THE CIVIC GOVERNMENT (SCOTLAND) ACT 1982 (LICENSING OF SKIN PIERCING AND TATTOOING) ORDER 2006

THE CIVIC GOVERNMENT (SCOTLAND) ACT 1982 (LICENSING OF SKIN PIERCING AND TATTOOING) ORDER 2006 LOCAL AUTHORITY IMPLEMENTATION GUIDE Versin 1.8 Scttish Licensing f Skin Piercing and Tatting Wrking Grup January 2018

Table f Cntents PAGE CHAPTER 1 Intrductin and Overview f the Order. 1 CHAPTER 2 Prcedures Cvered by the Order.. 2 CHAPTER 3 Persns Cvered by the Order 7 3.1 Persns r Premises Licensing Requirements. 7 3.2 Excluded Persns. 9 3.2.1 Regulated Healthcare Prfessinals. 3.2.2 Charities Offering Services Free-f-Charge. 9 10 CHAPTER 4 Requirements f the Order Premises 10 4.1 General State f Repair.. 10 4.2 Physical Layut f Premises.. 10 4.3 Requirements f Waiting Area 11 4.4 Requirements f the Treatment Rm 12 CHAPTER 5 Requirements f the Order Operatr and Equipment 15 5.1 The Operatr. 15 5.1.1 Cleanliness and Clthing. 5.1.2 Cnduct.. 5.1.3 Training.. 16 17 17 5.2 Equipment 18 5.2.1 Skin Preparatin Equipment.. 5.2.2 Anaesthetics 5.2.3 Needles 5.2.4 Bdy Piercing Jewellery 5.2.5 Tatt Inks.. 5.2.6 General Stck Requirements.. 19 20 23 23 25 26 CHAPTER 6 Requirements f the Order Client Infrmatin. 27 6.1 Cllectin f Infrmatin n Client.. 27 Licensing Implementatin Guide Versin 1.8 January 2018 ii

6.1.1 Age 6.1.2 Medical Histry 6.1.3 Cnsent Frms 27 28 28 6.2 Prvisin f Infrmatin t Client 29 CHAPTER 7 Requirements f the Order Peripatetic Operatrs.. 30 CHAPTER 8 Requirements f the Order Ear Piercing.. 31 8.1 Cllectin f Infrmatin n Client.. 33 8.1.1 Age.. 8.1.2 Medical Histry.. 8.1.3 Cnsent Frms.. 33 33 34 8.2 Requirements f the Premises 34 CHAPTER 9 Requirements f the Order Acupuncture.. 36 CHAPTER 10 Cleaning, Disinfectin and Sterilisatin. 37 10.1 Definitins.. 37 10.2 Requirements fr Equipment.. 38 10.3 Cleaning. 38 10.4 Disinfectin 40 10.5 Sterilisatin 40 10.5.1 Standard Steam Autclaves (Passive Air Remval). 10.5.2 Pre-Sterilisatin Vacuum Steam Autclaves.. 10.5.3 Strage and Sterility f Items Fllwing Sterilisatin 10.5.4 Maintenance and Operatin f Autclaves 10.5.5 Indicatrs.. 10.5.6 Legislatin 42 42 43 44 45 46 CHAPTER 11 Additinal Surces f Infrmatin.. 47 APPENDIX 1 Example f Advice Ntices fr Tatting/Piercing Premises 48 APPENDIX 2 Examples f Cnsent Frms... 51 APPENDIX 3 Examples f Aftercare Advice 55 APPENDIX 4 Standard Prtcl fr Operatin f Ultrasnic Baths 61 Licensing Implementatin Guide Versin 1.8 January 2018 iii

CHAPTER 1: INTRODUCTION AND OVERVIEW OF THE ORDER The Civic Gvernment (Sctland) Act 1982 (Licensing f Skin Piercing and Tatting) Order 2006 (hereafter referred t as the Order ) came int frce in Sctland n 1 st April 2006 and gives Lcal Authrities the pwer t license individuals wh carry ut skin piercing r tatting activities as a business. The Order lays ut a number f requirements in relatin t key issues aimed at reducing, if nt remving, risks t public health frm these practices. This infrmatin prvided within this guidance is intended t assist Lcal Authrities in implementing the Order and prvides infrmatin n best practice as well as specific requirements f the Order. This dcument is intended t cmplement the Order and shuld be used by fficers in cnjunctin with bth the Order itself and the Natinal Licence Cnditins prduced by the Scttish Licensing f Skin Piercing and Tatting Wrking Grup. Where recmmendatins exist within these dcuments that are nt laid ut in the Order itself, decisins may be made at a lcal level n the adequacy f cmpliance by a practitiner. Hwever, best practice shuld always be recmmended. Additinal surces f infrmatin cvering sme aspects f the Order, which are cmplementary t these dcuments, are als referred t within this guidance. In summary, the infrmatin that shuld be used by authrities in cnsidering licensing requests is as fllws: The Order all requirements laid ut within the Order must be met by peratrs. Natinal Cnditins can be adpted by authrities at a lcal level. Implementatin Guide prvides best practice infrmatin t assist fficers in making decisins at a lcal level (this dcument). Additinal guidance and legislatin t which reference is made within this dcument. Licensing Implementatin Guide Versin 1.8 January 2018 1

CHAPTER 2: PROCEDURES COVERED BY THE ORDER The Order is very specific in the range f activities that it aims t cntrl: csmetic bdy piercing acupuncture electrlysis tatting Definitins prvided within the Order itself are very precise but the key issues frm thse definitins are as fllws: csmetic bdy piercing is defined as the perfratin f the skin and underlying tissue in rder t create a tunnel in the skin thrugh which jewellery may be inserted this definitin is brad enugh t ensure that piercing f all sites f the bdy are cvered by the Order (except thse in cntraventin f the Prhibitin f Female Circumcisin Act 1985) N.B. The Order hwever des distinguish between piercing the lbe/cartilage area f the ear using a dedicated ear piercing system and piercing all ther parts f the bdy. Guidance n the requirements fr ear piercing using a dedicated system can be fund in Chapter 8 f this dcument. tatting is defined as the insertin int the skin f any cluring material designed t leave a semi-permanent r permanent mark including micrpigmentatin this definitin ensures that prcedures such as csmetic tatting, e.g. eyebrw r lip lining and ther advertised tempt micrpigmentatin prcedures are captured by the Order electrlysis is defined as the remval f bdy hair by electrcutin f the hair rts with an electrified needle acupuncture is defined as the insertin f needles int living tissue fr remedial r therapeutic purpses Table 1 prvides descriptins f skin piercing, beauty treatments and ther bdy mdificatin prcedures and indicates thse prcedures cvered by the Order. Fr thse prcedures nt cvered by the Order, ntes and links t existing infrmatin surces are prvided in rder t assist fficers in dealing with prcedures f that type. Licensing Implementatin Guide Versin 1.8 January 2018 2

TABLE 1 DESCRIPTION OF PROCEDURES COVERD/NOT COVERED BY THE ORDER Prcedure Descriptin Cvered? Ntes Acupuncture Insertin f needles int living tissue fr remedial r therapeutic purpses Culd be classed as Beading Insertin f beads under skin t create 3-dimensinal effect physical assault and wuld require plice investigatin n case-bycase basis Injectin f skin belw wrinkles t Bi skin jetting prmte frmatin f new tissue cntaining yung cllagen and elastic fibres which fill ut the wrinkle Btx Injectin f Clstridium btulinum txin thrugh the skin and int specific muscles t fill ut frwn lines Btx nt currently licensed fr csmetic use in UK requires prescriptin frm medical peratr Braiding Frm f scarificatin which invlves cutting strips f skin, leaving ne end attached, braiding adjacent strips and re-attaching the ends f the strips t skin Culd be classed as physical assault and wuld require plice investigatin n case-bycase basis Branding Frm f scarificatin in which ht metal is used t burn the skin and scar in a desired design Culd be classed as physical assault and wuld require plice investigatin n case-bycase basis Chirpdy Treatment f prblems assciated with the feet and lwer limbs CIEH / Barbur prvides best practice guidance n this prcedure Cllagen Injectins Injectin f cllagen under creased r sunken areas f the face t plump up and reduce their appearance Cln Hydrtherapy Use f warm water, intrduced int the cln via the rectum, t disperse stred waste CIEH / Barbur prvides best practice guidance n this prcedure Licensing Implementatin Guide Versin 1.8 January 2018 3

TABLE 1 cntd Descriptin f prcedures cvered/nt cvered by the Order Prcedure Descriptin Cvered? Ntes Cutting A frm f scarificatin which invlves cutting r slitting the skin t leave permanent scarring Culd be classed as physical assault and wuld require plice investigatin n case-bycase basis Dermal Punches Surgical instruments used fr bdy mdificatins and large gauge piercings Nrmally large gauge piercings in the cartilage r ther part f the bdy Designed t penetrate Derma Rller Skin treatment Treatment by rlling discs ver the skin which has a large number f fine needles the skin t varying degrees and t micr penetrate and disrupt underlying tissue many times as they are applied Ear Piercing Piercing f the ear which culd include lbe, upper cartilage, tragus, cnch r rk Order requirements differ fr piercing f different parts f the ear using different techniques Gradual enlargement f an earlbe Earlbe Stretching piercing. Tissue is stretched, micrtears are frmed which are then allwed t heal befre further stretching takes place. Can be carried ut n piercings at ther sites f the bdy but earlbes are mst cmmn Electrlysis Remval f bdy hair by electrcutin f the hair rts with an electrified needle Eyebrw Piercing Insertin f jewellery thrugh the eyebrw Cautin required t avid nerves just belw the eyebrw Genital Piercing Piercing f the clitral hd, labia, triangle r fchette (females) r glans, freskin, scrtum r urethra (males) Sme female piercings may be in cntraventin f the Prhibitin f Female Circumcisin Act 1985 Licensing Implementatin Guide Versin 1.8 January 2018 4

TABLE 1 cntd Descriptin f prcedures cvered/nt cvered by the Order Prcedure Descriptin Cvered? Ntes Hijama Cupping A cmplementary therapy and invlves cutting f the skin and drawing bld with suctin cups An ancient faith based practice that invlves bldletting Culd be classed as Implants Insertin f 3-dimensinal bjects under skin t create raised effect physical assault and wuld require plice investigatin n case-bycase basis Lip Piercing Piercing f upper r lwer lip area Piercing f the clured part f the lips is nt recmmended A semi-permanent csmetic tatting Micrblading technique f enhancing the eye brws by using fine needle blades t hand draw individual hairs and implanting pigment int the micr cuts. Lasts Pigment implanted in the basal membrane technique mre superficial than tatting apprximately 12 mnths. Cmpsing f tw Micr-Dermal Implants Insertin f an anchr r transdermal implant with jewellery attached cmpnents, an anchr and a step prtruding frm the surface f the surrunding skin Micr- pigmentatin Insertin f semi-permanent dye r pigment int the dermis f the skin Navel Piercing Piercing f either the skin surrunding the navel r the umbilicus Nse Piercing Piercing either thrugh the septum r nstril Nse piercing cannt be carried ut using dedicated ear piercing guns Licensing Implementatin Guide Versin 1.8 January 2018 5

TABLE 1 cntd Descriptin f prcedures cvered/nt cvered by the Order Prcedure Descriptin Cvered? Ntes Scalpelling f Ear Lbes A frm f bdy art similar t piercing fr the creatin f decrative perfratins thrugh the ear-lbe Scalpel used t cut a slit in the skin. Unlike dermal punching where skin is nt remved Culd be classed as Scarificatin Cutting and peeling f the skin t create permanent scarring physical assault and wuld require plice investigatin n case-bycase basis Culd be classed as Stapling Insertin f metal staples int the skin physical assault and wuld require plice investigatin n case-bycase basis Surface Piercing Piercing f flat surface skin, typically n the neck r frearms Very ften rejected by the bdy particularly in areas where skin is tight acrss piercing Definitin used within the Tatting Insertin f permanent dye r pigment underneath the epidermis f the skin Order cvers bth permanent and semipermanent tatting (micrpigmentatin) Tngue Piercing Piercing f the central area f the tngue Cautin is required t avid majr bld vessels Tngue Splitting Tngue is split centrally frm the tip t the centre f the tngue Als knwn as bifurcatin r frking Licensing Implementatin Guide Versin 1.8 January 2018 6

CHAPTER 3: PERSONS COVERED BY THE ORDER The Order applies t all individuals carrying ut a business and ffering the prcedures identified in Sectin 2. 3.1. Persn r Premises Licensing Requirements A licence will be required by businesses r self-emplyed individuals perating either independently within premises r in a peripatetic manner. In rder t clarify the requirements fr a range f ptential circumstances that may arise, Table 2 prvides examples fr illustratin. TABLE 2 - Licence Requirements fr Operatrs Situatin Self-emplyed peratr wrking alne within a fixed premises Operatr wh emplys a number f ther peratrs within a fixed premises Requirement Operatr shall require a licence fr the carrying n f their business and is required t cmply with all cnditins f that licence. The licence hlder shall be respnsible fr: ensuring that any changes t the riginal licence applicatin are ntified t the issuing Authrity within 30 days. surrendering the Licence t the issuing Authrity if called upn t d s fr the purpse f alteratin. Emplyer shall require a licence fr the carrying n f their business and shall be respnsible fr: ensuring that all peratrs in their emplyment are sufficiently trained and experienced, cmmensurate with the prcedures they are carrying ut ensuring that any individual underging training is cntinually supervised by a cmpetent individual ensuring that they, and all thse in their emplyment, cmply with all cnditins f the licence ensuring that any changes t the riginal licence applicatin are ntified t the issuing Authrity within 30 days, e.g. change f peratrs. surrendering the Licence t the issuing Authrity if called upn t d s fr the purpse f alteratin. Licensing Implementatin Guide Versin 1.8 January 2018 7

TABLE 2 cntd - Licence Requirements fr Operatrs Situatin Operatr wh wrks within a fixed premises and rents space ut t self-emplyed peratrs Operatr wh wrks peripatetically renting space in ne r mre fixed premises Operatr wh wrks peripatetically in clients hmes r ther such premises Requirement The principle peratr, i.e. the ne wh is in charge f the premises and rents ut space t ther peratrs, shall require a licence fr the carrying n f their wn business and is required t cmply with all cnditins f that licence. All self-emplyed peratrs wrking within the premises shall require a licence fr the carrying n f their business. This is because they are nt under the directin f the principle peratr and must therefre be cnsidered separately. Where the self emplyed peratr wrks frm mre than ne premises, all premises within which they perate shuld be detailed n that licence. If these premises are in different Lcal Authrity areas the peratr requires a licence frm each Authrity. Each f these named premises will require t cmply with the relevant cnditins cntained within the Order, prir t granting f said licence n.b. Smene wh is merely a landlrd and nt an peratr will nt require a licence. It is the licence hlder s respnsibility t ensure that the premises cmply with the licence cnditins. The licence hlder is respnsible fr: ensuring that any changes t the riginal licence applicatin are ntified t the issuing Authrity within 30 days. surrendering the Licence t the issuing Authrity if called upn t d s fr the purpse f alteratin. Operatr shall require a licence frm every Lcal Authrity within which they will perate and is required t cmply with all cnditins f that licence. The licence hlder is respnsible fr: ensuring that any changes t the riginal licence applicatin are ntified t the issuing Authrity within 30 days. surrendering the Licence t the issuing Authrity if called upn t d s fr the purpse f alteratin. When cnsidering applicatins frm peripatetic peratrs, an equivalent level f cmpliance is required as fr fixed premises. Due t the likely inability t cmply with all natinal licence cnditins, it is nt cnsidered apprpriate r acceptable fr licenses t be granted t peripatetic peratrs wh prpse t wrk in clients hmes r ther such premises. As such, licenses issued t peripatetic peratrs shuld relate t perating peripatetically frm ne r mre fixed premises e.g. renting space in multiple fixed premises and nt at client s hmes r similar premises Licensing Implementatin Guide Versin 1.8 January 2018 8

TABLE 2 cntd - Licence Requirements fr Operatrs Operatr wh wrks slely frm hme Operatr shall require a licence fr the carrying n f their business and is required t cmply with all cnditins f that licence. *The hme shall be treated as a premises fr the purpses f the licensing prcess and shuld meet all requirements f the Order. The licence hlder is respnsible fr: ensuring that any changes t the riginal licence applicatin are ntified t the issuing Authrity within 30 days. surrendering the Licence t the issuing Authrity if called upn t d s fr the purpse f alteratin. 3.2 Excluded Persns 3.2.1. Regulated Healthcare Prfessinals Individuals wh are registered with, r regulated by, bdies mentined in Sectin 25(3) f the Natinal Health Service Refrm and Health Care Prfessins Act 2002 are exempt frm the Order. These statutry bdies are regulated by the Prfessinal Standards Authrity (PSA) and at date f publicatin, the nine regulatry bdies verseen by the PSA (http://www.prfessinalstandards.rg.uk/regulatrs/statutry) are as fllws: General Chirpractic Cuncil (GCC) General Dental Cuncil (GDC) General Medical Cuncil (GMC) General Optical Cuncil (GOC) General Ostepathic Cuncil (GOsC) Health and Care Prfessins Cuncil (HCPC) Nursing and Midwifery Cuncil (NMC) Pharmaceutical Cuncil f Nrthern Ireland (PCNI) General Pharmaceutical Cuncil (GPhC) N.B. Exemptin frm the Order applies nly t rganisatins that are listed within the PSA statutry register. Organisatins listed within the vluntary accredited register f the PSA are nt exempt frm the Order. Licensing Implementatin Guide Versin 1.8 January 2018 9

3.2.2. Charities ffering services free-f-charge Given that the Order applies t the carrying n f a business, registered charities ffering any f the prcedures gverned by the Order shall be exempt frm licensing requirements. Many charities within Sctland wh currently ffer acupuncture, r acu-detx, are registered with an rganisatin called NADA-UK which ffers training t substance misuse services acrss the UK in ear acupuncture (using nly single-use needles) which is ffered t clients free f charge. Upn cmpletin f training, peratrs receive a permissin-t-practice certificate and they are then re-assessed n an annual basis t ensure cntinued fitness-t-practice. Hwever, authrities shuld be aware that many ther charity wrkers may be practicing in Sctland and may nt have such evidence f charity status as readily available. CHAPTER 4: REQUIREMENTS OF THE ORDER PREMISES 4.1. General State f Repair One basic requirement f the Order is that any premises within which skin piercing r tatting activities are cnducted shuld be in a gd state f general repair. This requirement cvers nt nly general cleanliness f premises but als advises that adequate levels f lighting and ventilatin, cmmensurate with the practices being carried ut n that premises, shuld be available. Anther general requirement f the premises is that all walls and flr surfaces shuld be bth smth, washable and durable in rder t ensure that cleanliness can be maintained. 4.2. Physical Layut f Premises In rder t minimise ptential public health risks and t ensure client privacy, the Order states the requirement that separate rms are prvided fr (i) waiting area; and (ii) the carrying ut f skin piercing r tatting. The Oxfrd English Reference Dictinary defines a rm in this cntext as a part f a building enclsed by walls r partitins, flr and ceiling. Therefre, in terms f the Order, the fllwing shuld be ensured: these rms shuld have a full physical divide, i.e. flr t ceiling the dividing wall shuld be cnstructed frm smth, washable and durable material bths which are nly partially segregated frm a waiting area either nn-flr t ceiling partitin/wall r curtain are nt acceptable in terms f the Order Licensing Implementatin Guide Versin 1.8 January 2018 10

screens are nt acceptable in terms f the Order these rms shuld be separated by a clse-fitting smth, impervius dr salntype drs are nt acceptable in terms f the Order a general purpse sink with ht and cld running water. Ideally this shuld be lcated ut with the treatment rm. Whilst nt a requirement in terms f the Order, the physical layut f the premises shuld be such that a client is ensured privacy during the prcedure, e.g. where a windw exists in a dividing wall between a studi waiting rm and treatment rm, this windw shuld be equipped with a washable/durable/nn-fabric screen which can be clsed at the request f the client. Similarly, fr premises where the treatment rm may be visible frm utside the premises, apprpriate washable/durable/nn-fabric screens shuld be available t ensure client privacy. 4.3. Requirements f Waiting Area As well as fulfilling the requirements f 4.1 and 4.2, a number f requirements are placed n the waiting area by the Order. Licence hlders are required t advise/prvide infrmatin t ptential clients using psters displayed within the waiting area - n a number f issues and rules in terms f their business: Clients shuld be advised that piercing r tatting will nt be carried ut n an individual wh is under the influence f drugs r alchl Clients shuld be advised that tatting will nt be carried ut n an individual under the age if 18 years Clients shuld be advised that piercing will nt be carried ut n individuals under the age f 16 years unless accmpanied by a persn wh has parental rights and respnsibilities in respect f that child and wh has als given their cnsent in writing t the piercing Clients shuld be advised f the ptential risks assciated with the bdy piercing r tatting prcedure these risks shuld include : allergic reactin t, r ptential embedding f, jewellery Licensing Implementatin Guide Versin 1.8 January 2018 11

allergic reactin t pigment. migratin and pssibly rejectin f jewellery lcalised infectin at the piercing/tatt site lcalised swelling and trauma at the piercing site kelid r scar frmatin bld pisning/septicaemia *Example ntices fr tatting and piercing premises are presented in Appendix 1. These can be used by fficers and distributed t licence hlders/applicants in cases where fficers are nt satisfied that these requirements are currently being fully met. Clients shuld be able t view names and phtgraphs f all licensed and authrised peratrs perating within the premises Clients shuld be able t readily view the licence, which shuld be clearly displayed n the premises Clients shuld be able t readily view the licence-hlder s Public Liability Insurance certificate, which shuld be clearly displayed n the premises 4.4. Requirements f the Treatment Rm As well as fulfilling the requirements f 4.1 and 4.2, a number f key requirements exist fr the treatment rm within licensed premises: All walls, flrs and surfaces shuld be smth, washable and durable. carpets must nt be used in the treatment rm as these cannt be prperly cleaned, can harbur bacteria and can increase the pssibility f crsscntaminatin sme peratrs cver all surfaces next t the treatment chair/cuch with prtective barriers, e.g. cling film, paper sheets this practice is acceptable prvided these barriers are changed between clients and dispsed f apprpriately Licensing Implementatin Guide Versin 1.8 January 2018 12

All areas f the treatment rm shuld be kept as clutter-free as pssible t ensure that cleaning f the area can be carried ut easily and effectively If it is necessary t lcate the general purpse sink within the treatment rm then tw distinct areas shuld be designated clean and dirty with all cleaning f cntaminated equipment taking place nly in the latter, as far frm the area where prcedures are cnducted as pssible. (see als page 35 Chapter 9 pertaining t acupuncture) The general purpse sink shall be lcated within the dirty area f the premises with a cnstant supply f ht and cld running water fr cleaning equipment prir t ultrasnic cleaning and autclaving. this sink shuld nt be used fr hand washing and shuld be clearly marked t indicate this. this shuld be psitined as far as pssible frm the area f the premises in which the piercing r tatting takes place The treatment rm shuld be equipped with a wash-hand basin with nn-hand perated taps and an adequate supply f ht and cld running water hand washing instructins shuld be clearly displayed at this basin. under n circumstances shuld equipment be washed at this basin. elbw perated taps are suitable fr this use. infra-red perated taps are suitable fr this use. electric geysers are acceptable fr this use prvided they are fitted with an adequate supply f water and nn hand perated cntrls. Self-Standing Mbile Units will nly be acceptable if demnstrated that fitting f pipewrk and/r installatin f drains is nt physically pssible. Such units must be maintained as per manufacturer s instructins. The rm shuld be equipped with a sap dispenser cntaining liquid sap, which shuld be adequately stcked fr the wrking day t minimise the need t fill up within hurs during which the premises is peratinal. slid sap bars shuld nt be used as these can harbur bacteria and increase the pssibility f crss-cntaminatin. The rm shuld be equipped with a paper twel dispenser, which shuld be fully stcked at the start f each wrking day t minimise r reduce the need t fill up within hurs during which the premises is peratinal. Licensing Implementatin Guide Versin 1.8 January 2018 13

fabric twels shuld nt be used as these can increase the pssibility f crss-cntaminatin. The treatment rm shuld be equipped with a supply f detergent, fresh bleach cntaining minimum 1000ppm available chlrine r ther purpse-designed disinfectin prducts, and alchl slutin in rder that envirnmental cleaning can be cnducted at the end f each day r whenever siling f surfaces ccurs. In the event f bld r bdily fluid cntaminatin, fresh bleach cntaining 10,000 ppm available chlrine shuld be used. The treatment rm shuld be equipped with tw pedal-perated bins, clearly marked fr clinical and nn-clinical (general) waste. The licence hlder is respnsible fr ensuring that : all peratrs dispse f waste in the apprpriate bin clinical and general (dmestic) waste is apprpriately segregated and stred in clearly marked bags all clinical waste (as defined in the current Cntrlled Waste Regulatins) is stred, cllected and dispsed f by a cntractr licensed under the Waste Management Licensing Regulatins. recrds f all waste dispsal are retained n the premises. The treatment rm shuld be equipped with a sharps cntainer fr dispsal f sharps and needles after use in preparatin fr dispsal this cntainer shuld cmply with the requirements f BS 7320:1990 the cntainer shuld be kept ut f reach f clients the licence hlder shuld ensure that the cntainer is remved as necessary, sealed and apprpriately labelled the cntainer shuld nt be filled t such an extent that it cannt be clsed r sealed peratrs shuld never place needles in with ther waste The chair/bench/cuch used fr the client shuld be washable and cmpletely cvered with dispsable paper sheets a new sheet shuld be used fr each client and the chair shuld be cleaned dwn after each client and thrughly cleaned at the end f each day r where siling f the chair ccurs. cntinuus cuch rlls are acceptable fr cvering the chair. Licensing Implementatin Guide Versin 1.8 January 2018 14

The Order des nt stipulate that separate treatment rms shuld be used fr each client the nly requirement in the Order is that the treatment rm shuld be separated frm the rm used fr waiting/seating. Therefre, prvided adequate space exists within the treatment rm fr peratrs t safely perate, and client privacy can be ensured, it is pssible t have mre than ne chair/bench/cuch within a treatment rm. If screens are used t ensure client privacy then these shuld be cnstructed frm washable and durable material. Best practice wuld recmmend nly ne chair/cuch within the treatment rm. Where mre than ne chair/cuch is present, enugh space shuld exist fr peratrs t place a washable, durable screen between these and still have adequate space t perate These screens shuld be washed dwn between clients and at the end f the day using fresh bleach cntaining minimum 1000ppm available chlrine r ther purpse-designed disinfectin prducts. In the event f bld r bdy fluid cntaminatin, fresh bleach cntaining 10,000 ppm available chlrine shuld be used. Guidance n this issue may be expanded as further investigatin is carried ut in this area. CHAPTER 5: REQUIREMENTS OF THE ORDER OPERATOR AND EQUIPMENT In rder t minimise the risk t public health, the Order lays ut a number f requirements in relatin t bth the peratr and the equipment that they use. 5.1. The Operatr Operatrs are required t wrk t the highest standards at all times, in cmpliance with the requirements f bth the Order and the Natinal Cnditins. Where a number f peratrs wrk within a premises, emplyed by the licence hlder, it is the duty f the licence hlder t ensure that all peratrs are in full cmpliance. The licence hlder shuld, fr the prtectin f bth the peratr and the client, ensure that all peratrs are immunised against Hepatitis B. Licensing Implementatin Guide Versin 1.8 January 2018 15

5.1.1. Cleanliness and Clthing Each peratr shuld maintain an acceptable standard f persnal cleanliness at all times. Operatrs shuld wear clean washable clthing when wrking with clients. It is advised that peratrs wrk wearing an aprn a fresh plastic dispsable aprn shuld be wrn fr each client. Operatrs hands shuld be washed with liquid sap and water and dried with a dispsable paper twel: befre cmmencing, and after cmpleting, each prcedure. if/when hands becme cntaminated with bdy fluid/bld/secretin. befre dnning, and after remving, dispsable nn-latex glves. after visiting the tilet. after handling mney. befre and after eating, drinking and smking. Any cuts r brken skin n the peratr s hands shuld be cvered with a waterprf dressing. Operatrs shuld wear dispsable nn-latex glves whilst carrying ut piercing r tatting prcedures. These shuld be changed and replaced with a fresh pair fr every client. at any ther time during a prcedure when glves becme punctured. if the peratr mves away frm the clean area. if the peratr requires t handle anything that may pse a risk f cntaminatin. Glves shuld be dispsed f as clinical waste. Licensing Implementatin Guide Versin 1.8 January 2018 16

5.1.2. Cnduct Operatrs shuld never undertake any prcedure whilst under the influence f drugs r alchl. Operatrs shuld nt, under any circumstances, eat, drink r smke during prcedures. 5.1.3. Training N frmal r recgnised training currently exists fr tatting r bdy piercing. Officers shuld be aware that a number f bdies currently issue certificates t piercers r tattists wh cmplete a range f curses, but these certificates can, in n way, be taken as a guarantee that the peratr is qualified in this area. Under the Health and Safety at Wrk etc. Act, 1974, licence hlders, as emplyers, are required t ensure that they prvide all infrmatin, instructin, training and supervisin necessary s far as is reasnably practicable t prtect the health and safety f their emplyees. Hwever, as there are n currently recgnised training curses, it is the duty f emplyers t prvide adequate n-the-jb training fr emplyees. Until such times as accredited curses becme available, in rder t ensure best practice, fficers are advised t ensure that: All licence hlders are aware they, and every peratr wrking under their licence, must be capable f demnstrating that they have sufficient knwledge, skills, training and experience cmmensurate with the prcedures they are carrying ut. Sme peratrs ffer apprenticeships in rder that new trainees can learn the skills and knwledge required whilst carrying ut lw risk and nn-invasive tasks/prcedures within the premises. Operatrs shuld be able t demnstrate a knwledge f general infectin cntrl and sterilisatin prcedures. Operatrs shuld be able t discuss and demnstrate cleaning prcedures and the peratin and use f ultrasnic baths and sterilisatin equipment, e.g. autclaves. Licence hlders shuld ensure that trainees are under the supervisin f an experienced and cmpetent peratr at all times. Licensing Implementatin Guide Versin 1.8 January 2018 17

Mre recgnised training is nw available fr the likes f micr-pigmentatin, semipermanent make up r micrblading. Hwever such training shuld nt be accepted as cmplete until verificatin has been received that the prtfli element has been successfully cmpleted i.e. case studies. This is particularly imprtant as sme curses can be shrt and the practical element f prtfli wrk is critical. Unlike tatting r skin-piercing apprenticeships that take lnger and have mre practical wrk assciated. The Licence hlder shall ensure there is sufficient first aid cver within the premises at all times and that an peratr hlds a current first aid certificate t fundatin (1-Day) level. Licence applicants shuld be advised that this is the equivalent f a ne-day curse. Licence hlders shuld retain cpies f certificatin fr all peratrs, available fr inspectin. Officers shuld ensure that certificates are prduced fr all peratrs named n the licence. Licence hlders and Operatrs shuld be familiar with the preparatin f risk assessments (r at least written methd statements acknwledging the risks invlved in their business) fr the wrk undertaken This shuld be recmmended as part f nging training fr apprentices/trainees. Gd, clear advice n the preparatin f risk assessments can be fund in Bdy Art, Csmetic Therapies and Other Special Treatments (CIEH and Barbur Index, 2001) which fficers can adapt fr distributin t licence hlders if desired. HSE Website http://www.hse.gv.uk/risk/index.htm 5.2. Equipment Bth the Order and the Natinal Cnditins cntain a range f requirements in relatin t equipment held and used within premises. Cnditins may be in relatin t the way in which equipment is stred r used, r in relatin t minimum requirements that are expected in terms f licensing. Licensing Implementatin Guide Versin 1.8 January 2018 18

It is strngly recmmended that single-use equipment shuld be used wherever pssible, and fficers shuld always advise peratrs twards this practice. It is als imperative that peratrs are aware that under n circumstances shuld single-use equipment be re-used. It is unacceptable fr peratrs t attempt t clean/sterilise single-use equipment fr re-use. Where it is nt pssible t use single-use equipment, the cleaning and sterilisatin prcedures utlined in Chapter 10 shuld be clsely fllwed by peratrs. Any nn-dispsable equipment that is liable t cme int cntact with bld r bdy fluids and cannt be sterilised, fr example tatt mtrs, shuld be adequately cvered (where pssible) t prtect frm such cntact and shuld be thrughly cleaned between clients. A 70% alchl slutin is cnsidered mst apprpriate fr this purpse. Sme peratrs enclse the tatt mtr and clip-crd within dispsable plastic bags r plastic film this practice is acceptable prvided the bag/cver is changed (and the machine cleaned as described) after every client. This same technique is acceptable fr items such as water spray bttles, lamps (where pssible and nt psing fire hazard) and any ther items that may be required in the immediate vicinity f the treatment cuch/bench/chair. Operatrs shuld als ensure that adequate strage space exists within the premises (treatment rm) fr all items in rder t minimise ptential fr crss cntaminatin f items sitting in the pen air fr lng perids f time. This strage shuld be abve grund level, i.e. items shuld nt be lying n the flr f the premises. Flr standing cupbards and cabinets are acceptable, as are wall-fixed units. 5.2.1. Skin Preparatin Equipment Where required, nly single-use dispsable razrs are acceptable fr use n the skin The area f the skin t be treated shuld be cleaned using an apprpriate skin-safe antiseptic. If the skin is visibly dirty then the area shuld first be cleaned with sap and water and dried with a paper twel. Licensing Implementatin Guide Versin 1.8 January 2018 19

A 70% alchl-impregnated swab (typically 70% isprpyl alchl) is the preferred methd and peratrs shuld be directed twards this methd. The swab shuld be wiped ver the skin fr 30 secnds and the skin left fr a further 30 secnds t dry in rder t render any bacteria inactive. Chlrhexidine (typically in alchl) is smetimes used if s, this shuld nly be in the frm f individually pre-packed swabs as bulk packed swabs are cntaminated nce pened. Betadine is ften a skin disinfectant f chice but may ptentially cause cell damage t sensitive tissue and can stain bth wrk surfaces and equipment Where it is necessary t mark the skin, a single-use water-based marker pen shuld be used, r a suitable single-use alternative If peratrs use markers dipped in ink (r any ther similar material fr marking the skin) then ink shuld be dispensed int a single-use pt fr each client. If this is nt the case then the entire bttle shuld be discarded after each client. Where prducts such as antiseptic cream r petrleum jelly are used fr prcedures, single-use packs shuld be used. Given that this may nt always be pssible: An apprpriate amunt f material shuld be dispensed, using a single-use implement, int a single-use pt fr every client. squeezable, cllapsible tubes r pump packs which displace liquids/gels withut taking in air are recmmended fr this purpse. Under n circumstances shuld peratrs use cream/ltin direct frm a jar/tube. Rll-n r stick applicatrs are nt acceptable fr use. The peratr s hands, even if glved, shuld never cme int cntact with the cntents f these jars/tubes. 5.2.2. Anaesthetics Much debate has surrunded the use f anaesthetics by bdy piercers r tattists. In rder t make a judgement n the use f these substances, it is imprtant t cnsider bth the legal aspects f ding s and the ptential adverse effects f their use. Licensing Implementatin Guide Versin 1.8 January 2018 20

The Human Medicines Regulatins (2012) identifies individuals wh can legally prvide supply, and/r administer, medicines (including anaesthetics) in the UK. Hwever, these prducts can be categrised depending n the amunt f cntrl r limitatin placed n their supply r administratin. Prescriptin Only Medicines these require t be dispensed by pharmacists in respnse t a prescriptin r script frm a registered prescriber. These wuld typically be prescribed by a medical dctr r dentist r ther registered nn-medical independent prescriber. Any medicine that is injected int the bdy autmatically becmes a prescriptin nly medicine. Use f any prescriptin nly medicine shuld nly be as a result f it being prescribed by a client s dctr. Pharmacy Medicines these are supplied r sld nly within a cmmunity pharmacy under the supervisin f a pharmacist but d nt require prescriptins. These can be used, and administered by, anyne purchasing them. Mst cmmnly used anaesthetics fall int this categry, e.g. ligncaine-based cream r spray, EMLA cream. These cannt be injected nly fr tpical applicatin (if injected, autmatically becme prescriptin nly medicines) General Sales Medicines these can be purchased frm a wide range f utlets, e.g. supermarkets. These can be bught whlesale fr the purpse f carrying ut a business, prvided they are used nly fr the purpse fr which they are licensed in the UK. Much f the debate surrunding the use f anaesthetics in the bdy piercing industry relates t the ptential adverse health effects fllwing their administratin. In particular, cncern has surrunded the use f ethyl chlride spray. Ethyl chlride is a highly vlatile liquid, which causes lcal anaesthesia when applied t the skin. Hwever, prlnged cntact can lead t a frstbite-like reactin f the skin. Due t the Licensing Implementatin Guide Versin 1.8 January 2018 21

ptential fr this adverse effect, Officers shuld ensure that licence hlders d nt use, r allw thse wrking under their cntrl t use, ethyl chlride spray. Where licence hlders are currently using ethyl chlride spray, its use shuld be discntinued and all remaining slutin dispsed f as special waste. Where peratrs d chse t use tpical r spray anaesthetics, fficers shuld nte: Creams r sprays shuld nly be used fr the purpse intended by the manufacturer and fr which they are licensed in the UK. Operatrs must advise clients that an anaesthetic will be used and, in fllwing the infrmatin prvided by the manufacturer, discuss any ptential allergy r cntraindicatin with the client. A cntraindicatin is smething that indicates against the carrying ut f a particular treatment. Where cncern exists, the anaesthetic shuld nt be administered until the client has discussed this with, and btained written authrisatin frm, their GP cpies f this infrmatin shuld be retained n recrd by the peratr. Xylcaine is an anaesthetic that is primarily used in either spray frm (lidcaine) r as a 4% tpical slutin (lidcaine hydrchlride). Neither prduct is specifically licensed fr tngue piercing (licenses were granted in 2002), i.e. tngue piercing is nt specifically listed as an indicatin fr which either prduct is licensed in the Summary f Prduct Characteristics. Cncern exists ver the use f Xylcaine spray fr piercings f the muth due t ptential cmplicatins. Xylcaine 4% tpical slutin can be applied t specific areas using single-use swabs, which can be discarded after use. It is recmmended that piercers currently using Xylcaine spray shuld be advised t change t Xylcaine 4% tpical shuld they wish t cntinue using this as an anaesthetic. As with all anaesthetics, peratrs must fllw all infrmatin regarding cntraindicatins prvided by the manufacturer and discuss, as apprpriate, with the client befre use. EMLA cream (2.5% lidcaine, 2.5% prilcaine) has recently been changed frm a prescriptin nly medicine t a pharmacy medicine in the UK. Anaesthetics shuld nt be injected by bdy piercers r tattists. Licensing Implementatin Guide Versin 1.8 January 2018 22

Where fficers are unfamiliar with the status (prescriptin nly, pharmacy r general sales medicine) f anaesthetics being used by an peratr, full details f the prduct name, manufacturer, active ingredients and strength shuld be btained. These can be used t find ut the status f the medicine in the UK and HPS can prvide assistance t authrities in this area. 5.2.3. Needles Only sterile single-use needles r cartridge systems shuld be used fr skin piercing r tatting. Fr skin piercing, the peratr shuld pen pre-sterilised single-use needles in frnt f the client just befre beginning the prcedure (nce dispsable nn-latex glves have been dnned). Needles shuld either be used directly frm the packaging r placed n a sterile surface/tray. Fr tatting, needles shuld either be sterile prepacked pre-cnstructed clusters f needles r sterile single-use needles sldered nt a needle bar. Where needles are sldered nt a needle bar, the entire cnstructin shuld then be cleaned and sterilised prir t use. Needles shuld be examined fr imperfectins prir t their use and discarded if any exist. Needles shuld always be dispsed f in a BS apprved sharps cntainer. Where cartridge systems are used the cartridges must be supplied with suitable membranes that prevent back tracking f bld r ther fluids. 5.2.4. Bdy Piercing Jewellery Operatrs shuld ensure that all jewellery used fr skin piercings is sterile prir t its use. Where jewellery is nt purchased pre-sterilised but is sterilised within the premises, the methd by which sterilisatin has been carried ut will determine hw sterile the jewellery remains. In rder t ensure lasting sterility, jewellery shuld be sterilised in apprpriate puches within a pre-vacuum steam autclave (see Chapter 10) with pst-sterilisatin drying phase. Licensing Implementatin Guide Versin 1.8 January 2018 23

The packaging material must be cmpletely dry befre the dr f the autclave is pened as micrrganisms may be able t penetrate the wet r damp packaging and cntaminatin f the jewellery can take place frm the mment the dr pens. Packages cntaining jewellery cannt be remved damp frm the autclave and dried subsequently. Jewellery will nt remain sterile if remved frm the autclave and placed int packages after sterilisatin. If jewellery is prcessed and stred prperly, it may retain its sterility indefinitely. Hwever, licence hlders shuld be advised t discuss issues such as shelf life with equipment (and packaging) manufacturers. A number f materials are used in skin piercing jewellery and acceptable materials include: Titanium Nibium Platinum Gld preferably slid gld 14 carat r 18 carat (fr ear piercing see Chapter 8) The use f gld higher than 18 carat is nt recmmended in bdy piercing as it is t sft and the ptential exists fr scratching r pitting f the metal which may increase the risk f infectin at the piercing site The use f gld lwer than 14 carat is nt recmmended in bdy piercing as it tends t be lwer in quality and has the ptential t cntain metallic impurities, which may lead t allergic respnse in the pierced individual Stainless steel has, histrically, been the material f chice fr many bdy piercers. Hwever, where stainless steel is being used, licence hlders shuld btain (and retain fr inspectin) evidence frm the manufacturer that the jewellery is in cmpliance with the Dangerus Substances and Preparatins (Nickel) (Safety) Regulatins 2005. These Regulatins prhibit the supply f any prducts that may be intended t cme int direct and prlnged cntact with the skin, which may cntain nickel r nickel cmpunds. Items cvered by the regulatins include earrings r ther jewellery t be inserted int a piercing site n the human bdy. The Regulatins als cver a wide range f ther items such as necklaces, bracelets, wristwatch cases, zips and buttns. Licensing Implementatin Guide Versin 1.8 January 2018 24

Under these Regulatins, jewellery can nly be used if the nickel release rate frm thse parts f these prducts cming int direct and prlnged cntact with the skin is 0.5 micrgrams per square centimetre per week, r less. Fr bdy piercing jewellery, pst assemblies - the part f the jewellery that is inserted int the wund caused by the piercing f the skin, including bth the piece that ges thrugh the wund and thse parts f the jewellery intended t hld the piece in and against the wund (earring back r balls n the end f a piercing bar r stud) - are prhibited unless their rate f nickel release is 0.2 micrgrams per square centimetre per week, r less. One prblem with these Regulatins is that they d nt apply t jewellery manufactured fr exprt t cuntries utside the Eurpean Unin. Where peratrs cannt prve that jewellery being used is in cmpliance with these regulatin, it is advised that use f that jewellery stps until the peratr can btain evidence frm the manufacturer f its cmpliance. 5.2.5. Tatt Inks Requirements exist within the Order fr either pre-packed inks in single-use vials r sterile pigment dispensed int single-use pts. Althugh a great deal f cncern surrunds the micrbilgical and chemical quality f inks used in tatting, very little cntrl currently exists ver their manufacture, supply r use within and ut with the UK. Pigments used in tatting are typically prduced fr a variety f ther uses, and never intended fr intradermal injectin. The majrity f reprts cncerning micrbilgical and chemical quality f inks surrund unpened inks as supplied frm manufacturers. Very little investigatin has been cnducted n the change in micrbilgical quality f inks nce pened, where bttles are pened and ink is decanted int pts. Hwever, in rder t minimise cncerns ver tatt inks and their ptential harm t health until evidence becmes available, fficers shuld nte the fllwing: Whilst nt currently widely available in the UK, pre-packed single-use vials f sterile inks are likely t becme mre readily available in future and peratrs shuld be advised that this wuld be the preferred ptin in terms f ink supply and use. Regardless f the frm in which inks are purchased, peratrs shuld be advised that they require t btain (and retain fr inspectin) evidence frm the ink supplier f the sterility f the ink in terms f micrbilgical cntaminatin and the absence f ptentially txic metals peratrs shuld be advised against purchasing inks frm manufacturers r suppliers wh cannt prvide this evidence. Licensing Implementatin Guide Versin 1.8 January 2018 25

Operatrs shuld be advised t purchase the smallest vlumes f ink available, particularly fr clurs that are required r used less ften, in rder t minimise ptential fr cntaminatin f ink remaining within bttles. Operatrs shuld be advised t purchase inks which are apprpriately labelled with clear indicatin f their durability n the label, r shuld be requested t btain frm a manufacturer r supplier, infrmatin n the shelf-life f inks bth sealed and nce pened. It wuld be cnsidered gd practice fr peratrs t retain a recrd f purchase dates and dates f pening fr all inks used and stred n the premises in rder t ensure that ut f date inks are identified and discarded apprpriately. Operatrs shuld be advised that when decanting ink frm larger ink bttles int singleuse pts, this shuld be carried ut in a designated area away frm the treatment cuch/chair and nly enugh ink fr ne client shuld be decanted. Operatrs shuld discard all unused ink with the pt at the end f each treatment (client). Ink bttles shuld be stred accrding t the manufacturers instructins. Where instructins are nt available, bttles shuld be stred in a cupbard within the premises in rder t minimise the ptential fr phtlytic breakdwn f the pigments and reduce the expsure f the bttles t the atmsphere within the treatment rm. Operatrs may be advised that bttles may be cvered by a fresh plastic bag as a barrier t ptential cntaminatin this bag shuld be changed each time the bttle is handled. Operatrs shuld be advised t purchase nly pre-diluted inks, where pssible. If cncentrated inks are being diluted n the premises, the peratr shuld use nly sterile water. This dilutin shuld always take place in a clean area within the premises and the diluent shuld be bth sterile and pre-packed fr single use. 5.2.6. General Stck Requirements Operatrs are required by the Order t hld a stck f a number f items in rder t ensure that they maintain adequate supplies t prtect bth themselves and their clients. Fr sme f these items, peratrs need nly retain a stck if they carry ut certain prcedures cvered by the Order. The fllwing list is intended fr use by fficers when discussing stck requirements with licence hlders: Licensing Implementatin Guide Versin 1.8 January 2018 26