Infection - PowerPoint Presentation

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Infectionprevention and control for acupuncture practice

Stephen Janz

Chair, Policy Codes and Guidelines Advisory Committee, Chinese Medicine Board of AustraliaSlide2

Overview

Background to guidelinesMethodology used to develop guidelinesGuidelines structure

Specific guideline discussion

Conclusion

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Background

Primary objective of Chinese Medicine Board (CMBA) is to protect public health and safety

Potential risk of infection with skin penetration and related techniques

No uniform national standard in place for acupuncture prior to these guidelines

State requirements vary

Registered practitioners exempt from some states’ skin penetration regulations

Need for nationally consistent, evidence based guidelines

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Australian guidelines for prevention and control of infection in healthcare

CMBA adopted the National Health and Medical Research Council (NHMRC) Australian guidelines for prevention and control of infection in healthcare

(the Australian Guidelines).

The Australian Guidelines uses a risk management approach to infection prevention and control based on the best available evidence

Not all areas of acupuncture practice are adequately covered in the Australian Guidelines

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Aim of CMBA Guidelines

CMBA initiated a project to identify specific requirements for the prevention and control of infections in acupuncture practice that are not covered in the Australian Guidelines

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Method

The Australian Guidelines were examined to identify areas requiring further acupuncture specific guidance

Literature search conducted to identify other literature regarding acupuncture infection prevention and control.

Very little acupuncture specific literature (mainly case reports of infections) and one set of guidelines identified

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Method continued...

A further search was conducted for evidence based guidelines for established procedures with a similar procedural risk profile to acupuncture.

NHMRC immunisation guidelines

WHO guide to best practice for injections and related procedures

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Method continued...

Draft guidelines were developed by the Policies, Standards and Guidelines Advisory Committee Revised and approved by the CMBA for stakeholder consultation

Stakeholder feedback was reviewed prior to finalising the document

http://www.chinesemedicineboard.gov.au/News/Past-Consultations.aspx

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The CMBA Guidelines

Consists of three parts, with hyperlinks to take the reader directly to reference material:

Part 1

: How to use NHMRC’s Australian Guidelines in conjunction with the CMBA’s guidelines

Part 2

: Additional CMBA requirements for the prevention and control of infection in acupuncture practice

Part 3

: State and territory guidelines and regulations relevant to acupuncture practice

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Part 1 – How to use the NHMRC Australian Guidelines

The Australian Guidelines provide guidance for:

Basics of infection prevention and control

Standard precautions

Transmission-based precautions

Recommended cleaning routine

Organisational support

http://www.nhmrc.gov.au/book/html-australian-guidelines-prevention-and-control-infection-healthcare-2010

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Part 2 - Additional CMBA requirements

Six specific areas identified:Reprocessing of reusable instruments and equipment

Hand hygiene and special precautions when using alcohol-based hand rub

Appropriate use of gloves

Requirements for routine skin preparation and post-treatment procedures

Requirements for non-sharp waste disposal

Prevention and management of sharps Injuries

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Reprocessing of reusable instruments and equipment

All items must be reprocessed according to the Australian Guidelines except single use of:Acupuncture needles and dermal hammers

Glass cups, scraping spoons and other equipment that comes into contact with blood or non-intact skin

unless sterilisation in accordance with Australian Standards AS/NZ 4187 and AS/NZS 4815

Bamboo cups in all cases

not constructed of a material suitable for sterilisation in accordance with the Australian Guidelines

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Hand hygiene and special precautions when using alcohol-based hand rub

A clinic must contain at least one hands-free sink which is dedicated for hand washing onlyHand hygiene performed with alcohol-based hand rub is more effective against microbes than plain soap or antiseptic soap and water

However, when hands are visibly soiled and after using the toilet, they must be washed with soap and water

Either of these must be located close to acupuncture treatment area and must be readily accessible

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Special precautions when using alcohol-based hand rub

Alcohol-based hand rub must be stored, and used, away from heat and naked flamesNo tasks should be attempted until hands are completely dry

Procedures involving exposure to a naked flame such as

moxibustion

or cupping must not be attempted until alcohol has evaporated and hands are completely dry

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Requirements for appropriate use of gloves

Gloves do not need to be worn if the patient and practitioner both have intact skin and excessive bleeding is not expected

Single-use gloves may be required if excessive bleeding is anticipated

Direct contact with blood or body substances is unlikely when inserting an acupuncture needle into intact skin

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Examples of procedures which may require glove use:

removing needles from an area which has beenpre-treated with heat or massage

using a dermal hammer

cupping applied after dermal hammering

vigorous needle technique

electro-stimulation applied to acupuncture needles

acupuncture point injection

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More on glove use:

Any break in the practitioner’s skin must be adequately covered or a fingercot or

gloves used

In acupuncture practice, gloves do not need to be sterile but must be changed after every individual patient contact

The use of gloves is not an alternative to hand hygiene

Some states and territories require gloves to be used when inserting and/or removing acupuncture needles - refer to Part 3 of these guidelines for more information

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Requirements for routine skin preparation

Provided the skin is visibly clean, there is no need to swab it with an antiseptic before inserting needles

An antiseptic (such as isopropyl alcohol) must be used if the skin is visibly soiled, or has been pre-treated with massage oil or other topical preparations

An antiseptic (such as isopropyl alcohol) should be used before treating potentially

immunocompromised

patients

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Requirements for post-treatment management

A clean, dry cotton wool swab should be placed over the site of needle withdrawal immediately after withdrawal - to control any pinpoint of blood which may be evident, whether or not gloves have been used

Massage should not be applied to a site which has just received acupuncture due to the potential for an increased risk of infection at the site

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Requirements for non-sharp waste disposal

The Australian Guidelines do not make specific recommendations about waste disposal

Where specific state or territory requirements are not in place the following guidance applies:

clinic waste such as used swabs which do not contain expressible blood can be treated as general waste, and

used swabs must be:

discarded into a leak-proof plastic bag

kept out of reach of children, and

disposed of as general wasteStandard precautions should be used when handling or disposing of all waste

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Sharps disposal containers

Containers that comply with AS4031 or AS/NZ 4261 must be located close to each patient receiving acupuncture and must be kept out of reach of children

Sharps containers must not be filled beyond three-quarters full and must be disposed of by a waste disposal contractor according to respective state, territory or local government regulations

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Prevention and management of sharps injuries

Incorrect handling of sharps can result in a sharps injury and associated health risks to the practitioner

The requirements for the handling of sharps :

acupuncture needles should not be reinserted into guide tubes after use, and

when injection techniques are used, needles must never be recapped

See CMBA guidelines on how to manage a sharps injury

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Part 3 - State and territory guidelines and regulations relevant to acupuncture practice

The CMBA Guidelines contains a list of each state and territory acupuncture guidelines or regulations

subject to change

Where there is an inconsistency between the CMBA Guidelines and state or territory guidelines, the state or territory guidelines must be followed

Practitioners are responsible in keeping up to date with state or territory requirements

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Summary

All registered acupuncturists must comply with:the NHMRC Australian Guidelines

the CMBA Guidelines, and

relevant state, territory and local government requirements which apply to their place of business

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ConclusionThese guidelines took effect from 20 May 2013

The CMBA will monitor these guidelines for effectiveness and review them at least every three years

All acupuncturists registered with the CMBA must comply with the guidelines

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For more information

CMBA Guidelines are available at: http://www.chinesemedicineboard.gov.au/

For an example of how to apply a risk management approach to infection control and acupuncture see:

http://www.acupuncture.org.au/Publications/Infection_Control.aspx

www.ahpra.gov.au

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