Acupuncture Continuing Education

Safety In Acupuncture #1: Excerpts

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Safety In Acupuncture 1


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Pathogens & Transmission

Health care providers are exposed to a host of pathogens on a daily basis. Both resident and transient microorganisms occupy the surface of our skin and hair. Many of the microorganisms living on the surface of our body are capable of causing disease or infection if they penetrate deeper into underlying tissue and our immune system fails to fight them off.  

Protecting ourselves and our patients is crucial to a safe and healthy clinical environment. Healthcare providers must be concerned with preventing transmission and cross-contamination. The Occupational Safety and Health Administration has established universal precautions for this purpose. All healthcare providers need to understand the mechanisms of transmission and prevention of infectious diseases. Some primary routes of transmission are given below.

Airborne Pathogens

Transmission: via aerosol and air droplets.

  • Tuberculosis
  • Influenza
  • Common cold
  • Streptococcus
  • Mononucleosis

Direct Contact With Pathogens

Transmission: via transfer by hands, hair, countertops, surfaces, etc... 

  • Staphylococcus
  • Methicillin Resistant Staphylococcus Aureus (MRSA)...

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Nosocomial Infections
All healthcare providers should also be aware of nosocomial infections. Nosocomial infections are those that are acquired in the hospital or clinical setting. The US Centers for Disease Control and Prevention (CDC) estimates that the number of healthcare associated infections (HAIs) in US hospitals in 2002 was approximately 1.7 million. The CDC notes:

  • In 2002, the estimated number of HAIs in U.S. hospitals, adjusted to include federal facilities, was approximately 1.7 million: 33,269 HAIs among newborns in high-risk nurseries, 19,059 among newborns in well-baby nurseries, 417,946 among adults and children in ICUs, and 1,266,851 among adults and children outside of ICUs. The estimated deaths associated with HAIs in 
  • U.S. hospitals were 98,987: of these, 35,967 were for pneumonia, 30,665 for bloodstream infections, 13,088 for urinary tract infections, 8,205 for surgical site infections, and 11,062 for infections of other sites.

The CDC also notes:

  • We estimate that 1.7 million HAIs occurred in U.S. hospitals in 2002 and were associated with approximately 99,000 deaths. The number of HAIs exceeded the number of cases of any currently notifiable disease, and deaths associated with HAIs in hospitals exceeded the number attributable to several of the top ten leading causes of death reported in U.S. vital statistics... 

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HIV & Hepatitis
Acupuncturists must be aware of the transmission risks of pathogens and exercise caution to prevent cross-infection and transmission. During a new patient intake, be certain to conduct a thorough health history. The best method to prevent nosocomial infections is to practice hand hygiene and to clean work surfaces. The following summarizes basic information on HIV and hepatitis transmission and incubation periods.

Hepatitis A (HAV)

  • 15 – 45 days Incubation
  • Bloodborne, fecal contaminated food and water
  • Abrupt Onset
  • Vaccine Available
  • Not Chronic, common with children and young adults

Hepatitis B (HBV) 

  • •50 – 180 days Incubation
  • •Bloodborne
  • •Insidious (slow) Onset
  • •Vaccine Available
  • •Chronic 5 – 10% of cases

Hepatitis C (HCV)...

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Acupuncture Precautions
This section is a summary of major acupuncture points of concern and other cautions, warnings and contraindications in common clinical practice. This course does not teach acupuncture needle techniques but provides text to assist in identifying compliance with established standards of practice for needle depth and angle of insertion. This course is only for licensed acupuncturists that have already been trained, licensed or otherwise certified in the practice of acupuncture.

Avoid puncturing major blood vessels, internal organs and pneumothorax by not needling deeply over the local regions of major anatomical structures. The following pages list common acupuncture needling contraindications and cautions. Note that needling depth and angle of insertion instructions do vary across classical and modern acupuncture literature. There is also variance in acupuncture point locations. The following are common acupuncture points of concern.


One of the more common points directly beneath the eyeball is ST1. Looking forward, this acupuncture point is directly below the pupil located between the eyeball and the infraorbital ridge. Strong manipulation of an acupuncture needle at this point is contraindicated. Moxibustion is contraindicated for use at this point.


ST1 and ST9

(Larger Detailed Images and Anatomical Diagrams in Course Materials)

The eyeball is pushed upwards to protect the eye when needling this point. A perpendicular insertion is used to a depth of 0.5 to 1.0 inches along the infraorbital ridge. The initial insertion of the needle my have a very slight inferior angle from the perpendicular position but never superior. Manual acupuncture techniques are to be avoided to protect this region that includes the infraorbital and ophthalmic arteries and veins. Do not apply lifting, thrusting, twisting and rotating. This area is innervated by the infraorbital, oculomotor and facial nerves. Similar care must be taken with other eye region points including extra point Qiuhou.

ST1 is an intersection point with the Yang Heel (Yang Motility, Yang Qiao) and Conception (Ren) channels. ST1 is used in the treatment of eye disorders and facial paralysis including deviation of the mouth and eyes. ST1 powerfully regulates lacrimation as indicated by its name “Container of Tears.”


This point is located near a major artery. The pulse of the common carotid artery is palpable at this point. ST9 is located in the depression between the anterior border of the sternocleidomastoideus muscle and the lateral aspect of the thyroid cartilage, level with the tip of the Adam’s apple (laryngeal prominence). 

Care must be taken to avoid the carotid artery. Laterally, the pulse of the carotid artery at the anterior border of the sternocleidomastoideus muscle is palpable. Medially to ST9, the thyroid cartilage is palpable. ST9 is in the depression between the carotid artery and the thyroid cartilage. Practitioners often use the fingers to spread the thyroid cartilage from the carotid artery to help define an unobstructed fossa.

ST9 is needled perpendicularly to a depth of 0.3 to 0.5 inches although some texts allow for a very slightly deeper insertion depths. The fingers are used during needling to hold the carotid artery lateral to the insertion site. Usually, the index finger and thumb are placed superior and inferior to the acupuncture point to hold the carotid artery laterally to the insertion site.

Local to this acupuncture point is the superior thyroid artery at the bifurcating area of the internal and external carotid arteries. The cutaneous cervical nerve and facial nerves are at the superficial level at this acupuncture point. Deep to this point is the sympathetic trunk, a pair of bundled nerve fibers that extend from the base of the skull to the coccyx. The sympathetic trunk interacts with spinal nerves and is a vital part of the sympathetic division of the autonomic nervous system. Lateral to this point is the descending branch of the hypoglossal and vagus nerves.

ST9 is a window of sky, sea of energy and intersection point of the Gallbladder and Stomach channels. ST9 regulates the qi and blood and benefits the throat. ST9 is indicated for the treatment of throat disorders including sore throat...

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Biomedical Waste
Biomedical sharps waste is often regulated by county rules along with state and federal regulations. In California, for example, the following rule applies for small quantity generators of medical waste:

For the two types of medical waste, biohazardous and sharps waste, the storage times do differ.  A facility that generates less than 20 pounds of biohazardous waste per month may store it for 30 days.  The waste may be stored for up to 90 days if kept at 32° F or below.  Sharps waste can be stored for 30 days, once the container is...

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