Is infection a possible complication of acupuncture? Recently, the mother-in-law of a friend of mine went for acupuncture at a reputable institution in Singapore. She complained of knee pain and received a few needles in her knee. A few days later, she developed severe pain and swelling in her knee joint. An infection has set in.

So what happened? I can never be sure about this case, but let’s take a look at acupuncture technique. The first step is always sterilisation and I can’t imagine anyone not using sterile, single use needles. The acupuncturist must first wash his hands, then disinfect them with 75% alcohol. Next, the skin over the area to be punctured must be disinfected with alcohol. This is usually done by swabbing the skin with a piece of cotton soaked in alcohol.

This step will certainly remove practically all pathogenic bacteria from the surface of smooth, tight skin. But what if the skin is not smooth and tight? What if it’s a piece of loose, thickened skin around the joints? Can an alcohol swab effectively disinfect the whole area? I’m not so sure.

What about hair-covered areas like the scalp? This is another area where I’ve raised my doubts. I believe very vigorous rubbing with a piece of cotton very well-soaked in alcohol is required in this area to make sure that the alcohol reaches the scalp. If the patient has dandruff or other skin diseases, then needles must not be inserted as the infection can get pushed further into the tissues.

Next, we look at needle insertion technique. Acupuncture needles are normally made of stainless steel. They are very fine, often not more than 0.3mm in diameter. This means they are extremely flexible. Short needles are OK. They don’t bend when you insert them with a single hand, holding the handle with fingers away from the body of the needle.

The problem arises when you insert with long needles 40mm or longer. In school, we were taught a “proper” 2-hand technique. The puncturing hand holds the needle at the handle. The supporting hand (fingers) grasp a small piece of dry cotton to guide the body of the needle so it doesn’t bend when the needle is inserted. Safe? I’m not sure because the dry piece of cotton is not not more sterile than the acupuncturist’s washed fingers.

There are alternative ways of inserting long needles. One which I’be tried and practised quite a lot on myself is a slow one-hand technique. No touching of the body of the needle at all, but the insertion would be slower and more painful. Another way is to hold the body of the needle near the point with a piece of cotton soaked in alcohol. Holding it so close to the point, the needle will be stiff enough not to bend during insertion. After skin penetration, the rest of the needle can be pushed in with a slow one-hand technique without much pain.

The rationale of using dry cotton is that alcohol smarts. But I thinking enduring a bit of smarting is well worth it. I’ll go to the exam with what I’ve been taught. Once graduated, I owe it to my patients to practice as safely and effectively as I know how.