COVID-19 and Dry Needling

Updated May 9, 2020 - Added downloadable checklist

Is it safe to dry needle during the COVID-19 pandemic?

Can I treat patients with Gunn IMS right now during the COVID-19 pandemic?
Currently there are many health advisories in place outlining when physiotherapy and medical services requiring direct patient contact are appropriate, including the appropriate use of PPE. We all need to review the relevant federal, provincial and licensing college regulatory statements and act in a socially and professionally responsible manner - that is our individual responsibility as health practitioners. Once we have complied with the advisories related to providing direct patient care, either as physicians or physiotherapists, in a general sense, we then need to consider any dry needling-specific issues.

If I deem Gunn IMS treatment to be both indicated and appropriate for my patient, is it possible to provide COVID-free interaction surfaces (plinth, skin, gloves)?
Yes. Standard Gunn IMS protocol is that we disinfect the plinth surface between every patient with appropriate disinfectant, practitioners wash their hands and wear gloves disinfected with hand sanitizer, the patient's skin is disinfected with alcohol swabs, and the needles are sterile.

What should you use as a disinfectant for treatment tables?
At the Allan McGavin Sports Medicine Clinic at UBC we use Caviwipes (Cavicide) to disinfect the treatment tables, but there are many options for disinfecting surfaces from SARS-CoV-2. Health Canada has published a list of disinfectants for use against SARS-CoV-2 that we recommend Canadian practitioners use as a reference to ensure their disinfection protocol is adequate.

Is any additional skin preparation necessary for my patient?
Gunn IMS protocol calls for disinfecting your patient's skin with 70% alcohol prior to needling. This concentration has been shown to be sufficient to disinfect skin surfaces from SARS-CoV-2.

What about contact surfaces between patient skin and gloves? 
Gunn IMS protocol is to wash your hands with soap and water before donning gloves and then disinfecting your gloves with alcohol-based hand sanitizer. Health Canada also has a list of hand sanitizers approved for use against SARS-CoV-2 that you can use for reference. One additional step that we currently recommend is washing your forearms to above the elbows between patients as we often use our forearms to stabilize the patient while treating with Gunn IMS.

What is the risk of infection from the needles themselves?
The needles are solid and fine (dry/"atraumatic") as opposed to hollow and cutting (wet/"traumatic"), so the use of IMS dry needles carries a lower risk of infection by introducing microorganisms from the patient's skin to beneath the skin compared to wet needles. Part of our standard informed consent procedures includes informing patients of the risk of infection by inserting a needle below the dermis, but that this risk is very low. 

Is there anything else I need to consider before resuming in-person treatments? 
Standard IMS protocol is that treating people with cold or flu symptoms with Gunn IMS is contraindicated. This is because we often stimulate the autonomic nervous system when we treat with Gunn IMS, and the autonomic nervous system interacts with the immune system. The precise outcome of this interaction is not known, but it may be that the immune system is temporarily depressed after treatment. Due to this, and the apparently prolonged incubation period of the virus that causes COVID-19, if your patient has any or a combination of the current known risk factors for severe COVID-19 illness (i.e. cardiovascular disease, hypertension, chronic respiratory disease, diabetes, history of cancer, older age, compromised immune system from a medical condition or treatment (e.g. chemotherapy)https://www.canada.ca/en/public-health/services/publications/diseases-conditions/vulnerable-populations-covid-19.html) - these should be considered a precaution to treatment with Gunn IMS. If your patient has cold or flu symptoms, COVID-19 related or not, Gunn IMS treatment is contraindicated, whether they also have underlying risk factors for serious COVID-19 illness or not.

Please use the document below to aid in implementing these important considerations into your practice.