Section 1200-23-03-.04 - TATTOO OPERATION(1) Universal precautions, as defined in these rules, shall be observed to prevent contact with blood or other potentially infectious materials. Employees shall be trained in universal precautions.(a) Assume all human blood, plasma, serum, body fluids (semen, saliva, breast milk, vaginal secretions and any fluid contaminated with blood) and tissues to be contaminated with Human Immunodeficiency Virus (HIV) and/or Hepatitis viruses (e.g., HBV).(b) The most susceptible route of occupational infection for HIV and HBV is by accidental needle sticks, contamination of the mucous membranes, or through broken, abraded, or irritated skin. Use appropriate caution and maximum protection to prevent such contact.(c) Proper decontamination procedures, emergency biohazard spill management, and proper use of biosafety equipment shall be utilized.(d) Use aseptic technique. Thorough hand washing is essential after client contact, after handling blood and body fluids, after wearing gloves, and prior to exiting the work area.(e) Needles and needle bar assemblies shall be sterilized prior to use. It is permissible to use sterilized disposable needles and disposable needle bar assemblies for tattooing.(f) Nondisposable needle and nondisposable needle bar assemblies shall be soaked in a disinfectant solution for a minimum of thirty (30) minutes prior to removing the needle. Do not remove a used needle from a needle bar by hand. Needles shall be removed from needle bars through the use of gloves and pliers or similar means to prevent accidental puncture. Dispose of needles and other sharps in puncture proof, autoclavable containers, or disposable biohazard containers.(g) After soldering a new needle to the needle bar, the completed assembly (needle and needle bar) shall be sterilized.(h) All regulated wastes shall be disposed of in labeled, manufacturer's color-coded waste containers.(i) A spill kit (bleach, leak proof container, paper towels, gloves, spray bottle) is to be used to clean up infectious material spills. Small spills can be wiped up, after donning protective gloves, with paper towels and sprayed with freshly made ten percent (10%) bleach solution.(j) Clean all work areas and equipment used in handling human biohazardous materials with proven disinfectant (e.g., 10% dilution of bleach) when concluding work to protect personnel from accidental infection.(k) Eating, drinking, smoking, and applying cosmetics or lip balm are not permitted in the work area. Food shall be stored in cabinets or refrigerators designated and used for this purpose only. Food storage cabinets or refrigerators shall be located outside the work area.(l) All procedures shall be performed carefully to minimize the creation of aerosols.(m) Report all work related accidents, incidents, and unexplained illness to your supervisor and/or physician immediately.(n) Used gloves shall be removed after each operation and prior to contacting work surfaces, door knobs, wall switches, or telephones. Dispose of used gloves in a bagged, trash container.(2) Personnel of a tattoo establishment(a) The tattoo establishment operator shall make available, at no cost to the personnel, Hepatitis B vaccination series, as well as any routine booster dose(s) to every person who may have occupational exposure to blood or other potentially infectious material. For new personnel the vaccine shall be made available within ten (10) working days of initial work assignment.(b) Personnel who decline to accept the Hepatitis B vaccination series must sign a form indicating their refusal.(c) The outer clothing of all personnel shall be clean.(d) Each tattoo artist shall use a single use lap cloth.(e) Tattoo artist/operators shall wash their hands with antiseptic soap before and after treating each client (i.e., before glove placement and after glove removal) and after barehanded touching of inanimate objects likely to be contaminated by blood, saliva, or respiratory secretions. Hands shall be washed after removal of gloves, smoking, eating, drinking, or using the toilet.(f) Tattoo artist/operators who have exudative lesions or weeping dermatitis, particularly on the hands, shall refrain from all direct client contact and from handling equipment until the condition resolves.(g) Personnel shall consume food only in approved, designated areas. There shall be no eating or drinking in the operation area of the establishment.(h) Personnel shall not use tobacco in any form while engaged in the operation or process of tattooing, nor while in areas used for equipment or utensil washing. Personnel shall use tobacco only in approved, designated areas.(i) Personnel shall maintain a high degree of personal cleanliness and shall conform to good hygienic practices during all working periods in tattoo studios.(3) Implementation of infection-control practices (a) Disposable latex or vinyl examination gloves shall be worn by a tattoo artist at all times while administering any tattoo. Gloves shall be changed and properly disposed of each time there is an interruption in the application of a tattoo, or whenever their ability to function as a barrier is compromised. Gloves shall be changed between clients and used gloves shall be properly disposed of as provided in these rules.(b) Only single use supplies (or sterilized equipment) may be used to apply a tattoo and shall be disposed of after each tattoo. This subsection includes single use disposable razors; single use towels or wipes; lubricants removed from a collapsible tube; and single use paper stencils or plastic stencils soaked in a germicidal solution. If the design is drawn directly onto the skin, it shall be applied only with a single use article. Single use or individual portions of dye and ink pots or trays shall be used. After tattooing, single use items, dyes, and containers shall be discarded and the tattoo work area disinfected.(c) When it is necessary to shave the area to be tattooed, a new blade for each patron or customer shall be used when a safety razor is employed, and the permanent part of such razor shall be treated as hereinafter set forth for the care of the straight razor or disposable safety razor. If a straight razor is used, it shall be cleaned with soap and water, rinsed in clear water, and then sterilized in an autoclave.(d) A sterile set of needles, needle bar, and tube shall be used for each patron or customer. Dried inks and other materials on instruments must be removed by either ultrasonic cleanser or by soaking in either detergent or disinfectant solution followed by rinsing in clean water prior to sterilization.(e) All tubes, needles, and needle bars shall be sealed for individual client use in autoclave bags with a chemical or autoclave indicator and date (month and year) of sterilization clearly visible. After tattooing, used non-disposable instruments such as tubes shall be kept in a separate, puncture resistant container until properly cleaned, disinfected, and sterilized using universal precautions and recognized medical methods. The needle tube of the tattooing machine shall be cleaned and sterilized in a similar method after use.(f) Microbiological monitoring for adequate functioning of each autoclave will be done at least monthly using a commercial source of Bacillus stearothermophilus which is then tested in an accredited commercial laboratory. All laboratory reports will be logged and kept for two years and shall be available for inspection.(g) Upon notification of a positive microbiological monitoring report (detection of viable spores), the sterilizer shall be immediately checked for proper use and function. A repeat test shall be performed within three (3) days. Upon a subsequent positive result from a repeat test, discontinue use of the sterilizer until properly serviced and a negative result obtained.(h) Sterilizer indicator tape and/or sterilizer bags with indicator tape areas which change color will be used with all items sterilized to indicate the item has been autoclaved. All items shall be marked with the date of sterilization.(i) Sterilized items in the sealed, autoclaved bags shall be stored in a clean, dry place, until used, for no more than one (1) year.(j) Sterilization indicators must change color or discontinue use of autoclave until a negative spore sample is obtained.(k) The requirement for an autoclave shall be exempt in cases where there is only the use of manufactured, pre-sterilized single use, preassembled needle and needle bar, disposable needles, needle bars and needle tubes and similar tattooing equipment, and/or the use of no other equipment or tools requiring sterilization.(4) Minimum standards for tattooing(a) After shaving the area to be tattooed, or if the area does not need to be shaved, the site of the tattoo shall be cleaned with soap and water, rinsed with clean water, and germicidal solution applied or wiped with alcohol in a sanitary manner before the design is placed on the skin.(b) Single-use towels or gauze shall be used in preparing the site to be tattooed and shall be disposed of after use on each patron or customer. The use of roll-on or stick deodorants for tattoo site preparation is prohibited.(c) Excess dye applied to the skin shall be removed with single-use gauze pads, towels, or cotton only. The entire site shall be covered with a sterile gauze dressing or telfa pad.(d) The stencil for transferring the design to the skin shall be maintained in a clean, sanitary condition.(e) Records showing the date of the client's visit, printed name, signature, address, age, design of the tattoo, its location on the body, and tattooist's name shall be kept on the establishment premises for a minimum of 2 years.(f) After each tattooing, written instructions shall be given to each patron or customer on the care of the skin of the tattooed site to prevent infection. A copy of these instructions shall be posted in a conspicuous place in the tattoo establishment, clearly visible to the customer or patron being tattooed. These instructions shall include, but are not limited to, bandaging, cleaning, sun exposure, scratching, and wearing of clothing over or around the tattoo site.Tenn. Comp. R. & Regs. 1200-23-03-.04
Original rule filed September 26, 2000; effective December 10, 2000.Authority: T.C.A. 4-5-202, 62-38-201et seq., and 68-1-103.