Used to be there was one thing you could nearly always find in the pocket of a neurodiagnostic technologist: a tape measure, likely the retractable type. This tool, so essential to EEG electrode placement, would always be at the ready.

Sometimes, a tech would even keep the retractable reel in her pocket and stretch out the tape to conveniently and quickly take each measurement. The coronavirus pandemic is changing that — but that’s a good thing.

A couple of months ago (pre COVID-19) we posted an article about the latest infection control guidelines published by ASET-The Neurodiagnostic Society. In it we mentioned a few surprising new recommendations, and one of them was that technologists stop using retractable measuring tapes.

Measuring tapes, along with other items such as blood pressure cuffs, combs, finger pulse oximeters, and china markers fall into a category called “non-critical patient care items.” These are items that come into contact with intact skin but not mucus membranes. Each requires low-level disinfection after patient use, according to the Centers for Disease Control (CDC).

The Joint Commission is paying more and more attention to patient care items that are considered non-critical, co-author Anna M. Bonner told us when ASET’s updated guidelines were first released. This, she added, is well explained in a 2019 paper called “Surviving a Joint Commission Visit in the Neurodiagnostic Department.”

The authors of that paper write that infection prevention “has been the most frequently cited TJC [The Joint Commission] standard in hospitals for the past several years.” Prior to a TJC visit, nurses in their own infection control department voiced concern over retractable tape measures used in the labs – if retracted after use, the tape is recontaminated, with no way to disinfect the inner case.

The authors recommend switching to single-use tape measures whenever possible.

Passing a Joint Commission inspection was at that time one of the biggest motivators for departments to up their infection control game. Today, the COVID-19 pandemic has eclipsed old concerns like this, and people are still talking about those retractable tape measures. In ASET’s COVID-19 and ND Testing Webinar, released in April, presenters from the Yale New Haven Hospital brought up the subject.

“If you are using a tape measure, it should not be one of the retractable ones. Just use a disposable one,” said Dr. Lawrence Hirsch, a neurologist.

“If you don’t have access to a disposable tape measure and you are using a retractable, best practice would be to extend it all the way and actually cut off the retractable reel portion,” added Rebecca Khozein, ABRET president and clinical coordinator. “It is easier for cleaning if you are having to reuse things.”

Cleaning any reusable tape measure (one that has been clipped off its retractable reel or one that came that way) requires low-level disinfection. All non-critical patient care items do, according to the CDC: “Most non-critical reusable items may be decontaminated where they are used and do not need to be transported to a central processing area.”

They should be cleaned with an EPA-registered disinfectant (sprayed or wiped down). Most labels for these kinds of products require 10 minutes of contact time, but the CDC writes that multiple investigators have demonstrated the effectiveness of these disinfectants against viruses “at exposure times of 30–60 seconds.”

In ASET’s webinar, Dr. Hirsch says you can further improve safety by adjusting how much a tape measure is actually used when working with COVID-19 patients. This is one way to reduce the amount of time (and thus the technologist’s exposure time to the virus) that it takes to set up a patient for EEG testing.

“You could cut down on measurements, either not do them all or only measure for a few key spots and the rest estimate,” he said.

“Any adjustments made because of COVID limitations should be notated,” Hirsch added. “Be aware of all the limitations, but the benefit might be worth it in this crisis.”

Breaking old habits can be hard, but in times like these chucking a few retractable reels should be well worth it.