Most epilepsy monitoring units today still use reusable electroencephalography (EEG) cup electrodes. Since they can be cleaned between each patient use, the thinking is that they are safe and more economical than single use electrodes. Evidence is growing, however, that reusables can harbor dangerous bacteria even after they are cleaned, and they may not save hospitals money in the long run.

EEG cup electrodes are considered semi-critical devices because the skin on the scalp is abraded before they are placed. This process inherently introduces some risk of infection and requires great care when using them. This fact is well known among neurodiagnostic technologists and even led ASET the Neurodiagnostic Society to establish a Skin Safety Task Force.

Skin safety and the related issue of hospital acquired infections are big concerns for technologists, hospitals, and patients alike. The added care required in these cases adds to the cost of reusables. When the cost of treating sepsis was factored in, a 2018 study published in the journal Pharmacoeconomics found that single use EEG cup electrodes may be associated with overall hospital savings.

Costs aside, in addition to the suffering patients may experience from minor infections, sequelae like sepsis can be catastrophic.

That is why Clinical Nurse Specialist, Nancy M. Albert, Phd from the Cleveland Clinic and her team swabbed 124 reusable EEG cup electrodes from four separate epilepsy monitoring units across the country. They were looking to see if the electrodes, which had been used but were cleaned and stored according to each center’s protocol, showed signs of bacterial growth.

Their conclusion was published in the December 2018 issue of the American Journal of Infection Control: “Twenty five percent of cleaned, reusable EEG cup electrodes and lead wires had bacterial growth.” The bacteria found included species of staphylococcus and micrococcus that were labeled at-risk and potential-risk for hospital acquired infections.

This led Albert to dive further into the data, looking more closely at the specific cleaning protocols used in the study. She and her team wanted to find out if there were specific factors more likely to result in bacterial growth. The results of this secondary study were published this year (2019) in the Neurodiagnostic Journal.

The most outstanding finding was the large amount of variability in cleaning protocols between each of the four epilepsy centers.The researchers did find that certain cleaning practices were associated with higher rates of bacterial growth.

In total, they identified nine cleaning factors. They are listed below:

  • Transportation time (from the patient to the cleaning area)
  • Wait time pre-cleaning
  • Pre-cleaning storage (covered or not covered)
  • Disinfection time
  • Cleaning time
  • Bundled or unbundled cleaning
  • Towel or air dried
  • Drying time
  • Post-cleaning storage (covered or not covered)

Of these, three factors tended to result in higher levels of positive cultures:

  • longer (air) drying times,
  • shorter pre-cleaning wait times, and
  • unbundled cleaning.

Albert and her team hypothesized that not being rushed to clean electrodes, more thoroughly washing electrodes in sets rather than singly, and towel drying, are practices probably worth adopting. Further they concluded, “For sites that clean EEG electrodes quickly due to the need to reuse, it might be prudent to switch to disposable electrodes.”

Certainly for centers that continue using reusable EEG electrodes, an audit and improvement (if needed) of their current cleaning practices should be undertaken. Of course, the establishment of a universally adopted, evidence-based cleaning protocol would be the ideal solution. Until that happens, however, single-use EEG electrodes offer a way to eliminate flawed cleaning processes entirely. Factor in patient safety and comfort, and it could be well worth the higher cost.

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