The world of neurodiagnostics got a rude awakening about infectious disease 30 years ago. That was when the largest outbreak of Hepatitis B in history was linked to 6 outpatient EEG clinics.

Since then, EEG labs and clinics have adopted more stringent infection control measures. It hasn’t been enough, though.

Researchers have continued to find contamination. The most recent example includes two papers by Albert et al., published in 2018 and 2019, that found 25 percent of cleaned, reusable EEG cup electrodes and lead wires had bacterial growth. And no two labs followed the same cleaning process.

“That was really alarming, because you would think that 30 years later we would be in a better position,” says Anna M. Bonner.

Bonner is a neurodiagnostic technologist and author of “Infection Prevention: 2020 Review and Update for Neurodiagnostic Technologists,” published in the Neurodiagnostic Journal.

This is the fifth iteration of infection control guidelines provided by ASET-The Neurodiagnostic Society in an effort to stem the tide of infection and disease transmission. The authors reviewed ASET’s past publications and incorporate new information from published scientific literature, online resources, print publications, national and international guidelines, the Occupational Safety and Health Administration, and other regulatory agencies.

We recently spoke with Bonner, who co-authored the paper with fellow neurodiagnostic technologist Petra Davidson, to understand some of the most recent changes. One of the biggest was the designation of reusable EEG electrodes as semi-critical items because the skin is abraded in preparation for electrode placement. Semi-critical items require a high level of disinfection, with 30 minutes of exposure to disinfectant depending on the FDA-cleared label claim.

The most surprising change, for many, is the increased attention recommended for non-critical patient care items. These include the following:

  • bedside tables
  • combs
  • hair clips
  • china markers
  • tape measures
  • rolls of skin tape
  • blood pressure cuffs
  • bed rails

“The joint commission is paying more and more attention to patient care items like tape,” says Bonner. “We never really thought about paper tape (used to secure electrodes) as being a source that could spread any sort of infection, but it can. And there’s no way to clean it really. There’s no way to disinfect it.”

As a solution, some labs are creating single-use packets that hold just enough tape, swabs, china marker, and paste for each patient.

Retractable tape measures are of particular concern: “If you retract that before disinfecting it, it’s considered contaminated and unusable. It’ll have to be thrown away,” Bonner says.

All of these non-critical patient items require a low level of disinfection, according to the new guidelines. This means up to 10 minutes of exposure to an EPA-registered disinfectant.

One final recommendation that Bonner says might surprise people has to do with the use of bleach. According to the article,

“Bleach is a strong and effective disinfectant – its active ingredient sodium hypochlorite is effective in killing bacteria, fungi, and viruses, including influenza virus – but it is easily inactivated by organic material.”

Bonner says this includes any kind of blood or skin cells, hair, or other organic material left on an electrode, so clean all reusable electrodes before disinfecting them.

The new ASET guidelines offer many more suggestions and best practices to decrease infection rates. The paper contains information on proper handwashing, use of gloves and gowns, and how to designate clean and dirty areas. It even has bleach solution recipes for different disinfecting levels. It’s an invaluable resource for individual technologists, labs, clinics, and neurodiagnostic schools.

The guidelines are currently available to ASET members and those subscribed to The Neurodiagnostic Journal. Bonner has hopes that it will eventually be even more widely available.

“Every laboratory, every patient care item, and every set of electrodes should be examined critically before use by the technologist,” she says.