Enforcement of personal services legislation: is it possible?

B.C. used to have the Personal Service Establishments Regulation, a short, 3 section piece of legislation that basically said: wash your hands, and don't cause a health hazard. With the creation of the Public Health Act, the provincial government took the initiative to move some legislation around, create some new stuff, and get rid of some dead weight. What that led to was the elimination of the PSE Reg, and the creation of the Regulated Activities Regulation, a much longer 7 section piece of legislation that basically says: wash your hands, and don't go in a tanning booth if you're a minor. Essentially, they just combined the a bunch of pieces of legislation that didn't fit with anything (including the use of public toilets and soil amendment codes of practice) and put them together. With the exception of the "don't tan if you're a minor", there are no offenses pursuant to this piece of legislation. The personal services industry is basically a free-for-all, with Environmental Health Officers relying on a broad definition and interpretation of "health hazard" to keep people from getting blood-borne illnesses.

As the idea of what constitutes "body modification" spreads beyond simple tattooing and piercing, and into bifurcations, brands, and scarification, it's more necessary than ever to ensure that the public health professionals who are out there inspecting these facilities not only know what they're seeing (and the potential health risks associated with those activities), but also have the tools to enforce non-compliance when it's found.

It's not just B.C. that's struggling with the idea of how to regulate the industry: a 2011 National Post article stated that Ottawa Public Health was "given extra money for another public health inspector to focus on tattoo and piercing parlours", leading to a 136% increase in inspections in these facilities.

A study in Pennsylvania and Texas looked at protocols and procedures in personal service establishments, and compared them to established guidelines meant for use in the health care industry. Besides trying to determine what existing practices were being followed in these establishments, the researchers also wanted to see whether local/state regulations had any effect on exposure reduction activities, whether membership in professional associations made workers more likely to follow established protocols, and whether there was any difference in compliance between employees and owners of shops.

In general, the researchers found that most shops were pretty good with the infection control procedures (with a couple of exceptions), but most were also terrible with the administrative and record keeping requirements (with few exceptions). The shops knew that they needed to do things like autoclave their equipment, but didn't have written policies and procedures for exposure control, and didn't offer or document hepatitis B vaccines. When comparing the compliance results to the existence of regulation, the researchers "found little difference in compliance whether shops were located in regulated or nonregulated locations". Interestingly, some study participants stated that they felt compliance staff "had no idea how the body art industry functioned".

The study did find a difference in compliance rates between shops that were affiliated with a professional association, and those that were not: only the affiliated shops showed any compliance with the administrative standards (as minimal as that compliance was). This might indicate that the professional associations could serve as a vehicle for getting information to body modifiers in a manner that they understand and respect. Clearly, the EHO/PHI is not being seen as a voice of knowledge in this industry, so information disseminated by local health authorities would likely not be as well received as if it came internally from the industry.

This specific study highlights the concerns that are found throughout Canada with regard to the regulation of the body modification industry: there aren't many regulations out there, and if there are, they're not well enforced. Public health professionals lack the training, knowledge, and tools to adequately regulate this growth industry, leading to an increased risk to clients and workers alike. To move forward, legislators need to work with the industry to establish guidelines and regulations, and then provide adequate training to regulators and practitioners alike (preferably in the same manner, at the same time, so they can learn from one another). Just using a "don't cause a health hazard, and wash your hands" approach to regulating body modification is leaving too much to chance.

Sources: Boseveld, S. (2011, December 12). Canadian health care can't keep up with body modifications. National Post. Retrieved from http://news.nationalpost.com/2011/12/12/canadian-health-care-cant-keep-up-with-body-modifications/

Lehman, E.J., Huy, J., Levy, E., Viet, S.M., Mobley, A., & McCleery, T.Z. (2010). Bloodborne pathogen risk reduction activities in the body piercing and tattooing industry. American Journal of Infection Control, (38), 130-138. 

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