Cross Infection in Acupuncture - Essay Example

Cross Infection in Acupuncture Acupuncture is the area medicine that involves the use of extremely thin needles inserted at strategic points of the body to ease pain. Acupuncture is a traditional form of Chinese medicine that helps in pain relief. According to the Chinese theoretical view, acupuncture enables one to balance the ‘chi’ flow in the body. Chi is an energy that contains the life force of any being according to Chinese traditional medicine. Modern acupuncture practitioners view the acupuncture points as stimulation points for muscles, connective tissues, and nerves. Stimulation of body muscle and nerves increases blood flow, increased blood flow increases the body’s ability to produce its own painkillers (Lao et. Al. 2003). As in any other medical field, acupuncture has a body that governs its conduct in order to prevent loss of life and reduce unnecessary risks. In Britain, the British Acupuncture Council gives a safety code of conduct to each practitioner on what standards to adhere to when carrying out an acupuncture procedure. The safety code dictates on matters concerning the equipment used, the premises, and the hygienic procedures, disposal of clinical waste and health and safety at work (Lao et. Al. 2003). Any acupuncturist that does not adhere to the safety standards set by the council is liable for legal action and revocation of their practicing license. The code of safety aims to protect both the practitioner and the patient from contracting contagious pathogens. Infection In acupuncture clinic, there are potential sources of infectious pathogens as in any other medical setting. Body fluids (blood, saliva, and sweat), hair, dust and clothing are all potential carriers of viral and microbial transmissions. Classification of such infections is in two classes, which are autogenous and cross infections. In autogenous infection, the body is already a carrier of the pathogen. Acupuncture needles aid the infection accidentally when they puncture the infected area and the bacteria spreads to other body parts which is fatal at times. According to the safety council guidelines, it is important to use varying needle sizes in different body parts to avoid such infections. Cross infections This form of infection is the most dangerous in acupuncture and unfortunately, it is the most common. It is the form of infection where one receives a pathogen either directly or indirectly. In direct transmission, there is transfer of the pathogen from the patient to the practitioner or from the practitioner to the patient through body fluids. In indirect infection, a patient gets the pathogen from another patient due to negligence by the practitioner. Indirect transmission can be through sharing of needles or through practitioners unwashed hands after dealing with one patient (Lao et. Al. 2003). Several pathogens depend on different factors for transmission from one host to another. The most common form of pathogen transmission in acupuncture is the blood borne pathogens. Blood borne pathogens reside in a patient’s blood stream and if they encounter another patient’s blood stream, they acquire a new host. In acupuncture, the most commonly transmitted blood borne pathogens include HIV virus and Hepatitis B virus. According to the British Acupuncture Council, each patient should be treated as a possible carrier of infectious disease. Treating each patient as a possible carrier ensures that the practitioner is attentive and very careful when dealing with each patient. A lapse of judgment or inattentiveness in an acupuncture practitioner can lead to infection in a patient or the practitioner (Lao et. Al. 2003). Apart from blood borne pathogens, practitioners and patients in an acupuncture setting may contract air borne pathogens and waterborne pathogens. Air borne pathogens are common due to their aerobic nature of transmission. They include bacteria such as tuberculosis or viruses such as SIRS. Water borne pathogens on the other hand depend on water for transmission from patient to patient. Water borne pathogens cause diseases such as dysentery and cholera. There are basic principles that govern acupuncturists in maintenance of a hygienic environment that prevents cross infection. These basic principles include: • Clean hands • Sterile needles • Clean field • Immediate isolation of used needles • Safe working space In order to understand why each of these principles is important, it is important to state how each works and what pathogens it prevents the patient and practitioner. Clean hands This form of hygiene is important since it prevents transmission of pathogens from one patient to another through contact. Acupuncture practitioners should carry out hand cleaning between clients. Cleaning and disinfecting of hands ensures that the body fluid that the acupuncturist contacted does not affect the next patient. Since acupuncture involves use of needles, bleeding in patients is common and the acupuncturist has to encounter the blood. Some of the blood that the practitioner encounters has pathogens that could infect another patient that is pathogen free. Hand cleaning is also applicable during situations where the practitioner handles excrete and other infectious waste. Sometimes the practitioner handles clothing items that have body fluids such as sweat and saliva; in this case, they have to use sanitary gloves and clean hands after handling the clothes. After cleaning of hands, one should use soap and other disinfectants in order to kill any pathogen that remains on the skin. In a situation where there is water shortage, alcohol based gels are advisable since they decontaminate and kill pathogens on body surfaces such as hands. In cases of practitioners who place needles then remove them later, it is a recommendation that before they return to remove the needles in their patients, the practitioners should clean their hands thoroughly in order to get rid of any contracted pathogens. Washing of hands should be vigorous and with plenty of soap or lathering disinfectants. It is also advisable to use gloves when a practitioner is in session with a patient in order to protect himself from contracting infections. Hand cleaning protects both the practitioner and the patient while use of gloves protects the practitioner. In cases where the practitioner is palpating a patient, and immediately before inserting needles into acupuncture points, cleaning of fingertips is necessary. In such a case, alcohol cleansing is an alternative to using water and soap since it is only at the fingertips. Use of sterile needles In this section, the council recommends that any equipment used to break the skin including seven-star needles or plum-blossom should be sterile and disposable. It means that the equipment is safe from germs in a sealed package and after use, the needle cannot be in use again and safe disposal is necessary. The council gives guidelines for disposal of needles and bans use of a single needle between patients. A seven stars or plum-blossom may be in use on different parts of the same patient’s body, but it should not be in use between patients. In needle pricks’ one is likely to gain hepatitis b virus more than that of HIV virus. The latter statement shows that the likelihood of transmitting blood borne diseases is higher in cases of acupuncture and careful measures have to be put in place to govern disposal and use if needles. According to the council’s recommendation, acupuncture needles should use secure packaging. Such packaging should avoid bubble form packaging, which at times loosens on the ends causing contamination. The suggested material for making of needles is stainless steel and after withdrawal the needle is immediately disposed. Clean field principle Under this principle, the council stipulates that the area under treatment is to be examined for lesions and other wounds or diseases. Due to risk of direct infection, acupuncture needles are not advisable to use for broken or inflamed skin. Acupuncture areas require cleaning with alcohol based disinfectants and the practitioner should ensure that the skin is intact. According to the council’s stipulations, the only acceptable time to touch a disinfected acupuncture point is after cleaning the fingertips and fingernails before insertion of the needle using alcohol gels. During insertion of needles, sterile cotton swaps are advisable to use in guiding the needle as opposed to bare fingertips. After puncturing, needle manipulation is done without the practitioner’s contact with the needle, which prevents contamination. After the procedure, the practitioner should use a cotton ball to withdraw the needle to avoid pricking themselves and contracting blood borne pathogens. A cotton ball prevents seeping of infectious fluids through the skin and touching the practitioner’s bare skin. In an acupuncture setting, all patients are possible carriers of HIV or Hepatitis viruses. In case of accidental pricking using a used acupunctural needle, one should seek medical advice immediately. Immediate isolation of used needles According to the British acupuncture council, there is a specific way of disposing used needles and any other sharp objects that could contain infectious pathogens. Immediately after a procedure, the practitioner in charge should dispose any infectious material and waste in the special containers stipulated in the guidelines. Failure to dispose infectious material in the proper manner is a medical violation that leads to exposure of patients to deadly pathogens. Safe working space According to the British acupuncture council, any place that a practitioner picks to be their acupunctural centre has to adhere to certain health standards. The clinic has to have good ventilation with access to a lot of fresh air in order to minimize the risk of infection through air borne pathogens. There should be access to clean water for both hand hygiene and drinking. Access to clean water minimizes the risk of water borne pathogens within the clinic. The surfaces within the clinic have to receive regular disinfection to avoid contamination through dust and dirt within the clinic. Practitioners within the acupunctural field have to observe proper personal hygiene and in case any of them has a contagious infection, they have to inform their patients beforehand. The methods discussed above aid in the prevention of cross infection by any form of pathogens be it blood, air or water borne pathogens. Bibliography BRITISH ACUPUNCTURE COUNCIL (Britain). (2003). Clean needle technique manual for acupuncturists: guidelines and standards for the clean and safe clinical practice of acupuncture. Gig Harbor, WA, National Acupuncture Foundation. Ernst E, White AR. Prospective studies of the safety of acupuncture: A systematic review. Am J Med 2001 Apr 15; 110(6): 481-5. Lao L, Hamilton GR, Fu J, Berman BM. Is acupuncture safe? A systematic review of case reports.AlternTher Health Med 2003 Jan-Feb; 9(1): 72-83. Park J, Lee M, Choi J, Kim B, Choi S. Adverse events associated with acupuncture: A prospective study. J Altern Complement Med 2010 Sep 16; (9): 959-63. TOMLINSON, D., & KLINE, N. E. (2010).Advanced clinical handbook. Heidelberg, Springer. White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med 2004; 22: 122–133. http://aim.bmj.com/content/22/3/122.full.pdf. Witt CM, Pach D, Brinkhaus B, Wruck K, Tag B et al. Safety of acupuncture: Results of a prospective observational study with 229,230 patients and introduction of a new medical information and consent form. ForschKomplementarmed2009 Apr 16; 2: 91-7. Xu S, Wang L, Cooper E, Zhang M, Manheimer E, et al. Adverse events of acupuncture: A systematic review of case reports. Evidence-Based Complementary and Alternative Medicine 2013. http://dx.doi.org/10.1155/2013/581203. http://www.hindawi.com/journals/ecam/2013/581203/. Accessed May 2013. Read More