Dec. 21, 2002. 09:10 AM
LANA SLEZIC/TORONTO STAR FILE
The Toronto health department warns acupuncture patients to observe health conditions in clinics before treatment. Acupuncturists aren't regulated by government.
Skin infection shuts clinics
12 have rare bacterial condition after visiting acupuncturist Toronto health officials cite dirty needles, poor sterilization

TANYA TALAGA
MEDICAL REPORTER

An acupuncturist at two private clinics has reportedly infected 12 people in the Greater Toronto Area with an unusual skin infection, a bacteria that's suspected to have been transmitted through dirty needles.

Toronto Public Health is trying to contact more than 100 people in the city and York, Halton, Peel and Durham regions who were also patients at the two clinics, one operating out of rented space in a doctor's office on Bathurst St. in North York, and the other in what's believed to be a private residence on Islington Ave. in Etobicoke.

According to the health unit, the acupuncturist admitted re-using some needles and acknowledged problems in sterilizing some needles.

The health unit is notifying all clients who visited the two clinics from April 1 to Dec. 16 that they may have been exposed to improperly sterilized acupuncture needles. They are being told to see their physicians immediately to receive tests for HIV, hepatitis B and C, and the skin infection.

The 12 people have become infected with Mycobacterium abscessus, a skin infection that is rarely seen in humans, according to Dr. Barbara Yaffe, director of communicable disease control at Toronto Public Health. Raised, red, lumpy lesions, sometimes with pus, appear on the skin as a result of the bacteria. It is treatable with a prolonged course of antibiotics, she said.

"A doctor needs to make sure the organism is tested in the laboratory to see what antibiotics will be effective," Yaffe said yesterday.

If healthy people become infected, they need treatment but they won't be seriously ill, she said. However, if the bacteria get into the lungs, an infection can result. For people with weakened immune systems, the infection can spread.

The health unit has closed down the clinics until the operator complies with health regulations.

Health officials won't identify the acupuncturist.

"We basically directed the acupuncturist to close and the person was co-operative. We've served the order outlining the conditions which they may re-open, but at this point they remain closed," Yaffe said.

Acupuncturists are not a regulated health profession in Ontario.

Anybody can hang up a shingle and call themselves an acupuncturist.

But the province is working to change that, says Paul Cantin, spokesperson for Health Minister Tony Clement.

Regulation is currently in the draft phase and the province is holding meetings with key people in the industry, he said.

This recent case underscores the importance of provincial regulation of the acupuncture industry, says Toronto Councillor Joe Mihevc, who is also chair of the city board of health.

"This whole area of acupuncture needs to be examined by the province. It needs to be a regulated profession, given the amount of disease that can be passed through needles," he said.

Regulation should also cover those who offer electrolysis and tattoo services, Mihevc added.

The bacteria Mycobacterium abscessus is often found in our environment.

It's in the water, soil, dust and in animals.

Human cases usually involve contaminated medical devices which have been placed under the skin.

`(Acupuncture) needs to be regulated, given the amount of disease that can be passed through needles'

Joe Mihevc, city councillor

Other outbreaks have been caused by contaminated water.

While most people get sick within a month of exposure, in others infection won't set in for many months.

The condition is not contagious.

Credible acupuncturists use new, clean needles every time they see a patient, said Aileen Burford-Mason, of the Acupuncture Foundation of Canada.

On Oct. 22, Toronto Public Health was contacted by a physician about a cluster of unusual skin infections in four patients.

All four patients had visited the same acupuncturist and all four had infections at places in their skin where acupuncture needles had been inserted.

The next day the clinic was open, public health officials immediately started an investigation, said Yaffe. The unit also collected specimens from the four patients and interviewed them.

Investigators did a detailed inspection of the clinic, observed techniques used by the acupuncturist, and both "revealed no ongoing health hazard," according to public health documents.

There was no evidence of "re-use of needles or critical infractions of provincial infection control guidelines," the document reads.

At the visit, the investigators found out about the other clinic. On Oct. 30, they conducted a detailed inspection and could not find any health hazard.

But almost a month later, lab results showed the four infections were caused by Mycobacterium abscessus. All four patients had the same strain. There are now 12 people who have the infection, all of them clients of the same acupuncturist.

On Dec. 13, the public health inspectors visited the clinic again and asked the acupuncturist to provide them with a list of all clients who received treatments from April 1 to Oct. 25, so they could notify them of the skin infection risk.

It was during this visit that the "acupuncturist reported for the first time that in the past they had re-used needles and had experienced some difficulty with sterilization equipment during the summer of 2002."

Once this was discovered, the investigators shut the clinics down until "the situation could be reviewed and the risk of blood-borne infections in clients be assessed," the document says.

The acupuncturist agreed and is complying with the health order.

Once the acupuncturist is ready to re-open, the public health unit will inspect the clinics again.

The health unit has been calling patients of the acupuncturist since Wednesday.

They are following up with a package of information for the patient and their doctor, said Yaffe.

Yaffe said acupuncture patients need to be wary of health conditions.

"If you are going for acupuncture, or electrolysis, or anything where people are sticking needles into you, you should be aware of proper infection control. They should watch to see they use a new needle every time. Are they wearing gloves? Are they washing their hands? If they have concerns, they should contact their local health unit," Yaffe said.

Acupuncturists are regulated in British Columbia, Alberta and Quebec.
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