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Clinical Hygiene as a Mindful Practice
In the seeming rush to maintain schedules, complete paperwork, and keep our patients from waiting, it is easy to allow our Clean Needle Technique (CNT) and hand washing protocols to become lax. We can become complacent and begin to cut corners or forget to maintain our standards. After all, the risk of infection with acupuncture needles is relatively minimal. This is risky business as it greatly increases the risk of infection, which, though low, is an ever-present liability. One way to overcome this potential slackening of our hygiene is to approach cleanliness and CNT as an opportunity to practice mindfulness. As practitioners of East Asian medical traditions we are often taught to consider the effect of our “intent” on the application of needles and to make “mindfulness” a part of our practice, but what does this mean? In their paper “Mindfulness: A Proposed Operational Definition" in the journal Clinical Psychology: Science & Practice, Scott R. Bishop, Mark Lau and their colleagues propose a psychological definition of “mindfulness”.
“The first component [of mindfulness] involves the self-regulation of attention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment. The second component involves adopting a particular orientation toward one’s experiences in the present moment, an orientation that is characterized by curiosity, openness, and acceptance.”
If we bring our full attention to our every moment, mundane tasks may become meaningful rituals that help us to powerfully develop this faculty. In Zen monasteries, there is often a sign at the front entrance that reads “it is forbidden to leave your sandals in disarray,” gently reminding the monks to carefully tie up and place their shoes neatly by the door as they remove them upon entry. Thich Nhat Hanh invokes this spirit when describing simple tasks: “I clean this teapot with the kind of attention I would have were I giving the baby Buddha or Jesus a bath. Nothing should be treated more carefully than anything else.”
As a medical practitioner and director of a school clinic, one of the small activities that I often consider as part of my own practice is hand washing and maintaining the cleanliness of my needling field. When I prepare to see patients in my office or our school clinic, a thoughtful and thorough hand washing has become one of my mindful rituals. Hand washing is not done automatically or thoughtlessly. I run warm water and carefully clean all the surfaces of my hands, scrubbing the dorsal and palmar surface of the hands and fingers, between each finger, scrubbing my fingernails with a brush or against my palm. I pay careful attention to avoid touching the sink with my clean hands as I turn off the water. I dry my hands with clean towels. The process allows me time to quiet my own dialogue, center myself, and become fully present in the moment for my interaction with my patient. This specific, focused, method of clinical hand washing that brings my mind into the appropriate space to practice medicine. When I wash my hands prior to inserting needles, the momentary ritual helps me focus my intent for the impending treatment. I remain present and avoid touching anything that may contaminate my hands, disturb my treatment, or lead to potential infection.
When I have completed treatment, repeating the ritual of hand washing helps me to let go of my previous interaction and clear my mind for interaction with my next patient. At the end of my day, the last thing I do is wash my hands a final time, ritually clearing my head and ending my clinical practice so I can shift my energy to the role of father, husband, teacher, or whatever is appropriate in my next phase. I find if I am able to turn my basic hygiene protocols into an opportunity to be mindful, I not only maintain good clinical standards but I am also able to find new depth and joy in my practice.