Agencies cite infection risk of glass tubing
OSHA, FDA, NIOSH advise alternatives
In addition to its recent emphasis on needlestick prevention, the Occupational Safety and Health Administration (OSHA) has joined with two other federal agencies in issuing a warning about possible exposure to bloodborne pathogens through breakage of glass capillary tubes.
Alternative products are available and should be considered, OSHA recommended in issuing the joint advisory with the Food and Drug Administration (FDA) and the National Institute for Occupational Safety and Health (NIOSH). Glass capillary tubes are used for collection of blood in a variety of health care settings, including hospitals, ambulatory care facilities, physicians’ offices, blood donation facilities, and blood testing centers. Accidental breakage of these slender, fragile tubes has been reported when the tubes are inserted into putty to be sealed and during centrifugation.1 Breakage of the tubes during putty insertion may result in a penetrating wound and blood inoculation to the user. One such injury resulted in the transmission of HIV to a physician who later died of AIDS.2 Glass capillary tubes can break during centrifugation and cause blood to splatter, potentially exposing personnel to bloodborne pathogens. The broken glass fragments can injure the user, resulting in a percutaneous exposure to blood.
At one acute care facility, the injury rate associated with glass capillary tubes was 2.6 per 100,000 tubes purchased in 1992.3 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. Two systems for surveillance of hospital-based health care worker injuries have reported injuries from glass capillary tubes, some of which caused blood exposure and resulted in the need for postexposure prophylactic antiretroviral therapy.4
To reduce the risk of injury due to capillary tube breakage, FDA, NIOSH, and OSHA recommend that users consider blood collection devices less prone to accidental breakage, including:
• capillary tubes that are not made of glass;5
• glass capillary tubes wrapped in puncture-resistant film;
• products that use a method of sealing 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.
Although FDA, NIOSH, and OSHA cannot recommend specific products, blood-collection devices with these characteristics are currently available, and their use may reduce the risk of injury and blood exposure, the advisory states. Copies of the advisory are available on the Internet at www.osha-slc.gov/SLTC/needlestick/.
References
1. Jagger J, Hunt EH, Pearson RD. Sharp object injuries in the hospital; causes and strategies for prevention. Am J Infect Control 1990; 18:227-231.
2. Aoun H. When a house officer gets AIDS. N Engl J Med 1989; 321:693-696.
3. Jagger J, Bentley M, Perry J. Glass capillary tubes: eliminating an unnecessary risk to health care workers. Adv Exp Prev 1998; 3:49-55.
4. Jagger J, Deitchman S. Hazards of glass capillary tubes to health care workers. JAMA 1998; 380:31.
5. Hudson, M, Morgan-Capner P, Wilson M. Potential hazards with fine bore capillary tubes used by non-pathology staff. J Hosp Infect 1994; 528:323-324.
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