Hands should be washed, with soap and water and disinfected before and after DN, especially if blood contact is made.

The use of sterile disposable gloves to prevent infection is recommended.

If coughing or sneezing the practitioner must use their elbow to cover their mouth, as opposed to their hands to avoid transmission of infection [21].

Only use needles within their expiration date, dispose of those needles that have past their expiry date.

Do not contact the needle on any part other than the shaft, to maintain sterility [21].

Skin must be disinfected prior to DN.

Ensure that the needle is well handled and that the direction, depth and choice of needle size and length is given due consideration prior to inserting the needle. Avoid vulnerable anatomy.

On completion, the DN must be disposed of into a medical sharps bin, along with any material that contains blood. Avoid putting the needle back into its packaging. Medical waste must be disposed of accordingly.

Avoid using any medical device in the area where DN was applied that has not been disinfected to prevent the spread of infection [21].

In the instance of a needle stick injury occurring the area must immediately be washed with warm water and soap and disinfected with 70% alcohol. The patient and/or clinician should be tested for HIV/AIDS, Hepatitis B and C, if the status is not already known. Refer to an A + E department for PEP if necessary.

The chiropractor should be appraised of his/her own health status to prevent the transmission of infection to the patient. Relevant vaccinations should be current.