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201711312

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Cleaning of Toys, Therapeutic and Entertainment Activity Items (4.1.18)

Cleaning of Toys, Therapeutic and Entertainment Activity Items (4.1.18) - Policies, Clinical, UW Health Clinical, Infection Control

4.1.18


UW HEALTH CLINICAL POLICY 1
Policy Title: Cleaning of Toys, Therapeutic, and Entertainment Activity Items
Policy Number: 4.1.18
Category: UW Health
Type: Ambulatory and Inpatient
Effective Date: October 23, 2017

I. PURPOSE

To ensure consistent cleaning and disinfection of toys in order to minimize potential for cross transmission of
infectious agents in the inpatient environments, inpatient playrooms, all child life areas, and clinical exam
rooms. Clinical waiting rooms are excluded from this policy. Refer to the clinical manager for a daily cleaning
schedule.

II. POLICY ELEMENTS

A. Only toys which meet the Infection Control criteria described in section III.A. are suitable for re-use by
multiple patients.
B. Toys which do not meet the Infection Control criteria described in section III.A. cannot be used by multiple
patients because they cannot be reliably cleaned and disinfected. If used, these single patient-use toys (e.g.,
Play-doh™, stuffed animals, and books) will either be given to the patient to take home or be discarded after
use. Refer to the Clinical Mobile Device Cleaning Requirements for information on cleaning of electronic
items (mobile phones, game systems, IPADs, laptop, etc).
C. Determination of the acceptability of toys with regard to age appropriateness, choking hazard, compositional
hazards (e.g., breakability, lead content), etc. is beyond the scope of this policy and is the responsibility of
the unit manager or Child Life staff member who purchases or accepts donation of the toys.
D. Washing in hot soapy water followed by immersion in dilute household bleach, using hospital grade
disinfecting detergent (HDD) or subjecting items to a sanitization cycle with heated drying in a dishwasher
dedicated for toy cleaning, are the preferred methods of cleaning and disinfecting toys handled by children.
E. The manager of the clinic, unit, or department in which toys will be used will assign designated staff
members the responsibility for consistently adhering to the toy cleaning procedures detailed in section III.,
below. Child Life staff are responsible for these activities on pediatric inpatient units.
F. Environmental Services personnel will be responsible for cleaning/disinfecting stationary toys and play
structures in public areas with HDD.
G. The hospital's waterless hand sanitizer product should be available in play areas and clinic waiting areas
which contain stationary toys, such as computer touchscreen games, to provide toy users an immediately
accessible option for hand hygiene. Use of hand sanitizer can reduce hand carriage of contaminants among
toy users and toy surface contamination.
H. Families are encouraged to bring personal toys, books and magazines for the patient's own use and take
them home upon the patient's discharge.

III. PROCEDURE

A. Toys intended for re-use by multiple patients must meet the following Infection Control criteria:
i. Stationary toys such as activity tables, computer monitor games and play structures will be made of
material which can withstand cleaning with the hospital disinfecting detergent (HDD). The active
ingredients of HDD are quaternary ammonium compounds or diluted household bleach
ii. Portable toddler toys which patients or visiting siblings may handle, carry or mouth must meet one
of the following criteria sets (a, b or c):
a. The toy must be submersible and able to withstand contact with dilute household bleach
solution (defined in III.D.1.) and of a design which precludes retention of water within the
toy.
b. The toy must be submersible and able to withstand cleaning in a sanitizing dishwasher
cycle with a heated drying cycle and of a design which precludes retention of water within
the toy.
c. If not submersible, the portable toddler toy must be nonporous and able to withstand
contact with hospital disinfecting detergent or hospital-provided premoistened disinfecting
wipes (currently CaviWipes™, CS# 4005875 or Clorox™ Bleach Germicidal Wipes, CS#
2200415 or 4012323, OxyCide Disinfectant Cleaner CS# 4015157, Clorox Hydrogen
Peroxide Wipes).
iii. Therapeutic toys (hand puppets, dolls, washable fabric items etc) used for psychiatric intervention



UW HEALTH CLINICAL POLICY 2
Policy Title: Cleaning of Toys, Therapeutic, and Entertainment Activity Items
Policy Number: 4.1.18

must be launderable, or meet the criteria described in III.A.2. above.
B. Stationary toys (including static computer touchscreen games) and structures will be cleaned with HDD by
Environmental Services personnel during routine daily cleaning activities. Items may be sprayed with HDD
and then wiped after adequate contact time, or wiped with a cloth soaked in HDD.
C. Segregation of clean and dirty portable toys must be maintained at all times.
i. Containers to collect dirty toys must be readily available within designated inpatient play areas
(e.g., American Family Children's Hospital playrooms), clearly designated for containing dirty toys,
and of adequate size to easily hold the number of toys generated in the specific play area during
the activities of a typical day.
a. Once a toy is used, it is considered "dirty" and must be promptly placed into the
designated dirty toy container.
b. Single patient-use toys, such as Play-doh™ or stuffed animals, will either be sent home
with the patient or promptly discarded after use.
ii. If the unit manager chooses to make portable toddler toys available in general clinic areas (e.g.,
General Pediatrics Clinics), clearly designated containers to collect dirty toys should be centrally
located to accommodate collection of dirty toys for cleaning.
a. Used portable toys should be removed from exam rooms and placed into the dirty toy bin
as part of routine room preparation for the next clinic patient.
iii. Patient-ready toys (those which have been cleaned, disinfected and dried as described in III.D.
below) must be stored in a clearly designated location and in a manner which prevents
contamination, rewetting, inadvertent mixing with dirty toys, or unsupervised access by children.
iv. Toys collected from patient’s room will be gathered in plastic bags and marked accordingly with a
sticker identifying “clean with bleach only or Enhanced precautions” if they are removed from an
Enhanced Contact isolation room. The toys will then be placed in the appropriate dirty toy bin
located in the soiled utility room. Do not place toys from patient’s room in the playroom for cleaning.
D. Toys collected in designated dirty toy containers will be cleaned at the end of the day, or more frequently if
required, according to one of the following three procedures:
i. Manual washing/disinfection of submersible toys.
a. Wipe down with Cavi wipes, OxyCide or Bleach wipes and allow for designated contact
time per manufacture recommendations. If disinfectant wipe becomes dry- place in regular
trash and retrieve a new wet wipe then continue cleaning the toys. If toys are visible soiled
-vigorously wash toys, using a brush for small crevices, in hot soapy water (dish detergent
is an acceptable product) then rinse with clean tap water. Toys that are heavily
contaminated with body fluids or stool should be disposed of immediately.
b. Bleach cleaning can be used in special circumstances by trained staff. Immerse the
washed toy into a diluted bleach solution (1:100 dilution) and allow the toy to soak for at
least 10 minutes, ensuring that all surfaces have contact with bleach solution.
1. Diluted bleach must be made up fresh daily.
2. A 1:100 dilution of bleach: cold tap water is used to disinfect toys.
3. Bleach is available from Central Supply, item #2210103.
4. To closely approximate a 1:100 dilution, 10 milliliters of bleach should be added
for each liter of tap water used. Volumes of bleach and tap water should be
measured to ensure that the proper dilution is consistently used.

To achieve approximately 1:100 dilution of bleach
Add this much bleach: To this much water:
10 milliliters of bleach 1 liter of tap water
38 milliliters (1.3 ounces) of bleach 1 gallon of tap water
190 milliliters (6.4 ounces) of bleach 5 gallons of tap water

c. All toys that might come in contact with a patient’s mouth need an additional rinse with
clean tap water or all surfaces wiped with a wet (tap water) washrag to remove any
chemical residue.
d. Allow toy to air-dry on clean absorbent material, or wipe dry with a clean towel, and then
return the toy to the clean storage area. Do not put wet toys in storage.
1. If cloth toweling is used as the absorbent surface, it should be changed daily in
order to prevent growth of microorganisms. If clean paper toweling is used as the
absorbent surface, it should be discarded after use.



UW HEALTH CLINICAL POLICY 3
Policy Title: Cleaning of Toys, Therapeutic, and Entertainment Activity Items
Policy Number: 4.1.18

ii. Automated washing/disinfection of submersible toys.
a. If a dishwasher is used, it must be designated solely for the purpose of cleaning children's
toys and similar lightly soiled non patient-care items and must have the capability of
running a sanitization cycle with heated drying.
b. Load dirty toys into the dishwasher in a manner that will allow spray heads to effectively
wash the items.
c. Use the recommended amount of detergent and set the dishwasher to a sanitizing cycle
with heated drying.
d. As dishwashers may vary in effectiveness, diligence must be used to ensure that toys are
being effectively cleaned. It may be necessary to increase the wash cycle time or to use
one of the more aggressive cleaning modes that the dishwasher has (i.e., heavy wash, pot
scrubber, etc.) if visual inspection of toys indicates that a standard wash cycle is not
achieving adequate cleaning.
e. Remove toys when the cycle is complete, spot dry if necessary, and then place into clean
storage as described in III.C.3.
f. Care must be taken to reliably discern whether the toys in the dishwasher have undergone
the cleaning cycle.
1. Dirty toys will not be loaded into the dishwasher for "temporary holding" prior to
washing, but only at the time the cycle is to be run.
2. A log will be kept so that, at minimum, the date and time of the dishwasher cycle
start is recorded, with a check box to indicate that the clean toys were
subsequently removed.
3. If there is uncertainty as to whether a load of toys in the dishwasher is clean, the
load will be subjected to a complete sanitization cycle with heated drying.
iii. Cleaning of portable toys which cannot be submerged:
a. Portable toys which cannot be submerged must be manually cleaned by spraying with
HDD, allowing adequate contact time, and then wiping with a clean cloth. Alternatively, the
toy may be wiped with a cloth soaked in HDD solution or with hospital-supplied
premoistened disinfecting wipes (currently CaviWipes™, CS# 4005875 or Clorox™
Bleach Germicidal Wipes, CS# 2200415 or 4012323 OxyCide Disinfectant Cleaner CS#
4015157, Clorox Hydrogen Peroxide).
1. Care must be taken to ensure that the pre-moistened disinfecting wipe visibly
wets the surface to be disinfected. These wipes are designed for disinfecting
fairly small areas and the wipe must be discarded promptly when it no longer
retains sufficient disinfectant to visibly wet the surface.
b. Portable toddler toys, because they are likely to be mouthed, must be wiped with a cloth
soaked in clean water after cleaning with HDD or hospital-supplied premoistened
disinfecting wipes, in order to remove residual disinfectant.
E. Therapeutic toys such as hand puppets or dolls used for psychiatric or Child Life interventions are typically
not handled by children with infection, nor children vulnerable to infection by virtue of underlying disease or
invasive devices. These toys need only be cleaned when visibly soiled.
i. Laundering and drying in a clothes dryer is adequate for cloth items.
ii. Cleaning with mild soap or with HDD are also acceptable options for nonporous items in this
subgroup of toys.
F. Electronic items such as DVD players, and hand held or monitor based electronic games (i.e., Nintendo™,
PlayStation™), should be sprayed with the hospital disinfectant and allowed to air dry, or be wiped with a
clean cloth moistened with HDD at least daily. Alternatively, moisture sensitive items may be cleaned and
disinfected with hospital supplied pre-moistened disinfecting wipes (CS# 4005875).
G. Removable cloth seat inserts for highchairs and activity centers (e.g., Exersaucer, Bouncy Seats) will be
laundered and subjected to a heated drying cycle after use by each patient.
H. Cleaning and disinfection of toys used by inpatients in their rooms will be performed prior to use by another
inpatient.
i. The outer cover of books will be wiped down with hospital supplied pre-moistened disinfecting
wipes before return to common book stocks.
ii. Toys used by patients under isolation will be subjected to the same cleaning and disinfection
procedures as all other toys.
iii. Toys, games, books and magazines that are taken into an isolation room (clinic or inpatient) but
which cannot be thoroughly cleaned will be sent home with the patient upon discharge, even if



UW HEALTH CLINICAL POLICY 4
Policy Title: Cleaning of Toys, Therapeutic, and Entertainment Activity Items
Policy Number: 4.1.18

patient is removed from isolation before discharge.

IV. COORDINATION

Author: Infection Control Practitioner
Senior Management Sponsor: SVP/Chief Nurse Executive
Reviewers: Hospital Epidemiologist; Manager, Child Life
Approval Committees: Infection Control Committee, UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: October 16, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

V. APPROVAL

Peter Newcomer, MD
Chief Clinical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VI. REFERENCES

UW Health Clinical Policy #4.1.8, Standard Precautions and Isolation
Clinical Mobile Device Cleaning Requirements

VII. REVIEW DETAILS

Version: Revision
Last Full Review: October 23, 2017
Next Revision Due: October 2020
Formerly Known as: Hospital Administrative Policy #13.19