[Question #84] Dr. Handsfiled, please help!

39 months ago
Dear Dr. Handsfield,

I'm from Hong Kong. I have a 4 year old son who had a blood draw today at a local reputable lab, the process went smoothly. However, afterwards I noticed that the blood tube holder was reusable and the nurse told me the holder was indeed used on multiple patients, but she said there was no risk at all and I shouldn't be worried. The needle and plastic blood collecting tubes were new and disposable. I called my family physician but she was not worried. 

However I am very concerned after googling online. I found out that OSHA has banned the reusable tube holders in the US due to its associated risks. So does this mean that there is some risk that my son might get some blood borne disease from this reusable tube holder ? (For example that some old blood from the previous patient on the holder flowed back to my son's blood vein? ) Were tube holders ever re-usable in the US before the ban, and if so, was there any case of infection due to the multiple use of tube holders? Basically is there any risk in this case both theoretically and practically? 

I would be very grateful if you could give me your professional opinions. I am a super worried and anxious mother right now. I regretted very much that I did not spot this before the blood draw and asked for a new holder. 

Thank you very much,
Susan 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Welcome to the forum. Thanks for your question.

You needn't worry. Your child's doctor and the blood draw technician are correct. OSHA's position is hyper-conservative, and to my knowledge there has never been a reported case of HIV (or any other blood borne infection) from use of such devices. (Probably there has been no such case of HIV from blood drawing anywhere in the world in the past 20 years, since needles ceased to be re-used.) I wouldn't be at all afraid to re-use such tube holders on myself or my family members. And certainly the Hong Kong public health authorities would not permit use of a device they considered unsafe.

So I see no need for you to be concerned or to reget not spotting the technique ahead of time. You needn't worry, and you should have have your child tested for HIV or other infections on account of this event.

I hope this has helped ease your fears. Best wishes--    HHH, MD



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39 months ago
Dear Dr. Handsfield,

Thank you so much for answering my questions, I feel a lot relieved now. 

It was probably just a typo, but just to clarify you mean that I should NOT have my son tested for any blood borne diseases on account of this event, right? 

Also, was there ever a time that such reusable holders were actually used in the US? 

Thanks a lot for your time!
Susan 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
39 months ago
Yes, a typo -- thanks for understanding and correctly interpreting it. Your son definitely does not need any testing on account of this event.

Reusable holders were used almost exclusively in the US from the time the Vaccutainer company first introduced them (in the early 1970s, as a guess) until several years ago. To my knowledge, they were never known to be responsible for transmission of any blood borne infection.

Best wishes and take care--

HHH, MD



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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
There is another thing you might find useful to know. Sorry I didn't think of it earlier.

There is a reason that it is OSHA (the federal Occupational Health and Safety Administration) is behind the guidelines that did away with multiple use blood draw devices. It was to reduce health workers' exposure to patients' blood. It had nothing to do with safety for patients.
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38 months ago
Dear Dr. Handsfield,

Thank you so much for taking your time to answer my questions and explain in detail. I really appreciate your professional advice. I feel totally relieved now. 

Best Wishes,
Susan 
38 months ago
Dear Dr. Handsfield,

I have one more question if you don't mind, I am not sure whether I need to open a new thread for this, please let me know if i should. 

My family physician ordered a routine blood test for my son recently, which was the one we have discussed about. Everything came back normal, but apparently the doctor checked for my son's hepatitis B antigen and antibody as well. Since Hepatitis B is very common in Asia, the doctor wants to make sure my son has developed an antibody after his 3 doses of vaccine during the first year. Apparently, his blood test shows negative Hep B surface Ag, Negative Hep B Core Ab, and Negative Hep B Surface Antibody as well. I am confused. Is it common for kids not to develop immunity after 3 doses of vaccination? His doctor suggested to have 3 more doses of vaccinations within the next 4 months? What is the chance that he would develop immunity by then? Also, my father has chronic hepatitis B. In this case, is there anything we should be especially careful of so that my son won't get it from my father?

Thank you very much, Dr. Handsfield! 

Best,
Susan 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
38 months ago
Somewhere around 10% of people immunized against hepatitis B do not develop measurable antibody as a result. (The only test that should be done is Hep B surface antibody, i.e. HBsAb. That's the only antibody that appears after immunization. For any future testing, make sure your doctor isn't ordering more tests than necessary, at extra cost.) However, even when HBsAb remains negative, people probably are protected against hepatitis B. I'm not an expert in hepaptis B vaccination, but I don't see why your son needs three more doses. I think most experts would recommend a single additional dose a few months after the last, and maybe another dose after that. Discuss it with your child's doctor, or perhaps ask for referral to an infectious diseases or liver disease expert.

But no matter what, your child will not catch hep B fromn his father, even if he is infected. Young children can acquire it from their mothers in the uterus or during delivery, but they don't catch it from their fathers unless there is sexual abuse. Your son probably will not be at risk for hepatitis B at all until he becomes sexually active many years in the future. So there's no hurry in assuring he has been properly immunized.

This will have to end this thread. If you have further questions about hepatitis B immunization, please do not ask on this forum. It's not a usual topic for an STI/HIV forum, and none of the moderators are genuine experts in this area. 

Best wishes to you and your growing family!
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