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Final word: Reuse of tube holders is prohibited
OSHA prevails in appeal of MetWest case
Those holdouts who still reuse blood tube holders, take notice: You are in violation of the Bloodborne Pathogen Standard and may be cited by the U.S. Occupational Safety and Health Administration.
Until recently, the reuse of blood tube holders was common practice at labs and hospitals. Phlebotomists released the used needles into disposal containers by pressing a button. But OSHA cautioned employers in 2003 that the practice needlessly creates the risk of a needlestick from the back end of the exposed needle.1
In December, the Occupational Safety and Health Review Commission upheld a citation for reuse of blood tube holders against MetWest, a subsidiary of the lab company Quest Diagnostics of Madison, NJ. MetWest argued that OSHA had once allowed the use of reusable blood tube holders and that its current enforcement was "inconsistent."2
However, when OSHA issued the standard, single-use holders were not available as they are now. The commission noted that the standard "plainly prohibits all contaminated needle removal except where the employer can demonstrate infeasibility or medical necessity."
"We have prevailed on this one and we're delighted," says Melody Sands, MS, director of OSHA's Office of Health Enforcement. "It does cost a bit more, but it prohibits an employee from being exposed to a potential hazard. That's a big win for OSHA."
Quest Diagnostics declined comment on the ruling.
Getting stuck by the back end
In 1999, a home health nurse removed the needle from a blood tube holder and moved toward the disposal container, which was located on top of the refrigerator to keep it out of reach of a small child in the home. As she carried it, the back end of the needle stuck her thumb. Weeks later, she learned she had contracted hepatitis C from the exposure.3
Julie Naunheim-Hipps became a vocal proponent for single-use blood tube holders. Even with a one-handed release, reusable blood tube holders are not safe, says Jane Perry, MA, director of communications for the International Health Care Worker Safety Center at the University of Virginia in Charlottesville, who wrote about Hipps' case in Advances in Exposure Prevention. Perry also testified in support of OSHA's enforcement action in the MetWest case.
The safety center maintains EPINet, a multihospital database of sharps exposures. "We did find [other] reports of injuries from the back end of needles that were removed from the blood tube holders," she says.
Although it may seem safe to simply push a release button while holding the device above a sharps container, after numerous uses, the needle may not release properly, says Sands. "Naturally, the phlebotomist is going to reach over and pull it out with their other hand," she says. "That is an unreasonable risk. It is not medically necessary to do that."
The review commission ruling settles the issue, says Perry. "OSHA not only issued a safety health and information bulletin sheet in 2003, but has now litigated this successfully against one of the major laboratory companies and its position has been upheld. There's no more wiggle room. It's clear that blood tube holders cannot be reused," she says.
It's not clear how many employers have already switched to the single-use blood tube holders. The large lab companies had balked at the additional cost of single-use holders.
"This is an all-too-common practice," says Bill Borwegen, MPH, safety and health director with the Service Employees International Union in Washington, DC. "This is a significant cause of needlestick injuries with some of the most dangerous needles blood-filled needles used in phlebotomy."
Multiuse blood tube holders shouldn't even be commercially available, he says. "We call upon companies that make reusable blood tube holders to stop making them so there's no temptation for employers to continue this illegal practice," he says.
1. U.S. Occupational Safety and Health Administration. Disposal of contaminated needles and blood tube holders used for phlebotomy. Safety and Health Information Bulletin; Oct. 15, 2003. Available at www.osha.gov/dts/shib/shib101503.html. Accessed on Jan. 20, 2008.
2. Perry J. When home is where the risk is. Advances in Exposure Prevention 2000; 5:25-33.
3. Secretary of Labor v. MetWest Inc. Occupational Safety and Health Review Commission Docket No. 04-0594. Issued Dec. 17, 2007.