[Objective]Using cotton to cover needle shafts when removing acupuncture needles is recommended in order to prevent blood contamination. However, the effect of risk reduction has not been confirmed by experimental studies. We, therefore, observed spreads of fluorescent agent, assumed as blood, with or without alcohol cotton to avoid direct contact between fingers and needle shaft.
[Methods]Subjects were two blind acupuncturists and two acupuncture students. We asked them to insert acupuncture needles to people who played a role of a patient. Of the five acupoints needled, we put the fluorescent agent to one point, and asked the subjects to remove the needles. After all the needles were removed, we took photographs of all points needled and the subjects'hands in order to assess the spread of the fluorescent agent. 'We performed two sessions. In Session A, the subjects used alcohol cotton to cover a needle shaft so that their fingers did not contact the needles directly. In Session B, they did not use alcohol cotton. The subjects were not told that we used the fluorescent agent.
[Results](1) In the forearm of those who were needled, adhesion of the fluorescent agent was not seen in three out of four subjects, in Session A. (2) In two of the four subjects who inserted the needles, the adhesion area of the fluorescent agent in the needle-supporting hands was smaller in Session A compared with Session B. (3) In three of the four subjects who inserted the needles, the adhesion area of the fluorescent agent in the needle-stimulating hands was smaller in Session A compared with Session B.
[Conclusion]It is suggested that covering needle shaft with alcohol cotton during needle withdrawal suppresses the spread of blood contamination.

[Objective]To analyze and understand cases of adverse effects of acupuncture and moxibustion published in medical journals between 2007 and 2011.
[Methodology]We searched relevant articles with the Web of Japan Medical Abstracts Society and PubMed. We used keywords for acupuncture, moxibustion and related adverse events.
[Results]We located 39 papers reporting 39 cases that occurred in Japan:infection (7 cases), organ injury (11), foreign body or needle breakage (8), neurological damage (6), cutaneous disease (1), adverse effects of moxibustion (4), and others (2). As for cases published in foreign countries, we located 60 relevant papers:infection (19 cases including 2 outbreaks), organ injury (13), foreign body or needle breakage (5), neurological damage (9), cutaneous disease (5), adverse effects of moxibustion (2), and others (7).
[Conclusion]Although causal relationship has not been established in some cases, occurrences of infection, organ injury, and needle breakage/foreign body are still as high as they were before. This suggests that continual feedback to acupuncturists of information on safety is necessary.

In The 63rd Annual Congress of JSAM (Ehime 2014), the Committee for Safe Acupuncture of Research Department in the Japan Society of Acupuncture and Moxibustion (JSAM) conducted a workshop entitled "The Regional Anatomy Q&A for safety needling"which provided information on organ damage and neurological injuries that may occur after acupuncture treatments. This workshop stated the need for improvements in safe practices of acupuncture.
This workshop was divided into three parts:(1) results of questionnaire surveys conducted in Japan for acupuncturists on their clinical experience of adverse events and for orthopaedic doctors on their clinical experience of patients who suffered adverse events after acupuncture treatment;(2) a literature search of severe adverse events e.g., pneumothorax and neurological injuries, associated with acupuncture treatment in Japan;(3) the regional anatomy of the upper part of the body, which is based on several anatomical studies on acupoints.
The incidence of severe adverse events is considered to be very low during all acupuncture treatments;however, the real incidence is estimated to be higher than the number of case reports in the literature. In order to prevent severe adverse events, regional anatomical knowledge of needling points is very important, and furthermore, safe needling techniques are required.
We hope that this workshop can aid in enhancing the knowledge and techniques and contribute to safe practices of acupuncture.

The safety committee has been undertaking activities, such as conducting regular workshops at the annual congresses, managing the "Safety Measures Website for Acupuncture and Moxibustion," researching the literature, conducting multicenter prospective studies on acupuncture and moxibustion-related adverse events, collecting information about medical accidents involving acupuncture and moxibustion in Japan, addressing the media pertaining to false information regarding the safety of acupuncture and moxibustion, and formulating the Safety Guidelines for Japanese Acupuncture and Moxibustion Practice. At the 71st annual Tokyo congress workshop, activities conducted over the past decade were summarized.　Regarding the studies on acupuncture and moxibustion-related adverse events, a literature review of reports concerning acupuncture- and moxibustion-associated adverse events published globally from 2004 to 2019 was introduced. Furthermore, the results of a multicenter prospective study conducted by the safety committee were also introduced. Additionally, the Safety Guidelines for Japanese Acupuncture and Moxibustion Practice were introduced, and the results of a questionnaire survey determining the degree of recognition of these guidelines were simultaneously reported. Moreover, regarding future developments, plans to create and publish a safety manual for acupuncture and moxibustion (provisional name) were reported.　In the second half of the workshop, reports on the past cases of needle breakage and retained needles were introduced under the topic "precautions and preventive measures regarding needle breakage and retained needles." Furthermore, the number of needle breakage claims filed under the liability insurance of acupuncture and moxibustion practitioners was reported. These details demonstrate that despite the common use of single-use acupuncture needles, accidents involving needle breakage still exist. Lastly, measures for reducing the difficulty in needle removal and preventing needle breakage were summarized, and opinions on the same were exchanged with the participants.