Clean Needle Technique 7th edition

7/23/2019 Clean Needle Technique 7th edition

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Clean Needle TechniqueCNT Manual

Best Practices for AcupunctureNeedle Safety

and Related Procedures7th Edition

Published by the Council of Colleges of Acupuncture and Oriental Medicine©2 15





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!"#$%& ()*+$,*-$. #/1 !A*- 01$@"1"%*/- >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4T

N:7&(5/7) 78 L:'+ M.(<;: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4T

M5()+(<+ K<'-(15/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4b

O(:/- M5';: 78 5.' "&'() *''+&' ,'-.)/01' 87< #-1;1)-51<' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4b

A> "*, O(:/- K</)-/;&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4S

M'55/)9 L; 5.' "&'() [/'&+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 44

N):;'-5/)9 *''+&' K(-I(9/)9 K</7< 57 L:' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4Q

MI/) K<';(<(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4Q

K(&;(5/)9 5.' K7/)5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4Q

N):'<5/)9 *''+&' 57 "7<<'-5 W';5. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 4P

*''+&' Y'?7G(& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QB

W'(&/)9 =/5. O&77+ 57 O&77+ "7)5(-5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QB

%()(9/)9 L:'+ *''+&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QB

"71)5/)9 *''+&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QC

T> "*, /) () $88/-' M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QA

,<'(5?')5 K<757-7& /) () $88/-' M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QA

b> "*, 87< d71:' "(&&:`,<(G'& M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Qb

,<(G'& f/5 `,<(G'& f/5 "(<</'< >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Qb

"&'() N5'?: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Qb

*7)R"&'() N5'?: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QD

,<(G'& f/5 N5'?: *75 /) O(9: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QD

d()+ "&'():'< >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QS

,<(G'& M.(<;: "7)5(/)'< >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QS

K<';(</)9 5.' f/5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QS



G/

,<'(5?')5 K<757-7& /) ( ,<(G'& M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QS

D> "*, /) ( "7??1)/5F #-1;1)-51<' "&/)/- 7< *#W# M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QP

,<'(5?')5 K<757-7& /) ( "7??1)/5F "&/)/- 7< *#W# M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> QP

S> "*, /) ( K1E&/- d'(&5. M'55/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PC

d()+=(:./)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PC

#-1;1)-51<' 601/;?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PA

K7:/5/7)/)9 5.' K(5/')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PA

Y'?7G/)9 *''+&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PA

K75')5/(& "7?;&/-(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PT

4> ,7F7.(</ #-1;1)-51<' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Pb

%7+/8/-(5/7): 57 M5()+(<+ "&'() *''+&' ,'-.)/01' 87< "7)5(-5 *''+&/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Pb

Q> M1??(<F 78 M(8'5F Y'-7??')+(5/7): 87< "&'() *''+&' ,'-.)/01' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PD

Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> PQ

&('$ @@@A !"#$ &'()$*)"# +,' 6"3($"2 -BC B++*)" &',)"2.'"# ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: HMH

C> %7J/E1:5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBA

%7J/E1:5/7) $G'<G/'= >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBA

Z')'<(& %7J/E1:5/7) K<'-(15/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBT

%7J( O':5 K<(-5/-' Z1/+'&/)':>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBb

W/<'-5 %7J/E1:5/7) R ,'-.)/01' 87< *7)RM-(<</)9 %7J/E1:5/7) =/5. %7J( "7)': >>>>>>>>>>>>>>>>>>>>> CBb

%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBb

M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBD

W/<'-5 %7J/E1:5/7) R ,'-.)/01' 87< M-(<</)9 %7J/E1:5/7) =/5. %7J( "7)': >>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBD

%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBD

M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBS

N)+/<'-5 %7J/E1:5/7) a ,'-.)/01' =/5. N)5'<;7:'+ %7J/E1:5/7)>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CB4

%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CB4

M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBQ

N)+/<'-5 %7J/E1:5/7) R ^(<?/)9 *''+&' %7J/E1:5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBQ

%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBQ

M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CBP

N)+/<'-5 %7J( a ,'-.)/01' =/5. %7J( M5/-I >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCB

%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCB



G//

M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCB

%7J( W/:;7:(& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCC

A> d'(5 X(?;: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCA

O':5 K<(-5/-' K<757-7&: 87< d'(5 X(?;: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCA

%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCA

M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCA

T> "1;;/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCb

"1;;/)9 $G'<G/'= >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCb

Z')'<(& Y'-7??')+(5/7): 87< "1;;/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCb

M(?;&' O':5 K<(-5/-' K<757-7&: 87< "1;;/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCD

[/<' "1;;/)9 %'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCS

M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCS

M1-5/7) "1;;/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CC4

%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CC4

^'5 "1;;/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CC4

%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCQ

b> ,.'<(;'15/- O&77+ ^/5.+<(=(& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCP

O&''+/)9 $G'<G/'= >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCP

Z')'<(& Y'-7??')+(5/7): 87< O&''+/)9 ,'-.)/01': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCP

M(?;&' O':5 K<(-5/-' K<757-7& 87< O&''+/)9 #-1;1)-51<' K7/)5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CCP

%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAB

b> K&1? O&7::7?`M'G') M5(< *''+&' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAA

K&1? O&7::7? $G'<G/'= >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAA

Z')'<(& Y'-7??')+(5/7): 87< K&1? O&7::7? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAA

O':5 K<(-5/-' K<757-7&: 87< K&1? O&7::7? >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAA

%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAT

D> Z1( M.( >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAb

Z1( M.( $G'<G/'= >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAb

M1??(<F 78 Z1( M.( Y'-7??')+(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAb

Z1( M.( O':5 K<(-5/-' K<757-7&: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAD

%'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAD

S> #-1;7/)5 N)]'-5/7) ,.'<(;/': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAS



G///

#-1;7/)5 N)]'-5/7) ,.'<(;F O':5 K<(-5/-' K<757-7&: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CA4

M(8'5F "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAQ

M1??(<F 78 M(8'5F Y'-7??')+(5/7): 87< "&'() N)]'-5/7) ,'-.)/01' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAP

Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CAP

&('$ @N O @0+")$*,0# -##,)*($"2 =*$8 -)./.0)$.'" (02 6"3($"2 P"(3$8)('" &'()$*)"# :::::::::::::::::::::::: HQH

C> K(5.79'): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTC

A> %'-.()/:?: 78 W/:'(:' ,<():?/::/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTC

#1579')71: N)8'-5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTA

"<7::RN)8'-5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTA

T> O&77+E7<)' K(5.79'): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTT

d';(5/5/: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTT

d';(5/5/: # 2d#c3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTb

d';(5/5/: # M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTb

d';(5/5/: O 2dOc3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTD

,<():?/::/7) 78 dOc >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTD

dOc M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTS

N)+/G/+1(&: (5 Y/:I 78 dOc N)8'-5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTS

6J;7:1<' 57 dOc >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CT4

dOc c(--/)(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CT4

,.' dOc N)8'-5/7) K<7-':: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTQ

,<'(5?')5 78 dOc >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTP

d';(5/5/: " 2d"c3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CTP

#-15' MF?;57?: 78 d';(5/5/: " >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbB

Y/:I [(-57<: 87< d"c N)8'-5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbB

d"c M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbC

"7):'01')-': 78 d"c N)8'-5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbC

d';(5/5/: W 2dWc3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbC

dWc M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbA

d';(5/5/: 6 2d6c3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbA

".<7)/- "(<</'<: 78 d';(5/5/: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbA

K<'G')5/7) 78 d';(5/5/: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbT

,(E&' CU M1??(<F 78 d';(5/5/: ".(<(-5'</:5/-: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbT



/J

d1?() N??1)7+'8/-/')-F W/:'(:' 2dNc3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbT

dNc ,<():?/::/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Cbb

dNc M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbD

Y/:I 78 ,<():?/::/7) 5.<719. N)G(:/G' K<7-'+1<': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbD

N)+/G/+1(&: (5 Y/:I 78 dNc N)8'-5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbD

,':5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbS

Y';7<5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Cb4

,.' dNc N)8'-5/7) K<7-':: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Cb4

,<'(5?')5 78 dNc >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbQ

#++/5/7)(& Y/:I: 57 d'(&5.-(<' ̂ 7<I'<: 2d"^:3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbQ

b> $5.'< d'(&5.-(<' #::7-/(5'+ N)8'-5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbP

,1E'<-1&7:/: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CbP

,O M1<G/G(& $15:/+' d7:5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDC

#-1;1)-51<' ,O M(8'5F >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDC

MI/) N)8'-5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDC

M5(;.F&7-7--1: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDC

%'5./-/&&/)RY':/:5()5 M5(;.F&7-7--1: #1<'1: 2%YM#3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDA

K<'G')5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDA

%YM# M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDT

M5<';57-7--1: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDT

%F-7E(-5'</( $5.'< 5.() ,1E'<-1&7:/: 2%$,3 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDT

d'<;': M/?;&'J >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDb

N)8&1')\( >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDD

N)8&1')\( M1<G/G(& /) 5.' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDD

"W" [1)+(?')5(& 6&'?')5: 57 K<'G')5 N)8&1')\( ,<():?/::/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDS

*7<7G/<1: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDS

K<'G')5/7) 78 *7<7G/<1: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDS

"&7:5</+/1? +/88/-/&' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CD4

K<'G')5/7) 78 M;<'(+ 78 "&7:5</+/1? +/88/-/&' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDQ

D> M1??(<F 78 K<'G')5/7) 78 W/:'(:' ,<():?/::/7) /) #-1;1)-51<' K<(-5/-'>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDP

O(:/- "</5/-(& K</)-/;&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDP

K<'G')5/)9 K(5/')5 57 K(5/')5 "<7:: N)8'-5/7): a "</5/-(& Y'-7??')+(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDP



J

K<'G')5/)9 K(5/')5 57 K<(-5/5/7)'< "<7:: N)8'-5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDP

K<'G')5/)9 K<(-5/5/7)'< 57 K(5/')5 "<7:: N)8'-5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CDP

Y'G/'=>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CSB

Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CSB

&('$ NA &"'#,00"3 P"(3$8E D3"(03*0"## (02 4(+"$5 &'()$*)"# ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: HKL

C> d()+=(:./)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CSQ

688'-5/G' d()+=(:./)9 ,'-.)/01' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CSP

d()+ dF9/')' ,'-.)/01'U M7(; ()+ ^(5'< >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CSP

d()+ W<F/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4B

d()+ dF9/')' ,'-.)/01' R #&-7.7&RO(:'+ M()/5/\'<: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4B

d()+=(:./)9 R #)5/:';5/- ,7='&'55': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4B

d()+ [&7<( >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4C

Y/)9:`V'='&<F >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4C

d'(&5.-(<' =7<I'<: ()+ #-51(& d()+=(:./)9 K<(-5/-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4C

*'-'::/5F 78 d()+=(:./)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4C

^.(5 /: 5.' </9.5 =(F 57 =(:. F71< .()+:g >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4A

Y'-7??')+(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4T

A> K(5/')5 MI/) K<';(<(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4T

#&-7.7& M=(E %'5.7+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4D

$;5/7): 87< MI/) K<';(<(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4D

Y'-7??')+(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4S

T> Y'-7??')+(5/7): 87< K<(-5/5/7)'< d'(&5. ()+ dF9/')' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4S

h'(<&F K.F:/-(& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C44

"&75./)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C44

d()+ "(<' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C44

K'<:7)(& d'(&5. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C44

,':5/)9 87< ,OH dOcH d"c ()+ dNc >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4Q

,O 5':5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4Q

dOc 5':5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4Q

d"c 5':5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4Q

dNc 5':5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4P

b> K'<:7)(& K<75'-5/G' 601/;?')5 2KK63 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> C4P



J/

#<' 9&7G': )''+'+ 87< (-1;1)-51<' )''+&' /):'<5/7)g >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CQC

#<' 9&7G': )''+'+ 87< (-1;1)-51<' )''+&' <'?7G(&g >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CQA

D> *''+&':5/-I N)87<?(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CQT

Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CQT

&('$ N@A D3"(0*0> (02 &($8,>"0 6"2.)$*,0 J")80*R."# *0 P"(3$8)('" (02 -BC &'()$*)" S,)($*,0# ::: HLT

C> W/:/)8'-5()5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CQP

"&(::/8/-(5/7): 78 W/:/)8'-5()5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPB

,F;': 78 W/:/)8'-5()5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPB

".&7</)' ()+ ".&7</)' "7?;71)+: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPB

%/-<7E/7-/+(& #-5/G/5F >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPC

Z&15(<(&+'.F+' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPC

dF+<79') ;'<7J/+' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPA

N7+7;.7<: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPA

K.')7& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPA

6K# ()+ [W# #;;<7G(& 78 W/:/)8'-5()5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPA

%7)/57</)9 ()+ X(E'&/)9 78 W/:/)8'-5()5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPA

A> N)+/-(5/7): 87< M5'</&/\(5/7)H d/9.RX'G'& W/:/)8'-5/7)H ()+ X7=RX'G'& W/:/)8'-5/7) >>>>>>>>>>>>>>>>>>>>>>>>>> CPT

T> "&'()/)9 601/;?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPT

Y'1:' 78 M/)9&'RL:' %'+/-(& W'G/-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPT

K<'R-&'()/)9 78 Y'1:(E&' %'+/-(& 601/;?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPT

N):5<1?')5 "&'()/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPb

!"#$%& ()*+$,*-$. #/1 K*.*-#$7%*-4 ?$)."R,$ H$+*7", MS)*@B$-% >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPb

b> "&'() L:' 78 X1E</-()5:>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPS

D> "&'()/)9 ()+ W/:/)8'-5/)9 6)G/<7)?')5(& M1<8(-': /) d'(&5.-(<' [(-/&/5/': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPS

L:' 78 W/:/)8'-5()5: 87< M1<8(-' "&'()/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CP4

S> O&77+ 7< O7+F [&1/+ M;/&&: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CP4

4> X(1)+'</)9 M.''5:H ,7='&: 7< $5.'< X/)'): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPQ

Q> M.(<;: ()+ *7)RM.(<;: O/7.(\(<+ 601/;?')5 ()+ W/:;7:(& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPQ

P> Y'91&(5'+ ^(:5' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> CPP

W/:;7:(& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABB

"7)5(?/)(5'+ X(1)+<F >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABB

M1??(<F 78 Y'-7??')+(5/7): a K(<5 cN >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABC



J//

Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABA

&('$ N@@A B++*)" &',)"2.'"# +,' 6*#< 6"2.)$*,0 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: UMV

C> ['+'<(& M5()+(<+: ()+ Z1/+'&/)': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABD

$Md#U O&77+E7<)' K(5.79'): M5()+(<+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABD

M5()+(<+ K<'-(15/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABS

*MK# >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ABS

$Md#U 6J;7:1<' "7)5<7& K&() >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AB4

$Md#U d(\(<+71: "7??1)/-(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACB

$Md#U $5.'< d(\(<+: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACC

$Md#U W/:;7:/)9 78 O/7.(\(<+71: ̂ (:5' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACC

W/:-(<+/)9 9&7G':H -7557) E(&&: ()+ 75.'< ?(5'</(& -7)5(?/)(5'+ =/5. E&77+ >>>>>>>>>>>>>>>>>>>>>>>>>>>> ACT

^.(5 :.71&+ ;(5/')5: +7 =/5. ;<':: 5(-I: 7< 75.'< /?E'++'+ +'G/-': 5.(5 5.'F )''+ 57 <'?7G'(5 .7?'g >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACT

A> M(8'5F "7):/+'<(5/7): Y'9(<+/)9 5.' K<(-5/-' 6)G/<7)?')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACb

T> Y'-7<+I'';/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACD

".(<5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACD

Z')'<(& ".(<5/)9 "7):/+'<(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACD

M5()+(<+ Y'01/<'?')5: 87< #$% -.(<5/)9 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AC4

W(/&F #;;7/)5?')5 M-.'+1&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACP

b> K(5/')5 "7)8/+')5/(&/5F >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACP

dNK## d'(&5. N)87<?(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ACP

Y';7<5/)9 78 "7??1)/-(E&' W/:'(:' ()+ #E1:' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAC

D> N)87<?'+ "7):')5 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAC

S> d/9.RY/:I K(5/')5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAA

4> $5.'< N?;7<5()5 M(8'5F K<(-5/-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAA

K<'G')5/)9 ,</;: ()+ [(&&: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAA

d7= 57 K<'G')5 [(&&: W1' 57 M&/;: ()+ ,</;: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAT

Y':;7):' 57 ( O7+/&F [&1/+ M;/&& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAT

[/<:5 #/+ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAT

%')5(& d'(&5. N::1':`M1/-/+' >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAb

Q> M1??(<F 78 Y'-7??')+(5/7): a K(<5 cNN >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAb

Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AAD



J///

&('$ N@@@ O -//"02*)"# :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: UUW

#;;')+/J #U Z&7::(<F`#EE<'G/(5/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AA4

#;;')+/J OU ^.'<' 57 [/)+ %7<' N)87<?(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATT

d'(&5.-(<' #::7-/(5'+ N)8'-5/7):>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATT

"W"`M;'-/8/- K(5.79'): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATT

d';(5/5/: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATT

dNc >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATb

,O >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATb

$5.'< W/:'(:': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATb

d()+=(:./)9 /)87<?(5/7) ()+ +'5(/&: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATD

M5()+(<+ K<'-(15/7): >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATD

$Md# W7-1?')5: ()+ ,<(/)/)9 Y'01/<'?')5: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATD

$Md# O&77+E7<)' K(5.79') M5()+(<+: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATD

6J;7:1<' "7)5<7& K&() 26"K3 M(?;&': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATD

$Md# W7-1?')5: Y'&(5/)9 57 6"K: >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATD

d(\(<+71: "7??1)/-(5/7) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATS

dNK## >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATS

#;;')+/J "U #-1;1)-51<' K7/)5: 5.(5 Y'01/<' M;'-/(& MI/&& >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> AT4

Y'8'<')-': >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ATP

D3"(0 1""23" J")80*R." W$8 92*$*,0 X-Y ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: UVM

@02"; ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: UVK





J/G

Preface

,.' ;<78'::/7) 78 (-1;1)-51<' ()+ $</')5(& ?'+/-/)' 2#$%3 /) 5.' L)/5'+ M5(5': -7)5/)1': 57

9<7= ()+ 'G7&G'> #: ;(<5 78 5./: 'G7&15/7)H ;<(-5/5/7)'<: (<' ;<7G/+/)9 (-1;1)-51<' :'<G/-': /)

.7:;/5(&:H /)5'9<(5'+ ?'+/-(& -')5'<:H ()+ 5'(-./)9 -&/)/-:> #: ?7<' (-1;1)-51</:5: ;<7G/+' -(<'/) 5./: -7?;&'J (<<(F 78 /)5'9<(5'+ :'55/)9:H 5.' )''+ 87< 'G/+')-'+RE(:'+ E':5 ;<(-5/-': /)

:(8'5F /: '::')5/(&> #-1;1)-51<' '+1-(5/7) /) 5.' L>M> .(: 'G7&G'+ 57 ?''5 5./: -.(&&')9'>

#--7<+/)9&FH #$% /):5/515/7): 5.(5 .(G' (-./'G'+ (--<'+/5(5/7) 7< (--<'+/5(5/7) -()+/+(-F

:5(51: =/5. 5.' #--<'+/5(5/7) "7??/::/7) 87< #-1;1)-51<' ()+ $</')5(& %'+/-/)' 2#"#$%3

-7)5/)1' 57 'J;()+ 5.'/< -1<</-1&1? 57 ?''5 5.' -.()9/)9 )''+: 78 5.' ;<78'::/7)H /)-&1+/)9

-71<:'=7

,.' /)87<?(5/7) (G(/&(E&' 8<7? 5.' "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7) 2"W"3H 5.'

$--1;(5/7)(& M(8'5F ()+ d'(&5. #+?/)/:5<(5/7) 2$Md#3H (: ='&& (: :5(5' ()+ &7-(& .'(&5.

+';(<5?')5:H .(: (&:7 'G7&G'+ :/)-' 5.' <'&'(:' 78 ;<'G/71: '+/5/7): 78 5.' F,$"- ;$$+,$

G$7C-*S)$ H"-)", > ".()9/)9 ';/+'?/7&79/-(& ;(55'<):H -.()9': /) =.(5 /: -7):/+'<'+ E':5

;<(-5/-': /) -&'() ()+ (:';5/- 5'-.)/01'H ()+ -.()9': /) 5'-.)7&79F .(G' (&& -7)5</E15'+ 57

/?;<7G/)9 -&/)/-(& :(8'5F> ^.(5 .(: )75 -.()9'+ /: 5.' )''+ 87< (-1;1)-51</:5: 57 (;;&F "&'()

*''+&' ,'-.)/01' :-<1;1&71:&F (: :(8'5F <'?(/): ( -</5/-(& (:;'-5 78 -&/)/-(& ;<(-5/-'>

,.' ;1<;7:' 78 5.' F,$"- ;$$+,$ G$7C-*S)$ H"-)", .(: (&:7 'G7&G'+> ,.' 8/<:5 '+/5/7) 78 5.'

?()1(& =(: 7)' 78 5.' 8'= 6)9&/:. &()91(9' :71<-': -7G'</)9 :(8' ;<(-5/-' :5()+(<+: 87<

(-1;1)-51</:5:> #$% '+1-(5/7)(& /):5/515/7): )7= .(G' ( <()9' 78 <':71<-': ()+ ()(--<'+/5(5/7) ?()+(5' 57 -7G'< E&77+E7<)' ;(5.79'):H :(8' ;<(-5/-'H '?'<9')-F ;<7-'+1<':H

</:I ?()(9'?')5H ()+ :(8'5F ;<757-7&: /) 5.'/< -1<</-1&(> N)87<?(5/7) ;<7G/+'+ /) 5.' F,$"-

;$$+,$ G$7C-*S)$ H"-)", .(: (&:7 :;<'(+ 9&7E(&&FH ;<7?75/)9 E'55'< :(8'5F :5()+(<+:

=7<&+=/+'>

*''+&/)9 ()+ 75.'< <'&(5'+ (-1;1)-51<' ;<7-'+1<': (<' -(<</'+ 715 /) ( 1)/01' ?())'< =.'<'

)''+&': ?(F E' ;&(-'+ /)57 5/::1' ()+ <'?7G'+H 7< ?(F E' ;&(-'+ /)57 5/::1' ()+ <':/+' 87< (

;'</7+ 78 5/?' E'87<' 5.'/< <'?7G(&> $5.'< ?7+(&/5/': ?(F (&:7 E' (;;&/'+ 7)57 5.' :1<8(-' 78

5.' :I/) ()+ &/I'=/:' E' /??'+/(5'&F <'?7G'+ 7< <'5(/)'+ 87< ( ;'</7+ 78 5/?'> #: :1-.H 5.'

(;;&/-(5/7) 78 'G/+')-'+RE(:'+ E':5 :(8'5F ;<(-5/-': 5(I': /)57 (--71)5 5.' ?())'< ()+ 5/?/)9

78 5<'(5?')5> N) +'G'&7;/)9 5.' F,$"- ;$$+,$ G$7C-*S)$ H"-)", H 'J;'<5: 8<7? $Md# ()+ 5.'

"W" ='<' -7):1&5'+ 57 '):1<' 5.(5 5.' <'-7??')+(5/7): /) 5.' ?()1(& ?''5 -1<<')5 $Md#

()+ "W" :5()+(<+:>

,.' F,$"- ;$$+,$ G$7C-*S)$ H"-)", ;&(F: () /?;7<5()5 <7&' /) ;<';(</)9 (-1;1)-51<' :51+')5:

87< :(8' ;<(-5/-' ()+ ;<7G/+/)9 E(:/- /)87<?(5/7) <'01/<'+ 87< )(5/7)(& -'<5/8/-(5/7) /)



JG

(-1;1)-51<' EF 5.' *(5/7)(& "'<5/8/-(5/7) "7??/::/7) 87< #-1;1)-51<' ()+ $</')5(& %'+/-/)'

2*""#$%3 ()+ 87< :5(5' &/-'):1<'> ,./: ?()1(& :1??(</\': /?;7<5()5 ;</)-/;&': 5.(5 97G'<)

:(8' ;<(-5/-' :1/5'+ 57 :1;;7<5 5.' =7 ,.' /)87<?(5/7) /) 5./: ?()1(& :1;;7<5: ()+-7)5</E15': 57 5.' '+1-(5/7)(& -1<</-1&( /) 5.' (<'(: 78 #$% 788/-' ;<7-'+1<' :(8'5FH

E&77+E7<)' ;(5.79'):H ()+ </:I <'+1-5/7) -7)-'<)/)9 (-1;1)-51<' ()+ 75.'< (+]1)-5/G'

5.'<(;/': (: ;<(-5/-'+ /) ;</G(5' ;<(-5/-'H -7)G')5/7)(& ()+ "#% /)5'9<(5'+ -&/)/-(& :'55/)9:H

()+ /) 5.' 5'(-./)9 -&/)/-: /) (--<'+/5'+ #$% ;<79<(?:>

,./: &(5':5 '+/5/7) 78 5.' F,$"- ;$$+,$ G$7C-*S)$ H"-)", .(: E'') 'J;()+'+H 1;+(5'+H ()+

'J.(1:5/G'&F <'G/'='+> ^./&' 'G'<F '887<5 .(: E'') ?(+' 57 '):1<' 5.(5 1;R57R+(5' :5(5/:5/-:

='<' /)-&1+'+ =/5. <':;'-5 57 (+G'<:' 'G')5: (</:/)9 /) #$% 788/-' ;<(-5/-':H /)-&1+/)9 5.'

:?(&& </:I 78 :;<'(+/)9 /)8'-5/71: +/:'(:':H /5 /: /?;7<5()5 57 <'?'?E'< 5.(5 5.':' :5(5/:5/-: (<'

-7):5()5&F -.()9/)9> #-1;1)-51<' ;<(-5/5/7)'<: -() 8/)+ 1;+(5'+ /)87<?(5/7) <'9(<+/)9

.'(&5.-(<' (::7-/(5'+ /&&)'::': 7) L>M> 97G'<)?')5 ='E:/5':H ( )1?E'< 78 =./-. (<' &/:5'+ /)

#;;')+/J O>



JG/

Acknowledgements

,.' :'G') '+/5/7): 78 5.' F,$"- ;$$+,$ G$7C-*S)$ OF;GP H"-)", <';<':')5 5.' -7&&'-5/G' 5./)I/)9

()+ ')'<9F 78 *(5/7)(& #-1;1)-51<' [71)+(5/7) O7(<+ %'?E'<:H *""#$% "7??/::/7)'<:H "71)-/&

78 "7&&'9': 78 #-1;1)-51<' ()+ $</')5(& %'+/-/)' "&'() *''+&' ,'-.)/01' "7??/55'' %'?E'<:H()+ "*, N):5<1-57<: ()+ -7&&'(91': (-<7:: 5.' L)/5'+ M5(5':>

,.' *(5/7)(& #-1;1)-51<' [71)+(5/7) O7(<+ %'?E'<: /)G7&G'+ /)-&1+' %(&G/) [/)I'&:5'/)H X>#->i

O(<E(<( %/5-.'&&H V>W>H X>#->H 26+/57<H 871<5. ()+ 8/85. '+/5/7)3i ̂ /&&/(? MI'&57)H X>#->i ()+ V(?':

,1<)'<H V>W>

,.' <7&& -(&& 78 5.' "7??/::/7)'<: 78 5.' *(5/7)(& "'<5/8/-(5/7) "7??/::/7) 87< #-1;1)-51<' ()+

$</')5(& %'+/-/)' 2*""#$%3 /)G7&G'+ /) 5.' ;<7-':: /)-&1+': V1)' O<(\/&H X>#->i 6+/5. W(G/: 26+/57<3i

Z&')) 6(<&H X>#->i M5'G') [/)()+7H K.>W>H X>#->i #&() [<()-/:i W()/'& V/(7H X>#->i M51(<5 f15-./):H X>#->i

V/? %-"7<?/-IH X>#-> 26+/57<3i %(W>H X>#->i #)9'&( ,1H X>#->i ()+ Z<(-' ̂ 7)9H X>#->

$5.'< ;<78'::/7)(&: =.7 ?(+' G(&1(E&' -7)5</E15/7): /)-&1+' Y'\() #I;/)(<H W>W>M> 261<7;'3H %>M>H

X>#->H X>%>,>i #)) O(/&'FH X>#->i %(55.'= O(1'<H X>#->i V'))F O'&&17?/)/H *>W>i %(<F "> O7&:5'<H %>M>H

Y>*>i 6+)( %> O<()+5H %>#->H X>#->H W/;&>#->i Y(&;. "7()H %>W>i Z(<F W7&7=/5\H %>W>i Y7E'<5 W199()H

X>#->i f'G/) 6<9/&H X>#->i M5'G' Z/G')H W>#>$>%>H X>#->i %(<5.( d7=(<+H %>W> 26+/57<3i d(/9 N9)(5/1:H

%>W>i V7:';. f(FH X>#->i W'I' f')+(&&H X>#->i K(5</-/( f&1-(:H Y>*>i M1 X/()9 f1H ">#>i M.') K/)9 X/()9H

X>#->i ̂ /&&/(? %1'&&'<H X>#->i ,7? Y//./?(I/i [&7<')-' K(5</-/( Y75.H %>M>H X>#->i Y7) M7I7&:IFH

%>M>$>%>H X>#->H W/;&> #->`">d>i ,/'<)'F ,1&&FH %>M>$>%>H X>#->i O<77I' ̂ /)5'<H X>#->i V1&/' j/)I1:H

X>#->i ()+ ̂ (&5'< O7)+ 78 5.' "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7)>

V'))/8'< O<'55H *>W>H X>#-> /: 5.' ;</)-/;(& '+/57< 87< 5.' ;<':')5 45.

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X/J/)9 X(7H K.>W>H ">%>W> 2"./)(3H X>#->i j7' O<'))'<H X>#-i ()+ 5.' "71)-/&k: "*, /):5<1-57<: W(<&')'

6(:57)H %>M>H W/;&>$%H X>#->i W()/'& V/(7H W>#>$>%H X>#->i l/(75/() M.')H X>#->H %>K>d>i ()+ V(?/'

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'J;<'::'+ 57 W719&(: V> f(&/)7=:I/H W/<'-57<H W/<'-57<(5' 78 "77;'<(5/G' ()+ M5(5' K<79<(?:H 8'+'<(&

$--1;(5/7)(& M(8'5F ()+ d'(&5. #+?/)/:5<(5/7)H 87< $Md#k: -7??')5: -7)-'<)/)9 ( "*, ;<757-7&

/::1'>



JG//

Introduction

N) CPQbH (5 5.' <'01':5 78 5.' (-1;1)-51<' ;<78'::/7)H 5.' *(5/7)(& "'<5/8/-(5/7) "7??/::/7)

87< #-1;1)-51<' ()+ $</')5(& %'+/-/)' 2*""#$%3 +'G'&7;'+ 91/+'&/)': ()+ <'-7??')+(5/7):

87< 5.' :(8' ()+ -&'() ;<(-5/-' 78 (-1;1)-51<'> ,.' 91/+'&/)': ='<' E(:'+ 7) 5.' 5.'7<F ()+;<(-5/-' 78 :(8'5F -7??7)&F 1:'+ /) .'(&5.-(<'> "7):-/')5/71: 1:' 78 5.' ;<7-'+1<':

<'-7??')+'+ ()+ +':-</E'+ /) 5./: ?()1(& =/&& <'+1-' 5.' </:I 78 :;<'(+/)9 /)8'-5/7) ()+

(--/+')5: /) 5.' ;<(-5/-' 78 (-1;1)-51<'>

N)-<'(:/)9 I)7=&'+9'H (&7)9 =/5. 5.' (;;&/-(5/7) 78 M5()+(<+ K<'-(15/7):H :(8' -&/)/-(&

;<(-5/-':H ()+ </:I ?()(9'?')5 5'-.)/01':H <'+1-': 5.' </:I 78 ( )1?E'< 78 ;75')5/(& (+G'<:'

'G')5: <'&(5'+ 57 (-1;1)-51<' ;<(-5/-'H <'+1-': 5.' :;<'(+ 78 /)8'-5/7)H ()+ .'&; '):1<' ;1E&/-

:(8'5F> [1<5.'<?7<'H 8<7? 5.' ?'+/-(&H &'9(&H ()+ '5./-(& ;'<:;'-5/G':H /5 /: 5.' ;<(-5/5/7)'<k:

<':;7):/E/&/5F 57 '):1<' 5.(5 "&'() *''+&' ,'-.)/01' .(: E'') 87&&7='+ -7<<'-5&F>

N) (++/5/7) 57 9')'<(& ;1E&/- .'(&5. :71<-':H :1-. (: 5.' "W"H $Md#k: O&77+E7<)' K(5.79'):

M5()+(<+:H ()+ 5.' L>M> K1E&/- d'(&5. M'<G/-'H 5.' /)87<?(5/7) /) 5./: ?()1(& .(: E'') +<(=)

8<7? (-1;1)-51<' <':'(<-. 5.<719.715 5.' =7<&+ ()+ (+(;5'+ 57 5.' 1)/01' <'01/<'?')5: ()+

5.' ;<(-5/-' 78 (-1;1)-51<'> ,.1:H ?()F 78 5.' <'-7??')+(5/7): /) 5./: ?()1(& (<'

?7+/8/-(5/7): 78 5'-.)/01': -1<<')5&F /) 1:' 5.<719.715 5.' L)/5'+ M5(5': /) ?()F .'(&5.-(<'

;<78'::/7):> ,.' 91/+'&/)': ()+ :5()+(<+: 5.(5 .(G' E'') +'G'&7;'+ (<' 5.' <':1&5 78 5.'

:F)5.':/: 78 6(:5 #:/() ()+ ^':5'<) <':71<-': 8<7? (-(+'?/-H <':'(<-.H ()+ -&/)/-(& (<')(:>

,./: ?()1(& <'8&'-5: 5.' -1<<')5 1)+'<:5()+/)9 78 E':5 ;<(-5/-': /) 5.' 8/'&+ 78 (-1;1)-51<'

-&/)/-(& 5'-.)/01':> O':5 ;<(-5/-': (<' +'8/)'+ (: n(-5/G/5/':H +/:-/;&/)': ()+ ?'5.7+: 5.(5 (<'

(G(/&(E&' 57 /+')5/8FH /?;&'?')5 ()+ ?7)/57< 5.' (G(/&(E&' 'G/+')-' /) .'(&5.-(<'o,.':'

(-5/G/5/': 9(/) /);15 ?(/)&F 5.<719. 871< +/:-/;&/)':U -&/)/-(& <':'(<-.H -&/)/-(& ';/+'?/7&79FH

.'(&5. '-7)7?/-: ()+ .'(&5. :'<G/-': <':'(<-.>Z 2C3 N) 5./: (;;&/-(5/7)H E':5 ;<(-5/-' ;</)-/;&':

(<' E'/)9 1:'+ 57 &/?/5 </:I: (::7-/(5'+ =/5. (-1;1)-51<' -&/)/-(& ;<(-5/-':>

,.':' ;<(-5/-': (<' 5.' E(:/: 78 E75. 5.' =</55') ()+ ;<(-5/-(& 5<(/)/)9 ()+ 'J(? ;7<5/7): 78 5.'

"*, -71<:' ()+ 'J(? 788'<'+ EF 5.' "71)-/& 78 "7&&'9': 78 #-1;1)-51<' ()+ $</')5(& %'+/-/)'>

#-1;1)-51<' :-.77&: ()+ ;<(-5/5/7)'<: )''+ 57 ?(/)5(/) () (=(<')':: 78 /)87<?(5/7)(& 1;+(5':

-7)-'<)/)9 :(8'5F /) ?()F (<'(: 78 ;<(-5/-' 2/)-&1+/)9 .'(&5.-(<' (::7-/(5'+ /)8'-5/7): ()+

$Md# E&77+E7<)' ;(5.79'): :5()+(<+:3H ()+ -7)5/)1(&&F 1;+(5' 5.'/< 1)+'<:5()+/)9 78 5.'

E':5 -&/)/-(& ;<(-5/-': /) 5.' 8/'&+>

,./: ?()1(& /: )75 ?'()5 57 +'8/)' :5()+(<+ ;<(-5/-': 7< :5()+(<+ 78 -(<' /) (-1;1)-51<'

5'-.)/01':> ,.' 5'<? :5()+(<+ 78 -(<' /: 785') 1:'+ :F)7)F?71:&F =/5. -1:57?(<F ;<(-5/-'> N5 /:



JG///

( &'9(& 5'<? 5.(5 /: -7??7)&F +'8/)'+ (: n=.(5 ( ?/)/?(&&F -7?;'5')5 ;.F:/-/() /) 5.' :(?'

8/'&+ =71&+ +7 /) 5.' :(?' :/51(5/7)H =/5. 5.' :(?' <':71<-':>p 2A3

M5()+(<+: 78 -(<' /) ?'+/-/)' ?(F (&:7 E' +'8/)'+ (: 5.' -1:57?(<F ;<(-5/-' 78 ( ;(<5/-1&(<

(<'( 7< &7-(&/5F> #-1;1)-51<' -&/)/-(& ;<(-5/-': G(<F EF :-.77&H <'9/7)H ()+ 5<(/)/)9> Z/G') 5.'

./:57</-(&&F =/+' G(</'5F 78 G(&/+H +7-1?')5'+ (-1;1)-51<' -&/)/-(& ;<(-5/-':H 5./: ?()1(& -())75

E' 15/&/\'+ 57 +'8/)' (-1;1)-51<' :5()+(<+ ;<(-5/-':>

[7< 5.' ;1<;7:': 78 5./: ?()1(&H 5.' 87&&7=/)9 5'<?: =/&& E' 15/&/\'+ 57 .'&; (-1;1)-51<'

;<(-5/5/7)'<: (;;&F E':5 ;<(-5/-': 57 5.'/< ;'<:7)(& ;<(-5/-':U

!"#$#%&' T ,./: (++<'::': 5.' (<'( 78 ./9.':5 -&/)/-(& </:I> ,.' ;<757-7& /: -7):/+'<'+ '::')5/(& 87<

5.' :(8'5F 78 5.' ;(5/')5 ()+ ;<(-5/5/7)'<H ()+ :-/')5/8/- +(5( +'?7):5<(5': 5.(5 7?/::/7) -71&+

-7):5/515' ( :'</71: ;1E&/- .'(&5. </:I>

($")*+', ./%)00/*1/1 T ,.':' ?'(:1<': (<' :5<7)9&F :1;;7<5'+ EF -&/)/-(& :51+/': 5.(5 :.7='88'-5/G')':: 78 5.' ?'(:1<': /) <'+1-/)9 </:I 7< (<' G/'='+ (: /?;7<5()5 EF .'(&5.-(<'

;<(-5/5/7)'<:> ,.'F (<' -7):/+'<'+ '::')5/(& ?'(:1<': ()+ 8<'01')5&F (++<':: (<'(: 78 ./9.

-&/)/-(& </:I>

./%)00/*1/1 T ,.':' ?'(:1<': /)-&1+' 5=7 5F;': 78 <'-7??')+(5/7):U 2C3 5.7:' 5.(5 (<'

:1;;7<5'+ EF ./9.&F :199':5/G'H E15 ;'<.(;: &':: '(:/&F 9')'<(&/\'+H -&/)/-(& :51+/': /) ( <'&(5'+

8/'&+H ()+ 2A3 5.7:' 5.(5 .(G' )75 E'') (+'01(5'&F <':'(<-.'+H E15 .(G' ( :5<7)9 5.'7<'5/-(&

<(5/7)(&' /)+/-(5/)9 5.(5 5.'F (<' '88'-5/G' 87< -&'() ()+ :(8' ;<(-5/-'> O75. 5F;': 78

<'-7??')+(5/7): (<' ]1+9'+ 57 E' ;<(-5/-(& 57 /?;&'?')5H E15 (<' )75 -7):/+'<'+ '::')5/(&

;<(-5/-' 87< 'G'<F ;<(-5/5/7)'< /) 'G'<F :/51(5/7)> K<(-5/5/7)'<: :.71&+H .7='G'<H -7):/+'< 5.':'

<'-7??')+(5/7): 87< /?;&'?')5(5/7) /)57 5.'/< ;<(-5/-':>

#-1;1)-51<' ;<7-'+1<': (<' ;'<87<?'+ (: ;(<5 78 5.' (15.7</\'+ :-7;' 78 ;<(-5/-' 78 :7?'

75.'< .'(&5.-(<' ;<78'::/7):> %7<'7G'<H :7?' .'(&5.-(<' ;<(-5/5/7)'<: 1:' 5'<?/)7&79F 8<7?

5.'/< 7=) ;<78'::/7) 87< 5.'<(;'15/- )''+&/)9 5'-.)/01': 5.(5 /: /)+/:5/)91/:.(E&' 8<7?

5.'<(;'15/- )''+&/)9 5'-.)/01' /) 5.' ;<(-5/-' 78 (-1;1)-51<'> ,</99'< ;7/)5 +<F )''+&/)9H +<F

)''+&/)9H 81)-5/7)(& +<F )''+&/)9H ()+ /)5<(?1:-1&(< ?()1(& 5.'<(;F 8(&& /)57 5./: -(5'97<F>

$5.'< .'(&5.-(<' ;<7G/+'<: =.7 ?(F 1:' )''+&/)9 5'-.)/01': /) 5.'/< ;<(-5/-'H =.'5.'< 7< )75

5.' ;<7G/+'<: +':-</E' 5.':' 5'-.)/01': (: (-1;1)-51<'H (<' :1E]'-5 57 5.' :(?' :(8'5F91/+'&/)': :/)-' 5.' :(8'5F 91/+'&/)': (;;&F (--7<+/)9 57 =.(5 577& 5.' ;<(-5/5/7)'< /: 1:/)9 ()+

.7= 5.(5 577& /: (;;&/'+ /) 5.' -71<:' 78 5<'(5?')5> #--7<+/)9&FH 5.<719.715 5./: ?()1(& 5.'

9')'<(& 5'<? n;<(-5/5/7)'<p /: 1:'+ /)(:?1-. (: 5.' :(8'5F :5()+(<+: -7)5(/)'+ /) 5.' ?()1(&

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<'&(5'+ 5'-.)/01': (: +':-</E'+ .'<'/)>



J/J

K<(-5/5/7)'<:H /):5<1-57<:H ;(5/')5:H ()+ 75.'<: 785') -7)5(-5 5.' ""#$% )(5/7)(& 788/-' 87<

-&(</8/-(5/7) -7)-'<)/)9 5.' E':5 :(8'5F 5'-.)/01': 87< (-1;1)-51<' ;<7-'+1<':>

$G'<G/'= 78 5.' M'-5/7):U

• N) K(<5 N 78 5.' ?()1(&H 5.' &/5'<(51<' /+')5/8F/)9 5.' ;75')5/(& 87< /)8'-5/7): ()+ 75.'<

(+G'<:' 'G')5: ()+ 5.'<'87<' 5.' )''+ 87< :;'-/8/- 5'-.)/01': ()+ :I/&&: /: <'G/'='+ (: (

<(5/7)(&' 87< E':5 ;<(-5/-':>

• N) K(<5 NNH :(8'5F -7):/+'<(5/7): 87< )''+&/)9 (<' +':-</E'+ /) +'5(/& ()+ 5.' ;<'-(15/7):

8<7? K(<5 N (<' <';'(5'+> ,.' <';'5/5/7) /: /)5')5/7)(& (: E75. ( 5'(-./)9 577& ()+ 57

<'/)87<-' 5.' 8(-5 5.(5 E':5 ;<(-5/-':H /)-&1+/)9 "&'() *''+&' ,'-.)/01' E(:/-:H (;;&F /)

(&& :/51(5/7):>

• N) K(<5 NNNH :(?;&' E':5 ;<(-5/-': 87< 75.'< #$% 788/-' ;<7-'+1<': (<' +/:-1::'+ ()+ 5.'

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• K(<5 Nc +'5(/&: 5.' .'(&5.-(<' (::7-/(5'+ /)8'-5/7): -7)-'<)/)9 =./-. (-1;1)-51<'

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• K(<5 c +/:-1::': ;'<:7))'& :(8'5F ;<(-5/-':>

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•

K(<5 cNNN -7)5(/): (;;')+/-': 87< ;<(-5/5/7)'< /)87<?(5/7)>

References

C> K'<&'5. %>H V(I1E7=:I/ 6>H O1::' Y> ^.(5 /: _E':5 ;<(-5/-'_ /) .'(&5. -(<'g M5(5' 78 5.' (<5 ()+

;'<:;'-5/G': /) /?;<7G/)9 5.' '88'-5/G')':: ()+ '88/-/')-F 78 5.' 61<7;'() .'(&5. -(<'

:F:5'?:: I$",%C 0/,*7&: ABBC V1)iDS2T3UATDRDB>

A> %788'55 KH %77<' Z> ,.' M5()+(<+ 78 "(<'U X'9(& d/:57<F ()+ W'8/)/5/7):U 5.' O(+ ()+ Z77+

*'=:> U$.% V MB$14 H$+ > ABCC ['E<1(<Fi CA2C3U CBPaCCA>



C

Part I:

AOM Clinical Procedures, Saf ety, Adverse Events (AEs) and Recommendations to Reduce AEs

M(8'5F <'?(/): 5.' ?7:5 /?;7<5()5 -7):/+'<(5/7) 87< (&& -&/)/-/():H /)-&1+/)9 (-1;1)-51</:5:> #)F

-&/)/-(& '88/-(-F /: ;75')5/(&&F ')+()9'<'+ =.') ( -&/)/-/() /: )75 -79)/\()5 78 5.' ;75')5/(& </:I:

78 ( -&/)/-(& ;<7-'+1<' 57 5.' ;(5/')5H ;(5/')5k: 8(?/&FH 7< 5.' -&/)/-/() ()+ -&/)/-(& :5(88> ,.' 8/'&+

78 (-1;1)-51<' .(: 8&71</:.'+ /) 5.' L)/5'+ M5(5': /) ;(<5 E'-(1:' (-1;1)-51</:5: (<' ;'<-'/G'+

EF ?'?E'<: 78 5.' ;1E&/-H :5(5' <'91&(57<:H ()+ 75.'< ;<7G/+'<: 57 E' ='&& 5<(/)'+ ()+ 5.'

;<(-5/-' 78 (-1;1)-51<' 57 E' <'&(5/G'&F :(8'> N) 5./: :'-5/7)H -7??7)&F 1:'+ (-1;1)-51<' ()+

<'&(5'+ -&/)/-(& 5'-.)/01': =/&& E' <'G/'='+ 87< 5.'/< :(8'5F ./:57<F (&7)9 =/5. () 7G'<G/'= 78

5.' E':5 ;<(-5/-': 87< &/?/5/)9 (+G'<:' 'G')5: 2#6:3> W'5(/&: 78 :(8'5F ;<757-7&: 87< (-1;1)-51<'

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Safety Guidelines to Prevent Needle Site Pain

4$',0>35

6"),??"02"2

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Safety Guidelines to Prevent Fainting

4$',0>35

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E'87<' (-1;1)-51<' )''+&' /):'<5/7) 57 (&&(F -7)-'<): ()+)'<G71:)'::>

• N)87<? ;(5/')5: 5.(5 5.'F :.71&+ '(5 CRA .71<: E'87<' (-1;1)-51<'

5<'(5?')5:>

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Stuck Needle

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Safety Guidelines to Avoid and/or Respond to Stuck Needle

4$',0>35

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Failure to Remove Needles

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Safety Guidelines for Needle Removal

4$',0>35

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Safety Guidelines for Aggravation of Symptoms

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Preventing Rare but Serious Adverse Events (SAEs) Associated with

Acupuncture Needling

Pneumothorax

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Safety Guidelines to Avoid Pneumothorax

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Injury to Other Organs

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Central Nervous System Injury

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2DT3

Safety Guidelines to Avoid Organ and Central Nervous System InjuryD'*$*)(3 • $E:'<G' :(8' )''+&/)9 +';5. ()+ ()9&': 57 (G7/+ -(<+/(- /)]1<F>

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Traumatic Tissue Injury

Peripheral Nerves

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Safety Guidelines to Avoid Traumatic Tissue Injury

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Safety Guidelines to Prevent Infection

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Safety Guidelines to Prevent Broken Needles

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References

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Preventing Moxibustion Adverse EventsBurns

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Safety Guidelines to Prevent Moxa Burns

D'*$*)(3 • ,(I' ( -(<'81& ;(5/')5 ./:57<F 57 /+')5/8F )'1<7;(5./': 7< 75.'<

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Safety Guidelines to Prevent Secondary Infection from Moxa Burns

D'*$*)(3 • K<'G')5 ?7J( E1<):>

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Nausea or Other Adverse Reactions to Moxa Smoke

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Safety Guidelines for Heat Therapies Other than Moxa

D'*$*)(3•

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References

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K<'::H O'/]/)9i CPQ4H ;;> TSTRTSP>

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T> l1 MH ^()9 XH "77;'< 6H j.()9 %H %().'/?'< 6H O'<?() OH M.') lH X(7 X> #+G'<:' 6G')5: 78

#-1;1)-51<'U # MF:5'?(5/- Y'G/'= 78 "(:' Y';7<5:> 6G/+')-'RO(:'+ "7?;&'?')5(<F

()+ #&5'<)(5/G' %'+/-/)' c7&1?' ABCT .55;U``+J>+7/>7<9`CB>CCDDÀBCT`DQCABT>

b> h(?(:./5( dH ,:1I(F(?( dH ,())7 hH */:./]7 f> #+G'<:' 'G')5: /) (-1;1)-51<'

()+ ?7J/E1:5/7) 5<'(5?')5U ( :/JRF'(< :1<G'F (5 ( )(5/7)(& -&/)/- /) V(;()> V #&5'<)

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D> X'' f^H d() MVH f/? WVH X'' %]> M;/)(& ';/+1<(& (E:-':: (::7-/(5'+ =/5. ?7J/E1:5/7)R<'&(5'+

/)8'-5/7) 78 5.' 8/)9'<> V M;/)(& "7<+ %'+> ABBQiTC2T3UTCPRAT>S> %1) VdH V'7) VdH V1)9 hV '5 (&> ,.' 8(-57<: (::7-/(5'+ =/5. -7)5(-5 E1<): 8<7? 5.'<(;'15/-

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6;1E ABCA $-5 TC

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Q> d(5:1I(</ NH d/57:19/ *H $.)7 YH '5 (&> K(<5/(& ;1</8/-(5/7) 78 -F5757J/- :1E:5()-': 8<7? ?7J(

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P> M7) "Z> M(8'5F 78 bR=''I /)+/<'-5R?7J/E1:5/7) 5.'<(;F (5 "cb ()+ "cQ> V #-1;1)-5 %'</+/()

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/) .';(5/5/: " ()+ .';(57-'&&1&(< -(<-/)7?(> X()-'5> ABBS %(F A4iTS42PDAb3UC4PB>

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3. Cupping


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;<(-5/5/7)'<:> "1;;/)9 1:': ( ;(<5/(& G(-11? 5.(5 -(1:': 5.' 5/::1' 57 51?'8F ()+ :5<'5-. /)575.' -1;> "1;;/)9 /)5')5/7)(&&F -<'(5': 5.'<(;'15/- ;'5'-./(' ()+ '--.F?7:/: 5.(5 (;;'(< /)

<71)+ 7< n)1??1&( 2C3

,.'<' (<' 5.<'' 5F;': 78 -1;;/)9H '(-. =/5. +/88'<')5 :(8'5F ;<78/&':U 8/<' -1;;/)9H :1-5/7)

-1;;/)9H ()+ ='5 -1;;/)9 2-1;;/)9 (85'< 5.' 1:' 78 ( &()-'5 87< E&77+ =/5.+<(=(&3> [/<' -1;;/)9

()+ :1-5/7) -1;;/)9 (<' G(</(5/7): 78 +<F -1;;/)9> O75. +<F ()+ ='5 -1;;/)9 (<' 1:'+ /)

5<(+/5/7)(& 6(:5 #:/() ?'+/-/)'H 5.' 5<(+/5/7)(& ?'+/-/)' 78 Z1&8 #<(E: 2./](?(.3H 2A3 /)

61<7;'() -71)5</':H ()+ /) '(<&F ^':5'<) ?'+/-/)' ()+ /5: &/)'(9' 78 '(<&F Z<''IH Y7?() ()+

69F;5/() ?'+/-/)'> "1;: 1:'+ /) 5.' ?7+'<) :'55/)9 (<' ?(+' 78 9&(::H ;&(:5/-H 7< :/&/-7)'>

"1;;/)9 /: 15/&/\'+ EF ;<(-5/5/7)'<: 57 5<'(5 -7)+/5/7): /)-&1+/)9 (-15' 7< -.<7)/- ;(/)i ?/&+ 57

:'G'<' -7)+/5/7): :1-. (: -7&+:H 8&1H ()+ 8'G' 2CHT3 nM/)-' CPDBo-1;;/)9 5.'<(;F .(: E'') (;;&/'+

(: ( 87<?(& ?7+(&/5F /) .7:;/5(&: 5.<719.715 "./)( ()+ '&:'=.'<' /) 5.' =7<&+>p 2b3

l1' '5 (&> 2D3 <';7<5 5.(5 7G'< ( CARF'(< ;'</7+ ?7:5 #6: (::7-/(5'+ =/5. -1;;/)9 ='<' ?/)7<

()+ ='<' ;</?(</&F I'&7/+ :-(<</)9H E1<): ()+ E1&&('> $5.'< <'G/'=: :/?/&(<&F <';7<5 )7 :'</71:

#6: 8<7? -1;;/)9> 2CHTHS3 d7='G'<H 5.'<' (<' (+G'<:' 'G')5:H :'</71: (+G'<:' 'G')5: ()+

)'9&/9')5 '<<7<: <';7<5'+ /) 5.' &/5'<(51<' 8<7? -1;;/)9 ()+H =./&' )75 -7??7)H ?7:5 -() ()+

?1:5 E' (G7/+'+>

Fire Cupping

O1<): 8<7? 8/<' -1;;/)9 (<' <';7<5'+ /) 5.' &/5'<(51<'i 5.'F (<' () (G7/+(E&' ?'+/-(&

'<<7<`(+G'<:' 'G')5> 2SRCC3 N) 5./: ;<7-'+1<'H ( E(&& 78 E1<)/)9 -7557) 7< ( &/5 (&-7.7& :=(E /:

E</'8&F ;&(-'+ /):/+' ( 9&(:: -1; 57 .'(5 5.' (/< /):/+'H =./-. 5.') -<'(5': ( ;(<5/(& G(-11? (: /5

-77&:> Z&(:: -1;: (<' 1:'+H (: 9&(:: /: /?;'<G/71: 57 .'(5 (5 5.' &'G'&: 1:'+ 87< 5./: ;<7-'+1<'>

,F;/-(&&FH -1;: (<' &'85 7) 5.' ;(5/')5k: :I/) 87< ARCB ?/)15':H E15 ?(F E' &'85 /) ;&(-' 87< 1; 57

AB ?/)15':H ()+ &'(G' ( 5'?;7<(<F <'++/:. ?( L)/)5')5/7)(& 'J;<'::/7) 78 E&77+ 7< 8&1/+ /)57 -1;: ?(F 7--1< (: ( <':1&5 78 8/<'

-1;;/)9 =.') 5.' :I/) /: )75 /)5(-5H 7< 8<7? ;<'G/71: )''+&/)9H &7-(& ;/?;&': 7< 75.'< &7-(& :I/)

;(5.7&79/':>

O1<): ?(F E' ( <':1&5 78 ;&(-/)9 5.' 8&(?' 577 -&7:' 57 5.' &/; 78 5.' 8/<' -1; :7 5.(5 5.' '+9'

E'-7?': G'<F .75H 7< 8<7? +<7;;/)9 5.' E1<)/)9 ?(5'</(& /)57 5.' 8/<' -1;H 5.') ;&(-/)9 5.' -1;



TA

7) 5.' :I/) =/5. 5.' .75 ?(5'</(& /):/+' 5.' -1;> ^./&' 5./: &(55'< ;<7-'+1<' .(: E'') 1:'+

5<(+/5/7)(&&FH ?7+'<) -1;;/)9 :.71&+ &/?/5 5./: ;<7-'::>

Suction Cupping

M1-5/7) -1;;/)9 /)G7&G': 5.' 1:' 78 ;&(:5/- 7< :/&/-7)' -1;: =/5. G(&G': (5 5.' 57; 5.(5 (55(-. 57

.()+ ;1?;:i 5.' ;1?;: -<'(5' :1-5/7) EF <'?7G/)9 ( 01()5/5F 78 (/< (85'< 5.' -1;: .(G' E'')

;&(-'+ 7) 5.' :I/)> ,F;/-(&&F -1;: (<' 7) 87< ARCB ?/)15':H E15 ?(F E' &'85 /) ;&(-' 1; 57 AB

?/)15': ()+ &'(G' ( 5'?;7<(<F <'++/:. ?( L)/)5')5/7)(& 'J;<'::/7) 78 E&77+ 7< 8&1/+ /)57 -1;: ?(F 7--1< (: ( <':1&5 78

:1-5/7) -1;;/)9 =.') 5.' :I/) /: )75 /)5(-5H 7< 8<7? ;<'G/71: )''+&/)9H &7-(& ;/?;&': 7< 75.'<

&7-(& :I/) ;(5.7&79/':>

Wet Cupping

N) 5./: ;<7-'+1<'H 5.' :I/) /: ;1)-51<'+ =/5. ( &()-'5 7< :5'</&' )''+&':H :1-. (: 5.7:' 1:'+ 87<

;&1? E&7::7? 5(;;/)9H E'87<' 5.' -1;: (<' (;;&/'+> ^'5 -1;;/)9 ?(F E' +7)' =/5. '/5.'<:1-5/7) -1;: 7< 8/<' -1;:> ,.' 5'-.)/01'H =./-. +<(=: 715 E&77+ ()+ $KN%H -(<</': 7EG/71: </:I

78 'J;7:1<' 57 ()+ 5<():8'< 78 E&77+E7<)' ;(5.79'):>

Other Cupping Procedures

K<(-5/5/7)'<: (&:7 1:' -1;;/)9 5'-.)/01': 5.(5 /)-&1+' ?7G/)9 7< :&/+/)9 -1;;/)9 +1</)9 =./-.

;<(-5/5/7)'<: 9')5&F ?7G' 5.' -1; (&7)9 ( &1E</-(5'+ :1<8(-' (<'(H -.())'&H 7< (&7)9 ?1:-&'

8/E'<:i '?;5F -1;;/)9H =./-. ?'(): 5.' -1;: (<' <'?7G'+ (85'< :1-5/7) =/5.715 +'&(Fi 7<

)''+&' -1;;/)9H +1</)9 =./-. 5.' ;<(-5/5/7)'< (;;&/': 5.' (-1;1)-51<' )''+&' 8/<:5H 5.') (;;&/':

5.' -1;: 7G'< 5.' )''+&':> ,.' </:I: 78 5.' 8/<:5 5=7 5'-.)/01': (<' 01/5' &/?/5'+> N) 5.' &(:5

5'-.)/01'H 5.' </:I: (<' ?7<' <'&(5'+ 57 5.' )''+&/)9 5.() 5.' -1;;/)9> "1;;/)9 ?(F -7?;<'::

5.' 5/::1'H -(1:/)9 (-1;1)-51<' )''+&': 57 ;')'5<(5' ?7<' +'';&F =/5. )''+&' -1;;/)9H 7<

:1E-15()'71: 5/::1': ?(F E' ;1&&'+ 1;=(<+ =/5. 5.' :(?' '88'-5H /)-<'(:/)9 5.' </:I 78

;)'1?75.7<(J 7< 75.'< 7<9() ;1)-51<' /8 +7)' 7G'< 5.' 5.7<(-/- <'9/7)> N8 )''+&/)9 -1;;/)9 /:

+7)' 7G'< 75.'< (<'(: 78 5.' E7+FH 5.'<' ?(F E' </:I 57 5.' -')5<(& 7< ;'</;.'<(& )'<G': 7<

E&77+ G'::'&:> *''+&' -1;;/)9 :.71&+ E' (;;&/'+ =/5. -(15/7) ()+ =/5. )''+&': /):'<5'+ (5 ()

7E&/01' ()9&'>

Cupping Adverse Events

Skin Reactions

M7?' <'(-5/7): 57 -1;;/)9 ?(F E' ;(<5 78 5.' 5.'<(;'15/- ;<7-':: E15 E' /)5'<;<'5'+ EF 75.'<

;<(-5/5/7)'<: 7< 7E:'<G'<: (: n.(<?:p 2CA3 7< 'G') -./&+ (E1:'> 2CTH Cb3 ,.':' /)-&1+' :='&&/)9H

;'5'-./('H '--.F?7:/:H ()+ ;'<:/:5')5 .F;'<;/9?')5(5/7)> ,F;/-(&&F 5.':' <'(-5/7): <':7&G' /) (

8'= +(F: 57 A =''I:> 2C3 Y':'(<-. .(: )75 ':5(E&/:.'+ :5()+(<+: 87< 5.' (;;<7;</(5' 5/?' 87<

-1;: 57 E' &'85 /) ;&(-' 7< 5.' (?71)5 78 G(-11? :1-5/7) 5.(5 /: /+'(&i 'J-'::/G' -1;;/)9 5/?' 7<



TT

:1-5/7) -() -<'(5' E<1/:/)9 ()+ .F;'<;/9?')5(5/7) 5.(5 /: 1)-7?87<5(E&' ()+ ;'<:/:5: 87< ?1-.

&7)9'<>

[&1/+ E&/:5'<: -(&&'+ E1&&(' (<' )75 () /)8<'01')5 715-7?' 78 -1;;/)9> 2CbRC43 N8 5.':' -7)5(/)

E&77+ 5.'F (<' -(&&'+ .'?7<<.(9/- E1&&('H ()+ (<' &':: -7??7) ()+ ?(F E' ?7<' &/I'&F /)

;(5/')5: 7) ()5/-7(91&()5 ?'+/-(5/7): ()+ :1;;&'?')5: 5.(5 ?(F (-5 (: E&77+ 5./))'<:> ,.'F

-() 87<? -<1:5/)9 :-(E: (: 5.'F .'(&H =./-. -() 5(I' 1; 57 A =''I:> 2CQ3 ,.' 7;')/)9 78 5.' :I/)

E(<</'< 7G'< 5/?' -<'(5': 'J;7:1<' ()+ </:I 78 /)8'-5/7)> N) 5.' /)(+G'<5')5 'G')5 78 :1-5/7)

E1&&('H ;(5/')5: :.71&+ E' /):5<1-5'+ 7) 1:' 78 ()5/E/75/- 57;/-(& 7/)5?')5H ()+ 7) I'';/)9 5.'

(<'( -&'() ()+ -7G'<'+H /8 )'-'::(<FH 1)5/& .'(&'+>

$5.'< 1)1:1(& :I/) &':/7): <';7<5'+ /) 5.' -1;;/)9 &/5'<(51<' (<' ;())/-1&/5/: ()+ I'&7/+

:-(<</)9> [(-5/5/(& 2:'&8R/)8&/-5'+3 ;())/-1&/5/: 28(55F &(F'< /)8&(??(5/7)3 -() E' ;<7+1-'+ EF

?'-.()/-(&H ;.F:/-(& 7< -.'?/-(& 5<(1?(> 2CP3 N5 ;<':')5: (: <'+ )7+1&':H /)8&(??(5/7) =/5./)

5.' -/<-1&(< (<'( =.'<' -1;: ='<' (;;&/'+> N5 /: 5F;/-(&&F :'&8R&/?/5/)9 ()+ 8(+': &/I' ( +'';E<1/:' =/5./) S =''I:H E15 -() E'-7?' /)8'-5'+ ()+ <'01/<' :1<9'<F> 2CS3 N8 ( ;(5/')5 +'G'&7;:

<'+ :1E-15()'71: )7+1&':H (G7/+ 81<5.'< -1;;/)9 ()+ <'8'< 87< ?'+/-(& 7E:'<G(5/7)>

,=7 (<5/-&': /) 5.' &/5'<(51<' ':5(E&/:. 5.(5 /5 /: ;7::/E&' 57 /)+1-' fw'E)'< ;.')7?')7) /)

;:7</(:/: ;(5/')5:> 2ABH AC3 ,.':' (<5/-&': +':-</E' 5.' (;;'(<()-' 78 ;:7</(:/: &':/7): 8<7?

;<'::1<' 7< 5<(1?( 57 5.' :1<8(-'> d/:57<F 7< ;<':')5(5/7) 78 ;:7</(:/: /) ( ;(5/')5 ?/9.5

-(15/7) (9(/):5 (99<'::/G' -1;;/)9H 7< -1;;/)9 (5 (&&>

$)' -(:' /) 5.' &/5'<(51<' <';7<5'+ 5.' +'G'&7;?')5 78 ( I'&7/+ :-(< (5 5.' 1;;'< E(-I 8<7? (

-1;;/)9 5<'(5?')5 87< -719.> 2AA3 ,.' ;(5/')5 .(+ )75 .(+ ;<'G/71: I'&7/+ :-(<</)9H ?(I/)9 5./:() 1)()5/-/;(5'+ (+G'<:' 'G')5> N5 /: <'-7??')+'+ 57 ;<7-''+ =/5. -(15/7)H 57 (G7/+ -1;;/)9

7< :5<7)9 -1;;/)9 /) ;(5/')5: =.7 (&<'(+F .(G' I'&7/+ :-(<:>

Cardiovascular

"1;;/)9 /: (::7-/(5'+ =/5. (+G'<:' 'G')5: /)G7&G/)9 5.' E&77+ ()+ .'(<5> N<7)R+'8/-/')-F

()'?/( 2NW#3 /) ?') /) f7<'( )75 /+')5/8/'+ 8<7? 75.'< I)7=) -(1:': /: :199':5'+ 2E15 )75

':5(E&/:.'+3 (: <'&(5'+ 57 ='5 -1;;/)9> 2AT3 X'' '5 (&> 2Ab3 +7 <';7<5 7) ( :/)9&' -(:' 78

'J-'::/G' ='5 -1;;/)9 7G'< S ?7)5.: /)+1-/)9 NW# =.'<' 75.'< -(1:': ='<' <1&'+ 715> ,.'

;(5/')5 <'-7G'<'+ (85'< :57;;/)9 ='5 -1;;/)9 ()+ :1;;&'?')5/)9 =/5. /<7)> M7.) '5 (&> 2AD3

<';7<5 7) ( =7?() =.7 :'&8R(;;&/'+ ='5 -1;;/)9 7G'< CB F'(<:H ()+ -<'(5'+ :'G'<' /<7)

+'8/-/')-F ()'?/( ()+ () ')&(<9'+ .'(<5 2-(<+/(- .F;'<5<7;.F3 5.(5 <'9<'::'+ 7G'< 5/?' 7)-'

:.' :57;;'+ ='5 -1;;/)9H ()+ :1;;&'?')5'+ =/5. ;<':-</;5/7) ?'+/-/)' ()+ /<7)> M7?' 78 .'<

-(<+/(- :F?;57?: ;'<:/:5'+ (5 T ?7)5.:>



Tb

f/? '5 (&> 2AS3 <';7<5 7) ( -(:' 78 <';'(5'+ +<F -1;;/)9 -(1:/)9 ()'?/( E15 788'< )7 'G/+')-'

75.'< 5.() ;'<:/:5/)9 .F;'<;/9?')5(5/7)> 2A43 ,.'F (&:7 (::'<5 5.(5 5<(+/5/7)(& -1;;/)9 -(1:'+ (

+'&(F /) -(<' =.') 5.' ;(5/')5 .(+ (&<'(+F -7):1&5'+ -7)G')5/7)(& +7-57<: 87< E(-I ;(/)>

# <(<' -7?;&/-(5/7) 78 (-01/<'+ .'?7;./&/( # =(: -(1:'+ EF -1;;/)9 /) ( DQRF'(<R7&+ =7?()>

2AQ3 N5 ;<':')5'+ (: 'J5'):/G' ()+ -7?;<'::/G' E<1/:/)9 =./-. &'+ 57 ;')+/)9 -7?;(<5?')5

:F)+<7?' 78 .'< &'85 5./9. A +(F: (85'< -1;;/)9H <':1&5/)9 /) .7:;/5(&/\(5/7)> #-01/<'+

.'?7;./&/( # /: G'<F <(<' E15 -() +'G'&7; /) (::7-/(5/7) =/5. (157/??1)' +/:'(:'H (&&'<9/- +<19

<'(-5/7):H ?(&/9)()-/':H ()+ ;<'9)()-F =/5. ./9.'< </:I /) +';<'::/7) ()+ ()J/'5F> [7< 71<

;1<;7:': 57 )75'H 5.' ;(5/')5 =(: -1;;'+ 7) 5.' ?'+/(& (:;'-5: 78 5.' 5./9. ()+ (<?>

c(:7G(9(& :F)-7;'H ( <(<' #6 78 -1;;/)9H 2CS3 /: ?7<' &/I'&F 57 7--1< =/5. 1)+'<&F/)9 -7)+/5/7):

5.(5 ?(F /)-<'(:' 5.' </:I 87< :F)-7;' 2+/(E'5':H <')(& +/:'(:'H :'/\1<' +/:7<+'<:H 8(:5/)9 7< &7=

E&77+ :19(<3>

#) /)5'<':5/)9 -(:' 78 :5<7I' Cb .71<: (85'< -1;;/)9 =(: (55</E15'+ 57 -1;;/)9 ;7/)5: /) 5.'

&7-(5/7) 78 (;;&/-(5/7)> "1;: ='<' (;;&/'+ 57 5.' )'-I -&7:' 57 () (<5'<F> # ;<'R'J/:5/)9

-7)+/5/7) 78 ;(<5/(& (<5'</(& 7--&1:/7) =(: )75 /+')5/8/'+> ,.' 87<-' 78 -1;;/)9 =(: 5.719.5 57

.(G' '/5.'< '&'G(5'+ E&77+ ;<'::1<' -<'(5/)9 .'?7<<.(9' 7< :5<7I' 2&'(:5 &/I'&F3H 7< 57 .(G'

;<'-/;/5(5'+ () /)5/?(& 5'(< 78 5.' &/)/)9 78 5.' (<5'<FH 7< .(G' -<'(5'+ :188/-/')5 &7-(& :5<':: (:

57 +/:51<E ( n5./) -(;p (5 () 7--&1:/7) :/5'> 2AP3 "7):/+'<(5/7) ?1:5 E' 9/G') 57 (;;&F/)9 -1;:

7G'< 5.' (<'(: 78 5.' )'-I 5.(5 (<' -&7:' 57 (<5'</':>

Infections

N)8'-5/7) .(: E'') <';7<5'+ (: () (+G'<:' 'G')5 78 -1;;/)9> X'' '5 (&> 2TB3 +':-</E' ( -(:' 78-'<G/-(& ';/+1<(& (E:-':: 2"CR"T3 8<7? (-1;1)-51<' =/5. -1;;/)9 5.(5 <':7&G'+ =/5. 7<(&

()5/E/75/- 5<'(5?')5> V1)9 '5 (&> 2TC3 <';7<5 ( -(:' 78 .'<;': :/?;&'J 8<7? (-1;1)-51<' ()+

-1;;/)9 =.'<' 5.' .'<;': &':/7) +'G'&7;'+ /) ( -/<-1&(< ;(55'<) 5.(5 ?(5-.'+ 5.'

-/<-1?8'<')-' 78 5.' -1;:H ()+ (5 5.' (-1;1)-51<' ;1)-51<' :/5': 5.(5 .(+ E'') (;;&/'+> ,.'

;(5/')5 .(+ )7 ;'<:7)(& 7< 8(?/&F ./:57<F 78 <'-1<<')5 -15()'71: .'<;': :/?;&'J G/<1: 2dMc3>

dMc -() E' :;<'(+ EF (E<(+'+ :I/)> ,<(+/5/7)(& -1;;/)9 =(: (&:7 7)' </:I 8(-57< 87< ./9.

;<'G(&')-' 78 d,XcRN /)8'-5/7) /) *7<5.'(:5 N<()H (&7)9 =/5. E&77+ 5<():81:/7) ()+

.7:;/5(&/\(5/7)> 2TA3 ,1<&(F '5 (&> 2TT3 +':-</E' ( &1?E(< (E:-':: 8<7? :-(</8/-(5/7) ='5 -1;;/)9>

,.':' -(:': ;7/)5 57 5.' ;7::/E/&/5F 78 5<():8'< 78 E&77+E7<)' ;(5.79'): 8<7? -1;:> d7) '5 (&>2Tb3 <';7<5 ( -(:' 78 () CCRF'(<R7&+ 9/<& =.7 +'G'&7;'+ !%"@C&,/7/77). ")1$). /)8'-5/7) 8<7?

-1;;/)9H <':1&5/)9 /) .7:;/5(&/\(5/7)> ,.' ;(5/')5 =(: E'/)9 5<'(5'+ 87< -.<7)/- '-\'?(>

"7&7)/\(5/7) 78 !: ")1$). /: -7??7)&F :'') /) -.<7)/- '-\'?( ;(5/')5:>



TD

Preventing Cupping Adverse Events

Burns

O1<): (<' (::7-/(5'+ =/5. 8/<' -1;;/)9 7)&F> Z')'<(& :(8' ;<(-5/-': 87< 1:' 78 () 7;') 8&(?'

:.71&+ E' 87&&7='+>

Safety Guidelines to Avoid Fire Cupping Burns

D'*$*)(3 • ,(I' ( -(<'81& ;(5/')5 ./:57<F 57 /+')5/8F +/(E'5':H )'1<7;(5./':H 7<

75.'< -7)+/5/7): 5.(5 ?/9.5 &/?/5 ( ;(5/')5k: <':;7):' 57 ;(/) 7< 5.'

(E/&/5F 57 :'):' .'(5> #::':: 5./: ;(5/')5 -(<'81&&F =.') 15/&/\/)9 8/<'

-1;;/)9>

4$',0>35

6"),??"02"2

• ,.' E1<)/)9 ?(5'</(& ?1:5 E' ;&(-'+ /) 5.' +'';':5 ;(<5 78 5.' -1;H

)75 )'(< 5.' </?>

• Y'?7G' 5.' E1<)/)9 ?(5'</(& E'87<' (;;&F/)9 5.' -1; 57 5.' ;(5/')5k:

:I/)>

•

*'G'< <'5(/) 5.' E1<)/)9 ?(5'</(& /):/+' 5.' -1; =.') 5.' -1; /:;&(-'+ 7)57 5.' :I/)>

Infections

,.' :(?' ;<7-'+1<': (<' <'-7??')+'+ (: /) ;<';(<(5/7) 87< (-1;1)-51<'U 87&&7= !"#$%&

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E&77+ 7< $KN% ?(F E' ;<':')5H /8 ;'<87<?/)9 ='5 -1;;/)9H 7< -1;;/)9 (85'< )''+&/)9>

#G7/+ -1;;/)9 7G'< &':/7):H <(:.':H /)]1</': 7< E<'(I: /) :I/) E(<</'<> "7&7)/\(5/7) 78 ;(5.79'):

:1-. (: !%"@C&,/7/77). ")1$). /: ( -7??7) -7?;&/-(5/7) 78 (57;/- -7)+/5/7): :1-. (: '-\'?(>

2TD3 ^./&' 5.'<' (<' :51+/': 7) 5.' 1:' 78 -1;;/)9 87< .'<;': \7:5'< ()+ 75.'< :I/) &':/7): 2S3

;<(-5/5/7)'<: :.71&+ E' :;'-/8/-(&&F 5<(/)'+ /) -1;;/)9 87< (-5/G' :I/) &':/7): E'87<' (;;&F/)9

-1;:>

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Safety Guidelines for Cup Disinfection

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Safety Guidelines for Preventing Cupping Skin Lesions

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Safety Guidelines for Needle Cupping

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References

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Preventing Gua Sha Adverse Events

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Safety Guidelines for Gua Sha

D'*$*)(3 • [7&&7= M5()+(<+ K<'-(15/7):>

• [7&&7= !"#$%& ()*+$,*-$. #/1 M.%"R,*.C*-4 "-+ H"*-%"*-*-4 " F,$"-

<*$,+:

• [7&&7= !"#$%& ()*+$,*-$. #/1 I"-+ !"-*%"%*/-:

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-7)+/5/7)>

• Z1( :.( :.71&+ )75 E' (;;&/'+ bQ .71<: E'87<' 7< Ab .71<: (85'<

-.'?75.'<(;F 5<'(5?')5>

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5.(5 .(G' E'') ;<7;'<&F +/:/)8'-5'+>

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571-./)9 5.' :;715 78 ( ;1?; -7)5(/)'< ?1:5 E' (G7/+'+>

•

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• W7 )75 91( :.( 7G'< :='&&/)9 7< <'-')5 5<(1?(H /)-&1+/)9 7G'< E1<): 7<

:1)E1<):>

4$',0>35

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• #)F (;;&/-(5/7) 78 91( :.( 87< -./&+<') :.71&+ E' +7)' /) 5.' ;<':')-'

78 ( ;(<')5 7< (::/9)'+ 91(<+/()>



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6"),??"02"2 • 6J;&(/) 5.' 5.'<(;'15/- /)5')5/7) 78 91( :.( (: ='&& (: 5.' 5/?'&/)' 87<

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91( :.(>

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<'01/<'+ 87< 91( :.( +'G/-':> ^.') 1:'+ 7) /)5(-5 :I/) 7)&FH 91( :.( +'G/-': =71&+ 01(&/8F (:

)7)R-</5/-(& <'1:(E&' ?'+/-(& +'G/-':> ,.' "W" +'8/)/5/7): 78 )7)R-</5/-(& +'G/-': -() E' 871)+

/) ()*+$,*-$. #/1 K*.*-#$7%*/- "-+ !%$1*,*W"%*/- *- I$",%C7"1$ <"7*,*%*$.: 2CC3 #: )7)R-</5/-(&

+'G/-':H <'1:(E&' 91( :.( :;77): ()+ 75.'< +'G/-': =71&+ E' -&'()'+ 78 &1E</-()5: ()+

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&'G'& +/:/)8'-5()5H /) (--7<+()-' =/5. 5.' &(E'& /):5<1-5/7)> ,.'F :.71&+ E' </):'+ ()+ +</'+ =/5.

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91/+'&/)': 87< 5.' 1:' 78 ()F ./9.R&'G'& -.'?/-(& +/:/)8'-5()5> 2CA3 N8 5.' 91( :.( +'G/-': (<'

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+/:;7:(E&' 91( :.( 577&: ?(F (&:7 E' -7):/+'<'+>

,.'<' /: ( -1<<')5 -7)5<7G'<:F <'9(<+/)9 .7= 785') 5.' :I/) E(<</'< /: -7?;<7?/:'+ +1</)9 91(

:.(> Y':'(<-.'<: 8<7? O'5. N:<('& %'+/-(& "')5'< .(G' /)+/-(5'+ 5.(5 5.' /)5')5/7)(& 7<

1)/)5')5/7)(& 'J;<'::/7) 78 E&77+ 7< 8&1/+ 7)57 91( :.( +'G/-': +'?7):5<(5': 5.' ;75')5/(&

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<';7<5:> %7<' :51+/': (<' )''+'+ 57 +'5'<?/)' .7= 8<'01')5&F 5.' /)5(-5 :I/) /: +/:<1;5'+ /)

91( :.(>

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)75 <'(+/&F (G(/&(E&' 57 ( ;</G(5' ;<(-5/5/7)'<> # 8'= :7&15/7): (<' (;;<7G'+ 87< -&/)/-(& 1:'

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DD

".77:/)9 5.' (;;<7;</(5' -.'?/-(& :7&15/7) ()+ 87&&7=/)9 &(E'& /):5<1-5/7): /: -</5/-(& )75 7)&F

57 ;<'G')5 /)8'-5/7)H E15 (&:7 87< :(8' 1:' EF 5.' ;<(-5/5/7)'<>

6(-. /)+/G/+1(& ;<(-5/5/7)'< ?1:5 9(19' 5.' -7)+/5/7) 78 5.' ;(5/')5 ()+ 5.' 'J5')5 57 =./-.

5.'/< 5'-.)/01' 78 91( :.( +/:51<E: 5.' /)5(-5 )(51<' 78 5.' :I/)k: :1<8(-'> O&77+ E'/)9 'J5<1+'+

+1</)9 91( :.( /: () 7EG/71: :/9) 5.(5 5.' ;<(-5/5/7)'<k: 5'-.)/01' +/:<1;5: 5.' :I/) E(<</'<> ,.'

;<(-5/5/7)'< ?1:5 I''; /) ?/)+ 5.(5 G/:1(& /):;'-5/7) (&7)' ?(F )75 E' (+'01(5' 57 (::':: 5.'

+'9<'' 5.(5 :I/) .(: E'') +/:<1;5'+ EF 91( :.(> O'-(1:' 5.' ;<(-5/5/7)'< -())75 I)7= 5.(5 5.'

:I/) .(: E'-7?' +/:<1;5'+ 1)5/& (85'< /5 .(: E'-7?' +/:<1;5'+H ()+ 5(I/)9 /)57 -7):/+'<(5/7)

5.' ;75')5/(& </:I 57 ;(5/')5:H /5 /: 5.' '+/57<k: 7;/)/7) 5.(5 /: ;<1+')5 57 -7):/+'< ./9.R&'G'&

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'J5')5 57 =./-. 91( :.( -7?;<7?/:': 5.' :I/) E(<</'<> d(G/)9 7)' ?'5.7+ 78 +/:/)8'-5/7)

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1:/)9 +'G/-': 5.(5 .(G' E'') ;<7;'<&F +/:/)8'-5'+> M/)9&'R1:' +/:;7:(E&' 577&: ?(F (&:7 E'

-7):/+'<'+>

Safety Guidelines for Disinfection of Gua Sha Tools

D'*$*)(3 • "&'() (&& 577&: 78 (&& &1E</-()5: ()+ E/7&79/-(& ?(5'</(& 1:/)9 :7(; ()+

=(5'< E'87<' +/:/)8'-5/)9>

• W/:/)8'-5 (&& 577&: 1:/)9 () (;;<7;</(5' [W#R-&'(<'+ /)5'<?'+/(5'R 57

./9.R&'G'& +/:/)8'-5/)9 :7&15/7)H /) (--7<+()-' =/5. &(E'& /):5<1-5/7):>

• L:' (;;<7;</(5' KK6 =./&' -&'()/)9 ()+ +/:/)8'-5/)9 91( :.( 577&:>

4$',0>35

6"),??"02"2

• W/:/)8'-5 (&& 577&: 1:/)9 () [W#R-&'(<'+ ./9.R&'G'& +/:/)8'-5/)9 :7&15/7)

87< :'?/R-</5/-(& +'G/-':H /) (--7<+()-' =/5. &(E'& /):5<1-5/7):>

References

C> */'&:') #H f&/9&'< OH f7&& OM> M(8'5F ;<757-7&: 87< Z1( :.( 2;<'::R:5<7I/)93 ()+ O(91()


A> */'&:') #H f)7E&(1-. *,%H W7E7: ZVH %/-.(&:') #H f(;5-.1I ,V> ,.' '88'-5 78 ~Z1( :.(k

5<'(5?')5 7) 5.' ?/-<7-/<-1&(5/7) 78 :1<8(-' 5/::1'U ( ;/&75 :51+F /) .'(&5.F :1E]'-5:>

MD@,/1$ O;[P> ABB4iTUbDSRbSS>

T> */'&:') #H f&/9&'< OH f7&& OM> #++')+1?U M(8'5F ;<757-7&: 87< Z1( :.( 2;<'::R:5<7I/)93 ()+

O(91() 2-1;;/)93> F/B@,$B$-% GC$1 H$+ > ABCbiAA2T3UbbSRbbQb> O<(1) %H M-.=/-I'<5 %H */'&:') #H '5 (&> 688'-5/G')':: 78 ,<(+/5/7)(& "./)':' nZ1( M.(p

,.'<(;F /) K(5/')5: =/5. ".<7)/- *'-I K(/)i ( Y()+7?/\'+ "7)5<7&&'+ ,</(&> 0"*- H$+ >

ABCCiCA2T3 2V()1(<F AQ3UTSARP>

D> X(1-.' YH ^1EE'&/)9 fH X1+5I' Y '5 (&> Y()+7?/\'+ -7)5<7&&'+ ;/&75 :51+FU K(/) /)5'):/5F ()+

;<'::1<' ;(/) 5.<':.7&+: /) ;(5/')5: =/5. )'-I ()+ &7= E(-I ;(/) E'87<' ()+ (85'<

5<(+/5/7)(& 6(:5 #:/() ~Z1( :.(k 5.'<(;F> =B V FC*- H$+ > ABCAibB2D3UPBDRPC4>



DS

S> "./1 VRhH Z(1 %RXH f17 MRhH ".()9 hRdH f17 MR"H ,1 dR"> 688'-5: 78 Z1(RM.( 5.'<(;F 7) E<'(:5

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D4

7. Plum Blossom Needling


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Preventing Plum Blossom Needling Adverse Events

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<'&'(:'+ /)57 5.' (/<>

Safety Guidelines for Plum Blossom (Seven Star) Therapy

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References

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DP

8. Press Tacks and Intradermal Needles


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Auricular Therapy/Press Tacks

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Safety Guidelines for the Use of Press Tacks or Intradermal Needling

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(-1;1)-51<' ;7/)5 =/5. -&'() -7557) 7< 9(1\'>

References

C> ^/)5'< XH M;/'8'& V> 6(< :5(;&/)9U ( </:IF ()+ 1);<7G') ;<7-'+1<' 87< (;;'5/5' :1;;<'::/7) ()+

='/9.5 &7::> M"1 ;/.$ GC1/"% V: ABCBiQP2CC3U6ABRA>

A> h'. "H "./()9 hH d788?() M '5 (&> 688/-(-F 78 (1</-1&(< 5.'<(;F 87< ;(/) ?()(9'?')5U (

:F:5'?(5/- <'G/'= ()+ ?'5(R()(&F:/:> M2*+ 3".$+ F/B@,$B$-% =,%$1-"% H$+ >

ABCbiABCbUPTbS4B>

T> K'))/-I cH X/++&' M> N)5'<G')5/7): 87< ;<'G')5/)9 ()+ 5<'(5/)9 ;'&G/- ()+ E(-I ;(/) /)

;<'9)()-F> F/7C1"-$ K"%"R".$ !&.% ?$2 > ABCTiQ2"WBBCCTP3 2#19C3>

b>,() VRhH %7&(::/75/: #H ^()9 ,H M1') X> "1<<')5 6G/+')-' 7) #1</-1&(< ,.'<(;F 87<

".'?75.'<(;FRN)+1-'+ *(1:'( ()+ c7?/5/)9 /) "()-'< K(5/')5:U # MF:5'?(5/- Y'G/'=

78 Y()+7?/\'+ "7)5<7&&'+ ,</(&:> M2*+ 3".$+ F/B@,$B$-% =,%$1-"% H$+ >

ABCbiABCbUbTB4PS

D> K/&I/)957) fH f/<I=77+ ZH Y(?;': dH "1??/)9: %H Y/-.(<+:7) V> #-1;1)-51<' 87< ()J/'5F ()+

()J/'5F +/:7<+'<: R ( :F:5'?(5/- &/5'<(51<' <'G/'=> =7)@)-7%)1$ *- H$+*7*-$> ABB4iAD2CR

A3UCRCB>

S> #&&/:7) ZH f<(G/5\ 6> X'55' ; M-4, V H$+ >

CP4DiAPT2CD3 2$-57E'< P3U4QB>

4> Z/&E'<5 VZ> #1</-1&(< -7?;&/-(5/7) 78 (-1;1)-51<'> ; ] H$+ V> CPQ4iCBB2QCP3 2%(<-. CC3UCbCR

CbA>

Q> O(&5/?7<' YH %7&F K> K'</-.7)+</5/: 78 5.' '(< (: ( -7?;&/-(5/7) 78 (-1;1)-51<'> =17C

E%/,"1&-4/, > CP4SiCBA2P3UD4ART>

P> W(G/: $H K7='&& ^> #1</-1&(< ;'</-.7)+</5/: :'-7)+(<F 57 (-1;1)-51<'> =17C E%/,"1&-4/, >CPQDiCCC2CC3U44BRC>

CB> V7.():') %H */'&:') f$> qK'</-.7)+</5/: 78 5.' '(< -(1:'+ EF (-1;1)-51<'s> Q4$.A1 L"$4$1 >

CPPBiCDA2T3 2V()1(<F CD3UC4ARC4T>

CC> Y(?7: MH K/)57 XH q#1</-1&(< ;'</-.7)+</5/: +1' 57 (-1;1)-51<'s> q+1' 57 (-1;1)-51<'s>

?$2*.%" 31".*,*$1" +$ E%/11*-/,"1*-4/,/4*"> CPP4iST2S3UCRDQP>



SA

CA> M7<'):') ,> q#1</-1&(< ;'</-.7)+</5/: -(1:'+ EF (-1;1)-51<' 5.'<(;Fs> Q4$.A1 L"$4$1 >

CPPBiCDA2CC3 2%(<-. CA3U4DAR4DT>

CT> ,<(15'<?()) dZH ,<(15'<?()) d> qK'</-.7)+</5/: 78 5.' '(< (1</-&' (85'< (-1;1)-51<'

2(15.7<_: 5<():&3s> I;E> CPQCiAP2P3 2M';5'?E'<3UTCARTCT>

Cb> ^(<=/-IRO<7=) *KH Y/-.(<+: #6> K'</-.7)+</5/: 78 5.' '(< 87&&7=/)9 (-1;1)-51<'> V L"1&-4/,E%/, > CPQSiCBB2CB3 2$-57E'<3UCC44RCC4P>

CD> ,() VRhH %7&(::/75/: #H ^()9 ,H M1') X> #+G'<:' 6G')5: 78 #1</-1&(< ,.'<(;FU # MF:5'?(5/-

Y'G/'=> M2*+ 3".$+ F/B@,$B$-% =,%$1-"% H$+: ABCbiABCbUDBS4DQ

CS> O1&I.'(+ MH ,7)I/):7) OH *7=&/) ,> #1</-1&75.'<(;F -7?;&/-(5/7):U 6(< :5(;&/)9 97)' E(+>

E%/,"1&-4/,/4&JJI$"+ "-+ ;$7A !)14$1& > ABB4iCT4UACD>

C4> %7<9() #> K:'1+7?7)(: ('<19/)7:( /)8'-5/7) +1' 57 (-1;1)-51<(& '(< :5(;&/)9> =B V 8-#$7%

F/-%1/, > ABBQiTS2QCP3USBA>

CQ> W')9 ZH Y1:-. cH c/-I'<: # '5 (&> Y()+7?/\'+ -7)5<7&&'+ 5</(& 78 ( :;'-/(& (-1;1)-51<'

5'-.)/01' 87< ;(/) (85'< 5.7<(-757?F> V GC/1"7 F"1+*/2".7 !)14> ABBQiCTS2S3UCbSbRCbSP>

CP> f75()/ *H d(:./?757 dH M(57 M'(> K<'7;'<(5/G' /)5<(+'<?(& (-1;1)-51<' <'+1-':

;7:57;'<(5/G' ;(/)H )(1:'( ()+ G7?/5/)9H ()(&9':/- <'01/<'?')5H ()+ :F?;(5.7(+<')(&

<':;7):':> =-$.%C$.*/, > ABBCiPDUTbPRTDS>

AB> M7&5()/R#<(E:.(./ YH ^7)9 VH W188F fH K7='&& W> [(-/(& (&&'<9/- 9<()1&7?(571: <'(-5/7) ()+

:F:5'?/- .F;'<:'):/5/G/5F (::7-/(5'+ =/5. ?/-<7)''+&' 5.'<(;F 87< :I/) <']1G')(5/7)>

V=H= K$1B"%/,: ABCbiCDB2C3 2V()3USQR4A>

AC> *7. ,H ^77) "H X'' %H ".7/ VH X'' MH ".()9 M> N)8'-5/7) =/5. %F-7E(-5'</1? 87<51/51?

+1</)9 (-1;7/)5 '?E'++/)9 5.'<(;F> V =B =7"+ K$1B> ABCTi4B2S3U'CTbRD>

AA> ,()9 KH ^(&:. MH %L<<(F " '5 (&> $15E<'(I 78 (-1;1)-51<'R(::7-/(5'+ -15()'71:

%F-7E(-5'</1? (E:-'::1: /)8'-5/7):> V F)%"- H$+ !)14: ABBSiCB2b3 2V1&R#193UCSSRP>



ST

9. Ear Seeds


6(< :''+: 2:7?'5/?': (&:7 <'8'<<'+ 57 (: n;<':: E(&&:p3 (<' 1:'+ 57 :5/?1&(5' (-1;1)-51<'

;7/)5:H 1:1(&&F 7) 5.' (1</-&' 78 5.' '(<H =/5.715 E<'(I/)9 5.' :I/)> %7:5 (<' ?(+' 8<7? ?'5(&::1-. (: :1<9/-(& :5(/)&':: :5''& 7< ?(9)'5:> ,<(+/5/7)(&&FH :''+: 8<7? ;&()5: :1-. (: F"1&/@C&,,).

"1/B"%*7). 2-&7G'3 ()+ 6"77"1*" C*.@"-*7" 2-7=.'<E3H ='<' 1:'+ 5.1: 9/G/)9 5.' )(?'

nG(--(</(p 57 (&& :1-. '(< :''+:> ,.':' ?'5(& 27< )(51<(&&F 7--1<</)93 :''+: -() E' 1:'+ 57

:5/?1&(5' ;7/)5: /) 75.'< (<'(: 78 5.' E7+FH :1-. (: (5 *'/91() 2KS3 87< )(1:'( 78 ;<'9)()-F

()+ ?75/7) :/-I)'::>

,.'<' (<' )7 ;<7:;'-5/G' :51+/': 7< <'5<7:;'-5/G' <'G/'=: /) 5.' 6)9&/:. &/5'<(51<' <'9(<+/)9 5.'

:(8'5F 78 5.' 1:' 78 '(< :''+:`G(--(</(> ,.'<' (<' ( 8'= :51+/': =./-. <'G/'='+ 5.' 1:': 78 ()+

5.'<(;'15/- '88'-5: 78 '(< :''+: 87< E(-I ;(/)H 2C3 ='/9.5 &7::H 2A3 ()+ -7):5/;(5/7)> 2T3

,.':' :51+/': <'G/'='+ ;(5/')5 (--';5()-' ()+ 5.'<(;'15/- 715-7?': =/5. :''+: E'/)9 &'85 /)

87< 1; 57 4 +(F:> *7)' <';7<5'+ #6: 7< ;(5/')5 /)57&'<()-'>

Preventing Ear Seed Adverse Events

,.'<' (<' )7 -7??7) #6: (::7-/(5'+ =/5. 5.' 1:' 78 '(< :''+:`G(--(</(> Z')'<(& -&'()

5'-.)/01': ()+ G/9/&()-' 57 (G7/+ 1:' 78 5.' :''+: =.'<' 5.'<' /: () (-5/G' :I/) /)8'-5/7) 7<

5<(1?( :.71&+ E' :188/-/')5 57 ?(/)5(/) 5.' :(8'5F <'-7<+ 78 G(--(</( 5<'(5?')5:>

Safety Guidelines for the Use of Ear Seeds

6"),??"02"2 ,(I' ( -(<'81& ;(5/')5 ./:57<F 57 /+')5/8F /8 5.' ;(5/')5 /: (&&'<9/- 57 5.'?'+/-(& 5(;' 1:'+ /) 5./: ;<7-'+1<'>

References

C> h'. "dH "./') X"H "./()9 h"H d1()9 X">#1</-1&(< ;7/)5 (-1;<'::1<' 87< -.<7)/- &7= E(-I ;(/)U

( 8'(:/E/&/5F :51+F 87< CR=''I 5<'(5?')5> 6G/+ O(:'+ "7?;&'?')5 #&5'<)(5

%'+> ABCAiABCAUTQTAD4> +7/U CB>CCDDÀBCA`TQTAD4> 6;1E ABCA V1& C>

A> d:/'. "d> ,.' '88'-5: 78 (1</-1&(< (-1;<'::1<' 7) ='/9.5 &7:: ()+ :'<1? &/;/+ &'G'&: /)

7G'<='/9.5 (+7&':-')5:> #? V "./) %'+> ABCBiTQ2b3US4DRQA>

T> j.71 llH j.7)9 hH ,')9 V> qM')/&' .(E/51(& -7):5/;(5/7) 5<'(5'+ =/5. (1</-1&(< 5.'<(;F E(:'+

7) 5.' ;(55'<)`:F)+<7?' +/88'<')5/(5/7)U ( <()+7?/\'+ -7)5<7&&'+ 5</(&s> j.7)9917 j.')

V/1> ABCA W'-iTA2CA3UCBPBRA>



Sb

10. Tui Na


,1/ )( /: ( ?()1(& 5.'<(;F =./-. 1:': "./)':' ?(::(9' ()+ ?()/;1&(5/7) 5'-.)/01':> ,.'<' (<'

)7 ;<7:;'-5/G' :51+/': 7< <'5<7:;'-5/G' <'G/'=: /) 5.' 6)9&/:. &/5'<(51<' <'9(<+/)9 5.' :(8'5F 785.' 1:' 78 51/ )(> ,1/ )( /: 'J5'):/G'&F 1:'+ /) "./)( 87< ( G(</'5F 78 ;(/) ()+ ?1:-1&7:I'&'5(&

:F)+<7?':> # <'-')5 :51+F =./-. <'G/'='+ 5.' 1:': 78 ()+ 5.'<(;'15/- '88'-5: 78 51/ )( 87< ;(/)

2C3 ()+ K(<I/):7)k: +/:'(:' 2A3 871)+ )7 (+G'<:' 'G')5: 7< <'(-5/7): (::7-/(5'+ =/5. 51/ )(

5.'<(;F>

M/?/&(<&FH ( "7-.<()' <'G/'= 78 5.' 1:' 78 ?(::(9' 2)75 51/ )(3 87< )'-I ;(/) 2T3 <';7<5'+

/)8<'01')5 <';7<5: 78 ;7:5R5<'(5?')5 ;(/) ()+ <(<' 7--1<<')-': 78 &7= E&77+ ;<'::1<' 87&&7=/)9

?(::(9' (: :/+' '88'-5:>

# <'-')5 ;<(-5/5/7)'< ]71<)(& (<5/-&' &/:5'+ 5.' 87&&7=/)9 -7)5<(/)+/-(5/7): 57 51/ )(U 2b3

• ^71)+:

• W'?(57:':

• W/:'(:': =/5. .'?7<<.(9/- 5')+')-/':

• #-15' /)8'-5/71: +/:'(:':

• W/:'(:': 78 5.' E<(/)H .'(<5H &/G'<H I/+)'FH ()+ 75.'< G/:-'<(

• %'):5<1(5/7) ()+ ;<'9)()-F

,./: &/:5 /: :/?/&(< 57 5.(5 1:'+ EF ?(::(9' 5.'<(;/:5: :/)-' 5.' 5/?' 78 Vd f'&&799 =.7 /) CQPD

&/:5'+ 5.' 87&&7=/)9 -7)5<(/)+/-(5/7): 57 ?(::(9'U 2D3

%(::(9' /: -7)5<(R/)+/-(5'+ /) )'(<&F (&& 87<?: 78 :I/) +/:'(:'H 'J-';5 /) 5./-I')'+

-7)+/5/7) 78 5.' :I/) &'85 E'./)+ EF -.<7)/- '-\'?(> N5 /: (&:7 -7)5<(R/)+/-(5'+ /) (-15'

-(:': 78 (;7;&'JF ()+ /) 5.' '(<&F :5(9': 78 )'1</5/:H =.') /<</5(E/&/5F :5/&& 'J/:5:H ()+

:.71&+ )'G'< E' (+?/)/:5'<'+ 57 (E:-'::':H 51?7<: 7< 51E'<-1&(< ]7/)5:>

# ?7<' <'-')5 (<5/-&' 7) -<'(5/)9 :5()+(<+: 87< ?(::(9' /) 5.' .7:;/5(& :'55/)9 (&:7 '&1-/+(5'+

:/?/&(< ;<'-(15/7):U 2S3

"7)5<(/)+/-(5/7): ()+ -(15/7):U L)+'< 5.' L%dM ;7&/-FH 5.'<(;'15/- ?(::(9' /: &7-(&&F-7)5<(/)+/-(5'+ /) 7< )'(< (<'(: 78 /)8'-5/7)H 51?7<:H 7< /)-/:/7):> $5.'<

-7)5<(/)+/-(5/7): /)-&1+' E15 (<' )75 &/?/5'+ 57 /?;(/<?')5 EF (&-7.7& 7< +<19:H 5.'

;<':')-' 78 -7)5(9/71: <(:.':H ()+ 8(/&1<' 78 5.' ;(5/')5 57 -7):')5 57 ?(::(9' 5.'<(;F>

,.'<' (<' ( 8'= 78 -(:': <';7<5'+ #6: 2-7?;&/-(5/7):3 (::7-/(5'+ =/5. 51/ )( /) 5.' "./)':'

&()91(9' ?'+/-(& &/5'<(51<'> %7:5 78 5.':' -(:': (<' +1' 57 /?;<7;'< 1:' 78 87<-' +1</)9 5.' 51/



SD

)( ;<(-5/-' =./-. &'+ 57 :1-. #6: (: :785 5/::1' /)]1<FH ;'</;.'<(& )'<G' /)]1<FH G/:-'<(& /)]1<FH

+/:&7-(5/7) 78 ( ]7/)5H E7)' 8<(-51<'H ';/+1<(& .'?7<<.(9'H /)]1<F 78 -')5<(& )'<G' :F:5'?

':;'-/(&&F -'<G/-(& :;/)' /)]1<FH '5-> 24RCB3 N5 /: -&'(< 5.(5 =./&' 5.':' (<' <(<' 7--1<<')-':H

;<7;'< 1)+'<:5()+/)9 78 ()(57?F ()+ ;.F:/7&79F /: )''+'+ 57 ;<'G')5 #6: (::7-/(5'+ =/5. 5.'

7G'<R1:' 78 87<-'>

Preventing Tui Na Adverse Events

,.'<' (<' )7 -7??7) #6: (::7-/(5'+ =/5. 5.' 1:' 78 51/ )(> Z')'<(& -&'() 5'-.)/01': ()+

G/9/&()-' 57 (G7/+ 1:/)9 51/ )( =.'<' 5.'<' (<' (-5/G' :I/) /)8'-5/7):H 7;') =71)+:H 8<(-51<':H 7<

(-15' 5<(1?(H ()+ -7):1&5(5/7) =/5. 75.'< ;.F:/-/(): =.') 1:/)9 5.' 5'-.)/01' (85'< :1<9'<F 7<

+1</)9 5<'(5?')5: 87< -()-'< :.71&+ E' :188/-/')5 57 ?(/)5(/) 5.' :(8'5F <'-7<+ 78 5./:

;<7-'+1<'>

Safety Guidelines for Tui Na

D'*$*)(3 •

[7&&7= !"#$%& ()*+$,*-$. #/1 I"-+ !"-*%"%*/->• *'G'< (;;&F 51/ )( 57 (<'(: 5.(5 .(G' +'<?(5/5/:H (-5/G' &':/7): 7<

75.'< =71)+:>

4$',0>35

6"),??"02"2

• K<7G/+' (;;<7;</(5' ;<'::1<' ()+ (+]1:5 51/ )( 5<'(5?')5:

(--7<+/)9 57 (9'H &7-(5/7)H E7+F -7):5/515/7) ()+ ?'+/-(& ./:57<F>

References

C> K()9 VH ,()9 dXH Z(7 X[H ^()9 fXH X'/ X%H X/1 j^H Z() ^H X1 hH j.71 d[H X/ VMH j.()9 m%>

qY()+7?/\'+ -7)5<7&&'+ 5</(& 7) '88'-5 78 ,1/)( 87< 5<'(5?')5 78 :1ER.'(&5. ;'7;&' 78

:7?(5/- ;(/)s>j.7)9917 j.') V/1> ABCB V()iTB2C3UDDRP>

A> ^(&57)Rd(+&7-IH V> K</?(<F K(<I/):7)_: +/:'(:'U ,.' 1:' 78 ,1/)( ()+ (-1;1)-51<' /) (--7<+

=/5. () 'G7&G/)9 .F;75.':/: 78 /5: -(1:' 8<7? 5.' ;'<:;'-5/G' 78 "./)':' 5<(+/5/7)(&

?'+/-/)'> #?'</-() V71<)(& 78 #-1;1)-51<' CPPQiAS2ART3UCSTRC44

T> K(5'& f"H Z<7:: #H Z<(.(? *H Z7&+:?/5. "dH 6\\7 VH %7</') #H K'&7:7 K%> %(::(9' 87<

?'-.()/-(& )'-I +/:7<+'<:> "7-.<()' W(5(E(:' MF:5 Y'G> ABCA M'; CAiPU"WBBbQ4C> +7/U

CB>CBBA`CbSDCQDQ>"WBBbQ4C>;1Eb>

b> N)+/-(5/7):H "7)5<(/)+/-(5/7): ()+ K7/)5: 87< #55')5/7) /) ,1/)(>

.55;U``5-?+/:-7G'<F>-7?`,1/)(R%(::(9'`/)87ÀBBQBPCTyACb>.5?& #--'::'+ W'-'?E'<

ABCA>D> f'&&79H Vd> GC$ =1% /# H".."4$> %7+'<) %'+/-/)' K1E&/:./)9 "7>H O(55&' "<''IH %N>H CQPD>

K>ABC

S> %FI&'E1:5 %H N&'< V> K7&/-F 87< 5.'<(;'15/- ?(::(9' /) () (-(+'?/- .'(&5. -')5' V #&5'<) "7?;&'?')5 %'+> ABB4 %(FiCT2b3Ub4CRD>



SS

4> "./ HM.1&()H'5 (&>淑兰，等．急性腰扭伤按摩致腰部血肿一例．颈腰痛杂志，1995；16( 2)：90. # -(:'

78 .'?(57?( (5 5.' =(/:5 (::7-/(5'+ =/5. ?(::(9' 87< 5<'(5/)9 (-15' &1?E(< :;<(/)> ,.'

V71<)(& 78 "'<G/-7+F)/( ()+ X1?E7+F)/(Hc7&>CSH)7> AH;>PBH CPPD> q#<5/-&' /) "./)':'s

Q> j.1H h7)9.1/>朱永辉．颈椎按摩致瘫痪1例报告．岭南急诊医学杂志，2001, 6(1)：69. # -(:' <';7<5

78 ;(<(&F:/: (::7-/(5'+ =/5. ?(::(9' (5 -'<G/-(& :;/)'> X/)9)() V71<)(& 78 6?'<9')-F%'+/-/)'Hc7&>SH)7>CH;>SPH ABBC> q#<5/-&' /) "./)':'s

P> j')9H M.')9?/)9>曾胜明．推拿治疗肩周炎致肋骨骨折一例．中国疗养医学，2001；l O( 1)：3. #

-(:' 78 </E 8<(-51<': (::7-/(5'+ =/5. ,1/)( 2"./)':' ?(::(9'3 5<'(5?')5 87< 8<7\')

:.71&+'<> "./)':' V71<)(& 78 "7)G(&':-')5 %'+/-/)'H c7&>CBH *7> CH ;>TH ABBC> q#<5/-&' /)

"./)':'s

CB> l/7)9H Z1()F1>熊冠宇．手法治疗颈椎病致脑干梗塞l例．河南中医，2003；23(1 0)：7. # -(:' 78

E<(/) :5'? /)8(<-5/7) (::7-/(5'+ =/5. ?()1(& 5.'<(;F 87< -'<G/-(& :;7)+F&7:/:> p d')()

,<(+/5/7)(& "./)':' %'+/-/)'Hc7&>ATH)7> CBH;>4H ABBT> q#<5/-&' /) "./)':'s



S4

11. Other Acupuncture-Related Tools

Manaka/Japanese Acupuncture Tools

A Review of the Literature

,.'<' /: )7 'G/+')-' /) 5.' 6)9&/:. &()91(9' ?'+/-(& +(5(E(:': 5.(5 5.'<' (<' ()F #6:

(::7-/(5'+ =/5. '/5.'< %()(I( ;1?;/)9 -.7<+: 7< %()(I( .(??'< 5<'(5?')5:>

Preventing Adverse Events

,.'<' (<' )7 -7??7) #6: (::7-/(5'+ =/5. 5.' 1:' 78 %()(I( ;<7+1-5:> Z')'<(& -&'()

5'-.)/01': ()+ G/9/&()-' 57 (G7/+ 1:' 78 5.' %()(I( ;1?;/)9 -.7<+: 7< %()(I( .(??'<

=.'<' 5.'<' /: () (-5/G' :I/) /)8'-5/7) 7< 5<(1?( :.71&+ E' :188/-/')5 57 ?(/)5(/) 5.' :(8'5F

<'-7<+ 78 5.':' 5<'(5?')5:>

Shonishin Pediatric Japanese Acupuncture Tools A Review of the Literature

,.'<' /: )7 'G/+')-' /) 5.' 6)9&/:. &()91(9' ?'+/-(& +(5(E(:': 5.(5 5.'<' (<' ()F #6:

(::7-/(5'+ =/5. M.7)/:./) 5<'(5?')5:>

Preventing Common Adverse Events

,.'<' (<' )7 -7??7) #6: (::7-/(5'+ =/5. 5.' 1:' 78 M.7)/:./) ;<7+1-5:> Z')'<(& -&'()

5'-.)/01':H ;<7;'< +/:/)8'-5/7) 78 :1-. +'G/-': (: )7)-</5/-(& +'G/-':H ()+ G/9/&()-' 57 (G7/+ 1:'

78 5.' ()F <'1:(E&' ?'+/-(& +'G/-' =.'<' 5.'<' /: () (-5/G' :I/) /)8'-5/7) 7< 5<(1?( :.71&+ E'

:188/-/')5 57 ?(/)5(/) 5.' :(8'5F <'-7<+ 78 5.':' 5<'(5?')5:>



SQ

Part II: Best Practices for Acupuncture - CNT

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Safety Guidelines for Hand Sanitation

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How to Wash Hands 2b3

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How to Use Hand Sanitizer 2T3

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Preparing and Maintaining a Clean Field

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Safety Guidelines for Preparing and Maintaining a Clean Field

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Alcohol Swab Method

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Safety Guidelines for Skin Preparation

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)''+&' ;')'5<(5/7)> 2D3

• N8 (&-7.7& :=(E: (<' 1:'+H 4Bt /:7;<7;F& 7< '5.()7& (&-7.7& /:

<'01/<'+>

• N8 (&-7.7& :=(EE/)9 /: 1:'+ 57 -&'() ;7/)5: E'87<' )''+&' /):'<5/7)H

(&&7= 5.' (&-7.7& 7) 5.' :I/) 57 +<F>

• W7 )75 1:' ( :=(E (5 ()F (++/5/7)(& :/5' /8 /5 .(: -7?' /)57 -7)5(-5

=/5. :I/) 5.(5 .(: G/:/E&' /)8&(??(5/7)H &':/7)H ()+ /)8'-5/7) 7< E<'(I

/) :I/) E(<</'<>

• # :';(<(5' :=(E :.71&+ E' 1:'+ 87< (<'(: 78 5.' E7+F 5.(5 .(G' ./9.

E(-5'</(& &7(+>

• W7 )75 <'1:' () (&-7.7& :=(E 7) ()75.'< ;(5/')5>

4$',0>35

6"),??"02"2

• W7 )75 ;<'R:7(I -7557) =77& /) ( -7)5(/)'< (: 5.':' E'-7?' ./9.&F

-7)5(?/)(5'+ =/5. .()+ ()+ ')G/<7)?')5(& E(-5'</(>• ,.' :(?' (&-7.7& :=(E ?(F E' 1:'+ 87< -&'()/)9 :'G'<(& ;7/)5 :/5': (:

&7)9 (: 5.' :=(E /5:'&8 .(: )75 +</'+H .(: )75 -.()9'+ -7&7< 7< E'-7?'

G/:/E&F +/<5F ()+ .(: 7)&F -7?' /)57 -7)5(-5 =/5. /)5(-5 :I/)>

6"),??"02"2 • #&-7.7& :=(EE/)9 78 (<'(: 57 E' 5<'(5'+ =/5. /)5<(+'<?(& 7<

:1E-15()'71: ?'5.7+: /: <'-7??')+'+ E15 )75 '::')5/(& (: &7)9 (:

5.' (<'( (;;'(<: 57 E' -&'()> 2D3

• N)G':5/9(5' ()+ 87&&7= &7-(& ()+ :5(5' <'91&(5/7) -7)-'<)/)9 :I/)

;<';(<(5/7)>

Isolation of Used Sharps

#)75.'< -</5/-(& -7?;7)')5 78 "*, /: 5.' /:7&(5/7) 78 1:'+ :.(<;:> M.(<;: :.71&+ E' /:7&(5'+ /) (

:.(<;: -7)5(/)'< :;'-/8/-(&&F +':/9)'+ 87< 5./: 1:'> #;;<7;</(5' -7)5(/)'<: (<' (G(/&(E&'

-7??'<-/(&&F> M.(<;: -7)5(/)'<: (<' ?(+' 78 ( ?(5'</(& /?;'<G/71: 57 )''+&': ()+ 8&1/+:H :1-.

(: ;&(:5/-H ()+ (<' +':/9)'+ 57 <'-'/G' -7)5(?/)(5'+ :.(<;: =/5.715 E'/)9 (E&' 57 <'5</'G' 5.'?



4b

(85'< 5.' :.(<;: (<' ;&(-'+ /) 5.' -7)5(/)'<> ,.':' -7)5(/)'<: (<' &(E'&'+ (: 57 -7)5')5: ()+

E'(< 5.' E/7.(\(<+ :F?E7&>

Standard Precautions

M5()+(<+ K<'-(15/7): (<' 715&/)'+ EF 5.' "')5'<: 87< W/:'(:' "7)5<7&>2CC3 [7< 5.7:' 1:'+ 57 5.'

5'<? L)/G'<:(& K<'-(15/7):H M5()+(<+ K<'-(15/7): -7?E/)' 5.' ?(]7< 8'(51<': 78 L)/G'<:(&

K<'-(15/7): 2LK3 ()+ O7+F M1E:5()-' N:7&(5/7) 2OMN3H ()+ (<' E(:'+ 7) 5.' ;</)-/;&' 5.(5 (&&

E&77+H E7+F 8&1/+:H :'-<'5/7):H 'J-<'5/7): 'J-';5 :='(5H )7)R/)5(-5 :I/)H ()+ ?1-71:

?'?E<()': ?(F -7)5(/) 5<():?/::/E&' /)8'-5/71: (9')5:> M5()+(<+ K<'-(15/7): /)-&1+' ( 9<71;

78 /)8'-5/7) ;<'G')5/7) ;<(-5/-': 5.(5 (;;&F 57 (&& ;(5/')5:H <'9(<+&':: 78 :1:;'-5'+ 7< -7)8/<?'+

/)8'-5/7) :5(51:H /) ()F :'55/)9 /) =./-. .'(&5.-(<' /: +'&/G'<'+> ,.':' /)-&1+'U .()+ .F9/')'i

1:' 78 9&7G':H 97=)H ?(:IH 'F' ;<75'-5/7)H 7< 8(-' :./'&+H +';')+/)9 7) 5.' ()5/-/;(5'+

'J;7:1<'i ()+ :(8' /)]'-5/7) ;<(-5/-':> 2,.' "W" :=/5-.'+ 8<7? 5.' 5'<? L)/G'<:(& K<'-(15/7):

57 M5()+(<+ K<'-(15/7): /) ABB4>3

M5()+(<+ K<'-(15/7): (<' =/+'&F 1:'+ 57 ;<'G')5 'J;7:1<' 57 ;75')5/(&&F /)8'-5/71: ?(5'</(&: /)5.' -71<:' 78 -&/)/-(& =7<IH /)-&1+/)9 (-1;1)-51<'> ,.':' ;<'-(15/7): (<' :1??(</\'+ E'&7=U

C> #::1?' (&& ;(5/')5: (<' ( ;75')5/(& :71<-' 78 /)8'-5/7)>

A> L5/&/\' -7<<'-5 ()+ 8<'01')5 .()+=(:./)9>

T> #&& .'(&5.-(<' ;<(-5/5/7)'<: ?1:5 1)+'<:5()+ 5.' (;;<7;</(5' 1:' 78 ;'<:7)(& ;<75'-5/G'

'01/;?')5 2KK63 :1-. (: 9&7G':H 'F' ;<75'-5/7)H ()+ ?(:I:>

b> d'(&5.-(<' 8(-/&/5/': (;;&F (;;<7;</(5' ')9/)''</)9 -7)5<7&:H :1-. (: ;<7;'<&F '01/;;'+

.()+=(:./)9 :5(5/7):>

D> N:7&(5/7) 78 :.(<;: /) (;;<7;</(5' :.(<;: -7)5(/)'<:>

S>

N:7&(5/7) 78 -7)5(?/)(5'+ ?'+/-(& =(:5' /) ( <'+ E(9 7< 75.'< (;;<7;</(5' -7)5(/)'<>

4> "7<<'-5 1:' 78 +/:/)8'-5()5:>

Q> #;;<7;</(5' -(15/7) =.') .()+&/)9 :.(<;:H /)-&1+/)9 (-1;1)-51<' )''+&':H :'G')R:5(<

.(??'<:H ()+ &()-'5:>

Basic Steps of the Clean Needle Technique for Acupuncture

C> ,.' ;<7G/+'< 87&&7=: !"#$%& ()*+$,*-$. /- I"-+ !"-*%"%*/->

A> # -&'() 8/'&+ /: :'5 1; 7) ( :5(E&' :1<8(-' )'(< 5.' 5<'(5?')5 5(E&'> ,.' -&'() 8/'&+ ?(F

-7):/:5 78 ( ;/'-' 78 ;(;'< 57='&/)9H 5(E&' ;(;'<H ( -&'() ?'5(& 5<(F '/5.'< ;<';(<'+ =/5.

( ;(;'< E(<</'< 7< -&'()'+ =/5. () (;;<7;</(5' +/:/)8'-5()5 E'5='') '(-. ;(5/')5 G/:/5H7< ( -&'() 8/'&+ ;1<-.(:'+ 87< 5./: ;1<;7:'>

T> *''+&':H /) 5.'/< 7</9/)(& ;(-I(9/)9H (<' ;&(-'+ 7) 5.' -')5'< 78 5.' -&'() 8/'&+>

b> *7)R:5'</&' -7557) E(&&: ()+ :I/) -&'():/)9 ?(5'</(&: 2'>9>H (&-7.7& :=(E:3 (<' ;&(-'+

'/5.'< )'(<EF 5.' 5<'(5?')5 5(E&' /) ( -&'() -7)5(/)'< 7< 7) 5.' ;'</;.'<F 78 5.' -&'()

8/'&+>

D> M.(<;: ()+ 5<(:. -7)5(/)'<: (<' ;&(-'+ (=(F 8<7? 5.' -&'() 8/'&+>



4D

S> ,.' (-1;1)-51<' ;7/)5: 7) 5.' ;(5/')5k: :I/) :.71&+ E' -&'()> [7< 5.' ;1<;7:': 78 "&'()

*''+&' ,'-.)/01'H :I/) -() E' -&'()'+ =/5. 4Bt /:7;<7;F& (&-7.7& H :7(; ()+ =(5'<H 7<

()75.'< ?'5.7+ E15 ?1:5 E' -&'() =.') /):'<5/)9 ( )''+&' 7< &()-'5>

4> N8 1:/)9 (&-7.7& 57 -&'() 5.' :I/)H 1:' ( )'= :=(E`-7557) E(&& =.')'G'< 5.' (&-7.7& :=(E

E'-7?': +/<5F 7< -7)5(?/)(5'+ 7< /: 577 +<F 57 &'(G' ( 5./) &(F'< 78 (&-7.7& :7&15/7) 7)5.' :I/)> ,.' /):'<5/7) ;7/)5 -() 5.') E' ;(&;(5'+ =/5. 5.' =(:.'+ 8/)9'<>

Q> ,.' )''+&' :.71&+ E' /):'<5'+ =/5.715 571-./)9 /5: :5'</&' :.(85> M.71&+ 5.' )''+&' E'

&7)9H :1-. (: ( 5.<'' 57 :/J /)-. )''+&'H 5.' :.(85 ?(F E' .'&+ =/5. :5'</&' 9(1\' 7<

:5'</&' -7557) E'5='') 5.' 8/)9'<: ()+ 5.' )''+&' :.(85> N):'<5 5.' )''+&' 7)&F 7)-'> N)

5.' 'G')5 5.(5 5.' )''+&' &7-(5/7) /: -.()9'+H 5.' )''+&' :.71&+ E' =/5.+<(=) ()+

;&(-'+ /) 5.' :.(<;: -7)5(/)'<> # )'= )''+&' ?1:5 E' 1:'+ 87< '(-. /):'<5/7)>

P> ,.' )''+&' /: 5.') :5/?1&(5'+ 87< 5.'<(;'15/- '88'-5>

CB> #85'< 5.' (;;<7;</(5' (?71)5 78 5/?'H 5.' )''+&' :.71&+ E' =/5.+<(=) ()+ ;&(-'+ /) (

:.(<;: -7)5(/)'<> W7 )75 ;&(-' 5.' )''+&' /) ( 5<(F 87< &(5'< 5<():8'< 57 5.' :.(<;:

-7)5(/)'< (: 5./: /)-<'(:': 5.' </:I 78 () (--/+')5(& )''+&':5/-I> W7 )75 .()+ 5.' 1:'+

)''+&' 57 () (::/:5()5> ,./: 5<():8'< (&:7 /)-<'(:': 5.' </:I 78 'J;7:1<' EF (--/+')5(&

)''+&':5/-I>

CC> #5 5.' ')+ 78 5<'(5?')5H 5.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+: ()+ -&'(): 1; 5.'

-&'() 8/'&+H /)-&1+/)9 <';&(-/)9 7< +/:;7:/)9 78 1)1:'+ :1;;&/':> N) 5.' 'G')5 5.(5 5.'

;<(-5/5/7)'< .(: 1:'+ :7?'H E15 )75 (&&H 78 5.' )''+&': /) ( ?1&5/R;(-I 78 (-1;1)-51<'

)''+&':H (&& 1)1:'+ )''+&': ?1:5 (&:7 E' +/:;7:'+ 78 /) 5.' :.(<;: -7)5(/)'<> $;')'+

)''+&' ;(-I: ?(F )75 E' 1:'+ 87< ( +/88'<')5 ;(5/')5 7< ( 5<'(5?')5 (5 ( &(5'< 5/?'>



4S

2. CNT Basic Principles"&'() *''+&' ,'-.)/01' 2"*,3 /)-&1+': 5.' 87&&7=/)9 E(:/- ;</)-/;&':U

C> #&=(F: =(:. .()+: E'5='') ;(5/')5:H ()+ E'87<' ()+ (85'< )''+&/)9>

A> #&=(F: ':5(E&/:. ( -&'() 8/'&+ E'87<' ;'<87<?/)9 (-1;1)-51<'>

T> #&=(F: 1:' :5'</&' :/)9&'R1:' )''+&': ()+ 75.'< /):5<1?')5: 5.(5 ?(F E<'(I 5.' :I/)>

:1-. (: :'G')R:5(< .(??'<:H ;<':: 5(-I:`/)5<(+'<?(& )''+&':H ()+ &()-'5:>

b> #&=(F: /??'+/(5'&F /:7&(5' 1:'+ )''+&': ()+ 75.'< :.(<;:>

D> [7&&7= M5()+(<+ K<'-(15/7):>

O':/+': 5.' 7EG/71: )'-'::/5F 87< :5'</&' )''+&':H &()-'5:H ()+ :'G')R:5(< .(??'<:H

.()+=(:./)9 /: 5.' :/)9&' ?7:5 /?;7<5()5 (-5/7) /) ;<'G')5/)9 -<7::R/)8'-5/7)> d()+: :.71&+ E'

=(:.'+ =/5. &/01/+ :7(; 1)+'< <1))/)9 =(5'< E'5='') ;(5/')5:H (: ='&& (: E'87<' ()+ (85'<

;'<87<?/)9 (-1;1)-51<' 7< 75.'< ;<7-'+1<':H ()+ =.')'G'< 5.' ;<(-5/5/7)'<k: .()+: ?(F .(G'

E'-7?' -7)5(?/)(5'+ =/5. ;75')5/(&&F /)8'-5/71: ?(5'</(&> 2M'' :'-5/7) 7) .()+=(:./)9 /) K(<5

c 78 5./: ?()1(&>3 K75')5/(& :71<-': 78 -7)5(?/)(5/7) /)-&1+' 571-./)9 5.' .(/<H -&75.':H 7<

1)-&'() :I/) 78 5.' ;(5/')5 27< ;<(-5/5/7)'<3i ;(;'<=7<Ii -7?;15'<: 7< ;.7)':i 7< ()F 75.'<

1)-&'() :1<8(-' 7< 7E]'-5 /) 5.' 5<'(5?')5 ')G/<7)?')5> ,.' ?(/) 97(& 78 M5()+(<+ K<'-(15/7):

/: :(8'5F ()+ :;'-/8/-(&&F 5.' ;<'G')5/7) 78 'J;7:1<' 57 ()+ 5<():?/::/7) 78 )7:7-7?/(& +/:'(:'>

N) 5.' 'G')5 5.(5 /5 /: /?;<(-5/-(& 7< /?;7::/E&' 87< 5.' ;<(-5/5/7)'< 57 =(:. ./: 7< .'< .()+:

=/5. :7(; ()+ =(5'<H () (&-7.7&RE(:'+ .()+ :()/5/\'< ?(F E' :1E:5/515'+> #&-7.7&RE(:'+ .()+

:()/5/\'<: (<' '88'-5/G' 87< <'+1-/)9 5.' ;<':')-' 78 ;75')5/(&&F /)8'-5/71: (9')5: E15 =/&& )75 E'

'88'-5/G' /) 5.' 'G')5 5.(5 5.' ;<(-5/5/7)'<k: .()+: (<' :7/&'+> ^.') 5.' ;<(-5/5/7)'<k: .()+:(<' :7/&'+H =(:./)9 .()+: =/5. :7(; ()+ =(5'< <'?(/): 5.' E':5 =(F 57 <'?7G' -7)5(?/)(5/7)>

,.' "W" (&:7 (&&7=: 87< 5.' 1:' 78 +/:/)8'-5/)9 .()+ =/;': =.') :7(; ()+ =(5'< .()+=(:./)9 /:

)75 () 7;5/7)> [7< ;<7;'< 1:' 78 (&-7.7&RE(:'+ .()+ :()/5/\'<: ()+ +/:/)8'-5/)9 .()+ =/;':H

;&'(:' :'' 5.' ?()18(-51<'<k: /):5<1-5/7):>

"7)5(?/)(5'+ )''+&': (<' 5.' 9<'(5':5 :71<-' 78 /)8'-5/7) </:I 57 5.' ;<(-5/5/7)'< ()+ ;(5/')5>

N5 /: '::')5/(& 57 ?/)/?/\' .()+&/)9 78 1:'+ )''+&': +1</)9 +/:;7:(&> ,.':' E(:/- ;</)-/;&': =/&&

E' +/:-1::'+ /) 5.' :'-5/7): 5.(5 87&&7=> N5 /: '::')5/(& 57 E' ?'5/-1&71: /) 87&&7=/)9 (&& (:;'-5:

78 "&'() *''+&' ,'-.)/01' ;<757-7& ()+ M5()+(<+ K<'-(15/7):> ,./: /)-&1+': 5.' 1:' 78 :5'</&'

)''+&':H .()+=(:./)9 E'5='') 5<'(5?')5:H ()+ /:7&(5/7) 78 1:'+ :.(<;:> MI/) ()+ ?1-1:

?'?E<()' -7)5(-5: 8<'01')5&F -() E' ;<'G')5'+ =/5. 5.' 1:' 78 E(<</'< ;<'-(15/7): :1-. (:

9&7G':H ?(:I:H 97=):H ()+ 9799&': =.') )'-'::(<Fi .7='G'<H 5.' 9<'(5':5 </:I 78 E&77+E7<)'

;(5.79') 5<():?/::/7) -7?': 8<7? )''+&':5/-I /)]1</':> M1-. (--/+')5: (<' )75 ;<'G')5'+ EF

E(<</'<: E15 /):5'(+ <'01/<' :5</-5 (+.'<')-' 57 "*, ;<757-7&: EF ;<(-5/5/7)'<:H /)-&1+/)9 5.'

/??'+/(5' /:7&(5/7) 78 1:'+ :.(<;:H 5.' -7)5/)1/)9 <'-79)/5/7) 78 5.' )''+ 57 .()+&' (&&



44

;(5/')5: (: /8 5.'F ='<' ;75')5/(&&F /)8'-5/71:H ()+ 5.' )''+ 57 5<(/) (&& :5(88 /) -&'() )''+&'

;<757-7&: ()+ M5()+(<+ K<'-(15/7):>

K<'-(15/7): (<' 5.' :(?' 87< .';(5/5/: ()+ #NWM (: ='&& (: 87< 75.'< +/:'(:': 5.(5 ?/9.5 E'

5<():?/55'+ EF )''+&':5/-I (--/+')5:> d'(&5.-(<' =7<I'<: (<' (+G/:'+ 57 +'G'&7; :5()+(<+ ()+

.(E/51(& ;<7-'+1<': 87< (&& ;(5/')5: 5.(5 ;<7G/+' 5.' )'-'::(<F ;<75'-5/7) (9(/):5 5.'

5<():?/::/7) 78 ;75')5/(&&F /)8'-5/71: (9')5:> 2CA3

Setting Up the Clean Field

# -&'() 8/'&+ /: 5.' (<'( 5.(5 .(: E'') ;<';(<'+ 57 -7)5(/) 5.' '01/;?')5 )'-'::(<F 87<

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-&'() 7< :5'</&' '01/;?')5>

# -&'() 8/'&+ 87< (-1;1)-51<' )''+&/)9 /: ':5(E&/:.'+ /) 5.' 5<'(5?')5 :'55/)9 EF ;&(-/)9 ( -&'()

;(;'< 57='&H -&'() 5(E&' ;(;'< 7< 75.'< -&'() E(<</'< 5.(5 =/&& :'<G' (: ( -&'() 8/'&+ 7) ()

(;;<7;</(5' =7 2N8 ( 5<(F /: 1:'+ (: 5.' -&'() 8/'&+H /5 ?1:5 E' -&'()'+ =/5. ()

(;;<7;</(5' +/:/)8'-5()5 E'5='') '(-. ;(5/')5 G/:/5 7< -7G'<'+ =/5. -&'() ;(;'< 7< 75.'<

E(<</'< 87< '(-. ;(5/')5 G/:/5>3 ,./: 8/'&+ :.71&+ E' 1:'+ 87< )''+&': 2E'87<' 1:'3 ()+ ()F -&'()

/5'?: 5.' ;<(-5/5/7)'< )''+: -&7:' (5 .()+ 87< )''+&/)9 ()+ 75.'< ;<7-'+1<':> ,.' -&'() 8/'&+

:.71&+ E' -.()9'+ (85'< '(-. 5<'(5?')5 :'::/7)> ,.' =7

0C/%/ R& K"1,$-$ M".%/- "-+ H/11*. I/)4C%/-:



4Q

Inspecting Needle Packaging Prior to Use

K</7< 57 1:'H (-1;1)-51<' ;<(-5/5/7)'<: )''+ 57 /):;'-5 5.' ;(-I(9/)9 78 ()F :/)9&'R1:' :5'</&'

)''+&': 2()+ 75.'< :5'</&' :.(<;:3 57 '):1<' 5.(5 5.' ;<75'-5/G' E(<</'< .(: )75 E'') E<'(-.'+

7< +(?(9'+ EF 'J;7:1<' 57 =(5'<> ,.' 'J;/<(5/7) +(5' 78 (&& )''+&': /) ( -&/)/- :.71&+ E'-.'-I'+ <'91&(<&F 2/>'>H ?7)5.&F3 ()+ (&& 'J;/<'+ )''+&': E' +/:-(<+'+> W/:-(<+ ()F ;(-I(9' 78

)''+&': 5.(5 .(: E'') ;1)-51<'+H 57<) 7< +(?(9'+H 7< ;(:5 5.' 'J;/<(5/7) +(5' 78 :5'</&/\(5/7)>

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Skin Preparation

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#-1;1)-51<' )''+&': :.71&+ )'G'< E' /):'<5'+ 5.<719. /)8&(?'+H /<</5(5'+H +/:'(:'+H 7< E<7I')

:I/)> $5.'<=/:'H /)8'-5/7): -() E' -(<</'+ +/<'-5&F /)57 5.' E7+F ;(:5 5.' E<7I') :I/) E(<</'<>

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Palpating the Point

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4P

Inserting Needle to Correct Depth

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Can I touch the needle during needle insertion?

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QB

Needle Removal

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Dealing with Blood to Blood Contact

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Managing Used Needles

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()+ -./&+<') =(/5/)9 87< 5.'/< ;(<')5:>



QC

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Counting Needles

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QA

3. CNT in an Office Setting[/<:5H 1;7) ')5'</)9 5.' <77? =/5. ( ;(5/')5H =(:. 7< -&'() .()+:> ,.') ;<7-''+ =/5. -&/)/-(&

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Treatment Protocol in an Office Setting

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QT

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Qb

4. CNT for House Calls/Travel Setting

Travel Kit /Travel Kit Carrier

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Clean Items

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Non-Clean Items

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Travel Kit Items Not in Bags

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Hand Cleanser

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Travel Sharps Container

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Treatment Protocol in a Community Clinic or NADA Setting

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$<H /8 :7(; ()+ =(5'< (<' 1)(G(/&(E&'H -&'() .()+: =/5. 5.' (&-7.7&RE(:'+ .()+ :()/5/\'<>

q-</5/-(&s

T> K&(-' ( -&'() ;(;'< 57='&H -&'() 5(E&' ;(;'< 7< 75.'< E(<</'< 5.(5 =/&& :'<G' (: ( -&'()

8/'&+ 7) 5.' =7 q:5<7)9&F <'-7??')+'+s

b> M'5 715 5.' ?(5'</(&: )''+'+ 87< (&& 5.' 5<'(5?')5: 57 E' ;'<87<?'+ /) ( :/)9&' :'::/7)>

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-')5'< 78 5.' -&'() 8/'&+ 8/<:5> q:5<7)9&F <'-7??')+'+s "7557) E(&&:H 9(1\'H ()+ 75.'<

?(5'</(&: :.71&+ E' ;&(-'+ -&7:'< 57 5.' '+9': 78 5.' 8/'&+> q<'-7??')+'+s

D> "&'() /5'?: :1-. (: -7557) E(&&: ()+ 1)7;')'+ :=(E: ?(F '/5.'< E' ;&(-'+ 7) 5.' -&'()

8/'&+ 7< I';5 /) ](<: 7< -7)5(/)'<: )'(< 5.' -&'() 8/'&+ :7 (: 57 E' (5 .()+ 87< 5.'

;<(-5/5/7)'<> q<'-7??')+'+s



PB

S> 6):1<' 5.' :I/) (5 5.' (-1;1)-51<' ;7/)5: 57 E' 1:'+ /: -&'()> N8 4Bt (&-7.7& :=(E: (<'

1:'+H (&&7= 5.' (&-7.7& 57 +<F> q:5<7)9&F <'-7??')+'+s

4> N8 ( ;<(-5/5/7)'< ?1:5 ;&(-' 5.' )''+&' /):/+' ( 91/+' 51E'H 5.' )''+&' :.71&+ E'

+<7;;'+ /)57 5.' 51E'H .()+&' 8/<:5H 57 ?/)/?/\' 5.' </:I 78 -7)5(?/)(5/)9 5.' ;7/)5 78

5.' )''+&'> q:5<7)9&F <'-7??')+'+sQ> N):'<5 5.' )''+&': =/5.715 571-./)9 5.' :.(85 78 5.' )''+&' 5.(5 =/&& E' /):'<5'+ /)57 5.'

;(5/')5k: :I/)> q-</5/-(&s N8 ( 91/+' 51E' /: 57 E' <'1:'+H /5 :.71&+ E' ;&(-'+ 7) 5.' -&'()

8/'&+ E'5='') 1:':H :/)-' /5 .(: E'') .()+&'+ ()+ /: )7 &7)9'< :5'</&'> q:5<7)9&F

<'-7??')+'+s

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)''+&' ?1:5 E' 1:'+> q-</5/-(&s K<(-5/5/7)'<: ?(F )75 <'/):'<5 ( )''+&' E'-(1:' 7)-' (

)''+&' .(: E'') /):'<5'+i /5 /: )7 &7)9'< :5'</&' ()+ ?1:5 E' +/:;7:'+ 78> q:5<7)9&F

<'-7??')+'+s

CB> L:' .()+ -&'():'< E'5='') '(-. ;(5/')5 5<'(5?')5> q:5<7)9&F <'-7??')+'+s

CC> 6):1<' 5.' :I/) (5 5.' (-1;1)-51<' ;7/)5: 57 E' 1:'+ /: -&'()> q-</5/-(&s

CA> Y';'(5 :5';: QRCC 87< '(-. ;(5/')5 E'/)9 5<'(5'+ +1</)9 ( :/)9&' :'::/7)>

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() (;;<7;</(5' :.(<;: -7)5(/)'<> q-</5/-(&s

Cb> N8 5.' ;<(-5/5/7)'< =/:.': 57 -7G'< 5.' :I/) =.'<' ( )''+&' .(: E'') <'?7G'+H ( -&'()H

+<F -7557) E(&& :.71&+ E' 1:'+> ,.' -7557) E(&& )''+ )75 E' :5'</&'> q:5<7)9&F

<'-7??')+'+s

CD> W/:;7:' 78 (&& -7557) E(&&: ()+ (&-7.7& :=(E: (: 5.'F (<' 1:'+H ;&(-/)9 5.'? /??'+/(5'&F

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57 E' ;&(-'+ 7) 5.' -&'() 8/'&+ (85'< 1:'> q<'-7??')+'+s

CS> ̂ (:.`-&'():' .()+: E'87<' &'(G/)9 5.' 5<'(5?')5 <77?> q:5<7)9&F <'-7??')+'+s



PC

6. CNT in a Public Health Setting,.'<' /: ( 9<7=/)9 1:' 78 (-1;1)-51<' /) ;1E&/- .'(&5. :'55/)9: :1-. (: (++/-5/7) 5<'(5?')5

8(-/&/5/':H -&/)/-: 5.(5 5<'(5 &(<9' )1?E'<: 78 dOcH d"cH ()+ dNc ;(5/')5:H ()+ -&/)/-: =/5. ./9.

;7;1&(5/7): 78 ;(5/')5: (5 </:I 78 ,OH (: ='&& (: /) /):5/515/7): :1-. (: ](/&:H ;1E&/- .7:;/5(&:H

-7??1)/5F -')5'<:H ()+ 75.'< :7-/(& (9')-/': 5.(5 .(G' 9<71; 5<'(5?')5 <77?: =.'<' :'G'<(&;(5/')5: :/5 ()+ <'-'/G' '(< 7< E7+F (-1;1)-51<'>

K(5/')5: ?(F (<</G' 579'5.'< 7< :';(<(5'&FH E15 1:1(&&F +7 )75 .(G' /)+/G/+1(& (;;7/)5?')5:>

%()F 78 5.':' <77?: +7 )75 .(G' ( :/)I> M7?' ?(F .(G' (--':: 57 7)' )'(<EFH E15 /5 /: )75

(&=(F: 91(<()5''+> %()F 78 5.':' :'55/)9: (/? (5 5<'(5/)9 ;'<:7): =.7 (<' +<19R ()+`7<

(&-7.7&R(++/-5'+ ()+ =.7 ;<':')5 =/5. <'&(5'+ ()+ 8<'01')5&F ?1&5/;&' .'(&5. ()+ :7-/(&

;<7E&'?: :1-. (: ,OH dNc /)8'-5/7)H ?')5(& /&&)'::H .7?'&'::)'::H .1)9'< 7< ?(&)15</5/7)H 7<

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/??1)' :F:5'?> M5(88 ;'<87<?/)9 (-1;1)-51<' 5<'(5?')5: (<' (;;<7;</(5'&F 5<(/)'+

(-1;1)-51</:5: ()+`7< (-1;1)-51<' -.'?/-(& +';')+')-F :;'-/(&/:5:H +';')+/)9 7) :5(5'

<'91&(5/7):> ,.'<' (<' 785') 75.'< ;<7G/+'<: 8<7? +/88'<')5 +/:-/;&/)': /)G7&G'+ :1-. (:

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)1<:' ;<(-5/5/7)'<:> ,.' -.(<(-5'</:5/-: 78 5.':' -&/)/-: ?()+(5' :7?' :;'-/(& +/:-1::/7)>

Handwashing

d()+=(:./)9 /: 7)' 78 5.' ?7:5 ;<7E&'?(5/- 57;/-: =/5./) ( ;1E&/- .'(&5. 7< 9<71; 5<'(5?')5

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'(-. 5<'(5?')5 +1' 57 5.' G7&1?' 78 ;(5/')5: 57 E' 5<'(5'+H 5.' 5/?' ()+ &79/:5/-: 5.(5 =71&+

E' <'01/<'+H ()+ 8<'01')5&FH 5.' &(-I 78 8(-/&/5/': 87< .()+=(:./)9> N5 /: -</5/-(&H .7='G'<H 5.(5

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5<'(5?')5> N5 /: (&:7 :5<7)9&F <'-7??')+'+ EF "W" 5.(5 ;<(-5/5/7)'<:U

C> ^(:. .()+: =/5. :7(; ()+ =(5'< 7) (<</G(& ()+ E'87<' &'(G/)9 =7<IH E'87<' '(5/)9H ()+

(85'< <':5<77? 1:'> q-</5/-(&s

A> N8 .()+: (<' +/<5F =/5. :7?' 7<9()/- ?(55'< :1-. (: E&77+H 5.'F ?1:5 E' =(:.'+ =/5.

<1))/)9 =(5'< ()+ :7(;> q-</5/-(&s

T> #) (&-7.7&RE(:'+ .()+ :()/5/\'< :.71&+ E' 1:'+ E'5='') 5<'(5?')5:H ;<7G/+'+ 5.(5 7)&F

5.' )''+&':H :5'</&' ;(-I(9':H ()+ 75.'< ?(5'</(&: )''+'+ 87< 5.' 5<'(5?')5 ='<'571-.'+> q:5<7)9&F <'-7??')+'+s

b> d()+: ?1:5 E' -&'():'+ E'5='') ;(5/')5 5<'(5?')5:> q-</5/-(&s

D> #) (&-7.7&RE(:'+ .()+ :()/5/\'< 7< .()+ =/;' -() E' 15/&/\'+ (: )''+'+ +1</)9

5<'(5?')5: ()+ E'5='') ;(5/')5 5<'(5?')5:> q<'-7??')+'+s



PA

S> Z&7G': :.71&+ E' (G(/&(E&' /) 5.' 5<'(5?')5 (<'( ()+ :.71&+ E' =7<) =.') 5.'<' /: ()

7;') =71)+ 7) 5.' ;<(-5/5/7)'<k: .()+ 7< 5.'<' /: </:I 78 E&77+ 7< $KN% -7)5(?/)(5/7)H

:1-. (: :/9)/8/-()5 E&''+/)9 8<7? () (1</-1&(< (-1;1)-51<' ;7/)5> q-</5/-(&s

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/):5()-':H :1-. (: -7)5(-5 =/5. E&77+ 7< ( E<'(I /) 5.' -&'() 8/'&+ E'5='') 7< +1</)95<'(5?')5:> q-</5/-(&s 2AB3

Q> K<(-5/5/7)'<: ?1:5 .(G' (;;<7;</(5' .()+ -&'():'<: (G(/&(E&' 57 5.'? (5 (&& 5/?': /) 5.'

;1E&/- .'(&5. 5<'(5?')5 ')G/<7)?')5> q-</5/-(&s

Acupuncture Equipment

W/:;7:(E&' )''+&': (<' <'-7??')+'+ 87< (&& (-1;1)-51<' 5<'(5?')5:> M7?' :5(5': ?()+(5'

5.(5 7)&F +/:;7:(E&' )''+&': -() E' 15/&/\'+ EF ;<(-5/5/7)'<:H /)-&1+/)9 5.7:' =7<I/)9 /) ;1E&/-

.'(&5. 8(-/&/5/': 5<'(5/)9 -.'?/-(& +';')+')-F> Z1/+' 51E': (<' )75 <'-7??')+'+ 87< (1</-1&(<

(-1;1)-51<'> #: (&=(F:H -(<' :.71&+ E' 5(I') 57 ?7)/57< ;<':: )''+&': 87< ;75')5/(& /)8'-5/7):>

Positioning the Patient

^.') 5.' ;(5/')5 /: :/55/)9 1;H /5 /: /?;7<5()5 57 ?(I' :1<' 5.(5H =.'<' ;7::/E&'H 5.' ;(5/')5 .(:

./: 7< .'< .'(+ ()+ )'-I :1;;7<5'+H 5.(5 5.' &'9: ()+ (<?: (<' )75 -<7::'+H ()+ 5.(5 5.' ;'<:7)

/: -7?87<5(E&F :'(5'+> K(5/')5: :.71&+ E' ')-71<(9'+ 57 1:' 5.' E(5.<77? ;</7< 57 5<'(5?')5>

N8 ( ;(5/')5 +7': )''+ 57 1:' 5.' <':5<77? +1</)9 5<'(5?')5H (&& )''+&': :.71&+ E' <'?7G'+

()+ 5.') <';&(-'+ =.') .' 7< :.' <'51<):>

Removing Needles

^.') ( ;<(-5/5/7)'< /: <'?7G/)9 )''+&':H /5 /: -</5/-(& 87< ( :.(<;: -7)5(/)'< 57 E' /) 5.'/??'+/(5' G/-/)/5FH ;<'8'<(E&F =.'<' 5.' -7)5(/)'< /: :'-1<' ()+ -())75 E' I)7-I'+ 7G'<> N)

?()F ;1E&/- .'(&5. :'55/)9: /5 /: /?;7<5()5 5.(5 )''+&': E' (--71)5'+ 87< EF -71)5/)9 5.'

)''+&': 1:'+> N) :'55/)9: :1-. (: ](/&:H 5.' ;(5/')5: 785') ?(F )75 &'(G' 1)5/& (&& )''+&': (<'

(--71)5'+ 87<> N) :7?' +'57J -&/)/-: ;(5/')5: <'?7G' 5.'/< 7=) )''+&':> N) 5.':' /):5()-': 5.'

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)''+&': E'87<'H +1</)9H ()+ (85'< '(-. :'::/7)H ()+ (85'< '(-. ;(5/')5k: )''+&': (<' <'?7G'+> N8

( )''+&' 8(&&: 715 78 5.' '(< 7)57 5.' -&75./)9 78 5.' ;(5/')5 +1</)9 5<'(5?')5H /5 :.71&+ E'

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)''+&':5/-I /)]1<F ?(F 7--1<> N5 /: (&:7 -</5/-(& 5.(5 ;<(-5/5/7)'<: E' (E&' 57 /+')5/8F 5.' )1?E'<

78 )''+&': 1:'+ ()+ 5.' )1?E'< ;<7;'<&F +/:-(<+'+ /) ( ;1E&/- .'(&5. :'55/)9>



PT

Potential Complications

N8 ( ;(5/')5 8(/)5: =./&' :/55/)9 1;H (&& )''+&': :.71&+ E' <'?7G'+ /??'+/(5'&FH &'9: '&'G(5'+

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;<':: W1 AS 2Y')\.7)93 57 .'&; <'G/G' 5.' ;(5/')5i -(&&/)9 87< ?'+/-(& .'&; ?(F E' )'-'::(<F /):7?' -(:':>

W'&(F'+ E&''+/)9 /: -7??7)> K<(-5/5/7)'<: ?1:5 E' (=(<' 78 5./: ;7::/E/&/5F> K(5/')5: :.71&+ E'

?7)/57<'+ (85'< )''+&' <'?7G(& ()+ E'87<' &'(G/)9 5.' ;<'?/:':>



Pb

7. Toyohari Acupuncture"7)5(-5 )''+&/)9 27< )7)R/):'<5/7) )''+&/)93 /: :7?'5/?': 15/&/\'+ /) V(;()':' ?'</+/() 5.'<(;F

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)''+&' +7': )75 ;')'5<(5' /)57 5.' E7+Fi 5.' )''+&' 5/; /: .'&+ (5 5.' :I/) :1<8(-' 7< ;'<.(;:

571-.': 5.' :I/) E15 +7': )75 ;')'5<(5' 5.' :I/)>p2AC3 ^.') ;'<87<?/)9 -7)5(-5 )''+&/)9H 5.')''+&' ?(F E' ;&(-'+ E'5='') 5.' -&'() 5.1?E ()+ /)+'J 8/)9'< 78 5.' )7)R+7?/)()5 .()+H

=./-. (<' <':5/)9 7) 5.' :I/) (5 5.' (-1;1)-51<' ;7/)5> ,./: /: -(&&'+ 5.' n7:./+'p /) V(;()':'

?'</+/() 5.'<(;F> 2AA3 M/)-' 5.' :.(85 78 5.' )''+&' /: )75 ;')'5<(5/)9 5.' :I/)H 5.' )''+&' :.(85

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5'-.)/01' ;<7;'<&F> 2AAHAT3

Modifications to Standard Clean Needle Technique for Contact Needling

,.' :5()+(<+: 78 .()+=(:./)9H :'55/)9 1; ( -&'() 8/'&+H /??'+/(5'&F /:7&(5/)9 1:'+ :.(<;: ()+

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,.' G(</(5/7) .'<' /: 5.(5 5.' :.(85 78 5.' )''+&' ?(F E' 571-.'+ EF 5.' ;<(-5/5/7)'<k: 8/)9'<: /)

5./: :5F&'>

N) ,7F7.(</ (-1;1)-51<'H 5.' )''+&' /5:'&8 +7': )75 ;')'5<(5' 5.' :I/)> ,.'<'87<'H =.')

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PD

8. Summary of Safety Recommendations for Clean Needle

Technique• "</5/-(&U [7&&7= "&'() *''+&' ,'-.)/01'>

• "</5/-(&U #&=(F: ':5(E&/:. ( -&'() 8/'&+ E'87<' :5(<5/)9 (-1;1)-51<' 7< ()F 5'-.)/01'

=./-. E<'(I: 5.' :I/)>

• "</5/-(&U $)&F 1:' :/)9&'R1:' :5'</&' /):5<1?')5: =.') E<'(I/)9 5.' :I/) :1<8(-' 2)''+&':

()+ &()-'5:3>

• "</5/-(&U #&=(F: =(:. .()+: /??'+/(5'&F ;</7< 57 :5(<5/)9 (-1;1)-51<' 7< ()F 5'-.)/01'

=./-. E<'(I: 5.' :I/)>

• "</5/-(&U W7 )75 571-. 5.' 5/; 7< :.(85 78 5.' (-1;1)-51<' )''+&' 5.(5 =/&& ')5'< 5.'

;(5/')5k: :I/) ;</7< 57 7< +1</)9 )''+&' /):'<5/7) =/5. ()F5./)9 =./-. /: )75 /5:'&8 :5'</&'>

• "</5/-(&U W7 )75 )''+&' /)57 ()F :I/) &':/7)> #-1;1)-51<' )''+&': :.71&+ )'G'< E'

/):'<5'+ 5.<719. /)8&(?'+ 7< E<7I') :I/)>

• "</5/-(&U N??'+/(5'&F /:7&(5' 1:'+ )''+&': /) () (;;<7;</(5' :.(<;: -7)5(/)'<>

• "</5/-(&U L:' )'= 5(E&' ;(;'< 7) '(-. 5<'(5?')5 5(E&' 87< '(-. )'= ;(5/')5 G/:/5>

• "</5/-(&U ^/;' +7=) '(-. 5<'(5?')5 -.(/< 7< 5(E&' =/5. () (;;<7G'+ +/:/)8'-5()5

:7&15/7) 7< +/:/)8'-5()5 -&75. E'5='') '(-. ;(5/')5 G/:/5>

• "</5/-(&U ^'(< 9&7G': 7< 8/)9'< -75:H 7< 75.'<=/:' -7G'< 1; ()F (<'(: 78 E<7I') :I/) 7)

5.' ;<(-5/5/7)'<k: .()+:>

• "</5/-(&U ".'-I )''+&': ;</7< 57 1:' 87< :5'</&/\(5/7) 'J;/<(5/7) +(5':H E<'(I: /) 5.'

;(-I(9/)9H 7< ()F 'G/+')-' 5.(5 (/< 7< =(5'< .(: ')5'<'+ 5.' )''+&' ;(-I(9/)9 ;</7< 57

1:'>

• "</5/-(&U %(/)5(/) -&'() ;<7-'+1<' (5 (&& 5/?': =./&' .()+&/)9 )''+&': ;</7< 57 /):'<5/7)>

N8 )''+&': 7< 51E': E'-7?' -7)5(?/)(5'+H 5.'F :.71&+ E' +/:-(<+'+>

• "</5/-(&U *''+&' ?()/;1&(5/7) ?1:5 E' ;'<87<?'+ =/5.715 5.' ;<(-5/5/7)'< -7?/)9 /)57

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References

C> ".')9 l/))7)9 2-./'8 '+/57<3> "./)':' #-1;1)-51<' ()+ %7J/E1:5/7)> [7<'/9) X()91(9':

K<'::H O'/]/)9i CPQ4>

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M'(55&'H ^#> CPQC>

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M()/5/\'< /) d()+=(:./)9U "&'() d()+: M(G'

X/G':.55;U``===>-+->97G`.()+=(:./)9`:.7=R?'R5.'R:-/')-'R.()+R:()/5/\'<>.5?&>

Y'G/'='+ $-57E'< C4i ABCb> #--'::'+ V()1(<F TH ABCb>

b> "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7)> ^.') e d7= 57 ^(:. h71< d()+: /)

d()+=(:./)9U "&'() d()+: M(G' X/G':> .55;U``===>-+->97G`.()+=(:./)9`=.')R.7=R

.()+=(:./)9>.5?&> Y'G/'='+ $-57E'< C4H ABCb> #--'::'+ V()1(<F TH ABCb>

D> ^7<&+ d'(&5. $<9()/\(5/7)> ^d$ E':5 ;<(-5/-': 87< /)]'-5/7): ()+ <'&(5'+ ;<7-'+1<': 577&I/5>

.55;U``=.0&/E+7->=.7>/)5`;1E&/-(5/7):ÀBCB`P4QPAbCDPPADAy')9>;+8> K1E&/:.'+ %(<-.

ABCB> #--'::'+ W'-'?E'< ABCA>

S> f.(=(]( YH M/I()+(< YH m1<':./ YH V(<')7 Y> Y715/)' MI/) K<';(<(5/7) =/5. 4Bt N:7;<7;F&

#&-7.7& M=(EU N: /5 *'-'::(<F E'87<' () N)]'-5/7)g m1(:/ M51+F> V X/(01(5 L %'+ d'(&5.

M-/')-': 2VXL%dM3> ABCTiCA2A3 2%(FR#193UCBPRCb>

4> W()) ,"> Y715/)' :I/) ;<';(<(5/7) E'87<' /)]'-5/7)U () 1))'-'::(<F ;<7-'+1<'> X()-'5 CPSPi

AU PSR4

Q> f7/G/:57 V#H ['&/9 K> N: :I/) ;<';(<(5/7) )'-'::(<F E'87<' /):1&/) /)]'-5/7)g X()-'5 CP4Qi CU

CB4ARCB4T

P> %-"(<5.F V#H "7G(<<1E/: OH M/)I K> N: 5.' 5<(+/5/7)(& (&-7.7& =/;' )'-'::(<F E'87<' () /):1&/)

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CB> *(5/7)(& N):5/515': 78 d'(&5.> K(5/')5 6+1-(5/7)U Z/G/)9 ( :1E-15()'71: /)]'-5/7)>

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CC> "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7)H d'(&5.-(<' N)8'-5/7) "7)5<7& K<(-5/-': #+G/:7<F

"7??/55'' 2dN"K#"3> ABB4 Z1/+'&/)' 87< N:7&(5/7) K<'-(15/7):U K<'G')5/)9 ,<():?/::/7)

78 N)8'-5/71: #9')5: /) d'(&5.-(<' M'55/)9:> K(<5 NNNU K<'-(15/7): 57 K<'G')5 ,<():?/::/7)



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78 N)8'-5/71: #9')5:> .55;U``===>-+->97G`./-;(-ÀBB4/;ÀBB4/;y;(<5T>.5?&> Y'G/'='+

W'-'?E'< APH ABBP> #--'::'+ *7G'?E'< ABCA>

CA> ^7<&+ d'(&5. $<9()/\(5/7)> %/)/?/\/)9 /)8'-5/7) 5.<719. /?;<7G'+ /)8'-5/7) -7)5<7&>

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CT> X/) VRZH ".71 KR"H ".1 dRh> #) 6J;&7<(5/7) 78 5.' *''+&/)9 W';5. /) #-1;1)-51<'U ,.' M(8'

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Cb> W'(+?()H K>H #&Rf.(8(]/H %> # %()1(& 78 #-1;1)-51<'> V71<)(& 78 "./)':' %'+/-/)'

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CS> "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7)> "W" 6J;7:1<' 57 O&77+H ^.(5 d'(&5.-(<'

K'<:7))'& *''+ 57 f)7=> .55;U``===>-+->97G`d#N`;+8:ÈE;`6J;y57yO&77+>;+8>

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CP> "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7)H d'(&5.-(<' N)8'-5/7) "7)5<7& K<(-5/-': #+G/:7<F

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8(-/&/5/':U <'-7??')+(5/7): 78 "W" ()+ 5.' d'(&5.-(<' N)8'-5/7) "7)5<7& K<(-5/-':

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d'(&5.-(<' M'55/)9:> .55;U``===>-+->97G`.()+.F9/')'Ò(:/-:>.5?&> Y'G/'='+ %(F CH

ABCb> #--'::'+ V()1(<F ABCD>

AC> O/<-.H M> ,<(+/5/7)(& *''+&/)9 ,'-.)/01': (: K<(-5/-(& "7):5<1-5/7): 8<7? Y'(+/)9 d/:57</-(&

W':-</;5/7):> ,.' 61<7;'() V71<)(& 78 $</')5(& %'+/-/)'i ABCT 42T3 ; A4>

AA> W')?(/H M.1+7> 688'-5/G' K7/)5 X7-(5/7)U [/)+/)9 #-5/G' #-1;1)-51<' K7/)5:> ABBTH M'(55&'U

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5.' #EF::> *7<5. #?'</-() V71<)(& 78 $</')5(& %'+/-/)'> ABBbH *7G'?E'< CC2TA3 ;;> ABR

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Part III: Best Practices for Related AOM Office Procedures

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CBA

1. Moxibustion

Moxibustion Overview

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CBT

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General Moxibustion Precautions• "</5/-(&U K<(-5/5/7)'<: ?1:5 =(:. .()+: 5.7<719.&F E'87<' :5(<5/)9 ?7J/E1:5/7)H ()+

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-7?87<5 ()+ :I/) <'(-5/7): +1</)9 (&& 5<'(5?')5:>

• "</5/-(&U ,(I' ( -(<'81& ;(5/')5 ./:57<F 57 /+')5/8F )'1<7;(5./': 7< 75.'< -7)+/5/7): 5.(5

?/9.5 &/?/5 ( ;(5/')5k: <':;7):' 57 ;(/) 7< 5.' (E/&/5F 57 :'):' .'(5>

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?7J(>• "</5/-(&U #G7/+ ?7J/E1:5/7) 7) 5.' 8(-' 7< /) 5.' .(/<&/)'>

• "</5/-(&U Y77?: /) =./-. ?7J/E1:5/7) /: E'/)9 ;'<87<?'+ ?1:5 .(G' ;<7;'< G')5/&(5/7)>

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(;;&/-(5/7) 78 ?7J( 5.'<(;/':>

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7--1<</)9 (: ( <':1&5 78 ?7J( 5.'<(;/':>

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=.') ;'<87<?/)9 ?7J/E1:5/7)>

• Y'-7??')+'+U Y77?: /) =./-. ?7J( /: 57 E' 1:'+ :.71&+ E' '01/;;'+ =/5. =(5'< ()+

( 8/<' 'J5/)91/:.'<>



CBb

• Y'-7??')+'+U "7):/+'< 7;5/7): 75.'< 5.() ?7J( 87< ;(5/')5: =/5. ( ./:57<F 78

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Moxa Best Practice Guidelines

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:5F&': 78 ;<(-5/-' (: &7)9 (: :(8'5F <'?(/): 5.' ;</7</5F>

Direct Moxibustion - Technique for Non-Scarring Moxibustion with Moxa Cones

# ?7J( -7)' /: ;&(-'+ 7) ( ;7/)5 ()+ /9)/5'+> ^.') (E715 A`T 78 /5 /: E1<)5 7< 5.' ;(5/')5 8''&:

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Method

C> # 5.7<719. ;(5/')5 ./:57<F /: ;'<87<?'+ 57 /+')5/8F ()F -7)+/5/7): 5.(5 E'/)9 ;'<87<?'+

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()+ 5<(/)/)9>

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CBD

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)'-'::(<F>

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Safety Considerations

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(> O' (E&' 57 :)188 ()F E1<)/)9 (:. 5.(5 8(&&:>

E>

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?7J/E1:5/7) (;;&/-(5/7)>

D> "7):/+'< 1:/)9 ( .'?7:5(5`5=''\'<:`87<-';: 57 (;;&F ()+ <'?7G' 5.' ?7J( -7)':> ,./:

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S> $)-' 5.' 5<'(5?')5 /: -7?;&'5'H 5.' -1; 78 =(5'< =/5. 5.' E1<)5 ?7J( :.71&+ E' 8&1:.'+

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4> *'G'< (;;&F +/<'-5 ?7J( 57 5.' 8(-' 7< =/5./) 5.' .(/<&/)'>

Direct Moxibustion - Technique for Scarring Moxibustion with Moxa Cones

# ?7J( -7)' /: ;&(-'+ 7) ( ;7/)5 ()+ /9)/5'+> N) 5./: ?'5.7+H 5.' ?7J( /: )75 <'?7G'+ 1)5/&

(85'< /5 .(: E1<)'+ +7=) 57 5.' ')+ 7< ( E&/:5'< 87<?:>

MethodC> # 5.7<719. ;(5/')5 ./:57<F /: ;'<87<?'+ 57 /+')5/8F ()F -7)+/5/7): 5.(5 E'/)9 ;'<87<?'+

5.(5 ?/9.5 &/?/5 ( ;(5/')5k: <':;7):' 57 ;(/) 7< 5.' (E/&/5F 57 :'):' .'(5 q-</5/-(&s 7< ?(F

/)-<'(:' ( <'(-5/7) 57 5.' ?7J( :?7I'> q<'-7??')+'+s

A> K<7;'< G')5/&(5/7) /: (::1<'+ 5.<719. 1:' 78 =/)+7=: 7< (/< 8/&5'<: 7< 75.'< (/< 8/&5'</)9

;<7-'::> q-</5/-(&s

T> %7J( -7)': (<' ;<';(<'+ ;</7< 57 &/9.5/)9 ()F ?7J(> q<'-7??')+'+s



CBS

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)''+'+> q<'-7??')+'+s

D>

,.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+:> q-</5/-(&sS> ,.' (<'( 57 =./-. ?7J( =/&& E' (;;&/'+ /: ;<';(<'+ =/5. :I/) &75/7) 7< &1E</-()5H /8

+':/<'+H E(:'+ 7) 5.' 5F;' 78 ?7J( ;<(-5/-'>

4> ,.' 8/<:5 -7)' 78 ?7J(H 1)&/5H /: (;;&/'+ 57 5.' :I/) (5 5.' ;7/)5 7< &7-(5/7) -.7:') EF 5.'

;<(-5/5/7)'<> q<'-7??')+'+s

Q> # ?(5'</(& :1-. (: () /)-'):' :5/-I /: &/9.5'+H 1:/)9 5.' &/9.5'<H (=(F 8<7? 5.' ;(5/')5>

$5.'< ?(5'</(&: -() E' 1:'+ (: &7)9 (: () 7;') 8&(?' /: I';5 :7?' +/:5()-' 8<7? 5.'

;(5/')5k: :I/)> q<'-7??')+'+s

P> N8 +':/<'+H ( .'?7:5(5 7< 5=''\'<: ?(F E' (;;&/'+ 57 5.' ?7J( ()+ 5.' /)-'):' 27< 75.'<

?(5'</(&3 /: 5.') 1:'+ 57 &/9.5 5.' ?7J(> q<'-7??')+'+s K<(-5/5/7)'<: ?(F (&:7 -.77:'

57 1:' 5.'/< 8/)9'<: 87< ?7J( (;;&/-(5/7) ()+ =/5.+<(=(& E(:'+ 7) ;'<:7)(& ;<'8'<')-'

()+ 5<(/)/)9>

CB> ,.' ;<(-5/5/7)'< ?7)/57<: 5.' :I/) 5'?;'<(51<' ()+ (?71)5 78 .'(5 9')'<(5'+ EF 5.'

?7J( -7)'> q:5<7)9&F <'-7??')+'+s

CC> ̂ .') 5.' -7)' 78 ?7J( .(: E1<)'+ +7=)H 7< 5.'<' /: ( G/:/E&' E&/:5'<H <'?7G' 5.' -7)'

()+ ;&(-' 5.' ?7J( /) 5.' -1; 78 =(5'< 7< (:.5<(F>

CA> L:' 8/)9'<: 7< 5.' .'?7:5(5:`5=''\'<: 57 ;&(-' 5.' )'J5 -7)' 7) 5.' :I/) ()+ <';'(5 (:

)'-'::(<F 57 (-./'G' 5.' +':/<'+ '88'-5>

CT> $)-' ( :?(&& E&/:5'< .(: 87<?'+H 5.' E1<) ?1:5 E' 5<'(5'+ ;<7;'<&FU "77& 5.' E1<) =/5.

-7&+ <1))/)9 =(5'< 1)5/& 5.' ;(/) /: <'&/'G'+i (;;&F :5'</&' 9(1\' ()+ 1:' :1<9/-(& 5(;' 57

I''; 5.' 9(1\' /) ;&(-'i (&5'<)(5'&FH ( -7??'<-/(&&F ;<';(<'+ E()+(9' ?(F E' 1:'+ 57

-7G'< 5.' E1<)'+ (<'(> q-</5/-(&s

#: ?()F (: 5.<'' 7< ?7<' -7)': 78 ?7J( (<' -7)5/)171:&F E1<)5 57 -(1:' 5.' 87<?(5/7) 78 (

:?(&& E&/:5'<> ,./: ?'5.7+ /: G'<F /)8<'01')5&F 1:'+ 'J-';5 87< :'G'<' -7)+/5/7):>


C> #&=(F: .(G' (--':: 57 =(5'< 57U

(> O' (E&' 57 :)188 ()F E1<)/)9 (:. 5.(5 8(&&:>

E> "77& ()F :?(&& E1<): 57 5.' ;(5/')5k: 7< ;<(-5/5/7)'<k: :I/) /??'+/(5'&F>

-> O' ( <'-';5(-&' 87< E1<)5 ?7J(H 1)&':: ( :1/5(E&' (:.5<(F 7< 75.'< )7)R

8&(??(E&' <'-';5(-&' /: ;<'8'<<'+>

A> *'G'< &'(G' ( ;(5/')5 (&7)' =.') ?7J( /: E'/)9 (;;&/'+>

T> %(I' :1<' )7 -&75./)9 /: -&7:' 57 5.' (<'( E'/)9 5<'(5'+ =/5. ?7J/E1:5/7)>



CB4

b> K(F G'<F -&7:' (55')5/7) 57 5.' ;(5/')5 +1</)9 ?7J/E1:5/7) (;;&/-(5/7) a +7 )75 &77I

(=(F 8<7? 5.' ;(5/')5 7< ?7J(H =</5' /) 5.' -.(<5H 7< 5(&I 57 ()F7)' E':/+': 5.' ;(5/')5

+1</)9 ?7J/E1:5/7) (;;&/-(5/7)>

D> "7):/+'< 1:/)9 ( .'?7:5(5`5=''\'<:`87<-';: 57 (;;&F ()+ <'?7G' 5.' ?7J( -7)':> ,./:

;<'G')5: 5.' ;<(-5/5/7)'<k: 8/)9'<: 8<7? E'/)9 E1<)'+ ()+ <'+1-': 5.' </:I 78 +<7;;/)9E1<)/)9 ?7J( 7)57 5.' ;(5/')5 7< 5<'(5?')5 :1<8(-'>

S> $)-' 5.' 5<'(5?')5 /: -7?;&'5'H 5.' -1; 78 =(5'< =/5. 5.' E1<)5 ?7J( :.71&+ E'

8&1:.'+ +7=) 5.' :/)I> W7 )75 ;15 ?7J( (:. +/<'-5&F /)57 ( 5<(:. -() (: 5./: ?(F /9)/5' (

5<(:. 8/<'>

W: *'G'< (;;&F +/<'-5 ?7J( 57 5.' 8(-' 7< =/5./) 5.' .(/<&/)'>

Indirect Moxibustion – Technique with Interposed Moxibustion

,.' /9)/5'+ ?7J( -7)' +7': )75 -7)5(-5 5.' :I/) +/<'-5&FH E15 /: /):1&(5'+ 8<7? 5.' :I/) EF (

&(F'< 78 9/)9'<H :(&5H 9(<&/-H 7< (-7)/5' -(I'> W';')+/)9 7) 5.' 5'-.)/01' 1:'+H 5./: I/)+ 78 ?7J(

?(F /)+1-' E&/:5'</)9H E15 /5 /: ?7:5 8<'01')5&F 1:'+ 87< )7)R:-(<</)9 ?7J/E1:5/7)>

Method

C> # :/)9&' ?7J( -7)' /: ;<';(<'+ ;</7< 57 1:'>

A> # 5.7<719. ;(5/')5 ./:57<F /: ;'<87<?'+ 57 /+')5/8F ()F -7)+/5/7): 5.(5 ?/9.5 &/?/5 (

;(5/')5k: <':;7):' 57 ;(/) 7< 5.' (E/&/5F 57 :'):' .'(5 q-</5/-(&s 7< ?(F /)-<'(:' (

<'(-5/7) 57 5.' ?7J( :?7I'> q<'-7??')+'+s

T> K<7;'< G')5/&(5/7) /: (::1<'+ 5.<719. 1:' 78 =/)+7=: 7< (/< 8/&5'<: 7< 75.'< (/< 8/&5'</)9

;<7-'::> q-</5/-(&s

b>

#&& '01/;?')5 /: ;&(-'+ 7) ( :5(E&' :1<8(-' +/<'-5&F )'J5 57 5.' 5<'(5?')5 5(E&'>601/;?')5U ?7J( -7)':H .'?7:5(5`87<-';:`5=''\'<:H .'<E(& /):1&(5/7) 2(-7)/5' -(I'H

9(<&/-H ()+ 9/)9'<3H -1; 78 =(5'< 2/8 +':/<'+3H (:.5<(F 2/8 +':/<'+3H &1E</-()5 7< :I/) &75/7)H

&/9.5'<H /)-'):' :5/-IH ()+ 75.'< '01/;?')5 (: )''+'+> q<'-7??')+'+s

D> ,.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+:> q-</5/-(&s

S> ,.' (<'( 57 =./-. ?7J( =/&& E' (;;&/'+ /: ;<';(<'+ =/5. :I/) &75/7) 7< &1E</-()5H /8

+':/<'+ E(:'+ 7) 5.' 5F;' 78 ?7J( ;<(-5/-'>

4> ,.' .'<E(& /):1&(5/7) /: 5.') (;;&/'+ 57 5.' (<'( 57 E' .'(5'+>

Q> ,.' -7)' 78 ?7J(H 1)&/5H /: (;;&/'+ 57 5.' .'<E(& /):1&(57<>

P>

N8 +':/<'+H ( .'?7:5(5 7< 5=''\'<: ?(F E' (;;&/'+ 57 5.' ?7J( ()+ 5.' /)-'):' 27< 75.'<?(5'</(&3 /: 5.') 1:'+ 57 &/9.5 5.' ?7J(> q<'-7??')+'+s K<(-5/5/7)'<: ?(F (&:7 -.77:'

57 1:' 5.'/< 8/)9'<: 87< ?7J( (;;&/-(5/7) ()+ =/5.+<(=(& E(:'+ 7) ;'<:7)(& ;<'8'<')-'

()+ 5<(/)/)9>

CB> # ?(5'</(& :1-. (: () /)-'):' :5/-I /: &/9.5'+H 1:/)9 5.' &/9.5'<H (=(F 8<7? 5.' ;(5/')5>

$5.'< ?(5'</(&: -() E' 1:'+ (: &7)9 (: () 7;') 8&(?' /: I';5 :7?' +/:5()-' 8<7? 5.'

;(5/')5k: :I/)> q<'-7??')+'+s



CBQ

CC> ̂ .') (E715 A`T 78 5.' ?7J( /: E1<)5 7< 5.' ;(5/')5 8''&: ( E1<)/)9 +/:-7?87<5H <'?7G'

5.' -7)' ()+ /):1&(57< ()+ ;&(-' 5.' ?7J( /) 5.' -1; 78 =(5'< 7< (:.5<(F>

q<'-7??')+'+s


C>

#&=(F: .(G' (--':: 57 =(5'< 57U

(> O' (E&' 57 :)188 ()F E1<)/)9 (:. 5.(5 8(&&:>

E> "77& ()F :?(&& E1<): 57 5.' ;(5/')5k: 7< ;<(-5/5/7)'<k: :I/) /??'+/(5'&F>

-> O' ( <'-';5(-&' 87< E1<)5 ?7J(H 1)&':: ( :1/5(E&' (:.5<(F 7< 75.'< )7)R

8&(??(E&' <'-';5(-&' /: ;<'8'<<'+>

A> *'G'< &'(G' ( ;(5/')5 (&7)' =.') ?7J( /: E'/)9 (;;&/'+>

T> %(I' :1<' )7 -&75./)9 /: -&7:' 57 5.' (<'( E'/)9 5<'(5'+ =/5. ?7J/E1:5/7)>

b> K(F G'<F -&7:' (55')5/7) 57 5.' ;(5/')5 +1</)9 ?7J/E1:5/7) (;;&/-(5/7) a +7 )75 &77I

(=(F 8<7? 5.' ;(5/')5 7< ?7J(H =</5' /) 5.' -.(<5H 7< 5(&I 57 ()F7)' E':/+': 5.' ;(5/')5

+1</)9 ?7J/E1:5/7) (;;&/-(5/7)>

D> "7):/+'< 1:/)9 ( .'?7:5(5`5=''\'<:`87<-';: 57 (;;&F ()+ <'?7G' 5.' ?7J( -7)':> ,./:

;<'G')5: 5.' ;<(-5/5/7)'<k: 8/)9'<: 8<7? E'/)9 E1<)'+ ()+ <'+1-': 5.' </:I 78 +<7;;/)9

E1<)/)9 ?7J( 7)57 5.' ;(5/')5 7< 5<'(5?')5 :1<8(-'>

S> $)-' 5.' 5<'(5?')5 /: -7?;&'5'H 5.' -1; 78 =(5'< =/5. 5.' E1<)5 ?7J( :.71&+ E'

8&1:.'+ +7=) 5.' :/)I> W7 )75 ;15 ?7J( (:. +/<'-5&F /)57 ( 5<(:. -() (: 5./: ?(F /9)/5' (

5<(:. 8/<'>

4> *'G'< (;;&F /)5'<;7:'+ ?7J( 57 5.' 8(-' 7< =/5./) 5.' .(/<&/)'>

Indirect Moxibustion - Warming Needle Moxibustion,./: ?'5.7+ 1:': E75. ( )''+&' ()+ ?7J(> #85'< 5.' (-1;1)-51<' ;7/)5 /: )''+&'+ ()+

:5/?1&(5'+ (: +':/<'+ 7< )''+'+ 87< 5.' (<</G(& 78 0/H ( :?(&& :'-5/7) 78 ( ?7J( :5/-I 2(E715 A -?

&7)93 7< ( ?7J( -7)' /: ;&(-'+ 7) 5.' .()+&' 78 5.' )''+&'> ,.' ?7J( :5/-I /: 5.') /9)/5'+ 8<7?

/5: E7557? ()+ (&&7='+ 57 E1<) 715>

,.' ?'5.7+ E'&7= 1:': )7 (++/5/7)(& ?(5'</(& 57 :'-1<' 5.' ?7J( 7) 5.' )''+&'> N):5'(+H (

;<75'-5/G' -7G'< 78 -(<+E7(<+ /: ;&(-'+ 7) 5.' :I/) 57 (G7/+ E1<)/)9 (:.': 8<7? 8(&&/)9 7) 5.'

;(5/')5> $5.'< ?'5.7+: ()+ +'G/-': .(G' E'') 15/&/\'+ :(8'&F 57 ;<'G')5 5.' ?7J( 8<7? 8(&&/)9

7) 5.' ;(5/')5> ,.' :;'-/8/- ?'5.7+ 7< +'G/-' 57 E' 1:'+ -() E' -.7:') E(:'+ 7) :(8'5F

'G/+')-' ()+ ;<(-5/5/7)'< ;<'8'<')-':>

Method

C> %7J( :5/-I: 7< -7)': (<' ;<';(<'+ ;</7< 57 &/9.5/)9 ()F ?7J(>

A> #&& '01/;?')5 /: ;&(-'+ 7) ( :5(E&' :1<8(-' +/<'-5&F )'J5 57 5.' 5<'(5?')5 5(E&'>

601/;?')5U ?7J( :5/-I: 7< &77:' ?7J( 57 ?(I' -7)':H 5=''\'<:`87<-';:`.'?7:5(5H -1;



CBP

78 =(5'< 2/8 +':/<'+3H (:.5<(F 2/8 +':/<'+3H ;<75'-5/G' :I/) -7G'<H &/9.5'<H ()+ /)-'):' :5/-I>

q<'-7??')+'+s

T> ,.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+:> q-</5/-(&s

b> # -&'() )''+&' 5<(F /: ;<';(<'+ (: +/:-1::'+ /) 5.' "*, :'-5/7) 78 5./: ?()1(&> q-</5/-(&s

D>

,.' (-1;1)-51<' /: ;'<87<?'+ 87&&7=/)9 "*, 91/+'&/)':> q-</5/-(&sS> N):'<5 ?'5(&R7)&F )''+&': 57 5.' +';5. <'01/<'+ 57 <'5(/) 5.' )''+&' 1;</9.5 :'-1<'&F>

W7 )75 1:' ;&(:5/- 5/;;'+ )''+&': (: 5.' ;&(:5/- ?(F ?'&5 +1</)9 5.' ?7J( 5.'<(;F>

q<'-7??')+'+s

4> # +/:- 78 /):1&(57< -(<+E7(<+ 7< 75.'< ?(5'</(& /: ;&(-'+ 7) 5.' ;(5/')5k: :I/) (<71)+ 5.'

E(:' 78 5.' )''+&'> #&5'<)(5'&FH ( +'G/-' 7< /):1&(57< ?(5'</(& /: (55(-.'+ 57 5.' )''+&'

E'&7= =.'<' 5.' ?7J( =/&& :/5> O75. ?'5.7+: ;<'G')5 (:. 8<7? 8(&&/)9 7) 5.' ;(5/')5k:

:I/)> q:5<7)9&F <'-7??')+'+s

Q> # :?(&& :5/-I 7< -7)' 78 ?7J( /: ;&(-'+ 7) 5.' .()+&' 78 5.' )''+&'>

P> ,.' /)-'):' /: &/9.5'+H 1:/)9 5.' &/9.5'<H (=(F 8<7? 5.' ;(5/')5> q<'-7??')+'+s

CB> ,.' /)-'):' /: 1:'+ 57 &/9.5 5.' ?7J(H =./-. .(: E'') ;&(-'+ 7) 5.' .()+&' 78 5.'

)''+&'> q<'-7??')+'+s

CC> ̂ .') (E715 A`T 78 5.' ?7J( /: E1<)5 7< 5.' ;(5/')5 8''&: ( =(<? :'):(5/7) (<71)+ 5.'

)''+&'H <'?7G' 5.' -7)' ()+ ;&(-' 5.' ?7J( /) 5.' -1; 78 =(5'< 7< (:.5<(F>

q<'-7??')+'+s

CA> M.71&+ 5.' ;(5/')5 /)+/-(5' 5.(5 5.'<' /: () 1)-7?87<5(E&' (?71)5 78 .'(5H 1:' 5.'

5=''\'<: 7< .'?7:5(5 57 /??'+/(5'&F <'?7G' 5.' )''+&' ()+ ?7J(> ,.' .75 )''+&'

?1:5 E' <'?7G'+ =/5. () /):5<1?')5H :/)-' /5 =/&& E' 577 .75 57 ?()/;1&(5' :(8'&F EF

.()+> q<'-7??')+'+s


C> #&=(F: .(G' (--':: 57 =(5'< 57U

(> O' (E&' 57 :)188 ()F E1<)/)9 (:. 5.(5 8(&&:>

E> "77& ()F :?(&& E1<): 57 5.' ;(5/')5k: 7< ;<(-5/5/7)'<k: :I/) /??'+/(5'&F>

-> O' ( <'-';5(-&' 87< E1<)5 ?7J(H 1)&':: ( :1/5(E&' (:.5<(F 7< 75.'< )7)R8&(??(E&'

<'-';5(-&' /: ;<'8'<<'+>

A> *'G'< &'(G' ( ;(5/')5 (&7)' =.') ?7J( /: E'/)9 (;;&/'+>

T> %(I' :1<' )7 -&75./)9 /: -&7:' 57 5.' (<'( E'/)9 5<'(5'+ =/5. ?7J/E1:5/7)>

b>

K(F G'<F -&7:' (55')5/7) 57 5.' ;(5/')5 +1</)9 ?7J/E1:5/7) (;;&/-(5/7) a +7 )75 &77I(=(F 8<7? 5.' ;(5/')5 7< ?7J(H =</5' /) 5.' -.(<5H 7< 5(&I 57 ()F7)' E':/+': 5.' ;(5/')5

+1</)9 ?7J/E1:5/7) (;;&/-(5/7)>

D> "7):/+'< 1:/)9 ( .'?7:5(5`5=''\'<:`87<-';: 57 (;;&F ()+ <'?7G' 5.' ?7J( -7)':> ,./:

;<'G')5: 5.' ;<(-5/5/7)'<k: 8/)9'<: 8<7? E'/)9 E1<)'+ ()+ <'+1-': 5.' </:I 78 +<7;;/)9

E1<)/)9 ?7J( 7)57 5.' ;(5/')5 7< 5<'(5?')5 :1<8(-'>



CCB

S> $)-' 5.' 5<'(5?')5 /: -7?;&'5'H 5.' -1; 78 =(5'< =/5. 5.' E1<)5 ?7J( :.71&+ E'

8&1:.'+ +7=) 5.' :/)I> W7 )75 ;15 ?7J( (:. +/<'-5&F /)57 ( 5<(:. -() (: 5./: ?(F /9)/5' (

5<(:. 8/<'>

4> *'G'< (;;&F =(<?/)9 )''+&' ?7J( 57 5.' 8(-'>

Indirect Moxa – Technique with Moxa Stick

%7J( :5/-I: ?(F E' 1:'+ '/5.'< 2C3 EF .7&+/)9 5.' ?7J( ART -? 7G'< 5.' :/5' 57 E' 5<'(5'+ 57

E</)9 ?/&+ =(<?5. 57 5.' (<'(`;7/)5 87< 1; 57 CD ?/)15':H 7< 1)5/& 5.' :I/) E'-7?': :&/9.5&F <'+

7< =(<? 57 5.' ;<(-5/5/7)'<k: 571-.i 7< 2A3 5.' /9)/5'+ ?7J( :5/-I /: ?7G'+ 1; ()+ +7=) 7G'<

5.' ;7/)5 7< )'(< 7< (<71)+ () (-1;1)-51<' )''+&'>

O'-(1:' ?7J( :5/-I: -() E' G'<F +/88/-1&5 57 E' &/5 ;<7;'<&FH 87< ;<(-5/5/7)'< :(8'5FH /5 /:

<'-7??')+'+ 5.(5 ( -()+&'H 7< 8/<';&(-' 8&(?' 57<-. E' 1:'+> N) 5.' ?'5.7+ E'&7=H ( -()+&' /:

1:'+> $5.'< ?'5.7+: 5.(5 I''; 5.' 8&(?' (=(F 8<7? 5.' ;(5/')5 ()+ 5.' ;<(-5/5/7)'<k: 8/)9'<:

?(F E' 15/&/\'+ E(:'+ 7) ;<(-5/5/7)'< ;<'8'<')-'>

Method

C> #&& '01/;?')5 /: ;&(-'+ 7) ( :5(E&' :1<8(-' +/<'-5&F )'J5 57 5.' 5<'(5?')5 5(E&'>

601/;?')5U ?7J( :5/-IH ?7J( 'J5/)91/:.'<H -1; 78 =(5'< 2/8 +':/<'+3H &/9.5'<H ()+ -()+&'>

q<'-7??')+'+s

A> ,.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+:> q-</5/-(&s

T> X/9.5 5.' -()+&' 1:/)9 5.' &/9.5'<> ,.') &/9.5 5.' ?7J( :5/-I 1:/)9 5.' -()+&'>

q<'-7??')+'+s

b> N??'+/(5'&F 'J5/)91/:. 5.' -()+&' 7)-' 5.' ?7J( /: &/5> q<'-7??')+'+s

D>

#;;&F ?7J( 1:/)9 7)' 78 5.' ?'5.7+: (E7G'>

S> 6G'<F 8'= ?/)15':H 5(; ()F (:. 8<7? 5.' ?7J( :5/-I /)57 5.' ?7J( 'J5/)91/:.'< 57

;<'G')5 8(&&/)9 (:. 8<7? 8(&&/)9 7) 5.' ;(5/')5 7< 5.' 5(E&'> q:5<7)9&F <'-7??')+'+s

4> ^.') 5.' ;(5/')5 8''&: =(<?5.H <'?7G' 5.' :5/-I ()+ (;;&F 57 5.' )'J5 ;7/)5 57 E'

=(<?'+H (: )''+'+> q<'-7??')+'+s

Q> #85'< 5.' <'01/:/5' ;7/)5: .(G' E'') =(<?'+ (: /)+/-(5'+ 87< 5.' 5<'(5?')5 +':/<'+H

;&(-' 5.' ?7J( :5/-I /) 5.' 'J5/)91/:.'<H &/5 ')+ +7=)=(<+> q-</5/-(&s

P> L:' 5.' -1; 78 =(5'<H /8 )'-'::(<FH 57 'J5/)91/:. (:. 5.(5 8(&&: 715:/+' 78 5.' ?7J(

'J5/)91/:.'< 5<(F> q<'-7??')+'+s


C> #&=(F: .(G' =(5'< 7) .()+ 57U

(> O' (E&' 57 :)188 ()F E1<)/)9 (:. 5.(5 8(&&:>

E> "77& ()F :?(&& E1<): 57 5.' ;(5/')5k: 7< ;<(-5/5/7)'<k: :I/) /??'+/(5'&F>

A> *'G'< &'(G' ( ;(5/')5 (&7)' =.') ?7J( /: E'/)9 (;;&/'+>





CCA

2. Heat Lamps

Best Practice Protocols for Heat Lamps

d'(5 &(?;: (<' +':/9)'+ 87< 1:' /) (;;&/-(5/7): :;'-/8/-(&&F <'01/</)9 ( :.7<5R=(G' /)8<(<'+

<(+/(5/7) :71<-'> N)8<(<'+ <(+/(5/7) 8<7? 5./: &(?; -(1:': :1<8(-': 57 E' .'(5'+> [7< ?7:5 785.' -7??7)&F 1:'+ -7??'<-/(& .'(5 &(?;: 2:1-. (: ,WK &(?;:3H &(?;: :.71&+ )'G'< E' ;&(-'+

-&7:'< 5.() CA /)-.': 57 ()F ;'<:7) 7< :1<8(-'> M7?' .'(5/)9 &(?;: (<' +':/9)'+ 87< ?1-.

&7='< 5'?;'<(51<': ()+ ?(F E' E<719.5 -&7:'< 57 5.' ;(5/')5k: :I/) :1<8(-' /8 5.(5 -() E'

(--7?;&/:.'+ :(8'&F ()+ (--7<+/)9 57 5.' ?()18(-51<'<k: ?()1(&:>

Method

[7< 1:' =.') .'(5/)9 /: )''+'+ 7G'< ( 9')'<(& (<'( 87< 5.'<(;'15/- =(<?/)9>

C> ".'-I &(?; 87< ()F +'8'-5:> q-</5/-(&s

A>

".'-I 5.' (<'( 57 E' 5<'(5'+ 87< :I/) &':/7):> q:5<7)9&F <'-7??')+'+sT> %(I' :1<' (&& -&75./)9 ()+ -7?E1:5/E&' ?(5'</(&: (<' ?7G'+ :188/-/')5&F 715 78 5.' (<'(

57 E' .'(5'+> q:5<7)9&F <'-7??')+'+s

b> K&19 &(?; /)57 5.' =(&& :7-I'5>

D> K7:/5/7) &(?; .'(+ (5 &'(:5 CA /)-.': 8<7? 5.' (<'( 57 E' .'(5'+> q:5<7)9&F

<'-7??')+'+s

S> ,1<) 7) 5.' .'(5 &(?; 5.') :'5 5/?' 87< )7 ?7<' 5.() CBRCD ?/)15':> q<'-7??')+'+s

4> O'-(1:' 5.' .'(5 78 5.' &(?; ?(F -(1:' 5.' .'(+ 78 5.' 1)/5 57 +<7; 57=(<+ 5.'

;(5/')5H )'G'< &'(G' 5.' /??'+/(5' (<'( 78 ( ;(5/')5 E'/)9 5<'(5'+ =/5. ( .'(5 &(?;>

q:5<7)9&F <'-7??')+'+sQ> ".'-I 5.' (<'( E'/)9 .'(5'+ (5 &'(:5 7)-' 'G'<F D ?/)15': 57 E' :1<' 5.(5 5.' :I/) +7':

)75 E'-7?' 577 .75 7< 5.(5 5.' &(?; (<? ;7:/5/7) .(: )75 -.()9'+> q:5<7)9&F

<'-7??')+'+s

P> L);&19 5.' &(?; 7)-' 5.' .'(5/)9 ;'</7+ .(: ')+'+> q<'-7??')+'+s


• "</5/-(&U d'(5 5.'<(;/': ?1:5 E' -&7:'&F ?7)/57<'+ EF ;<(-5/5/7)'<:>

• "</5/-(&U d'(5 &(?;: :.71&+ )75 E' 1:'+ 7) /)8()5:H -./&+<')H /)-(;(-/5(5'+H :&'';/)9H 7<

1)-7):-/71: ;'<:7):>

• "</5/-(&U ^.') .'(5 &(?;: (<' 1:'+ 7) ;(5/')5: =.7 .(G' ( <'+1-'+ <':;7):' 57 .'(5H

5.' 1:' 78 .'(5 ?1:5 E' ?7)/57<'+ (5 (&& 5/?':>

• "</5/-(&U K<'G')5 =(5'<H ?7/:51<'H &/01/+: 7< ?'5(& 7E]'-5: 8<7? -7?/)9 /) -7)5(-5 =/5.

5.' &(?;> W7 )75 1:' ( .'(5 &(?; /) ='5 7< ?7/:5 ')G/<7)?')5:>

• "</5/-(&U W7 )75 1:' /8 ()F ;(<5 78 5.' &(?; /: -<(-I'+> W7 )75 (&&7= ()F ;(<5 78 5.' &(?;

57 571-. (--'::7<F '01/;?')5>



CCT

• M5<7)9&F Y'-7??')+'+U d'(5 &(?;: :.71&+ )75 E' 1:'+ =/5.715 ( <':;7):/E&'

(55')+()5 ;<':')5 +1</)9 5.' ')5/<' +1<(5/7) 78 1:'>

• M5<7)9&F Y'-7??')+'+U W7 )75 1:' 7G'<R:'):/5/G' :I/) 7< ;'<:7): .(G/)9 ;77< E&77+

-/<-1&(5/7)> M188/-/')5 5'?;'<(51<': (<' 9')'<(5'+ 5.(5 ?(F -(1:' E1<):>

•

M5<7)9&F Y'-7??')+'+U ,(I' ( -(<'81& ;(5/')5 ./:57<F 57 /+')5/8F +/(E'5':H)'1<7;(5./':H 7< 75.'< -7)+/5/7): 5.(5 ?/9.5 &/?/5 ( ;(5/')5k: <':;7):' 57 ;(/) 7< 5.'

(E/&/5F 57 :'):' .'(5>

• M5<7)9&F Y'-7??')+'+U ,.' ;<(-5/5/7)'< :.71&+ ?7)/57< 5.' ;(5/')5k: :I/) 5'?;'<(51<'

()+ 5.' (?71)5 78 .'(5 9')'<(5'+ EF ( .'(5 &(?; ()+ )75 <'&F :7&'&F 7) ;(5/')5

8''+E(-I (E715 .'(5 :'):(5/7):>

• M5<7)9&F Y'-7??')+'+U W7 )75 1:' 5./: .'(5 :71<-' /) -&7:' ;<7J/?/5F 57 -7?E1:5/E&'

?(5'</(&: 2&/55'<H ;(;'<H '5->3 7< 57 ?(5'</(&: (+G'<:'&F (88'-5'+ EF .'(5 7< +<F/)9>

• Y'-7??')+'+U ^.') ( ;(5/')5k: /)87<?(5/7) /: 1)-&'(<H <'01':5 () 7;/)/7) 8<7? (

;.F:/-/() E'87<' 1:/)9 ( .'(5 &(?; 7) 5.' &/?E: 78 ( ;(5/')5 =/5. +/(E'5/- 7< 75.'<)'1<7;(5./':>



CCb

3.Cupping

Cupping Overview

"1;;/)9 2E( 91() 8(+3 /: ( 5.'<(;'15/- ;<7-'+1<' 1:'+ EF #$% ()+ 75.'< .'(&5.-(<'

;<(-5/5/7)'<: (<71)+ 5.' =7<&+> "1;;/)9H 7)' 78 5.' 7&+':5 ?'5.7+: 78 5<(+/5/7)(& "./)':'

?'+/-/)'H /: (--7?;&/:.'+ EF .(G/)9 ( -1; (;;&/'+ 57 5.' :I/)i 5.' ;<'::1<' /) 5.' -1; /:

<'+1-'+ EF 1:/)9 ( -.()9' /) .'(5 7< EF :1-5/7)/)9 715 (/<H :7 5.(5 5.' :I/) ()+ :1;'<8/-/(&

?1:-&' &(F'< /: +<(=) /)57 ()+ .'&+ /) 5.' -1;> "1;;/)9 1:': ( ;(<5/(& G(-11? 57 /)5')5/7)(&&F

-<'(5' 5.'<(;'15/- ;'5'-./(' ()+ '--.F?7:/: /) 5.' +'<?/:> ,.'<' (<' ( )1?E'< 78 -1;;/)9

:5F&':H /)-&1+/)9 :1-5/7) -1;;/)9H 8/<' -1;;/)9H '?;5F -1;;/)9H :&/+/)9 7< 9&/+/)9 -1;;/)9> O':5

;<(-5/-' 91/+'&/)': (<' ;<7G/+'+ 87< 5.<'' 78 5.':' :5F&':U 8/<' -1;;/)9H :1-5/7) -1;;/)9H ()+ ='5

-1;;/)9 7< -1;;/)9 (85'< 5.' 1:' 78 ( &()-'5 87< E&77+ =/5.+<(=(&>

General Recommendations for Cupping

• "</5/-(&U [7&&7= M5()+(<+ K<'-(15/7):>

• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 M.%"R,*.C*-4 "-+ H"*-%"*-*-4 " F,$"- <*$,+ >

• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 I"-+ !"-*% (5*/->

• "</5/-(&U "1;;/)9 :.71&+ )75 E' (;;&/'+ bQ .71<: E'87<' 7< Ab .71<: (85'< -.'?75.'<(;F

5<'(5?')5>

• "</5/-(&U "1; 7G'< -&'(< :I/) 7)&F> W7 )75 -1; 7G'< () (-5/G' :I/) &':/7)H ?7&':H :='&&/)9H

5<(1?(H /)8&(??(5/7)H /)8'-5/7)H 7< E1<): 2/)-&1+/)9 :1)E1<)3>

• "</5/-(&U K<(-5/5/7)'<: ?1:5 5(I' ( 5.7<719. ./:57<FH /)-&1+/)9 E&''+/)9 +/:7<+'<: ()+

?'+/-(5/7) ./:57<FH E'87<' (;;&F/)9 -1;:>

• "</5/-(&U K<(-5/5/7)'<: ?1:5 5(I' ( 5.7<719. ./:57<F 57 /+')5/8F +/(E'5':H )'1<7;(5./': 7<

75.'< -7)+/5/7): 5.(5 ?/9.5 &/?/5 ( ;(5/')5k: <':;7):' 57 ;(/) =.') ;&())/)9 57 15/&/\'

8/<' -1;;/)9>

• "</5/-(&U M-<'') ;(5/')5: 87< ./:57<F 78 <'(-5/G' :I/) &':/7): :1-. (: I'&7/+ :-(<</)9 7<

fw'E)'< ;.')7?')7)>

• "</5/-(&U #::':: -(<'81&&F 5.' 1:' 78 8/<' -1;;/)9 7) ;(5/')5: =.7 .(G' ( +'-<'(:'+

<':;7):' 57 ;(/) 2'>9>H 5.7:' =/5. +/(E'5': 7< )'1<7;(5./':3>

• "</5/-(&U K<(-5/5/7)'<: ?1:5 =(:. .()+: E'87<' :5(<5/)9 5.' ;<7-'+1<' ()+ (9(/) (85'<

<'?7G/)9 9&7G': 2/8 1:'+3>

• "</5/-(&U K'<:7)(& ;<75'-5/G' '01/;?')5 2KK63 R ='(< 9&7G': ()+ 'F' ;<75'-5/7) (5 (&&

5/?': =.') E&77+ 7< $KN% ?(F E' ;<':')5 2='5 -1;;/)9H -1;;/)9 (85'< )''+&/)93>

• "</5/-(&U 6(-. (<'( 57 E' ='5 -1;;'+ ?1:5 E' -&'()'+ /??'+/(5'&F E'87<' -1;;/)9 EF 5.'

;<(-5/5/7)'<>

• "</5/-(&U X()-'5: 1:'+ 87< ='5 -1;;/)9 :.71&+ E' :5'</&'H 1:'+ 7)&F 7)-'H 5.') +/:-(<+'+

/) ( ;<7;'< :.(<;: -7)5(/)'<>



CCD

• "</5/-(&U N8 E&77+ 7< 75.'< $KN% (<' ;<':')5H -7&&'-5 =/5. -7557) :=(EH 9(1\'H ;(;'<

57='&H 7< -&75. ()+ +/:;7:' /) E/7.(\(<+ 5<(:.>

• "</5/-(&U ^.') E&77+ 7< 75.'< $KN% (<' ;<':')5H (&&7= 5.' G(-11? 57 E' -7?;<7?/:'+

:&7=&FH ()+ 5.') <'?7G' 5.' -1;>

•

"</5/-(&U N8 &1E</-()5: (<' 1:'+ 87< 9&/+/)9 -1;;/)9 7< ?7G/)9 -1;;/)9H +'-()5 ( ;7<5/7) 87<1:'> W7 )75 +/; E(-I /)57 &1E</-()5 -7)5(/)'< 7< 571-. 5.' :;715 78 ( ;1?; -7)5(/)'<

=./&' -1;;/)9>

• "</5/-(&U L:' (;;<7;</(5' KK6 =./&' -&'()/)9 ()+ +/:/)8'-5/)9 -1;:>

• "</5/-(&U "&'() (&& -1;: 78 (&& &1E</-()5: ()+ E/7&79/-(& ?(5'</(& 1:/)9 :7(; ()+ =(5'<

E'87<' +/:/)8'-5/)9>

• "</5/-(&U W/:/)8'-5 (&& -1;: 1:/)9 () (;;<7;</(5' [W#R-&'(<'+ /)5'<?'+/(5'R 57 ./9.R&'G'&

+/:/)8'-5/)9 :7&15/7) /) (--7<+()-' =/5. &(E'& /):5<1-5/7):>

• M5<7)9&F Y'-7??')+'+U L:' -(15/7) /8 -1;;/)9 ;(5/')5: -1<<')5&F 5(I/)9 ()5/R-7(91&()5

?'+/-(5/7):>

•

M5<7)9&F Y'-7??')+'+U "1;;/)9 7G'< )''+&': ?(F -(1:' )''+&': 57 5<(G'& E'F7)+ (

:(8' +';5.> 6/5.'< /):'<5 5.' )''+&' 7E&/01'&FH 7< (G7/+ 5.' 5.'<(;F /) (<'(: =/5.

1)+'<&F/)9 7<9():>

• M5<7)9&F Y'-7??')+'+U K&(-' E1<)/)9 ?(5'</(& /)57 5.' +'';':5 ;(<5 78 -1;H ()+ )'G'<

<'5(/) 5.' E1<)/)9 ?(5'</(& /):/+' 5.' -1;: =.') 5.' -1;: (<' ;&(-'+ 7)57 5.' :I/)>

• M5<7)9&F Y'-7??')+'+U $E:'<G' -(<'81& ()+ &/?/5 <'5')5/7) 5/?' 57 5.' ;.F:/-(&

57&'<()-' 78 5.' ;(5/')5>

• M5<7)9&F Y'-7??')+'+U W/:/)8'-5 (&& -1;: 1:/)9 ( ./9.R&'G'& +/:/)8'-5/)9 :7&15/7)

87&&7=/)9 ;(-I(9' +/<'-5/7): 87< :'?/R-</5/-(& +'G/-':>

•

M5<7)9&F Y'-7??')+'+U 6J;&(/) 5.'<(;'15/- /)5')5/7) 78 -1;;/)9 ()+ ;<':')5 ( 5/?'&/)'

78 <':7&15/7)> "1; -./&+<') 7)&F /) 5.' ;<':')-' 78 ( ;(<')5 7< (::/9)'+ 91(<+/()>

• Y'-7??')+'+U L:' +/:;7:(E&' -1;: 87< ='5 -1;;/)9 ()+ +/:;7:' 78 1:'+ ='5 -1;: /)

5.' E/7.(\(<+ 5<(:.>

• Y'-7??')+'+U # .()+715 'J;&(/)/)9 -1;;/)9 /) -&/)/-(& ;<(-5/-'H /)-&1+/)9 :I/) -.()9':

()+ ( 5/?'&/)' 87< 5.'/< <':7&15/7)H ?(F ;<75'-5 5.' ;(5/')5 8<7? 5.' :5<':: 78

?/:/)5'<;<'5(5/7)>

Sample Best Practice Protocols for Cupping

#85'< <'G/'=/)9 5.' &/5'<(51<' (E715 -1;;/)9 :(8'5F 2K(<5 N 78 5./: ?()1(&3H 5.' :(8'5F<'-7??')+(5/7): (E7G'H ()+ 1:/)9 5.' /)87<?(5/7) (E715 5.' ;7::/E&' #6: (::7-/(5'+ =/5.

-1;;/)9 5.'<(;/':H 5.' 87&&7=/)9 E':5 ;<(-5/-' 91/+'&/)': .(G' E'') +'G'&7;'+> #: :5(5'+ (5 5.'

:5(<5 78 5./: :'-5/7) 78 5.' ?()1(&H 5.':' ;<7-'+1<': (<' +':/9)'+ 57 &/?/5 +()9'<: 57 ;(5/')5:H

;<(-5/5/7)'<: ()+ :5(88> N) (&& -(:':H 5.' 87&&7=/)9 ;<7-'+1<': -() E' <'G/:'+ (: )''+'+ 57 I'';

1; =/5. 5.' &(5':5 <':'(<-. ()+ ?7+/8/'+ (: )''+'+ 87< :;'-/8/- :5F&': 78 ;<(-5/-' (: &7)9 (:

:(8'5F <'?(/): 5.' ;</7</5F>



CCS

Fire Cupping Method

!"#$ &'()*+,'* #-.(/.*$ 0"* ,$* (1 2- (&*- 1/23* -*2' 2 &20#*-04 !"#$ 3256 #1 0"* 0*)"-#7,* #$

!"# %"!& '(""#)*+, "--.'/"!.**+ -.0'& 102!/!3 ()+ E&/:5'</)9 78 5.' :I/) 28/<:5 7< :'-7)+ +'9<''

E1<)3> N) (++/5/7)H 5.' -1;;/)9 ?(F &'(G' <'+ 7< E<1/:'R&/I' -/<-1&(< ?(<I: =.'<' 5.' -1;: (<'

(;;&/'+> ,.' ;(5/')5 :.71&+ E' '+1-(5'+ 5.(5 5.':' ?(<I: (<' -7??7);&(-' =/5. 5./:5'-.)/01'> ,.' ;(5/')5 :.71&+ (&:7 E' /)87<?'+ 5.(5 5.'F :.71&+ I''; 5.' -1;;'+ (<'(

;<75'-5'+ 8<7? =/)+ 7< -7&+ +<(85:> N5 /: :5<7)9&F <'-7??')+'+ 5.(5 ;(5/')5: E' (:I'+ 87<

-7):')5 E'87<' (;;&F/)9 -1;;/)9 5'-.)/01':>

C> #&& '01/;?')5 /: ;&(-'+ 7) ( :5(E&' :1<8(-' +/<'-5&F )'J5 57 5.' 5<'(5?')5 5(E&'>

601/;?')5U -1;;/)9 ](<H .'?7:5(5H &/9.5'<H -7557) E(&&H (&-7.7&H ()+ E1<) -<'(?>

q<'-7??')+'+s

A> ,.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+:> q-</5/-(&s

T> N8 5.' (<'( 57 =./-. -1;;/)9 =/&& E' (;;&/'+ )''+: 57 E' -&'()'+H -&'()/)9 -() E'

(--7?;&/:.'+ =/5. (&-7.7&H :7(; ()+ =(5'<H 7< ()75.'< -&'():/)9 5'-.)/01' q-</5/-(&s

b> ,.' 8&(?' (;;(<(51: /: ;<';(<'+ EF -&(?;/)9 ( -7557) E(&& /) 5.' .'?7:5(5 ()+ 5.')

:&/9.5&F ?7/:5')/)9 5.' -7557) =/5. (&-7.7&> #&5'<)(5'&FH () (&-7.7& :=(E ?(F E' 1:'+>

D> ,.' ](< /: .'&+ =/5. 5.' ?715. 8(-/)9 ;'<;')+/-1&(<&F 57 5.' :I/) :1<8(-' /) 5.' )7)R

+7?/)()5 .()+> q:5<7)9&F <'-7??')+'+s

S> ,.' 8&(?' (;;(<(51: /: &/5 ()+ 5.') /) 7)' :/)9&' ?75/7)U

(> ,.' 8&(?' /: /)5<7+1-'+ +''; /)57 5.' -1; 01/-I&F ()+ ;1&&'+ (=(F (5 5.' :(?'

5/?' 5.(5 5.' -1; /: 5.') (;;&/'+ 57 5.' :I/) :1<8(-' q-</5/-(&s

E> ,.' .'?7:5(5 /: <'?7G'+ 7E&/01'&F (=(F 8<7? 5.' ;(5/')5k: :I/) :1<8(-' /) 7<+'<

57 '):1<' :(8'5F> q:5<7)9&F <'-7??')+'+s

-> ,.' 8&(?' /: 'J5/)91/:.'+> q-</5/-(&s

+> $)-' 5.' 8&(?' .(: E'') 'J5/)91/:.'+ ()+ 5.' 8&(?' (;;(<(51: <'?7G'+ 57 5.'

'01/;?')5 :1<8(-'H 5.' ;<(-5/5/7)'< =/&& +'5'<?/)' 5.' &'G'& 78 :1-5/7) /)+1-'+

()+ =/&& <'5(/) 5.' -1; 87< ARCB ?/)15': 7< ?7<' 7< <';'(5 5.' (E7G' ;<7-'+1<'

57 -<'(5' ( :5<7)9'< G(-11?>

4> ,.' -1; /: <'?7G'+ =.') 5.' 5.'<(;F /: +7)' EF 9')5&F ;<F/)9 5.' ](< '+9' 1; 8<7? 5.'

:I/) 7< +';<'::/)9 5.' :I/) )'J5 57 5.' </? 78 5.' -1; 57 +'8'(5 5.' G(-11?> ,.' -1; /:

5.') ;15 (:/+' ()+ ;<7-'::'+ 87< -&'()/)9 ()+ +/:/)8'-5/)9> q:5<7)9&F <'-7??')+'+s


• ! #$%& '#()& $* +,$#$-&. (/. *0 (## 1201&! #!$%&'()*+, &, )+-)%&($- $.,$/0$!$ )+ (0),

!"#$"% !$'( )* +,%%,-*./ 0#1%$.0#2 '*((0#2 $3 *4$03!*#( ,# " -,56 '$5+"1* (7"( 0' #,(

!"#$$#%"& (&#)* %+, (-, -(* ,.& ,)&#,$&(, ,#%"&/ 01)2,21#"3

• !"# %&'( )*+,# -.)/ 0# (#*/ ,1#+' &2 &0)/'.,/3&4)5 q:5<7)9&F <'-7??')+'+s



CC4

• d(G' (--':: 57 =(5'< 57 ;15 715 5.' 8&(?' /8 )'-'::(<F 7< 57 -77& 5.' :I/) /8 ( :?(&& E1<)

+7': 7--1<> q<'-7??')+'+s

• K(F G'<F -&7:' (55')5/7) 57 5.' ;(5/')5 +1</)9 5.' -1; (;;&/-(5/7)> q:5<7)9&F

<'-7??')+'+s

•

!"#$ " &'($ $)*'+,-'./$( 0+ /"+1 '+ " (!!" $% &'$(' )!* +,- *.$%/ 0$,-R!"#$%&'( *+,,&'(-!"#$%&&#'(#()

• !" $%&'% ($ )%'*'"( +,-" -"./%01 2!"#$ &!" '() *+ ",#! #-. /"+*'" -0"

!"# %!&' ()*' +,!+

!"#$# &' () *$)+#( )$ ,$-,+#. -$#-! !"#$%$"&'(

Suction Cupping

"1;;/)9 ?(F &'(G' <'+ 7< E<1/:'R&/I' -/<-1&(< ?(<I: =.'<' 5.' -1;: (<' (;;&/'+> ,.' ;(5/')5

:.71&+ E' '+1-(5'+ 5.(5 5.':' ?(<I: (<' -7??7);&(-' =/5. 5./: 5'-.)/01'> ,.' ;(5/')5 :.71&+

(&:7 E' /)87<?'+ 5.(5 .' 7< :.' :.71&+ I''; 5.' -1;;'+ (<'( ;<75'-5'+ 8<7? =/)+ 7< -7&+

+<(85:> N5 /: :5<7)9&F <'-7??')+'+ 5.(5 ;(5/')5: E' (:I'+ 87< -7):')5 E'87<' (;;&F/)9 -1;;/)9

5'-.)/01':>

#: 5./: ?'5.7+ 1:': )7 8&(?'H E1<): (<' )75 () (+G'<:' 'G')5 (::7-/(5'+ =/5. 5./: ?'5.7+ 78

-1;;/)9>

Method

C> #&& '01/;?')5 /: ;&(-'+ 7) ( :5(E&' :1<8(-' +/<'-5&F )'J5 57 5.' 5<'(5?')5 5(E&'>

601/;?')5U -1;;/)9 ](<:H ;1?; 'J5<(-57<H &1E</-()5> q<'-7??')+'+s

A> ,.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+:> q-</5/-(&s

T>

N8 5.' (<'( 57 =./-. -1;;/)9 =/&& E' (;;&/'+ )''+: 57 E' -&'()'+H 1:' (&-7.7&H :7(; ()+=(5'<H 7< ()75.'< -&'():/)9 5'-.)/01'> q:5<7)9&F <'-7??')+'+s

b> # :?(&& (?71)5 78 &75/7) 7< &1E</-()5 /: (;;&/'+ 57 5.' :I/)> q<'-7??')+'+s

D> K&(-' 5.' -1; 7) 5.' :I/)H (55(-. 5.' ;1?; 'J5<(-57<H ()+ <'?7G' ')719. (/< 57 E</)9

:7?' :I/) /)57 5.' -1;>

S> ,.' -1; /: <'?7G'+ =.') 5.' 5.'<(;F /: +7)' EF <'&'(:/)9 5.' :1-5/7) G(&G' 57 +'8'(5

5.' G(-11?> ,.' -1; /: 5.') ;15 (:/+' ()+ ;<7-'::'+ 87< -&'()/)9 ()+ +/:/)8'-5/)9>

q<'-7??')+'+s

Wet Cupping

,./: ?'5.7+ /)G7&G': E75. E&77+R&'55/)9 ()+ -1;;/)9> O':5 ;<(-5/-': 87< E75. ;(<5: 78 5./:

5<'(5?')5 (<' /)-7<;7<(5'+ E'&7=>



CCQ

Method

C> #&& '01/;?')5 /: ;&(-'+ 7) ( :5(E&' :1<8(-' +/<'-5&F )'J5 57 5.' 5<'(5?')5 5(E&'>

601/;?')5U -1;;/)9 ](<:H &1E</-()5H ()+ ( -&'() 8/'&+ =/5. &()-'5:H -7557) E(&&:H (&-7.7&

:=(E:H :5'</&' 9(1\'H :.(<;: -7)5(/)'<H ()+ :I/) -&'():'<> q<'-7??')+'+s

A>

,.' ;<(-5/5/7)'< =(:.': ./: 7< .'< .()+:> q-</5/-(&sT> K<(-5/5/7)'<: ?1:5 1:' 9&7G': ()+ :.71&+ (&:7 15/&/\' 'F' ;<75'-5/7) 57 ;<'G')5 'J;7:1<'

57 E&77+> q-</5/-(&s

b> ,.' (<'( 57 =./-. -1;;/)9 =/&& E' (;;&/'+ /: -&'()'+ =/5. (&-7.7& 27< ?(F E' 5.7<719.&F

-&'()'+ =/5. (;;<7;</(5' ?(5'</(&: :1-. (: :7(; ()+ =(5'<3> q-</5/-(&s

D> ,.' :I/) (5 5.' :/5' :.71&+ E' ;1)-51<'+ 1:/)9 :5'</&' &()-'5:H =/5. ( )'= &()-'5 E'/)9

1:'+ 87< '(-. ;1)-51<'> q-</5/-(&s W/:-(<+ 5.' &()-'5: +/<'-5&F /)57 5.' :.(<;: -7)5(/)'<

(85'< 1:'> q-</5/-(&s

S> #;;&F 5.' -1;: 2;1?; 7< 8&(?' -1;;/)9 (: +':-</E'+ (E7G'3 ()+ <'5(/) 87< 5.' +':/<'+

&')95. 78 5.'<(;F>4> N8 5.' ;<(-5/5/7)'< .(: <'?7G'+ '/5.'< 9&7G': 7< 9799&':H ;15 5.' ;'<:7)(& ;<75'-5/G'

'01/;?')5 2KK63 E(-I 7) 87< -1; <'?7G(&> q-</5/-(&s

Q> #&&7= 5.' G(-11? 57 E' -7?;<7?/:'+ :&7=&F 5.') <'?7G' 5.' -1;H 5(I/)9 -(<' 57

;<'G')5 E7+F 8&1/+ 8<7? :;<'(+/)9 7< :;&(:./)9> q-</5/-(&s

P> N??'+/(5'&F /:7&(5' 5.' -1;:>

CB> M57; ()F -7)5/)1'+ E&''+/)9 5.<719. 1:' 78 (;;<7;</(5' ;<'::1<' 1:/)9 :5'</&' 9(1\'>

q-</5/-(&s

CC> "&'() 1; ()F E&''+/)9 5.(5 .(: 7--1<<'+> "&'() 5.' :/5' 78 5.' ;1)-51<': =/5. ()

(;;<7;</(5' :I/) -&'():'<> q:5<7)9&F <'-7??')+'+s

CA> W/:-(<+ 'J5<(G(:(5'+ E&77+ /) 5.' E/7.(\(<+ 5<(:.> q-</5/-(&s

CT> N??'+/(5'&F =(:. -1;: =/5. :7(; ()+ =(5'<>

Cb> Y'?7G' 9799&':H 97=) ()+ 9&7G':> W/:;7:' 78 KK6 (: /)+/-(5'+ EF 5.' -&/)/-k: $Md#

:5()+(<+>

CD> ̂ (:. .()+: =/5. :7(; ()+ =(5'<> q-</5/-(&s

CS> Y'?7G' -1;: 57 ;<7-'::/)9 (<'( 87< /):5<1?')5 +'-7)5(?/)(5/7)>

C4> "&'() 5.' -1;: 78 ()F E/7&79/-(& ?(5'</(& =/5. :7(; ()+ =(5'< ()+ &1E</-()5 ,d6*

:5'</&/\' 5.' -1;:> q-</5/-(&s $<H +/:-(<+ -7)5(?/)(5'+ -1;: /) 5.' E/7.(\(<+ 5<(:.>

q<'-7??')+'+s

CQ> M5'</&/\' =/5. ( (157-&(G' 7< EF 87&&7=/)9 &(E'& /):5<1-5/7) 87< ./9.R&'G'& +/:/)8'-5/7)

:7&15/7) 287< 'J(?;&'H /??'<:' 87< S .71<: /) 4>Tt .F+<79') ;'<7J/+' :7&15/7)3>q-</5/-(&s

CP> "&'() '01/;?')5 :1<8(-' ()+ 5(E&' =/5. () (;;<7;</(5' +/:/)8'-5()5 :7&15/7)> q-</5/-(&s



CCP

4. Therapeutic Blood Withdrawal

Bleeding Overview

N) FC*-$.$ =7)@)-7%)1$ "-+ H/D*R).%*/-5 2C3 5.' 1:' 78 5.' 5.<''R'+9'+ )''+&' 2&()-'3 /: :(/+

57 .(G' E'') ./:57</-(&&F 1:'+ 87< ./9. 8'G'<H ?')5(& +/:7<+'<:H :7<' 5.<7(5H ()+ &7-(& -7)9':5/7)7< :='&&/)9> %7+'<) ;<(-5/5/7)'<: ?(F 1:' E&''+/)9 5'-.)/01': 57 -&'(< .'(5 :F)+<7?':H

:5<7)9&F +/:;'<:' ;7/)5:H ()+ :5<7)9&F :5/?1&(5' :;'-/8/- ;7/)5:> #: 57 5'-.)/01'H 5.' ;7/)5 57 E'

E&'+ /: ;</-I'+ :1;'<8/-/(&&FH ]1:5 B>BDRB>C -1) 2/)-.':3 +'';H =./-. :.71&+ E' &/9.5 ()+

:1;'<8/-/(& ()+ 5.' (?71)5 78 E&''+/)9 57 E' z+'5'<?/)'+ EF 5.' ;(5.7&79/-(& -7)+/5/7)>z N)

9')'<(&H (-1;1)-51</:5: :.71&+ 1:' -(15/7) /8 '?;&7F/)9 E&''+/)9 5.'<(;F 87< ;'<:7): =.7 .(G'

='(I)':: 78 5.'/< F/) 7< F()9 0/H ( E&''+/)9 +/:7<+'<H ( ='(I -7):5/515/7)H 7< =.7 5(I'

()5/-7(91&()5 ?'+/-(5/7)>

General Recommendations for Bleeding Techniques

• "</5/-(&U K'<:7)(& ;<75'-5/G' '01/;?')5 2KK63 R ='(< 9&7G': (5 (&& 5/?': (: E&77+ ()+

$KN% =/&& E' ;<':')5>

• "</5/-(&U X()-/)9 +'G/-': ?1:5 E' &/?/5'+ /) 1:' 57 ( :/)9&' ;(5/')5>

• "</5/-(&U X()-'5: :.71&+ E' 1:'+ 7)&F 7)-'H ()+ 5.') +/:-(<+'+ /) ( ;<7;'< :.(<;:

-7)5(/)'<>

• "</5/-(&U X()-'5: :.71&+ E' 1:'+ 7)&F 7)-' ()+ -())75 E' <'/):'<5'+ /)57 ()75.'< :/5'

7) 5.' :(?' 7< ( +/88'<')5 ;(5/')5>

• "</5/-(&U K<(-5/5/7)'<: ?1:5 5(I' ( 5.7<719. ./:57<FH /)-&1+/)9 E&''+/)9 +/:7<+'<: ()+

?'+/-(5/7) ./:57<FH E'87<' 1:/)9 E&''+/)9 5'-.)/01':>

• "</5/-(&U W7 )75 E&''+ /) () (<'( 78 () (-5/G' :I/) &':/7)>

• Y'-7??')+'+U L5/&/\' 'F' ;<75'-5/7)H :1-. (: 9799&':H =.') ;'<87<?/)9 E&''+/)9

5'-.)/01':>

• Y'-7??')+'+U L5/&/\' :/)9&'R1:' &()-'5: ')9/)''<'+ 57 <'5<(-5 (85'< 1:' 57

:/9)/8/-()5&F <'+1-' 5.' </:I 78 )''+&':5/-I /)]1</':>

Sample Best Practice Protocol for Bleeding Acupuncture Points

#85'< <'G/'=/)9 5.' &/5'<(51<' (E715 E&''+/)9 :(8'5F 2/) K(<5 N 78 5./: ?()1(&3H 5.' :(8'5F

<'-7??')+(5/7): (E7G'H ()+ 5.' /)87<?(5/7) (E715 5.' ;7::/E&' #6: (::7-/(5'+ =/5. E&''+/)9

;<(-5/-':H 5.' 87&&7=/)9 E':5 ;<(-5/-' 91/+'&/)': .(G' E'') +'G'&7;'+> #: :5(5'+ (5 5.' :5(<5 78

5./: :'-5/7) 78 5.' ?()1(&H 5.':' ;<7-'+1<': (<' +':/9)'+ 57 &/?/5 +()9'<: 57 ;(5/')5:H

;<(-5/5/7)'<: ()+ :5(88> N) (&& -(:':H 5.' 87&&7=/)9 ;<7-'+1<': -() E' <'G/:'+ (: )''+'+ 57 I'';

1; =/5. 5.' &(5':5 <':'(<-. ()+ ?7+/8/'+ (: )''+'+ 87< :;'-/8/- :5F&': 78 ;<(-5/-' (: &7)9 (:

:(8'5F <'?(/): 5.' ;</7</5F>



CAB

Method

C> M'&'-5 ( -&'()H +<FH 8&(5 :1<8(-' 57 :'<G' (: 5.' :'55/)9 87< 5.' -&'() 8/'&+> 2*75'U ,.'

:'&'-5'+ &7-(5/7) "#**$, E' 5.' 5<'(5?')5 5(E&'}3q:5<7)9&F <'-7??')+'+s

A> ^(:. .()+: 87< (5 &'(:5 CBRCD :'-7)+: 1)+'< <1))/)9 =(5'<H &(5.'</)9 ='&& =/5. :7(;>

$<H /8 :7(; ()+ =(5'< (<' 1)(G(/&(E&'H -&'() .()+: =/5. () (&-7.7&RE(:'+ .()+ :()/5/\'<>q-</5/-(&s

T> K&(-' ( -&'() ;(;'< 57='&H -&'() 5(E&' ;(;'< 7< 75.'< E(<</'< 5.(5 =/&& :'<G' (: ( -&'()

8/'&+ 7) 5.' =7 q-</5/-(&s

b> M'5 715 5.' ?(5'</(&: )''+'+ 87< ( 5<'(5?')5> X()-'5: :.71&+ E' ;&(-'+ 7) 5.' -')5'< 78

5.' -&'() 8/'&+ 8/<:5> q<'-7??')+'+s

D> "&'() /5'?: :1-. (: -7557) E(&&: ()+ 1)7;')'+ (&-7.7& :=(E: ?(F '/5.'< E' ;&(-'+ 7)

5.' -&'() 8/'&+ 7< I';5 /) ](<: 7< -7)5(/)'<: )'(< 5.' -&'() 8/'&+ :7 (: 57 E' (5 .()+ 87<

5.' ;<(-5/5/7)'<> q<'-7??')+'+sS> K15 7) 9&7G': q-</5/-(&s ()+ 9799&': 7< 75.'< 'F' ;<75'-5/7) (: /)+/-(5'+ EF 5.' :(8'5F

-7??/55'' 7< 788/-'< (5 F71< -&/)/-> q<'-7??')+'+s

4> 6):1<' 5.(5 5.' ;(5/')5k: :I/) /: -&'() E'87<' /):'<5/)9 ( &()-'5> MI/) -() E' -&'()'+ =/5.

4Bt /:7;<7;F& (&-7.7&H :7(; ()+ =(5'<H 7< ()75.'< ?'5.7+> q-</5/-(&s N8 1:/)9 () (&-7.7&

:=(EH (&&7= 5.' (&-7.7& 57 +<F> q-</5/-(&s

Q> K1&& 5.' :I/) 5(15 )'(< 5.' (<'( 57 E' &()-'+> q<'-7??')+'+s

P> K<':: 5.' &()-'5 01/-I&F /)57 5.' ;7/)5> M7?' ;<(-5/5/7)'<: ;7:/5/7) 5.' &()-'5 E'G'& :/+'

+7=) 7G'< ()+ ]1:5 &(5'<(& 57 5.' /)5')+'+ ;7/)5H 5.') <7&& 5.' &()-'5 7G'< ()+ /)57 5.'

;7/)5 /) 7<+'< 57 (G7/+ 5.' +/:-7?87<5 78 ( :1++') +''; )''+&':5/-I> L:' ( <'5<(-5(E&'

:/)9&'R1:' &()-'5 /8 5.' ?'5.7+ E'/)9 1:'+ (&&7=: 87< 5.' 1:' 78 :1-.> q<'-7??')+'+s

M1-. +'G/-': 5')+ 57 ;<7+1-' ( +'';'< )''+&':5/-I ()+ ?(F -(1:' ?7<' ;(5/')5

+/:-7?87<5 E15 ?(F &/?/5 )''+&':5/-I </:I> d7='G'<H <'5<(-5(E&' +'G/-': ?1:5 E' 1:'+ 7)

( :/)9&' ;(5/')5 ()+ +/:-(<+'+>

CB> W/:;7:' 78 5.' &()-'5 /??'+/(5'&F /)57 () (;;<7;</(5' :.(<;: -7)5(/)'<> q-</5/-(&s

CC> n%/&Ip 7< n:01''\'p ')719. E&77+ 8<7? 5.' &()-'+ ;7/)5 (: /)+/-(5'+ 87< 5.' <':1&5 F71

'J;'-5>

CA> L:' ( :5'</&' -7557) E(&& 7< 9(1\' 57 <'?7G' E&77+ 8<7? 5.' &()-'+ (<'(>

q<'-7??')+'+s

CT> W/:;7:' 78 5.' -7557) E(&& /) 5.' E/7.(\(<+ 5<(:.> q:5<7)9&F <'-7??')+'+s

Cb> Y''J(?/)' )''+&'+ :/5': ( :'-7)+ 5/?' 87< :/9): 78 E&''+/)9 7< .'?(57?(H ()+ (;;&F

;<'::1<' =/5. ( :5'</&' -7557) E(&& 7< 9(1\' /8 )'-'::(<F> q<'-7??')+'+s

CD> "&'() 5.' :/5' 78 5.' &()-'+ :I/) ()+ -7G'< =/5. ( E()+(9' (: )'-'::(<F /8 /5 /: :5/&&

E&''+/)9> q:5<7)9&F <'-7??')+'+s

CS> Y'?7G' 9&7G': ()+ 9799&':> W/:;7:' 78 KK6 (: /)+/-(5'+ EF 5.' -&/)/-k: $Md# :5()+(<+>



CAC

C4> ̂ (:. .()+: /??'+/(5'&F (85'< -7?;&'5/)9 5.' ;<7-'+1<' ()+ <'?7G/)9 9&7G':> q-</5/-(&s



CAA

4. Plum Blossom/Seven Star Needle

Plum Blossom Overview

K&1? E&7::7?`:'G') :5(< )''+&': 27< -15()'71: (-1;1)-51<'3 /: +':-</E'+ /) =7)@)-7%)1$T =

F/B@1$C$-.*2$ G$D% 2A3 (: E'/)9 1:'81& 57 5<'(5 5.' -15()'71: -.())'&: ()+ /)5'<)(& +/:'(:':(::7-/(5'+ =/5. 5.' ?'</+/() 7G'< =./-. 5.' :I/) =/&& E' 5(;;'+> M'G') :5(< )''+&/)9 /: 1:'+ /)

#$% ;<(-5/-': 87< 5.' 5<'(5?')5 78 ( G(</'5F 78 ;(/) :F)+<7?':>

General Recommendations for Plum Blossom

• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 M.%"R,*.C*-4 "-+ H"*-%"*-*-4 " F,$"- <*$,+:

• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 I"-+ !"-*%"%*/-:

• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 !A*- 01$@"1"%*/->

• "</5/-(&U KK6 /: <'01/<'+ a ='(< 9&7G': (5 (&& 5/?': (: E&77+ ()+ $KN% =/&& E' ;<':')5>

• "</5/-(&U ,.' (<'( 57 E' 5<'(5'+ ?1:5 E' -&'() ()+ 8<'' 78 ()F :I/) &':/7): 7< 5<(1?(5/-

/)]1<F>

• "</5/-(&U ,.' (<'( 78 ;(5/')5k: :I/) 57 E' 5<'(5'+ ?1:5 E' -&'() ;</7< 57 5<'(5?')5>

• "</5/-(&U ,.' .'(+ 78 5.' ;&1? E&7::7? +'G/-' ?1:5 E' :5'</&'> W7 )75 571-. 5.' 5/;: 78

5.' )''+&':>

• "</5/-(&U L:' 7)&F :/)9&'R1:' :5'</&' ;&1? E&7::7? )''+&':>

• "</5/-(&U L:'+ ;&1? E&7::7? )''+&': ?1:5 E' +/:-(<+'+ /)57 ( ;<7;'< :.(<;: -7)5(/)'<

/??'+/(5'&F (85'< 1:'>

• M5<7)9&F Y'-7??')+'+U #G7/+ E</)9/)9 5.' .()+ .7&+/)9 5.' .(??'< 1; 577 ./9. 7<

5(;;/)9 577 87<-'81&&F :7 (: 57 ;<'G')5 ;1)-51</)9 5.' :I/)>• M5<7)9&F Y'-7??')+'+U #G7/+ 8&/)9/)9 5.' .(??'< (<71)+ :7 (: 57 ;<'G')5 5.' :;<'(+

78 E&77+ 7< $KN%>

• Y'-7??')+'+U K<(-5/5/7)'<: :.71&+ ='(< 9&7G': ()+ 'F' ;<75'-5/7) =./&' 1:/)9 5.'

;&1? E&7::7? +'G/-'>

Best Practice Protocols for Plum Blossom

#85'< <'G/'=/)9 5.' &/5'<(51<' (E715 ;&1? E&7::7? :(8'5F 2K(<5 N 78 5./: ?()1(&3H 5.' :(8'5F

<'-7??')+(5/7): (E7G'H ()+ 1:/)9 5.' /)87<?(5/7) (E715 5.' ;7::/E&' #6: (::7-/(5'+ =/5.

:'G') :5(< )''+&/)9 ;<(-5/-':H 5.' 87&&7=/)9 E':5 ;<(-5/-' 91/+'&/)': .(G' E'') +'G'&7;'+> #:

:5(5'+ (5 5.' :5(<5 78 5./: :'-5/7) 78 5.' ?()1(&H 5.':' ;<7-'+1<': (<' +':/9)'+ 57 &/?/5 +()9'<:

57 ;(5/')5:H ;<(-5/5/7)'<:H ()+ :5(88> N) (&& -(:':H 5.' 87&&7=/)9 ;<7-'+1<': -() E' <'G/:'+ (:

)''+'+ 57 I''; 1; =/5. 5.' &(5':5 <':'(<-. ()+ ?7+/8/'+ (: )''+'+ 87< :;'-/8/- :5F&': 78

;<(-5/-' (: &7)9 (: :(8'5F <'?(/): 5.' ;</7</5F>



CAT

Method

C> M'&'-5 ( -&'()H +<FH 8&(5 :1<8(-' 57 :'<G' (: 5.' :'55/)9 87< 5.' -&'() 8/'&+> 2*75'U ,.'

:'&'-5'+ &7-(5/7) "#**$, E' 5.' 5<'(5?')5 5(E&'}3q:5<7)9&F <'-7??')+'+s

A> ^(:. .()+: 87< (5 &'(:5 CBRCD :'-7)+: 1)+'< <1))/)9 =(5'<H &(5.'</)9 ='&& =/5. :7(;>

$<H /8 :7(; ()+ =(5'< (<' 1)(G(/&(E&'H -&'() .()+: =/5. () (&-7.7&RE(:'+ .()+ :()/5/\'<>q-</5/-(&s

T> K&(-' ( -&'() ;(;'< 57='&H -&'() 5(E&' ;(;'< 7< 75.'< E(<</'< 5.(5 =/&& :'<G' (: ( -&'()

8/'&+ 7) 5.' =7 q<'-7??')+'+s

b> M'5 715 5.' ?(5'</(&: )''+'+ 87< ( 5<'(5?')5> M'G') :5(< .(??'<: :.71&+ E' ;&(-'+ 7)

5.' -')5'< 78 5.' -&'() 8/'&+ 8/<:5> q<'-7??')+'+s

D> "&'() /5'?: :1-. (: -7557) E(&&: ()+ 1)7;')'+ (&-7.7& :=(E: ?(F '/5.'< E' ;&(-'+ 7)

5.' -&'() 8/'&+ 7< I';5 /) ](<: 7< -7)5(/)'<: )'(< 5.' -&'() 8/'&+ :7 (: 57 E' (5 .()+ 87<

5.' ;<(-5/5/7)'<> q<'-7??')+'+sS> K15 7) 9&7G': q-</5/-(&s ()+ 9799&': 7< 75.'< 'F' ;<75'-5/7)> q<'-7??')+'+s

4> 6):1<' 5.(5 5.' ;(5/')5k: :I/) /: -&'() E'87<' 15/&/\/)9 5.' ;&1? E&7::7? )''+&'> q-</5/-(&s

MI/) -() E' -&'()'+ =/5. 4Bt /:7;<7;F& (&-7.7&H :7(; ()+ =(5'<H 7< ()75.'< ?'5.7+> N8

1:/)9 () (&-7.7& :=(EH (&&7= 5.' (&-7.7& 57 +<F> q-</5/-(&s

Q> ,.' :'G') :5(< .(??'< /: .'&+ CRA /)-.': (E7G' 5.' :1<8(-' 78 5.' :I/) ()+ 5(;;'+

<(;/+&F (&7)9 5.' (<'( 57 E' :5/?1&(5'+> #G7/+ E</)9/)9 5.' .()+ .7&+/)9 5.' .(??'< 1;

577 ./9. 7< 5(;;/)9 577 87<-'81&&F :7 (: 57 ;<'G')5 ;1)-51</)9 5.' :I/)> #G7/+ 8&/)9/)9 5.'

.(??'< (<71)+ :7 (: 57 ;<'G')5 :;<'(+ 78 E&77+ 7< $KN%> q<'-7??')+'+s

P> ^.') 5.' :I/) E'-7?': <'+H 7< ;<7;'< <'(-5/7) .(: E'') 7E:'<G'+H :57; 15/&/\/)9 5.'

;&1? E&7::7? +'G/-'> q<'-7??')+'+s

CB> W/:;7:' 78 5.' ;&1? E&7::7? .(??'< /??'+/(5'&F /)57 () (;;<7;</(5' :.(<;:

-7)5(/)'<> q-</5/-(&s

CC> "&'() 5.' :/5' 78 5.' 5<'(5?')5 ()+ -7G'< =/5. ( E()+(9' (: )'-'::(<F 2/8 E&''+/)93>

q<'-7??')+'+s

CA> Y'?7G' 9&7G': ()+ 9799&':> W/:;7:' 78 1:'+ KK6 (: /)+/-(5'+ EF 5.' -&/)/-k: $Md#

+7-1?')5>

CT> ̂ (:. .()+: /??'+/(5'&F (85'< -7?;&'5/)9 5.' ;<7-'+1<' ()+ <'?7G/)9 9&7G':> q-</5/-(&s



CAb

5. Gua Sha

Gua Sha Overview

Z1( :.( /: 5.' ;<7-':: 78 -&7:'&FR5/?'+ 1)/+/<'-5/7)(& ;<'::R:5<7I/)9 78 5.' E7+F :1<8(-' =/5. (

:?775.R'+9'+ /):5<1?')5 57 /)5')5/7)(&&F <(/:' 5<():/57<F 5.'<(;'15/- ;'5'-./(' ()+'--.F?7:/: <';<':')5/)9 'J5<(G(:(5'+ E&77+ /) 5.' :1E-15/:> Z1( :.( /: )75 (::7-/(5'+ =/5.

:/9)/8/-()5 (+G'<:' 'G')5: 'J-';5 ?/:/)5'<;<'5(5/7) 78 5.'<(;'15/- ;'5'-./(' (: /&&)'::H /)]1<FH

7< (E1:' EF 75.'< ;<(-5/5/7)'<:> M51+F =/5. ( 01(&/8/'+ 91( :.( /):5<1-57< /: <'-7??')+'+ 57

&'(<) ;<'-/:'&F .7= ()+ =.'<' 57 91( :.( ()+ .7= 57 1:' 91( :.( /) ( -&/)/-(& ;<(-5/-'> 2M'' K(<5

N 87< 5.' &/5'<(51<' <'G/'=>3

Summary of Gua Sha Recommendations

• "</5/-(&U [7&&7= M5()+(<+ K<'-(15/7):>

• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 M.%"R,*.C*-4 "-+ H"*-%"*-*-4 " F,$"- <*$,+:

• "</5/-(&U [7&&7= !"#$%& ()*+$,*-$. #/1 I"-+ !"-*%"%*/-:

• "</5/-(&U K<(-5/5/7)'<: ?1:5 5(I' ( 5.7<719. ;(5/')5 ./:57<FH /)-&1+/)9 E&''+/)9 +/:7<+'<:

()+ ?'+/-(5/7) ./:57<FH E'87<' 15/&/\/)9 91( :.( /) 7<+'< 57 ;&() 87< ()F 'J-'::/G'

;'5'-./(' ;<7+1-5/7)>

• "</5/-(&U Z1( :.( :.71&+ )75 E' (;;&/'+ bQ .71<: E'87<' 7< Ab .71<: (85'< -.'?75.'<(;F

5<'(5?')5>

• "</5/-(&U N8 <'1:(E&' 91( :.( +'G/-': (<' E'/)9 1:'+H 5.'F ?1:5 E' -&'()'+ 78 &1E</-()5

()+ E/7&79/-(& ?(5'</(& ()+ 5.') +/:/)8'-5'+ 1:/)9 () (;;<7G'+ /)5'<?'+/(5'R 7< ./9.R

&'G'& +/:/)8'-5/)9 :7&15/7) 87&&7=/)9 ;(-I(9' +/<'-5/7): 87< <'1:(E&' ?'+/-(& +'G/-':>

• "</5/-(&U X1E</-()5: :.71&+ E' +/:;'):'+ 8<7? ( ;1?; 7< :01''\' E755&' 57 ;<'G')5

-7)5(?/)(5/)9 5.' &1E</-()5 <':'<G'> W7 )75 571-. 5.' :;715 78 5.' ;1?; 7< 5.' )7\\&'

78 5.' :01''\' E755&'>

• "</5/-(&U Z1( :.( :.71&+ E' (;;&/'+ 57 -&'(< :I/) 7)&F> W7 )75 (;;&F 57 (-5/G' <(:.H &':/7)H

/)8&(??(5/7)H /)8'-5/7)H ?7&':H :='&&/)9H 5<(1?(H E1<): 2/)-&1+/)9 :1)E1<)3H 7< E<'(I: /)

5.' :I/) E(<</'<>

• "</5/-(&U L:' (;;<7;</(5' KK6 =./&' -&'()/)9 ()+ +/:/)8'-5/)9 <'1:(E&' 91( :.( 577&:>

• M5<7)9&F Y'-7??')+'+U #)F (;;&/-(5/7) 78 91( :.( 87< -./&+<') :.71&+ E' +7)' /) 5.'

;<':')-' 78 ( ;(<')5 7< 91(<+/()>• M5<7)9&F Y'-7??')+'+U W/:/)8'-5 (&& 91( :.( +'G/-': 1:/)9 ( ./9.R&'G'& +/:/)8'-5/)9

:7&15/7)H 87&&7=/)9 ;(-I(9' +/<'-5/7): 87< 5.' +/:/)8'-5/7) 78 :'?/R-</5/-(& <'1:(E&'

?'+/-(& +'G/-':>

• Y'-7??')+'+U N??'+/(5'&F ;</7< 57 5.' ;<(-5/-' 78 91( :.(H 5.' 'J;'-5'+ <':1&5 78

;'5'-./(' :.71&+ E' 'J;&(/)'+ 57 5.' ;(5/')5>



CAD

• Y'-7??')+'+U "7):/+'< .(G/)9 ( .()+715 'J;&(/)/)9 'J;'-5'+ 91( :.( '88'-5: ()+ :I/)

-.()9': 57 9/G' 57 ;(5/')5: E'87<' (;;&F/)9 91( :.(>

Gua Sha Best Practice Protocols

#85'< <'G/'=/)9 5.' &/5'<(51<' (E715 91( :.( :(8'5F 2K(<5 N 78 5./: ?()1(&3H 5.' :(8'5F

<'-7??')+(5/7): (E7G'H ()+ 1:/)9 5.' /)87<?(5/7) (E715 5.' ;7::/E&' #6: (::7-/(5'+ =/5. 91(

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78 5./: :'-5/7) 78 5.' ?()1(&H 5.':' ;<7-'+1<': (<' +':/9)'+ 57 &/?/5 +()9'<: 57 ;(5/')5:H

;<(-5/5/7)'<: ()+ :5(88> N) (&& -(:':H 5.' 87&&7=/)9 ;<7-'+1<': -() E' <'G/:'+ (: )''+'+ 57 I'';

1; =/5. 5.' &(5':5 <':'(<-. ()+ ?7+/8/'+ (: )''+'+ 87< :;'-/8/- :5F&': 78 ;<(-5/-' (: &7)9 (:

:(8'5F <'?(/): 5.' ;</7</5F>

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N5 /: (&:7 ;7::/E&' 57 -7)5(?/)(5' E75. ( -7)5(/)'< 78 &1E</-()5 1:'+ 87< ?1&5/;&' ;(5/')5: ()+

5.' 91( :.( 577& /5:'&8H ()+ 5.') :;<'(+ 5.(5 -7)5(?/)(5/7) 5.<719. 5.' 1:' 78 91( :.( 57?1&5/;&' ;(5/')5:> ,.'<'87<'H 5.' ?'5.7+ 87< E':5 ;<(-5/-' /) 91( :.( /: (: 87&&7=:U

Method

C> K<';(<' F71< 577&:U

(> M'5 ( -&'()H +/:/)8'-5'+ ?1&5/R1:' 91( :.( 577& 27< ( -&'() +/:;7:(E&' 577&3 7) (

-&'() 8/'&+> q<'-7??')+'+s

E> K15 ( :?(&& (?71)5 78 &1E</-()5 /) ( +/:;7:(E&' ;(;'< -1; 21:/)9 ( 57)91'

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A> ^(:. F71< .()+:> q-</5/-(&s

T> 6):1<' 5.' (<'( 57 E' 5<'(5'+ /: 8<'' 78 -15:H /)8&(??(5/7)H /)8'-5/7)H :='&&/)9H 5<(1?(H

E1<):H ()+ (-5/G' &':/7): 5.<719. G/:1(& /):;'-5/7)> q-</5/-(&s

b> Y'/5'<(5' 5.' 8(-5 5.(5 ;'5'-./(' =/&& E' <(/:'+ ()+ E<1/:/)9 /: -7??7)i 9'5 ( G'<E(&

-7)8/<?(5/7) 5.(5 5.' ;(5/')5 1)+'<:5()+: 5.' 'J;'-5'+ :I/) +/:-7&7<(5/7) 8<7? 5.'

5<'(5?')5> q<'-7??')+'+s

D> #;;&F 91( :.( 57 (<'( 57 E' 5<'(5'+>

S> W/:-(<+ ()F &1E</-()5 /) 5.' -1; 2/8 1:'+3 ()+ ()F +/:;7:(E&' 91( :.( 577& 2/8 ( +/:;7:(E&'

577& /: 1:'+3> q<'-7??')+'+s

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57 I''; 5.' (<'( -7G'<'+ ()+ =(<?> q<'-7??')+'+s

P> ^(:. ()+ +/:/)8'-5 ()F <'1:(E&' 91( :.( 577&:> q-</5/-(&s



CAS

6. Acupoint Injection Therapies,.'<' (<' ( 8'= :5(5': /) =./-. (-1;1)-51</:5: ?(F 1:' /)]'-5/7): 2:1-. (: :(&/)'H ORCA 7< .'<E(&

'J5<(-5:3 57 :5/?1&(5' (-1;1)-51<' :/5':> #--7<+/)9 57 =7)@)-7%)1$T = F/B@1$C$-.*2$ G$D%5 2A3

5.':' /)]'-5/7): ?(F E' 9/G') (5 8<7)5 2H)3 7< E(-I 2!C)3 ;7/)5:H 7< n;7/)5: 78 ;7:/5/G'

<':;7):'>p

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;<(-5/-' (&&7=: /)]'-5/7):H 5.' 87&&7=/)9 <':71<-': (<' :199':5'+U

^d$ O':5 K<(-5/-': 87< N)]'-5/7) ,.'<(;/': ()+ Y'&(5'+ K<7-'+1<': ,77&I/5U 2D3

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()+ .55;U``===>7)'()+7)&F-(?;(/9)>7<9 243

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5'-.)/01' <'01/<'+H E15 E(:/- ;</)-/;&': 78 (:';5/- 5'-.)/01' ?1:5 E' (+.'<'+ 57 87< 5.'

;<';(<(5/7) 78 /)]'-5/7) :F</)9':> 2Q3 ,.' "W" <'-7??')+: 5.' 1:' 78 :/)9&'R+7:' G/(&: 78

/)]'-5(E&' ?'+/-(5/7) /):5'(+ 78 ?1&5/;&'R+7:' G/(&:> ^.'<' ?1&5/;&' +7:' G/(&: (<' 1:'+H 5.'

1:' 78 ( :';(<(5' ;<';(<(5/7) =7

,.' 87&&7=/)9 ;<(-5/-': (<' :5<7)9&F <'-7??')+'+ 57 '):1<' 5.' :(8'5F 78 /)]'-5/7):U

• K<7;'< .()+ .F9/')'>

• L:' 78 9&7G': =.'<' (;;<7;</(5'>

• L:' 78 75.'< :/)9&'R1:' ;'<:7)(& ;<75'-5/G' '01/;?')5>

• L5/&/\(5/7) 78 (:';5/- ;<(-5/-': /) :F</)9' ;<';(<(5/7)>





CAQ

S> M=/;' 5.' 57; 78 5.' ?'+/-(5/7) G/(&È755&' =/5. 4Bt (&-7.7&> q-</5/-(&s

4> N8 1:/)9 ( ?1&5/R+7:' G/(&H 5.' (/< '01/G(&')5 57 5.' +7:' :.71&+ E' +<(=) 1; /)57 5.'

:F</)9' 8/<:5 ()+ /)]'-5'+ /)57 5.' G/(& 57 8(-/&/5(5' '(:/'< =/5.+<(=(&> W7 )75 /)]'-5 (/<

/)57 ( :/)9&'R+7:' G/(& 7< (?;1&'>

Q>

$)-' 5.' &7(+'+ :F</)9' ()+ )''+&' .(G' E'') =/5.+<(=) 8<7? ( ?1&5/R+7:' G/(&H(+?/)/:5'< 5.' /)]'-5/7) (: :77) (: ;7::/E&'> q-</5/-(&s

P> N8 (/< E1EE&': (<' :'') /) 5.' :F</)9'H .7&+ /5 =/5. 5.' )''+&' 1;;'<?7:5H 5(; 5.' E(<<'&

57 E</)9 5.'? 57 5.' 57; ()+ 5.') <'?7G' 5.' E1EE&': EF ;1:./)9 5.' ;&1)9'< 57 'J;'&

5.' (/<>

CB> W71E&' -.'-I 57 '):1<' 5.' -7<<'-5 (?71)5 78 :7&15/7) /: /) 5.' :F</)9'>

CC> K<';(<' 5.' ;(5/')5k: :I/) =/5. 4Bt (&-7.7&>

CA> #&&7= 5.' :I/) 57 +<F>

CT> N):'<5 5.' :F</)9' 57 5.' +';5. <'01/<'+ 87< 5.' 5F;' 78 5.'<(;F 7< =.'<' 0/ :'):(5/7) /:

)75'+ 87&&7=/)9 91/+'&/)': 87< :(8' /):'<5/7) +';5.>

Cb> [7< () /)5<(?1:-1&(< /)]'-5/7)H +<(= E(-I 7) 5.' :F</)9' 57 -.'-I 87< 'G/+')-' 78

E&''+/)9 2/8 E&''+/)9 /: ;<':')5H <'?7G' 5.' )''+&' ()+ E'/)9 ;<7-'+1<' (9(/) =/5. (

)'= +'G/-' ()+ )'= ?'+/-(5/7)>

CD> N8 )7 E&77+ 8&(:.E(-IH /)]'-5 5.' :7&15/7) (5 ( ?7+'<(5' <(5'>

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=/5.715 <'R-(;;/)9>

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CQ> L:' ( )'= :5'</&' :F</)9' ()+ )''+&' 87< '(-. /):'<5/7) /)57 ( ?1&5/R+7:' G/(&> q-</5/-(&s N5

/: :5<7)9&F <'-7??')+'+ 5.(5 :/)9&'R1:' G/(&: 78 /)]'-5(E&' :7&15/7): E' 15/&/\'+

=.')'G'< ;7::/E&'>


• W$ *$, (&&7= 5.' )''+&' 57 571-. ()F -7)5(?/)(5'+ :1<8(-'>

• W$ *$, <'1:' ( :F</)9'H 'G') /8 5.' )''+&' /: -.()9'+>

• W$ *$, 571-. 5.' ?'+/-(5/7) G/(& +/(;.<(9? (85'< +/:/)8'-5/7) =/5. 5.' SBa4Bt (&-7.7&

2/:7;<7;F& (&-7.7& 7< '5.()7&3>

• W$ *$, ')5'< :'G'<(& ?1&5/+7:' G/(&: =/5. 5.' :(?' )''+&' ()+ :F</)9'>

• W$ *$, <'R')5'< ( G/(& =/5. ( )''+&' 7< :F</)9' 1:'+ 7) ( ;(5/')5>

•

#G7/+ /)]'-5/7) /) .(/< <775:H :-(<:H ?7&': ()+ 75.'< :I/) (E)7<?(&/5/':>

• #G7/+ /)]'-5/7) /)57 ()F (<'( 78 :I/) =/5. () (-5/G' &':/7)>

• f''; /)]'-5(E&' :7&15/7) 57 E' 1:'+ (5 1:' (5 <77? 5'?;'<(51<' ;</7< 57 /)]'-5/7)>

• L:' )''+&': 78 :.7<5'< &')95. ()+ :?(&&'< +/(?'5'< =.')'G'< ;7::/E&'>

• L:' ( )'= )''+&' 87< '(-. /)]'-5/7)>

• N):'<5 5.' )''+&' /) ( 01/-I :?775. ?7G'?')5 5.<719. 5.' :I/)>



CAP

• N)]'-5 :&7=&F ()+ 'G')&F> 6):1<' 5.(5 5.' ;&1)9'< 78 5.' :F</)9' .(: E'') 81&&F +';<'::'+

E'87<' =/5.+<(=/)9 5.' :F</)9' 8<7? 5.' :I/)>

• N)]'-5 7)&F =.') 5.' (&-7.7& 1:'+ 57 -&'() 5.' :I/) .(: 81&&F +</'+>

Summary of Safety Recommendations for Clean Injection Technique

• "</5/-(&U [7&&7= "&'() *''+&' ,'-.)/01'>

• "</5/-(&U #&=(F: ':5(E&/:. ( -&'() 8/'&+ E'87<' :5(<5/)9 () /)]'-5/7)>

• "</5/-(&U $)&F 1:' :/)9&'R1:' :5'</&' /)]'-5/7) /):5<1?')5:>

• "</5/-(&U #&=(F: =(:. .()+: /??'+/(5'&F ;</7< 57 :5(<5/)9 () /)]'-5/7)>

• "</5/-(&U $)&F 1:'+ :5'</&'H ;<';(<'+ ?'+/-(5/7):H /)-&1+/)9 :5'</&' =(5'< ()+ .'<E(&

;<';(<(5/7):H ?'()5 87< /)]'-5/7) 1:'i *6c6Y 1:' .7?'R;<';(<'+ :1E:5()-': 87<

/)]'-5/7):>

• "</5/-(&U #&& ?(5'</(& 57 E' /)]'-5'+ ?1:5 E' ?()18(-51<'+ :;'-/8/-(&&F 87< 5.(5 ;1<;7:'

()+ E' ?(/)5(/)'+ /) ( :5'</&' :5(5' ;</7< 57 1:'>• "</5/-(&U W7 )75 /)]'-5 /)57 ()F :I/) &':/7)>

• "</5/-(&U N??'+/(5'&F /:7&(5' 1:'+ )''+&': /) () (;;<7;</(5' :.(<;: -7)5(/)'<>

• "</5/-(&U W7 )75 /)]'-5 :1E:5()-': +/<'-5&F /)57 ( E&77+ G'::'&>

• "</5/-(&U ^'(< 9&7G': 87< (&& /)]'-5/7) ;<7-'+1<':>

• "</5/-(&U ".'-I :F</)9': ;</7< 57 1:' 87< :5'</&/\(5/7) 'J;/<(5/7) +(5':H E<'(I: /) 5.'

;(-I(9/)9 7< ()F 'G/+')-' 5.(5 (/< 7< =(5'< .(: ')5'<'+ 5.' ;(-I(9/)9 ;</7< 57 1:'>

• "</5/-(&U #&& ;(5/')5: )''+ 57 E' 5<'(5'+ (: /8 5.'F (<' -(<</'<: 78 E&77+E7<)' ;(5.79'):

:1-. (: d';(5/5/: O 7< dNc>

•

"</5/-(&U 6):1<' 5.(5 5.' ;(<5 78 5.' E7+F 57 E' 5<'(5'+ /: -&'()>• M5<7)9&F Y'-7??')+'+U "&'() :I/) =/5. 4Bt /:7;<7;F& (&-7.7& ;</7< 57 /):'<5/)9 (

:F</)9'>

• M5<7)9&F Y'-7??')+'+U L:' :/)9&' G/(&: 78 /)]'-5(E&' :7&15/7): =.')'G'< ;7::/E&'>

References

C> ".')9 l/))7)9 2-./'8 '+/57<3> FC*-$.$ =7)@)-7%)1$ "-+ H/D*R).%*/->[7<'/9) X()91(9':

K<'::H O'/]/)9i CPQ4

A> $_"7))7< V ()+ O'):IF W 25<():&(57<:3> =7)@)-7%)1$T = F/B@1$C$-.*2$ ,'J5> 6(:5&()+ K<'::H

M'(55&'H ^#> CPQC>T> Y15(&( ^#H ^'E'< WVH ()*+$,*-$ #/1 K*.*-#$7%*/- "-+ !%$1*,*W"%*/- *- I$",%C7"1$ <"7*,*%*$.5

XYYZ> "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7) d'(&5.-(<' N)8'-5/7) "7)5<7& K<(-5/-':

#+G/:7<F "7??/55'' 2dN"K#"3>

.55;U``===>-+->97G`./-;(-`;+8`91/+'&/)':`W/:/)8'-5/7)y*7GyABBQ>;+8 Y'G/'='+




CTB

b> */'&:') #H f&/9&'< OH f7&& OM> =++$-+)BU M(8'5F ;<757-7&: 87< Z1( :.( 2;<'::R:5<7I/)93 ()+

O(91() 2-1;;/)93> F/B@,$B$-% GC$1 H$+ > ABCbiAA2T3UbbSRbbQ>

D> ^7<&+ d'(&5. $<9()/\(5/7)> ^d$ E':5 ;<(-5/-': 87< /)]'-5/7): ()+ <'&(5'+ ;<7-'+1<':

577&I/5>.55;U``=.0&/E+7->=.7>/)5`;1E&/-(5/7):ÀBCB`P4QPAbCDPPADAy')9>;+8 ^d$

X/E<(<F "(5(&791/)9R/)RK1E&/-(5/7) W(5(>> K1E&/:.'+ %(<-. ABCB>>S> "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7)> N)]'-5/7) M(8'5F>

.55;U``===>-+->97G`/)]'-5/7):(8'5F`"W":Y7&'>.5?& #--'::'+ V()1(<F ABCT>

4> "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7) $)' ()+ $)&F "(?;(/9)>

.55;U``===>7)'()+7)&F-(?;(/9)>7<9`:(8'y/)]'-5/7)y;<(-5/-':> #--'::'+ V()1(<F ABCT>

Q> "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7)> M(8' N)]'-5/7) K<(-5/-' 57 K<'G')5 ,<():?/::/7)

78 N)8'-5/7): 57 K(5/')5:>

.55;U``===>-+->97G`/)]'-5/7):(8'5F`NKB4y:5()+(<+K<'-(15/7)>.5?&> Y'G/'='+ #;</& CH

ABCA> #--'::'+ V()1(<F ABCD>



CTC

Part IV – Infections Associated with Acupuncture and

Related Healthcare Practices

1. PathogensN5 /: '::')5/(& 5.(5 ;<(-5/5/7)'<: 1)+'<:5()+ 5.' ?'-.()/:?: 78 +/:'(:' 5<():?/::/7) ()+ I)7=

5.' -.(<(-5'</:5/-: 78 /)8'-5/71: +/:'(:':H ;(<5/-1&(<&F E&77+E7<)' ;(5.79'): :1-. (: .';(5/5/:

()+ dNcH :I/) /)8'-5/7): 8<7? !%"@C&,/7/77). ()+ !%1$@%/7/77). ()+ 75.'< -7??7) .'(&5.-(<'

(::7-/(5'+ /)8'-5/7): 2d#N3> ,.' I)7=&'+9' 78 ?'-.()/:?: ()+ -.(<(-5'</:5/-: 1)+'<:-7<': 5.'

)''+ 57 1:' "&'() *''+&' ,'-.)/01' 87< 5.' ;<75'-5/7) 78 ;(5/')5:H ;<(-5/5/7)'<:H ()+ :5(88> N5 /:

/?;'<(5/G' 87< () (-1;1)-51</:5 57 -7):/+'< 5.' :(8'5F 78 ;(5/')5:H -&/)/-/():H ()+ 75.'<

?'?E'<: 78 5.' -&/)/- :5(88> #+.'<')-' 57 "&'() *''+&' ,'-.)/01' =/&& <'+1-' 5.' </:I 78 5.'

:;<'(+ 78 E&77+E7<)' ()+ :1<8(-' ;(5.79'):>

Y'(+'<: 78 5./: ?()1(& :.71&+ )75' 5.(5 5.'<' (<' .1)+<'+: 78 ;(5.79'): 5.(5 (<' )75(++<'::'+ .'<'/)> #-1;1)-51<' ;<(-5/5/7)'<: ?1:5 I''; (E<'(:5 78 +'G'&7;?')5: /) .'(&5.-(<'

(::7-/(5'+ /)8'-5/7): ()+ :5(5' ()+ )(5/7)(& :5()+(<+: 57 -7)5<7& :1-. /)8'-5/7): /) -&/)/-(&

:'55/)9:>

2. Mechanisms of Disease Transmission

# 81)+(?')5(& <7&' 78 5.' /??1)' :F:5'? /: 57 +/88'<')5/(5' :'&8 8<7? )7)R:'&8> ,./:

+/88'<')5/(5/7) (&&7=: 5.' /??1)' :F:5'? 57 (55(-I 87<'/9) 7< ;(5.79')/- G/<1:': ()+ E(-5'</(

=./&' ;<75'-5/)9 5.' E7+Fk: 7=) -7):5/51')5:> [(/&1<' 78 5./: (E/&/5F 57 +/88'<')5/(5' :'&8 8<7?

)7)R:'&8 ?(F <':1&5 /) G(</71: /)8'-5/7): ()+ (157/??1)' +/:7<+'<:> ,.' ;<':')-' 78 G/<1:': 7<E(-5'</( (-5/G(5': /??1)' 8(-57<: 57 <':;7)+ 57 ;(5.79')/- 7<9()/:?:> ,.' /??1)' :F:5'?

-7):/:5: 78 .1?7<(& ()+ -'&&1&(< -7?;7)')5:> d1?7<(& -7?;7)')5: -7):/:5 78 5.' -7):5/515/G'

-7?;&'?')5 ;<75'/) :F:5'? ()+ /??1)79&7E/):> ,.':' ;<75'/): (<' 871)+ /) 5.' &/01/+ 8<(-5/7)

78 5.' E&77+H (: ='&& (: /) 75.'< 5/::1':> "'&&1&(< -7?;7)')5: /)-&1+' )'15<7;./&:H

?(-<7;.(9':`?7)7-F5':H (: ='&& (: O -'&&: ()+ , -'&&:> ,.' /??1)' <':;7):'H /)-&1+/)9 5.'

<':;7):' 57 /)8'-5/7)H <':1&5: 8<7? 5.' -7?;&'J /)5'<(-5/7) E'5='') 5.' .1?7<(& ()+ -'&&1&(<

-7?;7)')5: 78 5.' /??1)' :F:5'?>

,.' E7+F /: -7):5()5&F 'J;7:'+ 57 /)8'-5/71: (9')5:H :7?' 78 =./-. (<' )7<?(&&F 871)+ /) 7< 7)

:;'-/8/- (<'(: 78 5.' E7+FH ':;'-/(&&F 7) 5.' :I/)H /) 5.' ?715.H <':;/<(57<F ;(::(9'=(F:H

1</)(<F 5<(-5H -7&7)H ()+ ?1-71: ?'?E<()': 78 5.' 'F':> %()F 78 5.':' 7<9()/:?: 5.(5 (<'

)7<?(&&F ;<':')5 (<' -(;(E&' 78 -(1:/)9 +/:'(:' /8 5.'F 9(/) (--':: 57 75.'< 5/::1': 7< /8 5.'

/??1)' :F:5'? /: /)'88'-5/G' /) -7)5<7&&/)9 5.' /)8'-5/71: (9')5> N) (++/5/7)H ( ;'<:7) /:

/)5'<?/55')5&F 'J;7:'+ 57 G/<1&')5 E(-5'</( ()+ G/<1:': 8<7? 715:/+' 5.' E7+F 5.(5 -() -(1:'



CTA

:;'-/8/- +/:'(:':H :1-. (: ;)'1?7)/(H :5<';57-7--(& ()+ :5(;.F&7-7--(& /)8'-5/7):> ,.':'

/)8'-5/71: (9')5: ?(F E' G'<F /)G(:/G' ()+ 7G'<-7?' 5.' )(51<(& E(<</'<: 57 /)8'-5/7)>

*(51<(& E(<</'<: /)-&1+' /)5(-5 :I/) ()+ ?1-71: ?'?E<()': 78 5.' )7:'H 5.<7(5H 1<'5.<(H ()+

<'-51?> *(51<(& E(<</'<: (&:7 /)-&1+' :57?(-. (-/+ 29(:5</- (-/+ ;<7G/+': )7):;'-/8/- /??1)/5F

57 /)9':5'+ E(-5'</(& ;(5.79'):3 ()+ ( .'(&5.F <':;/<(57<F ?1-7:(H =./-. -() 'J;'& /).(&'+

;(5.79'):> $5.'< 8(-57<: /) 5.' /??1)' <':;7):' 5.(5 ;<75'-5 5.' E7+F 8<7? /)G(:/7) ()+

/)8'-5/7) (<' 5.' (-5/G/5F 78 5.' ';/5.'&/(& :I/) &(F'< ()+ ?1-1: ?'?E<()':H ()+ 5.' -&'():/)9

'88'-5: 78 5'(<:H 1</)'H ()+ G(9/)(& :'-<'5/7):>

%/-<7E': -() ')5'< 5.' E7+F 5.<719. ( E<'(I /) 5.' :I/)H :1-. (: ( -15 7< =71)+H 7< 5.<719. ()

7</8/-' 2?715.H )7:'H 1<'5.<(H '5->3> #)F /)8'-5/71: (9')5 -() -(1:' /)8'-5/7) /8 /5 9(/): (--':: 57

5/::1': ()+ :;(-': /) 5.' E7+F =.'<' /5 /: (&&7='+ 57 ;<7&/8'<(5' ()+ /)/5/(5' () /??1)'

<':;7):'> ,.'<' (<' ?()F ;75')5/(& :71<-': 78 /)8'-5/71: +/:'(:': /) () (-1;1)-51<' ;<(-5/-'

:'55/)9> ,.':' /)-&1+' -7)5(?/)()5: 7) 5.' :I/) 78 ;<(-5/5/7)'<:k ()+ ;(5/')5:k .()+:H E&77+H:(&/G(H :='(5H )(:(& ()+ 75.'< E7+/&F :'-<'5/7):H +1:5H -&75./)9H ()+ .(/<> N)8'-5/7): (::7-/(5'+

=/5. (-1;1)-51<' ?(F E' -&(::/8/'+ /)57 5=7 5F;': (--7<+/)9 57 5.' :71<-' 78 5.' +/:'(:' (9')5

a (1579')71: ()+ -<7::R/)8'-5/7):>

Autogenous Infections

#1579')71: 28<7? 5.' X(5/) n(157p a :'&8 ()+ n9')71:p a 9')'<(5'+3 /)8'-5/7): (<' -<'(5'+

=.') ;(5.79'): (&<'(+F ;<':')5 /) ( ;'<:7) (<' ?7G'+ /)57 5.' E7+F 7< 57 ()75.'< &7-(5/7)

=/5./) 5.' E7+F =.'<' 5.'F (<' ;(5.79'):> #) 'J(?;&' 78 5./: /: /?;'5/97 =.'<' )7<?(& :I/)

E(-5'</( ')5'< /)57 :1E-15()'71: (<'(: 5.<719. ( E<'(I /) 5.' :I/) ()+ :'5 1; ( ;1:51&'> ^./&'

5.'<' (<' )7 :;'-/8/- :51+/': /+')5/8F/)9 =.') (-1;1)-51<' ?(F -(1:' () (1579')71: /)8'-5/7)H

5.' /)-/+')-' 78 &7-(&/\'+ :I/) /)8'-5/7): (: -7):'01')-' 78 (-1;1)-51<' /: &7= E15 ;'<:/:5')5

()+ /?;&/': ( ;7::/E&' (1579')71: :71<-'> 2CHA3

$)' 78 5.' +()9'<: 78 <'1:/)9 ( )''+&' +1</)9 5<'(5?')5 /: 5.' 5<():8'< 78 () /)8'-5/71: (9')5

8<7? 7)' &7-(5/7) 57 ()75.'<> $<9()/:?: 5.(5 ?(F 'J/:5 /) &(<9' 01()5/5/': /) 7)' (<'( -() &'(+

57 ;75')5/(&&F &/8' 5.<'(5')/)9 /)8'-5/7): /) 75.'< &7-(5/7):> M.7C$1*7C*" 7/,* 2M: 7/,* 3H ( -7??7)

/)5':5/)(& 7<9()/:?H ?(F -(1:' :'</71: /)8'-5/7): /) 5.' 1</)(<F E&(++'<H ( <'9/7) =.'<' 5.'

7<9()/:? /: )75 )7<?(&&F 871)+> N)5':5/)(& 7<9()/:?: :1-. (: M: 7/,* -() -(1:' &/8'R5.<'(5')/)9

;'</57)/5/: 87&&7=/)9 /)]1<F 57 5.' E7='&> #: ()75.'< 'J(?;&'H 5.' -7??7) :I/) 7<9()/:?!%"@C&,/7/77). $@*+$1B*+*. -() -(1:' :'</71: /)8'-5/7): =.') 5./: 75.'<=/:' -7??7)

E(-5'</1? E'9/): ;<7&/8'<(5/)9 /) 7;') =71)+:>

Cross-Infections

,.':' /)8'-5/7): (<' -(1:'+ EF ;(5.79'): (-01/<'+ 8<7? ()75.'< ;'<:7) 7< EF 5.'

')G/<7)?')5> ,.'F ?(F E' (-01/<'+ +/<'-5&F 2'>9>H 8<7? -7)5(-5 E'5='') ;(5/')5 ()+



CTT

;<(-5/5/7)'<3H 7< EF 5<():8'< 2'>9>H -(<</'+ 8<7? 7)' ;(5/')5 57 ()75.'< 7) 5.' 1)=(:.'+ .()+:

78 5.' ;<(-5/5/7)'< 7< -7)5(?/)(5'+ /?;&'?')5:3> "<7::R/)8'-5/7): ?(F E' (-01/<'+ EF 5.'

;<(-5/5/7)'< ()+ 788/-' ;'<:7))'& (: ='&& (: EF ;(5/')5:> M7?' 78 5.' ?7:5 :'</71: 7<9()/:?:

5.(5 (<' (::7-/(5'+ =/5. -<7::R/)8'-5/7): /)-&1+' 5.' .';(5/5/: O G/<1:H dNcH ()+ ?'5./-/&&/)R

<':/:5()5 :5(;. (1<'1: 2%YM#3> ,1E'<-1&7:/: /: (&:7 ( :/9)/8/-()5 ;1E&/- .'(&5. -7)-'<) /) 5.'L)/5'+ M5(5':H /)-&1+/)9 :5<(/): 78 H&7/R"7%$1*)B %)R$17),/.*. <':/:5()5 57 ()5/51E'<-1&(<

()5/E/75/-:>

L)+'< )7<?(& -/<-1?:5()-': )(51<(& E(<</'<: ;<'G')5 5.' /)8'-5/71: (9')5 7< G/<1: 8<7? 9(/)/)9

(--':: 57 ( )'= .7:5 ()+ -(1:/)9 () /)8'-5/7)> O15 =.') 5.' )(51<(& +'8'):': (<' ='(I')'+H 7<

5.' /)8'-5/71: (9')5 .(: ( &(<9' ')719. 01()5/5FH 7< E/7&7(+H 57 7G'<=.'&? 5.' E7+Fk: +'8'):':H

5.' 7<9()/:? 7< G/<1: /) 01':5/7) -() -(1:' +/:'(:'> #: ( ;<(-5/5/7)'<H 5.' (-1;1)-51</:5 ?1:5

(&=(F: E' (&'<5 57 5.' ;75')5/(& 87< 5<():8'<</)9 +/:'(:'R-(1:/)9 (9')5: 57 ;(5/')5:>

#) /)8'-5/71: (9')5 -() 5<(G'& 8<7? 7)' .7:5 57 ()75.'< /) ( G(</'5F 78 =(F:H /)-&1+/)9 E'/)9-(<</'+ 7) +1:5 7< +<7;&'5: 78 ?7/:51<' /) 5.' (/<H E'/)9 5<():8'<<'+ /) E7+F 8&1/+:H ()+ EF

?'-.()/-(& 5<():8'< 8<7? 7)' :1<8(-' 57 ()75.'<> ,.' +'):/5F 78 () /)8'-5/71: (9')5 /: 7)' 78

5.' 8(-57<: /) </:I 78 -<7:: /)8'-5/7)> ^./&' ( &7= E/7&7(+ ?(F E' -7)5<7&&'+ EF 5.' E7+Fk:

;<7;'<&F 81)-5/7)/)9H ( ./9. E/7&7(+ ?(F 7G'<=.'&? 5.' /??1)' :F:5'?H ?7<' '(:/&F <':1&5/)9

/) () /)8'-5/7)> [7< 'J(?;&'H 5.' .';(5/5/: O G/<1: /: ( ./9.R+'):/5F G/<1:H 7)' 78 5.' 8(-57<: 5.(5

8(-/&/5(5' 5.' 5<():8'< 78 5./: 7<9()/:? 8<7? ;'<:7) 57 ;'<:7)>

3. Bloodborne Pathogens

Hepatitis# <'G/'= 78 5.' &/5'<(51<' :199':5: 5.(5 .';(5/5/: ?(F E' ( -7?;&/-(5/7) 78 (-1;1)-51<'> ^./&'

<';7<5: 78 .';(5/5/: <'&(5'+ 57 (-1;1)-51<' /) 5.' L>M> (<' &/?/5'+ 57 <';7<5: ;</7< 57 CPQQH 5.'<'

(<' ( )1?E'< 78 <'5<7:;'-5/G' :51+/': ()+ <';7<5: 78 .';(5/5/: <'&(5'+ 57 (-1;1)-51<' /) 75.'<

;(<5: 78 5.' =7<&+> 2THbHD3

,.'<' (<' -1<<')5&F 8/G' <'-79)/\'+ 5F;': 78 .';(5/5/: G/<1:': =./-. (<' &(E'&'+ (&;.(E'5/-(&&F

(:U #H OH "H WH ()+ 6> d';(5/5/: # ()+ 6 (<' 5<():?/55'+ ?(/)&F 5.<719. 8'-(& -7)5(?/)(5'+ 877+

()+ =(5'<> ,.' 75.'<: (<' 5<():?/55'+ EF E&77+ 7< :'J1(& -7)5(-5> d';(5/5/: /: :1-. ( -7)-'<) /)

.'(&5.-(<' :'55/)9: 5.' $--1;(5/7)(& M(8'5F ()+ d'(&5. #+?/)/:5<(5/7) 2$Md#3 .(: (+7;5'+:;'-/8/- &()91(9' <'9(<+/)9 5.' 5<():?/::/7) 78 .';(5/5/: ()+ <'-7??')+(5/7): 87< 5<(/)/)9 ()+

G(--/)(5/7) 78 (5R</:I :5(88 ?'?E'<:> ,.' "W" :5<7)9&F <'-7??')+: 5.(5 (&& .'(&5.-(<' =7<I'<:

E' G(--/)(5'+ 87< 5.' .';(5/5/: O G/<1: 2dOc3> ^.') () '?;&7F'' /: ./<'+ 87< ( ;7:/5/7) =.'<'

5.'<' /: ( </:I 78 /)8'-5/7) =/5. dOcH $Md# <'01/<': 5.(5 5.' '?;&7F'< ?1:5 788'< G(--/)(5/7) 57

5.(5 .'(&5.-(<' =7<I'< (5 )7 -.(<9'> N8 5.' '?;&7F'' <'81:': 57 E' G(--/)(5'+ 87< dOcH 5./:

'?;&7F'' :.71&+ E' <'01/<'+ 57 -7?;&'5' ()+ :/9) ( +7-1?')5 :5(5/)9 5.(5 .' 7< :.'



CTb

1)+'<:5()+: 5.' </:I: 78 )75 E'/)9 G(--/)(5'+ ()+ /: <'81:/)9 5.' G(--/)(5/7) /) :;/5' 78 5.' </:I

78 dOc /)8'-5/7)> 2M'' M'-5/7) S 87< () 7G'<G/'= 78 $Md# <'91&(5/7):>3

Hepatitis A (HAV)

d';(5/5/: # 2d#c3H 87<?'<&F -(&&'+ /)8'-5/71: .';(5/5/: 7< :.7<5R/)-1E(5/7) .';(5/5/:H /: (

-7??7) /)8'-5/7) /) -7)+/5/7): 78 ;77< :()/5(5/7) ()+ 7G'<-<7=+/)9> #&5.719. 5<():?/::/7) /:

?(/)&F 5.<719. 8'-(& -7)5(?/)(5'+ 877+ ()+ =(5'<H -7)5(?/)(5'+ E&77+ 7) .()+: -() ;7:' (

;75')5/(& .(\(<+ /) (-1;1)-51<' ;<(-5/-'> #++/5/7)(&&FH /) 5.7:' -&/)/-: 5.(5 ;<';(<' ?'+/-/)(&

5'(: 7< 75.'< 877+: 87< ;(5/')5:H () (=(<')':: 78 5.' 5<():?/::/7) <715': ()+ ;<'G')5/7)

;<(-5/-': /: -</5/-(&> N) /):5/515/7)(& 7< /)-(<-'<(5'+ :'55/)9: d#c ?(F :;<'(+ 8<7? ;'<:7) 57

;'<:7) 5.<719. :'J1(& -7)5(-5> Z77+ ;'<:7)(& .F9/')' ()+ ;<7;'< :()/5(5/7) -() .'&; ;<'G')5

5.' 5<():?/::/7) 78 d#c> ,.' /)-1E(5/7) ;'</7+ 78 d#c /: CD 57 DB +(F:H =/5. () (G'<(9'

/)-1E(5/7) ;'</7+ 78 AQ +(F:> 2S3

L)&/I' .';(5/5/: O 2dOc3 7< " 2d"c3H d#c /)8'-5/7) <':1&5: /) 5.' (E<1;5 7):'5 78 :F?;57?:>MF?;57?: /)-&1+' (E+7?/)(& +/:-7?87<5H &7:: 78 (;;'5/5'H 8(5/91'H )(1:'(H +( MF?;57?: 1:1(&&F &(:5 &':: 5.() A ?7)5.:> #&5.719. 5.'<' /: )7 -.<7)/- /)8'-5/7)H

(;;<7J/?(5'&F CDt 78 ;'7;&' /)8'-5'+ =/5. d#c .(G' ( ;<7&7)9'+ 7< <'&(;:/)9 -71<:' 78 /&&)'::

&(:5/)9 (: &7)9 (: SRP ?7)5.:> N)+/G/+1(&: =.7 .(G' .(+ d#c -())75 E' <'R/)8'-5'+>

N) 5.' L)/5'+ M5(5':H .';(5/5/: # .(: 7--1<<'+ /) &(<9' )(5/7)=/+' ';/+'?/-: (;;<7J/?(5'&F

'G'<F CB F'(<:H =/5. 5.' &(:5 /)-<'(:' /) -(:': /) CPQP> 243 ,.' d#c /)8'-5/7) <(5' .(: +'-&/)'+

:5'(+/&F :/)-' 5.' &(:5 ;'(I /) CPPDH =.') 5.'<' ='<' TDSHBBB -(:':> d/:57</-(&&FH -./&+<') A

5.<719. CQ F'(<: 78 (9' .(G' .(+ 5.' ./9.':5 <(5': 78 .';(5/5/: # 2CD 57 AB -(:': ;'< CBBHBBB /)

5.' '(<&F 57 ?/+RCPPB:3> M/)-' ABBAH <(5': (?7)9 -./&+<') .(G' +'-&/)'+ ()+ 5.' /)-/+')-' 78

.';(5/5/: # /: )7= :/?/&(< /) (&& (9' 9<71;:> 243 "<'+/5 87< 5.' -.()9': /: 9/G') 57 5.' /::1()-' 78

<715/)' -./&+.77+ G(--/)(5/7): 87< d#c :/)-' CPPP> [7<51)(5'&FH ?7:5 -(:': 78 d#c (<'

<'&(5/G'&F ?/&+H -7?;&/-(5/7): (<' 1)-7??7)H ()+ -.<7)/- -(<</'< :5(5': (<' )75 I)7=)> ,.'<' /:

( G(--/)(5/7) 87< d#c> ,.' "W" +7': )75 <715/)'&F <'-7??')+ d#c G(--/)(5/7) 87< .'(&5.-(<'

=7<I'<: :/)-' 5.'F (<' )75 (5 /)-<'(:'+ </:I> 2Q3 Y715/)' /)8'-5/7) -7)5<7& ;<'-(15/7):H

;(<5/-1&(<&F .()+=(:./)9H =/&& ;<'G')5 5<():?/::/7)>

Hepatitis A Survival in the Environment

,.' d';(5/5/: # G/<1: /: 'J5<'?'&F .'(<5F> d#c -() &/G' 715:/+' 5.' E7+F 87< ?7)5.:H +';')+/)97) 5.' ')G/<7)?')5(& -7)+/5/7):> ,.' G/<1: /: I/&&'+ EF .'(5/)9 57 ‚CQD +'9<'': [ 2‚QD +'9<'':

"3 87< 7)' ?/)15'> d7='G'<H 5.' G/<1: -() :5/&& E' :;<'(+ 8<7? -77I'+ 877+ /8 /5 /: -7)5(?/)(5'+

(85'< -77I/)9> #+'01(5' -.&7</)(5/7) 78 =(5'<H (: <'-7??')+'+ /) 5.' L)/5'+ M5(5':H I/&&: d#c

5.(5 ')5'<: 5.' =(5'< :1;;&F> M'' .55;U``===>-+->97G`.';(5/5/:`.(G`.(G8(0>.5?>



CTD

Hepatitis B (HBV)

d';(5/5/: O /: -(1:'+ EF 5.' .';(5/5/: O G/<1: 2dOc3H ( +71E&'R:5<()+'+ W*#R-7)5(/)/)9 G/<1:>

O'5='') CPPB ()+ ABBD 5.' /)-/+')-' 78 (-15' .';(5/5/: O +'-&/)'+ 4Pt> #?7)9 ;'<:7): (9'+

S F'(<: 7< 7&+'<H B>A4t .(+ -.<7)/- dOc /)8'-5/7) 2-7<<':;7)+/)9 57 (;;<7J/?(5'&F 4BbHBBB

;'<:7): )(5/7)=/+'>

2PHCB3

N) (+1&5:H 7)97/)9 dOc 5<():?/::/7) 7--1<: ;</?(</&F (?7)9 1)G(--/)(5'+ ;'<:7): =/5.

E'.(G/7<(& </:I: 87< dOc 5<():?/::/7) 2'>9>H .'5'<7:'J1(&: =/5. ?1&5/;&' :'J ;(<5)'<:H /)]'-5/7)R

+<19 1:'<: qNWL:sH ()+ ?') =.7 .(G' :'J =/5. ?') q%M%s3 ()+ (?7)9 .71:'.7&+ -7)5(-5: ()+

:'J ;(<5)'<: 78 ;'<:7): =/5. -.<7)/- dOc /)8'-5/7)> 2CC3

#) ':5/?(5'+ QBBHBBBRC>b ?/&&/7) ;'<:7): /) 5.' L)/5'+ M5(5': .(G' -.<7)/- dOc /)8'-5/7)> 2CA3

d';(5/5/: O G/<1: 2dOcH n:'<1? .';(5/5/:p 7< n&7)9R/)-1E(5/7) .';(5/5/:p3 /: 7)' 78 5.'

E&77+E7<)' ;(5.79'): ;<':')5/)9 ( :/9)/8/-()5 </:I 78 /)8'-5/7) /) 5.' (-1;1)-51<' -&/)/-

')G/<7)?')5> dOc /: 5.' :'-7)+ :1ER5F;' 78 .';(5/5/: 87< =./-. ( G(--/)' 'J/:5:> dOc -() -(1:'

&/8'&7)9 /)8'-5/7)H -/<<.7:/: 78 5.' &/G'<H &/G'< -()-'<H &/G'< 8(/&1<'H ()+ +'(5.> #&5.719. -.<7)/-

/)8'-5/7) /: ?7<' &/I'&F 57 +'G'&7; /) ;'<:7): /)8'-5'+ (: /)8()5: 7< F71)9 -./&+<')H <(5': 78 )'=

/)8'-5/7): ()+ (-15' +/:'(:' (<' ./9.':5 /) (+1&5:> K'<:7): =/5. -.<7)/- +/:'(:' 5.') :'<G' (: (

<':'<G7/< 87< -7)5/)1'+ dOc 5<():?/::/7)> 2CT3 d'(&5.-(<' ;'<:7))'& =.7 .(G' <'-'/G'+ dOc

G(--/)' ()+ +'G'&7;'+ /??1)/5F 57 5.' G/<1: (<' (5 G/<51(&&F )7 </:I 87< dOc /)8'-5/7)> 2Cb3

Transmission of HBV

dOc /: :;<'(+ 5.<719. -7)5(-5 =/5. -7)5(?/)(5'+ E&77+ ()+ E7+F 8&1/+:> N)8'-5'+ /)+/G/+1(&:

()+ 5.7:' -(</)9 87< 5.'?H :.(</)9 &/G/)9 :;(-'H 7< ;(<5/-/;(5/)9 /) ./9. </:I E'.(G/7<:

21);<75'-5'+ :'J =/5. ?1&5/;&' ;(<5)'<: ()+ +<19 1:'3 :.71&+ 87&&7= -(<'81& /)8'-5/7)

;<'G')5/7) ;<7-'+1<':> ,.' /)8'-5'+ ;'<:7) :.71&+ )75 :.(<' ()F /5'?: 5.(5 ?(F E'

-7)5(?/)(5'+ =/5. E&77+H /)-&1+/)9 <(\7<: ()+ 5775.E<1:.':> 2O75. <(\7<: ()+ 5775.E<1:.':

(<' <'91&(<&F -7)5(?/)(5'+ =/5. ?/-<7:-7;/- (?71)5: 78 E&77+ ()+ )''+ 57 E' 5<'(5'+ (:

-7)5(?/)(5'+>3 O(<</'< ;<'-(15/7): :1-. (: 9&7G': 87< .()+&/)9 =(:5'H 7< -7)+7?: ()+ +')5(&

+(?: =.') /)G7&G'+ /) :'J1(& (-5/G/5/':H :.71&+ E' 15/&/\'+>

[7< 5.7:' =.7 .(G' ( ;'<:7)(& ./:57<F 78 -.<7)/-H (-5/G' +/:'(:'H /&&/-/5 +<19: ()+ (&-7.7& :.71&+

E' (G7/+'+ 57 <'+1-' 5.' </:I 78 &7)9R5'<? -7?;&/-(5/7): 78 dOcH :1-. (: &/G'< -/<<.7:/:> Z77+-&'()/)9 78 5.' ;(5/')5k: ')G/<7)?')5 ()+ ;'<:7)(& -(<' /5'?: /: /?;7<5()5> ,.':'

;<'-(15/7)(<F ?'(:1<': :.71&+ E' 87&&7='+ 1)5/& 5.' ;'<:7) 5':5: )'9(5/G' 87< (-5/G' dOc

/)8'-5/7)>



CTS

HBV Survival in the Environment

dOc -() :1<G/G' 715:/+' 5.' E7+F (5 &'(:5 4 +(F: ()+ :5/&& E' -(;(E&' 78 -(1:/)9 /)8'-5/7)>

.55;U``===>-+->97G`.';(5/5/:`.EG`.EG8(0>.5?>

Individuals at Risk of HBV InfectionN5 /: ':5/?(5'+ 5.(5 5.'<' (<' () ':5/?(5'+ QBBHBBBRC>b ?/&&/7) ;'7;&' /) 5.' L)/5'+ M5(5': =.7

.(G' -.<7)/- dOc /)8'-5/7)> 2CT3 ,.' )1?E'< 78 )'= /)8'-5/7): .(: +'-&/)'+ F'(<&F :/)-' 5.'

CPQB:> Y715/)' G(--/)(5/7) /: 5.' ;</?(<F <'(:7) 87< 5./: +'-&/)'> 2CT3

N)+/G/+1(&: (5 </:I 87< dOc /)8'-5/7) 5.<719. 7--1;(5/7)(& 'J;7:1<': (<' 5.7:' =.7 (<' )75

/??1)' 57 dOc ()+ =.7 -7?' /)57 8<'01')5 -7)5(-5 =/5. E&77+ ()+ E&77+ ;<7+1-5:>

d'(&5.-(<' =7<I'<: :1-. (: (-1;1)-51</:5:H ;.F:/-/():H +')5/:5:H )1<:':H E&77+ E()I =7<I'<:H

;(<(?'+/-(& ;'<:7))'&H ()+ &(E7<(57<F :5(88 .(G' ( :/9)/8/-()5 </:I 78 7--1;(5/7)(& 'J;7:1<' ()+

(<' (5 </:I 78 dOc /)8'-5/7) /8 )75 G(--/)(5'+> $5.'<: =.7 (<' (5 </:I /)-&1+' 5.7:' =.7 -7?' /)

-7)5(-5 =/5. E&77+ 7< E7+/&F 8&1/+: 8<7? () /)+/G/+1(& =/5. ( ./9. </:I 78 /)8'-5/7)> ,.' </:I 78

dOc /)8'-5/7) /) 5.' =7<I;&(-' /: ;</?(</&F <'&(5'+ 57 5.' +'9<'' 78 -7)5(-5 =/5. E&77+ /) 5.'

=7<I;&(-' ()+ 57 5.' dOc :5(51: 78 5.' :71<-' ;'<:7)>

^./&' dOc -() E' 5<'(5'+H 5.' </:I 78 -.<7)/- .';(5/5/: /: :/9)/8/-()5H ()+ ;<'G')5/7) <'?(/):

5.' ?7:5 /?;7<5()5 =(F 57 <'+1-' 5.' ;75')5/(& 87< ( )'9(5/G' 715-7?'> N) 5.' =7<I;&(-'H 5.'

</:I 78 -7)5<(-5/)9 .';(5/5/: O /: (::7-/(5'+ =/5. -7)5(-5 =/5. /)8'-5'+ E7+F 8&1/+: :1-. (: E&77+>

,.' </:I 78 ( .'(&5.-(<' =7<I'< +'G'&7;/)9 .';(5/5/: 87&&7=/)9 'J;7:1<' 57 dOc /: AAtRTCt> ,.'

</:I 78 +'G'&7;/)9 :'<7&79/- 'G/+')-' 78 /)8'-5/7) /: T4tRSAt> 2CD3

$)' 78 5.' ?7:5 -7??7) ?7+': 78 dOc 5<():?/::/7) /) 5.' .'(&5.-(<' :'55/)9 /: 5.'

1)/)5')5/7)(& /)]1<F 78 ( .'(&5.-(<' =7<I'< 8<7? ( )''+&':5/-I 7< -15 EF ( -7)5(?/)(5'+

/):5<1?')5> ,.' <(5' 78 dOc 5<():?/::/7) 57 :1:-';5/E&' .'(&5.-(<' =7<I'<: <()9': 8<7? St 57

TBt (85'< ( :/)9&' )''+&':5/-I 'J;7:1<' 57 () dOcR/)8'-5'+ ;(5/')5H E15 /: G/<51(&&F \'<7 /8 5.(5

.'(&5.-(<' =7<I'< .(: E'') /??1)/\'+ (9(/):5 dOc> 2CD3 d';(5/5/: O :1<8(-' ()5/9') 2dO:#93

;7:/5/G' /)+/G/+1(&: =.7 (<' d';(5/5/: O n'p ()5/9') 2dO'#Z3 ;7:/5/G' .(G' ?7<' G/<1: /) 5.'/<

E&77+ ()+ (<' ?7<' &/I'&F 57 5<():?/5 +/:'(:'> ,.' ;<':')-' 78 dO'#9 :199':5: 5.(5 dOc /: /) ()

(-15' :5(9' ()+ :.71&+ E' -7):/+'<'+ ./9.&F /)8'-5/71:> ,.' )1?E'<: 78 7--1;(5/7)(&&F :;<'(+

dOc .(G' +'-&/)'+ :/)-' 5.' CPQB: 8<7? 7G'< CBHBBB ())1(&&F 57 E'&7= bBB /) ABBC> Y';7<5: 78

/)8'-5/7): /) ABBS ='<' /)8<'01')5> N) CPPAH 5.' "W" E'9() ( -7?;<'.'):/G' :5<(5'9F 57

'&/?/)(5' dOc 5<():?/::/7) /) 5.' L)/5'+ M5(5':H /)-&1+/)9 5.<719. G(--/)(5/7)> N) ABBD /5 =(:

)75'+ /) 87&&7=R1; :1<G'/&&()-' 5.(5 4Dt 78 .'(&5.-(<' =7<I'<: .(G' E'') G(--/)(5'+> 2CD3

$5.'< 9<71;: (5 </:I /)-&1+' 5.7:' =.7 &/G' /) -<7=+'+ 7< 1):()/5(<F -7)+/5/7): 2/)-&1+/)9

;</:7)'<: ()+ -'<5(/) /??/9<()5 ;7;1&(5/7):3H .(G' ?1&5/;&' :'J1(& -7)5(-5:H ?') =.7 .(G'

.7?7:'J1(& -7)5(-5H &/G' /) 5.' :(?' .71:' =/5. :7?'7)' =.7 .(: -.<7)/- dOcH .(G' :'J =/5.



CT4

:7?'7)' /)8'-5'+ =/5. dOcH .(G' .'?7;./&/(H (<' ( ;(5/')5 7< =7 2CT3

Exposure to HBV

dOc /: 5<():?/55'+ 5.<719. ;'<-15()'71: 7< ;(<')5'<(& -7)5(-5 =/5. /)8'-5'+ E&77+H E7+F

8&1/+:H ()+ EF :'J1(& /)5'<-71<:'> dOc /: 7)&F :;<'(+ =.') E&77+H :'?') 7< 75.'< E7+/&F 8&1/+:

2$KN%3 ')5'< 5.' E7+F 78 ()75.'< ;'<:7) 5.<719. () 7</8/-'H ( E<'(I /) 5.' :I/) 7< 5.<719.

?1-1: ?'?E<()':> dOc ?(F (&:7 E' 5<():?/55'+ ;'</)(5(&&F> dOc /: )75 :;<'(+ 5.<719. :.(</)9

'(5/)9 15'):/&:H -(:1(& -7)5(-5H 7< E<'(:58''+/)9> N5 /: )75 :;<'(+ EF -7)5(?/)(5'+ =(5'< 7<

877+> dOc /: (E&' 57 <'?(/) 7) ()F :1<8(-' /5 -7?': /)57 -7)5(-5 =/5. 87< (E715 ( =''IH '>9>H

5(E&'R57;:H <(\7< E&(+':H E&77+ :5(/):H =/5.715 &7:/)9 /)8'-5/G/5F> dOc +7': )75 -<7:: 5.' :I/) 7<

5.' ?1-71: ?'?E<()' E(<</'<> M7?' E<'(I /) 5./: E(<</'<H =./-. -() E' ?/)/?(& ()+

/):/9)/8/-()5H /: <'01/<'+ 87< 5<():?/::/7)> 2CAH CS3

d'(&5.-(<' =7<I'<: =.7 (<' )75 /??1)' (<' (5 ( ./9.'< </:I 87< dOc 5.() 5.' 9')'<(& ;1E&/-

+1' 57 5.'/< ;75')5/(& 87< 8<'01')5 7--1;(5/7)(& 'J;7:1<' 57 ()+ E&77+ ;<7+1-5:H (: ='&& (:

75.'< E7+F 8&1/+:>

d';(5/5/: O ?1:5 E' <'-79)/\'+ (: () 7--1;(5/7)(& .(\(<+ 87< (-1;1)-51</:5:H (: /5 /: 87< 75.'<

.'(&5.-(<' ;<78'::/7)(&: =.7:' ;<7-'+1<': -7??7)&F /)-&1+' 5.' ;')'5<(5/7) 78 5.' :I/) 7<

-(1:' 'J;7:1<' 57 E&77+ ()+ 75.'< E7+F 8&1/+:> N)G(:/G' ;<7-'+1<':H =.'<' 5.'<' /:

-7):/+'<(E&' </:I 78 'J;7:1<' 57 -7)5(?/)(5'+ E&77+ ()+ E7+F 8&1/+:H ;7:' 5.' 9<'(5':5 </:I 78

7--1;(5/7)(& /)8'-5/7) 8<7? dOc> ,.' "W" :5<7)9&F <'-7??')+: 5.(5 (&& ;'<:7))'& =7<I/)9 /)

:1-. (<'(: :.71&+ :-<1;1&71:&F 87&&7= M5()+(<+ K<'-(15/7):> W/:;7:(E&' '01/;?')5 ()+

;<75'-5/G' -&75./)9 :.71&+ E' 1:'+ =.') (;;<7;</(5'H ()+ (;;<7;</(5' +/:/)8'-5/7) ;<757-7&:

'?;&7F'+>

N) 5.' 'G')5 78 'J;7:1<'H .';(5/5/: O /??1)' 9&7E1&/) ()+ .';(5/5/: O G(--/)' .(G' E'') :.7=)

57 E' '88'-5/G' <':;7):':> [7< 5.' .'(&5.-(<' =7<I'<H ?1&5/;&' +7:': 78 .';(5/5/: O /??1)'

9&7E1&/) 7< .';(5/5/: O G(--/)' (&7)' /: 4BtR4Dt '88'-5/G' /) ;<'G')5/)9 :'01'&(' 78 dOc

'J;7:1<'> 2CD3

HBV Vaccination# G(--/)' (9(/):5 .';(5/5/: O =(: +'G'&7;'+ /) CPQC> #)F .'(&5.F (+1&5 =/5. () /)5(-5 /??1)'

:F:5'? =/&& &/I'&F <':;7)+ 57 7)' :'</': 78 5.' G(--/)'> #5 5./: 5/?' /5 /: -&'(< 5.(5 /??1)/5F

-&'(<&F &(:5: ='&& 7G'< 5=')5F F'(<:H E15 :/)-' 5.' G(--/)' .(: 7)&F E'') /) 'J/:5')-' :/)-' CPQCH

)7 7)' F'5 I)7=: 'J(-5&F .7= &7)9 /??1)/5F =/&& &(:5> ,.'<' /: )7 5':5/)9 <'-7??')+'+ E'87<'

G(--/)(5/7)i E15 CRA ?7)5.: 87&&7=/)9 -7?;&'5/7) 78 5.' :'</':H ( 5/5'< /: <'-7??')+'+ 57

(::':: 5.' <':;7):'> N8 5.'<' /: ( <':;7):'H )7 81<5.'< E77:5'<: 7< :'</': (<' <'-7??')+'+> N8



CTQ

5.'<' /: )7 <':;7):'H 5.') ( :'-7)+ :'</': ?(F E' 9/G') ()+ =/&& 1:1(&&F E' :1--'::81&> ,.'<'

(<' ( &7= )1?E'< 78 )7)R<':;7)+'<: 'G') (85'< 5.' :'-7)+ :'</':i )7 81<5.'< G(--/)' /:

<'-7??')+'+ 87< 5.'?> 2C43

c(--/)(5/7) /: <'-7??')+'+ 87< ;'<:7))'& ;'<87<?/)9 /)G(:/G' ;<7-'+1<':H -&'()/)9

-7)5(?/)(5'+ '01/;?')5H 7< ;'<87<?/)9 +15/': /) () (<'( =.'<' 5.'<' /: ( </:I 78 'J;7:1<'> ,.'

"W" <'-7??')+: 5.(5 (&& .'(&5.-(<' =7<I'<: E' G(--/)(5'+ (9(/):5 dOc> $Md# <'01/<': (&&

'?;&7F'<: 57 788'< dOc G(--/)(5/7) 57 ;'<:7))'& ;'<87<?/)9 /)G(:/G' ;<7-'+1<': 7< -&'()/)9

-7)5(?/)(5'+ '01/;?')5> 2Cb3 N) $-57E'< CPP4H 5.' #+G/:7<F "7??/55'' 7) N??1)/\(5/7)

K<(-5/-': 'J;()+'+ /5: .';(5/5/: O G(--/)(5/7) <'-7??')+(5/7): 57 /)-&1+' (&& -./&+<') (9'+ BR

CQ F'(<:>

The HBV Infection Process

,.' /)-1E(5/7) ;'</7+ 87< dOc /: DB 57 CQB +(F:> 2CQ3 W1</)9 5./: ;'</7+H 5.' /)8'-5/71: G/<1:

(;;'(<: /) 5.' E&77+H ()+ /5 ?(F (;;'(< /) 5.' 8'-': ()+ :'?')> W1</)9 5./: ;'</7+ 5.' /)8'-5/7)?(F E' :;<'(+ 57 75.'< ;'7;&' 'G') 5.719. )7 :F?;57?: (<' ;<':')5> dOc '(<&F :F?;57?:

785') E'9/) =/5. ?/&+ 8&1R&/I' :/9): ()+ :F?;57?: :1-. (: ( 8'G'< 2/) SBt 78 -(:':3H 9')'<(&

?(&(/:'H 7< 5.' /):/+/71: 7):'5 78 ()7<'J/( ()+ (E+7?/)(& ;(/)> $5.'< :F?;57?: ?(F /)-&1+'

-./&&:H )(1:'(H ]7/)5 ;(/):H <(:.H ()+ +/(<<.'(> ,F;/-(&&F 5.':' :F?;57?: &(:5 8<7? 5=7 57 :/J

=''I:> ,.':' :F?;57?: (<' 8<'01')5&F 87&&7='+ EF ( ;'</7+ 78 'J5<'?' 8(5/91' ()+ +';<'::/7)

5.(5 -() 'J5')+ 87< :'G'<(& ?7)5.:>

K<(-5/5/7)'<: :.71&+ E' (=(<' 5.(5 :7?' /)+/G/+1(&: /)8'-5'+ =/5. 5.' G/<1: +'G'&7; ?/&+

:F?;57?: 7< (<' (:F?;57?(5/-> #;;<7J/?(5'&F TBt 78 5.7:' /)8'-5'+ .(G' )7 :/9): 7<

:F?;57?:> 2C43 "./&+<') =/5. dOc (<' 785') (:F?;57?(5/-> d7='G'<H (:F?;57?(5/- ;(5/')5:

(<' (: /)8'-5/71: (: 5.7:' =.7 (<' :F?;57?(5/-> $)&F ( E&77+ 5':5 =/&& 5'&& =.'5.'< () /)+/G/+1(&

/: /)8'-5'+ =/5. dOc>

[1&&F 4Bt 78 ;'7;&' =.7 .(G' <'-7G'<'+ 8<7? 5.' :F?;57?(5/- :5(9' 78 5.' +/:'(:' (<' :5/&&

/)8'-5/71: 87< 5.<'' ?7)5.: 7< ?7<' (85'< :F?;57?: .(G' :1E:/+'+> #?7)9 /)8()5: =.7 (-01/<'

dOc /)8'-5/7) 8<7? 5.'/< ?75.'<: (5 E/<5.H 1; 57 PBt E'-7?' -.<7)/-(&&F /)8'-5'+> ,.' 7&+'<

F71 (<' =.') /)8'-5'+H 5.' &7='< 5.' <(5' 78 -.<7)/- /)8'-5/7)H =/5. TBtaDBt 78 -./&+<')

/)8'-5'+ (5 (9' CaD F'(<: E'-7?/)9 -.<7)/-(&&F /)8'-5'+H ()+ (?7)9 (+1&5: (;;<7J/?(5'&F Dt 78

(&& (-15' dOc /)8'-5/7): ;<79<':: 57 -.<7)/- /)8'-5/7)> 2CQ3

N8 ( ;<(-5/5/7)'< E'-7?': /)8'-5'+ =/5. dOcH .' 7< :.' ?(F 1)I)7=/)9&F 5<():?/5 dOc 57

;(5/')5: 7< 788/-' :5(88 5.<719. 5<():?/::/7) 78 E&77+ 8<7? -15: 7< 7;') :7<':> K<78'::/7)(&&F

()+ &'9(&&F 5.' <(?/8/-(5/7): 78 5./: 87<? 78 5<():?/::/7) (<' ')7<?71:> d/9. :5()+(<+: 78

.F9/')' ()+ "&'() *''+&' ,'-.)/01' =/&& 9<'(5&F <'+1-' 5.' </:I 78 dOc /)8'-5/7) 87<

;<(-5/5/7)'<:H (: ='&& (: ;(5/')5:> # ;<(-5/5/7)'< =/5. (-15' dOc :.71&+ )75 ;<(-5/-' +1</)9 5.'



CTP

/)8'-5/71: ;'</7+> N8 ( ;<7G/+'< /: 871)+ 57 E' /)8'-5'+H .' 7< :.' :.71&+ -7):1&5 =/5. ( ;.F:/-/()

E'87<' 97/)9 E(-I 57 =7 2Cb3

Treatment of HBV

^./&' dOc -() E' 5<'(5'+H 5.' </:I 78 -.<7)/- .';(5/5/: /: :/9)/8/-()5H ()+ ;<'G')5/7) <'?(/):

5.' ?7:5 /?;7<5()5 =(F 57 <'+1-' 5.' ;75')5/(& 87< ( )'9(5/G' 715-7?'> N) 5.' =7<I;&(-'H 5.'

</:I 78 -7)5<(-5/)9 .';(5/5/: O /: (::7-/(5'+ =/5. -7)5(-5 =/5. /)8'-5'+ E7+F 8&1/+: :1-. (: E&77+>

,.' </:I 78 ( .'(&5.-(<' =7<I'< +'G'&7;/)9 .';(5/5/: 87&&7=/)9 'J;7:1<' 57 dOc /: AAtRTCt> ,.'

</:I 78 +'G'&7;/)9 :'<7&79/- 'G/+')-' 78 /)8'-5/7) /: T4tRSAt> ,./: </:I /: :/9)/8/-()5&F ./9.'<

5.() 5.' (;;<7J/?(5'&F B>Tt -/5'+ 87< dNc> 2CD3

N) 5.' 'G')5 78 'J;7:1<'H .';(5/5/: O /??1)' 9&7E1&/) ()+ .';(5/5/: O G(--/)' .(G' E'') :.7=)

57 E' '88'-5/G' <':;7):':> [7< 5.' .'(&5.-(<' =7<I'<H ?1&5/;&' +7:': 78 .';(5/5/: O /??1)'

9&7E1&/) 7< .';(5/5/: O G(--/)' (&7)' /: 4BtR4Dt '88'-5/G'> 2CbRCP3

"7?E/)/)9 5.':' 5=7 5<'(5?')5: /)-<'(:': '88/-(-F> ,.' dOc G(--/)' /: :(8' ()+ '88'-5/G'>

Hepatitis C (HCV)

d';(5/5/: " G/<1: 2d"c3 /)8'-5/7) /: 5.' ?7:5 -7??7) -.<7)/- E&77+E7<)' G/<(& /)8'-5/7) /) 5.'

L)/5'+ M5(5':> [/<:5 /+')5/8/'+ /) CPQQH d"c /: 5.' -(1:(5/G' (9')5 87< =.(5 =(: 87<?'<&F I)7=)

(: )7)R# )7)RO .';(5/5/:H ()+ /: ':5/?(5'+ 57 .(G' /)8'-5'+ (: ?()F (: AbAHBBB #?'</-():

())1(&&F +1</)9 5.' CPQB:> %()F 78 5.7:' /)8'-5'+ (<' )75 (=(<' 78 5.'/< /)8'-5/7)H <':1&5/)9 /)

-.<7)/- &/G'< +/:'(:' 5.(5 ?(F )75 E'-7?' (;;(<')5 87< CBRAB F'(<:>

d"c /: ( G/<1: -7)5(/)/)9 ( :/)9&' :5<()+ 78 Y*# 5.(5 /: ?7:5 '88'-5/G'&F 5<():?/55'+ EF;'<-15()'71: -7)5(-5 5.<719. /)]'-5/7) +<19 1:' 7< 'J;7:1<' 57 /)8'-5'+ E&77+ 7< E&77+

;<7+1-5:>

,7+(FH ?7:5 ;'7;&' E'-7?' /)8'-5'+ =/5. 5.' .';(5/5/: " G/<1: EF :.(</)9 )''+&': 7< 75.'<

'01/;?')5 57 /)]'-5 +<19:> O'87<' CPPAH =.') =/+':;<'(+ :-<'')/)9 78 5.' E&77+ :1;;&F E'9()

/) 5.' L)/5'+ M5(5':H d';(5/5/: " =(: (&:7 -7??7)&F :;<'(+ 5.<719. E&77+ 5<():81:/7): ()+

7<9() 5<():;&()5:> 2AB3

^./&' d"c ?(F E' 5<():?/55'+ 5.<719. :'J1(& -7)5(-5H -7)5<(-5/)9 ( d"c /)8'-5/7) 5.<719. 5./:

<715' /: -7):/+'<(E&F &':: '88/-/')5> ,.' </:I 78 5<():?/::/7) 8<7? :'J1(& -7)5(-5 /: E'&/'G'+ 57 E'G'<F &7=> ,.' </:I /)-<'(:': 87< 5.7:' =.7 .(G' ?1&5/;&' :'J ;(<5)'<:H .(G' ( :'J1(&&F

5<():?/55'+ +/:'(:'H ')9(9' /) n<719. :'JpH 7< (<' /)8'-5'+ =/5. dNc> 2AC3

N) ABBPH 5.'<' ='<' () ':5/?(5'+ CSHBBB )'= .';(5/5/: " G/<1: /)8'-5/7): /) 5.' L)/5'+ M5(5':>

d7='G'<H 5.' 788/-/(& )1?E'< 78 <';7<5'+ .';(5/5/: " -(:': /: ?1-. &7='<> %()F ;'7;&' =.7 (<'



CbB

/)8'-5'+ )'G'< .(G' :F?;57?: ()+ 5.'<'87<' )'G'< -7?' 57 5.' (55')5/7) 78 ?'+/-(& 7< ;1E&/-

.'(&5. 788/-/(&:> 2AC3

K'(I <(5': 78 d"c 7--1<<'+ /) 5.' CPQB:H ()+ .(G' +'-&/)'+ +1' 57 ( <'+1-5/7) /) /)8'-5/7):

<':1&5/)9 8<7? /)]'-5/7) +<19 1:'> ^./&' )'= /)8'-5/7): (<' +'-&/)/)9H (;;<7J/?(5'&F T>P ?/&&/7)

/)+/G/+1(&: /) 5.' L)/5'+ M5(5': (<' -.<7)/-(&&F /)8'-5'+ =/5. d"c (: 78 ABCB> 2AB3

,.' </:I 78 :'<7-7)G'<:/7) (85'< ;'<-15()'71: 7--1;(5/7)(& 'J;7:1<' /: (;;<7J/?(5'&F C>Qt /8

5.' :71<-' E&77+ /: :'<7;7:/5/G' 87< d"c> ,./: /: -7):/+'<(E&F ./9.'< 5.() 5.' </:I 78

;'<-15()'71: 7--1;(5/7)(& 'J;7:1<' +1' 57 dNc :'<7;7:/5/G' E&77+ ()+ &7='< 5.() 5.' </:I 78

:'<7-7)G'<:/7) (85'< ;'<-15()'71: 7--1;(5/7)(& 'J;7:1<' 57 dOc :'<7;7:/5/G' 8&1/+:> 2CD3

Acute Symptoms of Hepatitis C

,.7:' =.7 ?()/8':5 :F?;57?: 78 (-15' .';(5/5/: " =/&& 'J;'</')-' :F?;57?: :/?/&(< 57 5.'

75.'< -(:': 78 (-15' .';(5/5/:H /)-&1+/)9 8&1R&/I' :F?;57?:H ]7/)5 (-.':H ](1)+/-' ()+`7< ?/&+

:I/) <(:.> $5.'< :F?;57?: /)-&1+' ( &7:: 78 (;;'5/5'H (E+7?/)(& ;(/)H +(<I'<R5.()R)7<?(& 1</)'

-7&7< ()+ &/9.5 7< 9<'F -7&7<'+ :577&:> K<(-5/5/7)'<: :.71&+ E' (=(<' 5.(5 &':: 5.() TBt 78 5.7:'

/)8'-5'+ =/5. .';(5/5/: " ?()/8':5 (-15' +/:'(:' :F?;57?:>

Risk Factors for HCV Infection

N)+/G/+1(&: =.7 /)]'-5 +<19:H 'G') /8 5.'F +/+ :7 7)&F 7) 7)' 7--(:/7) ?()F F'(<: ;<'G/71:&FH

.(G' 5.' ./9.':5 </:I 78 d"c /)8'-5/7)> N)+/G/+1(&: =/5. ( ./:57<F 78 /)]'-5/7) +<19 1:' <';<':')5

SBt 78 5.7:' /)8'-5'+> d"c /: <(;/+&F (-01/<'+ 87&&7=/)9 /)]'-5/7) +<19 1:' 5.<719. :.(</)9

)''+&': ()+ 75.'< '01/;?')5> #: ?()F (: QBt 78 /)]'-5/7) +<19 1:'<: (<' 871)+ 57 E' /)8'-5'+

=/5. d"c ()+ (<' 785') -7R/)8'-5'+ =/5. dNc 2TBRDBt3> 2AA3 $5.'< </:I: 78 d"c /)8'-5/7) /)-&1+'5<():81:/7): ()+ 5<():;&()5: E'87<' 5.' :-<'')/)9 5.(5 /: -1<<')5&F /) ;&(-' 2E'87<' CPPA3 ()+H

57 ( &'::'< +'9<''H :'J1(& -7)5(-5 2CDt3> ,.'<' /: ( </:I 78 7--1;(5/7)(& 'J;7:1<' 87< d"cH

;(<5/-1&(<&F =.'<' 5.'<' /: 'J;7:1<' 57 &(<9' (?71)5: 78 E&77+H :1-. (: .'?7+/(&F:/: ()+

:1<9'</':> d"c /: :;<'(+ 8<7? ?75.'< 57 E(EF> #E715 CBt 78 5.7:' /)8'-5'+ .(G' )7

<'-79)/\(E&' :71<-' 78 /)8'-5/7)> ^./&' /5 /: ;7::/E&' 87< d"c 57 E' 5<():?/55'+ 8<7?

;'<-15()'71: 'J;7:1<' 57 E&77+H 'J;7:1<': :1-. (: (-1;1)-51<'H 5(5577/)9H 7< E7+F ;/'<-/)9

.(G' )75 E'') :.7=) 57 ;&(-' ;'7;&' (5 /)-<'(:'+ </:I 87< d"c /)8'-5/7)> d"c /: ?7:5 '88/-/')5&F

5<():?/55'+ EF 'J;7:1<': 5.(5 /)G7&G' +/<'-5 ;(::(9' 78 E&77+ 5.<719. 5.' :I/)H ;(<5/-1&(<&F

=/5. .7&&7=RE7<' )''+&':>

^./&' 5.' </:I 78 7--1;(5/7)(& 'J;7:1<' &'(+/)9 57 d"c :'<7-7)G'<:/7) ?(F E' &/?/5'+ 57

)''+&': =/5. ( &1?')H /5 /: /?;7<5()5 57 :5(5' 5.(5 (: =/5. dNc ()+ dOcH 'J;7:1<' 87&&7=/)9 (

)''+&':5/-I /)G7&G/)9 () (-1;1)-51<' )''+&' ?1:5 E' 5<'(5'+ (: ( ;7::/E&' :71<-' 78 /)8'-5/7)>



CbC

d"c .(: E'') (::7-/(5'+ =/5. (-1;1)-51<' /) :7?' <'5<7:;'-5/G' :51+/': 78 (-1;1)-51<' #6:>

2DH AT3

HCV Survival in the Environment

,.' .';(5/5/: " G/<1: 2d"c3 -() <'?(/) G/(E&' 715:/+' 5.' E7+F 87< bRD +(F:> 2Ab3

Consequences of HCV Infection

#E715 CDRADt 78 5.7:' /)8'-5'+ -&'(< 5.'/< d"c /)8'-5/7) =/5.715 81<5.'< ;<7E&'?:> ,.'

<'?(/)+'< 24DRQDt3 =/&& +'G'&7; -.<7)/- /)8'-5/7) ()+ (;;<7J/?(5'&F SBR4Bt =/&& 97 7) 57

+'G'&7; -.<7)/- .';(5/5/:> 2# -.<7)/- /)8'-5/7) /: 5.' -.<7)/- ;<':')-' 78 5.' (9')5H d"cH ()+

5.' ;(5/')5k: /??1)' <':;7):'> ".<7)/- .';(5/5/: /: -.<7)/- /)8&(??(5/7) 78 5.' &/G'< 5.(5 ?(F

E' -(1:'+ EF -.<7)/- /)8'-5/7)> ^./&' 5.'F 785') 97 579'5.'<H 5.'F (<' +'8/)'+ +/88'<')5&F ()+

(: :1-. (: )75 /)5'<-.()9'(E&'>3 "/<<.7:/: 78 5.' &/G'< 7--1<: /) (5 &'(:5 ABt 78 ;(5/')5: 7G'< (

CBRAB F'(< ;'</7+ ()+ .';(57-'&&1&(< -(<-/)7?( 2&/G'< -()-'<3 7--1<: /) CRDt 78 -(:':> d"cR

(::7-/(5'+ -.<7)/- &/G'< +/:'(:' /: 5.' ?7:5 8<'01')5 /)+/-(5/7) 87< &/G'< 5<():;&()5(5/7) (?7)9(+1&5:> 2AD3 W<19 5<'(5?')5 /: () /?;7<5()5 (+]1)-5 57 -(<' 87< ?()F ;'<:7): =/5. d"c> ,.'<' /:

)7 G(--/)' 87< 5./: +/:'(:'> K'7;&' /)8'-5'+ =/5. d"c :.71&+ E' G(--/)(5'+ 87< d#c ()+ dOc 57

;<'G')5 81<5.'< -7?;&/-(5/7): 78 5.'/< +/:'(:'>

,.' /)-1E(5/7) ;'</7+ 78 d"c /: ABRPB +(F:H =/5. ?7:5 -(:': 7--1<</)9 D 57 CB =''I: (85'<

'J;7:1<'> 2AD3 ,.' ;'</7+ 78 -7??1)/-(E/&/5F 'J5')+: 8<7? 7)' =''I (85'< 'J;7:1<' 5.<719.

5.' -.<7)/- :5(9'> ,.' 7):'5 /: /):/+/71: ()+ (--7?;()/'+ EF ()7<'J/(H )(1:'(H G7?/5/)9H ()+

](1)+/-'> ,.' -71<:' /: :/?/&(< 57 dOc E15 ?7<' ;<7&7)9'+>

,.'<(;F 87< .';(5/5/: " /: ( <(;/+&F -.()9/)9 (<'( 78 E/7?'+/-(& -&/)/-(& ;<(-5/-'> ,<'(5?')5+'-/:/7): (<' E(:'+ 7) &/G'< ')\F?' &'G'&:H 9')75F;' 78 5.' /)8'-5/)9 G/<1:H ()+ -7)+/5/7) 78 5.'

&/G'<H /)-&1+/)9 5.' 'J5')5 78 :-(<</)9> L:1(&&F 5<'(5?')5 ?(F 'J5')+ 8<7? Ab =''I: 57 A F'(<:

()+ 8<'01')5&F /)-&1+': /)5'<8'<7) ()+ </E(G/</) 2AS3H (&5.719. )'='< ()5/RG/<(& 5.'<(;/':

15/&/\/)9 :1-. +<19: (: ;<75'(:' /)./E/57<: ()+ ;7&F?'<(:' /)./E/57<: (<' E'-7?/)9 (G(/&(E&'>

Hepatitis D (HDV)

dWcH :7?'5/?': I)7=) (: +'&5( .';(5/5/:H /: ( +'8'-5/G' G/<1: 5.(5 <'01/<': -7)-1<<')5 dOc

/)8'-5/7) 87< +'G'&7;?')5 78 +/:'(:'> N) 5.' L>M>H ?7:5 -(:': 78 .';(5/5/: W 7--1< /) /)]'-5/7)

+<19 1:'<: ()+ .'?7;./&/(-:> ,<():?/::/7) 78 .';(5/5/: W /: 5.<719. ;'<-15()'71: 7< ?1-7:(&-7)5(-5 =/5. /)8'-5/71: E&77+> ,.'<' /: )7 G(--/)' 87< dWci .7='G'<H :/)-' 5.' dWc G/<1:

<'01/<': 5.' ;<':')-' 78 dOcH G(--/)(5/7) (9(/):5 dOc /: '88'-5/G' (9(/):5 dWc <'&(5'+ +/:'(:'>

,.' 715-7?' 78 :/?1&5()'71: dOc ()+ dWc /: )7 +/88'<')5 8<7? 5.' 715-7?' 78 dOc (&7)'>

d7='G'<H =.') -.<7)/- dOc /)8'-5/7) /: (--7?;()/'+ EF dWcH /5 ?(F &'(+ 57 :'G'<'H

81&?/)(5/)9 .';(5/5/: 7< 5<():87<? ( ?/&+ 7< (:F?;57?(5/- -.<7)/- dOc /)57 ( ?7<' :'G'<'

+/:'(:' ;<7-'::H 7< ( +/:'(:' ;<7-':: 5.(5 ?(F E' (--'&'<(5'+ +1' 57 /)-<'(:'+ :-(<</)9 78 5.'



CbA

&/G'<> K<'G')5/7) 78 d';(5/5/: W /) ;'<:7): =.7 (<' )75 (&<'(+F dOcR/)8'-5'+ -() E'

(--7?;&/:.'+ 5.<719. d';(5/5/: O G(--/)(5/7)> 2A43

HDV Survival in the Environment

dWc /: 871)+ =/5. dOc> dOc -() E' -(;(E&' 78 -(1:/)9 /)8'-5/7) 87< ( =''I> %7:5 'J;'<5:

E'&/'G' 5.(5 dWc +7': )75 &(:5 (: &7)9 E15 /5 /: E':5 57 5(I' 5.' :(?' ;<'-(15/7): (: =/5. dOc>

Hepatitis E (HEV)

d';(5/5/: 6H &/I' .';(5/5/: #H /: :;<'(+ EF 8'-(&R7<(& 5<():?/::/7) 2AQ3> %7:5 715E<'(I: (<' 871)+

/) +'G'&7;/)9 -71)5</':H =.'<' +</)I/)9 =(5'< /: -7)5(?/)(5'+ EF 8'-': 8<7? /)8'-5'+ ()/?(&:

()+ .1?():> d6c /: <(<'&F :'') /) 5.' L>M>H =/5. 5.' 'J-';5/7) 78 5<(G'&'<: 57 +'G'&7;/)9

-71)5</':H ;(<5/-1&(<&F M715. #:/( ()+ *7<5. #8</-(> N)8'-5/7) 8<7? ;'<:7) 57 ;'<:7) /: &'::

8<'01')5 5.() =/5. .';(5/5/: #> ,.' /)-1E(5/7) ;'</7+ /: CD 57 SB +(F:H =/5. () (G'<(9' 78 bB

+(F:> ,.' 5/?' ;'</7+ /: CD 57 SB +(F:H =/5. () (G'<(9' 78 bB +(F:> ,.' 5/?' ;'</7+ 78

-7??1)/-(E/&/5F /: 1)I)7=)> ,.' +/:'(:' /: -.(<(-5'</\'+ EF :1++') 7):'5 78 8'G'<H ?(&(/:'H)(1:'(H ()+ ()7<'J/(> ,.' +/:'(:' G(</': /) :'G'</5F 8<7? ( ?/&+ /&&)':: &(:5/)9 4 57 Cb +(F: 57 (

:'G'<'&F +/:(E&/)9 +/:'(:' &(:5/)9 :'G'<(& ?7)5.:> V(1)+/-' ?(F E' ;<':')5> K<'9)()5 =7?')

.(G' ( ?7<5(&/5F <(5' 78 ABt> ,.'<' /: )7 'G/+')-' 78 ( -.<7)/- /)8'-5/7) /) &7)9R5'<? 87&&7=R1;

78 ;(5/')5: =/5. d6c> ,.'<' /: )7 G(--/)' 87< d6c>

Chronic Carriers of Hepatitis

".<7)/- -(<</'<: (<' /)+/G/+1(&: =.7 -7)5/)1' 57 :.'+ .';(5/5/: G/<1: 5.<719. E7+/&F 8&1/+: ()+

'J-<'5/7): &7)9 (85'< /)8'-5/7)> ,.'F (<' -&(::/8/'+ /)57 5=7 -(5'97</':U ".<7)/- K'<:/:5')5 ()+

".<7)/- #-5/G'> # -.<7)/- ;'<:/:5')5 -(<</'< /: (:F?;57?(5/- 7< .(: ?/)/?(& :F?;57?: E15 -()-7)5/)1' 57 /)8'-5 75.'<:> # -.<7)/- (-5/G' -(<</'< .(: ;<79<'::/G' :F?;57?(5/- +/:'(:' 5.(5

-7)5/)1': 57 +(?(9' 5.' &/G'<> MF?;57?: /)-&1+' ?(&(/:'H ='/9.5 &7::H &7:: 78 (;;'5/5'H ()+

785') ](1)+/-'> K(5/')5: =/5. .';(5/5/: # ()+ 6 )'G'< +'G'&7; -.<7)/- :5(5':> d';(5/5/: O

E'-7?': -.<7)/- /) D 57 CBt 78 /)8'-5/7): 25./: <(5' G(</': +';')+/)9 7) 5.' (9' 78 5.' ;(5/')53H

d"c /) 4DRQDt 78 /)8'-5/7):> ,7 9'5 ( 977+ .';(5/5/: ./:57<F (: ;(<5 78 5.' ;(5/')5 /)5(I'H (:I

(E715 -7)5(-5 =/5. E&77+ ;<7+1-5: :1-. (: 5<():81:/7):H +/(&F:/:H ()+ /)]'-5/7) +<19 1:'>

K(5/')5: =.7 .(G' <'-'/G'+ 5<():81:/7): 7< +/(&F:/: E'87<' CPPB 7< =.7 .(G' ( ./:57<F 78

/)]'-5/7) +<19 1:' ;<':')5 () /)-<'(:'+ </:I> #&:7H ?()F ;(5/')5: /) ( ;1E&/- .'(&5.-(<' :'55/)9H

:1-. (: -.'?/-(& +';')+')-FH dNcH ()+ ,O -&/)/-:H ?(F .(G' ( ./:57<F 78 :7?' 87<? 78 .';(5/5/:HE15 ?(F )75 I)7= =.(5 5F;' ()+ ?(F )75 I)7= =.'5.'< 5.'F (<' -.<7)/- -(<</'<:> ,.' 1:' 78

"&'() *''+&' ,'-.)/01' ()+ M5()+(<+ K<'-(15/7): /: 5.' 7)&F '88'-5/G' =(F 57 ;<'G')5

5<():?/::/7) 78 G/<(& .';(5/5/: +/:'(:':>



CbT

Prevention of Hepatitis

$)' 78 5.' ?7:5 -7?;'&&/)9 <'(:7): 87< 5.' +'G'&7;?')5 78 5.' "&'() *''+&' ,'-.)/01'

;<757-7& /) CPQb =(: 57 ;<7G/+' 91/+'&/)': 57 ;<'G')5 5.' 5<():?/::/7) 78 .';(5/5/: =/5./)

(-1;1)-51<' -&/)/- :'55/)9:> M/)-' 5.(5 5/?'H 5.' /)-/+')-' 78 .';(5/5/: O 5.<719. (-1;1)-51<'

.(: +<(?(5/-(&&F +'-<'(:'+> 2AHT3 "7)5/)1/)9 :5</-5 (+.'<')-' 57 "&'() *''+&' ,'-.)/01' /:'::')5/(& /) 7<+'< 57 ;<'G')5 5<():?/::/7) 78 dOc 7< ( <'&(5'+ G/<1: 57 ;(5/')5:H ;<(-5/5/7)'<:

()+ :5(88>

,.' &(-I 78 ()F 'G/+')-' 78 5<():?/::/7) 78 G/<(& +/:'(:' 8<7? (-1;1)-51<' )''+&': /) 5.' L>M>

:/)-' CPPB -() E' +/<'-5&F (::7-/(5'+ =/5. 5.' /)5<7+1-5/7) 78 "*, -71<:' ()+ 5.' 1:' 78 :/)9&'R

1:' +/:;7:(E&' :5'</&' )''+&':>

Table 1: Summary of Hepatitis Characteristics

2M'' .55;U``===>-+->97G`.';(5/5/:`<':71<-':`;<78'::/7)(&:`;+8:`(E-5(E&'>;+8 3 87< +'5(/&:

(E715 d';(5/5/: #H O ()+ "3

P"/($*$*# @0).[($*,0 J'(0#?*##*,0 B0#"$ N())*0" D8',0*)

- H\I\M 2(5# X")(3I,'(3 -['./$ ]"# 1,

! V\IHKM 2(5# !3,,2[,'0" @0#*2*,.# ]"# ^"/"02# ,0

(>" >',./

F\IHM_ *0

(2.3$#`

8*>8"' *0)8*32'"0G

D HVIHLM 2(5# !3,,2[,'0" @0#*2*,.# 1, W\IL\_

^ a0<0,=0 &"').$(0",.# ,'

?.),#(3 ),0$()$

=*$8 *0+")$*,.#

[3,,2

@0#*2*,.# 1, a0<0,=0

9 H\IKM 2(5# X")(3I,'(3 -['./$ 1, 1,

Human Immunodeficiency Disease (HIV)

,.' .1?() /??1)7+'8/-/')-F G/<1: 2dNc3 /: () Y*#R-7)5(/)/)9 G/<1: 5.(5 /) .1?(): &'(+: 57 (

-7):5'&&(5/7) 78 ;<7E&'?: 'J5')+/)9 8<7? +'-&/)/)9 /??1)' 81)-5/7) 5.(5 &'(+: 57 () ')+R:5(9'

:F)+<7?' /) 1)5<'(5'+ ;(5/')5:H -(&&'+ 5.' (-01/<'+ /??1)' +'8/-/')-F :F)+<7?' 2#NWM3> ,.':'

?'+/-(& ;<7E&'?: ?(F E' 'J(-'<E(5'+ EF -7R/)8'-5/7) =/5. 75.'< +/:'(:'R-(1:/)9 (9')5: :1-.

(: 5.' .'<;': G/<1:':> dNc -7)5/)1': 57 E' ( 9<7=/)9 ?'+/-(& -.(&&')9' =7<&+=/+'> %(5.'<: ()+



Cbb

X7)-(< /)+/-(5' 5.(5 7G'< 5.' AD F'(< ;'</7+ 8<7? ABBS 57 ABTBH E'5='') QP ?/&&/7) ()+ CC4

?/&&/7) ;'7;&' =/&& +/' 78 dNc`#NWM> 2AP3

,.' "')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7) 2"W"3 <';7<5: 5.(5 /) ABCAH bCHDBD -(:': 78 dNc

='<' +/(9)7:'+ /) 5.' L)/5'+ M5(5':> 2TB3

,7 +(5'H 5.'<' (<' )7 -7)8/<?'+ -(:': 78 7--1;(5/7)(& dNc 5<():?/::/7) 87&&7=/)9 () (--/+')5(&

)''+&':5/-I /)G7&G/)9 () (-1;1)-51<' )''+&' /) 5.' L)/5'+ M5(5':> ,.'<' =(: ( -(:' <';7<5 8<7?

ABBT 78 ( ;(5/')5 /) ,.(/&()+ /)+/-(5/)9 5.(5 (-1;1)-51<' =(: 5.' 7)&F I)7=) </:I 87< 5.'

:'<7-7)G'<:/7) 78 ( ;<'G/71:&F dNc :'<7)'9(5/G' SB F'(<R7&+ 8'?(&'>2TC3

M-/')5/:5: .(G' /+')5/8/'+ ( 5F;' 78 -./?;()\'' /) ^':5 #8</-( (: 5.' :71<-' 78 5.' dNc 5.(5

/)8'-5: .1?():> ,.' G/<1: ?7:5 &/I'&F ]1?;'+ 57 .1?(): =.') 5.'F .1)5'+ 5.':' -./?;()\'':

87< ?'(5 ()+ -(?' /)57 -7)5(-5 =/5. 5.'/< /)8'-5'+ E&77+> $G'< :'G'<(& F'(<: 5.' G/<1: :;<'(+

(-<7:: #8</-( ()+ &(5'< /)57 75.'< ;(<5: 78 5.' =7<&+> ,=7 5F;': 78 dNc .(G' E'') /+')5/8/'+U

dNcRC ()+ dNcRA> #&5.719. 5.'F .(G' :/?/&(< ';/+'?/7&79/-(& ()+ ;(5.7&79/-(& -.(<(-5'</:5/-:H

5.'F (<' +/88'<')5 :'<7&79/-(&&F ()+ 9'79<(;./-(&&F> Z')'<(&&FH dNcRA .(: ( :&7='<H :7?'=.(5

?/&+'< -71<:'> N5 :''?: 57 E' &':: /)8'-5/71: '(<&F 7) /) 5.' +/:'(:'H E15 E'-7?': ?7<'

/)8'-5/71: 7G'< 5/?'> N5 /: ;<'+7?/)(5'&F 871)+ /) ^':5 #8</-(> "(:': (<' :'') /)8<'01')5&F /)

5.' L>M> ()+ 1:1(&&F .(G' :7?' (::7-/(5/7) =/5. ^':5 #8</-(> dNcRC /: 5.' ?7<' G/<1&')5 G/<1:

()+ /: ?7<' '(:/&F 5<():?/55'+> N5 /: 5.' -(1:' 78 5.' ?(]7</5F 78 dNc /)8'-5/7): 9&7E(&&F> 2TA3

HIV Transmission

O&77+R57RE&77+ -7)5(-5 /: 5.' ?7:5 +/<'-5 ?'5.7+ 78 5<():?/55/)9 dNc 2(: ='&& (: dOc3> ^.')

/)8'-5'+ E&77+ ')5'<: 5.' E&77+:5<'(? 78 () 1)/)8'-5'+ /)+/G/+1(&H 5.'<' /: ( ;<7E(E/&/5F 78/)8'-5/7)H (&5.719. 5./: </:I /: ?1-. &7='< 5.() 5.(5 87< dOc> K<7:;'-5/G' :51+/': 78 .'(&5.-(<'

=7<I'<: 2d"^:3 .(G' ':5/?(5'+ 5.(5 5.' (G'<(9' </:I 87< dNc 5<():?/::/7) (85'< ( ;'<-15()'71:

'J;7:1<' /: (;;<7J/?(5'&F B>TtH 5.' </:I 78 dOc 5<():?/::/7) /: S 57 TBtH ()+ 5.' </:I 78 d"c

5<():?/::/7) /: (;;<7J/?(5'&F C>Qt> 2TT3 ,.' ?7:5 -7??7) ?7+' 78 5<():?/::/7) /:

;'<-15()'71: 'J;7:1<' 5.(5 7--1<: 8<7? -7)5(?/)(5'+ /):5<1?')5: 2?7:5&F 8<7? :151</)9 ()+

)''+&':5/-I:3H 7< -7)5(-5 78 -7)5(?/)(5'+ E&77+ =/5. )7)R/)5(-5 :I/)> ,.' </:IH .7='G'<H /:

'J5<'?'&F &7= /8 M5()+(<+ K<'-(15/7): (<' 87&&7='+> M5()+(<+ K<'-(15/7):H (: +'8/)'+ EF 5.'

"W"H /)-&1+' 5.' 1:' 78 E(<</'<: (: 9&7G':H ?(:I:H 97=):H 9799&':H ()+ ;<'G')5/7) 5'-.)/01':

(;;<7;</(5' 57 5.' ;(<5/-1&(< .'(&5.-(<' :'55/)9H +';')+/)9 7) 5.' :;'-/8/- </:I: /)G7&G'+> 2Tb3

,.'<' /: )7 'G/+')-' 5.(5 dNc /: :;<'(+ EF -(:1(& -7)5(-5> "(:1(& -7)5(-5 -7):/:5: 78 ()F (-5/G/5F

5.(5 +7': )75 /)G7&G' 5.' 'J-.()9' 78 E7+F 8&1/+: :1-. (: E&77+H :'?')H 7< G(9/)(& :'-<'5/7):>

*7)R</:I -(:1(& -7)5(-5 /)-&1+': :.(I/)9 .()+:H 571-./)9H .199/)9H .7&+/)9 .()+:H 7< I/::/)9>

,.' 1:' 78 7E]'-5: .()+&'+ 7< 571-.'+ EF () dNcR/)8'-5'+ ;'<:7) 287< 'J(?;&'H ( 5'&';.7)' 7<

57/&'5 :'(53 .(: (&:7 )75 E'') :.7=) 57 :;<'(+ 5.' G/<1:>



CbD

HIV Survival in the Environment

dNc +7': )75 :1<G/G' &7)9 715:/+' 5.' .1?() E7+F 2:1-. (: 7) :1<8(-':3H ()+ /5 -())75

<';<7+1-' 715:/+' 78 5.' E7+F> $15:/+' 78 5.' E7+FH 5.' G/<1: +/': =/5./) ?/)15': =/5.715 5.'

5'?;'<(51<' )'-'::(<F 87< /5: :1<G/G(&> .55;U``===>-+->97G`./GÈ(:/-:`5<():?/::/7)>.5?&

Risk of Transmission through Invasive Procedures

N) 9')'<(&H 5.' </:I 87< dNc 5<():?/::/7) E'5='') ;(5/')5: ()+ .'(&5.-(<' =7<I'<: /: G'<F &7=>

2APH TC3 #+.'<')-' 57 "W"R<'-7??')+'+ ;<7-'+1<': 87< M5()+(<+ K<'-(15/7): <'+1-': 5.' </:I

:/9)/8/-()5&F> K<(-5/5/7)'<: :.71&+ ;<'G')5 +/<'-5 E&77+ -7)5(-5 ()+ -(<<F 715 ;<7;'< +/:/)8'-5/7)

;<7-'+1<': (: +':-</E'+ /) 5./: ?()1(& ()+ (5 5.' ='E:/5'U

.55;U``===>-+->97G`d#N`:'55/)9:`715;(5/')5`715;(5/')5R-(<'R9&R:5()+(<+R;<'-(15/7):>.5?&

Individuals at Risk of HIV Infection

,.' 8/<:5 -(:': 78 #NWM /) 5.' L)/5'+ M5(5': ='<' <';7<5'+ /) CPQC> OF 5.' ')+ 78 CPQCH ( 575(& 78

TCS -(:': 78 5./: )'=&F +/:-7G'<'+ :F)+<7?' ='<' <';7<5'+ 57 5.' "W"> W1</)9 5.' CPQB: (:?()F (: CDBHBBB ;'7;&' E'-(?' dNc /)8'-5'+ '(-. F'(<> OF 5.' '(<&F CPPB: 5.' /)8'-5/7) <(5'

+<7;;'+ 57 (E715 bBHBBB '(-. F'(<> #5 5.' ')+ 78 ABBPH () ':5/?(5'+ CHCbQHABB ;'<:7): (9'+

CT ()+ 7&+'< ='<' &/G/)9 =/5. dNc /)8'-5/7) /) 5.' L)/5'+ M5(5':H /)-&1+/)9 AB4HSBB 2CQ>Ct3

;'<:7): =.7:' /)8'-5/7): .(+ )75 E'') +/(9)7:'+> 2TD3 ,.' )1?E'< 78 #NWM -(:': E'9() 57 8(&&

+<(?(5/-(&&F /) CPPS =/5. 5.' (+G')5 78 ;<75'(:' /)./E/57<:>

N5 /: /?;7<5()5 57 )75' 5.(5 5.' ;7;1&(5/7) +/:5</E15/7) 78 dNc .(: -.()9'+> N)/5/(&&F dNc =(:

871)+ ;</?(</&F (?7)9 ?') =.7 .(+ :'J =/5. ?')H /)]'-5/7) +<19 1:'<:H :'J =7<I'<:H ()+

5<():81:/7) <'-/;/')5:> ,7+(F dNc /: )7 &7)9'< &/?/5'+ 57 5.':' /)/5/(& ;7;1&(5/7):> Y'-')5&FH

?7<' -(:': (<' (::7-/(5'+ =/5. 1);<75'-5'+ :'J E'5='') ?/J'+ 9')+'< -71;&':> W1' 57

:1--'::81& ;<757-7&: 87< ;'</)(5(& -(:':H )'=E7<): (<' (-01/</)9 dNc 8<7? 5.'/< ?75.'<: ?1-.

&':: 8<'01')5&F> 6887<5: 57 5':5 (&& 'J;'-5()5 ?75.'<: ()+ :5(<5 5.7:' 871)+ dNc ;7:/5/G' 7)

()5/<'5<7G/<(& ?'+/-(5/7) .(G' E'') :1--'::81&> d7='G'<H ()F7)' =.7 ')9(9': /) (5R</:I

E'.(G/7<: 2?(/)&F :'J =/5. () /)8'-5'+ ;(<5)'< =/5.715 E(<</'< ?'5.7+: ()+ )''+&' :.(</)93 7<

/: /) ( ;<78'::/7) =/5. ( </:I 78 E&77+ 'J;7:1<' 2:1-. (: .'(&5.-(<' =7<I'<:3 /: /) +()9'< 78

-7)5<(-5/)9 dNc>

dNc :'<7-7)G'<:/7) /) .'(&5.-(<' =7<I'<: /: <(<'H E15 M5()+(<+ K<'-(15/7): ?1:5 E'

?(/)5(/)'+> $8 5.7:' .'(&5.-(<' ;'<:7))'& 87< =.7? -(:' /)G':5/9(5/7): ='<' -7?;&'5'+ 8<7?CPQCRABCBH D4 .(+ +7-1?')5'+ :'<7-7)G'<:/7) 57 dNc 87&&7=/)9 7--1;(5/7)(& 'J;7:1<':> ,.'

<715': 78 /)8'-5/7) /)-&1+'+ bQ 5.(5 ='<' +1' 57 ;1)-51<' 7< -15 /)]1</':> [7<5FR)/)' .'(&5.-(<'

;'<:7))'& ='<' 'J;7:'+ 57 dNcR/)8'-5'+ E&77+i 5.<'' 57 -7)-')5<(5'+ G/<1: /) ( &(E7<(57<Fi 7)'

57 G/:/E&F E&77+F 8&1/+i ()+ 871< 57 () 1):;'-/8/'+ 8&1/+> 2TS3

http://www.cdc.gov/HAI/settings/outpatient/outpatient-care-gl-standared-precautions.html





CbS

,.' "W" /: (&:7 (=(<' 78 CbT 75.'< -(:': 78 dNc /)8'-5/7) 7< ( +/(9)7:/: 78 #NWM (?7)9

.'(&5.-(<' =7<I'<: =.7 .(G' )75 <';7<5'+ 75.'< </:I 8(-57<: 87< dNc /)8'-5/7) ()+ =.7 <';7<5 (

./:57<F 78 7--1;(5/7)(& 'J;7:1<' 57 E&77+H E7+F 8&1/+:H 7< dNcR/)8'-5'+ &(E7<(57<F ?(5'</(&H E15

87< =.7? :'<7-7)G'<:/7) (85'< 'J;7:1<' =(: )75 +7-1?')5'+> N) 7<+'< 57 ;<'G')5 dNc

/)8'-5/7)H /5 /: -</5/-(& 57 1:' M5()+(<+ K<'-(15/7): =/5. 'G'<F ;(5/')5> 2TS3

,.'<' <'?(/): ( :/9)/8/-()5 </:I 78 /)8'-5/7) /) 5.' .'(&5.-(<' =7<I;&(-'> N) CPPSH 5.'<' ='<'

4QSHQQD ;'<-15()'71: ()+ ?1-7-15()'71: 'J;7:1<': 57 ;75')5/(&&F /)8'-5/71: :1E:5()-':

(?7)9 .'(&5.-(<' =7<I'<: 2d"^:3 /) 5.' L)/5'+ M5(5':> 2T43

O'-(1:' 78 5.' &7)9 /)-1E(5/7) ;'</7+ 78 dNc 2() (G'<(9' 78 QRCB F'(<: 8<7? /)8'-5/7) 57 5.'

+'G'&7;?')5 78 #NWM /) /)+/G/+1(&: )75 7) '88'-5/G' ()5/<'5<7G/<(& 5.'<(;F3H 5.' G(:5 ?(]7</5F 78

dNcR/)8'-5'+ /)+/G/+1(&: .(G' )7 :F?;57?: ()+ ?(F )75 I)7= 5.'F (<' /)8'-5'+> d7='G'<H

()F7)' /)8'-5'+ =/5. dNc ?(F E' (E&' 57 5<():?/5 5.' G/<1: 57 75.'<: 5.<719. E7+/&F 8&1/+:H

/)-&1+/)9 E&77+H :'?')H 7< G(9/)(& :'-<'5/7):H <'9(<+&':: 78 =.'5.'< 7< )75 5.'F .(G'+'G'&7;'+ #NWM> N5 /: E')'8/-/(& 57 <715/)'&F /)-7<;7<(5' </:I (::'::?')5 :5<(5'9/': /)57 5.'

;(5/')5 'G(&1(5/7) 57 +'5'<?/)' 5.' &/I'&/.77+ 78 'J;7:1<' 57H 7< 5.' ;<':')-' 78H dOc 7< dNc

/)8'-5/7): :1-. (:U

C> K(5/')5k: ./:57<F <'9(<+/)9 'J;7:1<' 57 E&77+ ()+ E&77+ ;<7+1-5:> 2nd(G' F71 .(+ (

E&77+ 5<():81:/7)gp3

A> K(5/')5k: ./:57<F 78 +<19 1:'> 2n^.(5 +<19: .(G' F71 1:'+ /) 5.' ;(:5 5') F'(<:gp3

T> K(5/')5k: :'J1(& ./:57<F`./:57<F 78 :'J1(&&F 5<():?/55'+ +/:'(:':> 2nd7= ?()F :'J

;(<5)'<: .(G' F71 .(+ /) 5.' &(:5 5=7 F'(<:gp3

Testing

c7&1)5(<F 5':5/)9 /: ')-71<(9'+> Y(;/+ 5':5: -() E' +7)' )7= =/5. <':1&5: E'/)9 (G(/&(E&'

=/5./) AB ?/)15':> #: ;(<5 78 /5: :5<(5'9/- ;&() 57 <'+1-' dNcH 5.' "W" .(: <'-7??')+'+ 5.(5

'G'<F7)' E'5='') 5.' (9': 78 CT ()+ Sb E' 5':5'+ (5 &'(:5 7)-' (: ( E(:'&/)'> 2TQ3 #)F7)'

8(&&/)9 /)57 ./9. </:I -(5'97</': -() -7)5/)1' 57 E' 5':5'+ <'91&(<&F (: ;(<5 78 <715/)' ?'+/-(&

-(<'> ,':5/)9 /: ':;'-/(&&F /?;7<5()5 87< 5.7:' =.7 8(&& /)57 5.' 87&&7=/)9 -(5'97</':U

C> K'<:7): /) ;<78'::/7): =/5. ( ./9. </:I 78 'J;7:1<'>

A> K'<:7): =.7 .(G' .(+ ( :'J1(&&F 5<():?/55'+ +/:'(:'>

T> ,.7:' =.7 .(G' ( ./:57<F 78 /)]'-5/7) +<19 1:' ()+ :.(<'+ )''+&':>

b> %') =.7 .(G' .(+ :'J =/5. 75.'< ?') :/)-' CP4Q>

D> %') ()+ =7?') =.7 .(G' 5<(+'+ :'J 87< ?7)'FH 877+H +<19:H 7< 75.'< /5'?:>

S> K'7;&' =.7 .(G' .(+ ?1&5/;&' :'J ;(<5)'<: ()+ 1:'+ /)5<(G')71: /)]'-5'+ +<19:>

4> M'J1(& 7< )''+&'R:.(</)9 ;(<5)'<: 78 5.' (E7G'>

Q> #)F =7?() 5./)I/)9 78 E'-7?/)9 ;<'9)()5>



Cb4

[7< :;'-/8/- /)87<?(5/7) 7) 5':5/)9 87< dNc -.'-I =/5. F71< &7-(& .'(&5. +';(<5?')5.

Reporting

# 1)/87<? -(:' +'8/)/5/7) ()+ -(:' <';7<5 87<? /: )7= 1:'+ /) (&& 8/85F :5(5': 87< 5.' <';7<5/)9 78

+/(9)7:'+ -(:': 78 #NWM> Y'G/:/7): /) 5.' +'8/)/5/7) 78 -&/)/-(& #NWM .(G' E<7(+')'+ 5.' <()9' 78

#NWMR/)+/-(57< +/:'(:': ()+ -7)+/5/7):> L:/)9 dNc +/(9)7:5/- 5':5: .(: /?;<7G'+ 5.' :'):/5/G/5F

()+ :;'-/8/-/5F 78 5.' +'8/)/5/7) 7G'< 5.' ;(:5 AB F'(<:>

The HIV Infection Process

dNc 5(<9'5: :'G'<(& -'&& 5F;':H /)-&1+/)9 5.' "Wb 2,b3 &F?;.7-F5'H =./-. /)5'<<1;5: 5.' -'&&R

?'+/(5'+ <':;7):' 57 ()5/9'):> 2TP3 ,./: ,b &F?;.7-F5' ;7;1&(5/7) /) 51<) <';&/-(5': dNc>

W(?(9' <':1&5: /) ( &7='< "Wb 2,b3 -'&& -71)5 &'(+/)9 57 ( <'+1-5/7) 78 5./: -'&& ;7;1&(5/7)H

;<7+1-/)9 /??1)' +'8/-/')-F> M/)-' 5.' "Wb 2,b3 &F?;.7-F5' ;&(F: ( -<1-/(& <7&' /) <'91&(5/7)

78 5.' /??1)' :F:5'?H +';&'5/7) 78 5.':' -'&&: +1' 57 dNc /)8'-5/7) <'+1-': 5.' /??1)'

<':;7):'>

dNc -(1:': ;<79<'::/G' +(?(9' 57 5.' .1?() /??1)' :F:5'? 7G'< ( &7)9 ;'</7+H ?(I/)9 5.'

/)+/G/+1(& G1&)'<(E&' 57 ( .7:5 78 /)8'-5/7): ()+ ?(&/9)()-/':> ,.' :F)+<7?' I)7=) (:

#-01/<'+ N??1)' W'8/-/')-F MF)+<7?' 2#NWM3 <';<':')5: 5.' &(5' :5(9' 78 dNc /)8'-5/7)> ,./:

:F)+<7?' /: (::'::'+ =.') 5.' ;(5/')5 /: dNc :'<7;7:/5/G' ()+ .(: () (E:7&15' "Wb -71)5 78

&':: 5.() ABB -'&&: ;'< ?/-<7&/5'<H 7< 7)' 7< ?7<' #NWM +'8/)/)9 /&&)'::':H :1-. (: K)'1?7-F:5/:

-(<)// ;)'1?7)/(H -<F;57:;7</+/7:/:H 7< f(;7:/k: :(<-7?(>

N)8'-5/7) =/5. dNc -() ;<':')5 (&7)9 ( -7)5/)11? <()9/)9 8<7? (:F?;57?(5/- 57 :F?;57?(5/->

K(5/')5: -() 'J./E/5 7)' 7< ?7<' 78 5.' :F?;57?: (::7-/(5'+ =/5. /?;(/<'+ /??1)' 81)-5/7)>N)/5/(& dNc /)8'-5/7) /: :7?'5/?': 87&&7='+ =/5./) A 57 b =''I: EF ( 8'E</&' /&&)':: <':'?E&/)9

?7)7)1-&'7:/: 7< /)8&1')\( =./-. <':7&G': :;7)5()'71:&F ()+ =./-. ?()F ;'7;&' +7 )75 )75'

(: :/9)/8/-()5 (5 5.' 5/?'> N5 /: +1</)9 5./: '(<&F 5/?' 5.(5 ;'7;&' (<' G'<F /)8'-5/71:> M7?'

;'7;&' /)8'-5'+ =/5. dNc <'?(/) <'&(5/G'&F .'(&5.F 87< ?()F F'(<: E'87<' 5.' :F?;57?: 78 dNc

/)8'-5/7) (;;'(<> #;;<7J/?(5'&F .(&8 78 5.' ;'7;&' =/5. dNc +'G'&7; #NWM =/5./) CB F'(<: (85'<

E'-7?/)9 /)8'-5'+> ,.' ?7:5 -7??7) :F?;57?: 78 dNc /)-&1+' 8'G'<H ?(&(/:'H E7+F (-.':H

?(-1&7;(;1&(< <(:.H &F?;.(+')7;(5.FH ()+ .'(+(-.'> $5.'< :F?;57?: /)-&1+' ;'<:/:5')5

8'G'< ()+ )/9.5 :='(5:i <(;/+H 1)'J;&(/)'+ ='/9.5 &7::i -.<7)/- +/(<<.'( )75 'J;&(/)'+ EF 75.'<

-(1:':i ;'<:/:5')5 -719. 5.(5 /: )75 (::7-/(5'+ =/5. :?7I/)9 7< /)8&1')\(i ()+ 8&(5 7< <(/:'+;/9?')5'+ &':/7): 7) 5.' :I/) <()9/)9 /) -7&7< 8<7? 8(/)5 ;/)I 57 <'+H E<7=)H 7< E&1'> %()F 78

5.':' :F?;57?: (<' )7)R:;'-/8/- ()+ (<' :'') /) 75.'< -7)+/5/7):> W(5( /)+/-(5' 5.(5 ?7:5

;'7;&' /)8'-5'+ =/5. dNc 'G')51(&&F +'G'&7; #NWM> ,.':' /)+/G/+1(&: +'G'&7; 7;;7<51)/:5/-

/)8'-5/7): ()+ )'7;&(:5/- +/:7<+'<: <(<'&F :'') /) /)+/G/+1(&: =/5. ( .'(&5.F /??1)' :F:5'?>

,.':' /)8'-5/7): /)-&1+' ':7;.(9'(& -()+/+/(:/:H -F57?'9(&7G/<1:H f(;7:/k: :(<-7?(H ()+



CbQ

K)'1?7-F:5/: -(</)// ;)'1?7)/(H 5.' ?7:5 -7??7) 7;;7<51)/:5/- /)8'-5/7) ()+ -(1:' 78 +'(5.

/) #NWM ;(5/')5:>

,.' -&/)/-(& ;<':')5(5/7): 78 #NWM ;(5/')5: G(<F 'J5'):/G'&F> N)+/G/+1(&: ?(F ;<':')5 =/5. dNc

=(:5/)9 +/:'(:'H =./-. /: -.(<(-5'</\'+ EF :'G'<'H /)G7&1)5(<F ='/9.5 &7::H -.<7)/- +/(<<.'(H

-7):5()5 7< /)5'<?/55')5 ='(I)'::H ()+ 8'G'< 87< TB +(F: 7< &7)9'<> N8 dNc /)8'-5: -'&&: /) 5.'

-'<'E<7:;/)(& 8&1/+H /)+/G/+1(&: ?(F +'G'&7; dNc ')-';.(&7;(5.FH ?F'&7;(5.FH 7< +'?')5/(

=/5. :F?;57?: <()9/)9 8<7? (;(5.F ()+ +';<'::/7) 57 ?'?7<F &7::H ?757< +F:81)-5/7)H ()+

+'(5.>

K<':')5&FH /5 /: )75 I)7=) =.F :7?' ;'7;&' /)8'-5'+ =/5. 5.' dNc G/<1: +'G'&7; :F?;57?:

?7<' 01/-I&F 5.() 75.'<:> Y':'(<-.'<: .(G' ;<7;7:'+ 5.(5 -'<5(/) -7R8(-57<: :1-. (: :5<'::H

;77< )15</5/7)H (&-7.7& 7< +<19 (E1:'H ()+ -'<5(/) :'J1(&&F 5<():?/55'+ +/:'(:': 2M,WM3H :1-. (:

:F;./&/: 7< .';(5/5/:H ?(F 5</99'< 5.' G/<1: 57 ?7<' <(;/+&F <';&/-(5' 7< ;&(-' 75.'< :5<'::7<: 7)

5.' E7+F :F:5'?:> N5 /: -&'(< 5.(5 =.') dNc /: /+')5/8/'+ '(<&F ()+ 977+ .'(&5.-(<' /: ;<7G/+'+H/)-&1+/)9 ()5/<'5<7G/<(& 5<'(5?')5 <'9/?'):H dNc -() E' ?()(9'+ (: ( &7)9 5'<? -.<7)/-

?'+/-(& -7)+/5/7)> ,7+(F 5.'<' (<' ?()F /)8'-5'+ /)+/G/+1(&: &/G/)9 G'<F &7)9 &/G':> 2TQ3

Treatment of HIV

#NWM <';<':')5: 5.' ')+ :5(9' 78 5.' -&/)/-(& :;'-5<1? 78 dNc> #5 5.' ;<':')5 5/?' 5.'<' /: )7

-1<' 7< G(--/)' 87< #NWMH (&5.719. ( G(</'5F 78 ?'+/-(5/7): (<' E'/)9 1:'+ 57 :&7= 5.'

;<79<'::/7) 78 5.' +/:'(:' ()+ 5<'(5 :7?' 78 5.' 7;;7<51)/:5/- /)8'-5/7):> 2TQ3

,.' )1?E'< 78 +<19: ()+ 5.' G(</'5F 78 5<'(5?')5 (;;<7(-.': .(G' 9<7=) 'J;7)')5/(&&F :/)-'

5.' (;;<7G(& 78 #j, /) CPQ4> ,.7:' ;<(-5/5/7)'<: =.7 <715/)'&F =7 ,.' &/:5 78 5.7:' +<19:H :/+' '88'-5: ()+ /)5'<(-5/7): (<'

-.()9'+ ()+ 1;+(5'+ <'91&(<&Fi /)-&1:/7) 78 () 1;+(5'+ &/:5 /) 5./: ?()1(& /: )75 8'(:/E&'>

Additional Risks to Healthcare Workers (HCWs) #) (++/5/7)(& </:I 57 ;<(-5/5/7)'<: =7<I/)9 =/5. ;'<:7): =/5. dNc /: 5.(5 :7?' 78 5.' -7??7)

:'-7)+(<F /)8'-5/7): /) 5./: ;7;1&(5/7) (<' 5.'?:'&G': -7)5(9/71:> ,.':' ?(F /)-&1+'

51E'<-1&7:/:H :5(;.F&7-7--(& /)8'-5/7):H .'<;': G/<1:':H ()+ .';(5/5/:> 2TQ3> #;;<7;</(5' -7)5<7&

;<'-(15/7): :.71&+ E' 5(I') ()+ ?(F /)-&1+' ?(:I: /) -(:' 78 <':;/<(57<F /)8'-5/7) ()+ 9&7G':/) -(:' 78 :I/) &':/7):> M5()+(<+ K<'-(15/7): :.71&+ E' ;<(-5/-'+ =/5. (&& ;(5/')5:> N5 /:

/?;'<(5/G' 57 (::1?' ()F ;(5/')5 ?(F E' dNc :'<7;7:/5/G' ()+ 57 1:' M5()+(<+ K<'-(15/7):

=/5. (&& ;(5/')5:>



CbP

4. Other Healthcare Associated Infectionsd'(&5.-(<'R(::7-/(5'+ /)8'-5/7): 2d#N:3 (<' /)8'-5/7): 5.(5 ;(5/')5: +'G'&7; +1</)9 5.' -71<:'

78 <'-'/G/)9 .'(&5.-(<' 5<'(5?')5 87< 75.'< -7)+/5/7):> ,.'F -() .(;;') 87&&7=/)9 5<'(5?')5 /)

.'(&5.-(<' 8(-/&/5/': /)-&1+/)9 .7:;/5(&: (: ='&& (: 715;(5/')5 -')5'<: ()+ -7??1)/5F -&/)/-:>

,.'F -() E' -(1:'+ EF ( =/+' G(</'5F 78 E(-5'</(H 81)9/H ()+ G/<1:':> M7?' 78 5.' ?7<' -7??7)d#N: 5.(5 ?(F E' <'&(5'+ 57 5.'<(;'15/- )''+&/)9 ()+ 75.'< -&/)/-(& ;<7-'+1<': (<' +/:-1::'+

E'&7=>

Tuberculosis

,1E'<-1&7:/: 2,O3 /: -(1:'+ EF 5.' E(-5'</1? H&7/R"7%$1*)B %)R$17),/.*.> ,./: 7<9()/:? /: ()

(-/+R8(:5 E(-5'</1? =/5. ( =(JF -7(5H /: 5<():?/55'+ 5.<719. 5.' (/<H ()+ .(: ( &7)9 /)-1E(5/7)

;'</7+ 78 1; 57 CA =''I:> 2bBH bC3

# 575(& 78 CCHCQA ,O -(:': 2( <(5' 78 T>S -(:': ;'< CBBHBBB ;'<:7):3 ='<' <';7<5'+ /) 5.' L)/5'+

M5(5': /) ABCB> O75. 5.' )1?E'< 78 ,O -(:': <';7<5'+ ()+ 5.' -(:' <(5' +'-<'(:'+i 5./:

<';<':')5: ( T>Ct ()+ T>Qt +'-&/)'H <':;'-5/G'&FH -7?;(<'+ 57 ABBP> ,.' )1?E'< 78 <';7<5'+

,O -(:': /) ABCB =(: 5.' &7=':5 <'-7<+'+ :/)-' )(5/7)(& <';7<5/)9 E'9() /) CPDT> 2bC3

^./&' ,O /)8'-5/7) <(5': (<' /) +'-&/)' /) 5.' L)/5'+ M5(5':H /5 <'?(/): ( :/9)/8/-()5 :71<-' 78 </:I

/) 5.' .'(&5.-(<' ')G/<7)?')5> V'):') '5 (&> 2bC3 &/:5 5.' 87&&7=/)9 ;7;1&(5/7): =.7 (<'

':;'-/(&&F (5 </:I 87< ,OU

• [7<'/9)RE7<) ;'<:7):H /)-&1+/)9 -./&+<')H ':;'-/(&&F 5.7:' =.7 .(G' (<</G'+ /) 5.'

L)/5'+ M5(5': =/5./) D F'(<: (85'< ?7G/)9 8<7? 9'79<(;./- (<'(: =/5. ( ./9. /)-/+')-'

78 ,O +/:'(:' 2'>9>H #8</-(H #:/(H 6(:5'<) 61<7;'H X(5/) #?'</-(H ()+ Y1::/(3 7< =.7

8<'01')5&F 5<(G'& 57 -71)5</': =/5. ( ./9. ;<'G(&')-' 78 ,O +/:'(:'>

• Y':/+')5: ()+ '?;&7F'': 78 -7)9<'9(5' :'55/)9: 5.(5 (<' ./9. </:I 2'>9>H -7<<'-5/7)(&

8(-/&/5/':H &7)9R5'<?R-(<' 8(-/&/5/': qX,"[:sH ()+ .7?'&':: :.'&5'<:3>

• d'(&5.-(<' =7<I'<: 2d"^:3 =.7 :'<G' ;(5/')5: =.7 (<' (5 ./9. </:I>

• d"^: =/5. 1);<75'-5'+ 'J;7:1<' 57 ( ;(5/')5 =/5. ,O +/:'(:' E'87<' 5.' /+')5/8/-(5/7)

78 ,O ()+ /):5/515/7) 78 -7<<'-5 (/<E7<)' ;<'-(15/7): 87< 5./: ;(5/')5>

• "'<5(/) ;7;1&(5/7): =.7 (<' ?'+/-(&&F 1)+'<:'<G'+ ()+ =.7 .(G' &7= /)-7?'H (:

+'8/)'+ &7-(&&F>

• K7;1&(5/7): (5 ./9. </:I =.7 (<' +'8/)'+ &7-(&&F (: .(G/)9 () /)-<'(:'+ /)-/+')-' 78 ,O

+/:'(:'>

• N)8()5:H -./&+<')H ()+ (+7&':-')5: 'J;7:'+ 57 (+1&5: /) ./9.R</:I -(5'97</':>

K'<:7): =.7 (<' /)8'-5'+ (<' ?7<' &/I'&F 57 ;<79<':: 57 (-5/G' +/:'(:' /8 5.'F ='<' /)8'-5'+

=/5./) 5.' ;<'G/71: 5=7 F'(<:H (<' dNc :'<7;7:/5/G' 7< /) :7?' 75.'< =(F



CDB

/??1)7-7?;<7?/:'+H () /)8()5 7< -./&+ &':: 5.() 871< F'(<: 78 (9'H .(G' 7)' 78 :'G'<(&

+/:7<+'<: :1-. (: :/&/-7:/: 7< +/(E'5': ?'&&/51:H 7< .(G' ( ./:57<F 78 /?;<7;'<&F 5<'(5'+ ,O>

,.' ;<':')-' 78 dNc -7)5</E15': 57 5.' ,O /)8'-5/7) <(5'H ;7::/E&F EF <'+1-/)9 /??1)/5F ()+

5.'<'87<' <':/:5()-' 57 ,O /)8'-5/7)> #)75.'< 8(-57< 5.(5 /)-<'(:': 5.' ;75')5/(& 87< .(<? 8<7?

,O /: 5.' ;<':')-' 78 :5<(/): 78 ,O 5.(5 (<' <':/:5()5 57 ?1&5/;&' ()5/51E'<-1&(< ()5/E/75/-:> M/)-'

CPPTH =.') 5.' ,O :1<G'/&&()-' :F:5'? =(: 'J;()+'+ 57 /)-&1+' +<19R:1:-';5/E/&/5F <':1&5:H

<';7<5'+ ?1&5/+<19R<':/:5()5 2%WY3 ,O -(:': .(G' +'-<'(:'+ /) 5.' L)/5'+ M5(5':> #?7)9 ,O

-(:': /) 5.' L)/5'+ M5(5': =/5. /)/5/(& +<19R:1:-';5/E/&/5F 5':5/)9 <':1&5: =.7 +/+ )75 .(G' ;</7<

5<'(5?')5H 5.' ;'<-')5(9' 78 ;</?(<F %WY ,O -(:': -.()9'+ :&/9.5&F 8<7? C>At 2QS -(:':3 /)

ABCA 57 C>bt 2PD -(:':3 /) ABCT> 2bA3

^./&' ?7:5 :5<(/): 78 H: %)R$17),/.*. -() E' 5<'(5'+ EF ()5/51E'<-1&(< ()5/E/75/-:H 5.'

5<'(5?')5 5(I': )/)' ?7)5.: 57 -7?;&'5'H ()+ /) 5.' 'G')5 5.' :5<(/) 78 H: %)R$17),/.*.

/)G7&G'+ /: +<19 <':/:5()5H 5<'(5?')5 ?(F E' +/88/-1&5 ()+ 5(I' &7)9'<> #: =/5. 5.' G/<(&&F?'+/(5'+ +/:'(:': +/:-1::'+ ;<'G/71:&FH ,O /: ?7:5 '88'-5/G'&F ?()(9'+ EF ;<'G')5/)9

/)8'-5/7)> K<'G')5/)9 5.' 5<():?/::/7) 78 ,O /: +7)' EF 5.' 87&&7=/)9U

C> d'(&5.-(<' =7<I'<: 2d"^:3 /)-&1+/)9 (-1;1)-51</:5: :.71&+ .(G' () ())1(& :I/) 5':5 87<

,O> ,./: 5':5 :.71&+ E' <';'(5'+ (85'< 5=7 =''I: /8 5.' ;<'G/71: 5':5 =(: )75 =/5./) 7)'

F'(<> #) (&5'<)(5/G' 5':5H 5.' m1()5/[6Y$* E&77+ 5':5 /: )7= (;;<7G'+ 87< ,O 5':5/)9>

,./: 5':5 .(: 5.' (+G()5(9' 5.(5 7)&F 7)' -7)5(-5 /: <'01/<'+H <':1&5: (<' (G(/&(E&' ?7<'

<(;/+&FH ()+ /: )75 /?;(-5'+ EF ;</7< O"Z 2E(-/&&/ "(&?'55'RZ1'</)3 G(--/)(5/7)>

A> N)+/G/+1(&: =.7 ='<' G(--/)(5'+ 87< ,O 7< .(G' ( ./:57<F 78 ( ;7:/5/G' :I/) 5':5 :.71&+

9'5 ( -.':5 JR<(F ()+ () ())1(& ;.F:/-(& 'J(?/)(5/7)>

T> N8 ( ;(5/')5 ;<':')5: /) F71< -&/)/- =/5. ( -.<7)/- -719. 78 1)I)7=) 7</9/)H 5.' ;(5/')5

:.71&+ E' (:I'+ 57 ='(< ( ?(:I> N5 /: ( 977+ ;7&/-F 57 .(G' ?(:I: (G(/&(E&' 87< ()F

;(5/')5 =/5. ( -719. 78 1)I)7=) 7</9/) 57 ;<'G')5 5<():?/::/7) 78 (/<E7<)' ;(5.79'):H

/)-&1+/)9 ,O>

b> N8 F71 :1:;'-5 F71< ;(5/')5 ?(F .(G' ,OH 5.' ;(5/')5 ?1:5 E' <'8'<<'+ 57 ( ;.F:/-/() 87<

+/(9)7:/: ()+ 5<'(5?')5>

# )1?E'< 78 :?(&& :51+/': .(G' E'') -7?;&'5'+ &77I/)9 (5 5.' '88'-5: 78 (-1;1)-51<' ()+

?7J/E1:5/7) 7) 5.' 5<'(5?')5 7< :F?;57?: 78 51E'<-1&7:/:H 785') =/5. 977+ <':1&5:> ^./&'5.'<' (<' )7 <';7<5: 78 51E'<-1&7:/: 5<():?/::/7) /) ( &/-'):'+ ;<(-5/5/7)'<k: ;<(-5/-' &7-(5/7)H

5.'<' /: 7)' -(:' 78 51E'<-1&7:/: E'/)9 -(1:'+ EF () /&&'9(& (-1;1)-51</:5H 2bT3 ./9.&/9.5/)9 5.'

)''+ 57 1)+'<:5()+ ()+ /+')5/8F 5./: +/:'(:'>

,<():?/::/7) 78 H&7/R"7%$1*)B %)R$17),/.*. /: ( <'-79)/\'+ </:I 57 ;(5/')5: ()+ .'(&5.-(<'

;'<:7))'& /) .'(&5.-(<' 8(-/&/5/':> ,<():?/::/7) /: ?7:5 &/I'&F 57 7--1< 8<7? ;(5/')5: =.7 .(G'



CDC

1)<'-79)/\'+ ;1&?7)(<F 51E'<-1&7:/: 7< 51E'<-1&7:/: <'&(5'+ 57 5.'/< &(<F)JH (<' )75 7)

'88'-5/G' ()5/R51E'<-1&7:/: 5.'<(;FH ()+ .(G' )75 E'') ;&(-'+ /) 51E'<-1&7:/: /:7&(5/7)>

,<():?/::/7) 78 H&7/R"7%$1*)B %)R$17),/.*. /) .'(&5.-(<' :'55/)9: .(: E'') (::7-/(5'+ =/5.

-&7:' -7)5(-5 =/5. ;'<:7): =.7 .(G' /)8'-5/71: 51E'<-1&7:/:> 2bb3

TB Survival Outside Host

H: %)R$17),/.*. -() :1<G/G' 87< ?7)5.: 7) +<F /)()/?(5' :1<8(-': ()+ -() :1<G/G' /) :7/& 87 6J;7:1<' 57 &/9.5 /)(-5/G(5': 5.'

E(-5'</1?> 2bD3

Acupuncture TB Safety

L&5/?(5'&F 5.' ?7:5 /?;7<5()5 -7?;7)')5 /) ( -&/)/-(& :(8'5F ;<79<(? /: :(8' ;<(-5/-' 7) 5.'

;(<5 78 5.' ;<(-5/5/7)'<> ,.' :(8' 1:' 78 :.(<;:H ;<'G')5/7) 78 5<():?/::/7) 78 E&77+E7<)'

;(5.79'):H ()+ 75.'< (;;<7;</(5' </:I ?()(9'?')5 5'-.)/01': ;<'G')5 .(<? 57 5.'

;<(-5/5/7)'<H ./: 7< .'< 8(?/&F ?'?E'<:H ()+ 5.' ;1E&/-> L5/&/\/)9 <':;/<(57<F '5/01'55' ()+M5()+(<+ K<(-5/-': =/&& &/?/5 'J;7:1<' 78 5.' ;<(-5/5/7)'< ()+ ;(5/')5: 57 ,O> M(8' ;<(-5/-'

<'?(/): 5.' ?7:5 /?;7<5()5 7E&/9(5/7) 87< 5.' (-1;1)-51</:5> "&'() *''+&' ,'-.)/01' ()+

M5()+(<+ K<(-5/-': (<' ( G/5(& ;(<5 78 :(8' ;<(-5/-' 87< 5.' (-1;1)-51</:5>

Skin Infections

K<7:;'-5/G' ()+ <'5<7:;'-5/G' :51+/': 78 (-1;1)-51<' :(8'5F ;7/)5 57 ( :?(&& )1?E'< 78

&7-(&/\'+ :I/) /)8'-5/7): 7--1<</)9 (: ( <':1&5 78 (-1;1)-51<'> 2C3

"7??7) <':/+')5 E(-5'</( 78 5.' :I/) /)-&1+' !%"@C&,/7/77). ()+ !%1$@%/7/77). :;'-/':>

N?;'5/97 ()+ 75.'< &7-(& :I/) /)8'-5/7): -() 7--1< =.') ( E<'(I /) 5.' :I/) (&&7=: 5.' :5(;. 7<

:5<'; 57 ')5'< 5.' +'<?/: 7< &7='< :5<1-51<':> 2bS3

Staphylococcus

Z<(?a;7:/5/G' E(-5'</( )7<?(&&F 871)+ 7) 5.' :I/)> nM5(;.p E(-5'</(H :1-. (: !%"@C&,/7/77).

$@*+$1B*+*. 7< !%"@C&,/7/77). ")1$).H (<' -7??7) E(-5'</(& -7)5(?/)()5: 871)+ 7) 5.' :I/)

5.(5 -() ')5'< 5.' E7+F 78 ( ;<(-5/5/7)'< 7< ;(5/')5> ,./: 5F;' 78 -7)5(?/)(5/7) /: 5.719.5 57

7--1< =.') 5.' E(-5'</( 7) 5.' :I/) /: ;(::'+ /)57 5.' E7+F 5.<719. /):'<5/7) 78 ( )''+&' /)57

5.' :I/)> 2b43

MI/) /)8'-5/7): -(1:'+ EF :5(;. (<' 1:1(&&F <'+ ()+ ;(/)81&> M7?' :5(<5 (: ;(/)81& E1?;: 5.(5

:''? &/I' :;/+'< E/5':H E15 01/-I&F E'-7?' (E:-'::': 2E7/&:3 8/&&'+ =/5. ;1:> 2bQ3

!%"@C&,/7/77). ")1$). (--71)5: 87< ?7<' 5.() .(&8 78 5.' <';7<5'+ -(:': 78 (-1;1)-51<'R

<'&(5'+ E(-5'</(& /)8'-5/7): 78 5.' :I/)> 2bP3



CDA

N)+/G/+1(& -(:' <';7<5: 78 :5(;. /)8'-5/7): (85'< (-1;1)-51<' /)-&1+' -(:': 78 ;'</-(<+/(&

(E:-'::H 2DB3 )'-<75/\/)9 8(:-//5/:H 2DC3 E(-5'<'?/(H 2DA3 ()+ :;/)(& :1E+1<(& '?;F'?(> 2DT3

K<'G')5/)9 !%"@C&,/7/77). /)8'-5/7): /)G7&G': :5()+(<+ ;<(-5/-': 78 .()+=(:./)9 ()+ (G7/+/)9

)''+&/)9 7< 75.'< ;<7-'+1<': /) (<'(: =/5. (-5/G' :I/) &':/7):>

Methicillin-Resistant Staphylococcus Aureus (MRSA)

,.' E(-5'</1? !%"@C&,/7/77). ")1$). /: ( 9<(? ;7:/5/G'H -7(91&(:' ;7:/5/G' ('<7E/- -7--1:

(::7-/(5'+ =/5. =71)+ /)8'-5/7): ()+ 75.'< ?'+/-(&&F :/9)/8/-()5 /)8'-5/7):> $)' :5<(/) 78 :5(;.

(1<'1:H <':/:5()5 57 5.' ()5/E/75/- ?'5./-/&&/) 2?'5./-/&&/)R<':/:5()5 !%"@C&,/7/77). ")1$).H

%YM#3 .(: E'-7?' ( :/9)/8/-()5 :71<-' 78 ()5/E/75/- <':/:5()5 /)8'-5/7):> 2DbH DD3 ,./: 7<9()/:?

/: :;<'(+ EF :I/)R57R:I/) -7)5(-5 ()+ -() E' <'(+/&F 5<():?/55'+ 8<7? ;(5/')5: 57 .'(&5.-(<'

;<7G/+'<:H :5(88 ()+ 75.'< ;(5/')5:> O'5='') ADt ()+ TBt 78 5.' ;7;1&(5/7) ?(F E' -(<</'<: 78

%YM#> 2DD3 ^./&' 5.' ?(]7</5F 78 %YM# /)8'-5/7): (;;'(< 57 E' )7:7-7?/(& 2/)8'-5/7): (-01/<'+

8<7? 5.' .'(&5.-(<' :'55/)93H CAt (<' -7??1)/5FR(-01/<'+> 2DD3

Prevention

N5 /: /?;'<(5/G' 57 ;<'G')5 5.' :;<'(+ 78 %YM# 57 ;(5/')5: ()+ -7R=7<I'<:> #;;<7;</(5'

;<'G')5/7) :5<(5'9/': /)-&1+' 5.' 87&&7=/)9U 2DSH D43

C> #;;<7;</(5' .()+=(:./)9 ()+ 5.' 1:' 78 .()+ -&'():'<:>

A> ,.' 1:' 78 E(<</'< ;<75'-5/7) :1-. (: 9&7G':H &(E -7(5: 7< 97=):H ()+ 8(-' ?(:I: (:

)'-'::(<F>

T> K<7;'< .()+&/)9 78 ;75')5/(&&F -7)5(?/)(5'+ ?(5'</(&: :1-. (: :.(<;:H +/:;7:(E&'

:1;;&/': :1-. (: -7557) ()+ 9(1\'H ()+ :7/&'+ 7< E&77+R:5(/)'+ &/)')>b> #G7/+ -7)5(-5 =/5. +<(/)/)9 =71)+:H ;/?;&'R&/I' &':/7):H 7< 75.'< :I/) &':/7): 5.(5 ?(F

E' ( :/5' 78 /)8'-5/7)>

D> #G7/+ (-1;1)-51<' ()+ 75.'< #$% 5'-.)/01': /) /)8&(?'+ 7< /)8'-5'+ :I/) <'9/7):>

S> L:' 78 "&'() *''+&' ,'-.)/01'>

4> M-<1;1&71: 1:' 78 5.' (;;<7;</(5' +/:/)8'-5()5:>

Q> Y'8'<<(& 78 ;(5/')5: 5.(5 ?(F E' /)8'-5'+ 57 ( ;.F:/-/() 87< (;;<7;</(5' 5<'(5?')5>

%YM# .(: E'') <';7<5'+ (85'< (-1;1)-51<' 5<'(5?')5: ()+ ?(F -(1:' :/9)/8/-()5 +(?(9'> 2AH

DQ3 N) 7)' -(:' :51+F 5.' 5<():?/::/7) 78 %YM# =(: -&'(<&F 8<7? 5.' ?'+/-(& ;<(-5/5/7)'< 57 5.'

;(5/')5:> 2DP3 ,.'<' (<' :/9)/8/-()5 </:I: (::7-/(5'+ =/5. 5<'(5/)9 ( ;(5/')5 5.(5 .(: &':/7):

-7):/:5')5 =/5. %YM#H /)-&1+/)9 +<(/)/)9 =71)+:H :1;;1<(5/)9 &':/7):H 7< ;1:51&': 5.(5 .(G'

)75 E'') (::'::'+ EF ( ;.F:/-/()> ,.'<' (<' (&:7 </:I: (::7-/(5'+ =/5. 5<'(5/)9 ;(5/')5: =.')

5.' ;<(-5/5/7)'< -1<<')5&F .(: (-5/G' :I/) &':/7): 5.(5 .(G' )75 E'') (::'::'+ EF ( ?'+/-(&

;<78'::/7)(&> N5 /: /?;'<(5/G' 5.(5 () (::'::?')5 78 ()F (-5/G' :I/) &':/7): /) '/5.'< ( ;(5/')5 7<



CDT

;<(-5/5/7)'< E' ?(+' (: :77) (: ;7::/E&'> N5 /: (;;<7;</(5' 57 +'&(F #$% 5<'(5?')5 1)5/& :1-.

() (::'::?')5 /: ?(+' ()+ (;;<7;</(5' ()5/E/75/- 5.'<(;F /)/5/(5'+>

MRSA Survival in the Environment

%7:5 :51+/': :199':5 5.(5 %YM# -() &/G' 1; 57 PB +(F: 7) /)()/?(5' 7E]'-5: ()+ +<F :1<8(-':>

%YM# E(-5'</( -() <'?(/) G/(E&' 7) :1<8(-': &7)9'< 5.() 75.'< E(-5'</( ()+ G/<1:': E'-(1:'

5.'F -() :1<G/G' =/5.715 ?7/:51<'> 2Ab3 %YM# -() :1<G/G' &7)9'< 7) .(<+ :1<8(-': 5.() :785

:1<8(-': E15 -() E' /)(-5/G(5'+ 1:/)9 (;;<7;</(5' 6K#R(;;<7G'+ +/:/)8'-5/)9 :7&15/7):>

Streptococcus

Z<71; # !%1$@%/7/77). 2Z#M3 /: ( E(-5'</1? 785') 871)+ /) 5.' 5.<7(5 ()+ 7) 5.' :I/)> Z#M

+/:'(:' ?(F 7--1< =.') E(-5'</( 8<7? 5.' 5.<7(5 7< :I/) ')5'<: ;(<5: 78 5.' E7+F =.'<'

E(-5'</( 1:1(&&F (<' )75 871)+H :1-. (: :1E-15()'71: 5/::1':H 5.' E&77+H 7< 5.' &1)9:> ,.':'

E(-5'</( (<' :;<'(+ 5.<719. +/<'-5 -7)5(-5 =/5. ?1-1: 8<7? 5.' )7:' 7< 5.<7(5 78 ;'<:7): =.7

(<' /)8'-5'+ 7< 5.<719. -7)5(-5 =/5. /)8'-5'+ =71)+: 7< :7<': 7) 5.' :I/)> 2SB3

M5<'; # ?(F -(1:' ( :I/) /)8'-5/7) :1-. (: /?;'5/97 7< 75.'< :I/) /)8'-5/7):> KF79')/- :I/)

/)8'-5/7): (::7-/(5'+ =/5. (-1;1)-51<' ?(F E' M5<';57-7--(& /)8'-5/7):> ̂ ./&' <(<'

2(;;<7J/?(5'&F DB -(:': <';7<5'+ 9&7E(&&F /) 5.' CP4B: ()+ CPQB:3 2SC3 M5<';57-7--(& /)8'-5/7):

?(F 7--1< (: ( <':1&5 78 (-1;1)-51<'>

K<'G')5/)9 M5<';57-7--(& /)8'-5/7): /)G7&G': :5()+(<+ ;<(-5/-': 78 .()+=(:./)9H M5()+(<+

K<(-5/-': ()+ (G7/+/)9 )''+&/)9 7< 75.'< ;<7-'+1<': /) (<'(: =/5. (-5/G' :I/) &':/7):> 2SA3

Mycobacteria Other than Tuberculosis (MOT)2H&7/R"7%$1*)B "R.7$..).5 H&7/R"7%$1*)B #/1%)*%)B5 H&7/R"7%$1*)B C"$B/@C*,)B3

H&7/R"7%$1*)B "R.7$..). -() E' 871)+ /) =(5'<H :7/&H ()+ +1:5> N5 .(: E'') I)7=) 57

-7)5(?/)(5' ?'+/-(5/7): ()+ ;<7+1-5:H /)-&1+/)9 ?'+/-(& +'G/-':> d'(&5.-(<'R

(::7-/(5'+ H&7/R"7%$1*)B "R.7$..). -() -(1:' /)8'-5/7): 78 5.' :I/) ()+ 5.' :785 5/::1': 1)+'<

5.' :I/)> N5 -() (&:7 -(1:' &1)9 /)8'-5/7): /) ;'<:7): =/5. G(</71: -.<7)/- &1)9 +/:'(:':> 2SC3

%F-7E(-5'</( 75.'< 5.() 51E'<-1&7:/: 2%$,3 (<' 78 :;'-/(& :/9)/8/-()-' 57 5.' (-1;1)-51</:5

E'-(1:' 78 ( )1?E'< 78 <';7<5: 78 #$%R(::7-/(5'+ :I/) &':/7): -(1:'+ EF %$,> %$,R<'&(5'+

:I/) +/:'(:': .(G' E'') <';7<5'+ /) 715E<'(I: (::7-/(5'+ =/5. :;'-/8/- (-1;1)-51<' -&/)/-: /)"()(+( ()+ f7<'(> 2A3 ,.' <'-79)/5/7) ()+ ?()(9'?')5 78 %$, +/:'(:': (<' /) 5.' +7?(/) 78

5.' +'<?(57&79/:5> 2ST3 %$, (<' :&7=R9<7=/)9 E(-5'</( 5.(5 -() -(1:' +/:'(:' /) E75.

/??1)7-7?;'5')5 ()+ /??1)7-7?;<7?/:'+ ;(5/')5:> ,.' ?7:5 -7??7) -&/)/-(&

;<':')5(5/7): 78 /)8'-5/7) (<' 5.' (;;'(<()-' 78 :1;;1<(5/G' ()+ 1&-'<(5'+ :I/) )7+1&':> 2Sb3



CDb

%$, (<' =/+'&F +/:5</E15'+ /) 5.' ')G/<7)?')5H ;(<5/-1&(<&F /) ='5 :7/&H ?(<:.&()+H :5<'(?:H

</G'<: ()+ ':51(</':> 2SD3 %$, (<' 9')'<(&&F 871)+ /) 5.' ')G/<7)?')5 (: 8<''R&/G/)9 7<9()/:?:

()+ 5.'<'87<' ?(F ;'<:/:5 /) ='5 7< +<F ')G/<7)?')5: 87< ( :/9)/8/-()5 ;'</7+ 78 5/?'>

H&7/R"7%$1*)B 2%$,3 /)8'-5/7): .(G' E'') <';7<5'+ (: <'&(5'+ 57 (-1;1)-51<' n;<7E(E&F

(::7-/(5'+ =/5. 5.' /)(+'01(5' :5'</&/\(5/7) 78 5.' )''+&': 7< 5.' ;1)-51<' :/5'>p 2SS3

H&7/R"7%$1*)B /)8'-5/7): (<' ;<7E(E&F )75 (::7-/(5'+ =/5. (-1;1)-51<' =.') 5.' ;<(-5/5/7)'<

87&&7=: (&& -</5/-(& -7?;7)')5: 78 5.' "*, ;<757-7&:> d7='G'<H ( )1?E'< 78 -(:': .(G' E'')

+/:-1::'+ /) 5.' &/5'<(51<'> 2AHSSR4B3 N5 /: &/I'&F 5.(5 :7?' 78 5.':' /)8'-5/7): (::7-/(5'+ =/5.

(-1;1)-51<' (<' ( <':1&5 78 +/<5 -(<</'+ /) EF ;(5/')5: ()+ 5.') &'85 E'./)+ 7) 57='&: 1:'+ 87<

.75 ;(-I:H 5<'(5?')5 5(E&' &/)'): ()+ 75.'< -&75. 5.(5 .(: )75 E'') -.()9'+ E'5='') '(-. ()+

'G'<F ;(5/')5 G/:/5>

K<'G')5/)9 %F-7E(-5'</1? 75.'< 5.() ,1E'<-1&7:/: 2%$,3 /) 5.' -&/)/-U

C>

#;;<7;</(5' .()+=(:./)9 ()+ 5.' 1:' 78 (&-7.7&RE(:'+ .()+ -&'():'<:>

A> M-<1;1&71: 1:' 78 "*, ;<7-'+1<':>

T> K<7;'< .()+&/)9 78 ;75')5/(&&F -7)5(?/)(5'+ ?(5'</(&: :1-. (: :.(<;:H ()+ +/:;7:(E&'

:1;;&/': :1-. (: -7557) ()+ 9(1\'>

b> M-<1;1&71: 1:' 78 5.' (;;<7;</(5' +/:/)8'-5()5: 87< 5.' 5<'(5?')5 <77? ()+ 5<'(5?')5

5(E&':>

D> %'5/-1&71: <';&(-'?')5 78 ()F :.''5: 7< 57='&: E'5='') '(-. ()+ 'G'<F ;(5/')5 G/:/5>

S> Y'8'<<(& 78 ;(5/')5: 5.(5 ?(F E' /)8'-5'+ 57 ( ;.F:/-/() 87< (;;<7;</(5' 5<'(5?')5>

Herpes Simplex,=7 :'<75F;': 78 .'<;': :/?;&'J G/<1: 2dMc3 .(G' E'') /+')5/8/'+U dMcRC ()+ dMcRA> dMcRC /:

1:1(&&F (::7-/(5'+ =/5. 7<(& &':/7): 2/>'>H -7&+ :7<':3H (&5.719. E75. dMcRC ()+ dMcRA ?(F E'

871)+ /) 7<(& 7< 9')/5(& ?1-7:(& &':/7):> dMcRC /: 5F;/-(&&F 5<():?/55'+ EF :(&/G( 7< EF 5.'

/)8'-5/7) 7) .()+: 78 .'(&5.-(<' ;'<:7))'&> 24B3 dMc -() E' 5<():?/55'+ EF +/<'-5 -7)5(-5 =/5.

';/5.'&/(& 7< ?1-7:(& :1<8(-':> dMc -() E' 5<():?/55'+ EF /)9':5/7)H ;(<')5'<(& /)]'-5/7)H

+<7;&'5 'J;7:1<' 78 5.' ?1-71: ?'?E<()': 2'F':H )7:' 7< ?715.3H ()+ /).(&(5/7) 78

('<7:7&/\'+ ?(5'</(&:> 24BH 4C3

O75. 87<?: 78 dMc (<' -.(<(-5'</\'+ EF <'-1<</)9 &':/7):> #85'< 5.' /)/5/(& /)8'-5/7)H =./-. /:

785') 5.' ?7:5 :'G'<' 715E<'(IH 5.' G/<1: =/&& 97 /)57 01/':-')-' 87< G(<F/)9 &')95.: 78 5/?'>

,.' )'J5 :5(9' /: ( ;<7+<7?(& :5(9'H =./-. ?(F /)-&1+' &7-(&/\'+ /5-./)9H ;(/) 7< 5/)9&/)9 (5 5.'

:/5' 78 5.' /)8'-5/7)> #5 5./: ;7/)5H 5.' G/<1: /: E'/)9 :.'+ ()+ 75.'<: -() E'-7?' /)8'-5'+> ,.'

&(:5 :5(9' /: -(&&'+ () 715E<'(I> $15E<'(I: (<' -.(<(-5'</\'+ EF 5.' :(?' :F?;57?: /) 5.'

:(?' &7-(5/7) (: 5.' /)/5/(& (55(-IH E15 5')+ 57=(<+ E'-7?/)9 ?/&+'< 7G'< 5/?'> N8 E&/:5'<: 87<?H



CDD

5.'F =/&& 5F;/-(&&F .'(& /) 4RCB +(F:> ,.' ;'<:7) =/5. dMc /: :5/&& :.'++/)9 G/<1: (5 5./: ;7/)5 ()+

-() :;<'(+ 5.' /)8'-5/7) 5.<719. 571-.> ,.' dMc G/<(& -F-&' =/&& 5.') :5(<5 (9(/)>

#-1;1)-51<'H ?7J/E1:5/7)H -1;;/)9 ()+ 75.'< #$% ;<7-'+1<': .(G' E'') (::7-/(5'+ =/5.

+'-<'(:/)9 5.' ;(/) ()+ /?;<7G/)9 .'(&5. 78 5.7:' =/5. .'<;':R<'&(5'+ &':/7):> 24AR4b3

#-1;1)-51<' ()+ -1;;/)9 ?(F (&:7 E' (::7-/(5'+ =/5. :;<'(+/)9 5.' dMc /8 M5()+(<+

K<'-(15/7): (<' )75 5(I')> 24D3

,7 ;<'G')5 5<():?/::/7) 78 5.' dMc G/<1:H M5()+(<+ K<'-(15/7): :.71&+ E' 87&&7='+>

K<(-5/5/7)'<: :.71&+ <'8<(/) 8<7? 571-./)9 (-5/G' &':/7): ()+ (G7/+ 5<'(5?')5 ;<7-'+1<': /) 5.'

(<'( 78 ()F &':/7):> M/)-' ;(5/')5:k .()+: -7)5(-5 ;<(-5/-' &7-(5/7) :1<8(-':H ()+ 5.' G/<1: -71&+

<'(-. () 7E]'-5 5.(5 /: 571-.'+ EF ()75.'< ;'<:7)H (&& :1<8(-': ?1:5 E' +/:/)8'-5'+ +(/&F> 24SH

443 ,.' dMc C ()+ dMc A G/<1: -() :1<G/G' 87< :'G'<(& .71<: 7) =7 24S3

Influenza

N)8&1')\( /: ;</?(</&F ( -7??1)/5FRE(:'+ /)8'-5/7) 5.(5 /: 5<():?/55'+ /) .71:'.7&+: ()+

-7??1)/5F :'55/)9:H /)-&1+/)9 .'(&5.-(<' -&/)/-:>

d'(&5.-(<'R(::7-/(5'+ /)8&1')\( /)8'-5/7): -() 7--1< /) ()F .'(&5.-(<' :'55/)9 ()+ (<' ?7:5

-7??7) =.') /)8&1')\( /: (&:7 -/<-1&(5/)9 /) 5.' -7??1)/5F> ,.'<'87<'H /)8'-5/7) -7)5<7&

?'(:1<': )''+ 57 E' 15/&/\'+ /) (&& (-1;1)-51<' ;<(-5/-' &7-(5/7): 57 <'+1-' 5<():?/::/7) 78 5.'

/)8&1')\( G/<1:> 24Q3

[7< ?7<' /)87<?(5/7) G/:/5U

N)8'-5/7) "7)5<7& /) .'(&5.-(<' [(-/&/5/':

2.55;U``===>-+->97G`8&1`;<78'::/7)(&:`/)8'-5/7)-7)5<7&`/)+'J>.5?3

Influenza Survival in the Environment

N)8&1')\( G/<1:': -() :1<G/G' /) 5.' ')G/<7)?')5 87< 1; 57 Ab .71<:> 24P3 K<7;'< -&'()/)9 /:

<'01/<'+ 57 ;<'G')5 5<():8'< 8<7? 5<'(5?')5 :1<8(-': 57 ;(5/')5:H :5(88 ()+ 8(?/&F ?'?E'<:>

#-1;1)-51<' -() E' '88'-5/G' /) 5<'(5/)9 7< .'&;/)9 ;<'G')5 1;;'< <':;/<(57<F /)8'-5/7):> 2QBH

QC3 d7='G'<H .(G/)9 ;(5/')5: (-15'&F /&& /) ( .'(&5.-(<' :'55/)9 /)-<'(:': 5.' </:I 78 5<():?/::/7)78 5.' G/<1: 57 .'(&5.-(<' =7<I'<: ()+ 75.'< ;(5/')5:> M5()+(<+ K<'-(15/7): )''+ 57 E'

87&&7='+ /) 5'<?: 78 .()+=(:./)9 ()+ 5<'(5?')5 <77? +/:/)8'-5/7)>



CDS

CDC Fundamental Elements to Prevent Influenza Transmission

K<'G')5/)9 5<():?/::/7) 78 /)8&1')\( G/<1: ()+ 75.'< /)8'-5/71: (9')5: =/5./) .'(&5.-(<'

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.'(&5.-(<' =7<I'<:H 788/-' :5(88H ()+ G/:/57<:> ,.' -7<' ;<'G')5/7) :5<(5'9/': /)-&1+'U 24Q3

•

N)8&1')\( G(--/)(5/7) 78 d"^: ()+ (5R</:I ;1E&/- ())1(&&F>

• N?;&'?')5(5/7) 78 <':;/<(57<F .F9/')' ()+ -719. '5/01'55'>

• N?;&'?')5(5/7) 78 M5()+(<+ K<'-(15/7):>

• #+.'<')-' 57 /)8'-5/7) -7)5<7& ;<'-(15/7): 87< (&& ;(5/')5R-(<' (-5/G/5/': ()+ ('<7:7&R

9')'<(5/)9 ;<7-'+1<':>

• N?;&'?')5/)9 ')G/<7)?')5(& ()+ ')9/)''</)9 /)8'-5/7) -7)5<7& ?'(:1<':>

d'(&5.-(<' =7<I'<: ?1:5 :5(F .7?' =.') (-15'&F /&&> N) ?7:5 -(:':H ;'<:7))'& :.71&+ )75 E'

(-5/G'&F :''/)9 ;(5/')5: 1)5/& 8<'' 78 8'G'< 87< (5 &'(:5 Ab .71<: =/5.715 5.' 1:' 78 *M#NW:>

Norovirus

*7<7G/<1:': (<' ( 9<71; 78 G/<1:': 5.(5 -(1:' 9(:5<7')5'</5/:H -(1:/)9 () (-15' 7):'5 78 :'G'<'

G7?/5/)9 ()+ +/(<<.'(> ,./: G/<1: /: G'<F -7)5(9/71: ()+ -() :;<'(+ <(;/+&F 5.<719.715

.'(&5.-(<' 8(-/&/5/':> 2QA3 K'7;&' -() E'-7?' /)8'-5'+ =/5. 5.' G/<1: /) :'G'<(& =(F:U

• d(G/)9 +/<'-5 -7)5(-5 =/5. ()75.'< ;'<:7) =.7 /: /)8'-5'+ 2( .'(&5.-(<' =7<I'<H

G/:/57<H 7< ()75.'< ;(5/')53>

• 6(5/)9 877+ 7< +</)I/)9 &/01/+: 5.(5 (<' -7)5(?/)(5'+ =/5. )7<7G/<1:>

•

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*7<7G/<1: /: 5<():?/55'+ EF .()+: -7)5(?/)(5'+ 5.<719. 5.' 8'-(&R7<(& <715'H +/<'-5&F 8<7?

;'<:7) 57 ;'<:7)H 5.<719. -7)5(?/)(5'+ 877+ 7< =(5'<H 7< EF -7)5(-5 =/5. -7)5(?/)(5'+

:1<8(-':> 2QT3 ,.' )7<7G/<1: /: <'&(5/G'&F :5(E&' /) 5.' ')G/<7)?')5 ()+ -() ;'<:/:5 87< =''I: 7)

.(<+ :1<8(-':>

*7<7G/<1:': .(G' )75 E'') &/)I'+ 57 (-1;1)-51<' 7< <'&(5'+ #$% ;<7-'+1<': /) 5.' ?'+/-(&

&/5'<(51<'> 6:5/?(5': (<' CPRAC ?/&&/7) -(:': 78 )7<7G/<1: (<' <';7<5'+ /) 5.' L>M> '(-. F'(<> 2Qb3

#: )7<7G/<1: +/:'(:': (<' 7)' 78 5.' ?7:5 -7??7) /)8'-5/7): /) 5.' L>M>H (&& .'(&5.-(<';<(-5/5/7)'<: )''+ 57 87&&7= M5()+(<+ K<'-(15/7): 57 ;<'G')5 5.' :;<'(+ 78 5./: ./9.&F

-7)5(9/71: 7<9()/:?>

Prevention of Norovirus

,.' -7<' ;<'G')5/7) :5<(5'9/': /)-&1+'U 2QT3



CD4

• [7&&7= .()+R.F9/')' 91/+'&/)':H ()+ -(<'81&&F =(:. .()+: =/5. :7(; ()+ =(5'< (85'<

-7)5(-5 =/5. ;(5/')5: =/5. )7<7G/<1: /)8'-5/7)>

• L:' 97=): ()+ 9&7G': =.') /) -7)5(-5 =/5.H 7< -(</)9 87< ;(5/')5: =.7 (<' :F?;57?(5/-

=/5. )7<7G/<1:>

•

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• Y'?7G' ()+ =(:. -7)5(?/)(5'+ -&75./)9 7< &/)'):>

• d'(&5.-(<' =7<I'<: =.7 .(G' :F?;57?: -7):/:5')5 =/5. )7<7G/<1: :.71&+ E' 'J-&1+'+

8<7? =7

#;;<7;</(5' .()+ .F9/')' /: &/I'&F 5.' :/)9&' ?7:5 /?;7<5()5 ?'5.7+ 57 ;<'G')5 )7<7G/<1:

/)8'-5/7) ()+ -7)5<7& 5<():?/::/7)> Y'+1-/)9 ()F )7<7G/<1: ;<':')5 7) .()+: /: E':5

(--7?;&/:.'+ EF 5.7<719. .()+=(:./)9 =/5. <1))/)9 =(5'< ()+ ()5/:';5/- :7(;> #&-7.7&RE(:'+

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:.71&+ :5(F (=(F 8<7? =7 2QT3

Clostridium difficile

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'J757J/):U 57J/) # ()+ 57J/) O> N5 /: ( -7??7) -(1:' 78 ()5/E/75/-R(::7-/(5'+ +/(<<.'( 2##W3> N5

(--71)5: 87< CDRADt 78 (&& ';/:7+': 78 ##W> 2QS3

*'(<&F (&& ()5/?/-<7E/(&: .(G' E'') /?;&/-(5'+ /) 5.' +'G'&7;?')5 78 F,/.%1*+*)B +*##*7*,$

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)(1:'(H ()+ (E+7?/)(& ;(/) ()+ 5')+'<)'::>

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,.' 5=7 ;</?(<F (9')5: 1:'+ 57 5<'(5 "W#W (<' ?'5<7)/+(\7&' ()+ 7<(& G()-7?F-/)> #+]1)-5/G'

5.'<(;/': 87< <'8<(-57<F +/:'(:' /)-&1+' '887<5: 57 <';&')/:. -7&7)/- 8&7<( =/5. 5.' 1:' 78 7<(&&F

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:1<8(-': 87< 1; 57 8/G' ?7)5.:> 2QQ

3 M;'-/(& ;<7-'+1<': )''+ 57 E' 87&&7='+ =.') -(</)9 87<

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CDQ

Prevention of Spread of Clostridium difficile"W" <'-7??')+(5/7): 57 ;<'G')5 5<():?/::/7) 78 "&7:5</+/1? +/88/-/&' /) ;<(-5/5/7)'<:k

788/-':U 2QS)

• L:' 9&7G': =.') ')5'</)9 ;(5/')5:k <77?: ()+ +1</)9 ;(5/')5 -(<' =.') 5.' ;(5/')5 /: (

I)7=) -(<</'< 78 F,/.%1*+*)B +*##*7*,$>

• K'<87<? .()+ .F9/')' (85'< <'?7G/)9 9&7G':>

o O'-(1:' (&-7.7& +7': )75 I/&& F,/.%1*+*)B +*##*7*,$ :;7<':H 1:' 78 :7(; ()+ =(5'< /:

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78 F,/.%1*+*)B +*##*7*,$ :;7<': /: ?7<' -.(&&')9/)9 5.() 5.' <'?7G(& 7<

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CDP

5. Summary of Prevention of Disease Transmission in Acupuncture

Practice

Basic Critical Principles

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Preventing Patient to Patient Cross Infections – Critical Recommendations

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Review

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References

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CSC

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c(--/)'RK<'G')5(E&' W/:'(:':> #5I/):7) ^H ^7&8' MH d(?E7<:IF VH '+:> CA5. '+>H :'-7)+

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http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/tuberculosis

http://www.cdc.gov/HAI/organisms/hiv/Surveillance-Occupationally-Acquired-HIV-AIDS.html

http://www.cdc.gov/hiv/pdf/statistics_2010_HIV_Surveillance_Report_vol_17_no_3.pdf

http://www.cdc.gov/HAI/settings/outpatient/outpatient-care-guidelines.html



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http://www.ewashtenaw.org/government/departments/public_health/disease_control/cd_fact_sheets/impetigo.pdf









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http://www2a.cdc.gov/STDTraining/Self-Study/herpes/default.htm





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CSQ

Part V: Personnel Health, Cleanliness and Safety Practices

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1. Handwashing

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CSP

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Effective Handwashing Technique

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Hand Hygiene Technique: Soap and Water

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C4B

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Hand Drying

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Hand Hygiene Technique - Alcohol-Based Sanitizers

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Handwashing - Antiseptic Towelettes

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C4C

Hand Flora

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2TbRTS3

Healthcare workers and Actual Handwashing Practices

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Necessity of Handwashing

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What is the right way to wash your hands?

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S>

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4> W'-7)5(?/)(5' .()+: (85'< <'?7G/)9 9&7G': =/5. :7(; ()+ =(5'<>

Q> O'87<' '(5/)9 ()+ (85'< 1:/)9 ( <':5<77?H =(:. .()+: =/5. :7(; ()+ =(5'<>

P> #)5/?/-<7E/(&R/?;<'9)(5'+ =/;': 2/>'>H 57='&'55':3 ?(F E' -7):/+'<'+ (: () (&5'<)(5/G'

57 =(:./)9 .()+: =/5. :7(; ()+ =(5'<>



C4T

d()+=(:./)9 =/5. :7(; ()+ <1))/)9 =(5'< /: 5.' ?7:5 '88'-5/G' 87<? 78 .()+=(:./)9>

d7='G'<H =.') 5.'<' /: )7 :/)I (G(/&(E&'H ;<(-5/5/7)'<: ?(F 1:' () (&-7.7&RE(:'+ .()+

:()/5/\'<> #) (&-7.7&RE(:'+ .()+ :()/5/\'< -() +'R9'<? .()+: /) &':: 5.() TB :'-7)+: ()+

').()-' I/&&/)9 78 5<():/')5 .()+ 8&7<( =/5.715 5.' 1:' 78 <1))/)9 =(5'<H :7(;H ()+ .()+ +<F/)9>

M51+/': .(G' :.7=) 5.(5 -&/)/-/(): 8/)+ (&-7.7&RE(:'+ .()+ :()/5/\'<: -7)G')/')5H (--'::/E&'H

()+ &':: /<</5(5/)9 57 5.' :I/)> 2TQ3 ,.' "W" .(: (&:7 (--';5'+ 5.' 1:' 78 ()5/:';5/- .()+

-&'():'<: 7< 57='&'55': 'J-';5 =.') -/<-1?:5()-': <'01/<' 5.' 1:' 78 :7(; ()+ =(5'<> 2TP3

,.' )'-'::/5F 78 .()+=(:./)9 E'5='') ;(5/')5: ()+ 5.' 1:' 78 M5()+(<+ K<'-(15/7): <'8&'-5:

5.' /?;7<5()-' 78 5<'(5/)9 (&& ;(5/')5: (: /8 5.'F ='<' -(<</'<: 78 .';(5/5/: 7< dNc> O'F7)+ 5./:H

5.' )''+ 57 =(:. 5.' .()+: /: E(:'+ 7) =.'5.'< 5.' .()+: E'-7?' -7)5(?/)(5'+ +1</)9 5.'

-71<:' 78 5<'(5?')5> K<(-5/5/7)'<: ?1:5 =(:. 5.'/< .()+: E'5='') ;(5/')5:H E'87<' ()+ (85'<

/):'<5/)9 )''+&':H E'87<' ()+ (85'< 75.'< -&/)/-(& ;<7-'+1<':H ()+ (85'< -7)5(-5 =/5. ;75')5/(&&F

/)8'-5/71: E7+F 8&1/+:>

Recommendations

• "</5/-(&U ^(:. .()+: E'5='') 'G'<F ;(5/')5 G/:/5>

• "</5/-(&U ^(:. .()+: /??'+/(5'&F ;</7< 57 /):'<5/)9 (-1;1)-51<' )''+&': 7< ;'<87<?/)9

75.'< ;<7-'+1<': 5.(5 E<'(I 5.' :I/)>

• "</5/-(&U ^(:. .()+: (85'< ')5'</)9 5.' -&/)/- ()+ E'87<' :5(<5/)9 ()F ;(5/')5 -(<'>

• "</5/-(&U ^(:. .()+: E'87<' ()+ (85'< '(5/)9>

• "</5/-(&U ^(:. .()+: =/5. :7(; ()+ =(5'< (85'< 1:/)9 5.' <':5<77?>

•

"</5/-(&U ^(:. .()+: (85'< <'?7G/)9 9&7G':>• M5<7)9&F Y'-7??')+'+U ̂ (:. .()+: E'87<' ;'<87<?/)9 ()F -&/)/-(& ;<7-'+1<'H

/)-&1+/)9 5.7:' 5.(5 +7 )75 E<'(I 5.' :I/) 2'>9>H -1;;/)93>

• M5<7)9&F Y'-7??')+'+U ̂ (:. .()+: (85'< 5(I/)9 ( ;(5/')5k: ;1&:' ()+ (85'< ;(&;(5/)9

;7/)5:>

• Y'-7??')+'+U ̂ (:. .()+: (85'< +'-7)5(?/)(5/)9 <'1:(E&' '01/;?')5>

2. Patient Skin Preparation,.'<' (<' )7 ;<7:;'-5/G' :51+/': +'?7):5<(5/)9 '/5.'< 5.' )''+ 87< 7< &(-I 78 )''+ 87< :I/)

;<';(<(5/7) E'87<' (-1;1)-51<' ()+ 75.'< #$% ;<(-5/-':> ,.' E':5 'G/+')-' /: 5.(5 .(G/)9 5.';(5/')5k: :I/) E' -&'() ()+ .(G/)9 5.' ;<(-5/5/7)'<: .()+: E' -&'() 5.<719. ;<7;'<

.()+=(:./)9 (<' ?7:5 /?;7<5()5>

,.'<' (<' )7 :51+/': =./-. -7?;(<' :I/) ;<';(<(5/7) ;</7< 57 (-1;1)-51<' )''+&' /):'<5/7)

=/5. )7 :I/) ;<';(<(5/7)> ,.' -&7:':5 /)87<?(5/7) (G(/&(E&' ;'<5(/): 57 :I/) ;<';(<(5/7) ;</7< 57

/)]'-5/7):H 2bB3H :1-. (: /):1&/) /)]'-5/7): 87< +/(E'5/-: ()+ G(--/)(5/7):> Y':'(<-. -7)+1-5'+ (:



C4b

'(<&F (: 5.' CPSB: EF W()) 2bC3 ()+ f7/G/:57 e ['&/9 2bA3 =/5. +/(E'5/- ;(5/')5: /)+/-(5'+ 5.(5

(&5.719. :I/) ;<';(<(5/7) =/5. (&-7.7& ;</7< 57 /)]'-5/7) ?(<I'+&F <'+1-'+ :I/) E(-5'</(&

-71)5:H :1-. 5<'(5?')5 /: )75 )'-'::(<F 57 ;<'G')5 (5 /)]'-5/7) :/5':> 2bT3 N) CPPP :7?'

:5()+(<+: 87< /??1)/\(5/7): ()+ 75.'< :1E-15()'71: /)]'-5/7): ='<' <'R=</55') :1-. 5.(5 :I/)

;<';(<(5/7) =(: )75 (E:7&15'&F )'-'::(<F> 2bb3

d'(&5.-(<' <':'(<-. .(: <'/)87<-'+ 5.' /?;7<5()-' 78 '):1</)9 5.(5 5.' :I/) 78 5.' ;(5/')5 /:

;.F:/-(&&F -&'() ()+ 5.(5 .'(&5.-(<' ;<7G/+'<: ?(/)5(/) ./9. :5()+(<+: 78 .()+ .F9/')' ;</7< 57

/):5/515/)9 ()F ;<7-'+1<' 5.(5 /)-&1+': ( E<'(I /) 5.' :I/)> 2bD3

,.' ^7<&+ d'(&5. $<9()/\(5/7) )7 &7)9'< <'-7??')+: :=(EE/)9 -&'() :I/) =/5. () ()5/:';5/-

:7&15/7) E'87<' 9/G/)9 /)5<(+'<?(& 7< :1E-15()'71: )''+&' /)]'-5/7):H (&5.719. /)5<(?1:-1&(<

/)]'-5/7): +7 <'01/<' :I/) ;<';(<(5/7) =/5. SBR4Bt (&-7.7&> 2bS3 ,.' "W" :5(5': 5.(5 (&-7.7&H

:7(; ()+ =(5'< 7< -.'?/-(& (9')5: (<' )75 )''+'+ 87< ;<';(<(5/7) 78 5.' :I/) ;</7< 57

G(--/)(5/7)H 1)&':: 5.' :I/) /: 9<7::&F -7)5(?/)(5'+ 7< +/<5F> 2b43 N) 7<+'< 57 E' -7):/:5')5 =/5.^d$ ()+ "W" 91/+'&/)':H :I/) -&'():/)9 :.71&+ E' -(<</'+ 715 =.')'G'< 5.' ;<(-5/5/7)'<

'J;'-5: 57 )''+&' E'&7= 5.' :1E-15()'71: &(F'

$5.'< <':'(<-.'<: .(G' <'-7??')+'+ 5.' -&'()/)9 78 5.' /)]'-5/7) :/5' /) 7<+'< 57 ?/)/?/\'

5.' </:I 78 /)8'-5/7)> 2bQRDB3 %()F ;<(-5/5/7)'<: E'&/'G' /5 87&&7=: E':5 ;<(-5/-' 91/+'&/)': 57

-&'() 5.' :I/) ;</7< 57 /)]'-5/7) 57 <'+1-' 5.' </:I 78 -7)5(?/)(5/7) 8<7? 5.' ;(5/')5k: 5<():/')5

:I/) 8&7<(>

,.'<' /: 7)' -(:' <';7<5 78 ( ;(5/')5 =.7 <';7<5'+&F .(+ :';5/-'?/( (85'< (-1;1)-51<' +1</)9=./-. 5.' :I/) =(: )75 :=(EE'+> ,.' -(:' =(: <';7<5'+ 8<7? M-75&()+ /) =./-. ( SPRF'(<R7&+

?() +/'+ 8<7? () /)8'-5/7) (85'< (-1;1)-51<' 5<'(5?')5 (5 5.' 5./9.> ,.' ;(5/')5 =(: &(5'<

871)+ 57 .(G' ( ;<''J/:5/)9 ;()-F57;')/( 2/>'>H &7= 575(& E&77+ -'&& -71)5H /)-&1+/)9 &'1I7-F5':3H

<':1&5/)9 /) () /)-<'(:'+ :1:-';5/E/&/5F 57 /)8'-5/7)> ,.' -(:' <';7<5 (15.7<H =.7 /: (&:7 5.'

;<(-5/5/7)'<H (+?/55'+ 5.(5 5.' ;(5/')5k: :I/) (5 5.' (-1;1)-51<' ;7/)5 =(: )75 -&'()'+ E'87<'

5.' )''+&' /):'<5/7) ()+ &(5'< 871)+ &7-(& ?1:-&' /)8'-5/7) =./-. &'+ 57 :';5/-'?/(> 2DC3

,.' ?7:5 -7??7) ()+ -7)G')/')5 ;<7-'+1<' 87< -&'()/)9 ( ;(5/')5k: :I/) /: 5.' 1:' 78 ()

(&-7.7& :=(E> #) (&-7.7& ;1?; +/:;'):'< ()+ -7557) E(&&: ?(F (&:7 E' 1:'+ /) ( 5<'(5?')5

:'55/)9 (: &7)9 (: 5.' -7557) E(&&: (<' +/:-(<+'+ =.') +<F 7< -7)5(?/)(5'+ ()+ 5.' ;1?;

+/:;'):'< /: -&'()'+ =/5. () (;;<7G'+ +/:/)8'-5()5 7) ( +(/&F E(:/: 2(: =/5. ()F 75.'< :1<8(-' /)

5.' 5<'(5?')5 <77?3>

M/)-' ?()F ;(5/')5: -7?' 57 5.' #$% 5<'(5?')5 &7-(5/7) 8<7? =7<IH (5 5.' ')+ 78 5.' +(FH

(85'< 'J'<-/:/)9H ()+ /) 9')'<(& &':: 8<'01')5&F /??'+/(5'&F (85'< :.7='</)9H /5 /: &/I'&F 5.(5 5.'

(-1;1)-51<' ;7/)5 &7-(5/7): (<' )75 -7?;&'5'&F -&'()> d()+:H 8''5H ()+ 5.' 8(-' (<' -7??7)&F



C4D

1:'+ (<'(: 87< (-1;1)-51<' ()+ (<' <'91&(<&F 'J;7:'+ 57 5<():/')5 7<9()/:?: +1</)9 5.' -71<:'

78 <'91&(< .7?' ()+ =7

#--7<+/)9 57 ( V1&F ABCT &'55'< 8<7? 5.' "W"H 2DA3 n,.' ;<7-'+1<': 715&/)'+ /) 5.' "*, %()1(&

(<' <'(:7)(E&'p <'9(<+/)9 :I/) ;<';(<(5/7)>

W7': 5./: ?'() 5.(5 :I/) ?1:5 E' -&'()'+ =/5. (&-7.7& :=(E: ;</7< 57 )''+&' /):'<5/7)g ^.(5 /:

-&'(< /: 5.(5 5.' :I/) ?1:5 E' -&'()H ()+ 5.(5 5.' :I/) 57 E' 5<'(5'+ :.71&+ E' 8<'' 8<7? 7G'<5

/)8'-5/7): 7< &':/7):> d7= /)+/G/+1(& ;<(-5/5/7)'<: -.77:' 57 ?(I' :1<' 5.' :I/) /: -&'() ()+ 8<''

78 &':/7): /: ( -&/)/-(& +'-/:/7) '(-. ;<(-5/5/7)'< ?1:5 ?(I'H E(:'+ 7) 5.' ;</)-/;&': ()+ :(8'5F

?()1(&: /) 1:' /) 5.' -&/)/-(& :'55/)9 /) =./-. 5.'F ;<(-5/-'>

M7?' :5(5': ?()+(5'+ 5.' 1:' 78 () ()5/:';5/- :=(E E'87<' /):'<5/7) 78 () (-1;1)-51<' )''+&'

/) 5.'/< ;<(-5/-' (-5: ()+`7< <1&':> ,./: ?()1(& :.71&+ )75 E' /)5'<;<'5'+ (: (+G/:/)9 (9(/):5 (

;<(-5/-' 715&/)'+ /) :5(5' &(=> K<(-5/5/7)'<: .(G' ( +15F 57 /)G':5/9(5' ()+ -7?;&F =/5. :5(5'

<'91&(5/7)>

Alcohol Swab Method

^.') +':/<'+H ;<';(<'+ (&-7.7& :=(E: (<' 1:'+ 57 -&'() (&& :/5': 'J;'-5'+ 57 E' )''+&'+ (85'<

:'55/)9 1; 5.' -&'() 8/'&+ ()+ E'87<' )''+&/)9> #&&7= 5.' :/5' 57 +<F> #&5'<)(5/G'&FH (;;&F ( SBa

4Bt (&-7.7&RE(:'+ :7&15/7) 2/:7;<7;F& (&-7.7& 7< '5.()7&3 7) ( :/)9&'R1:' :=(E 7< -7557)R=77&

E(&&> W7 )75 1:' ?'5.()7& 7< ?'5.F&R(&-7.7& (: 5.':' (<' )75 :(8' 87< .1?() 1:'> 2bS3

M=(EE/)9 5.' (-1;1)-51<' /):'<5/7) :/5' =/5. ( :(51<(5'+ SBR4Bt (&-7.7& :=(E ()+ (&&7=/)9

5.' :I/) 57 +<F /: ( 977+ ;<(-5/-' 57 <'+1-' E75. +/<5 ()+ 5.' )1?E'< 78 ;(5.79'): (5 ()(-1;1)-51<' :/5'> #&&7=/)9 5.' :/5' 57 +<F ;<'G')5: :5/)9/)9 =./-. ?(F 7--1< /8 (&-7.7& /: 5(I')

/)57 5.' 5/::1': 1;7) )''+&' ')5<F> 2DB3

Options for Skin Preparation

$;5/7): 87< -&'()/)9 5.' :I/) E'87<' (-1;1)-51<' E':/+': 4Bt (&-7.7& /)-&1+' <'01/</)9 ;(5/')5:

57 =(:. (&& :I/) :1<8(-': 57 E' 5<'(5'+ =/5. :7(; ()+ =(5' 2DT3 2*75'U [7< 57;/-(& (;;&/-(5/7) (: ( :I/) +/:/)8'-5/)9

:7&15/7)H -.&7<.'J/+/)' /: ?(<I'5'+ 1)+'< ?()F E<()+ )(?':H /)-&1+/)9 M;'-5<1?RbH d/E/:5(5H

"(&97) c':5(H O'5(:';5H WF)(Rd'JH ()+ d/E/-&'):>3

L:' 78 ;7G/+7)' /7+/)' ()5/:';5/- 7/)5?')5 7< E(-/5<(-/)`9<(?/-/+/)` ;7&F?FJ/) O 7/)5?')5 /:

)75 <'-7??')+'+ (: /7+/)' ?(F E' (E:7<E'+ ()+ ?(F -<'(5' -.()9': /) 5.F<7/+ 81)-5/7)H 2Db3

()+ 7G'<1:' 78 E(-/5<(-/) ()+ 75.'< ()5/E/75/- 7/)5?')5: ?(F &'(+ 57 E(-5'</(& <':/:5()-' 57

5.':' ;<7+1-5:>



C4S

*7 #$% ;<7-'+1<' :.71&+ E' -7)+1-5'+ =.'<' 5.'<' (<' (-5/G' &':/7): 7) 5.' :I/)> #&&

&7-(5/7): :.71&+ E' -&'():'+ E'87<' ;<7-''+/)9 =/5. (-1;1)-51<' 7< 75.'< ;<7-'+1<':> L:' 78

4Bt (&-7.7& :=(E: 7< -7557) :7(I'+ /) 4Bt (&-7.7& /: ( -7)G')/')5 ()+ -7:5R'88'-5/G' ?'5.7+

57 /?;<7G' :I/) -&'()&/)'::> MI/) -() E' -&'()'+ =/5. :7(; ()+ =(5'< 7< 75.'< ?'5.7+: 5.(5

'):1<' -&'()&/)'::>

N8 (&-7.7& /: E'/)9 1:'+H :=(E 5.' ;7/)5: ()+ (&&7= 5.' (&-7.7& 7) 5.' :I/) 57 +<F> ,.' :(?'

:=(E ?(F E' 1:'+ 87< :'G'<(& ;7/)5: (: &7)9 (: 5.' :=(E /5:'&8 /: )75 +<F ()+ .(: 7)&F 571-.'+

/)5(-5 :I/)> # )'= :=(E :.71&+ E' 1:'+ /8 5.' :=(E E'9/): 57 -.()9' -7&7<H E'-7?': G/:/E&F

+/<5FH E'-7?': +<FH 7< .(: -7?' /)57 -7)5(-5 =/5. ()F :I/) E<'(IH &':/7)H /)8&(??(5/7) 7<

/)8'-5/7)> ,.' (&-7.7& :.71&+ E' (&&7='+ 57 +<F 57 <'+1-' 5.' ;75')5/(& 87< +/:-7?87<5 +1</)9

)''+&/)9> # :';(<(5' :=(E :.71&+ E' 1:'+ 87< (<'(: 78 ./9. E(-5'</(& 8&7<( &7(+H :1-. (: 5.'

(J/&&( 7< 9<7/)>

Recommendations• "</5/-(&U #G7/+ (-1;1)-51<' /) (<'(: 78 (-5/G' :I/) &':/7):>

• "</5/-(&U K'<87<? #$% ;<7-'+1<': 7)&F /) (<'(: 78 -&'() :I/)>

• "</5/-(&U 6):1<' 5.' ;(5/')5k: :I/) /: -&'() E'87<' /):'<5/)9 )''+&': 7< &()-'5:>

• "</5/-(&U ^.') 1:/)9 (&-7.7& :=(E:H 1:' ( )'= (&-7.7& :=(E 87< '(-. ;(5/')5 ()+ ( )'=

:=(E /8 5.' :=(E E'9/): 57 -.()9' -7&7<H E'-7?': G/:/E&F +/<5FH E'-7?': +<FH 7< .(:

-7?' /)57 -7)5(-5 =/5. ()F :I/) E<'(IH &':/7)H /)8&(??(5/7) 7< /)8'-5/7)>

• M5<7)9&F Y'-7??')+'+U M=(E 'G'<F ;7/)5 =/5. 4Bt (&-7.7& 7< 75.'< -&'():/)9 (9')5

;</7< 57 n='5p -1;;/)9H 1:' 78 &()-'5: 7< 4R:5(< .(??'<:>

•

M5<7)9&F Y'-7??')+'+U L:' ( :';(<(5' :=(E 87< (<'(: 78 ./9. E(-5'</(& 8&7<( &7(+H :1-.

(: (J/&&( 7< 9<7/)>

• Y'-7??')+'+U d(G' ;(5/')5: -&'() .()+: ()+ 8(-' =/5. :7(; ()+ =(5'< ;</7< 57

(-1;1)-51<' /) 5.':' (<'(:>

• Y'-7??')+'+U N)G':5/9(5' ()+ 87&&7= &7-(& ()+ :5(5' <'91&(5/7) -7)-'<)/)9 :I/)

;<';(<(5/7)>

3. Recommendations for Practitioner Health and HygieneY'G/'=U d()+=(:./)9 /: -</5/-(&> ,.' ?7:5 -7??7) ?7+' 78 .'(&5.-(<'R(::7-/(5'+ /)8'-5/7)

5<():?/::/7) /: G/( 5.' .()+:} N) 5.' (-1;1)-51</:5k: ;<(-5/-' &7-(5/7) :71<-': 78 .()+-7)5(?/)(5/7) /)-&1+' E7+F 8&1/+: :1-. (: E&77+ ()+ :(&/G(H ()+ 8&1/+: 8<7? 7;') &':/7):> O7+F

8&1/+: ?(F -7)5(/) E(-5'</( :1-. (: !%"@C&,/7/77). :;'-/':H ()+ G/<1:': (::7-/(5'+ =/5.

.';(5/5/: ()+ dNc`#NWM> N5 /: (E:7&15'&F /?;'<(5/G' 5.(5 ;75')5/(&&F /)8'-5/71: 8&1/+: )75 E'

5<():8'<<'+ 8<7? 7)' ;'<:7) 57 ()75.'< 5.<719. 5.' (-1;1)-51<' ;<7G/+'<k: .()+:H 7< 8<7? 5.'

;(5/')5 57 5.' ;<(-5/5/7)'< ()+`7< 75.'< ?'?E'<: 78 5.' -&/)/- :5(88> ,./: /: ?7:5 '88'-5/G'&F

+7)' EF -(<'81&&F =(:./)9 .()+: =.')'G'< )''+'+> d()+=(:./)9 :.71&+ (&:7 5(I' ;&(-' E'87<'



C44

()+ (85'< ():='</)9 5.' ;.7)'H (85'< 1:/)9 ( -7?;15'<H =.')'G'< 5.' ;<(-5/5/7)'< 571-.': ./:

7< .'< 8(-' 7< .(/<H '(5:H 7< ')9(9': /) ()F 75.'< )7)R-&/)/-(& (-5/G/5F>

Yearly Physical

N5 /: <'-7??')+'+ 5.(5 .'(&5.-(<' ;<78'::/7)(&:H /)-&1+/)9 (-1;1)-51</:5:H .(G' ( F'(<&F

;.F:/-(& 5.(5 /)-&1+': 5':5/)9 87< 51E'<-1&7:/:>*75' 5.(5 ,M, ()+ KKW 5':5/)9 (<' :/?/&(<> ,.'

5'<? n51E'<-1&/) :I/) 5':5:p 2,M,:3 /: 1:'+ /):5'(+ 78 ;1</8/'+ ;<75'/) +'</G(5/G' 2KKW3 /) ?7:5

1;R57R+(5' "W" /)87<?(5/7)> 2DD3

Clothing

N5 /: <'-7??')+'+ 5.(5 (-1;1)-51</:5: ='(< -&'()H =(:.(E&'H 7< +/:;7:(E&' ;<75'-5/G' -&75./)9

=./&' ;'<87<?/)9 5<'(5?')5:> ,.' 8(E</- :.71&+ E' -.7:') 57 (G7/+ 5<(;;/)9 ()+ :.'++/)9

-7)5(?/)(5/)9 ;(<5/-&': 7< /)8'-5/71: (9')5: /) 5.' -&'() 8/'&+> X77:' 7< &(<9' ]'='&<FH -&75./)9H

()+ .(/<:5F&': 5.(5 571-. 5.' ;(5/')5 7< E<'(I 5.' -&'() 8/'&+ :.71&+ E' (G7/+'+> $;')R57'+

:.7': :.71&+ )75 E' =7<)H (: 5.'F ;7:' ( </:I 78 )''+&':5/-I /) 5.' 'G')5 5.(5 ( )''+&' /:

+<7;;'+> "&75./)9 :.71&+ -7G'< 5.' ;<(-5/5/7)'<k: &'9: ()+ 8''5 57 ;<'G')5 5.' </:I 78 (

)''+&':5/-I (--/+')5 /) 5.' 'G')5 5.(5 ( )''+&' /: +<7;;'+>

Hand Care

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http://www.cdc.gov/HAI/pdfs/ppe/PPEslides6-29-04.pdf

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051

http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf



CQQ

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Part VI:

Cleaning and Pathogen Reduction Techniques inHealthcare and AOM Practice Locations

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1. Disinfectants

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CPB

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Classifications of Disinfectants

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-&(::/8/-(5/7):>

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Types of Disinfectants

Chlorine and Chlorine Compounds

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CPC

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Microbiocidal Activity

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EPA and FDA Approval of Disinfectants

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CPT

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2. Indications for Sterilization, High-Level Disinfection, and Low-

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3. Cleaning Equipment

Reuse of Single-Use Medical Devices

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Pre-cleaning of Reusable Medical Equipment

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CPb

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Instrument Cleaning

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Safety Guidelines for Disinfecting Reusable Medical Equipment

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5. Cleaning and Disinfecting Environmental Surfaces in Healthcare

Facilities•

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Use of Disinfectants for Surface Cleaning

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6. Blood or Body Fluid Spills,.' "W" <'-7??')+: +'-7)5(?/)(5/7) 78 :;/&&: 78 E&77+ 7< 75.'< ;75')5/(&&F /)8'-5/71:

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E'5='') ;(5/')5:>

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8. Sharps and Non-Sharps Biohazard Equipment and Disposal2M'' (&:7 .55;U``===>-+->97G`)/7:.`;+8:`P4-CCCi ()+ E77)@"%*/-", !"#$%& "-+ I$",%C =7%

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ABB

Disposal

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• "&7:(E&'>

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Contaminated Laundry

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2CS3

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Summary of Recommendations – Part VI• "</5/-(&U #&& /):5<1?')5: 5.(5 E<'(I 5.' :I/) :.71&+ E' :/)9&'R1:' ;<'R:5'</&/\'+

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References

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http://cid.oxfordjournals.org/content/39/5/702.full.pdf+html



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http://www.cdc.gov/HAI/pdfs/ppe/PPEslides6-29-04.pdf



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Part VII: Office Procedures for Risk Reduction

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1. Federal Standards and Guidelines

OSHA: Bloodborne Pathogens Standard

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https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10051

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=1574&p_table=DIRECTIVES

https://www.osha.gov/OshDoc/Directive_pdf/CPL_2-2_69_APPD.pdf



ACB

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OSHA: Hazardous Communication

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https://www.osha.gov/dsg/hazcom/index.html



ACC

OSHA: Other Hazards

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OSHA: Disposing of Biohazardous Waste

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https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=FEDERAL_REGISTER&p_id=19269

https://www.osha.gov/Publications/laboratory/OSHA3404laboratory-safety-guidance.pdf



ACA

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ACT

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Discarding gloves, cotton balls and other material contaminated with blood

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What should patients do with press tacks or other imbedded devices that they

need to remove at home?

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http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/Sharps/UCM278775.pdf



ACb

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ACD

3. Recordkeeping

Charting

General Charting Considerations

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http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/HIPAAGenInfo/AreYouaCoveredEntity.html



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http://www.medscape.org/viewarticle/762170

http://www.wedi.org/workgroups/security-privacy



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http://womeninbusiness.about.com/od/insuranceandlegalissues/a/hipaa-privstate_2.htm



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How to Prevent Falls Due to Slips and Trips

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http://www.osha.gov/Publications/smallbusiness/small-business.pdf



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http://healthinformatics.uic.edu/resources/articles/confidentiality-privacy-and-security-of-health-information-balancing-interests/

http://healthinformatics.uic.edu/resources/articles/confidentiality-privacy-and-security-of-health-information-balancing-interests/



AAD

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References

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https://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1910



AAS

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http://www.cdc.gov/hai/settings/outpatient/outpatient-care-guidelines.html


https://www.osha.gov/dsg/hazcom/index.html

http://www.hercenter.org/rmw/osha-BPS.cfm

http://www.hercenter.org/rmw/rmwoverview.cfm




AA4

Part VIII – Appendices

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Hepatitis

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http://www.usa.gov/directory/federal/cdc-national-std-hotline.shtml

http://nccc.ucsf.edu/clinical-resources/pep-resources/pep-quick-guide/


http://www.who.int/bulletin/volumes/88/12/10-076737/en/



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http://www.cdc.gov/niosh/docs/2000-108/pdfs/2000-108.pdf


http://www.cdc.gov/hepatitis/HBV/PDFs/HepBGeneralFactSheet.pdf

http://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index1.html



http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/hepatitis-e




https://www.aids.gov/federal-resources/national-hiv-aids-strategy/nhas-fact-sheet.pdf

https://www.aids.gov/federal-resources/national-hiv-aids-strategy/nhas-fact-sheet.pdf




http://www.cdc.gov/hepatitis/HBV/PDFs/HepBGeneralFactSheet.pdf


http://www.cdc.gov/niosh/docs/2000-108/pdfs/2000-108.pdf



ATD

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Handwashing information and details

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OSHA Documents and Training Requirements

OSHA Bloodborne Pathogen Standards

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OSHA Documents Relating to ECPs

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https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=DIRECTIVES&p_id=1574

https://www.osha.gov/OshDoc/Directive_pdf/CPL_2-2_69_APPD.pdf


http://www2.cdc.gov/ncidod/dbmd/abcs/calc/calc_new/intro.htm



ATS

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http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/notice.html








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AbB

Clean Needle Technique 7th Edition FAQ

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')5/<' 8/'&+ E'/)9 ;<';(<'+ 87< ;(5/')5 5<'(5?')5: /: -&'()H )75

:5'</&'> "&'() 5'-.)/01' /: ( E'55'< +':/9)(5/7) 5.() :5'</&'

5'-.)/01' =./-. =71&+ <'01/<' :1<9/-(&R&'G'& -&'()&/)':: ()+

:5'</&/5F>c8($ #(+"$5 $'(*0*0> 2,"# B4P-

'"R.*'" F(# ( ?*0*?.?Gk

#--7<+/)9 57 K1E&/- X(= PCRDPSH PC:5 "7)9<'::H MH ACPTH W'-'?E'<

APH CP4B M'- 2D3> 6(-. '?;&7F'< R o:.(&& 81<)/:. 57 '(-. 78 ./:

'?;&7F'': '?;&7F?')5 ()+ ( ;&(-' 78 '?;&7F?')5H =./-. (<' 8<''

8<7? <'-79)/\'+ .(\(<+: 5.(5 (<' -(1:/)9 7< (<' &/I'&F 57 -(1:'

+'(5. 7< :'</71: ;.F:/-(& .(<? 57 ./: '?;&7F'':o,.' '?;&7F'<:.(&& :'' 5.(5 =7<I'<: (<' ;<7;'<&F /):5<1-5'+ ()+ :1;'<G/:'+ /) 5.'

:(8' 7;'<(5/7) 78 ()F ?(-./)'<FH 577&:H '01/;?')5H ;<7-'::H 7<

;<(-5/-' =./-. 5.'F (<' (15.7</\'+ 57 1:' 7< (;;&FoM'' K(<5 cNNN 78

5./: %()1(& 87< ?7<' +'5(/&:>



AbD

P,= 3,0> #8,.32 @ '"$(*0 '"),'2#

,+ "?/3,5"" B4P- $'(*0*0>k

Y1&' 78 5.1?EU 5/?' 78 '?;&7F?')5 ;&1: D F'(<:>

,.'<' /: )7 7)' :5()+(<+ &')95. 78 5/?' 57 I''; (&& 5F;': 78 5<(/)/)9

<'-7<+: 87< (&& $Md# <'91&(5/7):> ,<(/)/)9 <'-7<+ <'5')5/7) G(</':

8<7? :5(5' <'91&(5/7) 57 75.'< :5(5':k <'91&(5/7):> ,.' E':5 <1&' 78

5.1?E /: 57 I''; (&& 5<(/)/)9 <'-7<+: +1</)9 5.' =7<I'<_: 81&& ;'</7+

78 '?;&7F?')5H ;&1: D F'(<:> 2*75' 5.(5 ?"2*)(3 '"),'2# <'&(5/)9 577)R5.'R]7E /)-/+')5: ?1:5 E' I';5 87< 5.' &')95. 78 '?;&7F?')5

&Sa4 QM 5"('#>348,.32 $8" 0""23" /()<(>*0> ["

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571-./)9 5.' 715:/+' 78 5.' )''+&' ;(-I(9/)9> N8 5.' ;(-I(9/)9 /:

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E/7.(\(<+ 5<(:. E'-(1:' 5.(5 E&77+ /: )75 (E&' 57 E' n:01''\'+p

715 7)57 :I/) :1-. 5.(5 () /)8'-5/71: (9')5 -71&+ E' 5<():?/55'+>

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0""2 $, [" *#,3($"2 (+$"' .#"k

W/:/)8'-5'+H )75 /:7&(5'+>

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5.7:' -1;: )''+ 57 E' .()+&'+ -(<'81&&F (: E&77+ ()+ $KN% =/&& E'

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5./: -(:' ;</?(</&F 9&7G':H :.71&+ E' 1:'+ =.') .()+&/)9 :1-.

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;1<;7:': 78 KK6H 5.') /5 /: $f 87< -&/)/-/(): =7<I/)9 (5 .'(&5.-(<'

8(-/&/5/': 57 ;1<-.(:' 5.'/< 7=) 1)/87<?: ()+ &(1)+'< 5.7:' (5

.7?'>



AbS

Index

4Bt /:7;<7;F& (&-7.7&H TDH 4CH QbH C4bH C4DH C4SH AbC

(+G'<:' 'G')5 2#63U (-1;1)-51<'H TH 4H PH ATTi

E&''+/)9 5.'<(;FH bQi -1;;/)9H TCH TAH TTH Tbi

'&'-5<7(-1;1)-51<' 26#3H bTH bbH bDi 91( :.(H DAH

DTi ?7J/E1:5/7)H AbH ADH ASi K&1? O&7::7?

)''+&/)9H D4i ;<':: 5(-I: ()+ /)5<(+'<?(& )''+&':H

DPi :'</71: 2M#63H TH bH CBH CTH TCH bT

(99<(G(5/7) 78 :F?;57?:H bH PH PQ

#NWMH CbH C4H 44H CbTH C4AH C4SH C4QH CPT

(&-7.7& :=(EH 4CH 4AH C4bH C4DH AbC

(&-7.7&RE(:'+ .()+ :()/5/\'<H SPH 4QH QDH QSH CD4H

CDQH CSPH C4BH CQP

()5/:';5/-H 4CH CD4H CSQH C4BH C4TH C4bH C4DH CPAH AA4

(:';5/- 5'-.)/01':H J/GH CH SPH CASH AA4

(1579')71:H CSH CTA

E(-5'</(H 4PH CTCH CTAH CbPH CDCH CDTH CSPH C4BH C4CH

C4AH C4SH CQDH CPCH CPSH AA4H AAQH AAPH ATBH ATCH

ATAH AbA

E(-5'</(& &7(+H 4TH C4B

E(-5'</(& :;7<':H AAQH AAPH ATB

E/7.(\(<+ 5<(:.H TSH T4H AbD

E/7.(\(<+71: =(:5'H QSH CP4H AB4H ACCH ACAH ACTH

ACbH AAD

E&''+/)9H TH bH TPH bQH DBH D4H SPH QbH PAH PTH PSH CCbH

CCQH CCPH CABH CATH CAbH CA4H CAQH CQCH CQAH CQTH

CPSH AB4H AbbH AbDi N)5'<)(&H Cb

E&''+/)9 +/:7<+'<:H TPH DTH CCP

E&/:5'</)9H AbH CBAH CB4H CCS

E&77+H TCH TAH TTH TDH TSH bQH bPH DBH DAH D4H SPH 4bH

4SH QBH QbH QDH Q4H PCH PAH PbH CCDH CCPH CABH CAAH

CAbH CA4H CTAH CTTH CTbH CTDH CTSH CT4H CTQH CbBH

CbCH CbbH CbSH CDTH CSQH C4BH C4AH C4SH C4QH CQBH

CQCH CQTH CPCH CP4H CPQH CPPH ABBH ABSH AB4H ABQH

ACCH ACTH AbCH AbTH AbD

E7+F 8&1/+H SPH 4bH QBH CA4H CTTH CTDH CTSH CT4H CbbH

CbSH CSQH C4CH C4AH C4TH C4SH CQBH CQCH CQTH CP4H

ABDH ABSH ABQH ACAH ATBH AbT

E<7I') )''+&'H bH CQH CP

E<1/:/)9H TH bH AbH TbH TPH bPH CADH CA4H AAb

E1<):H J/JH AbH ADH ASH A4H AQH APH TBH CBAH CBTH CBDH

CBSH CBQH CBPH CCCH CCTH CCbH CC4H CAbH CADH CPCH

AAbH AAD

-(88'/)'H S

""#$%H JGH J/JH 4AH QbH CQQH AbA

"')5'<: 87< W/:'(:' "7)5<7& ()+ K<'G')5/7) 2"W"3H

TSH bPH DbH 4bH 4SH PCH CASH CA4H CTTH CTSH CT4H

CTQH CbbH CbDH CbSH CDSH CDQH CSQH C4AH C4TH C4bH

C4DH C44H C4QH CQBH CQAH CQPH CPBH CPTH CPbH CP4H

ABbH ABSH ACTH ATT

-.'?/-(& 9'<?/-/+':H CPBH CPAH ATB

-./&+ 7< '&+'< (E1:'H AAC

-.&7<.'J/+/)'H 4AH C4DH AbC

-&'() 8/'&+H SQH 4BH 4bH 4DH 4SH 44H QAH QTH QbH QSH Q4H

QQH QPH PBH PAH PbH PDH PSH CCQH CABH CATH CADH CAPH

CDPH C4DH C44H CQPH AAQH AbbH AbD

"&'() *''+&' ,'-.)/01' 2"*,3H C4H SQH SPH 4DH 4SH PDH

CA4H CTCH CTQH CbAH CDCH CDPH C44H ABbH ABSH AA4

-&'() 5'-.)/01'H AAQH Abb

-&'()/)9 (--/+')5(& :;/&&:H CP4

"&7:5</+/1? +/88/-/&'H CD4H CDQH CPC

-&75./)9H 4QH PAH C44H CP4H ABQ

-7??1)/-(E&' +/:'(:'H ABbH AAC

-7)8/+')5/(&/5FH C4PH ABbH ABDH ACPH AAb

-7)5(?/)(5/7)H PH DBH 4BH 4AH 4SH 44H QSH PAH PQH CADH

CASH CA4H CDCH CDQH C4AH C4bH C4SH CQAH CQTH CQPH

CPSH ABBH AAQH AbB

-1;;/)9H bH TCH TAH TTH TbH TDH TSH T4H TPH bQH DTH CCbH

CCDH CC4H CDDH C4SH CQTH CPbH CPSH CPPH AAAH AADH

AbCH AbAH AbbH AbD

-15()'71:H TH D4

+/:/)8'-5()5H C4H TSH DbH SBH 4bH 44H PDH P4H CCQH CA4H

CDAH CD4H CDQH C4bH CQPH CPBH CPCH CPAH CPDH CP4H

ABCH ABAH AAQH AAPH AbBH AbA

'--.F?7:/:H TCH TAH TPH bBH DAH CCbH CAbH AAQ

'&'-5</-(& :5/?1&(5/7)H bTH bDH bSH DPH AAP

')9/)''</)9 -7)5<7&:H 4bH CDSH AB4H ABQH ACb

8(/)5/)9H TH bH 4H bTH PTH CA4H AbB

8/<' +';(<5?')5 <'91&(5/7):H ABbH AAb

87<9755') )''+&'H bH Q

81)9/H CbPH C4CH ATB

9&7G':H C4H TDH TSH T4H DBH D4H SPH 4bH 4SH QbH PAH PDH

PSH CCbH CCQH CCPH CABH CAAH CATH CASH CA4H CAPH

CbbH CbQH CDAH CD4H CDQH C44H CQCH CQAH CQTH CP4H

ABBH ABDH ABSH ABQH ACTH AAb

9&15(<(&+'.F+'H CPC

Z<71; # M5<';57-7--1: 2Z#M3H CDT



Ab4

91( :.(H DAH DTH DbH CAbH CADH CPbH CPDH CPSH ABCH

AAAH AADH AbAH Abb

.()+=(:./)9H SPH 4BH 4bH 4SH 4QH 4PH PCH PbH P4H CTbH

CDAH CDTH CDDH CD4H CDPH CSBH CSQH CSPH C4BH C4CH

C4AH C4TH CQAH CQPH ABSH ABQH ACbH AAQH ATA

d(\(<+ "7??1)/-(5/7) M5()+(<+H ABbH ACB.'(&5.-(<' (::7-/(5'+ /)8'-5/7): 2d#N3H CTCH CbPH CSPH

C4CH ATT

.';(5/5/:H TH bH CbH ADH bQH 44H QBH PCH CASH CTCH CTTH

CTDH CTSH CTPH CbBH CbCH CbAH CbQH C4CH C4AH C4TH

C4SH C4QH C4PH ABQH ACPH ATTi .';(5/5/: # 2d#c3H

CTbi .';(5/5/: O 2dOc3H bQH QBH PCH CASH CTTH CTbH

CTDH CTSH CT4H CTQH CTPH C4QH C4PH CQPH CPAH ABDH

AB4H ABQH ACPi .';(5/5/: " 2d"c3H ADH QBH PCH CASH

CTPH CbBH CbCH C4Qi .';(5/5/: W 2dWc3H CbCi

.';(5/5/: 6 2d6c3H CbA

.';(5/5/: O 2dOc3H bQ

.'<;': :/?;&'J G/<1: 2dMc3H TbH CbQH CDbH CDD

dNK##H ABD

dNcH QBH PCH CTCH CTTH CTPH CbBH CbTH CbbH CbDH CbSH

Cb4H CbQH C4CH C4AH C4TH C4SH C4QH C4PH CPCH CPAH

ABDH ATbH AbT

.71:'I'';/)9H CPSH ABCH ABQH AAT

.F9/')'H CTbH CTQH C4SH C44i .()+H 4bH CASH CD4H CDQH

CSQH CSPH C4BH C4bH CQAH CQTH ABSH AAbi

<':;/<(57<FH CDSH ABSH AAb

.F;7-.&7</5' :7&15/7)H CPBH CPCH CPAH CP4H CPQH ABAH

AAQ/??1)' :F:5'?H PCH CTCH CTTH CT4H Cb4

/?;'5/97H CDT

/)8'-5/7)H TH bH CbH CSH AbH ASH TTH TbH TSH T4H bQH bPH

DPH SBH SbH S4H 4AH 4TH 4bH 4SH QBH QQH PCH CBAH CADH

CASH CA4H CTCH CTAH CTTH CTbH CTDH CT4H CTQH CTPH

CbBH CbCH CbbH CbDH Cb4H CbQH CbPH CDAH CDTH CDbH

CDDH CD4H CDQH CSBH CSQH C4bH C44H C4QH C4PH CQPH

CP4H ABDH ACCH ACPH AA4H AAQH ATB

/)8'-5/71: (9')5H 44H CTCH CTAH CTTH C4CH C44H CQBH

CPB

/)8'-5/71: +/:'(:':H SbH CA4H CTCH CTAH C44H CQBH ATC/)8&1')\(H CDDH C44H CP4

/)87<?'+ -7):')5H ABbH ABDH AACH AAA

/)]'-5/7):H CASH CA4H CAPH C4bH CQC

/)]1<FU E&77+ G'::'&:H CSi -')5<(& )'<G71: :F:5'?H CDi

.'(<5H CTi )'<G' /)]1<FH TH SDi 7<9()H CTi

;'</;.'<(& )'<G':H CDi 5/::1'H CD

&()-'5H C4H TCH TAH TDH bQH bPH DBH SQH 4bH 4SH QBH PDH

PSH CCbH CCQH CCPH CABH CATH CDPH C4SH CPPH AB4H

ACTH ATAH AbTH Abb

?(5'</( ?'+/-(H A

?'+/-(& =(:5'H 4bH QDH QQH ACAH AAD

?'5./-/&&/)R<':/:5()5 M5(;.F&7-7--1: (1<'1: 2%YM#3HCSH 4PH CTTH CDAH CDT

?7J(H J/JH AbH ADH ASH A4H APH SQH CBCH CBAH CBTH CBbH

CBDH CBSH CB4H CBQH CBPH CCBH CCCH ACCH AAAH AADH

ATBH AT4H Abb

?7J( :?7I'H ADH A4H CBA

%F-7E(-5'</( 75.'< 5.() 51E'<-1&7:/: 2%$,3H CDTH

CDb

*""#$%H JGH JG/H JG//

)''+&' ?()/;1&(5/7)H SH 4H CDH bTH PDH P4

)''+&':5/-IH QH 4DH 4SH 44H QBH QCH PAH CABH CTSH CbbH

C44H CQCH CQTH AbBH AbT*''+&':5/-I M(8'5F ()+ K<'G')5/7) #-5 2*MK#3H ABS

)7<7G/<1:H CDSH CD4

$Md#H CTQH CQBH CQCH CQAH CQPH CPTH CPQH ABBH ABbH

ABDH ABSH AB4H ACBH ACCH ACAH ACTH ACbH AAAH ATDH

AbD

;(-'?(I'<H bbH bSH b4H Abb

;(<':5.':/(H T

;(5/')5 <'-7<+:H ACDH AAD

;'<:7)(& ;<75'-5/G' '01/;?')5 2KK63H TDH 4bH CCbH

CCQH CCPH CASH C4PH CQBH CQTH ABBH ABCH ABSH ABQH

AAbH ATB;'5'-./('H TCH TAH TPH bBH DAH DbH CCbH CAbH CADH AAAH

AAQ

;&1? E&7::7?`z:'G')R:5(<zH C4H TAH D4H SPH 4bH 4SH

QBH CAAH CPPH ATCH ATA

;)'1?75.7<(JH bH CBH CAH TAH 4PH PDH AT4H ATQ

KKWH C44

;1E&/- .'(&5. :'55/)9:H PCH PA

</:I <'+1-5/7)H JGH ABbH ABD

<1E'8(-5/7)H Ab

M(8'5F Z1/+'&/)':U #99<(G(5/7) 78MF?;57?:H CBi

#G7/+ [/<' "1;;/)9 O1<):H TDi #G7/+ $<9() ()+"')5<(& *'<G71: MF:5'? N)]1<FH CDi #G7/+

K)'1?75.7<(JH CAi #G7/+ ,/::1' N)]1<FH CSi

O&77+&'55/)9H DBi O<7I') *''+&'H CPi "1;

W/:/)8'-5/7)H TQi "1;;/)9H TPi W/:/)8'-5/)9

Y'1:(E&' %'+/-(& 601/;?')5H CPbi W/:/)8'-5/7) 78

Z1( M.( ,77&:H DDi 6(< :''+:H STi Z1( M.(H DTi

d()+ M()/5(5/7)H SPi d'(5 ,.'<(;/':H AQi



AbQ

N)5<(+'<?(& *''+&':H SBi %7J( O1<) K<'G')5/7)H

ASi %7J( O1<) ,<'(5?')5H A4i %7J( M?7I'

Y'(-5/7)H A4i *''+&' "1;;/)9H bBi *''+&'

Y'?7G(&H Pi K&1? O&7::7? ,.'<(;FH D4i K<';(</)9

()+ %(/)5(/)/)9 ( "&'() [/'&+H 4Bi K<'::,(-I:H SBi

K<'G')5 O<1/:/)9H O&''+/)9 ()+ c(:-1&(< N)]1<FH DiK<'G')5 "1;;/)9 #+G'<:' 6G')5:H bBi K<'G')5

"1;;/)9RY'&(5'+ N)8'-5/7):H TSi K<'G')5 [(/)5/)9H

4i K<'G')5 N)8'-5/7)H C4i K<'G')5 *''+&' M/5' K(/)H

Si K<'G')5/)9 6# #+G'<:' 6G')5:H bDi K<'G')5/)9

6&'-5</-(& N)]1<F +1</)9 6#H bSi K<'G')5/)9

6J-'::/G' %1:-&' "7)5<(-5/7) +1</)9 6#H bDi

K<'G')5/)9 N)5'<8'<')-' =/5. ( "(<+/(- K(-'?(I'<

W1</)9 6#H bSi MI/) K<';(<(5/7)H 4Ti M51-I *''+&'H

Qi ,1/ *(H SD

:.(<;:H SQH 4TH 4bH 4SH 4QH CASH CQPH CPTH CPPH ABBH

ACCH ACAH AAQ:.(<;: -7)5(/)'<H 4TH 4bH QBH QCH QbH QDH QSH Q4H QQH

PAH CPPH ABCH ABQH ACb

:7(; ()+ =(5'<H TDH TSH T4H DbH SPH 4CH 4AH 4QH PCH

CD4H CDQH CSQH CSPH C4BH C4AH C4bH C4DH CQTH CPDH

CP4

M$#K )75':H AC4H AAD

:;/&&:H QbH CQTH CPSH CP4H CPQH CPPH ABC

M5()+(<+ K<'-(15/7):H JG//H SQH 4bH 4SH 44H PbH CT4H

CbAH CbbH CbDH CbSH CbQH CDDH CDSH C4CH C4TH C44H

CQBH CQCH ABBH ABbH ABSH AAAH AAbH ATCH ATD

!%"@C&,/7/77).H bH CTCH CTAH CDCH CDAH C4CH C4AH C4S

M5(;.F&7-7--1: (1<'1:H CSH TbH TDH CDA

:5'</&()5H CPBH CPCH CPAH CPS

:5'</&'H TH C4H CQH ASH TDH D4H DPH SBH SQH SPH 4BH 4bH

4DH 4SH 44H 4QH 4PH QCH QAH QTH QbH Q4H QPH PBH PCH

PbH PDH PSH CBAH CBSH CCQH CAAH CA4H CAQH CAPH CbTHCDPH CSBH C4CH C44H CPBH CPTH AA4H AAQH ATCH ATAH

AbBH AbCH AbAH Abb

:5'</&/\(5/7)H 4QH CPTH ABDH ATA

M5<';57-7--1:H CTCH CDCH CDT

:51-I )''+&'H bH 4

,WK &(?;:H A4H CCA

5<'(5?')5 <'-7<+:H ACDH ACQH ACP

%)R$17),/.*. OG3PH bH CTTH CbPH CDBH C44H CQBH CPCH

ATb

1)/G'<:(& ;<'-(15/7):> !$$:5()+(<+ ;<'-(15/7):H

!$$:5()+(<+ ;<'-(15/7):G(--/)(5/7)H CTTH CTbH CTSH CT4H CTQH CbCH CDBH CDSH

CDPH C4bH ABDH AB4

G(--/)'H QBH CTDH CT4H CTPH CbCH CbAH CbQH CQCH ABQ

G/<1:H CTCH CTTH CbTH CbPH C4CH C4AH C4SH C4QH CQPH

CPCH AAQH AAPH ATA

=7<I;&(-' G/7&')-'H ABb

j/;R&7-I E(9:H QS