Chapter 14 General Clean Needle

Technique (CNT) Protocol

(The excerpts of the sixth edition)

第十四章   美国洁针技术第六版（节选）

The following is a list of terms that are frequently used in this section of the manual.

Antiseptic: Products designed to reduce the density of microbial life on living tissue, particularly on the skin of the patient or practitioner.

Aseptic techniques: Techniques for preventing infection during invasive procedures such as surgical operations, dressing wounds, or some laboratory procedures. Acupuncture is not an aseptic procedure because it is not performed in a manner that preserves the sterility of the acupuncturist’s hands or the skin of the patient. Acupuncture is a clean rather than sterile procedure. That having been said, acupuncture needles must be kept in a sterile condition for use in CNT.

Clean field: The area that has been prepared to contain the equipment necessary for acupuncture in such a way as to protect the sterility of the needles. By extension, this includes not only the clean surface on which equipment will be placed, but also the patient’s skin around prepared acupuncture points, and anything that touches the skin. (Note: A clean field is not the same as a sterile field.)

Clean technique: The use of techniques (such as antisepsis, disinfection, sterilization, hand washing, and isolation of sharps) designed to reduce the risk of infection of patients, practitioners, and office personnel by reducing the number of pathogens, thereby reducing the chances for contact between the pathogens and the patients and personnel.

Contamination: The introduction of contaminating viruses, bacteria, or other organisms into or onto previously clean or sterile objects, rendering them unclean or non-sterile. (render v. to express or present something in a particular way)

Disinfectants: The chemicals employed in disinfection. They should only be used on inanimate (adj.

not living) objects, and are not to be confused with antiseptics that are applied to the body. Examples include hypochlorite dilutions such as bleach, and commercial disinfectants such as Staphene.

Disinfection: The use of chemicals and procedures designed to destroy or reduce the number of pathogens on inanimate objects such as equipment and clinic surfaces. It must be recognized that some bacteria, spores, and viruses may resist the often lethal effects of many chemicals.

Sterilization: The use of procedures that destroy all microbial life, including viruses. This is a rigid,

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uncompromising term. There is no such thing as partial sterility. In acupuncture, sterilization is required for all instruments that pierce the skin (needles, plum-blossom needles, seven-star hammers, and lancets) and insertion tubes.

BASIC PRINCIPLES

Clean needle technique (CNT) includes the following basic principles:

1. Always wash hands between patients, and before and after needling.

2. Always use sterile single-use needles and other instruments that may break the skin, such as seven-star hammers and lancets.

3. Always establish a clean field before performing acupuncture.

4. Always immediately isolate used needles and other sharps.

Besides the obvious necessity for sterile needles, lancets, and seven-star hammers, hand washing is the single most important action in preventing cross-infection. Hands should be washed with liquid soap under running water between patients, as well as before and after performing acupuncture, and whenever the practitioner’s hands may have become contaminated with potentially infectious material. Potential sources of contamination include touching the hair, clothes, or unswabbed skin of the patient; paperwork; or any other unclean surface or object in the treatment environment. The main goal of universal precautions is the prevention of exposure and nosocomial disease.

In the event that it is impractical or impossible for the practitioner to wash her or his hands with soap and water, an alcohol-based hand disinfectant may be substituted. Alcohol-based hand disinfectants are effective for reducing the presence of potentially infectious agents but will not be effective in the event that the practitioner’s hands are soiled ( soil v. to make something dirty, especially with waste from your body). When the practitioner’s hands are soiled, washing hands with soap and water remains the best way to remove contamination. For proper use of alcohol-based hand disinfectants, please see the manufacture’s instructions.

Contaminated needles are the greatest source of risk to the practitioner and patient. It is essential to minimize handling used needles during disposal. These basic principles will be discussed in the sections that follow. It is essential to be meticulous in following all aspects of clean needle technique protocol and universal precautions. This includes the use of sterile needles, hand washing between treatments, and isolation of used sharps. Skin and mucus membrane contacts frequently can be prevented with the use of barrier precautions such as gloves, masks, gowns, and goggles when necessary; however, the greatest risk of blood-borne pathogen transmission comes from needle stick injuries. Such accidents are not prevented by barriers but instead require strict adherence to CNT protocols by practitioners, including the immediate isolation of used sharps, the continuing recognition of the need to handle all patients as if they were potentially infectious, and the need to train all staff in clean needle protocols and universal precautions.

Precautions are the same for hepatitis and AIDS as well as for other diseases that might be transmitted by needlestick accidents. Health care workers are advised to develop standard and habitual procedures for all patients that provide the necessary protection against the transmission of potentially infectious agents.

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HAND WASHING

According to the CDC, hand washing is the single most important procedure for preventing infection in a health care setting. Hand washing has been shown to eliminate or markedly reduce pathogenic organisms on the skin. Hand washing includes the steps outlined below:

1. Gather the equipment needed to wash hands: paper towels, soap, and running water. Liquid soap is recommended due to the risk of contamination when using bar soap.

2. Roll up long sleeves; remove watch and jewelry, if applicable. A plain ring like a wedding band is acceptable, but bulky jewelry or rings with stones or intricate work should be removed. (Jewelry can harbor infectious agents in crevices that are not easily accessible)

3. Wet the soap and hands thoroughly.

4. Rub the soap to make lather.

5. Wash the entire surface of the hands between the fingers, around and under the fingernails and up to above the wrist.

6. Run water over the hands again to clean them.

7. Lower the hands so that water and soap drain off the fingertips as they are thoroughly rinsed.

8. Turn off the tap with a towel or use an elbow so that hands do not become soiled. Do not dry hands with the towel used to turn off the tap.

9. Dry the hands carefully using a clean paper towel or shake the hands dry in the air.

There are two types of infectious agents on the skin: resident and transient. Transient agents include those that are picked up from one patient and possibly carried to another. Soap is adequate for cleansing the surface of the skin of this type of infectious agent. Resident agents, which lodge deeper in the skin, present additional risk for an immunocompromised patient and germicidal soap or an alcohol-based hand disinfectant should be used. Therefore, it is strongly recommended that antimicrobial products be used for washing before and after treating patients who are severely immunocompromised (e.g., those with HIV or who are undergoing chemotherapy or dialysis).

It is strongly recommended that acupuncturists always wash their hands:

1. Immediately before the acupuncture procedure.

2. After contact with blood or body fluids or obvious environmental contaminants.

3. At the end of a treatment.

Hand washing with soap and running water is the most effective form of hand-washing. However, when there is no sink available, practitioners may use an alcohol-based hand disinfectant. An alcohol-based hand disinfectant can de-germ hands in less than 30 seconds and enhance killing of transient hand flora without the use of running water, soap, and hand-drying facilities. Studies have shown that clinicians find them convenient, accessible, and less irritating to the skin. The CDC has also accepted the use of antiseptic hand cleansers or towelettes.

The necessity of hand washing between patients and the use of universal precautions reflects the importance of treating all patients as if they were carriers of hepatitis or HIV. Beyond this, the need to wash the hands is based

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on whether the hands become contaminated during the course of treatment. Practitioners must wash their hands between patients, before and after inserting needles, and after contact with potentially infectious body fluids.

Sources of contamination include body fluids such as blood and saliva, vaginal secretions, and fecal contamination, and fluids from open lesions. Body fluids may contain bacteria such as Staphylococcus species, and viruses associated with hepatitis and HIV/AIDS. It is absolutely imperative (adj. extremely important and needing to be done or dealt with immediately) that potentially infectious fluids not be transferred from one person to another through the acupuncture provider’s hands, or from the patient to the practitioner and/or other members of the clinic staff. This is most effectively done by carefully washing hands whenever needed. Hand washing should also take place before and after answering the phone, whenever the practitioner touches her or his face or hair, eats, or engages in any other non-clinical activity.

The CDC recommends hand washing under the following circumstance:

1. When hands are visibly dirty or contaminated. (Wash with soap and water)

2. If hands are not visibly soiled. (Wash with soap and water or use an alcohol- based disinfectant)

3. Before contact with patients.

4. After contact with patients’ intact skin.

5. After contact with fluids or patients’ dressing.

6. After removing gloves.

7. Before and after eating.

Seven-Star or Plum-Blossom Needle

Seven-star and plum-blossom needles must be sterile. Either the whole device must be a single use and disposable device, or the head portion that contacts the patient’s skin must be sterile and disposable. Dot not attempt to sterilize, disinfect, or reuse these devices. Each seven-star hammer should be used on one region of the body only.

Cupping Devices

Cupping is not a sterile procedure. Cups must be clean but need not be sterile. After use on a patient, cups must be disinfected in a dilution of hypochlorite (bleach) or other appropriate disinfectant and then cleaned with soap and water. In some hospitals, cups must be sterilized in an autoclave or other on-site sterilizer before using. Discuss this with the appropriate administrator at each hospital or multiple care clinic.

Glove

It is recommended that gloves be used when there is risk of contact with blood or other potentially infectious body fluids; i.e., gloves must be worn when the practitioner bleeds an acupuncture point using a lancet or acupuncture needle. However, the use of gloves is not necessary during routine acupuncture practice in the absence of significant bleeding. The decision by an acupuncturist regarding whether gloves should be used must be viewed within the context of current research regarding risk factors involved in transmission of HBV and HIV and how these risk factors relate to both patients and practitioners within an acupuncture practice.

In order to protect the practitioner, the use of gloves is strongly recommended in the following instances:

1. During procedures such as bleeding where there is a greater risk of contact with larger amounts of blood.

2. When working with patients who have open lesions or weeping exudates from their skin.

3. When the practitioner has cuts, abrasions, chapped skin, hang nails, or broken cuticles on his or her hand that are located in a place where they pose a hazard.

4. When palpating or needling in the mouth or genital area.

5. When bleeding occurs in the course of routine acupuncture care.

In accordance with OSHA requirements, it is strongly recommended that “disposable (single use) non-latex gloves (such as surgical or examination gloves) shall be replaced as soon as practical when contaminated, or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised.”

Preparing the Site for Insertion of a Needle

It is strongly recommended that practitioners check that the skin at each point location to be treated is free of any cuts, wounds, or diseases. 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. It is strongly recommended that practitioners ensure that the part of the body to be treated is clean. The areas to be needled should be cleaned with an alcohol-impregnated swab. If body parts (e.g., the feet) are grossly dirty, they should be washed first with soap and water, and then swabbed as needed with an alcohol swab.

According to the CDC, 70% isopropyl alcohol is adequate for preparing a patient’s skin for procedures such as needle insertion. Isopropyl alcohol at a concentration above 70% is unacceptable because it evaporates too quickly to have an antiseptic effect. Other cleaning agents, if used, should also have adequate antiseptic properties. (Please note that if a patient is allergic to alcohol, the use of Betadine would be an acceptable alternative)

Swab the points and allow the alcohol to dry. It is recommended that points be swabbed in a way that touches the area only once so as not to recontaminate the area. One technique is to swab points using a rotary scrubbing motion, spiraling out from the center. Another technique is to swab from one end of the area to another or in a wide “C” motion. The same swab may be used for points in the same general area, for example, for several points on the back or on a single extremity such as the left forearm. A new swab should be used when changing areas of the body, for example from points on the torso to points on the extremities, or if the swab begins to change color. The alcohol should be allowed to dry to reduce the potential for discomfort during needling.

Dealing with Needle Spills

If used needles are accidentally spilled, remember that they are contaminated and will in turn contaminate anything they touch. Use gloves and forceps for picking them up and, if there is a possibility of dropping used needles on the practitioner’s clothing and contaminating it, a gown or impervious apron should be used. Then the spill area should be disinfected with a germicide since the HBV virus can survive on surfaces for more than one week at room temperature. Hypochlorite (bleach) at a 1:10 dilution or other commercial disinfectant can be used as the first-step cleanser, but since the organic material on the contaminated surface deactivates the cleanser, a second cleaning with bleach must still be done. All materials used in the clean-up job should be discarded in double wrapping. The last step is hand-washing. Ideally, sharps containers should be containers specifically constructed for holding medical sharps, with a positive closure and wall mounted where they cannot be knocked

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over and spilled. Sharps containers with medical waste must be disposed of according to local regulations. Ideally, a medical waste disposal firm should be contracted to transport filled sharps containers away from the clinic site. It is hazardous to transport filled sharps containers in your personal vehicle as these will pose an additional hazard to you, other victims, and emergency personnel in the event of a motor vehicle accident.

HAND WASHING

Hand washing is one of the most problematic topics within a public health or group treatment setting. It is not realistic to expect that the practitioner will wash his or her hands in a sink after each treatment due to the volume of patients to be treated, the time and logistics that would be required, and frequently, the lack of facilities for hand washing.

It is, however, strongly recommended by CDC that Practitioners:

1. Wash hands with soap and water on arrival and prior to leaving work, prior to eating, and after restroom use.

2. If hands are dirty with some organic matter such as blood, they must be washed with running water and either antimicrobial or non-antimicrobial soap.

3. An alcohol-based hand disinfectant or non-antimicrobial hand soap should be used between treatments, provided that only the needles, sterile packages, and other materials needed for the treatment were touched.

4. Hands must be decontaminated between patients.

5. Hands must be decontaminated after touching a patient’s intact skin, as well as inanimate objects and medical devices near the patient.

6. An alcohol-based hand disinfectant or washing hands with non-antimicrobial soap and water must be done between patients.

7. Gloves should be available in the treatment area and should be worn when there is a biohazardous spill, such as significant bleeding from an auricular acupuncture point.

8. Practitioners should wash their hands immediately with soap and water after critical instances, such as contact with blood or a break in the clean field between or during treatments.

9. Practitioners must have hand disinfectant available to them at all times in the public health treatment environment.

Federal Standards and Guidelines

Summary of CDC’s Universal Precaution Recommendations

1. All health care workers should adhere to universal precautions, including the appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments.

2. Hands should be washed before and after patient contact, and immediately if hands become contaminated with blood or other body fluids. Hands should also be washed after removing gloves.

3. Health care workers should comply with current guidelines for disinfection.

4. Instruments and other reusable equipment used in performing invasive procedures should be appropriately disinfected and sterilized as follows.

4.1 Equipment and devices that enter the patient’s vascular system or other normally sterile areas of the body

must be sterile.

4.2 Equipment and devices that do not touch the patient or that only touch intact skin of the patient need only be cleaned with a detergent or as indicated by the manufacturer.

5. Gloves should be worn whenever there is a possibility of contact with body fluids.

6. Body fluids to which universal precautions apply: blood, serum/plasma, semen, vaginal secretions, cerebrospinal fluid, vitreous fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, and wound exudates.

7. Use universal precautions whenever there is the risk of exposure to potentially contaminated fluids such as blood, sweat, tears, sputum, saliva, nasal, secretions, feces, urine, vomit, breast milk.

8. Health care workers who have exudative lesions or weeping dermatitis should refrain from all direct patient care and from handling patient-care equipment and devices used in performing invasive procedures.

9. Sharp objects represent the greatest risk for exposures. Contaminated needles should never be bent, clipped, or recapped. Immediately after use, contaminated sharp objects should be discarded into a puncture- resistant biohazard container designed for this purpose. Needle containers should never be overfilled; containers should be sealed and discarded when two-thirds to three-quarters full.

10. Contaminated equipment that is reusable should be cleaned of visible organic material, placed in an impervious container, and placed in a designated place for decontamination and reprocessing.

11. Masks should be worn whenever there is a possibility of splashing or splattering of body fluids or with an active TB patient.

12. Gowns should be worn if possible contamination of exposed skin or clothing is likely.

13. Spills of blood or blood-containing body fluids should be cleaned up using a solution of bleach (sodium hypochlorite) and water in a 1:100 solution for smooth surfaces and 1:10 for porous surfaces. Diluted bleach solutions should be no more than 24 hours old.

14. Current data indicate that health care workers infected with HIV or HBV who perform invasive procedures that are not exposure-prone pose no risk provided they practice the recommended surgical or dental techniques and observe universal precautions, and follow recommendations for sterilization and disinfection.

15. Medical/surgical/dental organizations and institutions at which these procedures are performed should identify exposure-prone procedures.

16. To minimize the risks for exchange of body fluids during resuscitation procedures, pocket masks or mechanical ventilation devices should be readily available where these procedures are likely to be needed.

【词语注释】

1. aseptic [,e'sɛptɪk] adj. free of or using methods to keep free of pathological microorganisms 无菌的，防 腐性的

2. sterile ['stɛrəl] adj. free of or using methods to keep free of pathological microorganisms 无菌的，不育的， 贫瘠的，不毛的，枯燥乏味的

3. sterility  [stə'rɪlɪtɪ] n. (of non-living objects) the state of being free of pathogenic organisms [ 泌尿] 不育， [ 妇产 ]不孕，无菌，不毛，内容贫乏

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4. sterilization [,sterəlaɪ'zeɪʃən] n. the procedure of making some object free of live bacteria or other microorganisms (usually by heat or chemical means) 杀菌，使不孕，无用状态

5. antisepsis [,æntə'sɛpsɪs] n. (of non-living objects) the state of being free of pathogenic organisms 防腐， 消毒，抗菌

6. disinfection [,dɪsɪn'fekʃən] n. treatment to destroy harmful microorganisms 消毒，杀菌

7. pathogen ['pæθədʒən] n . any disease-producing agent (especially a virus or bacterium or other microorganism 病原体，病菌

8. inanimate [ɪn'ænɪmət] adj. not endowed with life 无生命的，无生气的

9. dilution [dɪ'ljʊʃən] n. weakening (reducing the concentration) by the addition of water or a thinner 稀释， 冲淡；稀释法；冲淡物

10. bleach [blitʃ] v. make whiter or lighter ( 使 ) 漂白，（使）变白；n. an agent that makes things white or colorless 漂白剂

11. nosocomial [,nosə'komɪəl] adj. taking place or originating in a hospital 医院的

12. soil [sɔɪl] v. to make something dirty, especially with waste from your body 弄脏，变脏，污辱

13. meticulous [mə'tɪkjələs] adj. marked by precise accordance with details 对细节十分注意的，一丝不 苟的，小心翼翼的，拘泥小节的

14. protocol ['protə'kɔl] n. (computer science) rules determining the format and transmission of data 协议， 草案，礼仪

15. hepatitis [,hɛpə'taɪtɪs] n. inflammation of the liver caused by a virus or a toxin 肝炎

16. eliminate [ɪ'lɪmɪneɪt] v. terminate or take out 消除，排除

17. intricate ['ɪntrɪkət] adj. having many complexly arranged elements; elaborate 复杂的，错综的，缠结的

18. transient [trænʃənt] adj. lasting a very short time 短暂的，路过的；n. one who stays for only a short time 瞬变现象，过往旅客，候鸟

19. immunocompromised [ɪ,mjʊno'kɑmprəmaɪzd] adj. unable to develop a normal immune response usually because of malnutrition or immunodeficiency or immunosuppressive therapy 免疫功能不全的

20. germicidal  [,dʒɝmə'saɪdl] adj. preventing infection by inhibiting the growth or action of microorganisms 杀菌的，有杀菌力的

21. antimicrobial [æntimaɪ'krobiəl] adj. capable of destroying or inhibiting the growth of disease-causing microorganisms 抗菌的；n. an agent (as heat or radiation or a chemical) that destroys microorganisms that might carry disease 抗菌剂，杀菌剂

22. precaution [prɪ'kɔʃən] n. a precautionary measure warding off impending danger or damage or injury etc. 预防，警惕；预防措施；v. 警惕，预先警告

23. vaginal [və'dʒaɪnl] adj. of or relating to the vagina 阴道的，叶鞘的

24. secretion [sɪ'kriʃən] n. the organic process of synthesizing and releasing some substance 分泌，分泌物， 藏匿，隐藏

25. lesion ['liːʒ(ə)n] n. any break in the skin or an organ caused by violence or surgical incision 损害，身体 上的伤害，机能障碍

26. imperative [ɪm'pɛrətɪv] adj. extremely important and needing to be done or dealt with immediately 必 要的，不可避免的；紧急的；命令的，专横的；势在必行的

27. autoclave ['ɔtoklev] n. a device for heating substances above their boiling point; used to manufacture chemicals or to sterilize surgical instruments 高压灭菌器，高压锅；v. subject to the action of an autoclave 用高 压锅烹饪

28. abrasion [ə'breʒən] n. an abraded area where the skin is torn or worn off 擦伤，磨损，磨耗

29. genital ['dʒɛnɪtl] adj. of or relating to the external sex organs 生殖的，生殖器的；n. 生殖器，外阴部

30. swab [swɑb] n. implement consisting of a small piece of cotton that is used to apply medication or cleanse a wound or obtain a specimen of a secretion 药签；拭子；医用海绵，纱布；拖把，擦帚；v. wash with a swab or a mop 打扫，擦拭；涂抹（药）于

31. evaporate [ɪ'væpəret] v. lose or cause to lose liquid by vaporization leaving a more concentrated residue ( 使）蒸发，（使）挥发，（使）消失，（使）失踪

32. allergic [ə'lɝdʒɪk] adj. characterized by or caused by allergy 对…过敏的，对…极讨厌的

33. spiral ['spaɪrəl] v. to wind or move in a spiral course ( 使 ) 成螺旋形，( 使 ) 作螺旋形上升；n. a plane curve traced by a point circling about the center but at increasing distances from the center 螺旋，旋涡，螺 旋形之物；adj. in the shape of a coil 螺旋形的，盘旋的

34. forceps ['fɔrsɛps] n. an extractor consisting of a pair of pincers used in medical treatment (especially for the delivery of babies) 钳子，医用镊子

35. impervious [ɪm'pɝvɪəs] adj. not admitting of passage or capable of being affected 不受影响的，无动 于衷的，不能渗透的

36. apron ['eprən] n. a garment of cloth or leather or plastic that is tied about the waist and worn to protect your clothing 围裙，[ 航 ] 停机坪，舞台口；vt. 系着围裙于，围绕

37. germicide ['dʒɝmə,saɪd] n. an agent (as heat or radiation or a chemical) that destroys microorganisms that might carry disease 杀菌剂，杀菌物

38. deactivate [di'æktə,vet] vt. remove from active military status or reassign 使无效，使不活动，遣散， 复员

39. antimicrobial[,æntimaɪ'krobiəl] n . an agent (as heat or radiation or a chemical) that destroys microorganisms that might carry disease 抗菌剂，杀菌剂；adj. capable of destroying or inhibiting the growth of disease-causing microorganisms 抗菌的

40. decontaminate ['dikən'tæmə'net] vt. get rid of contamination 净化，给…去污

41.biohazardous [baiəu'hæzədəs] adj. 生物公害的，生物研究造成危害的

42. invasive [ɪn'vesɪv] adj. involving invasion or aggressive attack 侵略性的，攻击性的

43. detergent [dɪ'tɝdʒənt] n. a cleansing agent that differs from soap but can also emulsify oils and hold dirt in suspension 清洁剂，去垢剂

44. cerebrospinal [,sɛrəbro'spaɪnl] adj. of or relating to the brain and spinal cord 脑脊髓的

45. sputum ['spjʊtəm] n. saliva mixed with discharges from the respiratory passages 痰，唾液

46. saliva [sə'laɪvə] n. a clear liquid secreted into the mouth by the salivary glands and mucous glands of

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the mouth 唾液，涎

47. feces ['fisiz] n. solid excretory product evacuated from the bowels 排泄物，渣滓

48. urine ['jʊrən] n. liquid excretory product 尿

49. exudative [iɡ'zju:dətiv] adj. 渗出性的，流出的

50. dermatitis [,dɝmə'taɪtɪs] n. inflammation of the skin 皮炎，皮肤炎

51. seal [siːl] n. a device incised to make an impression 密封，印章，海豹，封条，标志；vt. close with or as if with a seal 密封，盖章

52. designated ['dɛzɪg,netɪd] adj. selected or named for a duty 指定的，特指的

53. resuscitation [rɪ,sʌsə'teʃən] n. the act of reviving a person and returning them to consciousness 复苏， 复兴，复活

54. ventilation [,vɛntl'eʃən] n. the act of supplying fresh air and getting rid of foul air 通风设备，空气流 通

【参考译文】

美国洁针技术第六版（节选）

以下是本手册本节中经常使用的术语列表

抗菌消毒剂：设计用于降低活组织，特别是患者或从业者皮肤上的微生物生命密度的产品。无菌技 术：用于在侵入性手术过程中预防感染的技术，如外科手术、包扎伤口或一些实验室程序。

针刺不是无菌操作，因为其不以保持针灸师的手或患者皮肤的无菌性的方式进行。针刺是一种清洁 而不是无菌的技术。在通用洁针技术协议里面已经说过，针灸针必须保持在无菌条件下使用。

清洁区域：是已经准备好的包含针灸所必需的设备以保护针具无菌性的方式的区域。推而广之， 这不仅包括将放置设备的清洁表面，而且包括患者准备好的针灸穴位周围的皮肤以及接触皮肤的任何东 西。（注意：清洁的区域与无菌区域不同）

清洁技术：使用旨在通过减少病原体的数量来减少患者、医生和办公室人员感染的风险的技术（例 如防腐、消毒、灭菌、洗手和隔离锐器），从而减少病原体与患者和工作人员之间接触的机会。

污染：污染性病毒、细菌或其他生物体进入到先前清洁或无菌的物体中或之上，使它们不洁净或不 无菌。

消毒剂：用于消毒的化学品。它们只应该用于无生命的对象，并且不与应用于身体的消毒剂混淆， 实例包括次氯酸盐稀释剂如漂白剂和商业消毒剂如Staphene。

消毒：化学品的使用过程旨在破坏或减少无生命物体（如设备和诊所表面）上的病原体的数量。必 须认识到，一些细菌、孢子和病毒可以抵抗许多化学物质的致命作用。

灭菌：用于破坏所有微生物生命的程序，包括病毒。这是一个严格的、不妥协的术语。没有所谓的 部分无菌。在针灸中，所有刺穿皮肤的器械（针灸针、梅花针、七星锤和柳叶刀）和针刺辅助管均需要 灭菌。

基本原则

针灸洁针技术包括以下基本原则：

1. 总是在患者之间和针刺前后洗手。

2. 总是使用无菌的一次性针具和一次性使用的其他可能侵入皮肤的器械，如七星锤和柳叶刀。

3. 在进行针灸前，要始终建立一个干净的区域。

4. 总是立即隔离使用过的针具和其他锐器。

除了无菌的针灸针、柳叶刀和七星锤明显的必要性外，洗手是预防交叉感染最重要的行动。在患者

之间，以及在进行针灸之前和之后，并且当医生的手可能已经被潜在的感染性材料污染时，都应该用液 体肥皂在自来水下洗手。潜在的污染源包括触碰了头发、衣服或未经擦拭消毒的皮肤、文书工作，或接 触了治疗环境中的任何其他未清洁的表面或物体。上述包含洗手等的普遍预防措施的采用主要目的是预 防职业暴露和医院内疾病的发生。

如果医生在不现实或不可能用肥皂和自来水洗手的情况下，（在未污染的情况下）则可以用含乙醇 的手消毒剂代替。含酒精的手消毒剂对于减少潜在感染性病原体的存在是有效的，但是在医生的手污染 的情况下是不会有效的。当医生的手被污染时，用肥皂和自来水洗手仍然是去除污染的最好方法。为了 正确使用酒精类手消毒剂，请参阅制造商的说明书。

被污染过的针头是医生和病人最大的危险源。在处置过程中尽量减少握持使用过的针（的时间）是 必要的。这些基本原则将在下面的章节中讨论。严格把握遵循洁针技术规程和通用预防措施是十分必要 的。这包括无菌针的使用，治疗之间的洗手，以及使用过的锐器的隔离。必要时使用屏障预防措施，例 如手套、面罩、罩衣和护目镜，可以防止皮肤和黏膜(与外界)的经常接触。然而，血源性病原体传播的最 大风险来自针刺伤。这样的事故不会被屏障阻止，而是要求医生严格遵守洁针技术协议，包括立即隔离 使用过的锐器，持续认识到“需要处理对待所有患者，就像他们有潜在的传染性”的必要性，以及需要 训练所有工作人员遵守洁针协议和通用预防措施。

对于肝炎和艾滋病以及可能通过针刺事故传播的其他疾病，预防措施是相同的。卫生保健工作者应 该制定标准和惯例程序，为所有患者提供必要的保护，以防止潜在的传染性病原体的传播。

洗手

根据美国疾病预防控制中心的研究，在医疗环境中洗手是预防感染的最重要的步骤。洗手已被证明 可以消除或显著减少皮肤上的致病微生物。洗手包括以下步骤：

1. 收集洗手所需的设备：纸巾、肥皂和流动水。洗手时建议使用洗手液，因为使用固体肥皂时有污 染的危险。

2. 如果可以的话，洗手时应该卷起长袖，取下手表和珠宝。像婚戒一样的普通戒指是可以接受的， 但笨重的首饰或者用石头或复杂工序做的戒指应被摘除。（珠宝可以在不易接触的缝隙中携带传染性物 质）

3. 彻底地润湿肥皂和手。

4. 摩擦肥皂使产生泡沫。

5. 在手指之间，指甲周围和下方直到手腕上方，清洗手的整个表面。

6. 再次将双手置于自来水下冲洗干净。

7. 放低双手，以便水和肥皂沫在彻底冲洗后从指尖排出。

8. 用毛巾或用肘尖关闭水龙头以便手不会被污染，不要使用用过于关闭水龙头的毛巾来擦干手。

9. 用干净的纸巾小心地擦干手，或在空气中摇动将手干燥。

皮肤上有两种类型的传染性病原体：固定和暂时的。暂时的病原体包括从一个患者身上获得并可能 携带到另一个患者的那些病原体，肥皂足以清洗这种类型的传染性病原体的皮肤表面。固定的病原体是 指隐藏在皮肤深处的病原体，对免疫功能低下的患者存在额外的风险，（面对这类病原体）应使用杀菌 皂或含酒精的手部消毒剂。因此，强烈建议在对严重免疫功能低下的患者（例如，那些艾滋病患者或正 在接受化疗或透析的患者）治疗前后均要使用抗菌产品清洗双手。

强烈建议针灸师总是洗手

1. 在针刺之前。

2. 接触血液或体液或明显的环境污染物后。

3. 在治疗结束时。

用肥皂和流动水洗手是最有效的洗手方式。然而，当没有可用的水槽时，从业者也许可以使用含酒

Billingual Acupuncture and Moxibustion

精的手部消毒液。含酒精的手部消毒液可以在不到30秒内对手进行除菌，并且在不使用自来水、肥皂和 干手设备的情况下增强对暂居性手部菌群的杀灭。研究表明，临床医生发现手部消毒液（的使用）方 便、容易，对皮肤刺激小。美国疾病预防控制中心还接受了使用抗菌手部清洁剂或湿纸巾。

洗手的必要性在治疗患者之间和普遍预防措施的使用反映了对待所有患者的重要性，如同他们是肝 炎或艾滋病毒携带者一样。除此之外，洗手的必要性取决于在治疗过程中手是否受到污染。医生必须在 患者之间，在进针之前和之后，以及接触了潜在的传染性体液后洗手。

污染源包括体液，如血液和唾液、阴道分泌物和粪便污染物，以及来源于开放性病灶的液体。体液 中可能含有细菌，如葡萄球菌属，以及与肝炎和艾滋病相关的病毒。极其重要的是，潜在的感染性液体 不允许通过针灸师的手从一个患者转移到另一个患者，或者从患者转移到医生和/或诊所的其他工作成 员，最有效的（预防）方法就是仔细地清洗双手。在接听电话之前和之后也应该洗手，每当医生在触摸 自己的脸或头发，吃东西，或从事任何其他非临床活动之后都应该洗手。

美国疾病预防控制中心建议在以下情况下洗手

1. 当手被明显地弄脏或污染时（用肥皂和流动水清洗）。

2. 如果手没有被明显地（可视性）污染时（用肥皂和水清洗或使用含酒精类的手消毒剂）。

3. 在与患者接触之前。

4. 与患者完好皮肤接触后。

5. 在接触（患者）体液或患者敷料后。

6. 在取下手套后。

7. 在进食前后。

七星针或梅花针

七星针和梅花针必须是无菌的。整个装置要么必须是一次性使用的一次性装置，要么与病人皮肤接 触的头部必须是无菌的和一次性的。不要试图进行杀菌，消毒，或重复使用这些设备。每个七星锤只能 在身体的一个区域使用。

拔罐设备（器具）

拔罐不是一个无菌操作。罐子必须清洁，但不必是无菌的。在患者使用后，罐子必须用稀释的次氯 酸盐（漂白剂）或其他适当的消毒剂消毒，然后用肥皂和水清洗。在一些医院中，在使用之前，罐子必 须在高压灭菌器或其他现场消毒器中消毒。在每个医院或联合诊所与适当的管理员讨论这个问题。

手套

建议在有接触到血液或其他潜在感染性体液的危险时使用手套，即当医生使用刺血针（柳叶刀）或 针灸针放血时必须戴手套。然而，在没有明显出血的情况下，常规针灸治疗时不需要使用手套。针灸师 关于是否应该使用手套的决定必须在当前关于涉及乙肝病毒和艾滋病病毒传播的风险因素的研究背景下 以及在针灸实践中，这些危险因素与病人和医生的关系中来看待。

为了保护执业者，在以下情况下强烈推荐使用手套

1. 在出血等过程中，当有较大的接触大量血液的风险时。

2. 当治疗皮肤有开放性损伤或渗出物渗出的患者时。

3. 当医生在他或她的手上（发现)有易造成危险的地方，如切口、擦伤、皲裂的皮肤、倒刺或破损的 角质层，面临暴露的风险时。

4. 当在口腔或生殖器区域触诊或针刺时。

5. 在常规针灸治疗过程中出血时。

根据职业安全与卫生条例的要求，强烈建议“一次性非乳胶手套（如手术或检查手套）在被污染时 或者如果它们被撕裂、刺穿或者当它们作为屏障的能力受到损害时，应尽可能快地更换。

准备好进针的部位

强烈建议医生（从业人员）检查每个要治疗的部位的皮肤是否没有任何切口、伤口或疾病。针灸针 绝不能通过发炎、刺激、患病或破损的皮肤插入。否则，感染可以通过破损的皮肤屏障直接进入身体。 强烈建议医生确保被治疗的身体部位是清洁的。针刺的区域应用含酒精的棉签清洁。如果身体部位（例 如，脚）是非常肮脏的，他们应首先用肥皂和水清洗，然后根据需要用酒精棉签擦拭。

根据美国疾病预防控制中心的要求，70％异丙基酒精适用于在诸如进针的程序中准备患者的皮肤。 浓度高于70％的异丙醇是不可接受的，因为它蒸发太快而不具有消毒的效果。其他清洁剂，如果使用， 也应具有足够的消毒性能。（请注意：如果患者对酒精过敏，使用聚维酮碘将是一种可接受的替代选 择）

（用酒精棉签）擦拭穴位，并让酒精干燥。建议以仅接触该区域一次的方式擦拭穴位，以免重新污 染该区域。一种方法是采取从中心到四周的回旋搽拭动作来消毒。另一种方法是从该区域的一端顺次消 毒到另一端或采用宽“C”字运动消毒法。相同的拭子（棉签）可用于相同区域中的多个穴位消毒，例 如，背部或四肢（如左前臂)上的几个穴位。当改变身体区域时，例如从躯干上的穴位到四肢上的穴位， 或者如果棉签开始改变颜色时应当使用新的棉签。（在消毒过程中）应该让酒精干燥，以减少针刺期间 潜在的不适感。

处理针漏

如果使用过的针具意外溅出，请记住，它们已被污染，反过来也会污染它们接触过的任何东西。使 用手套和镊子将其捡起来，如果在有用过的针具掉在医生的衣服上并污染衣物的可能性的情况下，则应 使用长袍或防渗围裙。然后在泄漏区域使用杀菌剂消毒，因为HBV病毒可以在室温下在表面上存活超过 一周；可以使用1∶10稀释的次氯酸钠（漂白剂）或其他商业消毒剂作为第一步清洁剂，但是由于污染 表面上的有机物质会使清洁剂失效，因此仍需进行第二次漂白剂处理。清洁工作中使用的所有材料都要 用双层包装丢弃。最后一步是洗手。理想情况下，尖锐的容器应该是专门用于容纳医疗锐器而构造的容 器，具有正面的封闭件和壁挂式安装，使其不能被翻倒和溢出。用于装置医疗废物的锐器容器必须根据 当地法规处理。理想情况下，医疗废物处理公司应与医疗机构签订合同，运送已装满的锐器容器离开诊 疗机构。使用你的私人车辆运输满载的锐器容器是危险的，因为这会在发生机动车事故时对您、其他受 害者和急救人员造成额外的危害。

洗手

洗手是公共卫生或团体治疗中最有疑问的话题之一。期望医生在每次治疗后在水槽中洗手，这是 不现实的，因为这是由需要治疗的患者的数量、所需的时间和后勤保障所决定的，并且经常缺乏洗手设 施。然而，美国疾病预防控制中心强烈建议从业者：

1. 在开始工作和在离开工作之前，进餐之前和在使用洗手间后用肥皂和自来水洗手。

2. 如果手被一些有机物质如血液弄脏，他们必须使用流动水和抗菌或非抗菌肥皂清洗。

3. 在治疗之间应使用含酒精的手部消毒剂或非抗菌洗手液洗手，以便于接触针、无菌包装和治疗所 需的其他材料。

4. 在治疗患者之间（医生的）手必须消毒。

5. 在接触患者完整的皮肤，以及患者附近的无生命物体和医疗设备后，手必须消毒。

6. 在患者之间，必须用含酒精类的手消毒剂或用非抗菌皂和自来水洗手。

7. 手套应该在治疗区域备用，并且当有生物危险的溢出时，例如耳穴处有明显出血时，应戴手套。

8. 在紧要的情况下，医生应立即用肥皂和自来水清洗双手，例如手在治疗之间或治疗期间与血液接 触或在清洁区被污染情况下。

9. 在公共卫生治疗环境中，医生（从业人员）必须备有随时可使用的手消毒剂。

Billingual Acupuncture and Moxibustion

联邦标准和准则（指南）

美国疾病预防控制中心通用预防建议摘要

1. 所有医护人员应遵守通用的预防措施，包括适当地使用洗手、防护屏障，以及在使用和处理针头 和其他尖锐器械时的注意事项。

2. 在接触患者前后应清洗双手，如果手被血液或其他体液污染时，应立即清洗。在摘除手套之后也 应该清洗双手。

3. 健康护理工作者（医护人员）应遵守当前的消毒指南。

4. 用于进行侵入性手术的器械和其他可重复使用的设备应进行如下适当的消毒和灭菌。

4.1 进入患者血管系统或身体其他正常无菌区域的设备和装置必须是无菌的。

4.2 不接触患者或只接触患者完整皮肤的设备和装置只需用清洁剂或制造商指定的清洁剂来清洁。

5. 当有可能与体液接触时，应戴手套。

6. 适用于普遍（通用）预防措施的体液包括：血液、血清/血浆、精液、阴道分泌物、脑脊液、玻璃 体液、滑液、胸腔积液、心包液、腹腔液、羊水、伤口分泌物。

7. 每当有可能接触潜在受污染的液体如血液、汗液、眼泪、痰液、唾液、鼻腔分泌物、粪便、尿 液、呕吐物、母乳的危险时，应采取通用预防措施。

8. 有渗出性病变或湿疹的医护人员应避免进行所有直接的病人护理和把持侵入性操作中使用的病人 护理设备和装置。

9. 尖锐物体代表暴露的最大风险。受污染的针头不应弯曲、修剪或翻新。使用后立即将受污染的尖 锐物体丢弃到专为此目的设计的防刺穿生物危害容器中。针头容器不应过满；容器应当在三分之二至四 分之三满时密封并丢弃。

10. 可重复使用的污染设备应清洁可见的有机物质，置于不透水的容器中，并放置在指定的地方进行 净化和再处理。

11. 当有可能溅出体液或与活动性结核病患者接触时，应戴上手套。

12. 如果可能污染暴露的皮肤或衣服时，应穿着长袍。

13. 溢出的血液或含有血液的体液应使用稀释过的次氯酸钠漂白溶液来清洗，其中1∶100的次氯酸钠 溶液（次氯酸钠∶水）用于光滑表面，1∶10的次氯酸钠溶液用于多孔表面。稀释的漂白液应该不超过24 小时。

14. 目前的数据表明，感染艾滋病毒或乙肝病毒的医护人员进行侵入性操作，不易发生暴露的风险， 只要他们实施推荐的手术或牙科技术和遵守普遍预防措施，并遵循灭菌和消毒的建议。

15. 执行这些程序的医疗/外科/牙科组织和机构应确定易受暴露的程序。

16. 为了尽量减少复苏过程中体液交换的风险，应当在需要这些程序(操作)的地方随时备用口罩或机 械通气装置。