Infection Control & Hospital Epidemiology (2019), 40, 383–390 doi:10.1017/ice.2018.354


Letter to the Editor


Acupuncture-associated infections: A matter of concern in China Pengcheng Zhou MD1,2, Yuhua Chen MSN2, Bizhen Chen MSN3, Yaowang Wang MSN2, Xun Huang MD2 and


Xue-Gong Fan MD1 1Hunan Key Laboratory of Viral Hepatitis and Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China, 2Infection Control Center, Xiangya Hospital, Central South University, Changsha, Hunan, China and 3Department of Infection Control, The Second Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China


— To the Editor The therapeutic benefits of acupuncture have been


confirmed by many studies.1 Acupuncture has become an impor- tant component of complementary and alternative medicine throughout the world, and it has been recommended by guide- lines.2 Although the subsequent problem of healthcare-associated infection deserves our attention, few reports of these events are available in the Chinese literature, and these events may be drastically underreported. Transmission of bloodborne diseases in subjects can occur due to


inadequatedisinfectionandreuse ofdisposableneedles.Accordingto health authority regulations, reusable acupuncture needles should be sterilized by autoclaving.However, short-termdisinfection by gluta- raldehyde or alcohol soakings or wipes arenotuncommonin the pri- mary care organizations and small clinics in China.3 In view of China’s huge populations infected with hepatitis B (∼93 million) and hepatitis C (∼10 million) as of 2015,4,5 as well as the estimated growth of HIV-infected patients (769,175) as of 2018,6 inadequate sterilization might lead to the spread of these diseases. More than 80 hepatitis B cases and several HIVcases have been associated with acupuncture in the other countries7; however, it is strange that no confirmedcaseshave beenreportedinChina, acountrywith the larg- est population of viral hepatitis and the greatest use of acupuncture. Puncture site infections are not uncommon inChina; 17 patients


were reported to have been infected with nontuberculous Mycobacteria in a private clinic in Zhejiang province in 2012. Puncture site infections mainly result from the inadequate skin dis- infection, the use of contaminated acupuncture needles, and the low compliance of hand hygiene among medical staff. The common pathogens of puncture site infections include Staphylococcus aureus, Mycobacteria, and Enterobacteriaceae.8,9 More recently, with increasing antibiotic resistance, multidrug-resistant organisms have become important pathogens.7 Occupational exposures might also lead to the transmission of


bloodborne diseases to medical staff. Needlestick injuries can occur during the puncture process and withdrawal and discard of nee- dles, in addition to needle cleaning, disinfection, and maintenance. Occupational exposures are very common in the Department of Acupuncture because practitioners of acupuncture are not very aware of standard precautions. During the process of acupuncture, puncture and withdrawal of needle without gloves, cleaning, and


Author for correspondence: Xun Huang, Xue-Gong Fan,Emails: xgfan@hotmail.com, huangxun224@126.com Cite this article: Zhou P, et al. (2019). Acupuncture-associated infections: A matter of


concern in China. Infection Control&Hospital Epidemiology, 40: 383–384, https://doi.org/ 10.1017/ice.2018.354


© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.


maintenance of needles without personal protective equipment are all too common. Nevertheless, epidemiological data regarding occupational exposures related to acupuncture in a national level in China are lacking. Another issue of concern is that some organizations (eg, barber-


shops, beauty salons,massage parlors, clinics, and primary hospitals) andindividualsperformacupuncturewithoutqualification, andthese illegal acts have not been eliminated effectively in China.Unqualified sterilization and nonstandard operating activities might occur more frequently under these conditions because of economic interests or the lack of knowledge of infection control. Outbreak of acupunc- ture-associated infection in China is possible, and infection control measures areurgentlyneededfor the acupuncture process.Thehealth authorities should apply lessons learned from the spread of human immunodeficiency virus (HIV)to 5 people at 1 hospital after a doctor reuseddirtyneedles during treatment (reportedon February 9, 2017). The following measures might be of great help. First, detailed


infection control rules during the acupuncture should be devel- oped and strictly implemented nationwide. Second, reusable acu- puncture needles should be replaced by disposable needles as soon as possible. Third, acupuncture staff should be educated about infection control. Lastly, acupuncture by unqualified persons should be forbidden. Fortunately, the State Administration of Traditional Chinese


Medicine is aware of this situation, and guidelines for the preven- tion and control of acupuncture-associated infections were issued on July 3, 2017.10 The guideline includes comprehensive and standardized the operation of acupuncture according to 10 aspects: (1) applicable range, (2) management requirements, (3) air ventilation, (4) environmental cleaning and disinfection of facilities especially procedure rooms, (5) cleaning and disinfec- tion of fabrics, (6) provision of hand hygiene stations, (6) require- ments for aseptic technique, (7) use and disposal of needles, (8) preprocessing of reusable needles, (9) prevention of occupational exposure, and (10) treatment of occupational exposure. Training courses for the guideline have been held throughout the country.


Acknowledgments. None.


Financial support. This work was supported by the National Natural Science Foundation of China (No.81800472), the Natural Science Foundation of Hunan Province (grant no. 2018JJ6062), and the Soft Science Project of the Fujian Health and Family Planning Commission (grant no. 2016-RK-8).


Conflicts of interest. All authors report no conflicts of interest relevant to this article.


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