Infection Control Guidelines Needed for Acupuncture
By Laurie Barclay, MD
Medscape Medical News
March 19, 2010 — Funding is needed to develop infection control guidelines for acupuncture, according to an editorial posted online March 18 in the British Medical Journal.
"Acupuncture, which is based on the theory that inserting and manipulating fine needles at specific acupuncture points located in a network of meridians will promote the harmonious flow of 'Qi,' is one of the most widely practised modalities of alternative medicine," write Patrick C.Y. Woo, MD, and colleagues from the University of Hong Kong. "Because needles are inserted up to several centimetres beneath the skin, acupuncture may pose risks to patients. One of the most important complications is transmission of pathogenic micro-organisms, from environment to patient or from one patient to another."
The editorialists claim that the number of reported acupuncture-transmitted diseases (namely, 50 cases of infection described worldwide) may be "the tip of the iceberg." Because acupuncture-related infections are typically underdiagnosed, clinicians should have a high index of suspicion.
Inadequate skin disinfection before acupuncture may result in transmission of pyogenic bacteria from the patient's skin flora or the environment. Localized infections typically occur along meridians or at acupuncture points.
Although the prognosis is good for most of these infections, about 5% to 10% of reported pyogenic bacterial infections are fatal, and another 10% or more result in serious complications including:
septic arthritis with joint destruction,
multiorgan failure,
flesh eating disease, and
paralysis.
Infective endocarditis, meningitis, endophthalmitis, cervical spondylitis, retroperitoneal abscess, intraabdominal abscess, and thoracic empyema have also been reported.
Staphylococcus aureus accounts for more than half of the reported cases of acupuncture-related bacterial infection. The first reports of methicillin-resistant S aureus transmitted by acupuncture surfaced in 2009. In addition, outbreaks of hepatitis B have been attributed to acupuncture-related transmission, thought to be the result of the reuse of improperly sterilized needles from an infected patient. In one acupuncture-associated hepatitis B outbreak, however, transmission was thought to be from the acupuncturist to the patients. Hepatitis C and HIV could, in theory, be transmitted by acupuncture, with some evidence for the association of hepatitis C virus infection with acupuncture from epidemiological and case-control studies.
Acupuncture mycobacteriosis is a new clinical syndrome first recognized in the 21st century. Contaminated cotton wool swabs, towels, and hot pack covers may promote rapid growth of mycobacteria around the acupuncture insertion point. After a long incubation period, large pustules, abscesses, and ulcerative lesions typically develop.
"To prevent infections transmitted by acupuncture, infection control measures should be implemented, such as use of disposable needles, skin disinfection procedures, and aseptic techniques," the editorialists conclude. "Stricter regulation and accreditation requirements are also needed. Clinicians should also have a high index of suspicion, particularly for viral and mycobacterial infections transmitted by acupuncture because of their prolonged incubation periods, and they should alert health authorities about clusters of cases."
The authors have disclosed no relevant financial relationships.