Addendum: Safety Standards for Gua sha (press-stroking) and Ba guan (cupping)

Our previous article Safety Standards for Gua sha (press-stroking) and Baguan (cupping) discussed the risk of transfer of blood-borne pathogens with Gua sha and Ba guan, identified Gua sha and Ba guan 'instrument criticality' as semi-critical and offered recommendations for safe practice based on hospital disinfection standards. Based on the article's feedback, we feet the need to clarify that Gua sha and Ba guan instruments, if intended for reuse, must undergo high level disinfection (HLD) or, in the case of 'wet-cupping', sterilization. We update our recommendations to be amenable to both private practice and education settings. (C) 2014 Elsevier Ltd. All rights reserved.