Infection Prevention and Control Canada (IPAC Canada) has revised its Toys Practice Recommendations, in collaboration with the IPAC Canada Standards & Guidelines Committee and the IPAC Canada Paediatric and Neonatal Interest Group (November 2022).  The following is an overview of the guidelines for use and cleaning of toys in healthcare settings.  It is not the full and complete document. The entire Practice Recommendation, including elaboration on the points described in the overview, definitions and references can be found at www. https://ipac-canada.org/position-statements-practice-recommendations.

Patients, their siblings and families should have access to clean and safe play equipment and toys in healthcare settings.  Toys can be a reservoir for potentially pathogenic microorganisms that can be present in saliva, respiratory secretions, faeces or other body fluids.  Healthcare providers must decide whether the benefits of an environment in which patients are free to interact with each other, share toys, and practice their social skills, outweigh the risks of infections that may be acquired.

Recommendations include:

1. Hand Hygiene

Before and after playing with toys/play equipment (e.g. playhouses/climbers), patients should be encouraged or assisted to clean their hands with alcohol-based hand rub (ABHR) or soap and water (when visibly soiled). Play areas should have access to both ABHR and a hand wash station supplied with liquid hand soap; and paper towers in dispensers.  Hand hygiene with ABHR must be supervised by the designated support persons or staff (as applicable).

2. Toy Material/Design

Toys should be selected based on Health Canada’s safety guidelines and regulations and be nonporous, smooth/non-textured and able to withstand rigorous mechanical cleaning and disinfection.  Toys that are shared must be cleaned and disinfected.  Toys not able to be cleaned should be designated to a specific patient.  Items that are not able to withstand cleaning and disinfection (e.g. puzzles, books, motorized compassion/companion pets) should be avoided.  Use should be based on organizational risk assessment.  If these are to be used, hand hygiene is to be performed before and after handling these items.

3. Frequency and Responsibility for Toy Cleaning and Disinfection

Designated support persons should be encouraged to bring a limited number of the patient’s favourite toys from home.  These toys are to be stored in a cleanable container, kept at the patient’s bedside and labelled with the patient’s name.  Toys brought from home are not to be shared and are to be cleaned and disinfected on a regular basis or when visibly soiled.  If a personal toy is visibly dirty, it should be the responsibility of the parents to ensure it gets cleaned and disinfected, taken home (and not brought back to the healthcare settings) if  unable to be cleaned and disinfected, or discarded.

4. Toy Storage

Play areas that are used by more than one patient should have an area for segregation of dirty toys (e.g. labelled/marked bin ‘Used Toys’ into which parents/families/staff can place used/mouthed toys.  Clean and disinfected toys should be stored in a manner that prevents contamination (e.g. dust and water splatter) and should be clearly marked as clean.

5. Procedure for Toy Cleaning and Disinfection

Toys should be inspected for damage, cracked or broken parts each time the toy is cleaned and disinfected as these may compromise cleaning.  Any toy that is found to be damaged, cracked or broken should be discarded.

Disinfection options include:

Option 1:  Use a dedicated commercial, NSF-approved dishwasher/cart washer that sanitizes using either hot water (e.g. 82^oC for 10 seconds) or a chemical sanitizing agent.  Do not clean toys in dishwashers normally used to clean and sanitize dishes and utensils used for food service.

Option 2: Clean toys manually prior to disinfection, or use a 1-step cleaner/disinfectant product.

Unless otherwise specified by the manufacturer, replace disinfectant solution after each use. Phenolics must not be used for toys or equipment that come into contact with infants.  If a disinfectant is used, toys must be rinsed with potable water thoroughly after cleaning and disinfection. Allow toys to air-dry, in a manner that prevents contamination, prior to storing.

6. Audit/Monitoring Compliance

An audit process should be in place to monitor adherence to the policies to further minimize potential infection risk.

This document was developed by IPAC Canada based on beset available evidence at the time of publication.  The application and use of this document are the responsibility of the user.  IPAC Canada assumes no liability resulting from any such application or use.  For more information, contact info@ipac-canada.org.