For years the call has been slowly building in EEG labs across the country to replace reusable EEG cup electrodes with the single-use variety. COVID-19 just gave that trend a huge shove.

In response to the novel coronavirus pandemic, the American Clinical Neurophysiology Society (ACNS) released updated EEG guidelines stating that disposable electrodes “should be utilized whenever possible.” This was backed up in a paper about performing neurodiagnostic studies on patients with COVID-19, published in May in The Neurodiagnostic Journal.

And this same recommendation came up again in a COVID-19 webinar released by ASET – The Neurodiagnostic Society.

“By and large we recommend the use of disposable electrodes if and wherever possible,” said Rebecca Khozein, president of ABRET (the nonprofit credentialing board for EEG techs) and clinical program director in neurophysiology at Yale New Haven Hospital.

The reasoning behind the recommendation is the same as it was pre-COVID: using single-use EEG cup electrodes reduces the risk of infection. Recent evidence for this came in two papers published in 2018 and 2019 in which the authors found that 25 percent of cleaned, reusable EEG cup electrodes and lead wires had bacterial growth. They also found an alarming inconsistency in cleaning methodology between labs.

This is not to say that reusable EEG cup electrodes can’t be used anymore, they just need to be cleaned well. According to the updated ACNS guidelines released in March, if disposable electrodes are not available, “then consider soaking electrodes in a disinfecting solution for a minimum of 1 minute. Although not specific for EEG electrodes, [the U.S. Centers for Disease Control and Prevention] recommends 70 percent isopropyl alcohol or dilute bleach solution for disinfection of solid surfaces.”

It is important to note here that single-use cup electrodes cannot be cleaned and used again like those designed to be reused. Reusables are made of metal and coated with gold, while single-use electrodes are molded out of plastic and coated with silver/silver chloride.

“If you clean the single-use electrodes, you will wash off the coating and there will be degradation of the signal. You are not supposed to even rinse them,” says Brett Alpaugh, senior marketing manager for neurology products at Ambu Inc.

The deadly and highly contagious nature of COVID-19 has added a new level of complexity to considering all risk factors when using any kind of reusable product. For this reason, many EEG labs are making the switch to single-use items.

“Up until this time there were a lot of labs that still used reusable electrodes. Now they all want disposable electrodes,” said ASET President Connie Kubiak in a recent phone interview.

The question for Ambu and other single-use cup electrode providers: Will they be able to meet that demand? Alpaugh says “absolutely.”

“We were the first company to come out with single-use cup electrodes back in 2004. Two years ago, we saw a shift in the market with increased requests for them, so we built a machine that would automate and speed up the process of production,” he adds. “In the past few weeks we have seen a tremendous uptick in requests for single-use cup electrodes and still our capacity is significantly more than our production is now. We have the potential to ramp up as much as the demand.”