April 14, 1998

ENROLLED ORDINANCE

NO. 98-253

INTRODUCED BY COMMISSIONER(S): Patterson and Parker

AN ORDINANCE TO ESTABLISH ENVIRONMENTAL HEALTH STANDARDS FOR THE CONDUCT OF BODY ARTS PROCEDURES, TO REGULATE THE ESTABLISHMENT AND PRACTICE OF BODY ARTS SERVICES; TO AUTHORIZE THE HEALTH DEPARTMENT TO ENFORCE THESE STANDARDS AND REGULATIONS BY INSPECTION, AND PERMITTING FOR BODY ART ESTABLISHMENTS; TO PROVIDE FOR SUSPENSION AND REVOCATION OF PERMITS; AND TO PROVIDE FOR MISDEMEANOR AND CIVIL INFRACTION PENALTIES FOR VIOLATIONS OF CERTAIN REQUIREMENTS AND PROHIBITIONS OF THIS ORDINANCE.

IT IS HEREBY ORDAINED BY THE PEOPLE OF THE CHARTER COUNTY OF WAYNE:

SECTION 1. COMMISSION FINDINGS

Based upon a proposed Model Code developed by the National Environmental Health Association and upon further testimony gathered at local hearings, the Wayne County Commission finds as follows:

(A) Body art is widely practiced, particularly among younger persons. It would appear to be an enduring practice, and not merely a quickly passing fad. Injuries, infections and occasional disease transmission is occurring. Most persons assume and believe that body art establishments are already being inspected and monitored by public health authorities.

(B) If body art establishments and practitioners are to be regulated, it should be accomplished in a comprehensive manner.

(C) The environmental health section of public health agencies are best trained and able to provide cost-effective regulation of this kind of activity.

(D) Both body art establishments and individual practitioners should be regulated.

(E) Body art practitioners should be required to demonstrate knowledge, skills and ability in body art, through apprenticeship training requirements, as well as knowledge and proficiency in subjects such as anatomy, universal precautions, disease transmission, skin diseases, and sanitary and sterilization procedures.

(F) A client who is under 18 years of age, should have written consent and presence of a parent or legal guardian.

(G) A practitioner should provide a potential client with both verbal and written health educational information that is needed to make an informed decision, as well as written information regarding a client's responsibilities for after-care. This information should be reviewed and approved by health department officer as to its accuracy and completeness.

(H) A body art establishment should conspicuously post the name, address, and phone number of the regulating agency.

(I) A practitioner should keep a record of all body art services performed, including the name, age, and address of the client; a signed statement of the client regarding any known health problems; and a description of services performed, date of performance, and location on the body. These records should be kept confidential, but must be made available for health inspector review upon request.

(J) All practitioners should be required to obtain a Hepatitis B vaccination series; or HAVE MEDICAL EVIDENCE OF IMMUNITY, OR HAVE AN APPROVED MEDICAL WAIVER.

(J) All practitioners should be required to obtain a Hepatitis B vaccination series; or HAVE MEDICAL EVIDENCE OF IMMUNITY, OR HAVE AN APPROVED MEDICAL WAIVER.

(K) All body art establishments should be equipped with an autoclave or other approved sterilizing equipment.

(L) Temporary body art establishments, such as at street or mall fairs, as well as permanent establishments should also be regulated.

(M) Body art establishments which provide earlobe piercing services ONLY should be exempted from regulation, because there is no compelling medical evidence to indicate that these establishments pose a significant risk to public health.

(N) Fees charged to body art establishments and practitioners should be set at a level which is sufficient to pay for the full costs of a regulatory program.

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SECTION 2. DEFINITIONS (HIGHLIGHTED BY BOLDFACE TYPE IN TEXT)

2.1 "Antiseptic" means an agent that destroys disease-causing microorganisms on human skin or mucosa.

2.2 "Body Art" means the practice of physical body adornment by permitted establishments and practitioners utilizing, but not limited to, the following techniques: body piercing, tattooing, cosmetic tattooing, branding and scarification. It does not include practices or procedures which are considered to be medical procedures by the state medical board, such as, hair or skin implants, or plastic surgery.

2.3 "Body art establishment" means any place or premise, whether public or private, transient, temporary or permanent in nature or location, where the practice of body art, whether or not for profit, is carried out.

2.4 "Body piercing" means any method of piercing the skin or mucosa, except an ear lobe, in order to place any object, including but not limited to rings, studs, bars, or other forms of jewelry or ornamentation, through the skin or mucosa.

2.5 "Contaminated waste" means any liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials and are capable of releasing these materials during handling; and contaminated sharps and pathological and microbiological wastes containing blood and other potentially infectious materials, as defined in 29 Code of Federal Regulations, Part 1910.1030 (latest edition), known as "Occupational Exposure to Bloodborne Pathogens."

2.6 "Cosmetic tattooing" means the practice of deposition pigment into the epidermis, utilizing needles, which is either permanent, semi-permanent or temporary by someone other than a state licensed physician. Cosmetic tattooing shall also mean the same as permanent cosmetics, demography, micropigmentation, permanent color technology and micropigment implantation.

2.7 "Department" means the Wayne County Department of Public Health.

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2.8 "Disinfection" means the killing of those microorganisms on inanimate objects or surfaces which cause disease in humans.

2.9 "Equipment" means all machinery, including fixtures, containers, vessels, tools, devices, implements, furniture, display and storage areas, sinks, and all other apparatus and appurtenances used in connection with the operation of a body art establishment.

2.10 "Handsink" means a lavatory equipped with hot and cold running water under pressure used solely for washing hands, arms, and other portions of the body.

2.11 "Hot water" means water which is at a constant temperature of at least 100 degrees Fahrenheit.

2.12 "Instruments used for body art" means hand pieces, needles, needle bars and other instruments that may come in contact with a client's body fluid during body art procedures.

2.13 "Invasive" means entry into the body either by incision or insertion of an instrument into or through the skin or mucosa, or by any other means intended to compromise the skin or mucosa.

2.14 "Operate/Operator" means an individual who is self-employed and conducts his or her own body art establishment, or who is employed by another person to directly manage the day-to-day activities of a body art establishment.

2.15 "Permit" means written approval by the department to operate a body art establishment. Approval is given in accordance with these regulations and is separate from any other licensing requirements that may exist within communities or political subdivisions within Wayne County.

2.16 "Person" means a natural person, any form of business or social organization and any non-governmental legal entity including but not limited to a corporation, partnership, limited liability company, association, trust or unincorporated organization.

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2.17 "Practitioner" means any person who controls, operates, manages, conducts, or practices body art activities, and who is responsible for compliance with these regulations, whether or not actually currently performing body arts activities. The term includes technicians and persons who assist in the actual performance of body art activities.

2.18 "Procedure surface" means any surface that contacts a client's unclothed body during a body art procedure or any associated work area that may require sanitizing.

2.19 "Sanitize/sanitization" means a treatment of the cleanable surfaces of equipment by a product registered with the United States Environmental Protection Agency and which has been approved by the Wayne County Health Department as being effective in reducing the number of microorganisms to a safe level.

2.20 "Sharps" means any sterilized object that is used for the purpose of penetrating the skin or mucosa including, but not limited to, needles, scalpel blades, razor blades, and broken glass.

2.21 "Sharps container" means a puncture-resistant, leak-proof container that can be closed for handling, storage, transportation and disposal, and is labeled with the international "biohazard" symbol.

2.22 "Single use" means products or items that are intended for one-time, one-person use and are disposed of after use on each client including, but not limited to, cotton swabs or balls, tissues or paper products, paper or plastic cups, gauze and sanitary coverings, razors, piercing needles, scalpel blades, stencil ink cups, and protective gloves.

2.23 "Sterilize/sterilization" means destruction of all forms of microbiotic life, including spores.

2.24 "Tattooing" means any method of placing ink or other pigment into or under the skin or mucosa by the aid of needles or any other instruments used to puncture the skin, resulting in permanent coloration of the skin or mucosa. This includes all forms of cosmetic tattooing.

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2.25 "Temporary body art establishment" means any place or premise operating at a fixed location where a practitioner performs body art procedures for no more than 14 days consecutively in conjunction with a single event or celebration.

SECTION 3. PERMITS REQUIRED

(A) A person shall not operate a body art establishment without an annual permit from the department. The establishment permit shall be conspicuously displayed within the reception area of the establishment. A permit shall clearly indicate whom to contact or call with a complaint. A permit is not transferable and shall not be issued or renewed before the full fee is paid, the premises, equipment, and operations of the establishment have been inspected, and the operator has complied with all inspection deficiencies.

(B) An operator of a permitted establishment shall not allow the practice of body art procedures until the department has determined that the operator is knowledgeable and proficient in:

(C) A permit may be revoked pursuant to the procedures set forth in Section 11 if an inspection determines that a practitioner has failed to follow standard disease control techniques, or has failed to keep required records of services performed, or has provided services to an underage person without the required consent and presence of a parent or legal guardian.

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(D) A person shall not operate a temporary establishment for the performance of body art procedures without a permit from the department. The department may issue a temporary establishment permit for a period of up to 14 days to provide body art services outside the physical site of a permitted establishment for purposes of product demonstration and promotion, industry trade shows, or for educational purposes. The department shall promulgate rules to prescribe reasonable standards needed to assure that body art which is performed in a temporary facility is conducted in a safe, sanitary, and disease-free manner. A temporary permit shall be conditioned upon full compliance with these standards.

(E) A person shall not operate a mobile body art establishment within the County of Wayne. The department shall not permit the use of mobile body art establishments.

(F) The department shall annually recommend to the County commission a permit fee schedule which is sufficient to pay the full costs of this regulatory program.

SECTION 4. BODY ART PROHIBITIONS

(A) A practitioner shall not perform a body art procedure upon a person who is under the age of 18 without the written consent and presence of a parent or legal guardian of that minor. A practitioner shall require positive proof of age from all prospective clients who reasonably appear to be less than 25 years of age, such as a driver's license or equivalent photo identification card, and shall make and keep a photocopy of that proof of age as a part of the permanent client record.

(B) A practitioner shall not perform a body art procedure upon any person who appears to be under the influence of alcohol or other drugs.

(C) A practitioner shall not perform a body art procedure upon a person who has not completed a medical screening questionnaire: This questionnaire shall ask whether the client falls within one or more of the following risk group categories. To protect confidentiality, a client may not be asked to specify the Risk Group.

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SECTION 5. EXEMPTIONS

(A) Physicians licensed to practice in the State of Michigan, who use body art procedures as part of patient treatment, are exempt from these regulations.

(B) An establishment whose practice is limited to the piercing of ear lobes only is exempt from the permit requirements of these regulations, but may be required to demonstrate to a Health Department inspector that equipment, supplies and jewelry that comes in contact with a client's ear are sterile, and that disposable medical examination gloves are used.

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SECTION 6. CLIENT NOTICE REQUIREMENTS

(A) Before performing any body art procedure, a prospective client shall be provided with written factual information regarding the effects, risks, and permanence of that body art procedure. This written information shall first be submitted for approval of the department as to accuracy and completeness. Before undertaking a procedure, a client shall acknowledge on a copy of the written information that he or she has read and understands the information, and this copy shall be retained in the permanent file for that client.

(B) After a procedure is completed, a client shall also be provided with written instructions, also pre-approved by the department, on proper care of the body art site. These instructions shall at a minimum advise the client to consult a physician at the first sign of infection; shall contain the name, address and phone number of the establishment; and shall name the department and phone number to which to make a complaint. If tattooing was performed, this document shall also specify the colors applied and when available, the manufacturer or catalogue identification number of each color applied. This document shall be executed in at least two copies and signed by both the practitioner and the client. A copy shall be provided to the client and another shall be retained in the permanent record.

SECTION 7. REQUIRED RECORDS

(A) An establishment shall maintain a record of all clients who have had body art services performed. This record shall indicate the name, address, phone number, and date of birth of the client; a signed acknowledgment of understanding the pre-procedure information; a signed medical screening questionnaire; a description of procedures performed and name of each practitioner performing the services; proof of age where relevant; proof of parent or guardian consent and presence where relevant; and signed copy of the aftercare instructions and pigment identification.

(B) These records shall be retained for at least five years. These records shall be made available to a Health Department inspector immediately upon request, but shall otherwise be maintained in confidence.

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SECTION 8. STANDARDS FOR PREMISES

(A) A body art establishment shall meet all of the following minimum standards and specifications:

(B) If a new establishment is proposed after the date that this ordinance is adopted, the applicant shall submit a scale drawing of the floor plan for review and approval by the department, before proceeding to construction, as a part of the permit application process.

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SECTION 9. REQUIRED PROCEDURES FOR PREPARING BODY AREA

(A) Before performing a procedure, the skin of and surrounding the area where the procedure is to be performed shall be washed with antimicrobial soap or treated with iodine, as appropriate.

(B) If shaving of the area is necessary, safety razors with single-use blades shall be used and discarded after each use, and the reusable holder shall be autoclaved after each use. After shaving, the shaved area shall be washed with antimicrobial soap and the washing pad shall be discarded after a single use.

(C) In the event of blood flow, all products used to check the flow or to absorb the blood shall be single-use and shall be disposed as bio-hazard waste.

SECTION 10. REQUIRED PROCEDURES FOR PERFORMING BODY ART

(A) A practitioner shall maintain a high degree of personal cleanliness, conform to hygienic practices and wear clean clothing when performing body art procedures. Before performing procedures, a practitioner shall thoroughly wash hands in hot running water using liquid microbial soap, scrubbing for at least one minute, then rinse and dry hands with disposable paper towels. This procedure shall be repeated as often as needed to remove contaminants.

(B) While performing procedures, a practitioner shall wear disposable medical gloves. The gloves shall be disposed at a minimum after each client.

(C) If, while performing a procedure, a glove is pierced, torn, or otherwise contaminated, the glove shall be immediately discarded and hands washed thoroughly before a new glove is applied. Any item dropped on the floor or otherwise contaminated shall be immediately discarded and a new one used.

(D) All reusable instruments used for body art shall be cleaned thoroughly after each use by scrubbing with an antimicrobial soap solution and hot water or by an appropriate disinfectant, to remove blood and tissue residue, and placed in an ultrasonic unit which shall be operated in accord with the manufacturer's instructions.

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(E) After cleaning, all reusable instruments used for body art shall be packed individually in paper peel-packs and sterilized. All paper peel-packs shall contain either a sterilizer indicator or internal temperature indicator. Paper peel-packs shall be dated with an expiration date not to exceed thirty days. Sterile equipment shall not be used after the expiration date without first repackaging and re-sterilizing.

(F) All reusable instruments used for body art shall be sterilized in an autoclave or dry heat sterilizer approved by the department. The sterilizer shall be used, cleaned, and maintained in accord with the manufacturer's instructions. A copy of the manufacturer's instructions must be kept available on the premises for inspection by the department.

(G) Each holder of a permit to operate a body art establishment shall demonstrate that the sterilizer used is capable of attaining sterilization by conducting a monthly spore test through an independent laboratory. The permit shall not be
issued or renewed until documentation of satisfactory testing is presented to the department. Test records shall be kept for at least three years and made available to the department upon request.

(H) After sterilization, an instrument used for body piercing or tattooing shall be stored in a dry, clean cabinet or other tightly covered container reserved for storage of only such instruments.

(I) All instruments used for body piercing or tattooing shall remain stored in sterile packages until immediately prior to performing a body art procedure. When assembling instruments used for performing a body art procedure, a practitioner shall wear disposable medical gloves and use techniques to ensure that the instruments and gloves are not contaminated.

(J) All inks, dyes, pigments and sharps shall be specifically manufactured for performing body art procedures and shall not be adulterated. Immediately before applying a tattoo, the quantity of dye to be used for the tattoo shall be transferred from the dry bottle and placed into sterile single-use paper or plastic cups. Upon completion of the tattoo, these single-use cups and all of their contents shall be discarded.

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(K) All sharps shall be sterilized prior to use and stored in paper peel-packs in the manner prescribed in sub-paragraphs (D), (E), and (F).

(L) Single-use sharps shall not be used for more than one client for any reason. After use, all single-use needles, razors and other sharps shall be immediately disposed in an approved sharps container.

(M) All body art stencils shall be single-use and disposable. Petroleum jellies, soaps and other products used in the applications of stencils shall be dispensed and applied to the area to be tattooed with sterile gauze or in a manner to prevent contamination of the original container and it's contents. The gauze shall be used only once and then discarded.

SECTION 11. SUSPENSION OR REVOCATION OF PERMITS

(A) A permit issued under this Ordinance may be suspended temporarily by the department for failure of the holder to comply with one or more requirements of this Ordinance.

(B) If a permit is to be suspended, the department shall give the holder prompt notice and the suspension shall occur immediately upon receipt of the notice.

(C) If a permit is suspended, the holder may apply at any time for immediate reinstatement of the permit. If a reinspection fee is first paid, the department shall respond promptly and in not less than ten working days to a request for reinstatement. If reinspection determines that the holder has come into compliance with this Ordinance, the permit shall be promptly reinstated.

(D) For serious or repeated violations of the requirements of this Ordinance, the department may permanently revoke a permit. Before issuing a permanent revocation, the department shall give notice in writing of its intent and the reasons therefore, and conduct a hearing within ten working days at which the permit holder may appear and contest those reasons. A permit may be temporarily suspended pending a revocation hearing.

(E) Notice and hearings shall comply with the due process requirements of the Administrative Procedures Ordinance, being Ordinance No. 90-847

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SECTION 12. MISDEMEANOR PENALTIES

(A) If a person who is not exempt under section 5 of this Ordinance violates the permit requirement specified in subsections 3(A) or 3(D) of this Ordinance, or the licensing requirement specified in subsection 3(B) of this Ordinance, or the prohibition on the operation of a mobile body art establishment in subsection 3(E), that person is guilty of a misdemeanor, and shall be subject to a fine of up to five hundred dollars, or a term of confinement in a Wayne County jail facility for up to ninety days, or both. If an establishment which is in violation of subsection 3(A) is owned by an incorporated entity, the person who shall be held liable and guilty under this section is the chief operating executive who is in direct control of establishment operations. If a person is sentenced to a term in a Wayne County jail facility for violating the provisions of this Ordinance, the Sheriff shall take aggressive action to obtain full reimbursement for the costs of that incarceration.

(B) If a person violates the underage consent requirements of subsection 4(A), that person is responsible for a civil infraction and is liable for a civil fine of up to five hundred dollars.

(C) If a person shall impede or impair a health department inspector from carrying out his or her duties as authorized under this Ordinance, that person is responsible for a civil infraction and is liable for a civil fine of up to five hundred dollars.

SECTION 13. PROMULGATION OF RULES

The department may promulgate rules reasonably needed to facilitate performance of its powers and duties under this Ordinance. These rules shall be adopted in conformity with the requirements of the Administrative Procedures Ordinance, being Ordinance No. 90-847.

SECTION 14. SEVERABILITY

If any part of the requirements of this Ordinance is found by a court of competent jurisdiction to be void or unenforceable, all remaining parts of this Ordinance shall remain fully valid and enforceable.

SECTION 15. JURISDICTION

This Ordinance is enforceable in all parts of the County of Wayne except in those Home Rule municipalities which adopt a resolution or ordinance to opt out or which adopt or have adopted a municipal ordinance which addresses this same subject matter.

SECTION 16. EFFECTIVE DATE

This Ordinance is effective on October 1, 1998.
ADOPTED BY THE WAYNE COUNTY COMMISSION APRIL 14, 1998

(98-68-001B)