Infection
prevention and control for
acupuncture practice
Stephen Janz
Chair, Policy Codes and Guidelines Advisory Committee,
Chinese Medicine Board of Australia
Overview
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Background to guidelines
Methodology used to develop guidelines
Guidelines structure
Specific guideline discussion
Conclusion
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Background
Primary objective of Chinese Medicine Board (CMBA) is to
protect public health and safety
Potential risk of infection with skin penetration and related
techniques
No uniform national standard in place for acupuncture prior
to these guidelines
State requirements vary
– Registered practitioners exempt from some states’ skin
penetration regulations
Need for nationally consistent, evidence based guidelines
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Australian guidelines for prevention and
control of infection in healthcare
CMBA adopted the National Health and Medical Research
Council (NHMRC) Australian guidelines for prevention
and control of infection in healthcare (the Australian
Guidelines).
The Australian Guidelines uses a risk management
approach to infection prevention and control based on
the best available evidence
Not all areas of acupuncture practice are adequately
covered in the Australian Guidelines
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Aim of CMBA Guidelines
CMBA initiated a project to identify specific
requirements for the prevention and control of
infections in acupuncture practice that are not
covered in the Australian Guidelines
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Method
The Australian Guidelines were examined to identify
areas requiring further acupuncture specific guidance
Literature search conducted to identify other literature
regarding acupuncture infection prevention and
control.
Very little acupuncture specific literature (mainly case
reports of infections) and one set of guidelines
identified
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Method continued...
A further search was conducted for evidence based
guidelines for established procedures with a similar
procedural risk profile to acupuncture.
NHMRC immunisation guidelines
WHO guide to best practice for injections and related
procedures
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Method continued...
Draft guidelines were developed by the Policies,
Standards and Guidelines Advisory Committee
Revised and approved by the CMBA for stakeholder
consultation
Stakeholder feedback was reviewed prior to finalising
the document
http://www.chinesemedicineboard.gov.au/News/PastConsultations.aspx
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The CMBA Guidelines
Consists of three parts, with hyperlinks to take the reader
directly to reference material:
Part 1: How to use NHMRC’s Australian Guidelines in
conjunction with the CMBA’s guidelines
Part 2: Additional CMBA requirements for the prevention
and control of infection in acupuncture practice
Part 3: State and territory guidelines and regulations
relevant to acupuncture practice
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Part 1 – How to use the NHMRC Australian
Guidelines
The Australian Guidelines provide guidance for:
• Basics of infection prevention and control
• Standard precautions
• Transmission-based precautions
• Recommended cleaning routine
• Organisational support
http://www.nhmrc.gov.au/book/html-australian-guidelinesprevention-and-control-infection-healthcare-2010
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Part 2 - Additional CMBA requirements
Six specific areas identified:
A) Reprocessing of reusable instruments and equipment
B) Hand hygiene and special precautions when using
alcohol-based hand rub
C) Appropriate use of gloves
D) Requirements for routine skin preparation and posttreatment procedures
E) Requirements for non-sharp waste disposal
F) Prevention and management of sharps Injuries
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Reprocessing of reusable instruments and
equipment
All items must be reprocessed according to the Australian
Guidelines except single use of:
• Acupuncture needles and dermal hammers
• Glass cups, scraping spoons and other equipment that
comes into contact with blood or non-intact skin
– unless sterilisation in accordance with Australian
Standards AS/NZ 4187 and AS/NZS 4815
• Bamboo cups in all cases
– not constructed of a material suitable for sterilisation in
accordance with the Australian Guidelines
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Hand hygiene and special precautions
when using alcohol-based hand rub
A clinic must contain at least one hands-free sink which
is dedicated for hand washing only
Hand hygiene performed with alcohol-based hand rub is
more effective against microbes than plain soap or
antiseptic soap and water
However, when hands are visibly soiled and after using
the toilet, they must be washed with soap and water
Either of these must be located close to acupuncture
treatment area and must be readily accessible
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Special precautions when using alcoholbased hand rub
Alcohol-based hand rub must be stored, and used,
away from heat and naked flames
No tasks should be attempted until hands are
completely dry
Procedures involving exposure to a naked flame such
as moxibustion or cupping must not be attempted
until alcohol has evaporated and hands are
completely dry
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Requirements for appropriate use of gloves
Gloves do not need to be worn if the patient and
practitioner both have intact skin and excessive
bleeding is not expected
Single-use gloves may be required if excessive bleeding
is anticipated
Direct contact with blood or body substances is unlikely
when inserting an acupuncture needle into intact skin
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Examples of procedures which may require
glove use:
• removing needles from an area which has been
pre-treated with heat or massage
• using a dermal hammer
• cupping applied after dermal hammering
• vigorous needle technique
• electro-stimulation applied to acupuncture needles
• acupuncture point injection
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More on glove use:
Any break in the practitioner’s skin must be adequately
covered or a fingercot or gloves used
In acupuncture practice, gloves do not need to be sterile
but must be changed after every individual patient
contact
The use of gloves is not an alternative to hand hygiene
Some states and territories require gloves to be used
when inserting and/or removing acupuncture needles
- refer to Part 3 of these guidelines for more
information
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Requirements for routine skin preparation
Provided the skin is visibly clean, there is no need to
swab it with an antiseptic before inserting needles
An antiseptic (such as isopropyl alcohol) must be used if
the skin is visibly soiled, or has been pre-treated with
massage oil or other topical preparations
An antiseptic (such as isopropyl alcohol) should be used
before treating potentially immunocompromised
patients
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Requirements for post-treatment management
A clean, dry cotton wool swab should be placed over
the site of needle withdrawal immediately after
withdrawal - to control any pinpoint of blood which
may be evident, whether or not gloves have been
used
Massage should not be applied to a site which has just
received acupuncture due to the potential for an
increased risk of infection at the site
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Requirements for non-sharp waste disposal
The Australian Guidelines do not make specific
recommendations about waste disposal
Where specific state or territory requirements are not in
place the following guidance applies:
• clinic waste such as used swabs which do not contain
expressible blood can be treated as general waste, and
• used swabs must be:
– discarded into a leak-proof plastic bag
– kept out of reach of children, and
– disposed of as general waste
• Standard precautions should be used when handling or
disposing of all waste
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Sharps disposal containers
Containers that comply with AS4031 or AS/NZ 4261
must be located close to each patient receiving
acupuncture and must be kept out of reach of children
Sharps containers must not be filled beyond threequarters full and must be disposed of by a waste
disposal contractor according to respective state,
territory or local government regulations
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Prevention and management of sharps injuries
Incorrect handling of sharps can result in a sharps injury
and associated health risks to the practitioner
The requirements for the handling of sharps :
• acupuncture needles should not be reinserted into
guide tubes after use, and
• when injection techniques are used, needles must
never be recapped
See CMBA guidelines on how to manage a sharps injury
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Part 3 - State and territory guidelines and
regulations relevant to acupuncture practice
The CMBA Guidelines contains a list of each state and
territory acupuncture guidelines or regulations
– subject to change
Where there is an inconsistency between the CMBA
Guidelines and state or territory guidelines, the state
or territory guidelines must be followed
Practitioners are responsible in keeping up to date with
state or territory requirements
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Summary
All registered acupuncturists must comply with:
• the NHMRC Australian Guidelines
• the CMBA Guidelines, and
• relevant state, territory and local government
requirements which apply to their place of business
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Conclusion
These guidelines took effect from 20 May 2013
The CMBA will monitor these guidelines for
effectiveness and review them at least every three
years
All acupuncturists registered with the CMBA must
comply with the guidelines
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For more information
CMBA Guidelines are available at:
http://www.chinesemedicineboard.gov.au/
For an example of how to apply a risk management
approach to infection control and acupuncture see:
http://www.acupuncture.org.au/Publications/Infection_
Control.aspx
www.ahpra.gov.au
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