LabNotes - Volume 13, No.2, Spring 2003

Plastic Collection Tubes Decrease Risk of Employee Injury

Although plastic collection tubes have been available for over ten years, laboratories have been slow to convert usage from glass to plastic for many reasons. Regardless of the barriers to plastic tube conversion, some labs have overcome them all for only one overriding reason: employee safety.

• A clinical laboratory worker took the stopper off a lavender-top tube for CBC testing. He didn't realize that the tube was cracked. When he removed the stopper, the broken glass cut his left thumb.
• A laboratorian sat down at his bench and was preparing to enter information into the computer on specimens that had just come into the lab for testing. When he rested his hands on the desktop, he felt something sharp in the palm of his hand; a shard of bloody glass had pierced his palm.
• As a phlebotomist was filling a glass blood collection tube, the tube broke in her hands. Startled, she accidentally stuck herself with the needle that she had just removed from an AIDS-infected patient. Nine months later, she tested positive for HIV. Her health deteriorated rapidly, and she died several years later.

Each of these exposures might have been prevented had the healthcare worker handled collection tubes made from plastic instead of glass. With the current focus on safety needles, exposure to glass sharps has not been getting as much attention as some argue it deserves. Though not as prevalent as accidental needlesticks, cuts from contaminated glass pose just as great a risk of transmitting hepatitis, HIV and other infectious diseases and are just as preventable.

The barriers to universal use include economics, complacency, and the resistance to change, but many experts believe that industry-wide conversion is inevitable. More clinical evidence is becoming available every day that supports this move from glass to plastic tubes. Medical professionals are beginning to realize the serious threat posed by broken glass tubes and that there are solutions, namely plastic tubes, to address this threat.

EPINet™, the nationwide exposure surveillance system at the University of Virginia's International Healthcare Worker Safety Center, has recorded 48 exposures to broken glass from blood specimen containers since it started monitoring exposures in 1995.¹ Of those, 32 occurred in clinical laboratories. This figure, however, does not take into account the number of unreported exposure incidents. If laboratorians are as negligent about reporting broken glass exposures as they are accidental needlesticks - up to 97 percent underreporting according to one study - the actual frequency of broken glass exposure would appear alarmingly high.

Janine Jagger, MPH, PhD, the director of the International Health Care Worker Safety Center at the University of Virginia School of Medicine, argues that managers should implement the use of products that minimize the risk of broken-glass exposures as often as possible.

"There should be plastic substitution for all glass items for which plastic substitution is possible. The top priority should be directed toward glass specimen containers and glass equipment that contain or make contact with body fluids or tissue specimens," she said.

Jagger identifies glass specimen collection tubes, capillary tubes, pipettes, and glass slides as top candidates for substitution, but she recognizes that not all glass can be eliminated. "If there are specific circumstances under which plastic cannot be used, they need to be described, justified, and kept to an absolute minimum," she said. "The language put forth by OSHA in the Federal Register on January 18, 2001, relating to the new law explicitly includes glass devices in their definition of contaminated sharps."

Jagger is referring to the Needle-stick Safety and Prevention Act signed into law to modify the OSHA Blood-borne Pathogen Standard to mandate the use of devices that protect against exposure to contaminated sharps.

Barriers to Industry-Wide Conversion

Although plastic collection tubes have been available for more than ten years, they aren't widely used. Manufacturers and industry experts point to a multitude of factors that have kept facilities from converting. One of these is the necessity for parallel studies to assure that results will not be compromised. NCCLS has published guidelines that clearly define the requirements for such studies. Yet, many laboratories balk at the prospect of having to design studies, test specimens in parallel, record raw data, and evaluate the results.

Industry experts suggest that the transition can be simplified when incorporated with other laboratory transitions. For example, if a laboratory is converting to new instrumentation, incorporate tube conversions with that change.

Another obstacle is the perception that plastic tubes are more expensive than glass. However, plastic tubes are only marginally more expensive to produce than their glass counterparts, and the cost of safer tubes should not be considered alone. Shatter-resistant plastic blood collection tubes weigh less than glass and can be more efficiently incinerated, thereby decreasing medical waste expense. Therefore, when you calculate in the reduction of the weight of a facility's biohazardous waste, plastic tubes cost significantly less to use overall.

The potential savings increase further when managers consider the costs associated with an accidental exposure to a contaminated sharp. One study reports that the cost of treating an employee infected with HIV while he/she is performing routine procedures can exceed $500,000.² The immediate cost to treat a percutaneous exposure has been estimated to be up to $4,000, including testing both patient and worker and administering HIV prophylaxis.³ If the exposure results in an acquired disease, the cost skyrockets. In the case of hepatitis, a liver transplant can cost an employer $150,000 or more; the average lawsuit for occupationally acquired HIV settles for $2 million to $5 million. Armed with these estimates, managers and healthcare professionals can build a convincing case for converting to shatter-resistant plastic collection tubes.

As pervasive as these barriers are in the industry, Dr. Jagger sees them falling away.

"Plastic substitution, especially for blood collection tubes and capillary tubes, got off to a slow start but is picking up steam. Each product category requires a focused initiative. Initial industry efforts were directed toward needles. But the focus on glass has recently increased. The Joint Safety Advisory on the risks of glass capillary tubes issued by the FDA, NIOSH, CDC, and OSHA in February 1999 provided tremendous momentum in the transition away from glass capillary tubes. Glass is on the way out but everyone including manufacturers, purchasers and users need to push to complete this transition as quickly as possible."

Reprinted in part from Medical Laboratory Observer, May 2001. Copyright© by Nelson Publishing Inc. www.mlo-online.com

1. Exposure Prevention Information Network (EPINet Summary report for needlestick and sharp object exposure), International Health Care Worker Safety Center, University of Virginia, Charlottesville, NC 1990-1998.
2. Stock S., Universal precautions to prevent HIV transmission to healthcare workers: an economic analysis. Can Med Asso J 1990; 142(9): 932-946.
3. Pallatroni L. Needlesticks: Who pays the price when costs are cut on safety? MLO, 1998; 30(7): 30-35.

Further Information about BD Products and Services:

• BD Vacutainer Blood Collection Tubes
• Healthcare Worker Safety
• EPINet (The Exposure Prevention Information Netwrok)

EPINet is a trademark of the University of Virginia

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