Clinical Safety 安全课

Infection Prevention and Control

感染预防和控制

•Infection prevention and control is an essential consideration for TCM practitioners when providing patients with safe health care services.

•感染预防和控制是中医从业者为患者提供安全医疗服务时的一个重要考虑因素。

•Infections can occur with or without direct skin penetration.

•无论是否直接穿透皮肤，都可能发生感染。

•Sharps (e.g., acupuncture needles, dermal needles) are intended to penetrate the skin thereby becoming easily and regularly contaminated by blood or body fluids. The contaminated sharp can infect the practitioner through inadvertent penetration caused by unsafe disposal or handling of the sharps.
• 锐器（例如针灸针、真皮针）旨在刺入皮肤，从而很容易且经常被血液或体液污染。受污染的锐器可能会因不安全处置或处理锐器而导致无意刺穿而感染从业者。

•Infections may be the result of the use of contaminated equipment or utensils coming in contact with open cuts or contaminated hands inadvertently touching mucous membranes at the eye, nose, or mouth.

• 感染可能是由于使用受污染的设备或器具接触开放性伤口或受污染的手无意中接触眼睛、鼻子或嘴巴的粘膜而造成的。

Infectious Agent

传染性病原体

•A pathogenic micro-organism causing the infection or disease.

•引起感染或疾病的病原微生物。

•The four types of infectious agents that cause most infectious disease are viruses, bacteria, fungi and parasites.

•引起大多数传染病的四种传染源是病毒、细菌、真菌和寄生虫。

Reservoir

储存库

•The reservoir is where the organism lives and grows between outbreaks. This can be food, water source, feces, in the environment, or in a living organism.

• 储存库是生物体在爆发期间生存和生长的地方。这可以是食物、水源、粪便、环境中或生物体中的物质。

Portal of Exit

出口

•Portal of exit identifies how the infectious agent is able to leave the reservoir (e.g., blood, mucus, secretions, and open wounds).
• 出口确定传染源如何离开储存库（例如血液、粘液、分泌物和开放性伤口）。

Transmission

传播

•Transmission identifies how the agent is able to move from one host to another host (e.g., human-to-human through blood contact, respiratory droplets or other secretions, on the hands of a health care worker, through the air in an unfiltered ventilation system, attached to a living organism like a mosquito).

•传播确定病原体如何从一个宿主传播到另一个宿主（例如，通过血液接触、呼吸道飞沫或其他分泌物、医护人员的手上、通过未经过滤的通风中的空气在人与人之间传播）系统，附着在像蚊子这样的生物体上）。

•Knowing how the infection is transmitted is essential for deciding the infection control measures that will be the most effective. 

•了解感染如何传播对于决定最有效的感染控制措施至关重要。

•In a TCM practice setting, the four main transmission routes that are important to understand are direct contact, indirect contact, droplet, and airborne.

•在中医实践中，了解重要的四种主要传播途径是直接接触、间接接触、飞沫传播和空气传播。

Vulnerable Host 

易受攻击宿主

•The vulnerable host is the person infected by the agent. The most vulnerable are often the very young and the very old, or those who have their immune systems suppressed.

•易受攻击的宿主是易被感染的人。最脆弱的人群往往是非常年轻和非常年长的人，或者那些免疫系统受到抑制的人。

•Because of the occupational exposure of health care workers, TCM practitioners and staff have increased opportunities to be exposed to infectious diseases.

•由于医护人员的职业暴露，中医执业者和工作人员接触传染病的机会增加。

Contamination 污染

•Contamination is the spread of infectious micro-organisms to an object (such as an acupuncture needle or herb storage container).
• 污染是传染性微生物传播到物体（例如针灸针或草药储存容器）上。

Sterilization & Disinfection 灭菌和消毒

2. 建立清洁区域

2. Establish a Clean Field

•使用金属托盘或干净的纸巾：

•确保用品区域干净，布置清洁区域，不要污染它。

•在场地中只放置干净的用品，摆放针头、棉球。摆放适当数量的针头，不要污染场地或针头。无菌针头不得放置在非无菌环境中（例如托盘、棉花）。

•只用干净的手接触干净的用品

•废物袋和锐器容器必须放在远离清洁区域的区域。•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.

3. 使用一次性无菌针头

3. use sterile single-use needles

•使用前，针灸师需要检查一次性无菌针头（和其他无菌尖锐器具）的包装，以确保保护屏障没有因接触水而被破坏或损坏。

•应定期（即每月）检查诊所内所有针头的有效期，并丢弃所有过期的针头。

•丢弃任何已被刺破、撕裂或损坏或超过灭菌有效期的针头包装。

•当使用包含多根针头的包装中的针灸针时，治疗结束时剩余的所有针头也必须作为非无菌尖锐器具处理，因此必须丢弃在适当的尖锐器具容器中。任何未使用但未消毒的针头。

•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.

•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.

4. 安全处理和处置使用过的针头和其他尖锐物品。

4. Safe Handling and Disposal of isolate used needles and other sharps.

•尖锐物品容器必须：

• 防刺穿，• 防泄漏

• 设计成可轻松存放尖锐物品，但难以取出

• 设计有安全的盖子和手柄，便于携带

• 清晰标有“生物危害”字样，并带有易于识别的符号

• 足够大，可容纳所有尺寸的尖锐物品

• 装满 3/4 时以适当的方式处理

•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

5. 遵循标准预防措施

5. Follow Standard Precautions

皮肤准备

针灸针只能在皮肤清洁且无病害的地方使用。

针灸针绝不能插入发炎、发炎、患病或破损的皮肤。否则，感染可能会通过破损的皮肤屏障直接进入体内。

治疗前，针灸针插入部位应清洁。建议在针灸针插入前用酒精擦拭，但只要该区域是干净的，则不是必需的。

如果擦拭某个区域，则需要 70% 的酒精。

Skin Preparation

Acupuncture 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.

触诊穴位

清洁皮肤后触诊穴位是一种可接受的清洁技术，只要手是干净的且没有被污染。

但是，强烈建议在拿起针头或触诊穴位之前，如果自上次洗手以来，手因整理衣服或做笔记等活动而被污染，则应使用肥皂和水或含酒精的洗手液清洗双手。

第二次洗手后，除了针柄、导管和穴位上方的皮肤外，其他部位都不要触摸。

如果触摸了其他任何东西，应按照上述方法再次清洁手指，然后再继续。

Palpating the Point

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.

插入针头时我可以触摸针头吗？

Can I touch the needle during needle insertion?

如果您在插入针头时需要支撑针头的杆身，无论是因为您使用的是细针（例如，0.15 毫米宽）还是长针（例如，长度超过 25 毫米），或者两者兼而有之，您都必须在手指和针头之间使用无菌屏障。

洗手虽然可以去除手和手指皮肤上的大部分暂时性细菌，但并不能去除常驻细菌。有些人的皮肤上携带的常驻细菌对其他人是致病的。

任何刺穿皮肤的物体都必须是无菌的。为了支撑针头的杆身，必要时，请在手指和针头之间使用无菌纱布或无菌棉。

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.

管理使用过的针头

Managing Used Needles

刺穿皮肤的旧器械必须立即隔离在合适的锐器容器中。使用过的针头、刺血针和七星/梅花针头不得重复使用。

使用过的针头对从业者、工作人员和等待父母的孩子构成风险。

当使用包含多根针头的包装中的针头时，治疗结束时所有剩余的针头都应丢弃至锐器容器。

用于放置使用过的针头的锐器容器应放在治疗台旁边的平坦、稳定的表面上（不要直接放在治疗台上）

锐器容器应定期更换，并且不得超过 75%。

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%.

Hepatitis 肝炎

•甲型肝炎是甲型肝炎病毒 (HAV) 的常见来源。
•甲型肝炎在卫生条件差的地方更常见。食用被含有甲型肝炎的粪便污染的食物和饮用水是甲型肝炎病毒 (HAV) 的常见来源。
•甲型肝炎比乙型肝炎或丙型肝炎轻。
•甲型肝炎感染的血液对从业者的风险较小。
•有一种可以接种甲型肝炎疫苗的疫苗。
•预防 HAV 感染的有效方法是经常洗手。

•Hepatitis A is common source of Hepatitis A virus (HAV).

•Hepatitis A is more frequently evidenced in locations with poor sanitation. Eating food and drinking water that is contaminated by fecal matter containing Hepatitis A is common source of Hepatitis A virus (HAV).

•Hepatitis A is less severe than Hepatitis B or C.

•Hepatitis A infected blood presents a smaller risk to practitioners.

• There is a vaccine that can be administered for Hepatitis A.

• An effective means of prevention against HAV infection is regular hand washing.

•乙型肝炎是由感染乙型肝炎病毒 (HBV) 引起的肝脏刺激和肿胀。
•乙型肝炎可导致急性疾病，但也可能变成慢性疾病（终身）。
•接种疫苗是预防 HBV 感染的有效手段。
•经常接触血液和其他体液的医护人员尤其容易感染乙型肝炎，应接种乙型肝炎疫苗。
•使用清洁针头技术可大大降低感染风险。

•Hepatitis B is an irritation and swelling of the liver caused by infection with the Hepatitis B virus (HBV).

•Hepatitis B can cause acute illness but can become chronic (lifelong).

•Vaccination is an effective means to prevent HBV infection.

•Health care workers who regularly come in contact with blood and other body fluids are particularly at risk and should be immunized against Hepatitis B.

•The use of the clean needle technique greatly reduces the risks of infection.

•丙型肝炎是由丙型肝炎病毒 (HCV) 引起的。
•HCV 通过受污染的血液传播
•丙型肝炎有急性和慢性两种形式。
•有一些治疗方法，但没有疫苗。
•使用清洁针头技术大大降低了感染风险。

•Hepatitis C is caused by the Hepatitis C virus (HCV).

•HCv transmit by contaminated blood

•Hepatitis C has an acute and chronic form.

•There are some treatments, but there is no vaccine.

•The use of the clean needle technique greatly reduces the risks of infection.

结核病 Tuberculosis
•结核病是一种传染性细菌感染，主要影响肺部。
•它还可以扩散到骨骼、皮肤、胃肠道。
•结核病可通过吸入感染者咳嗽或打喷嚏时产生的飞沫传播。

•Tuberculosis is contagious bacterial infection that mainly involves the lungs.

•it can also spread to bone, skin, gastrointestinal tract.

•Tuberculosis can be transmitted by breathing in droplets from a cough or sneeze of an infected person.

获得性免疫缺陷综合征（艾滋病）

Acquired Immune Deficiency Syndrome (AIDS)

•艾滋病是由感染人类免疫缺陷病毒（HIV）引起的

•HIV通过血液直接接触和直接接触某些体液（包括血液）传播。

HIV可导致获得性免疫缺陷综合征（艾滋病），这是一种当人体免疫系统被削弱时可能感染的疾病。

艾滋病可通过血液检测来诊断。

•经常接触血液和其他体液的医护人员应采取适当的预防措施。

•AIDS caused by infection with Human Immunodeficiency Virus (HIV)

•HIV is spread through direct blood-to-blood contact and through direct contact with certain body fluids, including blood.

HIV can lead to Acquired Immune Deficiency Syndrome (AIDS), which is a collection of diseases that a person can contract when their immune system is weakened.

HIV can be diagnosed with a blood test.

•Health care workers who regularly come in contact with blood and other body fluids should take appropriate precautions.

Influenza 流感

•流感主要影响呼吸道，由流感病毒引起。

•流感通过咳嗽或打喷嚏时产生的飞沫、封闭空间内的空气、直接接触受污染的手以及间接接触受污染的物体（例如门把手）传播。

•流感通常具有季节性。老年人或体弱者更容易出现并发症。

•Influenza or the flu affects primarily the respiratory tract and is caused by the influenza virus.

•Influenza is spread through droplets when someone coughs or sneezes, through the air in enclosed spaces, through direct contact with contaminated hands, and indirect contact with contaminated objects (e.g., door knobs).

•Influenza often has seasonal strains. The elderly or weak are at greater risk of worsening complications.

Pneumonia 肺炎

•肺炎是一种由肺部感染引起的呼吸系统疾病。

•肺炎可能是由细菌、病毒或真菌引起的。

•对于成人来说，细菌感染是最常见的病因（例如，鼻窦或口腔中的细菌可能扩散到肺部）。对于婴儿和儿童来说，病毒通常会引起肺炎。

•Pneumonia is a respiratory condition caused by an infection of the lungs.

•Pneumonia may be caused by bacteria, viruses, or fungi.

•In adults, bacterial infection is the most common cause (e.g., bacteria from the sinuses or mouth may spread to the lungs). In infants and children, viruses can commonly cause pneumonia.

Skin Infections皮肤感染

• 皮肤感染的病因（细菌、真菌）、可见度（从小斑点到覆盖身体大部分）和严重程度（从无害到危及生命）各不相同。

•最常见的细菌性皮肤感染类型是由葡萄球菌和链球菌引起的。细菌可以通过破损的皮肤侵入，引起一系列不适和溃疡。中医实践的性质要求从业者对自己和患者的皮肤病保持警惕。

• Skin infections can range in cause (bacterial, fungal), visibility (from small spot to covering large portions of the body) and in seriousness (from harmless to life threatening).

•The most common types of bacterial skin infections are caused by Staphylococcus and Streptococcus. Bacteria can invade through broken skin causing a range of discomfort and ulcerations. The nature of TCM practice requires practitioners to be vigilant of skin disorders on themselves and on their patients.

•不良反应是无法预测或预见的意外和不良影响。不良反应的原因因患者当前的心理、情绪和身体状况而异。

由训练有素且熟练的从业者进行针灸是一种安全的方法。从业者应识别与不良反应和事故相关的症状、原因和管理策略，例如：

•Adverse reactions are unexpected and undesirable effects that were not predicted or foreseen. The reasons for adverse reaction vary greatly based on the current mental, emotional, and physical status of the patient.

Acupuncture is a safe procedure when conducted by trained and skilled practitioners. Practitioners are expected to identify symptoms, causes and management strategies related to the adverse reactions and accidents such as:

Fainting:晕厥：

原因：
多因神经紧张、体质虚弱、饥饿、疲劳、体位不当或用力过猛等引起。

表现：
针刺治疗时，可出现头晕、眩晕、心悸、气短、恶心、面色苍白、冷汗、脉细弱等症状，严重者可出现四肢发凉、血压下降、意识不清等症状。

处理：
出现头晕、眩晕、恶心等晕厥先兆时，应立即停针，拔出所有针头，扶患者平卧，给予温水或糖水，稍事休息后症状即可消失。严重者，可用指甲用力按压GV 26、PC 9、PC 6和ST 36，或艾灸DU 20、Ren 6和Ren4。

一般患者会有反应，如无反应，应采取其他急救措施。

预防：
病人饥饿或疲劳时避免针刺，不要用力操作针头。

Cause:

This is often due to nervous tension, delicate constitution, hunger, fatigue, improper position or to the too forceful manipulation.

Manifestations:

During acupuncture treatment. there may appear dizziness, vertigo, palpitation, short breath, nausea, pallor, cold sweating, weak pulse. In severe cases, there may be cold extremities, drop of blood pressure, and loss of consciousness.

Management:

When fainting aurae such as dizziness, vertigo and nausea appear, stop needling immediately and withdraw all the needles. Then help the patient to lie down and offer him some warm or sweet water. The symptoms will disappear after a short rest. In severe cases, press hard with the fingernail GV 26, PC 9, PC 6 and ST 36, or apply moxibustion to DU 20, Ren 6 and Ren4.

Generally, the patient will respond, but if not, other emergency measures should be taken.

Prevention: 

Avoid needling patient when their hunger or fatigue, not to forceful manipulation the needles.

Stuck needle 滞针

原因：

这可能是由于紧张、进针后局部肌肉强烈痉挛、针头旋转幅度过大或只朝一个方向旋转，导致肌肉纤维僵硬，或进针后患者体位改变所致。

表现：

进针后，有时发现很难或无法旋转、提起和插入针头。

这种情况称为滞针。

处理：

让患者放松。

如果针头因朝一个方向过度旋转而卡住，则在朝相反方向旋转针头时，情况会缓解。

如果卡针是由肌肉暂时紧张引起的，请将针头留在原处一段时间，然后旋转拔出，或按摩穴位附近的皮肤，或在附近插入另一根针以转移患者的注意力。

如果因患者体位改变而导致针刺，应恢复原位再拔针。

预防：

应鼓励敏感患者放松紧张情绪。

进针时避免刺入肌腱。

在任何情况下都不允许过大幅度或只朝一个方向旋转。

在操作过程中，患者应保持原位。

Cause:

This may arise from nervousness, strong spasm of the local muscle after the insertion of the needle, twirling the needle with too large amplitude or in one direction only, causing muscle fibers to bind, or from a change of the position of the patient after the insertion of the needles.

Manifestations:

After the needle is inserted, it is found at times difficult or impossible to rotate, lift and thrust the needles.

This situation is known as stuck needle.

Management:

Ask the patient to relax.

If the needle is stuck due to excessive rotation in one direction, the condition will release when the needle is twirled in the opposite direction.

If the stuck needle is caused by the tension of the muscle temporarily, leave the needle in place for a while, and then withdraw it by rotating, or by massaging the skin near the point or by inserting another needle nearby to transfer the patient's attention.

If the stuck needle is caused by the changing of the position of the patient, the original posture should be resumed and then withdraw the needle.

Prevention:

Sensitive patients should be encouraged to release their tensions.

Avoid the muscle tendons during insertion.

Twirling with too large amplitude or in one direction only shall in no case be allowed.

In the process of manipulation, the posture of the patient should remain original.

Bent needle 弯针
症状：
提、插、旋、拔针困难，并伴有疼痛。

原因：
可能由于操作不熟练或用力过猛，或针头碰到硬组织，或因各种原因患者体位突然改变，或卡针处理不当所致。

处理：
针头弯曲时，切忌提、插、旋，应顺着弯曲的轨迹缓慢拔针。如因患者体位改变而导致弯针，应将患者移回原位，放松局部肌肉后拔针，切忌用力拔针。

预防：
要求插入准确，操作轻柔，患者体位要正确、舒适，留针期间不得改变体位。

Manifestations:

It is difficult to lift, thrust, rotate and withdraw the needle. At the same time, the patient feels pain.

Cause:

This may result from unskillful manipulation or too forceful manipulation, or the needle striking the hard tissue, or a sudden change of the patient's posture for different reasons, or from an improper management of the stuck needle.

Management:

When the needle is bent, lifting, thrusting, and rotating shall in no case be applied. The needle may be removed slowly and withdrawn by following the course of bend. In case the bent needle is caused by the change of the patient's posture, move him to his original position, relax the local muscle and then remove the needle. Never try to withdraw the needle with force.

Prevention:

Perfect insertion and gentle manipulation are required. The patient should have a proper and comfortable position. During the retaining period, change of the position is not allowed.

Broken needle 断针

原因：

可能由于针的质量不好，或用针太用力，或肌肉痉挛剧烈，或患者在针刺时突然移动，或拔出卡住的针头。

表现：

操作过程中针身折断，断头在皮肤表面以下。

处理：

发生断针时，应嘱患者保持镇静，防止断针进一步深入体内。

如断头突出皮肤，可用镊子或手指取出。

如断头与皮肤平齐，可按压断头周围组织，直至断头露出皮肤，再用镊子取出。

如断头完全在皮肤下，应手术治疗。

预防：

为防止意外，治疗前应仔细检查针的质量。

针身不要全部插入体内，应有少许露出皮肤。

针头插入时，若针头弯曲，应立即拔出。切勿用力过猛插入针头。

Cause:

This may arise from the poor quality of the needle or from too strong manipulation of the needle, from strong muscle spasm, or a sudden movement of the patient when the needle is in place, or from withdrawing a stuck needle.

Manifestations:

The needle body is broken during manipulation and the broken part is below the skin surface.

Management:

When it happens, the patient should be asked to keep calm to prevent the broken needle from going deeper into the body.

If the broken part protrudes from the skin, remove it with forceps or fingers.

If the broken part is at the same level of the skin, press the tissue around the site until the broken end is exposed, then remove it with forceps.

If it is completely under the skin, surgery should be resorted to.

Prevention:

To prevent accidents, careful inspection of the quality of the needle should be made prior to the treatment.

The needle body should not be inserted into the body completely, and a little part should be exposed outside the skin.

On needle insertion, if it is bent, the needle should be withdrawn immediately. Never try to insert a needle with too much force.

Properly Positioning the Patient 确定患者体位

•医生必须意识到，正确患者体位可以降低晕厥或突然移动导致针头弯曲或卡住的可能性。

•根据要针刺的部位，医生应仔细考虑患者的舒适度以及有效、安全插入和操作针头的要求。患者和医生都应该感到舒适。

•Practitioners must be aware that the proper positioning of patients can reduce the likelihood of fainting or of causing sudden movements that can result in bent or stuck needles.

•Depending on the area to be needled, the practitioner should carefully consider both the comfort of the patient as well as the requirements for effective and safe insertion and manipulation of the needle. Both the patient and the practitioner should feel comfortable.

Hematoma 血肿

病因：
可能是进针时伤及血管，或拔针后未按压穴位所致。

症状：
拔针后局部肿胀、膨胀、疼痛。

处理：
局部肿胀、疼痛严重时，可局部按压、轻按摩、温灸等方法消肿。

预防：
避免伤及血管。Cause:

This may result from injury of the blood vessels during insertion, or from absent pressing of the point after withdrawing the needle.

Manifestations:

Local swelling, distension and pain after withdrawal of the needle.

Management:

If the local swelling and pain are serious, apply local pressing, or light massage, or warming moxibustion to help disperse the hematoma.

Needle stick injury 针刺伤
针刺伤可能导致严重或致命的血源性病原体感染，如乙肝病毒、丙肝病毒或艾滋病毒。
任何可能接触针头的工人都有风险。只要针头或其他尖锐器具暴露在外，就可能造成伤害。研究表明，针刺伤通常与以下因素有关：
未使用安全设计的尖锐器具或使用不当
未将用过的针头妥善处理在防刺尖锐器具容器中

预防针刺伤

作为一名医疗保健专业人员，您可以通过以下方式保护自己免受针刺伤：
使用具有安全功能的设备
在使用针头前规划安全处理和处置
及时将用过的针头处理在方便放置且合适的尖锐器具处置容器中
参加与感染预防相关的培训
接种乙肝疫苗

如果遭遇针刺伤该怎么办？
如果您在工作期间遭受针刺伤或接触了患者的血液或其他体液，请立即按照以下步骤操作：
用肥皂和水清洗针刺伤和伤口
向您的主管报告事件
立即就医

Needlestick injuries can lead to serious or fatal infections with bloodborne pathogens such as hepatitis B virus, hepatitis C virus, or HIV.

Any worker who may come in contact with needles is at risk. Whenever a needle or other sharp device is exposed, injuries can occur. Studies have shown that needlestick injuries are often associated with:

Not using safety-engineered sharps or using them incorrectly

Failing to dispose of used needles properly in puncture-resistant sharps containers

As a healthcare professional, you can protect yourself from a needlestick injury by:

Using devices with safety features

Planning for safe handling and disposal of needles before using them

Promptly disposing of used needles in conveniently placed and appropriate sharps disposal containers

Participating in training related to infection prevention

Getting a hepatitis B vaccination

If you experienced a needlestick injury or were exposed to the blood or other body fluid of a patient during your work, immediately follow these steps:

Wash needlesticks and cuts with soap and water

Report the incident to your supervisor

Immediately seek medical treatment

NEEDLES STRUCTURE 针头结构

Size of needles:

Normal reaction of needles/De Qi 针的正常反应/得气

•针刺入穴位后，为了促进气感，需要使用一定的操作技巧。

•基本操作技巧包括提插技巧和旋转技巧。

1.提插技巧

•方法

•针由浅入深叫刺，由深入浅叫提。

这种反复操作针的方法称为提插技巧

2.旋转技巧

•当针刺入一定深度时，针向前和向后旋转。

•方法

•当针刺入穴位时，针在穴位内反复向前和向后旋转；这种技巧称为旋转。

3.旋转提插技巧
•组合技巧旋转提插技巧。

•After the insertion of the needles, in order to promote Qi Sensation, certain manipulating techniques are used.

•The basic manipulating techniques include lifting-thrusting techniques and rotating techniques.

1 . Lifting and thrusting techniques

•Method

•The needle pushed from the shallow region to the deep region is called thrusting and from the deep region to the shallow region is called lifting.

•When inserted into a certain depth, the needle is rotated forward and backward.

•Method

•When inserted into acupoint, the needle is rotation repeatedly forward and backward in the acupoint; This technique is called rotation.

•combined techniques  rotating lifting- thrusting technique.

针灸治疗注意事项及禁忌症

Precautions and Contraindications in Acupuncture Treatment

•1）患者饥饿或暴饮暴食、过度疲劳或虚弱时，宜少针或延后针灸。

•2）怀孕三个月以下的妇女，不宜针刺小腹及腰骶部穴位。

•怀孕三个月后，不宜针刺上下腹部及腰骶部穴位。

合谷穴、缺盆穴、三阴交穴、昆仑穴、肩井穴等感觉强烈的穴位。

3）婴幼儿的头顶穴位，在囟门未闭合时不宜针刺。此外，婴幼儿不能配合医生，因此不能留针。

•4) 针刺时应避开血管，以防出血。胸背穴位应小心谨慎，以免伤及重要器官。

•5) 危险穴位：
• 靠近眼球的穴位：
• 睛明 (UB 1)、承栖 (ST 1)
• 靠近椎管的较深穴位：
• 崖门 (Du15)、风府 (Du16)
• 注意：椎管位于皮肤表面 1.5 至 2 寸深之间，根据体型而有所不同。因此，深垂直或上斜插入是严格禁忌的。

•6) ST17 和 Ren8 上禁止用针

•1) It is advisable to apply few needles or to delay giving acupuncture treatment to the patients who are either hungry or overeaten, over fatigued or very weak.

•2) It is contraindicated to puncture points on the lower abdomen and lumbosacral region for women pregnant less than three months.

•After three months pregnancy it is contraindicated to needle the points on the upper and Lower abdomen and lumbosacral region.

Those points causing strong sensation such as Hegu (LI4), Quepen(ST12), Sanyinjiao (SP6), Kunlun (BL60), Jianjing (GB21).

3) Points on the vertax of infants should not be needled when the fontanel is not closed. In addition, retaining of needles is forbidden since the infants are unable to cooperate with the practitioner.

•4) Needling should avoid the blood vessels to prevent bleeding. Points of the chest and back should be carefully needled to avoid injury of the vital organs.

•5) Dangerous Points:

•Points are located close to the eyeball:

•Jing Ming (UB 1), Chengqi (ST 1)

•Points are deeper are  close to spinal canal:

•Yamen(Du15), Fengfu (Du16)

•Caution: the spinal canal lies between 1.5 and 2 cun deep to the skin surface, varying according to body build. Deep perpendicular or superior oblique insertion is therefore strictly contraindicated.

•6) No needle on ST17 and Ren8

Risk Management 风险管理

工作环境

•维护安全工作环境的原则

•用于中医和针灸实践的场所必须适合并适合安全提供专业医疗保健服务。

•场所必须有洗手设施。

•治疗室必须便于移动和高效清洁。

•治疗室和工作室程序必须降低可能的交叉污染风险。

•如果诊所位于私人住宅内，治疗室必须与用于起居、睡眠、用餐或其他与提供医疗服务不相容的家庭用途的任何房间完全分开。

Working Environment

•Principles for Maintaining Safe Working Environments

•The premises used for the practice of Traditional Chinese Medicine and Acupuncture must be appropriate and suitable for the safe delivery of professional health care services.

•The premises must have hand-washing facilities.

•The treatment room must allow for ease of movement and efficient cleaning.

•The treatment room and work room procedures must reduce the risk of possible cross-contamination.

•If the practice is in a private home, the treatment room(s) must be entirely separate from any rooms used for living, sleeping, dining or other domestic purposes that are not compatible with the delivery of health services.

执业场所 Site of Practice

•针灸在各种地点和环境中进行，包括私人诊所、医院、教育机构和多学科医疗保健环境。

•每个场所必须遵守适当的监管要求和司法法规。

•以下是执业场所和建筑的指导原则。

•检查城市法规，确保场所划定为中医执业区。确保符合建筑规范要求。

残疾患者或员工的无障碍设施：

•您所在的辖区可能会或可能不会要求中医诊所提供轮椅无障碍设施。

•如有需要，患者和工作人员可能需要从停车场到办公室有轮椅通道。

•如有需要，患者和工作人员需要使用配有移动杆的厕所，以及高度适宜的洗手池。

电气/供暖/通风/空调系统

•电气、供暖、通风和空调系统必须保持适当的工作状态。

•根据当地要求安装烟雾探测器和一氧化碳探测器。艾灸的使用增加了持续监测和预防性维护的重要性。

•如果您在治疗室使用艾灸，通风系统尤为重要，必须符合当地政府的要求。

空气质量控制：

•艾灸烟雾可能需要安装特殊通风系统。

•艾灸治疗需要仔细监测，因为存在潜在的火灾隐患。

•通风和空气过滤系统是重要的考虑因素。

•漂白剂和其他溶剂等消毒剂的气味可能会引起过敏反应或疾病。精心选择消毒剂是重要的风险管理考虑因素。

紧急情况

•明确标明并张贴紧急情况下可拨打的电话号码列表。

•这些电话号码可能需要包括当地医院、当地医生和社区卫生中心以及毒物控制中心。

火灾应急计划

•火灾紧急情况是中医和针灸实践中的潜在风险因素，尤其是在使用艾灸或火罐疗法时。

•在诊所使用艾灸时，艾灸灭火器或装有沙子的容器至关重要。

•诊所和诊所必须有一份书面防火计划，其中包括：

•火灾警报和灭火器位置信息

•灭火器使用说明

•如何以及在何处撤离建筑物

•协助疏散残疾患者或工作人员的指南

•如果人们因火灾被困在建筑物中，则指南

•诊所使用或储存的易燃化学品清单

化学危害和标签

•中医诊所经常使用和储存消毒剂、漂白剂、酒精。只要容器贴有正确标签（明确标明常用或化学名称以及任何危害）并按指示使用，大多数这些物品都可以安全储存和使用。

•对于从散装容器转移到其他通用容器的化学品，确实需要采取预防措施。这些通用容器应贴有标签，明确标明重要注意事项，以免化学品被不当使用

急救和急救认证

•每个中医诊所都应配备一个功能齐全的急救箱。

•建议：

– 注册从业者持有现行标准急救证书（或同等证书），或

– 中医诊所有持有现行标准急救证书（或同等证书）的人员在场。

•Acupuncture is practised in a variety of locations and settings including private clinics, hospitals, educational institutions, and multi-disciplinary health care settings.

• Each site must comply with the appropriate regulatory requirements and jurisdictional bylaws.

•The following are guidelines for the building and site of the practice.

•Check city bylaws to ensure the premises are zoned for the practice of TCM. Make sure that building code requirements are met.

Accessibility for disabled patients or employees:

•Wheelchair accessibility to a TCM practice may or may not be a requirement for your jurisdiction.

•Where required, patients and staff may need wheelchair access from the parking area to the office.

•Where required, patients and staff will need access to a restroom with a toilet stall equipped with a transfer bar, and with a sink that is at an accessible height. 

Electrical/Heating/Ventilation/Air Conditioning Systems

•The electrical, heating, ventilation and air conditioning systems must be maintained in suitable working condition.

•Install smoke detectors and carbon monoxide detectors in compliance with local requirements. The use of moxa increases the importance of ongoing monitoring and preventative maintenance.

•If you use moxa in your treatment room(s), the ventilation system is of particular importance and must comply with local government requirements.

Air Quality Control:

•Moxa smoke may require the installation of special ventilation systems.

•Moxibustion treatments need to be carefully monitored as a potential fire hazard.

•Ventilation and air filtration systems are important considerations.

•Odors from disinfectants such as bleach and other solvents may cause allergic reactions or illness. Thoughtful selection of a disinfectant is an important risk management consideration.

Emergencies

•Clearly identify and post a list of phone numbers to call in the event of an emergency.

•These telephone numbers may need to include local hospital, local physician and community health centre, and the poison control centre.

Fire Emergency Plans

•Fire emergencies are a potential risk factor in the practice of TCM and acupuncture, especially in the use or moxa or fire-cupping therapies.

•Moxa extinguishers or containers with sand are critical when using moxa in the clinic.

•It is important that clinics and practices have a documented fire prevention plan that includes:

•information on location of fire alarms and fire extinguishers

•instructions on how to use the fire extinguisher

•how and where to evacuate the building

•guidelines to assist the evacuation of patients or staff with disabilities

•guidelines if people become trapped in the building due to the fire

•lists of flammable chemicals used or stored in the practice

Chemical Hazards and Labelling

•Disinfectants, bleach, alcohol are often used and stored in TCM practices. Most of these items can be safely stored and used as long as containers are properly labelled (with common or chemical name and any hazards clearly indicated) and used as directed.

•Precautions do need to be taken with chemicals that are transferred from bulk containers to other generic containers. These generic containers should be labelled with important precautions clearly indicated so that chemicals are not improperly used

First Aid and First Aid Certification

•Every TCM clinic should be equipped with a functional first aid kit.

•It is recommended that:

–registered practitioners hold a current Standard First Aid Certificate (or equivalent), or

–a person is present at the TCM clinic that holds a current Standard First Aid Certificate (or equivalent).

执业范围

•中医执业者为患者提供一套重要且独特的诊断和治疗技能。

•与所有医疗保健专业人员一样，中医执业者也有明确的执业范围。

•除非经过培训且适用法律允许，否则中医执业者不得基于非中医方式/疗法做出医学诊断。

与执业者-患者关系相关的法律概念

•保密性：患者有权期望其个人信息保密

•知情同意

同意

•同意是个人自愿同意允许某事发生在他们身上和/或对他们做某事和/或允许他们参与某事。

•每个有能力的成年人都有绝对权利决定自己身体会发生什么，这是一项基本权利。这项权利受法律保护。

有效同意必须满足以下条件：

•患者必须有能力表示同意

•同意必须是自愿的

•患者必须获得他们要求的所有信息，以便做出决定

如果列出的任何一项要求未得到满足，则同意可能不具有法律效力。

儿童可以在没有监护人许可的情况下同意接受治疗吗？

•是的，根据卑诗省《婴儿法》，19 岁以下的个人可以自行同意接受医疗治疗，只要医疗保健提供者确信治疗符合儿童的最佳利益，并且儿童了解治疗的细节，包括风险和益处。医疗保健提供者有责任评估并确保儿童理解治疗。（HealthLinkBC）

在不列颠哥伦比亚省，儿童被认为有能力同意接受医疗保健，这一点没有年龄限制。

•医疗保健提供者可以接受未成年人的同意，前提是医疗保健提供者确信未成年人了解以下内容：

•- 治疗的必要性

•- 治疗涉及哪些内容

•- 以及接受治疗的益处和风险

Scope of Practice

•Practitioners of TCM offer an important and unique set of diagnostic and treatment skills to their patients.

•Like all health care professionals, TCM practitioners have a defined scope of practice.

•Unless training and applicable legislation allows, TCM practitioners must not make a medical diagnosis based on non-TCM modality/therapy.

Legal Concepts that are Relevant to the Practitioner-Patient Relationship

•Confidentiality: patients have the right to expect that their personal information will remain confidential

•Informed Consent

Consent

•Consent is the voluntary agreement given by a person to allow something to happen to them, and/or to be done to them, and/or to allow their participation in something.

•It is a fundamental right that every adult with capacity has the absolute right to determine what happens to their own body. This right is protected by law.

Valid consent has to meet the following:

•The patient must have the capacity to give their consent

•The consent must be given voluntarily

•The patient must have been given all the information they ask for in order to make their decision

If any one of the requirements outlined are not met then the consent may not be legally valid.

Can a child consent to treatment without guardian permission?

•Yes, according to the BC Infants Act, individuals under 19 years of age may consent to a medical treatment on their own as long as the health care provider is sure that the treatment is in the child’s best interest, and that the child understands the details of the treatment, including risks and benefits. It is up to the health care provider to assess and ensure the child’s understanding of the treatment. (HealthLinkBC)

There is no age in British Columbia when a child is considered capable of giving consent to health care.

•A health care provider can accept consent from a minor provided the health care provider is confident the minor understands the following:

•- the need for treatment

•- what is involved in the treatment

•- and the benefits and risks of having treatment

治疗记录

•中医师有法律和道德责任对患者信息保密。

•执业者必须遵守与以下方面相关的所有法律法规：

••信息的收集、使用、披露、处置和传输；

••影响信息质量和安全的过程；

••授予访问患者信息的权限的程序。

患者记录保存

执业者必须遵守与以下方面相关的所有法律法规：

•信息的收集、使用、披露、处置和传输；

•影响信息质量和安全的过程；

•授予访问患者信息的权限的程序。

记录保存的目的

•患者“记录”包括所有书面、扫描、数字、摄影、放射或其他形式的记录。

•• 患者健康记录

•• 照片、图像、录音带或录像带

•• 实验室报告、影像报告

•• 电子邮件、电话交谈记录或短信

记录可以包括以下内容：

• 就诊日期和时间

• 患者姓名、地址和联系电话

• 相关医疗和健康史（过敏、处方药和非处方药、既往疾病、怀孕等）

• 相关家庭和社会史

• 正在使用的其他治疗/疗法

• 过敏，并注明任何过敏警告。

•记录对药物、食物、环境物质等的不良反应

中医咨询

•症状和体征（由患者识别，并由医生使用望、闻、问、切四种诊断方法检测和识别）

•评估结果，包括舌脉观察/触诊

•中医诊断（有明确证据表明对患者病情进行了彻底评估）

•治疗原则

•详细治疗计划

•患者知情同意的证据。 （例如，注明日期并签名的“同意治疗”表格。）

•首次就诊

•主诉和其他投诉

•健康史

•过敏记录

•药物

•正在使用的其他疗法

•中医诊断

•治疗原则

•治疗计划

•同意治疗

•实施的治疗

给出的建议

•随访：

•进度记录、预约期间的重要观察结果和临床发现

•向患者提供的解释

•与患者讨论

•对先前治疗的反应

•记录患者拒绝遵循建议的情况

•记录错过的预约、取消和迟到

•与患者和其他人的通信（例如，血液测试、电子邮件）

记录管理

必须按照省级个人信息和隐私保护法处理和访问记录。

• 患者记录或任何其他与患者相关的信息不应通过电子邮件发送。

• 除中医师和授权员工外，任何个人均不得访问或使用诊所的计算机。

• 如果中医师离开诊所，她或他必须为这些记录的转移提供安全的安排。

Treatment records

•TCM practitioners have a legal and ethical responsibility to keep patient information confidential.

•Practitioners must comply with all laws and regulations related to:

•• collection, use, disclosure, disposal and transfer of information;

•• processes that affect the quality and security of the information;

•• procedures that grant access to patient information.

Patient Record Keeping

Practitioners must comply with all laws and regulations related to:

• collection, use, disclosure, disposal and transfer of information;

• processes that affect the quality and security of the information;

• procedures that grant access to patient information.

Purpose of Record Keeping

•The patient ‘record’ includes all written, scanned, digital, photographic, radiological or other forms of documented.

•• patient health records

•• photographs, images, audio or video tapes

•• lab reports, imaging reports

•• e-mails, records of telephone conversations or text messages

The records can include the following：

•date and time of consultation

•patient’s name, address and contact number

•relevant medical and health history (allergies, prescription and non-prescription medications, past illnesses, pregnancies, etc.)

•relevant family and social history

•other treatments/therapies being used  

•allergies with any allergy alerts noted.

•document adverse reactions to medications, foods, environmental substances, etc.

TCM consultation

•symptoms and signs (identified by the patient and detected and recognized by the practitioner using the four diagnostic methods of Inspection, Auscultation and Olfaction, Inquiry and Palpation)

•assessment findings including tongue and pulse observation/palpation

•TCM diagnosis (with clear evidence of thorough assessment of the patient's condition)

•treatment principles

•detailed treatment plan

•evidence of informed consent by patient. (e.g. a dated and signed “Consent to Treatment” form.)

•First visits

•  chief complaint and other complaints

•  health history

•  allergy notation

•  medications

•  other therapies being utilized

•  TCM diagnosis

•  treatment principles

•  treatment plan

•  consent to treatment

•  treatment performed

   advice given

•Follow-up visits :

•progress notes, significant observations during appointment, and clinical findings

•explanations given to the patient

•discussions with the patient

•responses to previous treatment(s)

•documented patient's refusal to follow recommendations

•document missed appointments, cancellations, and late arrivals

•correspondence with the patient and others (e.g., blood tests, e-mail messages)

Records Management

Records must be handled and accessed in compliance with provincial personal information and protection of privacy acts.

• Patient records, or any other patient-related information, should not be sent by email.

• No individual should be permitted to access or use the practice’s computer(s), other than the TCM practitioner and authorised staff.

• If a practitioner leaves a practice, she or he must provide a safe arrangement for the transfer of those records.

针灸治疗记录中应包含哪些内容

•知情同意书副本

•使用名称或编号说明针的位置

•如果是触发点针刺，应使用肌肉名称和针的深度描述针的位置。针刺应用图有时可能会有用

•左、右或双侧针刺位置

•每根针有无德气

•治疗后是否已取出针

•如何刺激针以及刺激次数

•是否使用并设置了计时器

•针刺持续时间

•患者在针刺治疗期间是否独自一人，

•任何不良事件或评论

•还可以包括以下内容：

•针的深度

•针的角度（例如倾斜/垂直）

•任何可以降低危险点风险的方法。

保留和存储

•患者记录具有生命周期，记录关闭后必须保留规定的年限。目前，患者记录必须保留十年（10 年）（如果患者未满 18 岁，则保留时间更长）。

• 当前记录的存储区域应防止或限制对记录的损坏（例如火灾、水灾）。

• 存储区域应安全，以限制非法或未经授权的访问。

• 电子文件容易发生技术故障（电源故障、计算机故障）。备份文件。

• 如果需要保留但当前不再需要，纸质记录可以放置在辅助存储区域（异地）或扫描并以电子方式保存。

处置

• 患者记录的处置（治疗结束后加上建议的保留期）必须以可控和保密的方式进行。

• 执业者必须遵守与合法处置患者记录相关的所有法规和要求。

• 记录必须在安全的环境中销毁或粉碎。

• 保留已销毁记录的登记册。

患者隐私和报告义务

•作为医疗保健提供者，执业者有法律和职业义务对患者信息保密。但是，他们有责任和需要向相应的政府或监管机构报告特定事件或情况。

What to include in acupuncture treatment records

•A copy of the informed written consent form

•Location of the needles using Name or Numbers

•If trigger point needling, the location of the needles should be described using muscle name and depth of needle. A diagram of needle application may sometimes be useful

•Left, right, or bilateral needle placement

•De Qi present or not present for each needle

•Has the needle been removed following treatment

•How the needle was stimulated and how many times

•Was a timer used and set

•The duration of needles

•Was the patient left alone during the acupuncture treatment,

•Any adverse events or comments

•The following can also be included:

•Depth of needle

•Angle of needle (such as oblique/perpendicular)

•Anything to reduce risk at risky points.

Retention and Storage

• Patient records have a life cycle, and must be retained for a stated number of years after the records are closed. Currently patient records must be retained for ten (10) years (or longer if the patient is under 18 years of age).

• The storage area for current records should prevent or limit damage to records (e.g., fire, water).

• Storage areas should be secure to restrict unlawful or unauthorized access.

• Electronic files are subject to technical failure (power failure, computer break-down). Backup files.

• Paper records may be placed in a secondary storage area (off-site) or scanned and saved electronically if they need to be retained but are no longer required for current use.

Disposal

•Disposal of patient records (following the end of treatment plus the recommended periods of retention) must be conducted in a managed and confidential way.

•Practitioners must comply with all regulations and requirements related to the legal disposal of patient records.

•Records must be destroyed or shredded in a secure environment.

•Keep a register of the records that have been destroyed.

Patient Privacy and Duties to Report

•As a health care provider, practitioners have a legal and professional duty to keep information about their patients private and confidential. However, there is a responsibility and a need to report particular events or conditions to the appropriate government or regulatory agency.

• 信息和隐私专员办公室 (http://www.oipc.bc.ca) 独立于政府，负责监督和执行不列颠哥伦比亚省的《信息自由和隐私保护法》（FIPPA）以及《个人信息保护法》（PIPA）。

•The Office of the Information and Privacy Commissioner (http://www.oipc.bc.ca) is independent from government and monitors and enforces British Columbia's Freedom of Information and Protection of Privacy Act (FIPPA) and Personal Information Protection Act (PIPA).