Infection Control in Acupuncture

Basic Definitions

• Cross Infection: Occurs when a patient contracts an infection from another person or the environment.
  • Example: A practitioner touches a patient with athlete’s foot, fails to wash their hands, and then gives a massage to another patient, resulting in the second patient contracting a fungal infection.
• Autogenous Infection: An infection where a patient’s own bacteria or virus is spread to another area of their body.
  • Example: A practitioner massages a patient’s athlete's foot and then uses the same needle to insert into the patient’s UB 1 point, resulting in a fungal infection in the eye.

Prevention of Infections

• To prevent cross-infections and autogenous infections, always use new, sterile needles and guide tubes.
• Sterilize all equipment to ensure it is free of microbial life.
• When performing acupuncture, swab the area to be needled with 70% isopropyl alcohol. Avoid touching the needle shaft except with sterile cotton or gauze.
• Use proper hand hygiene: Wash hands before and after contact with every patient and after potentially contaminating yourself.

Biohazardous Waste

• Any waste that may pose an infection risk to people.
• Example: Blood spills.
• In case of a blood or body fluid spill:
  • Put on gloves.
  • Clean the area with a disinfectant, followed by soap and water.
  • Dispose of cleaning materials in a biohazard bag.
• Medical waste disposal companies are responsible for collecting biohazardous waste. Do not dispose of it in regular trash.

Disinfectants

• Products that kill microbial life.
• Used on inanimate objects, such as massage tables and floors.
• Not used on people.

Universal Precautions

• Treat all patients as if they have every infectious disease. Always practice caution with blood, saliva, and other body fluids, regardless of the patient’s medical history.
• Handle needles carefully, removing them one at a time and disposing of them in sharps containers.
• Report any needle stick incidents to the clinic director.
• If a sharps container spills, use gloves, forceps, and magnets to pick up the sharps, not bare hands. Clean the area with disinfectant.

Infectious Diseases

• Hepatitis:
  • Five types: A, B, C, D, E
  • Blood-borne transmission (Hepatitis B, C, and D): Occurs through contact with infected body fluids, such as a needle stick.
  • Oral-fecal transmission (Hepatitis A and E): Occurs through contact with contaminated food or water, often due to poor hygiene.
  • Hepatitis A: Incubation period of 15-50 days. Symptoms include fever, nausea/vomiting, muscle aches, right upper quadrant pain, and potentially jaundice. Most people fully recover. A vaccine is available but not routinely recommended as most people recover naturally.
  • Hepatitis B: Incubation period of 50-180 days. Often presents with flu-like symptoms and can progress to jaundice. It can become chronic and lead to liver disease. The CDC recommends all healthcare workers be vaccinated against hepatitis B.
  • Hepatitis C: Incubation period of 20-90 days. Most common chronic blood-borne viral infection in the US. Usually presents gradually with digestive symptoms and leads to chronic hepatitis 80% of the time, which can cause liver failure. No vaccine available.
  • Hepatitis D: Requires the presence of Hepatitis B for infection. Therefore, a Hep B vaccine also protects against Hep D.
  • Hepatitis E: Similar to Hepatitis A. More common in developing countries.
• HIV:
  • Spread through contact with blood/body fluids.
  • Retrovirus that attacks T-helper cells/CD4 lymphocytes and macrophages, weakening the immune system.
  • Over time, the person becomes more susceptible to infections. This stage is known as AIDS.
  • May take many years for someone with HIV to reach the point of AIDS.
  • Approximately 0.3% chance of contracting HIV from a contaminated needle stick.
• MRSA:
  • Antibiotic-resistant skin infection.
  • If suspected, delay treatment and refer the patient to a medical doctor.

Patient Safety and Clinic Policy

• Pneumothorax: If you suspect a patient has a pneumothorax (collapsed lung), characterized by shortness of breath, chest pain, pallor, cough, etc., remove needles immediately and alert your supervisor to call 911.
• Pierced Vein: If you pierce a vein, apply direct pressure for about 1 minute.
• Pierced Artery: If you pierce an artery, apply direct pressure for up to 5 minutes.
• Stuck, Bent, or Broken Needles: Try to remove the needle by twirling, massaging surrounding muscles, inserting another needle nearby, changing the patient’s position, using forceps, pushing down on the surrounding skin. If the needle is broken under the skin, immediately refer the patient to a surgeon.
• Patient Passing Out: Remove all needles immediately. Lay the patient flat, elevate their legs slightly, and offer water. If the patient is not improving, alert your supervisor to call 911.
• Medical Emergencies: Always report any patient situation that could potentially lead to a malpractice complaint to the clinic director. This includes suspected medical emergencies, such as heart attack, stroke, or any situation where there is imminent danger of the patient’s health.
• Suicide: If a patient states they are planning to commit suicide and has a plan to carry it out, call 911. If they do not have a specific plan, report the situation to the clinic director.
• Student Needling: Students may only needle patients in the PCOM clinic or class with approved L.Ac. supervision. Always receive supervisor approval before needling any patient.
• Accidental Needle Stick: PCOM provides medical counseling to students who suffer accidental needle sticks.
• Scope of Practice: PCOM clinic’s scope of practice includes acupuncture, massage, moxa, gua sha, cupping, heat lamps, and herbs.
• Prohibited Practices: Homeopathy and spinal adjustments are not within PCOM’s scope of practice. PCOM does not allow bleeding techniques in the clinic.
• Dress Code: Must dress professionally or at least business casual, including a clean lab coat, neatly trimmed beard, nails trimmed, and hair tied back. No shorts, sandals, sneakers, mini-skirts, etc.

This quiz focuses on understanding the types of infections relevant to acupuncture practice, specifically cross infection and autogenous infection. It also covers prevention strategies to maintain hygiene and ensure patient safety during treatments. Test your knowledge on these essential concepts.