Safety Program Handbook for Traditional Chinese Medicine Practitioners and Acupuncturists Copyright © 2012 by College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia and College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario Materials contained in this handbook may not be reproduced, displayed, modified or distributed without the express prior written permission of the copyright holder. All rights are reserved. December 2012 Revised December 2015 TABLE OF CONTENTS SECTION 1: OVERVIEW OF SAFETY COURSE CONTENT ......................................... 4 1.1 INTRODUCTION ........................................................................................................................................................ 4 1.2 OVERVIEW OF THE HANDBOOK ................................................................................................................................... 4 1.3 DEMONSTRATION OF UNDERSTANDING ........................................................................................................................ 5 1.4 ACKNOWLEDGEMENTS............................................................................................................................................... 5 1.5 INTELLECTUAL PROPERTY AND COPYRIGHT ..................................................................................................................... 5 SECTION 2: INFECTION PREVENTION AND CONTROL ........................................... 6 2.1 INTRODUCTION ........................................................................................................................................................ 6 2.2 OVERVIEW OF INFECTION CONTROL ............................................................................................................................. 7 2.3 ROUTINE PRACTICES................................................................................................................................................ 13 2.4 ADDITIONAL PRECAUTIONS ....................................................................................................................................... 19 2.5 CLEAN ENVIRONMENT, CLEAN EQUIPMENT ................................................................................................................. 20 2.6 SAFETY RESPONSIBILITIES OF PRACTITIONERS AND STAFF ................................................................................................ 29 2.7 WASTE MANAGEMENT ............................................................................................................................................ 34 2.8 OTHER REGULATIONS .............................................................................................................................................. 34 2.9 BREAKING THE CHAIN OF INFECTION........................................................................................................................... 35 SECTION 3: RISK MANAGEMENT OF TCM PRACTICE .......................................... 42 3.1 INTRODUCTION ...................................................................................................................................................... 42 3.2 RISK MANAGEMENT: WORKING ENVIRONMENT ........................................................................................................... 42 3.3 RISK MANAGEMENT: SITE OF PRACTICE ...................................................................................................................... 46 3.4 RISK MANAGEMENT: EMERGENCIES ........................................................................................................................... 47 3.5 RISK MANAGEMENT: CHEMICALS AND WASTE ............................................................................................................. 48 3.6 RISK MANAGEMENT: STAFF ...................................................................................................................................... 49 3.7 RISK MANAGEMENT: PATIENTS AND THEIR RECORDS .................................................................................................... 52 3.8 PATIENT PRIVACY AND DUTIES TO REPORT .................................................................................................................. 61 3.9 RELEVANT REGULATIONS ......................................................................................................................................... 62 SECTION 4: SAFE PROCEDURES & PROCESSES: ACUPUNCTURE .......................... 64 4.1 REQUIRED COURSE MATERIALS ................................................................................................................................. 64 4.2 CLEAN NEEDLE TECHNIQUE ...................................................................................................................................... 64 4.3 PREPARING THE SITE ............................................................................................................................................... 66 4.4 ASEPTIC TECHNIQUE ............................................................................................................................................... 66 4.5 ACUPUNCTURE INSTRUMENTS AND EQUIPMENT OVERVIEW ............................................................................................ 67 4.6 MANAGING NEEDLESTICK ACCIDENTS ......................................................................................................................... 68 4.7 CONTRAINDICATIONS AND PRECAUTIONS FOR ACUPUNCTURE ......................................................................................... 70 4.8 MANAGING ADVERSE REACTIONS TO ACUPUNCTURE TREATMENT ................................................................................... 72 4.9 INJURY TO VITAL ORGANS ........................................................................................................................................ 74 4.10 OTHER POSSIBLE SIDE EFFECTS AND ADVERSE REACTIONS ............................................................................................ 76 4.11 SPECIFIC CONSIDERATIONS RELATED TO OTHER TECHNIQUES ........................................................................................ 77 4.12 ACUPUNCTURE TREATMENT IN UNFAMILIAR SETTINGS ................................................................................................ 79 4.13 PATIENT PRIVACY AND DRAPING.............................................................................................................................. 80 TCMPA: Safety Course December 2012 Page 1 SECTION 5 - SAFE PROCEDURES AND PROCESSES: HERBOLOGY ........................ 84 5.1 REQUIRED COURSE MATERIALS ................................................................................................................................. 84 5.2 OVERVIEW OF SAFETY ISSUES RELATED TO HERBAL MEDICATIONS .................................................................................... 84 5.3 SAFETY CONSIDERATIONS: TCM PRESCRIPTIONS .......................................................................................................... 89 5.4 DISPENSING CHINESE HERBAL MEDICATIONS ............................................................................................................... 94 5.5 SAFE MANAGEMENT OF A TCM HERBAL DISPENSARY ................................................................................................... 97 5.6 ADDITIONAL REFERENCES ....................................................................................................................................... 100 APPENDICES .................................................................................................... 102 APPENDIX 1 TABLE OF POINTS: CTCMA-BC DANGEROUS/CAUTIONARY POINTS .................................................................. 102 APPENDIX 2 INDEX OF MATERIA MEDICA (PIN-YIN, CHINESE AND BOTANICAL OR PHARMACEUTICAL NAME).............................. 118 APPENDIX 3 ANIMAL AND PLANT INGREDIENTS IN TRADITIONAL MEDICINE (ENVIRONMENT CANADA, 2011) ............................ 128 APPENDIX 4 PROFESSIONAL REFERENCES ........................................................................................................................ 134 TCMPA: Safety Course December 2012 Page 2 TCMPA: Safety Course December 2012 Page 3 Section 1: Overview of Safety Course Content 1.1 Introduction The College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia (CTCMA-BC) and the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (CTCMPAO) are mandated by their respective provincial government to protect the public’s right to safe, effective and ethical traditional Chinese medicine (TCM) services by regulating the practice of TCM. On February 18, 2011, the CTCMA-BC and the transitional Council of the CTCMPAO signed an agreement to jointly develop a Safety Program that provides materials and standards for safe practices and tools to assess practitioners’ understanding of safe practices. The purposes of the Program are: To inform practitioners of traditional Chinese medicine (TCM) the expected safety standards, procedures and processes when offering TCM services; To ensure that practitioners registered with CTCMA-BC and/or CTCMPAO engage in safe practices; and To provide a base for registered practitioners to reference, to maintain and to upgrade in their professional development efforts.