Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
Meaningful Outcome Measures
the level of public safety they feel with their performance and their interactions with operators and artists. Programs can work toward achieving these characteristics by having a thorough onboarding process for inspectors that can help ensure consistent and effective inspection practices, build- ing relationships with operators and artists, and ensuring inspectors conduct follow-through actions related to con- sumer complaints and waste disposal. Trust building with operators and artists is important for success, as this allows them to be honest about the proce- dures they are doing and to gain information from inspec- tors to protect their clients and themselves. As a participant put it simply, “The goal isn’t necessarily compliance with the rule as it’s written. The goal is public health.” The regulatory authority of a body art program in terms of licensing and permitting contributes to how the program can successfully implement enforcement and infection and injury control measures. Some departments license or per- mit the establishment only, some license each body artist only, and some license both. Those programs that license or permit only the body art establishment indicate that the state agency licenses indi- vidual artists. In this situation, oversight is on both enti- ties involved in body art—the artist and the establishment in which the artist practices. Those programs licensing or permitting the artists indicated that the licensing and per- mitting is tied to a body art establishment. Relocation of an artist would require the artist to get a new license. For those that license and permit both the establishment and artist, it was important to them that they retain the abil- ity to take regulatory action, if necessary, on either entity, depending on where an issue occurs. While not part of the original research, jurisdictions might find it helpful to use the Body Art Model Code (BAMC) developed by NEHA in 1998, with subsequent updates in 2019 and 2024. Created with input from environmental health and industry professionals, the BAMC serves as voluntary guidance that jurisdictions can use as a resource to develop or update their body art codes, which can help reduce the risk of bloodborne pathogen transmission and other health hazards associated with body art procedures.
PURPOSE
METRIC
Program effectiveness
• Percentage of body art establishments inspected within required timeframes per year • Number of violations identified per 100 body art inspections per year * • Percentage of body art establishments maintaining current permits and licenses per year * • Percentage of body artists maintaining current licenses per year * • Percentage of inspection staff completing required bloodborne pathogens training annually * • Average number of body art inspections completed per staff member per week and annually • Number of reported infections and/ or adverse events associated with body art establishments per year * • Number of complaints received annually
Workload management
Public health protection
* EPH professionals who participated in focus groups, key informant interviews, and/or the national field survey consistently identified this metric as moderately to extremely useful. The number and type of violations being cited during inspections of body art establishments can be meaning- ful measures of how well body art inspection programs are educating operators and artists to prevent exposure to potential health hazards. Along these lines, the frequency of re-inspections and complaint inspections can also be useful measures. For situations where different agencies are licensing estab- lishments and artists, navigating multiple licensing pro- cesses might be complicated and can result in unlicensed artists, a common citation according to some participants. In these instances, the ability of the body art program inspectors to assist operators and artists in navigating these processes and becoming licensed can be reflected in an outcome metric. While direct attribution of bloodborne disease incidence to a specific body art procedure might be difficult due to long incubation periods, acute skin infections at the body art site could be a useful metric for body art inspection programs
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