While most conventional blood tube holders can be reused multiple times, to best control worker exposure to blood, most health care facilities discard the entire device, with needle attached, after each use. As health care safety research indicates, needlestick injuries after blood draws are most likely to occur while removing the blood-drawing needle from the patient's arm or while disposing of an unprotected needle into a sharps container. Because the reuse of tube holders requires the removal of used needles, exposing health care workers to contaminated, unsafe, back-end needles, workers have been urged not to reuse holders.

The Occupational Safety and Health Administration’s (OSHA) requirements for preventing needlestick injuries are provided in the Bloodborne Pathogens Standard (29 CFR 1910.1030) and OSHA Instruction CPL 2-2.69. OSHA requires that employers evaluate, select and use appropriate engineering controls, including:

• Use sharps with engineered sharps injury protection (SESIP) that includes single-use blood tube holders attached.
• Dispose of blood tube holders with contaminated needles attached after the activation of the safety feature.
• Use engineering and work practice controls that provide the highest degree of safety to eliminate potential injuries after performing blood draws. Dispose of blood tube holders with contaminated needles attached after the activation of the safety feature.
• In very rare situations, needle removal is acceptable if it can be demonstrated that no feasible alternative to needle removal is available (e.g., inability to purchase single-use blood tube holders due to a supply shortage of these devices), or the removal is necessary for a specific medical or dental procedure. In these rare cases, the employer must ensure that the contaminated needle is protected by a SESIP prior to disposal. In addition, the employer must ensure that a proper sharps disposal container is located in the immediate area of sharps use and is easily accessible to employees.
• Many sharps containers are designed with openings that do not allow for disposal of a SESIP that is attached to the blood tube holder. These containers would not be in compliance with the bloodborne pathogens standard. Employers must ensure that, where blood is being drawn, the sharps container is appropriate for immediate disposal of sharps.
• If it is necessary to draw blood with a syringe, a SESIP syringe must be used and the protected needle removed using safe work practices. Transfer of blood from the syringe to the tube must be done using a needleless blood transfer device.

The Bloodborne Pathogens Standard (29 CFR 1910.1030) and OSHA Instruction CPL 2-2.69, require immediate disposal into a sharps container of the entire blood tube holder unit with needle attached, after activation of the safety feature. The standard provides:

"Contaminated needles and other contaminated sharps shall not be bent, recapped or removed, unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical or dental procedure."

More specifically, the CPL states that:

"Removing the needle from a used blood-drawing/phlebotomy device is rarely, if ever, required by a medical procedure. Because such devices involve the use of a double-ended needle, such removal clearly exposes employees to additional risk."

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