General Information	State of Indiana
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Indiana Body Art Sterilization Guidelines

.Legislation
In 1997, Senate Bill No. 13 was passed. This bill addressed tattooing in Indiana. The following are highlights of this legislation:

The law defined tattooing as: (1) any indelible design, letter, scroll, figure, symbol, or other mark placed with the aid of needles or other instruments; or (2) any design, letter, scroll, figure, or symbol done by scarring upon or under the skin.
The law lists criminal penalties for tattoo artists that provide tattoos to persons less than 18 years, unless a parent or legal guardian is present at the time the tattoo is provided and provides written permission for the person to receive the tattoo. Complaints regarding this issue should be directed to local law enforcement.
The law required that the Indiana State Department of Health (ISDH) adopt rules to regulate the sanitary operation of tattoo parlors.
In 1999, Senate Bill No. 38 was passed. This bill addressed body piercing in Indiana. The following are highlights of this legislation:

The law defined body piercing as the perforation of any human body part other than an earlobe for the purpose of inserting jewelry or other decoration or for some other nonmedical purpose.
The law lists criminal penalties for body piercers who perform body piercing upon persons less than 18 years, unless a parent or legal guardian is present at the time of the body piercing and provides written permission for the person to undergo the body piercing. Complaints regarding this issue should be directed to local law enforcement.
Local ordinances regarding tattooing and body piercing that are at least as restrictive or more restrictive than the present laws may be adopted.
The law required that the ISDH adopt rules to regulate the sanitary operation of body piercing facilities.
ISDH: Rule governing the sanitary operations of tattoo parlors and body piercing facilities
The ISDH developed a rule governing the sanitary operation of tattoo parlors in 1998 and revised this rule in 2000 to include the sanitary operation of body piercing facilities. The rule allows for complaint investigations. When violations are noted that threaten the health of patrons, the health department can issue a compliance order. This orders the artist and/or parlor to cease and desist from the violative practice and comply with the requirements of the rule. Section B of this guideline contains a copy of this rule and Section C contains information that you may find useful in complying with the rule.

The definitions listed in the rule apply throughout the rule and must be referred to when there is a question regarding the meaning of the defined words. Some of the definitions listed may seem like they do not belong in this rule. An example is the definition of "other potentially infectious materials" that was included to be consistent with the Indiana Universal Precautions Rule and the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogen Standard. Many of the definitions are consistent with other ISDH rules. For example, the importance of the definition section in this rule is illustrated by reviewing the definition of body piercing. Body piercing is defined as the perforation of any human body part other than an earlobe for the purpose of inserting jewelry or other decoration, or for some other nonmedical purpose. Thus, persons who pierce earlobes only are not regulated by this rule, but persons who pierce the upper ear are regulated.

The rule does not require that tattoo artists or body piercers register with the ISDH and ISDH does not routinely inspect these facilities. Tattoo artists and body piercers should contact the local health department to see if there are any local requirements. There may be local requirements and local inspections. Investigations may occur as the result of a complaint.

Patron Rights Information
The rule requires the operator to display information prepared by ISDH regarding universal precautions and patron rights. Local health departments and ISDH can provide you with this information. This information is found here.

The Occupational Safety and Health Administration's Bloodborne Pathogen Standard
In 1991, OSHA published the Bloodborne Pathogen Standard. The Standard requires that employers who have employees at a reasonably anticipated risk of contact with blood or other potentially infectious materials (OPIM) provide the following:

A written exposure control plan
Engineering and work practice controls
The hepatitis B vaccine
Post-exposure medical evaluation
Annual training on bloodborne pathogens and the employer's policies relating to the handling of blood and/or "other potentially infectious materials"
Record keeping about medical information and training.
The OSHA Standard covers employees ONLY. For questions about whether individuals working in a facility would be considered employees, contact the Indiana Department of Labor, Bureau of Safety Education and Training at 317/232-2688. If employees have contact with blood or OPIM as part of their job duties, requirements of the OSHA Bloodborne Pathogen Standard must be followed, in addition to meeting the requirements of the ISDH rule.

Operators of tattoo parlors and body piercing facilities who are not covered by the OSHA Standard must observe only the requirements of the ISDH rule, and are encouraged to be familiar with the OSHA Bloodborne Pathogen Standard, since it is referenced in this rule. A copy of the Standard can be accessed on the Internet at: http://www.osha-slc.gov/OshStd_data/1910_1030.html

Hepatitis B Vaccine
All tattoo artists and body piercers should consider vaccination against the hepatitis B virus. Hepatitis B is spread by direct contact with infected blood or certain other body fluids, such as semen and vaginal secretions. Direct contact may include being stuck with a needle contaminated with blood, getting blood on an open sore, or getting blood in the eyes or mouth. Intact skin is a barrier and does not allow the virus into the body. The hepatitis B vaccine has very few side effects and provides protection against the disease in most people who complete the 3-shot series. Since the tattoo artist and body piercer are exposed to blood daily, this vaccine is highly recommended.

Human Immunodeficiency Virus and Hepatitis C
Both the Human Immunodeficiency Virus (HIV) and the Hepatitis C virus (HCV) can be spread by direct contact with blood or OPIM. These viruses can result in serious illness and death. Many persons with HIV infection will develop acquired immunodeficiency syndrome. HCV infection results in potentially serious liver disease. There are approximately 4 million Americans infected and HCV infection is the most likely reason for a liver transplant in the United States. There are no vaccines available to protect against HIV and HCV infection.

Post-exposure Follow-up
The OSHA Bloodborne Pathogen Standard requires that employees be offered a medical evaluation when an exposure to someone else's blood occurs. An exposure could occur by a puncture with a needle contaminated with blood or by getting someone's blood on an open sore or in the eyes or mouth. Even when there are no employees, tattoo parlors should consider having policies relating to first aid procedures and for evaluation by a health care provider following exposures. A health care provider may recommend medication or vaccinations that could prevent the exposed person from becoming ill with a serious bloodborne disease. This rule does not require a post-exposure medical evaluation but ISDH recommends that a medical evaluation occur after all exposures.

Bloodborne Pathogen Training
Yearly training on bloodborne pathogen disease transmission for tattoo artist, body piercers, and anyone who has contact with blood at the facility is a requirement of this rule. Some examples of who may provide the training are a professional association, persons familiar with bloodborne pathogen disease transmission and the requirements of the laws that apply, and the American Red Cross or other health care professional group.

The American Red Cross chapters within Indiana offer a bloodborne pathogen course called "Preventing Disease Transmission/Universal Precautions." This course will provide you with the essential information for running a safe facility for both staff and clients. In addition, the American Red Cross of greater Indianapolis has developed a Bloodborne Pathogens for Tattoo Artists and Body Piercers Course that is accessed at the following Internet address: www.redcross-indy.org. In order to meet the requirements of this rule, any on-line course must be taken at a time when a course instructor is available to answer questions immediately. The American Red Cross of greater Indianapolis has a course instructor available Monday through Friday from 8 a.m. to 3 p.m. (Indianapolis time). For further questions about this course, call 317/684-1441.

Other sources of information about bloodborne pathogens and preventing disease transmission are professional associations, Centers for Disease Control and Prevention (http://www.cdc.gov), and the Indiana State Department of Health (http://www.in.gov/isdh or 317/233-7825).

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