IC considerations for toys in the waiting room

By: February 24th, 2010 Email This Post Print This Post

It’s common for medical facilities to keep books and toys in the waiting room to entertain children who come in, but along with those books and toys come infection prevention considerations. Toys are problematic, mainly because children can’t resist the urge to stuff them in their mouth.

There are a variety of ways to deal with this issue, all of which revolve around building a policy and communicating that policy to staff members and patients.

The Infection Control Manual for the Physician’s Office addresses toys and magazines in the waiting room suggesting medical facilities should either avoid them all together, or only accept toys that can be wiped down or cleaned (so no stuffed animals). You could also consider giving toys to children individually as they come in the waiting room to take home with them.

William A. Rutala, Ph.D., M.P.H., an expert on disinfection and sterilization procedures at the University of North Carolina (UNC) Health Care System and UNC at Chapel Hill, spoke at APIC’s 2009 conference with a special emphasis on pediatric issues.  Rutala also recommends toys that can be washed with soap and thoroughly rinsed with tap water, or cleaned with 70% alcohol wipes. Non-washable toys could be used by older children, but should be gas sterilized or discarded when soiled. You can also wash plastic or vinyl toys with cholorine bleach detergent in the dishwasher, on the hottest setting.

There is also some guidance from the National Guidance Clearinghouse, which is an initiative by the Agency for Healthcare Research and Quality (AHRQ). Number 21 of the guidelines states:

In facilities that provide health care to pediatric patients or have waiting areas with child play toys (e.g., obstetric/gynecology offices and clinics), establish policies and procedures for cleaning and disinfecting toys at regular intervals.

Use the following principles in developing this policy and procedures:

  • Select play toys that can be easily cleaned and disinfected
  • Do not permit use of stuffed furry toys if they will be shared
  • Clean and disinfect large stationary toys (e.g., climbing equipment) at least weekly and whenever visibly soiled
  • If toys are likely to be mouthed, rinse with water after disinfection; alternatively wash in a dishwasher
  • When a toy requires cleaning and disinfection, do so immediately or store in a designated labeled container separate from toys that are clean and ready for use

If you go to the Tools page on OSHA Healthcare Advisor there are two downloads that might help: the Sample Cleaning and Disinfection Schedule, and the Infection Control Survey for the Physician’s Office. Even if you are a larger medical facility or a hospital, these two documents might help you build your own policy or checklist.

Do you like this guidance? Libby will address similar common infection control issues in an April 21st Webcast, Infection Prevention Survey Strategies for ASCs: Comply with CMS’ Conditions for Coverage. Libby will team up with Dawn McLane, an AAAHC surveyor for ASC accreditation and Medicare certification to provide guidance on CMS requirements and common IC missteps. Stay tuned to OSHA Healthcare Advisor for links and more information.


By Virginia Hotchkiss on February 24th, 2010 at 2:33 pm

What exactly is the OSHA standard for washing of toys in the small office setting?

By Nancy McAlley on February 24th, 2010 at 3:20 pm

This was immensely helpful and the OSHA toolkit link was a big help as well.
Thank you

By Barbara Piskor on February 24th, 2010 at 3:50 pm

Do you have any recommendations related to infection prevention/control for computer lap-top use and cleaning? Thank you.

By Libby Chinnes on February 24th, 2010 at 4:27 pm

As far as I am aware, there are no OSHA standards on disinfecting toys. Remember, OSHA is for the protection of employees, not really patients.

By Libby Chinnes on February 24th, 2010 at 5:00 pm

Dr. Bill Rutala has a wonderful website which we have already mentioned: http://www.disinfectionandsterilization.org. If you will review his lecture which is available entitled, “Disinfection and Sterilization: Challenges in the XXI Century”, you will note that he discusses disinfection of computer keyboards among other things. He mentions a study publised in the 2006 volume of Infection Control and Hospital Epidemiology journal, volume 27, pg 372. In the study, computer keyboards were inoculated with strains of MRSA and Pseudomonas aeruginosa. All tested disinfectants (3 quaternary ammonium compounds, 70% isopropyl alcohol, a phenolic, and chlorine-80 ppm)were 95% effective in removing &/or inactivating the tested pathogens. There was no functional or cosmetic damage after 300 wipes. He therefore notes that disinfectants are effective in removing/inactivating pathogens of nosocomial concern and recommends daily disinfection of keyboards for 5 seconds and when visibly soiled.

By Barbara Piskor on February 24th, 2010 at 7:01 pm

Thank you. Very helpful.

By Kathleen JWalsh on September 18th, 2014 at 12:33 pm

I need a schedule for sanitation etc. for toys in clinic lobbies.

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