Feds warn against glass capillary tubes
New safety alert to protect health care workers
Glass capillary tubes used to collect blood in health care settings can break during sealing and centrifugation, potentially exposing health care workers to risk of infection with bloodborne pathogens, several federal agencies warn.1
A joint safety alert issued by the Food and Drug Administration (FDA), the Occupational Safety and Health Administration (OSHA), and the National Institute for Occupational Safety and Health (NIOSH) notes that glass capillary tubes are used in various health care settings, including hospitals. (See a copy of the safety advisory, pp. 54-55.)
Accidental breakage of the slender, fragile tubes has been reported both during centrifugation and when the tubes are inserted into putty to be sealed. Tubes that break during centrifugation can expose workers via blood spatters and penetrating glass fragments. In one case when a tube broke during putty insertion, a physician was cut by broken glass and exposed to HIV-infected blood. He subsequently seroconverted from the injury and died of AIDS.2
The safety alert marks the second warning about sharps that could transmit bloodborne pathogens to HCWs. The first, issued in 1992, warned against the practice of using needles to access intravenous lines. The FDA has been under fire in the intervening years to issue additional alerts. All three federal agencies signing onto the joint advisory are taking action this year to comply with a federal directive to reduce potentially deadly sharps injuries among HCWs. (See Hospital Employee Health, March 1999, pp. 25-28.)
"At one acute-care facility, the injury rate associated with glass capillary tubes was 2.6 per 100,000 tubes purchased in 1992. Approximately 108 million glass capillary tubes are sold each year in the United States, suggesting that approximately 2,800 injuries may occur nationwide if a similar injury rate occurs at other health care facilities," the warning states.
Some injuries from the tubes have caused blood exposures requiring prophylactic postexposure antiretroviral therapy, the advisory adds.
To reduce injury risks, the agencies recommend that hospitals use blood collection devices "less prone to accidental breakage," including:
• capillary tubes not made of glass;
• glass capillary tubes wrapped in puncture-resistant film;
• products that use a sealing method that does not require manually pushing one end of the tube into putty to form a plug;
• products that allow the blood hematocrit to be measured without centrifugation.
While the agencies do not recommend specific products, they state that devices with those characteristics are currently available on the market.
Occupational illnesses and injuries from capillary tubes may be recordable under OSHA’s record-keeping requirements. In a recent notice to field compliance officers, OSHA states that employers using capillary tubes may be cited under the bloodborne pathogens standard in certain circumstances, such as improper housekeeping (i.e., picking up broken, contaminated capillary tubes with the hands), improper handling of regulated waste (i.e., improperly disposing of contaminated tubes), or lack of personal protective equipment (i.e., not using gloves when handling contaminated capillary tubes).
References
1. Food and Drug Administration, Occupational Safety and Health Administration, National Institute for Occupa tional Safety and Health. "Glass Capillary Tubes: Joint Safety Advisory about Potential Risks." Washington, DC; February 1999.
2. Aoun H. When a house officer gets AIDS. N Engl J Med 1989; 321:693-696.
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