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CLEAN NEEDLE TECHNIQUE AND CLINICAL
PREPARATION
Print T(rue) or F(alse or Circle the best
answer or the exception.
43-49. Match the following terms to their
appropriate definitions:
A. Disinfection.
B. Contamination.
C. Sterilization.
D. Disinfectant.
E. Antiseptic.
F. Clean Field.
G. Clean Technique.
_____Area which has been prepared to contain
equipment necessary for acupuncture, in such a way to protect
sterility of needles and insure clean surface on which equipment
will
be placed, and patient's skin around selected
acupuncture points, and anything that touches the skin.
____The introduction of disease-causing
organisms into/onto previously clean/sterile objects. making them
impure/unclean.
_____The chemicals employed in disinfection.
_____Products designed to reduce microbial life
on living tissue, particularly on the patient's and/or the
practitioner's skin.
_____The use of techniques (antisepsis,
disinfection, sterilization, washing, etc.) designed to reduce the
risk of infection of patients, practitioners, and office personnel
by reducing the strength of or killing pathogens, or by reducing the
chances for contact between the pathogens and the patients and
personnel.
_____The use of procedures which destroy all
microbial life, including viruses, on instruments which pierce the
skin or come into contact with instruments which pierce the skin.
_____The use of chemicals and procedures
designed to destroy or reduce the number of pathogens on inanimate
objects.
50. Which of the following three
sterilization methods are unacceptable?
A. Autoclave.
B. Dry heat.
C. Ethylene oxide.
D. Glass bead sterilizer.
E. Chemical sporicides.
F. Boiling water.
G. Alcohol.
H. Gamma rays.
51. Which of the following physical
agents play the major role in sterilization?
A. Germicides.
B. Lysol.
C. Moist or dry heat.
D. 70% alcohol.
52. An autoclave's pressurized steam bath
should be maintained at what combination temperature, pressure, &
time to sterilize instruments?
A. 200*F @ 10 labs. @ 20
min.
B. 250*F @ 10 labs. @ 40
min.
C. 300*F @ 15 labs. @ 50
min.
D. 250*F @ 15 labs. @ 30
min.
E. 212*F @ 15 labs. @
10 min.
53. In the United States, a major health
protection agency states explicitly, "Critical items are instruments
or objects that are introduced directly into the blood stream or
into other normally sterile areas of the body (including mucous
membranes) ... Sterility at the time of use is required for these
items." The initials are CDC. What is the name of this agency?
A. Civil Defense Control.
B. Criminal Defense Center.
C. Center for Disease Control.
D. Center for Drug Control.
54. Chemical disinfection should be used
only on:
A. Skin.
B. Inanimate objects.
C. Hand.
D. Mucous membranes.
55. Which of the following instruments do
not need to be sterilized?
A. Acupuncture needles.
B. Plum-blossom needles.
C. Seven-star needles.
D. Pricking needles.
E. Forceps, storage tray, guide tubes.
F. None of the above.
56. Which of the following is/are
techniques for preventing infection during invasive procedures?
A. Aseptic techniques.
B. Disinfectant techniques.
C. Antiseptic techniques.
D. Contamination techniques.
57. Seven-star or plum-blossom needles:
A. Must be sterilized between patients.
B. Are often discarded after single use.
C. May be used on more than one site on
a patient.
D. With plastic handles & bodies are
flexible, easy to use, but cannot be autoclaved.
58. Needle guide tubes:
A. Must be sterilized between patients.
B. Should be disposed of after each
patient if not autoclavable.
C. Should be wiped clean of blood and
fluids and autoclaved at the end of each day.
59. Disposable needles:
A. Should be employed on all patients
with known or suspected serious infectious diseases.
B. Should be employed on all patients
with immune deficiency due to disease or chemotherapy.
C. Are a reasonable choice for all
situations in clinical practice.
D. Are essential for the protection of
either patient or practitioner under protocols of double
sterilization.
60. Clean needle technique includes the
following basic elements except:
A. Sterile needles.
B. Clean and organized office and
waiting room.
C. Clean hands.
D. Clean field.
E. Immediate isolation of used needles.
61. The single most important thing in
preventing cross-infection is:
A. Clean field.
B. Sterile needles.
C. Immediate isolation of used needles.
D. Handwashing
62. The greatest source of risk to the
practitioner is:
A. Contaminated needles.
B. Hands.
C. Sink & toilet.
D. Forceps.
63. Handwashing should always be except
A. Immediately after leaving each
patient.
B. Immediately before inserting needles.
C. Between the insertion of two points
on the same patient.
D. Immediately before inserting needles
and again after leaving each patient.
64. What should be done with contaminated
disposable needles?
A. Place into a brown paper bag with
used cotton and throw away in each day's trash.
B. Toss onto the floor for clinic
assistants to clean up before next patient.
C. Drop into a special impervious
biohazard container for proper medwaste disposal.
65. The assurance of successful
sterilization involves:
A. The choice of materials and design of
equipment in terms of ability to be sterilized.
B. Avoid instrument reuse.
C. Equipment used for sterilization
process.
D. Suitable packaging materials which
allow sterilizing agent to reach package contents.
E. Sterilization procedures are
monitored.
66. The best place for a container for
used disposable needles would be:
A. Inside a locked cabinet in each
patient room to prevent patients or their children from handling.
B. On top of a cabinet at the foot of
each patient's table to be near to the practitioner.
67. Preferably, acupuncture should be
performed with needles made of:
A. Silver.
B. Gold.
C. Iron.
D. Stainless steel.
68. Steam pressure cookers are a
perfectly acceptable and cheap alternative to autoclaves for
sterilization. True.
False.
69. Recycling of used acupuncture needles
by autoclaving or glass bead sterilizers is a good idea and can save
you a lot of money on the purchase of acupuncture needles.
True. False.
70. The reason autoclaving can kill all
microorganisms is:
A. Proper loading of autoclave.
B. Suitable packing materials.
C. Pressure breaks down the cell walls
of resistant c
D. None of the above.
71-74. Dry heat sterilization, (T)rue, (F)alse:
_____Heated air with pressure.
_____Shorter sterilization than autoclaving.
_____338*F @ 2 hours.
_____Space packages - not important.
75-80. Proper autoclave sterilization, (T)rue,
(F)alse:
_____A rack should be lower than the water
level.
_____Impervious containers should be tightly
covered.
_____Biological monitors should be used all of
the time.
_____Space packages - not important.
_____Residual air must be bled out of the
autoclave.
81-84. Ethylene oxide, (T)rue, (F)alse:
_____Good for use in acupuncture clinics.
_____Effective sterilizing agent.
_____Biological monitors should be used in each
sterilizing run.
_____Much greater margin of safety than steam.
85-89. Disinfectants, (T)rue, (F)alse:
_____All disinfectants will act as sterilants.
_____Are for use on all instruments made of
plastic or rubber.
_____Are seldom destructive to sterilized
substances.
_____A dilute NaOH (sodium hypochlorite)
solution is an excellent sterilant.
85. The following chemicals are
appropriate disinfectants:
A. Glutaraldehyde.
B. Acetone.
C. Acetaldehyde.
D. Sodium hypochloride.
E. H202
F. Stabilized hydrogen peroxide.
G. Phenothiazine.
H. A & G.
I. A & D & F.
J. B&C&G
K. C&E&F
86. What is the most important factor in
the glass bead device sterilization question:
A. Are approved by the FDA.
B. Provide satisfactory sterilization.
C. Only the needle body is heated, not
the handle, and handle may be contaminated during handling.
D. Have not been implicated in the
transmission of hepatitis.
87. Boiling water:
A. Provides adequate sterilization.
B. Is destructive to resistant bacterial
spores and viruses.
C. Is more appropriately designated as a
process of disinfection.
D. Can be used for objects that
penetrate the skin.
88. Alcohol:
A. Is an adequate sterilization agent.
B. Is commonly used for the purpose of
sterilization.
C. Is the substance of choice for
sterilization in an acupuncture clinic.
D. Is an antiseptic.
89. The sterilization process can break
down. How?
A. Mechanical fault.
B. Error in procedure.
C. Equipment failure.
D. All of the above.
90. Non-disposable needles should be
cleaned:
A. After the 1st sterilization.
B. Before the 1st sterilization.
C. Before the 2nd sterilization.
D. Before the insertion of needles.
91. Cleaning is usually done by using
water:
A. With detergent.
B. Without detergent.
C. With or without detergent.
92. Each needle should be wiped with a
cotton ball:
A. Before sterilization.
B. After sterilization.
C. After dry heat.
D. Before cleaning.
93. An appropriate time to inspect each
needle for burrs, pitting, or corrosion:
A. Before sterilization.
B. After sterilization.
C. After dry heat.
D. Before cleaning.
94. Sterilization of needles:
A. Should be done immediately after use.
B. Needles should be cleaned before
sterilization.
C. Needles should not be transferred
from their container to the sterilizer tray without handling.
D. After the first sterilization,
handling, wiping, etc. should not be done.
95. Used needles and contaminated
equipment:
A. A low-level chemical disinfectant can
be used after the first sterilization.
B. Sterilant does not need to be washed
off because it evaporates.
C. Preliminary sterilization is
essential before cleaning and packaging.
D. Disinfectant can be used as a 2nd
stage disinfectant for any instrument that penetrates the skin.
96 - 99. Proper sterilization of needles: T(rue),
F(alse)____
_____Is the only step necessary to ensure that
the needle is sterile when it penetrates the skin.
______After sterilization, avoiding contamination is not a major
concern.
______Traveling kit protocols provide a lot of
sterilization controls.
______Travel kit protocols are always
convenient for office use.
100. Traveling kits are important to the
acupuncturist mainly because:
A. The concept helps develop a sense of
proper handling in a variety of settings.
B. Acupuncturists are often called upon
to travel.
C. The protect the sterility of needles.
D. They include treatment procedures.
E. All of the above
101-104. In the preparation of
instruments for sterilization: T(rue), F(alse)
_____Needles and other equipment must be
cleaned before sterilization.
_____Cleaning itself will kill microorganisms.
_____Cleaning is the physical removal of
organic material.
_____Needles only need to be sterilized once
after use.
105 – 108.
About sterilization: T(rue), F(alse)
_____Sterile gloves need to be used for
second-stage sterilization
_____Needles need to be washed in sterile water
for for first-stage sterilization.
_____More problems occur after first-stage
sterilization than second-stage sterilization. _____Needles are
packed in regular containers after second-stage sterilization.
109. Liquid used in the soaking of needles
must (or should) be:
A. Discarded after each use.
B. At the end of every day.
C. At the end of each week.
D. Continue to use and refresh the
container as necessary.
110. After cleaning, in a covered tray,
needles:
A. Should be placed in a bed of cotton
or gauze as closely as possible.
B. Placed obliquely or vertically in a
bed of cotton or gauze.
C. Far enough apart so that they can be
removed by fingers without touching the handle of the needles.
D. Far enough apart so that they can be
removed even though they touch the interior of the container.
111. If sterilized needles are loose in the
bottom of the tray, they can be used if they are removed with:
A. Fingers.
B. Tweezers.
D. None of the above.
112. The indicator tape shows that the
package has been through the sterilizer, and
A. indicates that the contents are
sterile.
B. is not an assurance of sterility.
113. All needles in individually sealed
packages:
A. Should be marked with the date of
sterilization.
B. If not used within an appropriate
time must be resterilized before use.
C. If in a torn, opened or wet package,
must be resterilized before use.
D. All of the above.
114. Sterilized material:
A. Can be removed when still wet and the
lid placed on he tray.
B. When dry, the material can be removed
and the lid placed on the tray.
C. Can be left in the tray if the lid is
still on it.
115-122.
_______The clean field is as rigidly controlled
as a sterile field.
_______The purpose of the clean field is to
protect the sterility of needles while you are doing a treatment.
_______Immediately before palpating the
acupuncture point, the finger tips should be. cleaned.
_______Microorganisms are on every non-sterile surface.
_______Staphyloccus is perhaps the most serious
contaminant that is found on the skin and many surfaces.
_______In most cases, the acupuncturist swabs
the skin with alcohol first and then palpates the point.
_______Removal of hand jewelry can decrease the
effectiveness of handwashing.
_______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.
123. If the patient's body parts are
grossly dirty, you should or must:
A. Wash your hands.
B. Alcohol swab your hands.
C. Ask the patient to wash first with
soap and water.
D. Proceed as usual and insert the
needles.
124. An antiseptic agent adequate for
preparing a patient's skin for procedures such as inserting needles
is:
A. 10% isopropyl alcohol.
B. 70% isopropyl alcohol.
C. 65% grain alcohol.
D. 100% isopropyl alcohol.
E. None of the above.
125. An alcohol swab followed
by a Betadyne swab is recommended for immunocompromised patients.
126.___________The longer the disinfectant has
to act, the more effective the action by the disinfectant.
127. The proper motion to be used by the
acupuncturist in swabbing points to be needled is:
A. A rotary scrubbing motion.
B. Back and forth.
C. A rotary scrubbing motion spiralling
outward from the center.
D. None of the above.
128._______The order of swabbing of points
should be from the torso toward the extremities.
129. In the act of swabbing Hegu point (L.I.
4), the direction of cleaning should be:
A. From fingertip toward Hegu.
B. From Hegu toward the fingertip.
C. From Yanxi (L.I. 5) toward Hegu.
D. None of the above.
130-132. Alcohol should be allowed to dry
because:
______Reduce discomfort on needling.
______Reduce the possibility of injecting
minute amounts of contaminant dissolved in the alcohol.
______The acupuncturist really does not concern
himself with whether the alcohol is dry or not.
133. It is acceptable clean needle
technique to touch the acupuncture points:
A. Before cleaning the skin, with your
clean fingers.
B. After cleaning the patient's skin,
with your clean fingers.
C. Before cleaning the skin, with your
clean fingers, and fingers swabbed with alcohol.
D. After cleaning the patient's skin,
with your clean fingers, and fingers swabbed with alcohol.
134. Just before inserting the needle, you
touch your clothes. Do you think you need to clean your fingers
again?
Yes or No
135._______The needle shaft must be maintained
in a sterile state prior to insertion.
136. When you do insertion of needles, the
guide tube may be used on different points on the same patient.
After insertion of the first point, you decide a second point needs
needling. At this moment, you put the guide tube on:
A. Countertop
B. Clean field.
C. Gauze pad in the clean field.
D. None of the above.
137. If a guide tube is used on your
patient, you want to drop the needle into the tube:
A. Handle first.
B. Shaft first.
C. None of the above.
138.______ The sterile needle shaft must be
supported by the bare fingers during positioning or insertion.
139. You can support your needle with
_______ to reduce the risk of contamination.
A. Clean gauze.
B. Clean cotton ball.
C. Clean guide tube.
D. None of the
above.
140. Bare fingers are unacceptable for
supporting the needle because:
A. Risk of accidental needle stick
injury is too high.
B. Level of contamination on bare
fingers is too high, even after washing and/or swabbing.
C. Not many acupuncturists use bare
fingers on insertion, so it is untraditional.
141.______Needle manipulation must be performed
without the practitioner's hands coming into contact with the handle
of the needle.
142. When withdrawing the needle, to "close
the hole," it is important to use a:
A. Sterile cotton ball.
B. Clean cotton ball.
C. Your finger.
143._______When withdrawing the needle, the
bare fingers should not be used to press the skin down at the
insertion site.
144._______The container for used needles
should have a tight lid that cannot be knocked off if the container
is dropped.
145. The container should:
_________Be right beside the treatment table.
_________Be clearly marked.
_________Be easy to open for inserting needles.
_________Be designed for easy transfer to the
sterilizer.
_________Be made of unbreakable material.
_________Have a wide-enough base so that it
won't tip over.
146. If you accidentally spill used
needles, you need & need to do:
A. Gloves and tweezers for picking them
up.
B. Wash the floor and disinfect.
C. Wrap and discard the gloves and
cleaning materials safely after use.
D. All of the above.
147.______A needles that are not in specially
designed containers must be sterilized before discarding.
148._______The disposable needles only solve
the problem which is the assurance that the needle is sterile when
it is still in an unbroken package.
149. About disposable needles:
______Some bubble-type packages loosen around
the edges so that contamination becomes possible.
______Needles left in soft plastic bags must be
carried in a hard-side container.
______The individual packets must be handled
carefully to avoid the needles puncturing the plastic foam from the
inside and becoming contaminated by external contact.
______Packages that bind the needles too
tightly also increase risk of contamination in the struggle to free
the needles.
150. The first thing to do before
establishing your clean field is:
A. Place all your treatment equipment on
the flat surface.
B. Wash your hands.
C. Place clean paper towelling on the
flat surface.
151. Lids of containers and trays become
contaminated easily by your fingers. This contamination can in turn
be transmitted to your sterile fingers later. Should this initial
lid contamination occur, you:
A. Stop whatever you are doing and put
all instruments into your sterilizer.
B. Rub alcohol over all surfaces.
C. Place sterile gauze over the lids and
handles when lifting.
152. You may wish to place a piece of
sterile gauze on the clean field for a new patient. This is useful
for:
A. Satisfying NCCA test requirements and
impressing patients.
B. Keeping the container for used
needles on.
C. Keeping the trash bag for wrappers
and cotton balls on.
D. Setting a needle or packet on before
using it.
153. The strongly recommended method of
washing hands is:
A. Rinsing under cold water and drying
on your pants or coat.
B. Vigorous rubbing together of
well-lathered hands for at least 10 seconds, followed by rinsing
under a stream of running water.
C. Dipping into a mild Clorox solution,
then drying on a clean white cotton towel.
D. Just like you usually do at home.
154. The use of germicidal soap and
anti-microbial products are advised when treating:
A. All patients, just to play safe.
B. Severely immuno-compromised patients,
such as those with HIV or who are undergoing chemotherapy.
155. Judgment regarding when to wash hands
should be based on the following:
A. Level of risk in individual
situations; the higher the risk, the more precautions.
B. Desire to please your teachers and
pass exams.
156. It is strongly recommended that
acupuncturists should always wash their hands:
A. Between patients.
B. After shaking hands with a patient,
or handling money.
C. Immediately before the acupuncture
procedure.
D. After contact with blood or body
fluids or obvious environmental contaminants.
157. Swabbing the fingertips with alcohol
is an acceptable substitute for full handwashing:
A. Before rolling up or adjusting the
patient's clothing.
B. Immediately before palpating the
point and swabbing it prior to needling.
C. Between patients.
D. After using the restroom.
158. Microorganisms are on every
non-sterile surface. The most serious contaminant found on the skin
and on many surfaces is:
A. Staphylococcus.
B. E-Coli.
C. Fungi and mold spore.
D. Chamylida
159.______An acupuncturist's hand jewelry, such
as wedding rings, does not harbor much potential for microorganism
contamination, since the items are washed so frequently.
160. If a selected acupuncture point
appears inflamed, irritated, diseased, has broken skin, before
needling you must first (most of the time):
A. Swab extra hard to remove potential
surface contamination.
B. Blow off the point and pick one that
has no such appearance.
161.______Since lancing a boil is a common
medical procedure, acupuncturists need not be concerned with
infections which might be carried deeper into the body or into the
surrounding tissue by a needle from a localized infection, such as a
boil.
162. You are now swabbing points on the
patient prior to insertion. The recommended order is:
A. One cotton ball or swab for each
point.
B. Torso to extremeties.
C. Extremeties toward torso.
D. Whatever feels right.
163. For palpating the point just before
needling, it is acceptable clean technique to:
A. Touch the point after cleaning the
skin, as long as the hands are clean and the fingers have been
swabbed with alcohol. The needle handle, guide tube, and point may
be touched just prior to insertion.
B. It is unacceptable technique to
palpate the skin after swabbing with alcohol, before insertion of
the needles. Only the needle handle and guide tube may be touched
just prior to insertion.
164. After removal from the packaging, the
needle shaft got touched by one of your fingers when you changed
your mind about needling a point. The appropriate next step is:
A. Insert the needle when you have
selected the correct point.
B. Dispose of the needle or sterilize
it, without insertion.
C. Wipe the needle with alcohol and
insert when dry.
165. Caution must be exercised when opening
a needle packet, including folding back the packet paper/plastic
just so. Why?
A. To insure that the needle shafts do
not touch anything the fingers have touched.
B. To avoid accidental needlestick
injury.
166. Pre-clean needle technique
acupuncturists "closed the hole" after withdrawing the needle by
placing their finger on the hole to stop the flow of Qi or blood.
Nowadays, acupuncturists:
A. Don't worry about the escape of Ai or
blood from the hole.
B. Use sterile gauze to cover the hole.
C. Use a clean cotton ball to cover the
hole.
D. Wear a rubber glove on the hand
holding the cotton when withdrawing a needle if it is deemed
appropriate. Additionally, even if not wearing a glove, they use a
cotton ball to cover the hole.
167. High-risk patients present special
potential problems for the acupuncturist. Types of persons
considered high risk might be:
_______Test positive for HIV, AIDS,
& Hepatitis.
_______Undergoing chemotherapy.
_______Severly malnourished.
_______Serious debilitation.
_______Receiving drugs which
suppress the immune system, such as for kidney transplant, or
postsplenectomy patients.
_______Test positive for strep.
_______Have acne or boils which
appear to be staph infections. Have influenza or bronchitis.
168. Special practices should be performed
regarding the treatment of high risk patients, including:
A. After the previous patient has left,
spray the treatment table with a disinfectant such as Lysol and then
wipe thoroughly.
B. Wash your hands with a germicidal
soap.
C. Prepare the patient's skin with
Betadyne swab, allow to dry.
D. Wipe off the Betadyne with an alcohol
swab and allow to dry.
E. Use disposable needles and wear
gloves.
F. Double-glove for HIV-AIDS patients.
G. Give herbs only because acupuncture
on these patients is just too dangerous.
H. Sterile (not clean) cotton balls
should be used to close the hole (or to draw blood).
17
169. After the high-risk patient leaves, spray
the treatment table, doorknob, and any other surfaces the patient
might have contacted, including the toilet seat, handle, sink, etc.,
with Lysol, then wipe thoroughly. After this, some clean-technique
type of common-sense would indicate the following:
A. Change the pillow casing, don't turn
it over.
B. Burning incense and chanting to
cleanse the patient room of evil Qi.
C. Leaving the cap off of a bottle of
alcohol in the patient room for awhile.
170. The name of the very dangerous bone
infection which may result from the needling technique
(osteo-acupuncture) used to stimulate the periosteurm (covering of
the bone) is:
A. Osteosarcoma.
B. Osteocyanosis.
C. Osteoblastitis.
D. Osteomyelitis.
171. The safest environment for this osteo-acupuncture
is:
A. Operating room, with standard
surgical procedures; palpation of the point with the finger is not
permitted.
B. Clean room within the clinic, set
aside for this procedure, and palpation of the point with the finger
is permitted.
172._________Since bone infection is a
possibility which might result from your normal acupuncture
practices, if point location is inaccurate, or depth, or whatever
brings the needle into contact with the bone, in all insertions,
care should be taken to avoid touching the bone, except when osteo-acupuncture
is intended and proper procedure has been followed.
173. Your travel kit should be or contain
the following items (treatment items all in one large Ziploc bag):
A. Tight closure of kit.
B. Sealed, sterilized packages needles.
C. Clean paper towels in a separate
plastic bag.
D. Clean cotton balls in their own
plastic bag.
E. Sterile cotton balls in their own
plastic bag.
F. Sterile gauze.
G. Rubber gloves.
H. Sterile gloves.
I. 70% isopropyl alcohol in a small
leakproof bottle, or on cotton balls pre-wet and stored in a
leakproof container, or on gauze swabs in commercially sealed
packets.
174.______The travel kit's plastic bags can be
reused from lunch if washed and dried.
175. The second large Ziploc bag should
contain the following:
A. A small paper bag with plastic liner
to receive waste.
B. An impervious, unbreakable container,
clearly marked "Contaminated," for used needles.
C. Bandaid boxes.
176._______The waste paper bag and the used
needle container may be placed on the clean field if you set them
onto sterile gauze which is on the clean field. |