Clean Needle Technique (CNT) standards dictate protocols for minimizing the risk of infection and disease transmission when using needles. CNT guidelines USED to say swabbing acupuncture points with alcohol before inserting a needle was mandatory. Due to lack of evidence for effectiveness, and even some evidence that alcohol swabbing increases the risk of infection, those guidelines were changed in 2015.

But I Saw Another Acupuncturist Who Swabs!

Many acupuncturists still swab points out of habit or because they don’t know about the change in guidelines. I swabbed points while in acupuncture school and my first few years in practice, but happily transitioned to less swabbing once I read the new guidelines last year.

Reasons Against Alcohol Swabbing

1. Isopropyl alcohol is toxic to humans. It is dangerous to breathe the fumes, and unhealthy to be applied to your skin.
2. You have a natural defense against infection on your skin, called the microflora (good bacteria) layer, and alcohol swabbing removes it, potentially leaving you more susceptible to infection.
3. Alcohol swabs are just as likely to move bacteria around as to remove any. Even in cases of injections, not swabbing did not lead to an increase in rates of infection.

When Swabbing is Appropriate

• If there is visible dirt/debris/sweat on a point that I want to use, and I cannot find an alternative, I will swab the point with ethyl alcohol first.
• Deep intramuscular needling sites may be swabbed. For more information about this type of needling, see Dry Needling.
• For injections, I always disinfect the skin with betadine. Betadine is an effective antiseptic, unlike alcohol.
• If you would prefer I swab all acupuncture points with betadine, please ask and I will be happy to do so.

Sources

1. CCAOM Position Paper on Skin Preparation:
   • The CCAOM supports the position that the skin should be clean prior to acupuncture needle insertion, but that cleaning the skin with an antiseptic is not necessarily essential to prevent infections.
2. Koivisto VA, Felig P. Is skin preparation necessary before insulin injection? Lancet. 1978 May 20;1(8073):1072-5.
3. Myths of Wound Care
4. Risks of Isopropyl Alcohol
5. Skin Microbes Protect Against Infection