Infection control in acupuncture treatment

The relationship between microbes and humans is complex, yet this relationship does not always lead to an infection. The body surface has all kinds of micro-organisms and they normally make life on the host without causing any harm. They are called ‘normal flora’ of the body. However, when the micro-organisms harm their host and cause disease, they become ‘pathogens’ (1). The pathogens such as viruses, bacteria, fungi and parasites travel through reservoirs of people, equipment or water.

Once the harmful factors are out of the reservoirs by the form of droplets or secretions as examples, the harmful factors are transmitted by direct or indirect contact. Then the infectious agents enter the susceptible host via mucous membrane, broken skin or respiratory track. This circle of infection could go on and on until the chain is broken. (2). Thus, breaking the vicious chain is important, especially in healthcare setting, to protect both patients and health care professionals. In this context, acupuncturists should be aware that the infectious chain could be broken with proper practice they perform.

In preparation of the acupuncture treatment, the room should be well ventilated in order to prevent air pollutants from affecting the health of patients and practitioners. The treatment bed should be disinfected with proper disinfectant and covered with clean linen. Also, the fomites such as waiting room furniture, treatment tables or doorknobs, which cause potential infection by contact, must be free from micro-organisms. The equipment especially acupuncture needles or lancets for bloodletting must be sterilised and used once only; and the cups for cupping must be clean.

More importantly, thorough hand washing must be performed by practitioners before and after procedure since hands are the most usual means of transmission of disease. Plus, the practitioners are encouraged to comply with standard precaution even though the patient does not manifest any signs and symptoms of the infection (3). At the commencing of the treatment, practitioners should wash their hands and use antiseptic agent or disposable alcohol swab to disinfect the skin of the patient. Certain equipment for the procedure should be placed on the right place. For example, acupuncture needles should be on sterile surface with no contamination (3).

During the procedure, needle penetration must be handled with aseptic techniques. If necessary, personal protective equipment (PPE) will be utilised by the practitioners. For instance, if the patient reports that he or she is having the flu which could be transmitted via

droplets, then mask will be worn by the practitioners. Likewise, when blood or body fluid is anticipated while bloodletting, clean non-sterile medical gloves are supposed to be used to prevent from blood borne disease (3).

When the treatment ends, needles and sharps are treated with extra care so as to prevent infections and injuries to both the practitioners and patients. Needles and sharps are discarded into a designated sharp bin. Counting the needles when inserting, removing and discarding should be a habit of the practitioners. Also, checking bed, linens and surrounding areas for dropped needle should be done before, during and after the treatment. If there is blood spill, the affected area should be cleaned with a recommended disinfectant in accordance with manufacturer’s instruction (3).

When needlestick incident occurs to the patient, immediate action is required: remove the needle right away; let the wound bleed without milking the wound; cleanse the affected area thoroughly with soap and warm water; and document the incident including date and time (4).

In consideration of application of infection control for the context of acupuncture practice, two examples are chosen from the given examples. One example is of a patient (let us call him Mr. A for the convenience) who might be a carrier of hepatitis B with healthy appearance. Another example is about a patient (let us name her Ms. B for the convenience) who was diagnosed with malignancy and was on chemotherapy and the patient seems to have pneumonia often.

Firstly, hepatitis B is a highly contagious viral disease, spreading through body fluids from person to person. Hepatitis B is transmitted via open cuts or wounds, sexual contact, sharing personal items like toothbrush or razors, blood transfusion and passed from infected mother to her baby at birth. After being infected, the patient may be fully recovered or carry the virus in his or her blood (5). At an acupuncture clinic, Mr. A has arrived for the treatment. He appeared quite healthy physically.

However, the practitioner has noted that Mr. A could be a hepatitis B carrier by taking medical history. In fact, it is believed that around 400 million people are hepatitis B virus (HBV) carrier in the world. In other words, roughly five percent of the world’s populations are HBV carriers (6). According to a study conducted by Department of Microbiology, The University of Hong Kong in 2010, potential viral infections are transmitted by acupuncture treatment. The study found that patient-to-patient transmission of blood borne disease can be occurred by reusing improperly sterilised needles (7).

Therefore, use of disposable needles should be encouraged to minimise the incidents of blood related virus transmission. What is more, the practitioners should be vaccinated and try to avoid the needle stick injuries with a great deal of care when handling the needles. Also, conducting universal precaution is essential: eyewear and gloves should be worn when bloodletting; 75 percent alcohol should be used for skin disinfection before needle insertion; and disinfection of work area should be followed after treatment (7,8).