by Claudia Voyles
Note: the following statements are intended as best practice recommendations based on most recent measures published by the Centers for Disease Control and Prevention, NOT as absolute guidelines. Please modify and adapt your practices to fit the ever-evolving reality. The NCCAOM and the American Society of Acupuncturists (ASA) have also published useful resources on their website.
Minimum conditions needed to resume in-person treatment:
- Your state/province/city allows your program to open/function.
- You feel safe/comfortable resuming direct NADA acupuncture/acupressure.
- If you are working in a program, find out what the facility’s protocol and plans are for practice in terms of access to protective equipment and disinfection for all involved in giving and receiving NADA services.
- If you do not work for a program and are eligible to provide NADA on an independent basis, develop a protocol and plan that you can implement and follow and make available to anyone who inquires about the steps you have taken to reduce the risk of infection.
CONSIDER THESE FACTORS:
Needling cannot be done from a safe physical distance so you must take extra steps to reduce risk of infection for all parties. (Self-acupressure with or out without seeds/beads can be done from social distance.)
If conditions allow, treat outside, or semi-outside, with appropriate shade. Opening windows and increasing ventilation in an enclosed space has also proven to be helpful in decreasing risk.
A person can be infectious without having symptoms, but a person with symptoms needs to be referred to appropriate testing and care or seen via telehealth.
Screening tools include symptom and behavior review and taking temperature. Ideally these are done before entry to the location. Screen yourself as well.
Several of the malpractice providers for acudetox/acupuncture recommend that you have a written policy for safety and have clients sign a specific release at every treatment. This is not a replacement for the informed consent to care.
NADA is traditionally experienced in groups. At this moment it is better to treat fewer people at a time, and have them seated 6-8 feet apart. There are some NADA settings in which the population has been sheltered-in-place together and, like a family, functions without the six feet of physical distance.
While we strongly advocate that in normal times the acudetox specialist (ADS) sits with the group, it may be prudent to minimize exposure by going in and out of the room once the needles are in place. The risks of transmission increase with time/exposure as well as proximity.
Some practitioners/programs are considering outside and in car/parking lot treatments as safer alternatives.
Everyone, both providers and clients/patients/persons, needs to wear a mask the entire time. Wear eye protection when physically close to a person: glasses, goggles or shields. Avoid touching your face, especially eyes, nose, mouth with contaminated hands.
About masks: KN95 or equivalent for practitioner. It is important that the KN95 do not leak and have a good fit. Surgical paper masks (preferred) or good quality cloth mask for recipient. See here for a state-by-state description of face mask requirements, published May 15, 2020.
Following CDC guidelines for PPE conservation, “extended reuse” strategies will be implemented for masks. For KN95 masks, the device will be fitted at the beginning of a shift, and not removed until the end of the shift. When a mask is removed, it must be carefully placed in a container (e.g., paper bag) labelled with the providers name and the date worn, then stored for a three-day decontamination period. The accepted number of re-uses is five. The provider must immediately wash his/her hands after touching the mask, and should take care to touch the mask as little as possible while putting on and taking off the mask. Hold the mask by elastic straps when possible. To extend use, consider using a face shield or a cloth mask on top of the KN95.
It is not necessary to wear gloves but it is necessary to wash your hands (duration of 20 seconds) or use hand sanitizer after completing each client encounter. If you do wear gloves, change gloves after each complete treatment and wash hands or use hand sanitizer.
Use clean needle technique. Think about people’s heightened fears and be not only safe but sensitive to their perceptions of safety.
If practicing with another ADS, have separate clean fields/supplies so that you do not risk cross-contamination.
Disinfect/sanitize the chairs and tables after each use and any contact areas that are your responsibility.
Use an EPA-approved disinfectant and wear fresh gloves during the disinfecting process. Added care includes having a checklist and documenting surfaces cleaned pre- and post-contact.
Upon returning to your home, it is recommended to take off the clothes worn at the clinic and put them in the wash immediately, leaving shoes outside.
In summary, the EXTRA measures you need to have in place in order to provide the NADA protocol in the COVID-19 pandemic include:
- Screen for active symptoms – including temperature (may be done by agency)
- Covid-19-specific consent form.
- PPE – KN95 for ADS, surgical or good cloth for recipient.
- Disinfect/sanitize chairs and other contact surfaces and document each cleaning.
Claudia Voyles is an Austin-based NADA trainer and acupuncturist. In May 2020 she published her doctoral thesis in the Journal of Addiction Science: Asking NADA: A Needs Assessment for Training Renewal. To contact: firstname.lastname@example.org.