SAFE NEEDLE PUNCTURE
All members of The Acupuncture Society must follow this code:
Only use pre-sterilised disposable needles. Always wipe the skin with non-allergenic wipes prior to and after needling.
Wear sterile vinyl or latex gloves if you have a skin disease, have sweaty fingers, cuts, abrasions, lesions or suffers from an infectious disease. Some needle types allow for aseptic puncture without the use guide tubes by holding the needle handle, whilst others require the use guide tubes. Never allow your fingers or anything else which is not sterile to touch the needle shank prior to insertion. For longer needles we recommend the use of guidetube or wearing sterile gloves. Needles must be used directly from the sterile pack and not placed on non-sterile surfaces prior to use.
Where the point of an unused needle comes in contact with the skin, nail or any non sterile surface it must not be used, and be discarded in a yellow sharps container. All used needles must be placed in a yellow sharps container and disposed of correctly by incineration by an approved sharps service. Used cotton wool wipes and couch roll must be disposed of in an appropriate manner according to local authority regulations.
NEEDLE AND INSTRUMENT QUALITY CONTROL
All needles should be purchased from a reputable medical supplier. Do not use the needles if you have any doubt of their quality, such as, bent or broken needles, torn sterile packaging etc. Ensure any needle used is within its use by date. Since May 2014 there has been a recognised International Standard for needle quality which has been adopted as a British Standard by the British Standards Institute. The title for this is sterile acupuncture needles for single use and the Standard Number is BS ISO 17218:2014.
All electro-acupuncture equipment must be checked and serviced by a registered electrician following the Electricity at Work Regulations (1989). Documentation of its electrical safety test certificate should be retained.
The Acupuncture Society recommend against the use of indwelling semi-permanent needles and auricular acupuncture inserted devices because the use of semi-permanent needles carries a greater risk of infection than with regular acupuncture techniques (Ernst & White 1999).
Auricular Acupressure balls/magnets/seeds
The use of acupressure balls, magnets or seeds in the ear is a technique that carries less risk than semi-permanent needles. We advise that acupressure balls magnets or seeds should not be used until full training has been completed in auricular acupuncture.
Withdrawal of auricular needles and ball/seed/magnets
We recommend using medical tweezers to grab and withdraw pasters for auricular balls/seeds/magnets and needles, tweezers must be washed as instructed below between patients.
Re-usable equipment such as glass or plastic cups, probes and massage equipment should be washed between uses in hot water with detergent and stored in a clean dry place. If possible, washing of re-usable equipment should be done in a dishwasher at high temperature
Alcohol swabs should always be available should they be required though their use is not mandatory (Cummings & Reid 2004).
They should always be used within their use by date. Visibly soiled or dirty skin or skin which has recently had emollients applied can be cleaned with 70% isopropanol or 0.5% chlorhexidine or soap and water.
Cotton wool balls are recommended to be used to control a small bleed following the removal of the acupuncture needle. Cotton wool balls must remain clean, but sterile cotton wool is not mandatory. They should be disposed of according to environmental health guidlines.
First aid kit
All practices should have a fully stocked first aid kit. The first aid kit should be regularly checked and restocked and there should be an appointed person to take charge of first aid arrangements. There is no mandatory list of items to put in a first aid box. The contents of any first aid kit should reflect the outcome of your first-aid needs assessment. The Health and Safety Executive have a suggested list of contents, please see
http://www.hse.gov.uk/pubns/indg214.pdf for more information.
All sharps containers should be yellow with an orange lid and compliant with UN3291 and BS7320 standards. They should be kept locked away when not in use. Sharps containers should be kept at a safe height, in a stable place and adjacent to the treatment couch when in use.
Each treatment area should have a treatment couch. All treatment couches should be height adjustable and in good working order. The non-
porous upholstery should be free from tears. Treatment couches should be covered with disposable paper couch roll which should be renewed after each patient. Material couch covers can be used and they should be changed and laundered regularly, however we do not advise their use.
Infection Prevention and Control
Storage of sharps
Under the Health and Safety at Work Act 1974 Section 3 we have a duty to protect those people who are not in our employment, i.e.
members of the public, guests, patients, visitors, contractors to site; and so the method to lock away potential hazardous objects is seen as a measure of protection. Therefore the Acupuncture Society recommend best practice to be storing sharps of all types (including new boxes of needles, used sharps and sharps containers) in a lockable cupboard or equivalent.
Steps to remain “sharps safe”:
• All sharps containers should be yellow with an orange lid and approved under BS7320: 1990/ UN 3291
• Do discard of any sharps directly into the sharps container immediately after use at the point of use. Close the aperture to the
sharps container when carrying or if left unsupervised to prevent spillage or tampering
• Do place the sharps container close to your working area so you do not have to travel with the sharps.
• Do carry sharps containers by the handle and do not hold them close to the body
• Do lock the container when its three-quarters full using the closing mechanism
• Do label the sharps containers with premises/departmental address prior to disposal
• Do place any damaged sharps containers inside a larger sharps container. Lock and label prior to disposal. Do not place this or
anything sharp inside a hazardous waste bag as it may cause injury
• Do keep sharps containers in a locked room/ cupboard when not in use
• Do keep all sharps waste in a designated, secure area until it is collected
• Do dispose of disposable razors in a sharps bin immediately after use. Razors should never be re-sheathed after use
• Do not place anything other than sharps in the sharps container
• Do not try to re-sheath any used needles, should they be supplied sheathed
• Do not leave sharps lying around and do not try to retrieve items from a sharps container
• Do not try to press sharps down in the container to make more room
• Do not place sharps containers on the floor, window sills or above shoulder height. Use wall or trolley brackets, they should be stored above knee level and below shoulder level
• Do not bend or break needles before discarding them
• Do not re-use needles during or after any treatment session
• Do not use makeshift containers such as drinks cans, bottles or cardboard boxes as sharps disposal. They are not adequate for the purpose and may find their way into domestic waste and present hazard to refuse workers and members of the public
• Full sharps containers must be collected and disposed of by a licenced waste management company
Clinical waste disposal HSE (n.d.)
All waste that has become contaminated with blood or body fluids should be disposed of correctly by a licensed waste handler.
Some local councils may provide support with clinical waste disposal.
Local Council Waste Collection Services
All clinic areas must be cleaned regularly and it is advised that a cleaning log is maintained to demonstrate regular cleaning. A policy should be in place to dictate when certain clinic areas and equipment should be
cleaned and how this cleaning should take place.
Blood borne virus
BBV’s are viruses that some people carry in their blood and which may cause severe disease in certain people and few or no symptoms in others. The virus can spread to another person, whether the carrier of the virus is ill or not.
The main BBV’s of concern are:
• Hepatitis B Virus (HBV), hepatitis C virus (HCV) and hepatitis D virus, which all cause hepatitis, a disease of the liver
• Human immunodeficiency virus (HIV) which causes acquired immune deficiency syndrome (AIDS), affecting the immune system
of the body
These viruses can also be found in body fluids other than blood, for example, semen, vaginal excretions and breast milk. Other body fluids or
materials such as urine, faeces, saliva, sputum, sweat, tears and vomit carry a minimal risk of BBV infection, unless they are contaminated with blood. Care should still be taken as the presence of blood is not always obvious.
Immunisation (vaccination) is available against Hepatitis B Virus (HBV), but no other blood borne viruses. The need for a worker to be immunised should be determined by the risk assessment where appropriate. It should only been seen as a supplement to reinforce other control measures. Employers should make vaccines available free of charge to their employees if they are needed. It is recommended that a vaccination record is kept and a reminder of when it is next due.
The Acupuncture Society recommends practitioners to be vaccinated against HBV.
See Health Authority Guidlines
Under ideal laboratory conditions HIV can remain infectious in dried blood and liquid blood for several weeks and HBV stays active for even longer. If materials become contaminated with blood or other body fluids, there are several methods available for decontamination. These procedures are designed to inactivate BBVs, mainly by using heat or chemical disinfection. You should have a local code of practice for dealing with spillages and other forms of contamination and all staff should be familiar with it.
• Methods of decontamination are:
• Physical cleaning
• Thermal washer disinfection
• Dry heat
• Chemical disinfection
This section is taken from HSE (2013a) Health and Safety
Employers are required to train their employees on the use of sharps, the
training provided to employees must cover:
• The correct use of safer sharps (if appropriate)
• Safe use and disposal of medical sharps
• What to do in the event of a sharps injury
• The employer’s arrangements for health surveillance and other
All Acupuncture Society members must ensure that they have recieved proper training in safe use and management of sharps prior to Joining
Sharps injury: notifying manager
An employee who receives a sharps injury at work must notify their employeras soon as is practicable. The employer will need to ensure
they have sufficiently robust arrangements to allow employees to notify them in a timely manner, including where the employee works out-of-office or away from the employer’s premises.
Recording and investigating a sharps injury
Employers must make a record of the sharps injury when they are notified of it, whoever provides that notification. They must investigate the circumstances and causes of the incident and take any action required.
The injured person is required to provide sufficient information to their employer to allow them to carry out this investigation. The extent of the investigation should be proportionate to the potential severity of the sharps injury. The purpose of the investigation should be to establish whether the employer’s existing risk control measures are adequate. It should look at underlying and root causes as well as the immediate factors that led to the individual injury. Any lessons to be learnt should be applied across the organisation (as appropriate), not just in the location of the injury.
In the case of an injury where there may have been exposure to a blood-borne virus or other significant infection, the
investigation may also involve establishing the infection status of the source patient (where it is possible to identify the individual).
If this information is known, it should be handled following usual patient confidentiality procedures.
If it is promptly shared with the medical professional who is treating the injured person, it can greatly assist with ensuring they receive the right treatment or that they do not take unnecessary prophylaxis or anti-viral treatments.
Treatment and follow-up of a sharps injury
The employer must ensure that, when notified of any incident in which an employee has been injured by a sharp that has or may have exposed them to a blood-borne virus, the employee:
• Has immediate access to medical advice
• Has been offered post-exposure prophylaxis and any other medical treatment, as advised by a doctor
• The employer has considered whether counselling would be appropriate for the employee
Even if the employee works out-of-hours or off the employer’s premises, the employer should
have robust systems in place to enable employees to receive treatment in a timely manner.
RIDDOR stands for “Reporting of Injuries, Diseases and Dangerous
Occurrences Regulations”. There are certain incidents that require
reporting by RIDDOR, a list of such incidents can be found on the “types
of reportable incidents” page of the RIDDOR website, please follow the
link for further information.
(Instruments in Healthcare Regulations 2013 Guidance for employers and employees. Health and Safety Executive).
Hands and finger nails must be scrubbed clean with antibacterial soaps between each patient, where sterile gloves are not used. Paper masks must be used when in close contact with patients and whilst administering moxibustion. Use sterilised disposable gloves during needle insertion and withdrawal. Disposable hand towels are recommended. Medical non alergy examination gloves must be worn when coming into contact with skin disease. Refrain from smoking or consuming food in the treatment area.
Needlestick injuries should be logged and a blood test taken, if the needle had penetrated the dermal layers see above
PATIENT CHECK LIST TO BE FILLED IN PRIOR TO TREATMENT
Practitioners must ask patients to fill in this or a similar check list before administering treatments:
If you suffer from any of the conditions listed below or other conditions which have not been included that you feel are relevant, please inform us prior to treatments so that we can assess your suitability for such treatment.
Where there is any doubt please consult your GP.
– A recent operation
– An untreated medical condition
– Severe bone or joint disorders (Rheumatoid/Osteo arthritis, osteoporosis)
– Cardiovascular disorders (high blood pressure, heart / circulatory desease, thrombosis)
– Endocrine disorders
– Drug addiction or recent use of recreational and/or prescribed drugs and or exessive alcohol consumption
– Pregnancy (or post natal within the last 6 months)
– Severe skin disorders
– Severe mental illness
– Spinal injuries
– Prone to fainting
– If you suffer from infectious deseases like hepatitis B or HIV
You must also have eaten within 2 hours prior to treatment (please inform practitioner if you haven’t)
– Is there anything else we should know about your health?
The EU laws concerning Herbal medicine came into force in April 2011, which only apply to patent medicines and preparations made up in factories for thirds parties. Those practitioners and retail outlets who are trading in patent medicines will be able to apply for a licence to continue to supply these patent or factory prepared formulations from the HPC (see the written ministerial statement below published 16 February 2011).
UK legislation due in early 2013 is likely to require registration of Herbal Practitioners with the HPC, it’s anticipated that this will greatly increase our acceptance within the orthodox medical community. There will be a consultion process begining in late 2012 leading to legislation expected in 2013, there will be grandparenting arrangements for all those qualified prior to the legislation becoming active. Until the White Paper is published it is not yet clear what exactly it will contain, but its expected to follow simillar processes that occured when previous aspirant therapies attained registration to the HPC in the past. The Acupuncture Society is seeking to attain automatic grandparenting for all its Herbal Members.
Follow this link to the hpc website page on herbal regulation http://www.hpc-uk.org/aboutregistration/ aspirantgroups/aspirantgroups/
Herbalist’s must not use endangered species animal and mineral substances in their formulae nor use patient medicines nor ask third parties to prepare them or their insurance may be void.
List of Banned Herbs and legal implications of new EU herbal regulation
A: RESTRICTED UNDER THE CONVENTION ON INTERNATIONAL TRADE IN ENDANGERED SPECIES (CITES) Herbs which are endangered in the wild are restricted but may be traded with the appropriate CITES certification. In the case of Appendix I this is normally only permitted for scientific purposes if at all. Suppliers can trade in herbs listed in Appendix II but only when obtained from an authenticated cultivated supply. An example of this is XI YANG SHEN which is available from farmed sources.
HU GU (Os tigris)
SHE XIANG (Secreto Moschus)
XI JIAO (Cornu Rhinoceri)
XIONG DAN (Vesica Fellea Ursi)
BAO GU (Os Leopardis)
DAI MAO (Carapax Ertmochelydis)
MU XIANG (Saussurea lappa) NOTE: Vladimira species are permitted as a substitute herb.
CHUAN SHAN JIA (Squama Mantis Pentadactylae)
HOU ZAO (Calculus Macacae)
LING YANG JIAO (Cornu Antelopis)
GUI BAN (Chinemys reevesii)
SHI HU (Dendrobium species)
BAI JI (Bletilla striata)
TIAN MA (Gastrodia elata)
GOU JI (Cibotium barometz)
LU HUI (Aloe ferox)
XIAO YE LIAN (Podophyllum emodii)
ROU CONG RONG (Cistanches deserticola)
XI YANG SHEN (Panax quinquefolius) NOTE: Only applies to the whole and sliced root.
HU HUANG LIAN (Picrorrhiza kurroa)
B: RESTRICTIONS UNDER STATUTORY INSTRUMENTS
SI 2130 1997 These herbs were listed as an in addition to those listed in the Medicines Act 1968 as being potent and hence in need of dosage regulation. In some cases they are forbidden at any level of internal dosage.
MD= Maximum single dose MDD=Maximum Daily Dose
FU ZI/CAO WU (Aconitum species) NOTE: Permitted to use externally at a dose of 1.3% or below. Internal use prohibited.
SHI LIU PI (Punica granitum). Internal use prohibited.
BING LANG (Areca catechu) Pharmacy use only.
DA FU PI (Areca catechu) Pharmacy use only
MA HUANG (Ephedra sinica). MDD: 1800 mg. MD: 600 mg.
YANG JIN HUA (Datura stramonium). MDD: 150 mg. MD: 50 mg.
YANG JIN HUA (Datura stramonium). MDD: 150 mg. MD: 50 mg.
DIAN QIE CAO (Atropa belladona). MDD: 150 mg. MD: 50 mg.
TIAN XIAN ZI (Hyocyamus niger). MDD: 300 mg. MD: 100 mg.
NOTE: SI 2130 also applies to other herbs not employed in Chinese medicine. S1 1841 2002
This ban relates to all Aristolochia species and also includes herbs which have been confused with Aristolochic species due to poor quality assurance.
The sale, supply and importation of the following is banned:
MU TONG (Aristolochia manshuriensis). NOTE: this ban also applies to Akebia quinata, Akebia trifoliata, Clematis montana and Clematis armandii.
FANG JI (Aristolochia fangji). NOTE: this ban also applies to Stephania tetrandra, Cocculus laurifolius, Cocculus orbiculatus and Cocculus Trilobus
MA DOU LING (Aristolochia contorta, Aristolochia debilis)
TIAN XIAN TENG (Aristolochia contorta, Aristolochia debilis)
QING MU XIANG (Aristolochia debilis)
SI 548 2008
All species of Senecio are prohibited for internal use due to the presence of toxic pyrrolizidine alkaloids
(PA). This mainly applies to the use of Senecio scandens QIAN LI GUANG
C: VOLUNTARY RESTRICTION Due the presence of Aristolochic Acid in Asarum species there is a voluntary ban on the use of: XI XIN (Asarum species)
D: RESTRICTIONS UNDER THE MEDICINES ACT 1968 Under Section 12(1) of the 1968 Medicines Act 1968, herbal remedies which are administered after a one-to-one consultation with a practitioner do not require a medicines licence (marketing authorisation). This legislation was enacted before traditional medicines from non-European cultures, which use non-plant substances, had any significant presence in the UK. Since the term ‘herbal remedies’ refers to plant materials, the MHRA has stated in its guidance on medicines law that the use of mineral and animal substances, which do not have a marketing authorisation, is illegal.
Section 12(1) is currently under review and the RCHM is working to re-establish the use of animal and mineral products. It is also expected that this redefinition of what constitutes a ‘herb’ will be clarified in European and UK legislation in the near future to include non-plant medicines.
In the meantime, members are warned that the use of these products may result in legal action by the MHRA and absence of insurance cover in the case of a claim. Hence all animal and mineral products should not be used until otherwise informed.
Whatever the outcome of this process, the following must never be used in any form:
ZHU SHA (Mercuric sulphide) Cinnabar
QING FEN (Mercuric chloride) Calomel
HONG FEN (Mercuric oxide) Realgar
HEI XI Lead
PRESCRIPTION ONLY MEDICINES (POM)
It is strictly prohibited to include any drug which is made available only through prescription by a registered medical doctor.
This includes the following:
YING SU KE (Papaver somnifera)
MA QIAN ZI (Strychnos nux vomica)
STEROIDS Including external use in creams such as PI YAN PING or 999 SKIN CREAMS.
FU ZI Internal use
E: PATENT FORMULAE
It should be noted that several patent formulae traditionally contain some of the above restricted herbs and toxic minerals, and recently some have been found to contain drugs. These include the following, which may present a health risk if used as a patent:
NIU HUANG JIE DU PIAN (May contain arsenic) TIAN WANG BU XIN DAN (May contain mercuric salts)
It is the responsibility of the practitioner to ensure that all patent formulae are obtained from ‘bonafide’ suppliers. In practice this means that all ingredients are listed and none of the above are included in the formula.
Patients should not be treated if they have consumed alcohol or combinations of alcohol, prescribed or recreational drugs or if they haven’t eaten two to three hours prior to treatment. They should have also taken their prescribed medicine to the prescribed dose prior to treatment. Patients should be treated whilst they are lying on the treatment couch and not whilst sitting on a chair as this will reduce the risk of syncope.
Abortion.Pregnancy related symptoms against the advice of a midwife or a medical doctor. Controlled infectious disease which require hospitalization in isolation. Treatment for cancer and other serious diseases like diabetes, high cholesterol, blood pressure, thyroid or any other conditions requiring medication must not be offered as a replacement to conventional medical treatment.
ORIENTAL MASSAGE SAFE PRACTICE STANDARDS (INCLUDING TUINA, THAI, ACUPRESSURE AND CHINESE MASSAGE)
An Oriental Massage Practitioner members will be able to demonstrate that they:
1. know and comply with their Professional the Acupuncture Society’s Code of Professional Conduct and Ethics.
2. keep clear and appropriate records.
3. understand cautionary techniques, and conditions requiring special consideration.
4. can offer appropriate lifestyle recommendations.
5. follow an accurate and appropriate assessment procedure.
6. use appropriate and accurate techniques.
7. can demonstrate reflective practice.
9. are working within the scope of practice of thier training.
10. have certificate or diploma qualification recognised by the Acupucture Society.
11. carry upto date professional indemnity/ public liability insurance cover.
12. have a minimum of anatomy and physiology qualification equivalent to the national standards of level 3.
13. hold a currant a first aid certificate.
14. can refer clients to a more approriate practitioner or a doctor when out of thier scope of practice.
15. can refer clients to their GP if any symptoms presented are not understood, are potentially dangerous or may require further investigation or medical treatment.
16. have undertaken the required annual CPD course hours and submitted them on the Society’s log.