Tsunematsu Mikako, et al.. Japanese Acupuncture and Moxibustion; 2019; Vol.15(1): 9-12

Short Communications

Influence of Using Gloves and Finger Stalls During Operations of Acupuncture
Needles. Observation Under an Electron Microscope: A Pilot Study
Tsunematsu Mikako1), Imai Motoyuki2), Imai Kenji1)1) Department of Acupuncture and Moxibustion, Faculty of Health Care, Teikyo Heisei University2) Department of Electrical Engineering, Faculty of Engineering, Tokyo University of ScienceAbstract
The aim of this study is to evaluate by a scanning electron microscope (SEM) whether using gloves and finger
stalls can prevent foreign bodies adhering to the acupuncture needle from the fingers of the acupuncturist. Afterattaching sodium bicarbonate to their fingers, the acupuncturist touched the acupuncture needles under three
conditions: bare hands, using powdered latex finger stalls and using powder-free nitrile gloves.
The acupuncture needles were observed by an SEM. Additionally, the elemental components of the foreign bodies
on the surface of the needle were analyzed with energy dispersive X-ray spectrometry. After touching theacupuncture needle with bare hands, we observed that there was adhesion of foreign bodies containing elements of
sodium to the surface of the acupuncture needle. After touching the acupuncture needle using powdered latex finger
stalls, we observed that there was adhesion of foreign bodies containing elements of silicon and magnesium to thesurface of the acupuncture needle. After touching the acupuncture needle using powder-free nitrile gloves, we did notobserve that there was any adhesion of foreign bodies to the surface of the acupuncture needle. In conclusion, using
powder-free gloves prevents foreign bodies from adhering to the acupuncture needles from the fingers of theacupuncturist.
Key words: Gloves, Finger Stalls, Scanning electron microscope (SEM)
I. Introduction
Kanshin-ho (needling with tube method) is anacupuncture technique devised in Japan in the 17thcentury, and the technique made it possible to insert athinner acupuncture needle with safety and less pain1,2).
Even today, Kanshin-ho is widely used in Japan.
However, Kanshin-ho is also a technique that often
requires directly touching the acupuncture needle while
inserting it into the body with the acupuncturist's fingers.
In recent years, medical gloves and finger stalls arerecommended during acupuncture treatment3), however,there are few reports on its effectiveness in theacupuncture field. This study aims to evaluate by ascanning electron microscope (SEM) whether using
medical gloves and finger stalls can prevent foreign
bodies adhering to the acupuncture needle from thefingers of the acupuncturist or not.
Ⅱ．Materials and Methods
The subject was an acupuncturist. The acupuncturist
put their thumb and index finger in sodium bicarbonate(NaHCO3) from a clean sheet to act as a model offoreign bodies, and then rubbed their fingers together toget any excess NaHCO3 off. Next, they touched anacupuncture needle with their fingers. After attaching theNaHCO3, the acupuncturist ran their fingers overacupuncture needles made of stainless steel (φ0.20mm,Nissin Medical Instrument Co., Ltd, Osaka, Japan) 5
times from the base to tip with their fingers under three
conditions: bare hands, using talc powdered latex finger
stalls (Clean finger stall, Meikensha Co., Ltd, Tokyo,Japan) and using powder-free nitrile gloves (Glacier zero,Moraine Co., Ltd, Tokyo, Japan). When using the fingerstalls and the gloves, the acupuncturist put them on so as
to have as little skin-to-glove contact as possible.
After touching the needles, the acupuncture needles
were observed by an SEM (Supra40; Carl Zeiss
Microscopy GmbH Co., Ltd, Jena, Germany) at amagnification of 300 x. In addition, the elemental
components of the foreign bodies on the surface of theneedle, and the surface of the needle itself, wereanalyzed with energy dispersive X-ray spectrometry(EDS) (XFlash 6|10; Bruker Co., Ltd, Massachusetts,USA). This is an analytical method to investigate
elements constituting an object from X rays generated
when an object is irradiated with an electron beam.

Corresponding author: Tsunematsu Mikako, Department of Acupuncture and Moxibustion, Faculty of Health Care, Teikyo Heisei
University, 2-51-4 Higashi-Ikebukuro, Toshima-ku, Tokyo, Japan.

10Tsunematsu Mikako, et al.. Japanese Acupuncture and Moxibustion; 2019; Vol.15(1): 9-12This study was carried out with the approval of theethics committee of Teikyo Heisei University (Approval
No. 29-116).
Ⅲ．ResultsFig. 1 shows the acupuncture needle after touchingwith bare hands. We observed that there was adhesion offoreign bodies to the surface of the acupuncture needle(Fig 1a). The EDS image showed that the foreign bodies
contained the element of sodium (Fig. 1b).
Fig. 2 shows the acupuncture needle after being
touched by powdered latex finger stalls. We observedthat there was adhesion of foreign bodies to the surfaceof the acupuncture needle (Fig. 2a). In addition, the EDS
image showed that the foreign bodies contained
elements of silicon and magnesium (Fig. 2b and crespectively).

Fig. 1. (a). SEM image of the acupuncture needle after touching with bare hands,and EDS elemental maps of the same needle for (b) sodium, (c) nickel and (d)iron.

Fig. 2. (a). SEM image of the acupuncture needle after touching using powdered latex finger stalls,and EDS elemental maps of the same needle for (b) silicon, (c) magnesium, (d) nickel and (e)iron.

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Tsunematsu Mikako, et al.. Japanese Acupuncture and Moxibustion; 2019; Vol.15(1): 9-12

Fig. 3. (a). SEM image of the acupuncture needle after touching using powder-free nitrile gloves, andEDS elemental maps of the same needle for (b) nickel and (c) iron.

However, we did not observe that there was any
adhesion of foreign bodies to the surface of theacupuncture needle when the acupuncture needle wastouched by powder-free nitrile gloves (Fig. 3).
IV. Discussion
In this study, after touching NaHCO3, we observed
acupuncture needles with an SEM under each of thesethree conditions: bare hands, using powdered latex
finger stalls and using powder-free nitrile gloves.
Under conditions that the acupuncture needle wastouched with bare hands, foreign bodies adhered to thesurface of the acupuncture needle; furthermore, theforeign bodies contained sodium. This result indicatesthat the NaHCO3 on the hands had adhered to theacupuncture needle. Under conditions that the needle
was touched using powdered finger stalls, foreign bodies
also adhered to the surface of the acupuncture needle.
However, the foreign bodies did not contain sodium,
they contained silicon and magnesium; it seems to betalc (Mg3Si4O10(OH)2) which is coated on the finger stallsurface. On the other hand, under conditions that theneedle was touched using powder-free nitrile gloves, noforeign bodies were observed on the surface of theacupuncture needle. The results of our study demonstratethat the adhesion of NaHCO3 as a model of foreign
bodies, attached to the fingers, transferring to theacupuncture needle was prevented under the condition of
being touched using powdered finger stalls and powderfree nitrile gloves. Of course, hand hygiene operations;washing hands and disinfection of hands ofacupuncturists before acupuncture treatment must bedone thoroughly to keep acupuncture needles clean.

However, even if foreign bodies are attached to theacupuncturist's fingers, the gloves and finger stalls may
be able to prevent the adhesion of foreign bodies fromthe fingers to the needles.
However, under the condition that the needle wastouched using powdered finger stalls, talc that is coatedon the finger stalls adhered to the acupuncture needle. In
addition, talc powdered gloves were banned by the Foodand Drug Administration because of potential harm tohuman health4). Because of this announcement, medical
gloves have been switching to ones without powder5).
Thus, using powder-free gloves prevents foreign bodies
from adhering to acupuncture needles and it makes
acupuncture procedures safe. In a clean and safe
acupuncture procedure, it is important that no foreign
bodies adhere to the needles. It is assumed that if
harmful substances are attached to the fingers ofacupuncturists, they may be inserted into the patients.
Thus, in order to provide clean acupuncture, using
powder-free nitrile gloves during acupuncture operations
is the best of the three. However, the finger stalls also
prevented the transferring of foreign bodies from thehand to the acupuncture needle, therefore the providingof powder free finger stalls is required.
Cases of infection that are considered to be caused byacupuncture have been reported6-9). It is undeniable thatthe microorganisms attached to the fingers of theacupuncturist adhered to the acupuncture needles andpassed on to the patients’ bodies causing infection. If
acupuncturists use clean gloves or finger stalls, it may
also prevent infections related acupuncture operations.
However, we examined using NaHCO3, as a model offoreign bodies, not real bacteria in this study. The caseof bacteriological examinations requires further12Tsunematsu Mikako, et al.. Japanese Acupuncture and Moxibustion; 2019; Vol.15(1): 9-12

investigation of clean acupuncture procedures. Inaddition, this is a single case study. In order to establish
a cleaner acupuncture procedure, more studies that
increase the number of subjects and having a
reproducibility check by repeating the same operations
are required.
V. Conclusion
Using clean gloves and finger stalls prevents foreign
bodies from adhering to the acupuncture needles fromthe fingers of the acupuncturist.
Acknowledgment
This work was supported by MEXT KAKENHI Grant
Number JP 17K08927.
Conflict of interest
The authors declare no conflicts of interest associatedwith this manuscript.
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