Infection Risk in Acupuncture and Clean Needle Technique

Get medical care promptly for signs of infection

Redness that spreads, heat, swelling or pus at a needle site, fever, or a lump that gets more painful in the days or weeks after acupuncture needs medical attention. Tell the clinician you had acupuncture. Call 911 for severe symptoms such as confusion, trouble breathing or a very high fever with feeling extremely unwell.

The risk in plain terms

Any procedure that breaks the skin can carry germs into the body. The US National Center for Complementary and Integrative Health says serious problems, including infections, have followed nonsterile needles and improper treatment. [1] The National Cancer Institute (NCI) says reported accidents and infections appear to be related to violations of sterile procedure, negligence of the practitioner, or both. [2]

Infections from acupuncture are not common, and no good rate exists. Case reports and outbreak investigations show what can happen when hygiene fails; they cannot tell us how often.

What the reviews found

• A review of English-language case reports from 1965 to 1999 found 202 incidents. Complications included infections (mainly hepatitis from a few practitioners), and fewer serious complications were reported after 1988. [3]
• NCI notes that of 118 reported infection incidents in that same period, 94 involved hepatitis, and very few hepatitis or other infections have been reported since 1988, when widespread use of disposable needles began. [2]
• A later review of reports from 2000 to 2011 found infections were still the main complication, but the pattern had changed: most were bacterial and came from skin contact at the needle site, and the authors found no hepatitis cases. [4] They concluded that clean needle technique must be followed. [4]
• An overview of 17 systematic reviews found infection was one of four main groups of adverse events, with a median of 17 cases and 0.5 deaths per review. [5] The authors rated the quality of the reviews as overall mediocre. [5]

These are reports of events that doctors chose to publish, so they do not count every infection.

Outbreaks linked to reused needles

Outbreak investigations show the problem is real when needles are reused:

• Hepatitis B in Canada. Investigators linked two cases of acute hepatitis B to one acupuncturist. An inspection found high-risk re-use and inappropriate storage of disposable needles, and the authors judged contaminated needles the likely cause. [6] The clinic was ordered to stop practice until infection control was fixed. [6]
• Tuberculosis in China. In a private clinic, 56 of 2,561 patients (2.2 percent) developed tuberculosis. Investigators concluded the outbreak was caused by acupuncture and passed on through shared needles contaminated with the bacteria. [7]
• A second tuberculosis cluster in China. Thirteen patients developed abscesses after needle treatment and muscle injections at a local clinic where needles and syringes were reused after autoclave sterilization. [8] This outbreak involved injections as well as acupuncture.

Single-use sterile needles

In the United States, the Food and Drug Administration regulates acupuncture needles as medical devices and requires that they be sterile and labeled for single use only. [1] Cleveland Clinic says practitioners throw needles away after one use. [9] Our page on acupuncture needles, types and regulation covers the devices themselves.

What clean needle technique means

"Clean needle technique" is the name for the set of hygiene practices taught in training, such as hand hygiene, skin preparation and safe disposal. NCI notes that national certification requirements for clean needle technique were developed and enforced as an acupuncture licensure requirement in the United States. [2] This page does not describe how to carry out these steps, because they are for trained practitioners.

Questions you can ask

• Are the needles new, sterile and single-use, and do you open them in front of me?
• Do you have a licence or certification, and can I check it? See how to choose an acupuncturist.
• What do you do with used needles?

If answers are vague, or you see needles reused or hygiene that worries you, you can decline treatment. See red flags in acupuncture practice.

Who is at higher risk

Skin that is already infected or broken is a reason to avoid needling in that area. [10] NCI says people having chemotherapy or radiation are immunocompromised, so strict clean needle technique is needed. [2] A 2026 case report described septic arthritis presumed to be linked to acupuncture in a man on treatment for multiple myeloma. [11] A single case cannot show how often this happens. See who should avoid or take extra care.

Reporting a problem

To report a suspected infection or unsafe practice, see reporting an acupuncture adverse event or complaint. The wider overview is on the side effects and precautions page.