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

1 December 2023

The following frequently asked questions provide helpful information on infection prevention and control for acupuncture practice.

Chinese medicine practitioners and those endorsed for acupuncture practice should read and practice in accordance with the Chinese Medicine Board of Australia’s (the Board) Guidelines on infection prevention and control for acupuncture and related practices.

All registered practitioners are also expected to follow ‘standard precautions’ in their practice, as set out in the Australian Government’s Australian guidelines for infection prevention and control in healthcare (2019) (the Australian guidelines).

This is not a suitable building for acupuncture practice. The Board expects that every acupuncture clinic will have at least one hands-free sink that is specifically for handwashing and is not used for other purposes. Alcohol-based hand rubs must be readily available in all work areas and near patients.

No. A clinic must contain at least one hands-free sink that is dedicated for only 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 that 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.

The Board expects alcohol-based hand rubs to be readily available in all work areas and near patients. The National Hand Hygiene Initiative manual advises that alcohol-based hand rub is the gold standard of care for hand-hygiene practice in healthcare settings, whereas washing hands with soap and water is reserved for situations when the hands are visibly soiled, or when caring for a patient with Clostridioides difficile or a nonenveloped virus (for example, norovirus). Soap and water should also be used to complement alcohol-based hand rubs if hands become sticky.

The Board expects flooring in areas that might be contaminated with fluids, such as near sinks or treatment tables, to be covered with an impervious surface and able to be cleaned effectively. The impervious surface might be a flat plastic mat. Hard surfaces are easier to clean, although carpeting may offer advantages unrelated to infection prevention and control, including noise reduction.

While stating that carpeting should be avoided in clinical areas where patient care and treatments are carried out, the Australian guidelines suggest that textile floor finishes may be considered if there is a comprehensive maintenance and replacement program in place complying with AS/NZS 3733:2018. Carpet may be used in areas within clinical zones such as interview rooms and office areas, provided that regular thorough cleaning, maintenance and replacement processes are in place.

The Australian guidelines state that a sharps disposal container must be located at the point of use in a treatment room, in a secure position or mounted to the wall to prevent tipping, at an accessible height for the registered practitioner.

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

Sharps containers must not be filled beyond three-quarters full, be out of reach of children and others to prevent hands and fingers entering the disposal unit and away from general waste bins to minimise the risk of incorrect disposal.

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 Board guidelines. Practitioners are reminded that if the guide tube becomes contaminated a new guide tube is required.

The Board expects that registered practitioners will not re-insert acupuncture needles 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 that 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.

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 the Board guidelines.

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

An opened pack of pre-sterilised needles must be discarded at the end of a treatment. 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 must not be used on more than one patient.

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, the practitioner should hold the needle wearing sterile gloves to avoid contaminating the needle.

Yes. The use of carpet in clinical areas where patients are treated should be avoided however, where carpet is used, the Australian guidelines state that public areas and in general patient-care areas should be vacuumed daily with well-maintained equipment fitted with high efficiency particulate air (HEPA) filters to minimise dust dispersion.

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 of a porous material that is not suitable for cleaning, disinfection or sterilisation in accordance with the Australian guidelines and pose a risk of infection if re-used. 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. Bamboo cups must be discarded after use.

Plastic cups that come into contact with blood or non-intact skin are deemed to be semi-critical items. If these items have been in contact with intact skin only, they are deemed to be non-critical items.

If contaminated, semi-critical items can be re-used after being reprocessed consistent with the requirements of the Australian Standards AS/NZS 4815:2006 for office-based practices and AS/NZ 4187:2014 and AS18/07:2019 for larger health facilities.

If reprocessing cannot be carried out consistent with the requirements of AS/NZS 4815:2006 or AS/NZ 4187:2014 and AS18/07:2019 (whichever is relevant), then these contaminated items must be treated as single use items and be disposed of immediately after use.

Non-critical items can be reprocessed by cleaning and/or disinfecting according to the Australian guidelines.

No. A practitioner must not use equipment that has not been reprocessed and may be contaminated with blood or been in contact with non-intact skin, according to the Australian 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 single use items and must be disposed of immediately after use.

Wood is a porous material and is unsuitable for cleaning/disinfecting in accordance with the Australian guidelines. Registered practitioners should use a non-porous material such as porcelain or plastic for scraping tools and reprocess by cleaning and/or disinfecting as a semi-critical item according to the Australian guidelines.

No. The Australian guidelines recommend that all practitioners follow the immunisation recommendations of the Australian Government’s Australian Immunisation Handbook. 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. Practitioners also need to keep up to date and comply with any public health orders issued by governments, such as those concerning COVID-19.

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

Yes. Each acupuncture clinic should have in place a clinic-wide strategic plan for infection prevention and control that establishes a system to manage infection prevention and control with input from practitioners, management and administrative staff.

The Board expects every acupuncture clinic to have in place an infection prevention and control plan that is tailored to the size of the acupuncture clinic, and that all registered practitioners and their staff to be aware of their individual responsibility for maintaining a safe care environment for patients and other staff.

Practitioners should also be aware of laws, regulations and guidelines specific to the state that they are practising in. Full details of these are given in Appendix One of the Board guidelines.

Staff members should not come to work if they have signs or symptoms of a potentially infectious disease, and should observe the exclusion period as recommended by the Australian guidelines.

The Australian guidelines advise that every healthcare facility should have comprehensive written policies about disease-specific work restriction and exclusion. Practitioners should be familiar with the exclusion periods for each communicable disease. An exclusion period is 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.

Appendix A and Appendix B of the Board guidelines identify the various state and territory requirements, accurate at the time of publication.

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 responsibility of registered practitioners to be aware of requirements in the state or territory that they are practising in.

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

Page reviewed 30/11/2023