More sleep labs are replacing reusable electrodes with one-time-use products in order to reduce infection risk. Here’s what to consider before making the switch.

By Sree Roy

If your sleep lab is considering switching from reusable to disposable electrodes this year, you are in good company.

Due primarily to a drive to reduce healthcare-associated infections (HAIs), as well as technological improvements in disposables, electrode manufacturers, distributors, and sleep lab employees note increased purchases of one-time-use-only electrodes.

“You cut down on the costs of cleaning products and have peace of mind that you will have no cross-contamination issues,” says Dana Burger-Dipzinski, who has noticed the trend toward disposables in her position as vice president of distributor ElectraMed Corp.

Improvements in Disposables

Leah Hanson, vice president of global sales at Rhythmlink International, has been fielding questions about disposable electrodes for years via Sleep Review’s online Expert Insight column (available at www.sleepreviewmag.com/expert-insight).

For years, Hanson would note that a disadvantage to disposable electrodes is they were not available in gold plating, only in silver (historically, gold was deemed too expensive for a one-time-use product), but that is no longer a limitation. “Gold disposable EEG electrodes are now available from select vendors, so this offers a nice options to folks who prefer that metal type,” Hanson says. “The only disadvantage will be the price….it is common [that] any gold metal product will be slightly higher priced than a silver-silver chloride simply due to the cost of that material to source. My recommendation is to perform good research and negotiate with all options in the market.”

Quality has also improved in recent years, and current disposable electrodes are comparable or identical in quality to reusable ones, Hanson says. But she encourages labs to compare electrodes head-to-head for themselves before switching types. “For instance, use reusables on the right and disposables on the left and compare directly. This is the most reliable way to compare quality of each lead type for your individual patient demographic and application style,” she says via Expert Insight. “This will answer the top priority question…does a disposable record as well as a reusable?”

Feature options too have vastly expanded; for example, today there are disposable electrodes available that are cleared for use in MRIs. Hanson says, “My recommendation is to first make a list of what you need in a disposable electrode, and I don’t simply mean a low price but also features. For instance, 1) what cable length do you need; 2) what ‘shape’ of electrode is best suited for your service as not everything is a cup shape and not all cups are the same shape; 3) any other features such as CT imaging capability or clearance for MRI.”

Finally, prices of disposables have also dropped—a key improvement since price has typically been the most compelling argument against switching to disposable electrodes.

Disposables’ Major Advantage Is No Cross-contamination

The Centers for Disease Control and Prevention (CDC) notes that HAIs are a “major, yet often preventable, threat to patient safety.”1 These infections, which can be spread via anything that has contact with more than one person, can decrease significantly when healthcare facilities, care teams, and individual doctors and nurses are aware of infection problems and take specific steps to prevent them.2

Hanson says, “Much of the HAIs are tied to bacteria being transferred via reusable electrodes, cables, etc, from one patient to another. Due to this potential source of contamination, risk management/infection control departments are evaluating use of any product that is reusable. And add in the fact that hospitals won’t always get reimbursed if a patient gets a HAI and that’s the reason for the push to eliminate the source of any potential contamination.”

A study published in 1997 used a forensic test to check EEG surface electrodes for blood after routine EEG recordings. (The recordings were performed at a teaching hospital by experienced technologists in compliance with standards set by the American EEG Society.) Seven out of 574 electrodes (1.2%) tested positive for the presence of blood, even though none of the positive electrodes had visible blood on the electrode or at the electrode site.3

To Calculate Cost Difference, Do a Full Analysis

For sleep labs considering a switch to disposables, the cost difference compared to reusables typically gives managers pause. To resolve this, a comprehensive cost analysis should be done. For some labs, the costs will be in favor of reusables; for others, disposables will, perhaps surprisingly, be the less expensive option overall.

“The direct cost of disposables versus reusables will no doubt show a cost savings to the reusable product,” Hanson explains. “But it’s not just the direct purchase cost that should be considered. Costs of additional inventory, chemicals for cleaning and disinfecting, and…even what seems to be a small amount of labor [costs, for cleaning and disinfecting reusable electrodes] can add up quickly. So, costs, historically, have leaned toward reusables, but now a service should run analysis and decide if that is true for their situations.”

Hanson continues, “The reusable electrode requires strict compliance with cleaning and disinfecting protocols to ensure the electrode is safe for repeat use across multiple patients. If the skin of the patient is abraded, meaning if you use a Q-Tip, for example, with Nuprep or any other prep that is designed to lightly abrade the skin, that electrode falls under the criteria of a ‘semi-critical’ item and requires specific disinfecting protocols.…And this can lead to higher labor costs to clean and disinfect a reusable electrode. Even if you have staff spending 20 minutes to clean and disinfect reusable electrodes—this is money and cost for the department or service that must be considered when a cost comparison is being done between reusables and disposables.”

Other aspects to consider in a cost analysis include: average life of current electrodes, cost for cleaning and disinfecting chemicals for current electrodes, number of electrodes used per procedure, number of procedures per year, cleaning and disinfection labor costs (salary and benefits for employees involved in cleaning protocols), and cost of storage room space.

You may also want to consider the warranty period on the lab’s current electrodes. Though many electrodes continue to function properly well after the warranty period, if they do fail after it expires, there may be little recourse but to buy new ones. A longer warranty provides more assurance that costs will be contained. ElectraMed’s Burger-Dipzinski advises sleep labs to read reusable electrodes’ cleaning instructions and warranty information thoroughly. “There are many sensors that cannot be submerged or you void your warranty,” she says. Burger-Dipzinski also says that when researching disposable electrodes, take note as to whether there are reusable components to the otherwise disposable electrode—which could negate some of the aforementioned advantages. “In some cases, there still is a reusable portion of the sensor that will need to be cleaned,” she says.

Whether your sleep lab favors disposables or reusables currently, it may be wise to regularly weigh the pros and cons of each option. Each year, improvements in both categories may shift the balance for your lab.

Sree Roy is editor of Sleep Review.

References

1. CDC. Healthcare-associated Infections. Available at www.cdc.gov/hai/surveillance/index.html.

2. CDC. Vital Signs: Central Line-Associated Blood Stream Infections—United States, 2001, 2008, and 2009. March 4, 2011/60(08);243-8. Available at www.cdc.gov/mmwr/preview/mmwrhtml/mm6008a4.htm.

3. Bild S. Detection of occult blood on EEG surface electrodes. American Journal of Electroneurodiagnostic Technology. 1997;37(4):251-7.