Chinese Medicine Board of Australia - Infection prevention and control for acupuncture practice
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Infection prevention and control for acupuncture practice

This FAQ relates to Guidelines on infection prevention and control for acupuncture and related practices.

The Board published revised Guidelines on infection prevention and control for acupuncture and related practices on 1 September. The current Guidelines are effective until 30 November 2023, with the revised Guidelines taking effect on 1 December.

This FAQ refers to the current Guidelines and will be updated to refer to the revised Guidelines on 1 December 2023.

No. A clinic must contain at least one hands-free sink which is dedicated for hand washing and not used for other purposes, such as the reprocessing of equipment or food preparation.

A hands-free sink refers to a sink which can be operated by foot pedals, no-touch sensors or (properly used) elbow-operated controls. Either a hands-free sink or alcohol-based hand hygiene station must be located close to every acupuncture treatment area and must be readily accessible. Please see Part 2 of the Board guidelines (388 KB,PDF), Word version (737 KB,DOCX).

As good practice, alcohol-based hand rubs should be available to all healthcare workers as required. They do not need to be in each treatment room if a hands-free sink is available instead. Please see Part 2 of the Board guidelines (388 KB,PDF), Word version (737 KB,DOCX).

Floor coverings have not been generally related to healthcare associated infection. Hard surfaces are easier to clean, although carpeting may offer advantages unrelated to infection prevention and control, including noise reduction.

The Australian guidelines for the prevention and control of infection in healthcare (NHMRC 2010) (NHMRC Guidelines) suggest that textile floor finishes (such as carpet) should not be considered unless there is a comprehensive maintenance and replacement program in place complying with AS/NZS 3733. In carpeted areas, regular thorough cleaning, maintenance and replacement are essential.

When carpet is used, the Board notes that short-pile carpet squares are preferred. Carpet squares allow for easy cleaning, replacement and maintenance of soiled or damaged floor coverings consistent with the guidance provided on textile floor coverings by the NHMRC Guidelines.

A sharps disposal container must be located in every treatment room.

A portable sharps disposal container is considered sufficient, provided the bin is in the treatment room and is as close as possible to the point of use, out of reach of children and secure to prevent tipping.

Sharps containers must not be filled beyond three-quarters full (NHMRC guidelines, pp. 63-64).

The Boards guidelines state that:

"The requirements for the handling of sharps are that:

  • acupuncture needles should not be reinserted into guide tubes after use..."

Whenever a practitioner inserts a needle into a guide tube there is a risk of a needle stick injury. For this reason a needle which has already been inserted into a patient should not be re-inserted into a guide tube due to the potential risk of the practitioner acquiring an infection from the used needle.

The re-use of a single pre-sterilised guide tube with the same patient using a new pre-sterilised needle each time is not against the CMBA guidelines. Practitioners are reminded that if the guide tube becomes contaminated then a new guide tube is required.

If the practitioner sustains a needle stick injury from a new sterile needle, then the practitioner must cover the injury, or wear a finger cot, or gloves in accordance with CMBA guidelines.

The risk of a needle stick injury even with a sterile needle when re-using guide tubes makes the use of a needles pre-packaged, with their own guide tube, preferable.

Good infection control practice is to open a pre-sterilised pack just before it is needed. The most likely risk of contamination to an opened pack of acupuncture needles is from the practitioner handling the opened package of needles. Because of the risk of contaminating needles between patients an opened pre-sterilised pack should not be used on more than one patient. An opened pack of pre-sterilised needles should be discarded at the end of a treatment.

It is a requirement that sterile acupuncture needles only be used. Once the shaft of a needle has been touched it is potentially contaminated and is unsuitable for use. If a technique requires that the shaft of a needle be held or guided, then the practitioner should use either a sterile single use glove to hold the shaft of the needle, or hold the needle with a single use sterile swab to avoid contaminating the needle.

No. While this is considered ideal (p.72 of NHMRC Guidelines), it is not essential in office-based acupuncture practice.

No. Regular cleaning and adherence to hygiene standards is expected in all acupuncture practices but formal record-keeping is not essential for office-based practices.

Domestic laundry machines and powders are considered adequate for washing these items in normal circumstances.

In situations when an increased risk of infection transmission is present, items should be laundered according to AS/NZS 4146. Used linen may be washed in domestic washing machine in separate loads to other domestic washing. If hot water is not available, only individual patient loads should be washed one at a time.

It is recommended that clothes dryers are used for drying.

Bamboo cups are made up of a porous material which is not suitable for cleaning, disinfection or sterilization in accordance with NHMRC Guidelines, and poses a risk of infection if reused. The porous nature of bamboo means that bamboo cups have been traditionally used by infusing them in a mixture of boiling herbs before use.

Requiring bamboo cups to be single use allows this traditional technique to continue while protecting the public from the risk of infection.

The CMBA guidelines state that:

"Cups (made of glass or plastic), scraping spoons, gua sha tools and any other equipment which has been in contact with intact skin only are noncritical items and can be reprocessed by cleaning and/or disinfecting according to the NHMRC Guidelines’.

Cups that have been contaminated with blood or been in contact with non-intact skin (such as after dermal hammering) are deemed to be critical items and must be sterilised in accordance to the standards in the CMBA guidelines.

It is unlikely that plastic cups will tolerate sterilization and therefore plastic cups contaminated with blood or which have been in contact with non-intact skin should be disposed of. Plastic cups that have been in contact with intact skin only may be reprocessed and reused according to the NHMRC guidelines.

No. A practitioner must not use equipment which may be contaminated with blood or been in contact with non-intact skin which has not been reprocessed according to the Board’s guidelines. There is a risk of cross infection if contaminated equipment is brought into a clinic as it could inadvertently be used on another patient, or contaminate other equipment. Cups that have been contaminated with blood or been in contact with non-intact skin are deemed to be critical items and must be sterilised in accordance to the standards in the CMBA guidelines, or disposed of.

Wood is a porous material and is unsuitable for cleaning/disinfecting in accordance with NHMRC guidelines. Choose a non-porous material such as porcelain or plastic for scraping tools and reprocess by cleaning and/or disinfecting according to the NHMRC Guidelines.

No. While it is recommended that all practitioners follow the immunisation recommendations (C2.2 of the NHMRC Guidelines), the Board recognises the right of individuals to choose not to be immunised. However, if this choice is made, it must be with a clear understanding of the risks, both to the practitioner and to patients.

These risks must be actively managed while remembering that the health and wellbeing of the patient is the practitioner’s primary concern.

It is essential to be familiar with the exclusion periods* for each communicable disease.

*Exclusion period: The period of time that contact should be avoided between a person infected with a communicable disease and a vulnerable person to avoid transmission of the disease between them.

No. An ICMP is mandatory for Queensland practices only. However, practitioners in other states may find it a useful document to aid them in identifying and managing infection risks specific to their practice.

The Board guidelines (388 KB,PDF), Word version (737 KB,DOCX) contain a table in Part 3 that identifies the various state and territory requirements, accurate at the time of publication. Hyperlinks to these and other useful resources are included in Part 2 of the guidelines.

State and territory requirements can change from time to time and for this reason the Board has not detailed specific state and territory requirements. It is the acupuncturist’s responsibility to keep abreast of local requirements.

Professional associations may also be a useful source of information about state and territory infection prevention and control requirements.

Page reviewed 1/09/2023