being
held accountable is unacceptable in a modern democracy that believes in
liberty. It is to have no rights. It is also impossible to comply with the
premises standards of this Article, which means this is not a genuine offer.
4. Permits shall not be transferable from one person to another or from one place to another place. 5. A valid permit shall be prominently displayed to the public in every body art establishment, temporary body art establishment and mobile body art establishment.
7. Body art establishment permits may be revoked or suspended by the Commissioner, after notice and an opportunity for a hearing, for failure of the permit holder to comply with the requirements of this Article, or with any lawful notice or order issued pursuant thereto. For serious or persistent violations of any the requirements of this Article, or for interference with the Department's representative in the performance of his/her duties, after notice and an opportunity for a hearing has been provided by the Commissioner, the permit may be revoked or suspended. Both sentences have exactly the same wording "after notice and an opportunity for a hearing" which implies that the serious or persistent violations will cause a permit to be revoked before a hearing, otherwise why the two sentences. Article 13 – Food Establishments 760-1303 (4) holds the Commissioner accountable to have valid conditions present: "which constitutes a danger to public health and it appears prejudicial to the public interest to delay action pending a hearing." But no such requirement is offered for body art. Another problem, it is not imaginable what situation could reasonably develop or be considered a danger to public health. There is no similarity with food protection to justify the requirements. 8. ...hearings shall be conducted...all notices ...served at least 15 days prior to the date of the hearing... Food establishments are offered in Article 13 760-1303(4) "...within 15 days, the Commissioner shall provide such person an opportunity to be heard." For body art it could be a month or longer before a hearing is scheduled. These are unfair burdens.
9. Service of notices of hearing...
A one year permit for a business is not
acceptable.
760-1405 Plan Review; Construction or Pre-operational Inspection 1. Floor Plan a. When a body art establishment ..constructed...remodeled...converted...properly prepared plans and specification...must be submitted to the department... b. All construction...shall be done in accordance with approved plans. c. ...application 2. ...pre-operational inspection...prior to opening... The topic of sanitation in food manufacturing operations encompasses a wide array of subjects including food plant design and construction, process equipment, cleaning and sanitizing, hygienic practices by employees, control of pests including insects and rodents, packaging sanitation, sanitation of food storage facilities, etc. p791, Sanitation in Food Manufacturing Operations, Walker, LaGrange, Disinfection, Sterilization and Preservation, SS Block In food processing, all these subjects have a direct contamination exposure to food and are the subject of great concern. Any program designed to reduce exposure must first examine the subject to determine the probably routes of exposure. Unfortunately this is not done for body arts and so a quick fix of appending food operation requirements was applied. This is not acceptable. The premises play no role in exposure to blood borne pathogens in body art settings the same way that hospital premises are not a source of exposure. This is recognized for hospitals and we therefore believe they apply to our setting. As a matter of interest, the interpretation is that clients contaminate the hospital, not vice versa. Further, it is a premise for CDC recommendations when cleaning housekeeping surfaces.
E. Keep housekeeping surfaces (e.g., floors,
walls, tabletops) visibly clean on a regular basis and clean up spills
promptly (279). Category II June 6, 2003 / 52(RR10);1-42 Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) Except on rare and special instances (as mentioned below), items that do not ordinarily touch the patient or touch only intact skin are not involved in disease transmission, and generally do not necessitate disinfection between uses on different patients. CDC Sterilization or Disinfection of Medical Devices: General Principles
There is no evidence that the premises have any effect on infection rates and many commentators including OSHA and the CDC work on the same premise.
Construction must adhere to local construction
codes which make provision for known building-related illnesses that affect
all buildings. There is more concern with a visit to a yoga class or health
club than a tattoo shop.
760-1406 Inspection of Body Art Establishments, Access, Inspection of Records. Issuance of Notices; Service of Notices 1. The Commissioner or any duly authorized representative may inspect each body art establishment located within his jurisdiction and may make as many additional inspections and reinspections as are necessary for the enforcement of this Article. Whereas the Department may inspect body art establishments "as many additional" should be replace with "reasonable."
Whereas the Department may inspect body art establishments this provision exceeds reasonable and takes liberties without consideration given to the establishments themselves. Certainly the Department should not be prevented from entering for observation and non-intrusive inspections that would not disrupt the business. Any business disruption inspection other than an emergency situation should be arranged beforehand at a mutually agreeable reasonable time and date.
The last sentence "a person familiar with these records in the shop during the hours of operation" is an unnecessary demand and burden. These records are clerical in nature and unrelated to exposure procedures, incidents or emergency health matters that are time sensitive to protect employees and patrons. They have no bearing on emergency health matters. Availability should be upon request in a reasonable amount of time after reasonable cause is shown for those records to be examined. 3. Whenever the Commissioner or any duly authorized representative makes an inspection of a body art establishment, the Department's findings shall be recorded on an inspection report form provided for this purpose, and a copy of such inspection report form shall be furnished to the permit holder or person in charge. 4. Whenever the Commissioner or any duly authorized representative makes an inspection of a body art establishment and discovers that any of the requirements of this Article have been violated, the Commissioner or any duly authorized representative shall notify the permit holder or person in charge of such violations by delivering to him/her a copy of the inspection report or other written notice. In such notification, the Commissioner or any duly authorized representative shall:
a. Set forth specific violations
found. 5. Notices provided for under this section shall be deemed to have been properly served when the original of the inspection report or other notice has been delivered personally to the permit holder or person in charge, or such notice has been sent by registered or certified mail, return receipt requested to the last known address of the permit holder. A copy of such notice shall be filed with the records of the Department. 6. The most recent record of inspection by a representative of the Department shall be retained on the premises until the next inspection and this report shall be available for review by any person upon request. A notice provided by the Department indicating the availability of this most recent report must be prominently displayed to the public alongside the establishment's permit. This notice is provided in Appendix F of this Article.
760-1407 Examination, Embargo, and Condemnation 1. The Commissioner or any duly authorized representative may take, without payment, any item or any substance, used in connection with body art procedure(s), for the purpose of examination in connection with an investigation or inspection of the establishment. 2. The Commissioner or any duly authorized representative may, upon written notice to the owner or person in charge; place an embargo on any item, substance or thing, that is determined or that he/she has probable cause to believe is associated with the cause of an illness or infection, does not meet the requirements of the New York State Public Health Law, the new York State Sanitary Code, the Suffolk County Sanitary Code, or otherwise constitutes a danger or poses a potential threat to the public health. 3. It shall be unlawful for any person to remove or alter an embargo order, notice or tag placed on any item, substance or thing by the Department. Such item, substance or thing shall not be altered, disposed of, or destroyed without permission of the Department, except by order of a court of competent jurisdiction. 4. The permit holder, or person in charge, shall have the opportunity to a hearing within fifteen (15) calendar days after the date of order of embargo. On the basis of evidence produced at such hearing, the Commissioner may vacate the hold order, or may, by written order, direct the permit holder, or person in charge of the item, substance or thing, which was placed under the hold order, to bring it into compliance with the provisions of the Article, or to destroy such item, substance or thing. This section is too far reaching without any safeguards in place to protect establishments from unreasonable searches and seizures. We can imagine something that required only a minor modification be seized whereas a simple repair or change would correct the problem. A business could suffer financial hardship waiting for a hearing. It seems that little regards is given to the business. Either this needs further evaluation or those actions deemed necessary would claim other Sanitary Law enforcement. Secondly, we ask for clarification why the Department needs "reasonable" cause but the establishment is required to provide evidence. What is the difference?
760-1408 Suspect Infections; Procedures
This section Paragraph (1) is copied verbatim from Food establishment standards. The threats posed by food handling and contamination of food are entirely different than tattoo/piercing. This section, as a copy of Article 13 is not acceptable. 1. When the Commissioner or any duly authorized representative has reasonable cause to suspect the possibility of disease transmission from any body art establishment employee or procedure, OSHA and CDC have dropped the use of expressions like "possible" and "possibility" and replaced them with the approved expression "reasonably likely" which more closely reflects the meaning and intents of the Standards. The use of these expressions in the Article should be changed to reflect current thinking which will clarify intent.
It is
surprising to discover here that when faced with an infection the Department
will automatically assume the employee or procedure is the source and
commence an investigation based on that premise. This may be a method used
for the spinach fields of California but it is not appropriate for body
arts. It is clear from this that conducting an investigation is too
challenging for the Department and this section must be removed. A further concern is what constitutes "reasonable cause to suspect." One can image that a doctor has a patient who has a skin infection on a tattoo/piercing she got a week ago (notice that we word this not "from" a tattoo but "of or on" a tattoo- an important distinction to prevent misunderstanding). Will this constitute cause to suspect the employee or shop? We are concerned that an infection, even an easily treated or self-resolving one will be considered reasonable cause to suspect an employee or shop as the cause, which in turn will/could trigger an investigation that will likely disrupt business, cause public embarrassment, stigmatize and prejudice the general public without corroborating evidence, such as a cluster of cases from the same shop. We are concerned that statistics will be used against body arts to attribute disease to body arts whereas we believe studies support the view that 1) fewer infections occur after body art procedures than occur in the general population. (The conclusion of the 1999 study done at the William-Beaumont Hospital.) And 2) The most likely cause is contamination after leaving the shop coming from the clients themselves or other sources. The Commissioner or any duly authorized representative shall secure a medical history of the suspected employee Applying food handling contamination distorts the investigatory pattern that would be appropriate for tattoo/piercing. We believe the Article incorrectly focus all attention on transmission routes from employee or procedure to the client overlooking the most probable exposure: the client, afterwards. This is not mentioned because food contamination is likely from the source of food production. Of course. Therefore, taking a history as the first and primary tool will confuse the determination and may violate an employee's expectation of privacy and fair play. We believe this supports our view. Or make such other investigation as may be indicated, and take appropriate action. Because the Article is misappropriated from food handling, body arts are looking for assurance that “such other” and "appropriate action" is appropriate. The Commissioner may require any or all of the following measures:
a. The immediate exclusion of the employee from
all body art establishments; These actions may be reasonable for food preparation plants and restaurants, but are not appropriately written to reflect the unique properties of body art. 2. When a body artist, operator of the establishment is made aware that a customer/patron suspects that his/her body art procedure might be infected The word "procedure" should be dropped to prevent any misunderstanding. it is the obligation of the personnel affiliated with the establishment to direct that customer or patron to seek medical attention. Documentation of this report is to be written onto the customer record. The Department’s intent to assure that suspected infections get medical review and attention is the desire of all body art shops. Non-clients often walk into shops to discuss many things about their body art, including asking about infections. In our view this procedure should be part of aftercare and apply to anyone walking in seeking attention and advice. Since no medical advice is given, no action taken by the shop but a suggestion that they consult their health care provider, recording the event should not be discouraged but be a matter of discretion because this also applies to non-clients. Short of recording and taping the interview written notes are only written notes. 3. A body artist who is under the influence of alcohol or taking medication or drugs that could impair the artist's ability to safely perform body art procedures in any way, shall not conduct any body art procedures on any clients or patrons. Almost all medications and drugs have warnings that they may impair abilities to perform activities. The _expression "could", to better reflect current terminology should be removed.
The question is not longer "could" but likely to
or does impair.
760-1409, Personnel, Health, and Disease Control, Update Nov 23, 2006
Section 1. Section 1 needs study to determine the
practicality, legality and accuracy of this requirement. Having “any”
communicable disease is not a likely justification to prohibit body art
activities. In hospitals, the actual disease and the workers likelihood of
transmitting that disease are considered on an individual case by case
basis. The issue of communicability and scenarios is not addressed by
supplying a list of items that can become contaminated by a worker. Basing
the prohibition on a list is not sufficient reasoning to prohibit workers
their livelihood. If this were legal and appropriate, it would be clearer
to require that no person with a contagious disease engage in activities
that would pose a likelihood of causing the transmission of disease to
others. Section 2 can be used to illustrate a weakness throughout the Article: specifically, the intent should be to write standards that can be applied to situations. Instead, it is written as a shopping list of allowable and prohibited actions without establishing the standards or the responsibilities needed to help body artists determine the proper responses to daily challenges. 2. The following requirements shall be applicable to all employees engaged in the practice of Body Art Procedures:
a. During all body art procedures,
7. "Sleeves"
(short sleeves) are made mandatory, long sleeves are prohibited. For unspecified reasons tank tops and sleeveless shirts are prohibited. Because long sleeves can become contaminated in some tattooing by leaning on the client or dragging the long sleeve across a tattoo we can understand the thinking but it is not an accurate assessment of the extent of the problem nor the proper solution. Personal Protective Equipment is the last step of defense against blood exposure to prevent contamination of the worker. When the tattooist is leaning on a tattoo the arm and any clothes must be protected with PPE. This prohibition exposes the arm to contamination. This is a serious. More than half of all tattoos do not have a likelihood of blood exposure to the artist's arm, and no piercing procedures exposes the piercer to exposure. The issue has nothing to do with sleeve length. The principle is that when any body part or a worker's clothes are likely to become exposed to blood they must be protected.
b. The body artists shall perform proper hand washing in an acceptable hand washing facility before starting work and as often thereafter as may be necessary.
The next section deals with gloves. c. Both of the Body Artist's Hands shall be covered with disposable, Single Use, examination gloves approved by the Department when a body art procedure is performed. These gloves must be changed if they rip or tear, touch any other person, or touch any object or thing that might be a source of contamination during a body art procedure, and for each new customer.
You can see the "add-ons" as they occur to the
authors.
-2) It would have been sufficient to write
"Single Use examination gloves shall be worn when contamination is likely."
or "Personal protective equipment (for example, gloves) shall be used when
exposure to blood or body fluids is anticipated." The paragraph continues with a list of the conditions that explain when gloves should be changed. These gloves must be changed if they rip or tear, touch any other person, or touch any object or thing that might be a source of contamination during a body art procedure, and for each new customer.
First, anything “might” be a source of contamination, so that
is not helpful. 2) Rip and tear mean the same but holes are forgotten.
It should be something like "maintain the
protective performance of the glove."
There's more in every sentence.
The condition as written confuses the issue. a) Might means also
might not. How to judge might is a problem? b) What about things we think
might not be contaminated but are? Should they be included? c) "During" a
body art procedure leads to the question: not before or after? and d) what
about contamination from touching the client-person, where does that fit in?
e) For each "new" customer. (not old customers?). The clarifications create
new exceptions which cause more clarifications to be written and results in
leaving things out that should be included. The attempt to be exhaustively
inclusive is self-defeating. This is everywhere and not isolated.
c. The body artist shall keep fingernails clean and neatly trimmed. The problem here is the tortured stream of thinking. What does "shall not wear" anything "deemed" to interfere with "grooming practices." Grooming practices? How do cosmetics "subsequently interfere with effective hand washing"? Is hand washing a grooming practice or "performance" of any body art? Do cosmetics (usually confined to the face) interfere "with prescribed personal hygiene and grooming practices put forth by the department" What practices? Where are these “prescribed grooming practices” to be found? Yes, jewelry and long nails can produce challenges to gloves that we would like to avoid by keeping nails short and limiting the amount and types of jewelry worn. But this is not surgery. Tattoo and piercing do not create the same dangers as creating open exposed wounds. This is piercing and tattooing not surgical procedures. The rigors of surgery are not \appropriately applied to tattooing and piercing. This is a characteristic error of the Article: it includes ancillary good ideas (that would not be discouraged), such as fingernail brushes and files at every hand washing facility for every artist, as if they are crucial and thus must be compulsory.
Here's another example 760-1409 2:e (this entire section can easily be replaced with a simple sentence)
e) "The use of
tobacco in any form or any other substance (as if non-tobacco smoking
items are not prohibited – so the writer adds more) used in the form of
a cigarette or pipe for smoking purposes (The felt need is to spell out
that a cigarette or pipe is used for smoking. Then it says) "The use of
tobacco will be prohibited...in conformance with New York State Public
Health Law."
Instead of saying "Body Art Shops are not exempt from the NYS
Clean Air Act" and leaving it at that we get a barrage of
obsessive-compulsive writing. Even this statement is not necessary because
the law already exists and is known. The next paragraph: "f. The consumption of food and drink by employees shall be restricted to designated areas acceptable to the commissioner. There shall be no consumption of food or drink in the workstation areas of the body art establishment." This prohibition is copied from Food Preparation regulations and reasonable in that situation. It is obvious that eating a sandwich when packaging food or making pizza is not a good idea. OSHA's position is that food and drink must be stored and used in areas where cross-contamination is unlikely, primarily addressing laboratories that have beakers and dishes of contaminated items on benches and places that have refrigerators for medical purposes. Here, the Department usurps the role of the employer and micro-manage. Not only is eating prohibited in the work area but a special designated area within the approved area must get approval. You would not be allowed to drink a soda at the counter.
Understanding
the issues, the reasons could be written something like: "food and drink
shall only be stored and consumed in areas where and in a manner that
contamination is unlikely." – that takes care of everything. There is an issue here that needs consideration.
In defense of the prohibition it was said "Don't you know food can cause infection?" This was a sad statement.
760-1410, Work Room 1. Each body art establishment shall have its workroom(s) physically separate and apart from waiting and all other areas. The workroom shall not be used as a corridor for access to other rooms. Only patrons or customers actually receiving body art procedures and staff are allowed in said room.
Body artists petition the Board to recognize the long, safe and historic tradition of tattooing and piercing in open areas not separate and apart from other areas of the establishment. This open layout comes from a century of tattoo experience and contributes to a shared experience and bond among the tattooed that unites them, contributes to social harmony among friends, among family and loved ones. It's impossible to count how many hands have been squeezed in encouragement, how many cheers have erupted from friends and the delight on the faces of those who have completed the ordeal. It is part of the positive experience of tattoo just like walking down the isle and other social rituals. Shops can and do make provision for private areas but more often the real reason is the artist wants the privacy not the client. Some clients are uncomfortable with this isolation because they want and need a friend at hand. The Article has it all wrong. There never has been an issue with disease by using open area tattooing. Privacy is up to the customer if they feel comfortable with the shop procedures or not. Artists know things that no outsider does, that the sharing and witnessing is often as important as the tattoo contributing psychologically to maturing and learning to bear the pain, and sometimes a community right of passage. Because there is no evidence that an open layout contributes to the spread of disease, any attempt to ban this practice will be resisted. It is an integral part of the tradition of tattoo. Lacking compelling reasons this section must be deleted. 2. Unnecessary traffic through a workroom is prohibited. This provision relies on a vague understanding that would vary with every shop making it an "unnecessary" provision. The use of a strong word like "prohibited" instead of "discouraged" or some other expression displays the Article's method: regulating is the compilation of listing prohibitions and listing allowable actions. This is an improper approach to protecting the health of the community. This method is also called "fascist." 3. Each workstation in the workroom shall be equipped with hand washing sink There is no support from OSHA or the CDC to require a hand washing sink at each and every "workstation" even in laboratories. OSHA requires that hand washing sinks should be "readily available in the vicinity of the worker." Having a hand washing sink readily accessible in the vicinity of the workstation is sufficient to protect the worker and the client. For the exclusive use of the body artist for washing his/her hands And preparing
customers who are receiving body art procedures. Each such sink shall be equipped with hot and cold running water dispensed through a mixing faucet with wrist action, automatic, or foot controls This describes the usual sink but it should have been written more appropriately. Something like: equipped for "hands-free" operation. OSHA has always left open the possibility for new technologies and techniques, so definitions should be "performance-based" as much as possible rather than lists of currently available alternatives. hand cleaning liquid or powdered soap in suitable labeled dispensers, This entire section shows the detail obsessiveness of the Article believing their task is to stipulate the smallest details. A USEPA (EPA) approved or hospital grade germicidal solution, Because this item is sandwiched between hand cleaning soaps and hand brushes we hope the Article recognizes these as disinfectants not for use on skin. Individual hand brushes and fingernail files for each body artist, Nail cleaning accessories would not be discouraged but their mention is excessive. One can imagine the inspector counting the nail files and nail brushes lined up in a row, asking for placards of ownership to not mix them up, perhaps each with their owner's name, or a tag. This is unacceptable. Body Artists do not require parental guidance and talked down to like children. It is sufficient as mentioned elsewhere to be hygienic and clean. Having dirty fingernails is not clean. This type of statement is insulting and unnecessary. And approved single-use sanitary towels from an enclosed dispenser It is impossible for the Department to meaningfully "approve" or disapprove sanitary towels. Sanitary? Ordinary air is not a significant source of contamination. If the Article is trying to target rolls of paper towels without a dispenser that would become unsanitary by being picked up and torn off that would hardly be a good way to express it. This is appropriate for an explanation of what constitutes sanitary methods, not further regulation. And the ultimate degradation of body artists. An employee hand washing sign provided by the department is to be posted at each work station hand sink. A sign? Provided by the department...and worst of all...this is serious. Talk about disrespect, this is it. The sink is not contaminated with blood or body fluid. What is the health threat if a non-employee washes their hands in the sink? 4. Individual workstations in the workroom shall be provided with counter areas and storage cabinetry for body art instruments, dyes, ointments, bandages etc. that are of sanitary design, maintained in good repair, and protected from potential sources of contamination. There seems to be no end to usurping the legitimate functions of the shop owner in the design of the studio. Little do they know that body artists do not use dyes. It is sufficient to require that shops be kept hygienic and clean. 5. Work chairs, benches or tables shall be provided for each body artist. Surfaces of the chairs, benches or tables shall be constructed of material that is smooth, non-absorbent, and easily cleanable. It is sufficient to require that shops be kept hygienic and clean. The focus should have been performance based – cleanable, able to be disinfected if necessary would have been far better, if at all. 6. The surfaces of furniture, equipment and fixtures that come in contact with the body part receiving the body art procedure or that may be directly or indirectly exposed to contamination from blood, blood products, and other body fluids during the course of a body art procedure must be covered or draped with an appropriate single-use, non-absorbent sanitary or sterile barrier material. The Article tortures this. Disposable barrier products are used to protect surfaces likely to become contaminated and discarded after use. 7. Easily cleanable, covered receptacles shall be provided for waste paper, biomedical waste and other refuse at each individual workstation. These receptacles must have a hands-free mechanism to open and close the lid while the body artist is engaged in body art procedures. This type of trash receptacle should not be discouraged but does pose operator difficulty during the procedure and should not be required like this. Continuously opening and closing trash receptacles would not be best practice, not foot operated at least. Another point is the wording seems to imply at least three different trash binds all within foot-reach of the artist. 8. Body Artists may not set up temporary facilities at fairs, festivals or expositions unless a Temporary Body Art Establishment permit is obtained from the Commissioner. There is no explanation for
the necessity and a troubling use of the word "establishment." 9. In all new, remodeled, expanded or renovated body art establishments, temporary body art establishments and mobile body art establishments, body artist's work station in the establishment shall have a procedure area with at least 45 square feet of floor space. Body art establishments in existence at the time of the adoption of this article are exempt from this requirement until remodeled, expanded or renovated. It is desirable to have suitable space to work. Though 45 square feet of space may be a good approximation for any type of work, with no evidence that work cannot be performed safely in less space, this should not be a subject of regulation but left to the experienced judgment of body artists. 10 All body art establishments, temporary body art establishments and mobile body art establishments shall provide at least one procedure area that is capable of being completely screened from public view for clients requesting privacy. Most artists would see this as a sound business decision, but to compel shops to provide such space because clients request a private space is unlikely to be upheld by the courts. 11. The work station areas shall be supplied with an adequate supply of single-use barrier materials for the purpose of covering or draping equipment, hardware, spray bottles or any other surfaces that might come into contact with the gloved hands of the body artist so as to prevent potential contamination from one person to another. The purpose of this paragraph is to belittle body artists as if they are children incapable of buying enough supplies to protect clients. The stated purpose obscures the direct purpose: to prevent the item from becoming a source for contamination. The word "potential" is no longer used by OSHA or CDC but is replaced everywhere with reasonable likelihood or likely to occur 12. All containers in the body art establishment are to be labeled as to their contents. OSHA requires all hazardous chemicals in the workplace be labeled and the FDA does not require content labeling of non-hazardous materials for professional use. The purpose for this regulation would seem to be for squirt and spray bottles though it might be meant for everything. IS the label to say "Ink" or does it mean the ingredients. This is a good idea for housekeeping and should read: "should be labeled" but again this is a matter of housekeeping and should not be written into the regulations. 13. Poisonous compounds, toxic compounds, and cleaning agents must be clearly labeled and stored and used in a manner that will not pose a threat to safe compounds, body art instruments and equipment used for body art procedures or occupants of the body art establishment. Yes, these are good and worthwhile procedures. However, they have no place written into the regulations. These are worthwhile to include as examples of housekeeping procedures under OSHA regulations, as explanations that apply to all businesses, not in the written regulations.
760-1411 Operation Standards; Records 1. RECORDS a. The holder of a body art establishment permit shall maintain proper records of body art procedures that have been administered and/or jewelry that has been installed for each patron.
c. The records shall be entered in ink, on paper, which is kept in an organized file, notebook or folder that is kept solely for this purpose. These records shall be available during the course of an inspection for examination by the Commissioner's representative and shall be preserved for at least two (2) years from the date of the most recent body art procedure recorder in the establishment. d. Before performing the body art procedure, there shall be a discussion with the patron on the risks of the procedure and the possible health complications, which shall be noted in the record.
Leaving the privacy issue, this section also illustrates the need for a look at the approach to regulating. . Point c. requires the records be in ink, on paper, in an organized file, or folder, that is kept solely for that purpose. The purpose is to have records readily accessible for the Department. Contrast this with how OSHA approaches similar record keeping. Here they are considering where to keep the Exposure Control Plan in a facility so that it is readily accessible. "The 'location' of the plan may also be adapted to the circumstances of each particular workplace provided that the employee can access a copy of the plan at the workplace, during the work shift. For example, if the plan is maintained on a computer, access to the computer or hardcopy must be available to the employee." Summary and Explanation OSHA (c)(1)(iii)OP CIT.
It is the accessibility of
the records that is important, not how they are stored, on paper or on a
computer. Employers are left to determine the best record keeping for their
situation as long as those records are accessible when needed. This is
performance-base regulating. The performance is getting the records. This
presupposes the existence of records to get, not that they must be in ink.
OSHA states "...it does not wish to take away from the flexibility of the
performance approach to compliance...while not dictating the specific form
of the documentation." Therefore the standard reads Paragraph (c)(1)(iii)
"Each employer shall assure that a copy of the Plan is accessible to
employees." OpCit. Point d. the risks of the procedure and the possible health complications requires a re-direction of emphasis and the whole truth, that the risks are minor and it is not expected that they would result in health complications. "Risk" and "possible" are both improperly used and confused. What needs to be added, more importantly, is not the procedure that causes health complications but the clients are the cause of health complications. More emphasis should be on explaining this to clients instead of focusing the attention on the procedure. The additional requirement that this discussion which shall be noted in the record. is a good idea for liability protection, but not reason that the noting be part of the Article. e. Consent
(1) Minors are prohibited from being tattooed (NY Penal Law
260.21). No one can give consent fro the application for application of a
tattoo to a minor, NY Penal Law 260.21. f. No body art procedures shall be performed upon a person who appears incoherent, or appears to be under the influence of drugs or alcohol. 2. Tattooing Procedures. a. There shall be printed Aftercare instructions, as approved by the Department and consistent with Appendix A of this Article, given to each patron or customer on the care of the skin to prevent infection and proper, safe healing after Tattooing. The printed material shall include information for the patron to consult a personal physician immediately, who, in turn, may immediately notify the Suffolk County Department of Health Services, or advise the patient to do so, should an infection become evident. This section is the most important in the Article and should be cleaned up. It should read something like: Each client shall be given printed Aftercare Instructions consistent with modern wound healing techniques. A sample of these instructions is available in Appendix A and must include the warning "If you suspect an infection get medical attention right away." The way it is written is frightening as if it were Ebola and the physician must immediately notify the Department of a local easily treated skin infection. And if it is that important why the: or advise the patient to do so. Further, Appendix A is not medically accepted wound healing technique, but ritual practices that can delay healing and promote infection. b. A copy of such printed Aftercare instructions shall be posted in a conspicuous place in the workroom, clearly visible to the person being tattooed. This is a good idea as a suggestion to emphasize aftercare but aftercare usually goes without incident even when not perfect. There are no dire consequences when aftercare is not perfectly followed. Delay of healing by a few hours or day does not expose the client to unacceptable dangers by that delay and does not need a large sign that can be clearly read while being tattooed. (What would be the sense of it being "visible" if it could not be read?) If any place it should be in an area where the client can concentrate on it, certainly not in the chair. c. When necessary to shave the area to be tattooed, only single-use, sterilized, disposable safety razors shall be used. The "sterile" specification is objectionable. It has never been a problem to shave with disposable single-use non-sterile razors. Point c. also illustrates clearly the lack of a performance-based approach because it specifies one method of hair removal excluding all others. It should not be part of the Article. How barbershops handle the straight razors might be relevant. d. Before placing the design on the patron's skin, the body artist shall treat the area with an EPA approved or hospital grade germicidal solution, which shall be applied with sterile cotton or sterile gauze. Only petroleum jelly (petrolatum) or sterile dressings shall be applied to the area to be tattooed and only from single-use, collapsible metal or plastic tubes. The application may be spread by the use of sterile gauze, but not directly with the fingers.
Several comments need to be
considered. 3.) The restrictive applied with sterile cotton or sterile gauze is not the only way to apply antiseptics to the skin, nor do the wipes have to be sterile. The petroleum is not sterile.
4.) It is a long and safe
tradition to use jars of A&D removing amounts of ointment with sterile
tongue depressors. There is no evidence that this procedure has caused the
spread of disease. 7.) A gloved finger or hand is used to move ointment around but it is unheard of to use plain fingers. This is not a method used and should not be pointedly prohibited as if it were a known and used method. e. The use of single-use tissue and hectographic stencils shall be required for applying a tattoo outline to the skin. Multi-use stencils shall be prohibited. If drawn free hand, non-toxic markers or other devices as approved by the Department shall be used. The purpose here is to prohibit the use of re-useable plastic stencils and toxic markers. 1.) There are no such things as "hectographic" stencils though we get the meaning. The current method is to use duplicator stencil masters composed of Carnauba wax and crystalline violet. One manufacturer sells "Hectograph" pencils, which seems to be a trade name not a description of the process that is promoted to write on paper which then can be transferred to the skin.
None of this has ever been
shown to be harmful. 3.) The approved by the Department pops up again and should be dropped. The Department is unable to approve drawing devices other than to read the labels. These are not sterile either applied to the skin f. Any skin or mucosa to receive a body art procedure shall be free of rash or any visible infection. This is probably too restrictive of skin conditions to look for, but not being medically trained I can only guess that it should be more inclusive, such as: visible abnormal skin condition. 3. Dyes or Pigments a. In preparing non-toxic dyes or pigments to be used by a body artist, only non-toxic, sterile material shall be used. Single-use or individual portions of dyes or pigments in clean, sterilized containers or single-use containers must be used for each patron. 1.) Though dyes are not used in tattoo because they are water soluble there is reason to expand the title to cover the entire contents of the ink formulation, not just the coloring agent. Though dyes currently have no use in tattoo that situation could change. Some new ink concepts are being developed by Harvard Professor Rox Anderson. Regulations must allow for technological improvements. 2.) The clause In preparing non-toxic dyes or pigments to be used by a body artist is confusing. This points to the formulator, preparer or manufacture of the ink. If this is the intention it is not possible to formulate using sterile materials though it is possible to sterilize ink. 3.) Non-toxic is vague without reference to any standard or degree of non-toxicity. This needs more study before being included. 4.) It is only this year that "sterile" ink has been introduced as an option to inks not claimed to be sterile. Unless it can be demonstrated that non-sterile inks contribute to disease this should be dropped from the standard. It is also only this year that individual portions have been manufactured. It has never been a problem, and until proof is offered that it does pose a threat it should not be included. 5.) Ink cups have never been sterile and have never been pointed to as a contributing agent in contamination. There is not justification offered for this. b. After tattooing, the remaining unused dye or pigment in the single-use or individual containers must be discarded. c. All inks, dyes, pigments, needles, body art instruments and equipment for performing body art procedures shall be specifically manufactured for that purpose and shall be used according to the manufacturer's instructions. When available, the inks, dyes and pigments for body art procedures must comply with applicable U. S. Food and Drug Administration regulations. The mixing of approved inks, dyes or pigments and/or their dilution with sterile water or alcohol using aseptic procedures is acceptable if in conformance with applicable U. S. Food & Drug Administration regulations when available. This restrictive expression "shall be specifically manufactured for that purpose" discourages the development of technology. There is no compelling reason to prohibit using new and novel techniques and tools not specifically manufactured for body art. The use of tools and techniques in ways other than intended by the manufacturer has provided significant improvements in life and this industry and should not be prohibited by the Article. For example, most all the tools used for piercing were made for dentistry, not intended for body arts. The very needles we used were entomology needles not tattoo needles. In the 1980's we had a hard time getting a sterilizer, suppliers in Suffolk County refused to sell them to us. The last sentence The mixing of approved inks, dyes or pigments and/or their dilution with sterile water or alcohol using aseptic procedures is acceptable if in conformance with applicable U. S. Food & Drug Administration regulations when available 1.) According to the presentation of the FDA Science Forum on April 19, 2006 the mixing of anything with the ink is adulteration. This provision itself is in violation of FDA rules. 2.) The body artist must prove the ink or the mixing conforms to FDA regulations. Even the Department could not do this. To require this of body artists is unreal. d. Patrons shall be provided printed warning of the potential physical reactions from the use of certain dyes (when available) in a form acceptable to the Department. Occasionally a client has an allergic reaction to ink: an area swells up. It has been treated with shots of cortisone and other methods. Treated or not the area recedes in a few months or even a year. It has also been reported that an allergy to an ink has been known to break out years after the tattoo. There has not been sufficient study available to the tattoo community that would help us direct clients to acceptable treatment regimens. A warning should be given that some people are allergic to some ink, and although bothersome, perhaps itchy and of great distress to the client does not seem to be a health threat. The FDA has reiterated their position that it is up to clients to avoid being tattooed with inks that cause them to have an allergic reaction. 4. Sterilizing and Care of Tattoo Needles and Equipment. a. A set of individual, single-use, sterilized needles shall be used by a tattoo artist for each new patron. An adequate number of sterilized needles shall be on hand to supply peak demands.
1.) The word "set" is
confusing because it is never used in tattoo to refer to tattoo needles. A
question might arise "Does that mean we can't use just one needle?" and
"What does a set consist of?" There is no need for the word at all.
Single-use, sterilized needles... is exactly correct and not confusing.
b. Sterilization shall be accomplished by holding needles in an acceptable steam autoclave for no less than 20 minutes at no less than 15 pounds pressure at a temperature of no less than 250 degrees Fahrenheit or 121 degrees Celsius or other methods as approved by the Department.
The most usual method of
in-house sterilization is by steam. With improvements in technology new
methods and sterilizers are available. For example, new autoclaves are
currently available that utilize higher temperatures and decreased time, and
though dry heat is not the most appropriate it is an effective method of
sterilization. A performance-based approach might word this point something
like: In-house sterilization shall be appropriate for the item and reach a
Sterility Assurance Level of 10 to the minus 6. c. All sets of needles shall be placed in chemically treated sealed bags that indicate, by color change, sterilization has occurred. A performance-based rule might read something like this: When sterilized in-house, needles, tubes and grips will be sterilized in pouches designed for that purpose. d. No rusty, defective or faulty needles shall be used for tattooing. This should be removed because by definition "needles" used for tattoo would exclude rusty, defective or faulty needles. This sentence is insulting. e. Unused, Sterilized needles shall remain in sealed sterilized bags until needed and stored in such a manner to prevent contamination. Unused Sterilized needles tubes and grips will be kept in their sealed sterilization bags until used and handled and stored to insure the integrity of the bag. f. Upon conclusion of the use of a set of tattoo needles on a patron by a body artist, and if the needle stems are going to be reused, the used needle & stem unit is to be first sterilized, then the needles shall be removed from the needle stem and placed immediately into an acceptable sharps container for storage until final disposal from the premises. This point violates a caveat of infection control procedures: handling of contaminated items must be kept to an absolute minimum. This point violates OSHA regulations.
1910.1030(d)(2)(vii)
Exception procedure: (d)(2)(vii)(B)
1910.1030(d)(4)(iii)(A)(1) Point f. should read something like: All contaminated needles must be discarded immediately or as soon as possible in "sharps" containers located as close as is feasible to the immediate area where sharps are used. The word "must" is crucial because it means there are no exceptions. g. All needle tubes are to be of the shallow open-end type and must be sterilized in accordance with approved methods prior to use. Sterilized needle tubes shall be stored in such a manner as to prevent contamination. 1.) Though tubes do not pose the same level of puncture threat as needles they are still contaminated during use and can be included in points a., b., c and e. above. (if d. is deleted). 2.) Specifying the construction of the tubes prohibits many current styles without evidence that only this type is safe to use. There are other styles that are used and there is no evidence that other styles contribute to disease. Point g. is misguided and should be removed. 5. Aftercare of Tattoo. a. The completed tattoo shall be washed with a piece of sterile gauze or sterile cotton saturated with an EPA approved or hospital grade germicidal solution. It shall be allowed to air dry. 1.) The incorrect germicidal is listed again, as pointed out in 760-1410 and above. The EPA approves hard surface disinfectants for inanimate matter not human skin. 2.) This section needs re-examination in light of modern wound healing techniques by a wound healing expert. The purpose of wound cleansing is to remove 'foreign bodies', excess exudate and bacteria from a wound. This is particularly important in infected wounds or those at risk of infection. (1)p239 Exudate is required on the wound surface to maintain phagocyte levels, as well as other wound healing hormones and chemical stimuli. Wound irrigation will remove these and is therefore best avoided. However, it may be necessary to cleanse the surrounding skin to prevent excoriation from excess exudate. This may be achieved by irrigation or wiping AROUND the wound with a wet swab and then a dry swab. This is not always an easy procedure. It is preferable that a dressing should be used which maintains moist wound healing but absorbs excess exudate and does not allow it to leak onto the surrounding skin. In this case cleansing the wound as a separate procedure is NOT necessary. OpCit p.240 b. After drying, anti-bacterial ointment shall be applied from a single-use collapsible metal or plastic tube and the entire area covered with a piece of sterile, non-stick tissue, bandage or gauze fastened to the site with a low-tack tape. Aftercare instructions provided to the client must be consistent with those outlined in Appendix A of this document. One of the major misconceptions in the treatment of acute wounds is the use of topical agents...Many physicians still use these agents, either out of habit or because most of their patients heal in spite of them. In fact, many antimicrobial agents have been found to inhibit either cell proliferation or migration in vitro. Our practice with regard to all topical agents in acute wound healing is 'Prime, no nociere' (first, do no harm); that is, in the majority of cases we do not use them. Derm. Clinics p635
The choice of dressing must
reflect the patient's risk of infection, the management of identified
infection, and the risk of cross infection. Infection Control p.240 6. Body Piercing, Scarification and Branding procedures a. Printed aftercare instructions, as approved by the Department and consistent with Appendix A of this article shall be given to each patron or customer on the increased risk of an invasive infection resulting from the piercing of mucus membrane tissue, specifically piercing the navel area, genital area, tongue and nipple. Such printed instructions shall also include information for the patron on the care of the body opening caused by body piercing, scarification or branding as a precaution to prevent infection and to consult a private physician immediately who, in turn, may immediately notify the Suffolk County Department of Health Services or advise the patient to do so should an infection become evident. Information should also be provided with reference to the security or snugness of certain jewelry to prevent ingestion or lodging in body cavities. 1.) This section is specific to body piercing, scarification and branding. One of the points in the first sentence is to compare the "the increased risk of an invasive infection" with piercing without making it clear that wounds of outer layers of skin as seen in tattoos provide less of a threat of systemic infection compared to wounds that expose deeper layers of the skin as seen in piercings. This makes sense but may not be a complete picture. "Invasive" is most likely an incorrect description. The conclusion to draw is that piercing wounds require more aftercare concern than tattoo. This needs more consideration. 2.) ...increased risk of an invasive infection resulting from the piercing of mucus membrane tissue, specifically piercing the navel area, genital area, tongue and nipple. None of the body parts listed, the navel, genital area, tongue and nipple are lined with mucous membranes ... This sentence probably should have ended increased risk of an invasive infection resulting from piercing, (period.) the rest omitted. 3.)... Such printed instructions shall also include information for the patron on the care of the body opening caused by body piercing, scarification or branding. Scarification and branding do not create body openings. Body opening should have been omitted. 4.) These seem to be three different aftercare considerations. 5.) Comments were previously made in reference to "private physician" and won't be repeated here though they should be considered here as well. 6.) We are glad to see the security of jewelry addressed. This is a very good innovative addition. An expansion would find it useful to include information on how to remove jewelry. Clients come back saying they tried but don't know how to remove their captive bead ring. b. A copy of such printed aftercare instructions shall be posted in a conspicuous place in the workroom, clearly visible to the person being pierced. A copy of "Healing Periods for Body Piercing", Appendix E of this Article, must be posted at each body piercing station. Objections to this have been made elsewhere. One can imagine a workroom now with five sets of instructions on the walls large enough to be read by the clients during the procedures: Tattooing, Piercing, Piercing Times, Scarification and Branding. c. When necessary to shave the area to be pierced, only single-use, sterilized and disposable safety razors shall be used. The comments previously made should be considered here also. The rationale for sterile needle use is the knicking of the skin during shaving might contribute to the spread of infection. As long as the razors are single-use should be sufficient. There is no evidence to suggest otherwise. d. Ear piercing guns and ear piercing needles are to be used only for piercing ear lobes. The piercing device may not be used to pierce any other part of the body. 1.) Instructions that come with the gun say that the gun can be used for the ear lobe and outer cartilage. This needs further examination. 2.) "Ear piercing needles" should be removed because it is a customs import term used to label cannula needles used for piercing. e. For all body piercing, a single-use, sterilized disposable surgical piercing needle of the same gauge as the jewelry shall be required. 1.) There is no classification "surgical piercing needle" in the Federal Register of Medical Devices. 2.) The same concern shown with tattoo needles with reference to sterilization and disposal should be applied to piercing needles. They are no less contaminated and do not posed any less of a threat. 3.) There is no evidence to support the requirement that only a needle of the same gauge size must be used. Some piercers have always used slightly larger needles. This practice, since the inception of piercing, should not be prohibited without convincing evidence that it is harmful. f. Skin shall be marked with a non-toxic marker prior to cleansing with antiseptic. The area being pierced must be free of sores and lesions.
1.) The procedure is
washing, then an antiseptic, then the marking, just like tattoo. g. When applied, jewelry should be pushed through the skin following the needle, in the same direction as the piercing. Whereas the most common method of piercing is as described, the Article is attempting to regulate the actual procedure and method of piercing unrelated to health matters preventing the development and introduction of other and perhaps superior techniques. A European technique uses a catheter and inserts the jewelry from the other end. This must be deleted. h. Ear lobe piercing is exempt from provisions of the Article, except those provisions dealing with personal hygiene, use of single-use sterile equipment devices, aftercare instructions and jewelry. This point is now confused.
Is the piercing gun a
single-use sterile device? i. If the body art procedure area requires covering, it must be done with sterile, non-stick gauze, non-stick bandage or non-stick tissue and fastened to the body with an appropriate, adhesive first-aid type bandaging tape.
1.) This consideration
should be handled in the aftercare instructions sections, just like tattoo. 7. Sterilization of Piercing Jewelry and Needles; Jewelry Requirements a. An individually bagged sterilized single-use needle and bagged sterilized jewelry shall be used for each piercing. These requirements for piercing and tattoo should mirror each other. For tattoo it is written a. A set of individual, single-use, sterilized needles shall be used by a tattoo artist for each new patron. An adequate number of sterilized needles shall be on hand to supply peak demands Better would be: Individually packaged single-use sterile needles and jewelry shall be used for each client. That should be adequate. The jewelry does not have to be bagged separately. The same objections to certain parts of tattoo apply here as well. b. Sterilization shall be accomplished by holding needles in an acceptable steam autoclave for no less than 20 minutes at no less than 15 pounds pressure at a temperature of no less than 250 degrees Fahrenheit or 121 degrees Celsius or by any other method approved by the Department. The same comments as in (4)(b.) above apply here. c. All sets of needles shall be placed in chemically treated sealed bags that indicate, by color change, sterilization has occurred. A performance-based rule might read something like this: When sterilized in-house, needles, tubes and grips will be sterilized in pouches designed for that purpose. d. Unused, Sterilized needles and jewelry shall remain in sealed sterilized bags until needed and stored in such a manner to prevent contamination. Unused Sterilized needles tubes and jewelry will be kept in their sealed sterilization bags until used and handled and stored to insure the integrity of the bag. e. Corroded, defective or faulty needles and Jewelry shall not be used for body piercing. This should be removed because by definition "needles" and jewelry used for piercing must be suitable and therefore exclude Corroded, defective or faulty needles and Jewelry. f. Upon completion of the piercing, used needles shall be placed immediately into an acceptable sharps container for storage until final disposal from the premises.
This point could use more
accurate _expression to reflect relevant comments provided in (4)(f) g. Packages of single-use factory-sterilized needles, jewelry, tubes, clamps and other body art instruments must indicate the process by which sterilization was accomplished, have an indicator that clearly demonstrates successful sterilization and, if there is an expiration date on the package, the contents must not be kept in the body art establishment past such date. 1.) A compelling reason is not offered why naming the particular process, e.g. Gas or Steam, should be the subject of regulation. Some piercing needles are gas sterilized in very economical packages. It should be enough for small items that the box or outer wrapping contain an assertion to that effect. 2.) It is obvious the Article believes piercers may use stale dated products. It should be remembered that dating does not mean the item is no longer sterile. h. Jewelry to be used for a body art procedure must consist only of those materials listed in the definition of jewelry herein. This provision like others attempts to exhaustively include and exclude the material of jewelry without presenting any evidence and making some blunders. For example, there is no classification "surgical-IMPLANT grade stainless steel, and no "surgical-grade plastic". It would only be reasonable, without the particular expertise to draw all the distinctions that neither we nor the Board has, to require that the material be considered hypoallergenic and suitable for the purpose. For example, it would not be suitable to insert jewelry containing free nickel, known to cause common nickel allergy, or other type or shape of jewelry, e.g. sharp edges that would delay normally expected healing. Unless they were deep, jagged or sharp "angel hair" cracks and small pitting will not delay or interfere with healing nor harbor bacteria greater than the piercing itself. 8. Care of Multi-use body art instruments for body art and related equipment. a. All other multi-use equipment and body art instruments used in connection with a body art procedure shall be so designed and of such material as to be durable, non-toxic, corrosion resistant, smooth and easily cleanable. Such equipment and body art instruments shall be stored cleaned and in a protected manner and when necessary be sterilized. The Department has not exhibited expertise to determine the suitable construction of body art instruments. Whereas these qualities are desirable, their absence is not excluding which leaves, stored cleaned and in a protected manner and when necessary be sterilized. b. The following process shall be performed after each use of a multi-use body art instrument used for body art: (1) The body art instrument shall be cleaned by scrubbing with an appropriate soap or disinfectant solution and warm water, or by procedures that follow the manufacturer's cleaning instructions to remove blood and tissue residue. This more properly should read something like Re-useable Contaminated body art instruments shall be cleaned and sterilized before re-use. There is no blood or tissue residue. (2) The body art instrument shall be placed in an ultrasonic cleaner, which shall be operated in accordance with the manufacturer's instructions. A copy of these instructions shall be kept by the body artist(s) in the area of the ultrasonic cleaner for review by the department's representative and the body artists. The purpose of cleaning is to reduce the bioburden level so that sterilization is achievable. Ultrasonic cleaners dislodge fine particles that can't be reached by hand scrubbing. Because there is no blood or tissue seeping into areas that cannot be reached by hand scrubbing there is no compelling reason to require ultrasonic cleaning. (3) The body art instrument shall be packed individually in a peel-pack containing either a sterilizer indicator or an internal temperature indicator. It shall then be sterilized.
A more reasonable
_expression might be: Re-useable contaminated body art instruments will be
sterilized in pouches designed for that purpose, kept in their sealed
sterilization bags until used and handled and stored to insure the integrity
of the bag. (4) All multi-use and single-use body art instruments, needles, jewelry autoclaved on-premise must have the date of sterilization and the initials of the person doing the sterilization. Any such sterilized item not used within 365 days of the processing date is to be opened and its contents re-sterilized. Any item sterilized on-premise must have etc.. The reason for the signature needs explanation. c. Sterilizers shall be used, cleaned and maintained according to the manufacturer's instructions. A copy of the procedures recommended by the manufacturer for the operation of the sterilization unit shall be available for inspection by the Department. The manufacturer's use and maintenance instructions are for reference for the employee. They must be available to the employee if needed. It is not necessary to include "shall be available for inspection by the Department" because they are required to be available to the employee. It should be reworded and changed focus from enforcement to performance. d. A written record showing the history of the use of the sterilizer in the most recent 36 months shall be kept on the premises. This record will include the type of body art instruments sterilized, the date of the process, duration of time for the sterilization process, the maximum temperature and pressure attained during the process and the name of the person performing the process. With dated, signed bags and periodic spore testing this extensive record keeping needs compelling justification. e. The body art establishment shall demonstrate by quarterly spore destruction tests that the sterilizer used is capable of attaining sterilization. The tests shall be verified through an independent laboratory approved by the department. These test records shall be retained in the body art establishment for a period of 3 years. The body art establishment's permit shall not be issued or renewed until the department receives such documentation of the sterilizer's ability to destroy spores. 1.) Sterility Assurances means repeated spore testing consistently produces negative results. A failed spore test means there is no assurance that the items sterilized since the last successful spore test are sterile. A successful spore test is necessary before the sterilizer can be put back into service. All the items after the last successful test are then re-sterilized. For this reason it is prudent to test frequently so that few items would be used that could be suspect. A month or less is a minimum. Quarterly is unheard of. 2.) It would contribute to sterility assurance to allow in-house spore testing so that this can be done economically, faster and more often. The ideal situation would be no release into use until the spore test is confirmed. Factory made needles, tubes and supplies are not released without a confirmed spore test for every lot. There is no evidence to suggest that body artists would be falsifying their own records and this should go forward. f. The ultrasonic cleaner and the sterilizer shall not be located or operated in body art procedure areas or areas frequented by the public. g. Prior to use, all body art instruments used for body art procedures and jewelry to be used in approved body art procedures are to be sterile and single use. Those body art instruments that are designed for multiple uses must be sterilized in accordance with Sections 760-1410.4b and 760.1410.7b described herein. These sterile body art instruments and jewelry are to be stored in a safe, sanitary, manner and protected from accidental contamination until such time as they are to be used for the body art procedure. All jewelry and body art instruments that are packaged and sterilized in the establishment must be clearly marked with the date of sterilization and the initials of the person monitoring the process. If the package containing the body art instrument has been breached, the expiration date has passed, the "indicator" has not changed to verify a successful sterilization process, or the package is otherwise visibly compromised or contaminated, the body art instrument or jewelry must be repackaged and re-sterilized. This paragraph is a duplication of paragraph 7601411.8d4, 7g, 8a, 8d
760-1412 General, Facilities and Equipment This section does not address body art establishments but presents commercial food establishment regulations copied from Article 13 as if they applied, which they don’t. Under examination of the requirements for food establishments to protect the health of the food supply and body establishments, one finds there are almost no similarity between the two types of establishments except one point we can agree on: they both must be kept clean and in good repair.
Below is the
comparison, word for word.
Nobody would
argue with the opening sentence.
All floors, walls and ceiling in body art establishments, including
doors, windows,
skylights and similar closures and attached equipment such as light
fixtures, vent
covers, wall mounted fans and decorative materials, shall be kept
clean and in
good repair. Why the elaborate list, but so far so good.
(Body Art Article 14)
compared to
(Article 13)
workstation area. Univ of Florida writes "The sanitary objectives for interior building design and construction are to: Minimize potential harborages of pests and microorganisms: maximize cleanability; and maximize the protection of the food products from contamination.
"To design and build in
features that protect the food product from contamination should be the
ultimate goal of planners and designers." University of Florida Sanitary Design and Construction of Food Processing and Handling Facilities. http://edis.ifas.ufl.edu/FS120 The dangers that threaten the food supply do not bear any resemblance to body art, for example: dripping grease from the ceiling.
If left exposed in other parts of the
establishment, they shall be finished as to
provide an easily cleanable surface.
2. The floor surfaces in the workstation area and
toilet rooms shall be made of
smooth, nonabsorbent materials and constructed so
as to be easily cleanable. The floor of the body art establishment shall be of impervious material. The workstation and toilet room(s) shall be wet-mopped with an approved sanitizer daily. Whereas Article 14 prohibits carpeting in any area of the body art establishment it does allow carpeting in areas in food establishments. 760-1412(3.c) Properly installed carpeting is permitted in public areas of food establishments, such as vestibules, dining rooms, powder rooms, hallways and lobbies. "The floor of the body art establishment shall be of "impervious material.
CDC Writes June 6, 2003 / 52(RR10);1-42 III. Carpeting and Cloth Furnishings
Follow appropriate procedures for managing spills on carpeting. FSM writes Floors. Floors are the most abused surface in a food processing facility...Food processing areas should have floors covered with an appropriate type of coating...floors can be rinsed, foamed, rinsed, sanitized and still show positive microbial swabs. These organisms can be splashed onto equipment and can be tracked around the facility by processing personnel...As such, floor coverings should be smooth, non-absorbent and easily cleanable." Food Safety Magazine-04,2006 Floors in body art establishments are not exposed to mechanical abuse, chemical abuse, temperature abuse or microbial contamination that are likely to find their way into a tattoo or piercing as compared to food processing facilities. FSM Writes Walls. Although not as critical as floors, walls also require a smooth, non-absorbent surface to prevent microbial growth (mold, yeast, bacteria) and absorption of materials containing dust from allergen materials...The more sensitive the product being processed, the more attention must be paid to the wall surfaces. FSM OpCit Back to Body Art Article 14
3. All walls in the workstation area and walls in
toilet rooms shall be easily cleanable,
light colored and shall have nonabsorbent
washable surfaces.
3c. Concrete blocks or other masonry used in
wall construction shall be finished
These standards
are appropriate for food establishments not body art establishments.
"3.b...so as to leave no cracks which would permit accumulations of
grease or debris or provide harborage for insects, rodents or vermin."
Food
preparation generates grease, steam, spills, splattering, splashing,
aerosolization, food particles and allergens that are transferred to every
part of a food establishment. Cleaning, sanitizing and controlling the
buildup of food processing residues is a major activity. Food attracts
rodents, insects, mold, mildew and a host of living hazards that are a
threat to the health of patrons and safety of the food. There is no rational
application of food establishment standards to body art. E. Keep housekeeping surfaces (e.g., floors, walls, tabletops) visibly clean on a regular basis and clean up spills promptly (279). Category II FSM writes Anything hung on the facility's walls should be hung with a minimum of one inch of space between the back of the item and the wall surface. This allows for improved cleaning access and keeps areas behind electrical boxes and equipment hangers from becoming a habitat for insects or niches for microbial growth and allergen residues to reside. FSM OpCit DSP writes
Environmental surfaces
such as floors, walls and related objects are not associated with
transmission of infections to patients or health-care workers and therefore,
extraordinary attempts to disinfect these surfaces are not
necessary. Cleaning to remove gross filth and contamination is sufficient.
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