INTERNATIONAL EXPERIENCE OF LEGAL REGULATION OF THE PROCEDURE OF TATTOOING SERVICES’ PROVISION AND ITS IMPLEMENTATION IN UKRAINE
Alona O. Milevska1, Alexander A. Lyubchik2, Alina N. Chorna3, Olha M. Khimich4, Roman M. Opatskyi5
1University of the State Fiscal Service of Ukraine, Irpin, Ukraine
2Luhansk State University of Internal Affairs named after E.O. Didorenko, Severodonetsk, Ukraine
3Kharkiv National University of Internal Affairs, Kharkiv, Ukraine
4University of Modern Knowledge, KYIV, Ukraine
5Dnipropetrovsk State University of Internal Affairs, Dnipro, Ukraine
Introduction: The fashion for tattoos in Ukraine and in the world is becoming massive among young people and middle-aged people. The existence of a great demand and the lack of standards that would establish a procedure for the provision of such services in Ukraine lead to the realization of such activities by persons who are not sufficiently knowledgeable about the safety, contraindications and risks of such activities for the health of a client. The realities of the present time indicate that the unregulated tattoo services can trigger the outbreak and spread of dangerous infectious diseases, and also pose a threat to public health.
The aim: The objective of this article is to comprehensively analyze and study the main tendencies in the legal regulation of the provision of tattoo services in the EU countries and the US. The main task of the paper is to distinguish and generalize the positive experience of legal regulation of the provision of tattooing services, to formulate propositions for their implementation in Ukraine.
Materials and methods: The authors during the research have used theoretical methods (analysis, synthesis, generalization, systematization, etc.) and empirical methods (observation, classification, etc.). The systematization and analysis of national and international legislation in the field of regulation of tattooing services has been carried out.
Review: The authors of the article have analyzed the tendencies of legal regulation of the provision of tattooing services in the EU countries and the US. Analysis, systematization and generalization of legal regulation of tattooing in these countries made it possible to find out that the safety of the provision of such services for public health can only be achieved through comprehensive legal regulation that combines sanitary requirements, vocational training and licensing requirements, infection control and control of chemical composition of paints for tattoos.
Conclusions: The necessity of introduction of positive experience in legal regulation of tattooing services in Ukraine has been established. It will protect the population from the spread of dangerous infectious diseases and will promote the health of the youth who massively address for such services.
KEY WORDS: tattooing, infectious diseases, medical risk, infection control, sanitary requirements
Wiad Lek 2019, 72, 5 cz. I, 933-937
Tattooing have been practiced in different cultures for centuries, but today this form of art has undergone significant changes. More and more young people and middle-aged people turn to numerous studios or individual masters to get a picture on the body, trying to express their individuality. According to the analytical report “Safety of Tattoos and Permanent Makeup. The Final Report” of the Joint Research Center of the European Commission, 12% of Europeans have tattoos as of 2016 . According to open statistics as of 2017 – 4 out of 10 adult US residents have tattoos . Unfortunately, the collection of statistical data in Ukraine on this criterion and the registration of persons who have received a tattoo is not carried out. There is also no normative regulation of the procedure for providing tattooing services and requirements for the manufacturers of such services in Ukraine. All this suggests that the state does not perceive a service as the threat to public health, which is globally recognized as potentially harmful to the consumer and the one that can contribute to the spread of dangerous infectious diseases, in particular hepatitis and HIV / AIDS. In particular, outbreaks of hepatitis among people who received a tattoo service were recorded at one time in the United States and Holland.
Considering the fact that Ukraine is the leader in Europe in terms of the number of HIV-positive people (according to estimates at the beginning of 2018, there were 244 000 HIV-positive people in the country, that is, every hundredth of Ukraine’s citizens aged 15-49 were infected with HIV ), the policy of the state should be aimed at overcoming this situation and minimizing the possible ways of spreading the infection. Therefore, special attention in Ukraine should be paid to the problem of providing tattooing services. Besides, the danger to the health of a consumer of tattoo services can be borne and the use of harmful pigment. Thus, the tattoos in Ukraine require an immediate response from the state and the introduction of a positive international experience of legal regulation in this area.
The objective of this article is to comprehensively analyze and study the main tendencies in legal regulation of the provision of tattooing services in the EU countries and the US. The main task of the paper is to distinguish and generalize the positive experience of legal regulation of the provision of tattooing services, to formulate propositions for their implementation in Ukraine.
Materials and Methods
The authors during the research have used theoretical methods (analysis, synthesis, generalization, systematization, etc.) and empirical methods (observation, classification, etc.). The analysis of international legislation in the field of regulation of tattooing services has been carried out under the following categories: sanitary requirements, training and licensing, infection control, control over chemical composition of pigments. International experience of legal regulation of tattooing services has been systematized and summarized. The application of these methods allowed to properly justify the conclusions drawn and to formulate directions for the improvement of domestic legislation.
Review and discussion
In the early 1980s the outbreak of hepatitis B in Amsterdam was the start of the development of the first guide to hygiene for tattoo producers in the Netherlands. Since then, infection control in the practice of tattoos continues to prove its importance, since we continue to receive reports of outbreaks of infectious diseases associated with tattoos in Europe . The tattoos were generally banned from 1961 through 1996 in the US, due to the outbreak of hepatitis. However, such an approach of the state has only created the “shadow” nature of the masters of tattoos. We believe that it is not appropriate to use the prohibition to apply these legal relationships. It is more effective to develop efficient norms of legal regulation of the provision of tattooing services, which safeguard or minimize the possibility of negative consequences for the health of consumers of such services. Besides, masters of tattooing themselves have a desire to establish requirements for their profession and conduct research on the safety of ink for tattoos. Rick Stevens, one of the representatives of this business in the UK, said that they had to face the influx of cheap Chinese ink of dubious quality. “Systems for checking the quality of these paints just do not exist”, – he stressed .
The scientific literature includes for medical risks while tattooing:
– bacterial infections, which are manifested as acute infections after tattooing and during tattoo treatment. They can be local or systemic and ultimately progress to sepsis (cases of sepsis from tattoos are fixed in Ukraine );
– traumatic and other local skin phenomena due to the wrong technique of tattooing and amateurism with acute, sub-chronic or chronic consequences;
– chronic infections associated with tattoos, especially viral hepatitis B and C and HIV infections;
– manifestations of carcinogenic, mutagenic and reproductive toxic (CMR) ink ingredients and manifestations of toxic or allergic effects of metals;
– special chronic reactions, which, for example, are related to the lymphatic system and pain syndromes;
– manifestations of interaction with a client’s skin diseases, as well as with general diseases and weaknesses of the organism [4, p. 219].
Considering the nature of such risks, the preconditions for their occurrence may be as: the lack of appropriate measures for disinfection and sterilization of tattoo equipment; the lack of knowledge of the tattoo masters about the risks and ways of transmitting infectious diseases during tattooing, methods for preventing allergic reactions and rules for first aid; the lack of state control over tattoo service providers; the use of a pigment to perform a picture containing chemical elements that are hazardous to the health of a client, etc. Taking into account the above-mentioned preconditions for the emergence of medical risks of tattoos, it should be noted that security in the provision of such services can be achieved by defining and consolidating the requirements for the organization of such activities in the law. This is about sanitary requirements, requirements for professional training and licensing, infection control, control over the chemical composition of tattoo paints, etc. We will analyze the international norms defining the ways to overcome the medical risks of using the tattoo according to each of these requirements.
Most states in the United States have requirements for: the obligation of the authorized health care authority to check tattoo salons (Tennessee – every 90 days); restrictions on the consumption of food and tobacco in the treatment rooms; requirements for disinfection and sterilization of equipment; requirements for the separation of procedural tattoo offices from other premises of the salons; requirements for recycling the waste of tattoo procedure. The Mississippi law provides that all surfaces of the treatment room, including the ceiling, can be washed .
Most of the Member States of the European Union have the norms of national legislation that establish sanitary requirements for tattoo salons. In particular, all materials in Belgium according to Arrêté Royal 25/11/2005 réglementant les tatouages et les piercings, must be disinfected or disposable, the sterilization of heat-resistant materials should be carried out in an autoclave, tattoo studios and piercings should have the following separate spaces: waiting area, work zones, zone of decontamination / sterilization, waste zone and dirty linen .
Sanitary rules in Ukraine are foreseen only for the arrangement of various types of hairdressers and cosmetology offices. However, there are no such rules regarding the arrangement of a tattoo salon or the master’s working place. The initiative of the National Association of Masters of Tattoo, Permanent Makeup and Piercing of Ukraine is positive in this aspect. They offer own sanitary rules for the arrangement of offices for the members of the Association on their Internet web-page .
REQUIREMENTS FOR PROFESSIONAL TRAINING AND LICENSING
Almost every American state has requirements for the licensing of tattoo salons. The US law also requires the master of tattooing to undergo anatomy and first aid training. Moreover, the law of the state of Illinois provides that tattoo services by a person who does not have a medical license is the violation of Class A (Ill Rev. Stat. 720, §5 / 12C-35) .
The license in the Czech Republic, Romania, Belgium, Italy, Liechtenstein, Malta, Slovenia, Slovakia, Switzerland and the Netherlands is mandatory to open a tattoo studio and provide tattoo services. In particular, a tattoo master in the Czech Republic, according to the Act No. 258/2000 Coll., on the protection of public health – must have the necessary knowledge in the field of public health, verified by the relevant competent authority . Luxembourg requires a hairdresser, cosmetologist or master of manicure diploma to open a salon . In Belgium, the Czech Republic, France, Italy, Liechtenstein, Romania and Sweden, the legislation provides the obligation to take hygiene and health training courses for tattoo masters. The legislation of Austria, Denmark and Latvia also provides the need for special training for those who wish to be engaged in tattooing activities.
The legislation of Ukraine does not contain requirements for special knowledge or qualification of masters on tattoos, and the existence of such specialists in the Classifier of Occupations of Ukraine is not provided at all.
INFECTIOUS DISEASE CONTROL
The federal law of the United States provides the following measures for the infectious control over tattoo services: the requirement for the use of sterile equipment and disposable needles; requirement for vaccination of the master of hepatitis B; an obligation to inform a client about the risks of the procedure and the particularities of tattoo care; the customer’s commitment to complete the medical form . In accordance with the resolutions of the Council of Europe (ResAP (2008) 1) – Belgium, France, Liechtenstein, Norway, Slovenia, Spain, Sweden, Switzerland, the Netherlands, Italy, Malta and Romania have introduced special disposable tattoo containers that provide the sterility of tattoo ink before the use. The laws of these countries also stipulate the requirements for the sterility of equipment and the obligation to use disposable needles. Masters of tattoos in France, Liechtenstein, Malta, Norway, Slovenia, Sweden, Switzerland and the Netherlands should provide clients with extended information on potential health risks, tattoo care features, tattoo removal procedures, indicate the need for the consultation with a physician in case of the occurrence of complications of health. Many countries, such as France, Italy, Norway, Switzerland or the Netherlands, require the written consent of a client or his legal representative, which must be kept for a long time. Norway and the Netherlands, for example, have introduced civic awareness campaigns targeting tattoo clients regarding the potential health risks associated with tattoo procedures. Besides, the website http://www.veiligtatoeerenenpiercen.nl/ contains the list of all Dutch licensed salons and specifies the age limitations of clients, also providing data on the risks of tattoos, care instructions, etc.
The Red Cross in the United States prohibits individuals with tattoos from being blood donors for 12 months from the date of marking, unless the procedure is carried out in a licensed salon using sterile equipment . It is also prohibited in the UK to be a blood donor person for four months after marking a tattoo . The Ministry of Health of Ukraine also sets limits on the ability to be blood donors for people with tattoos or piercings for one year .
CONTROL OVER THE CHEMICAL COMPOSITION OF PAINTS FOR TATTOOS
In the framework of the control over the chemical composition of tattoo paints in the European countries, the Council of Europe adopted the Resolution “On Tattoo and Permanent Makeup” (ResAP (2003) 2) and the Resolution “On Requirements and Criteria for the Safety of Tattoos and Permanent Makeup” (ResAP (2008) 1). The provisions of the Resolution “On Requirements and Criteria for the Safety of Tattoos and Permanent Makeup” establish the list of requirements for the pigments used in the tattoo procedure, in particular regarding their chemical composition, the assessment of their risks and the labeling by the procedure used in the tattooing. The purpose of adopting these resolutions was to introduce established recommendations to the national legislation of the Member States for the protection of public health .
The countries that have introduced regulations on the control over the chemical composition of tattoo paints into the national legislation in accordance with ResAP 2003 and 2008 are Austria, Denmark, Belgium, Latvia, Slovenia, France, Netherlands, Germany, Sweden, Norway, Switzerland, Spain. The legislation of the Czech Republic, Finland, Italy, Malta, Romania and Slovakia also has regulatory acts that define the requirements for the safety of tattoo services and provides the supervision over the chemical composition of paints, with reference to the list of hazardous chemicals specified in the Resolution ResAP 2008 1 . The National Agency for the Safety of Medicines and Medical Products (ANSM) controls the access of tattoo products to the market in France. The person responsible for producing tattoo products to the market must notify the National Safety Agency of Medicines and Medical Products (ANSM) of all possible serious side effects from the use of these products. Same thing is done by health care employees and tattoo masters who indicate, whether a serious side effect was the result of improper use of the product and a description of the conditions, where the tattoo was performed. Also, consumers can declare to the ANSM the negative impact of tattoo products 
The analysis of international tattoo management experience allows us to distinguish the following areas and measures to improve the national legislation. In particular, in the direction of ensuring sanitary requirements: it is necessary to adopt sanitary rules and standards for the equipment of tattoo salons and tattoo master rooms, taking into account the necessary requirements for the disinfection of equipment and tattooing equipment. In the direction of providing vocational training and licensing, it is necessary to legislatively establish the need for licensing the activities of tattoo masters by analogy with the licensing of piercing services, and in the direction of admission to the profession – to oblige the tattoo masters to undergo medical courses for knowing the anatomy, hematopoietic pathogens and the procedure for providing the first aid. In the direction of ensuring the infectious control of tattoo services, it is advisable to establish a requirement for the hepatitis B tattoo masters’ vaccination, to oblige to provide a client, before the tattoo, the full information about the risks of tattooing, taking care of it and the need for consultation with a physician in case of complications, and to oblige the masters to keep records of all persons whose condition has deteriorated due to the tattooing and to inform about them the appropriate health care facilities. In the direction of controlling the chemical composition of tattoo paints, it is necessary to develop and adopt the norms of national legislation in accordance with the Resolution of the Council of Europe “On Requirements and Criteria for the Safety of Tattoos and Permanent Make-up” (ResAP (2008) 1). Besides, it is necessary to set at the legislative level, the minimum age for those who want to have a tattoo, since there is a case in Ukraine of rendering a tattoo service for a child of 7 years, which is totally unacceptable in regard to possible health risks 
The analysis of international experience of legal regulation of tattoo services demonstrates that the legislation of most foreign countries establishes the appropriate requirements for the tattoo procedure, its organization and licensing, infection control, hygienic standards and chemical composition of paints. In regard to comprehensive regulation of tattoo salons activities and providing tattoo services in Ukraine, the authors have offered to establish at the state level clear rules and standards that will ensure the safety of such a service and minimize its negative consequences for public health.
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According to the order of the Authorship.
Conflict of interest:
The Authors declare no conflict of interest.
Alona O. Milevska
University of the State Fiscal Service of Ukraine,
31, Universitetskaya str., Kyiv region, Irpin, 08201, Ukraine