Subject: Digest Number 1257 Needling through stockings

[Guest guest]

Thank you KarateStan@ for posting this interesting article.

 

It is notable that there is a marked lack of fundamental research

into this topic. The article seems to rest on known physiology of the

skin and common experience of injection - which is okay in my opinion.

 

The article all makes sense to me except one point. It says that you

can needle into infected or contaminated sites if they are

" disinfected with alcohol " .

 

Applying the article's own logic this would seem to be inappropriate

as much of the infective material would be present throughout the

depth of the dermis, epidermis and/or subcutaneous layer and needling

would very likely transmit that material deeper into the body.

Surface swabing with alcohol would have no affect on those deeper

bacteria.

 

Also, at my CM school we were taught *not* to needle into infected

tissue at all.

 

Best regards, David

 

 

KarateStan@ wrote:-

-----

> Peter Hoffman

> clinical scientist

> Central Public Health

> Laboratory

> _phoffman_ (phoffman)

> Summary

> The need for skin disinfection before insertion of

> an acupuncture needle is controversial and there is

> no specific research on this topic. However

> research and observations on the effect of, and the

> need for, skin disinfection before injections forms

> a good analogy of acupuncture. Whilst microorganisms

> present on the surface of the skin are

> accessible to disinfection, those located under the

> surface in ducts, glands and follicles are out of

> reach and can be inoculated into the sterile tissues

> below by needle insertion. Fortunately, the

> bacteria resident on the skin have a low potential

> to cause infection if host immunity is not severely

> impaired or compromised by the long-term

> presence of foreign material, such as a surgical

> stitch. Disinfection of clean skin before

> injection is not generally considered necessary

> and observations of lack of infection

> following injections without prior skin

> disinfection support this; however, contamination

> by micro-organisms not normally resident on

> skin can pose a higher risk of infection. If

> skin is visibly soiled, it should be washed and if

> needle insertion is near an infected or

> contaminated site, it should be disinfected with

> alcohol.

> Practitioner hand hygiene between patients is

> important, even if gloves are worn. Hands should

> be washed with soap or detergent and water, or an

> alcohol handrub can be used if hands are

> physically clean.

> Keywords

> Acupuncture, skin disinfection, handwashing.

> Introduction

> The Microbiology of Skin

> Skin is an inhospitable environment; it is dry,

> salty, acidic and there are few readily-available

> nutrients. The most fertile area of the skin is the

> outermost layer, but this surface is constantly

> being sloughed off and replaced by lower layers.

> An assortment of glands, follicles and ducts that

> go deep into the skin are also home to many

> microbes. As with many other microbial niches,

> competition between colonising species is severe

> and established species will exclude most

> potential newcomers.

> Total bacterial counts on the skin’s surface

> range from around 10 to 1,000,000 per square

> centimetre, but typically around 1,000. These

> bacteria are mostly present within microscopic

> colonies, typically composed of a few hundred

> bacteria, but which can contain up to 10,000

> bacterial cells.1 However, if the bacteria found in

> the ducts, glands and follicles below the skin’s

> surface are taken into account by using a biopsy

> sampling method, the numbers recovered are

> around ten-fold higher than by sampling just the

> surface;2 so most of the skin’s microbial

> inhabitants are hidden from all but the most

> invasive of sampling methods. Passing a needle

> through the skin is thus one of the most searching

> methods of ‘sampling’ its microbial population.

> Microbes on the skin can be divided into two

> groups: those that live and replicate on the skin,

> known as the skin’s ‘resident microflora’, and

> those that are not long-term residents but whose

> presence results from recent contamination,

> termed ‘transient microflora’.

> Skin Disinfection and Acupuncture

> Peter Hoffman

> ACUPUNCTURE IN MEDICINE 2001;19(2):112-116.