Abstract

Scientific research has established that disposable EEG electrodes play a crucial role in reducing cross-contamination and healthcare-associated infections (HAIs) in electroencephalography procedures. Multiple peer-reviewed studies have demonstrated that reusable EEG electrodes pose a significant risk of infection, with contamination rates as high as 25% even after proper cleaning protocols are followed. The evidence supports the adoption of single-use electrodes as an effective strategy for infection control.

Key Contamination Research Findings

Multicenter Contamination Studies

A landmark multicenter study published in the American Journal of Infection Control examined cleaned, ready-to-use reusable EEG cup electrodes from four epilepsy monitoring units across the United States.¹ The study revealed significant findings:

• 25% of cleaned reusable EEG electrodes tested positive for bacterial cultures (range: 13.3%-43.3% across different sites)¹
• Of the bacteria identified, 88-90% were classified as having potential for or being at risk of causing healthcare-associated infections¹
• Bacterial species included Staphylococcus epidermidis (38.7%), Micrococcus species (22.6%), and other pathogenic organisms¹
• 6% of cleaned electrodes harbored bacteria classified as potential risk or at risk for infection¹

Cost-Effectiveness Analysis

A comprehensive economic evaluation using data from 73,834 patients found significant findings regarding infection rates and costs:²

• Sepsis incidence was 33 cases per 100,000 EEG procedures when using reusable electrodes²
• The average cost of treating sepsis was $33,718 per patient²
• Single-use EEG electrodes demonstrated cost-effectiveness compared to reusable electrodes when infection costs were factored in²
• Total cost per procedure with reusable electrodes (including cleaning and infection risk) was $19.95 compared to $18.50 for disposables²

Regulatory Classification and Requirements

Semi-Critical Device Status

EEG electrodes are classified as semi-critical medical devices by the CDC and FDA because they:

• Contact abraded or non-intact skin during application³⁴
• Require the highest level of disinfection (high-level disinfection or sterilization) between uses³⁴
• Fall under the same classification as bronchoscopes and colonoscopes³

Infection Control Guidelines

Multiple professional organizations have established guidelines supporting disposable electrode use:

• American Clinical Neurophysiology Society (ACNS) recommends that "disposable electrodes may be considered as another option for reducing the risk of iatrogenic infections"⁵
• ACNS Consensus Statement specifically states that "disposable single-use electrodes should be considered, especially for patients with scalp wounds or recent neurosurgical procedures"⁶
• Guidelines emphasize that electrodes "must be disinfected with appropriate procedures" after use on patients with contagious diseases⁵

Cleaning Practice Variability

Standardization Challenges

Research has documented significant variability in cleaning practices across healthcare facilities:¹

• Lack of standardized cleaning protocols across different institutions
• Prolonged drying time (>5 minutes) was associated with 71% higher odds of positive bacterial cultures¹
• Microorganisms were found on cleaned electrodes from all four hospital centers despite varying cleaning practices¹
• Some cleaning practices were associated with higher contamination rates¹

Cleaning Effectiveness Limitations

Studies have shown that even rigorous cleaning protocols may be insufficient:

• High-level disinfection does not guarantee complete decontamination¹
• Bacterial contamination persists despite compliance with established cleaning guidelines¹
• Environmental factors and human variability in cleaning execution contribute to inconsistent results¹

Historical Infection Outbreaks

Hepatitis B Outbreak Case Study

A major hepatitis B outbreak in Toronto EEG clinics provides stark evidence of infection risks with reusable electrodes:⁷

• 75 patients developed hepatitis B between 1991-1996, all associated with reusable subdermal EEG electrodes⁷
• Peak infection rate reached 18.2 cases per 1,000 EEG procedures in 1995⁷
• No cases occurred among patients who used only disk electrodes for sleep studies⁷
• The outbreak was attributed to inadequate infection control practices and a contaminated technician⁷

Economic and Practical Considerations

True Cost Analysis

When accounting for all associated costs, disposable electrodes demonstrate economic advantages:

• Reprocessing costs for reusable electrodes: $5.57 per procedure for labor and materials²
• Acquisition costs for reusable electrodes: $3.25 per procedure (based on 82 reuses per electrode set)²
• Infection treatment costs significantly exceed electrode costs when HAIs occur²

Workflow Benefits

Healthcare facilities report operational advantages with disposables:

• Elimination of complex cleaning protocols required for semi-critical devices³
• Reduced risk management concerns related to infection control compliance
• Simplified procedures in clinical settings

Professional Recommendations

Evidence-Based Guidelines

Multiple studies conclude with strong recommendations for disposable electrode adoption:

• "Use of single-use electrodes and research on scalp infection and infection reduction interventions are warranted"¹
• "Single-use electrodes may be a safe and cost-effective option for hospitals, reducing the risk of patient cross-contamination"
• "Alternatively, single-use EEG electrodes may be considered to minimize the potential risk of patient-to-patient cross-contamination"

Risk Assessment Framework

The scientific literature supports a risk-based approach to electrode selection:

• High-risk patients (immunocompromised, surgical patients) should receive disposable electrodes⁶
• Extended monitoring situations may benefit from disposables due to increased exposure time
• Resource-limited settings should consider the total cost of ownership including infection risks²

Conclusion

The scientific evidence overwhelmingly supports the role of disposable EEG electrodes in reducing cross-contamination and healthcare-associated infections. With contamination rates of 25% in cleaned reusable electrodes, significant cleaning practice variability, documented infection outbreaks, and favorable cost-effectiveness profiles, disposable electrodes represent an evidence-based solution for infection control in neurophysiology. The literature demonstrates that the adoption of single-use EEG electrodes can eliminate patient-to-patient cross-contamination risk while potentially reducing overall healthcare costs when infection prevention benefits are considered.

The transition toward disposable electrodes is supported by regulatory guidelines, professional society recommendations, and growing clinical adoption driven by infection control priorities. As healthcare systems continue to prioritize patient safety and infection prevention, disposable EEG electrodes offer a scientifically validated approach to reducing one potential source of healthcare-associated infections.

References

1. Albert NM, Bena JF, Ciudad C, et al. Contamination of reusable electroencephalography electrodes: A multicenter study. Am J Infect Control. 2018;46(12):1360-1364. doi:10.1016/j.ajic.2018.05.021
2. Sohrt A, Mærkedahl A, Padula WV. Cost-effectiveness analysis of single-use EEG cup electrodes compared with reusable EEG cup electrodes. Pharmacoecon Open. 2018;3(2):265-272. doi:10.1007/s41669-018-0090-3
3. Scott NK. Infection prevention: 2013 review and update for neurodiagnostic technologists. Neurodiagn J. 2013;53(4):271-288.
4. Rutala WA, Weber DJ, Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for disinfection and sterilization in healthcare facilities, 2008. Centers for Disease Control and Prevention; 2008.
5. American Clinical Neurophysiology Society. Guideline 1: Minimum technical requirements for performing clinical electroencephalography. J Clin Neurophysiol. 2016;33(4):303-307.
6. Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part II: personnel, technical specifications and clinical practice. J Clin Neurophysiol. 2015;32(2):96-108. doi:10.1097/WNP.0000000000000165
7. Allard R, et al. An outbreak of hepatitis B associated with reusable subdermal electroencephalogram electrodes. CMAJ. 2000;162(8):1127-1131.]