Toys in a pediatric hospital: are they a bacterial source?

Background: In children's hospitals, children are commonly provided with toys. Measures to guarantee the safety of these toys are usually not taken. This study was conducted to determine whether toys were contaminated with potentially pathogenic bacteria when they arrived in the hospital, and whether they were contaminated in the hospital.

Methods: The study was conducted during a 3-month period. Children who were hospitalized for at least 3 days were chosen as study subjects. Once these children were identified, cultures from their toys were obtained within the first 48 hours of admission. After this first culture, toys were cleaned with 4% chlorhexidine and water and were immediately re-cultured. Following cultures were collected on days 5 to 7, 10 to 15, and every week thereafter until the owner-patient was discharged. Specimens were collected in a standardized manner with moistened swabs and placed in transport media. They were later inoculated onto trypticase soy agar with 5% sheep blood and brain heart infusion agar, incubated at 37 degrees C for 48 hours and examined for colony growth at 24 to 48 hours.

Results: Seventy children's toys were included in this study. Patients' median age was 26 months (range: 1 day to 9 years). Respiratory infections (43%) and diarrhea (26%) were the most common causes of hospitalization. Fifty-three (76%) toys were made of plastic, 8 (11%) metallic, and 9 (13%) other materials. Twenty-nine (41%) were brought from home, 38 (55%) were purchased from roving vendors, and 3 (4%) were purchased from toy stores. All first cultures were positive for at least 1 pathogenic microorganism: 55 (78%) coagulase-negative Staphylococcus (CNS); 26 (37%) Bacillus spp; 13 (18%) Staphylococcus aureus; 8 (11%) alpha-hemolytic Streptococcus; 5 (9%), Pseudomonas spp; 2 (3%) Stenotrophomonas maltophilia, and 6 (11%) other gram-negative organisms. After toys were cleaned, subsequent cultures showed significant decreases in bacterial growth rates (P <.05). Because some patients were discharged, additional cultures were obtained for only 31 toys.

Conclusions: Toys entering a hospital can be contaminated with potentially dangerous bacteria and may provide unnecessary risks for nosocomial infection. Effective measures must be implemented to prevent the spread of infections via toys.