CNT BASIC PRINCIPLES 针灸无菌基本原理

CLEAN NEEDLE TECHNIQUE (CNT) INCLUDES THE FOLLOWING BASIC PRINCIPLES (2-1)

• 1. ALWAYS WASH HANDS BETWEEN PATIENTS, AND BEFORE AND AFTER NEEDLING.

• 2. ALWAYS ESTABLISH A CLEAN FIELD BEFORE PERFORMING ACUPUNCTURE.

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CLEAN NEEDLE TECHNIQUE (CNT) INCLUDES THE FOLLOWING BASIC PRINCIPLES: (2-2)

• 3. ALWAYS USE STERILE SINGLE-USE NEEDLES AND OTHER INSTRUMENTS THAT MAY BREAK THE SKIN, SUCH AS SEVEN-STAR HAMMERS, PRESS TACKS/INTRADERMAL NEEDLES, AND LANCETS.

• 4. ALWAYS IMMEDIATELY ISOLATE USED NEEDLES AND OTHER SHARPS.

• 5. FOLLOW STANDARD PRECAUTIONS.3

1. HAND HYGIENE

• HAND WASHING SHOULD BE DONE:

· BEFORE AND AFTER PATIENT CONTACT OR ACUPUNCTURE TREATMENT;

· WHEN HANDS ARE CONTAMINATED DURING THE TREATMENT;

· IMMEDIATELY AFTER INADVERTENT EXPOSURE TO BLOOD OR BODY FLUIDS;

· AFTER CONTACT WITH ENVIRONMENTAL SURFACES OR EQUIPMENT;

· AFTER REMOVING GLOVES;4

HAND WASHING PROCEDURE (2-1)

• REMOVE ANY HAND OR WRIST JEWELERS AND AVOID USE OF ARTIFICIAL NAILS. FOLLOW THESE 6 STEPS WHEN HAND WASHING.

• 1. WET YOUR HANDS IN WARM RUNNING WATER.

• 2. APPLY SUFFICIENT LIQUID SOAP TO ACHIEVE LATHER.

• 3. WASH ALL SURFACES OF YOUR HANDS INCLUDING BACKS OF HANDS, FINGERTIPS, BETWEEN FINGERS, WRISTS, BASE OF THUMBS, AND AROUND AND UNDER FINGER NAILS. SCRUBBING SHOULD LAST APPROXIMATELY 15 SECONDS.

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HAND WASHING PROCEDURE (2-2)

• 4. RINSE WELL AND LEAVE WATER RUNNING.

• 5. DRY THOROUGHLY WITH A DISPOSABLE PAPER TOWEL OR ELECTRIC HAND DRYER.

• 6. TURN OFF THE WATER WITH THE TOWEL, AND NOT WITH YOUR BARE HANDS.

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2. ESTABLISH A CLEAN FIELD

• USE A METAL TRAY OR CLEAN PAPER TOWEL:• ENSURE AREA FOR SUPPLIES IS CLEAN, LAY OUT THE CLEAN FIELD WITHOUT

CONTAMINATING IT.• PLACE ONLY CLEAN SUPPLIES IN FIELD, SET OUT NEEDLES, COTTON BALLS.

LAY OUT AN APPROPRIATE NUMBER OF NEEDLES FOR THE PROCEDURE WITHOUT CONTAMINATING THE SITE OR THE NEEDLES. STERILE NEEDLES MUST NOT BE PLACED ON A NON-STERILE ENVIRONMENT (E.G., TRAY, COTTON).

• TOUCH CLEAN SUPPLIES ONLY WITH CLEAN HANDS • THE WASTE BAG AND SHARPS CONTAINER MUST BE ESTABLISHED IN AN AREA

AWAY FROM THE CLEAN FIELD. 8

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3. USE STERILE SINGLE-USE NEEDLES

• PRIOR TO USE, ACUPUNCTURE PRACTITIONERS NEED TO INSPECT THE PACKAGING OF ANY SINGLE-USE STERILE NEEDLES (AND OTHER STERILE SHARPS) TO ENSURE THAT THE PROTECTIVE BARRIER HAS NOT BEEN BREACHED OR DAMAGED BY EXPOSURE TO WATER.

• THE EXPIRATION DATE OF ALL NEEDLES IN A CLINIC SHOULD BE CHECKED REGULARLY (I.E., MONTHLY) AND ALL EXPIRED NEEDLES BE DISCARDED.

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• DISCARD ANY PACKAGE OF NEEDLES THAT HAS BEEN PUNCTURED, TORN OR DAMAGED, OR PAST THE EXPIRATION

DATE OF STERILIZATION.

• WHEN USING ACUPUNCTURE NEEDLES FROM PACKAGES THAT CONTAIN MORE THAN ONE NEEDLE, ALL NEEDLES LEFT OVER AT THE END OF A TREATMENT MUST ALSO BE TREATED AS NON-STERILE SHARPS AND MUST THEREFORE BE DISCARDED IN AN APPROPRIATE SHARPS CONTAINER. ANY UNUSED BUT UNSTERILE NEEDLES

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4. SAFE HANDLING AND DISPOSAL OF ISOLATE USED NEEDLES AND OTHER SHARPS.

• SHARP CONTAINER MUST BE:

• PUNCTURE RESISTANT, • LEAK PROOF

• DESIGNED TO ALLOW SHARPS TO BE EASILY DEPOSITED, BUT DIFFICULT TO REMOVE

• DESIGNED WITH A SECURE LID AND HANDLE FOR CARRYING

• CLEARLY MARKED “BIOHAZARD” WITH EASILY IDENTIFIABLE SYMBOL

• LARGE ENOUGH TO HOLD ALL SIZES OF SHARPS

• DISPOSED OF IN A SUITABLE MANNER WHEN 3/4 FULL 12

5. FOLLOW STANDARD PRECAUTIONS

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Skin PreparationAcupuncture needles should be used only where the skin is clean and free of disease.Acupuncture needles should never be inserted through inflamed, irritated, diseased, or broken skin. Otherwise, infections can be carried directly into the body past the broken skin barrier.The areas to be needled should be clean prior to treatment. Alcohol swabbing is recommended but not essential before acupuncture needle insertion as long as an area is clean. If swabbing an area, 70% alcohol is required.

PALPATING THE POINT

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It is acceptable clean technique to palpate the acupuncture point after cleaning the skin, as long as the hands are clean and have not been contaminated. However, it is strongly recommended that before picking up the needle or palpating the point, the hands should be washed with soap and water or an alcohol-based hand sanitizer if they have been contaminated since the last handwashing by some activity such as arranging clothing or taking notes. After this second cleaning of the hands, nothing should be touched but the needle handle, guide tube, and the skin over the point. If anything else is touched, the fingers should be cleaned again as described above before proceeding.

INSERTING NEEDLE TO CORRECT DEPTH

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1. Follow the suggested needle depths indicated in standard texts, being sure to allow for variation in body size, age, underlying disease and risk factors. 2. Safe needling depth of the thoracic region to avoid pneumothorax and cardiac tamponade on most patients can be as little as 10-20 mm. Limiting the depth of acupuncture needle insertion to the subcutaneous layer is critical and avoiding use of needles that are longer than the safe needling depth for a particular body area is strongly recommended. 3. Soft tissue abdominal depths in an adult can vary from 2-4 cm. and will be less if the patient is thin or the tissue is compressed by palpation.

CAN I TOUCH THE NEEDLE DURING NEEDLE INSERTION?

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If you need to support the shaft of the needle during needle insertion, either because you are using a thin needle (e.g., 0.15 mm width) or a long needle (e.g., more than 25 mm length) or both, you must use a sterile barrier between your fingers and the shaft of the needle. While washing your hands removes most of the transient bacteria from the skin of the hands and fingers, it does not dislodge the resident bacteria. Some people carry resident bacteria on their skin that is pathogenic to other people.Any object that pierces the skin must be sterile. To support the shaft of the needle, when necessary, use sterile gauze or sterile cotton between the fingers and the needle shaft.

NEEDLE REMOVAL

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There are no specific standards regarding needle removal techniques. While it is clear that removed needles need to be placed immediately into a sharps container, there is no evidence indicating that needles must be removed and placed in a sharps container one at a time. Always use a cotton ball or other clean, absorbent materials (swab, gauze) for covering the hole after needle removal; never use your hand or finger. Some blood may be present, especially in the ear or on the scalp and best practices dictate that for safety, a barrier between the practitioner’s hands and the open area of skin is best to reduce the likelihood of transfer of pathogens from the patient to the practitioner or vice versa.

COUNTING NEEDLES

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One way to ensure that needles are not left in a patient or left on treatment tables or floors where they may cause a needlestick injury to office personnel is to count the number of needles used during a treatment and then count the number of needles removed and discarded after a treatment is completed. These needle counts can be documented in the patient’s chart.At the end of a treatment, if one or more needles are not located during needle removal, the practitioner should check the treatment table and floor around the table for needles that may have fallen out during the treatment session.

DEALING WITH BLOOD TO BLOOD CONTACT

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Acupuncture practitioners and office personnel are at risk for exposure to bloodborne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Exposures occur through needlesticks or cuts from other sharp instruments contaminated with an infected patient's blood or through contact of the eye, nose, mouth, or skin with a patient's blood. In the healthcare workplace, accidental contact with potentially contaminated blood or body fluids may be unavoidable. However, strict observance of Standard Precautions can preventsinfection from exposure, including bloodborne pathogens such as HBV, HCV, and HIV.

MANAGING USED NEEDLES

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Used instruments that have penetrated the skin must be isolated immediately in an appropriate sharps container. Used needles, lancets and the head of a seven star/plum blossom should not be reused. Used needles present risk for practitioners, staff, and children waiting for their parents.When using needles from packages that contain more than one needle, all needles left over at the end of a treatment.A sharps container for the used needles should be right beside the treatment table, on a flat, stable surface (not directly on the treatment table)Sharps containers should be replaced regularly and not be filled over 75%.