| Reusable equipment, such as electroencephalography (EEG) cup electrodes, may harbor bacteria that can lead to hospital-acquired infection (HAI) (including antibiotic-resistant HAI) because cleaned, ready-to-use EEG electrodes may be placed in critically ill or immunocompromised patients. The EEG procedure, which starts with abrasion of the skin to allow placement of EEG cup electrodes, may be a source of HAI. Insufficient cleaning of reusable EEG electrode surfaces, especially around the cup area that comes into contact with the abraded scalp skin surface, could expose patients to bacteria and microscopic epithelial cells or blood. Therefore, EEG electrodes are categorized as a semi-critical device that requires comprehensive reprocessing to prevent HAIs.1-3 Other investigators found bacterial growth on inanimate objects used in hospital and health care environments, such as electrocardiographic lead wires,4 ultrasound probes,5 bath basins,6 and blood pressure cuffs.7 Further, cleaning of EEG electrodes may not be simple because an EEG electrode set encompasses multiple lead wires and cup electrodes that may become entangled, and microscopic debris, including blood, may be hard to remove from EEG electrodes. Cleaning technique policies are not always standardized, and health care providers who complete disinfection procedures may not adhere to recommended policy expectations.8,9 In a consensus statement on continuous EEG monitoring in critically ill adults and children, authors created many recommendations specific to training personnel for monitoring of infection control. Themes included EEG electrode equipment monitoring, disinfecting equipment, applying scalp electrodes, monitoring of a patient’s scalp for evidence of skin breakdown or infection (during monitoring and after electrode removal), removing electrodes from nonintact skin, and highlevel disinfection and steam sterilization.10 However, consensus statement recommendations did not provide specific semi-critical (moderate-level) disinfection recommendations after removing EEG electrodes from noncritical patients.10 Bacterial HAIs are costly for the health care sector and Medicare11 and are burdensome for patients. Heightened quality of care and patient safety expectations have led to an increased interest in the role of cleaning surfaces and hands to manage HAI.12 Strict cleaning procedures and proper cleaning and disinfecting techniques are part of a multibarrier strategy to prevent HAIs.13,14 It is important to learn if bacteria, epithelial cells, and blood remain on cleaned reusable EEG electrodes. The primary purposes of this study were to examine if cleaned, ready-to-use EEG electrodes harbored bacteria and, if bacteria were present, to identify the bacterial species, risk for human infection, and prevalence of antibiotic resistance. Secondary purposes were (1) to examine the prevalence and load of epithelial cells and blood on cleaned, readyto-use EEG electrodes and (2) to determine if the presence of EEG electrode microbial growth was variable across 4 data collection sites. |
