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IPAC CANADA PRACTICE RECOMMENDATIONS
Toys in Healthcare Settings
Toys referred to in this document include dolls, games,
books, puzzles, cards, craft supplies, electronic equipment and teaching toys/dolls as well as those
ordered/recommended for treatment purposes (e.g., therapeutic aids).
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.
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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.
Stakeholders: All HCWs who use toys as part of their duties and infection control professionals in settings
where in-patient or out-patient care is provided and where toys, games or similar may be provided for
patient use, including acute care facilities, rehabilitation facilities, and primary care offices/clinics
Infection Prevention and Control Practice Recommendations for Toys
1. Hand Hygiene
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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 towels in dispensers.
Hand hygiene with ABHR must be supervised by designated support persons or staff (as
applicable).
2. Toy Materials/Design
Toys should be selected based on Health Canada’s safely guidelines
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and regulations
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, and be
nonporous, smooth/non-textured and able to withstand rigorous mechanical cleaning and
disinfection.
Toys that are shared must be able to be cleaned and disinfected. Toys that are not able to be
cleaned are to be dedicated to a single patient.
DEVELOPED BY:
IPAC Canada’s Paediatric and
Neonatal Interest Group
November 2011, July 2016,
November 2022
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Water-retaining bath toys should not be used
Items that are not able to withstand cleaning and disinfection (e.g., puzzles, books, motorized
compassion/companion pets
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) should be avoided. Use should be based on organizational risk
assessment. If these are used, hand hygiene is to be performed by patients before and after handling
these items.
Donated toys should:
o Be new and in their original packaging
o Have manufacturer or store tags if stuffed or made of fabric
o Be donated to a single patient only and sent home with the patient on discharge or
discarded after use
o Meet the requirements of toy materials/design (as stated above)
o Be checked against the Health Canada recalled product list
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(as current) and discarded if
recalled
Bubbles: when used for play or other therapeutic purposes, each patient is to be provided with
their own container of bubbles and wand and these are not to be shared. Patients are to be
instructed not to blow bubbles; and rather to wave the wand through the air to make bubbles
Craft Supplies:
o Shared supplies (e.g., glue bottles, scissors) should be cleaned and disinfected between
patients
o Consumable supplies (e.g., beads, paper, and paint) should be dispensed to individual
patients. Leftover items may be discarded
• Do not use food or other items that may pose a choking or other hazard (e.g., potting soil, Styrofoam
peanuts, items that may be mistaken for food or that may support microbial growth)
3. Frequency and Responsibility for Toy Cleaning and Disinfection
Toys from Home:
o 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.
o Toys brought from home are not to be shared and are to be cleaned and
disinfected on a regular basis or when visibly soiled.
o 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 setting) if unable to be cleaned and disinfected, or discarded.
Written procedures should state the frequency and method for cleaning and disinfection of the toys
including:
o Assigned responsibilities for cleaning and disinfecting toys
o All toys belonging to the facility or organization should be cleaned and disinfected between
users
o Individuals responsible for cleaning and disinfecting unit/facility owned toys should receive
training on orientation (e.g., prior to assigned tasks) and on an ongoing basis as required
(e.g., following changes in the cleaning/disinfection protocol).
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o Toys used or stored in individual patient rooms should be cleaned, at a minimum, when
visibly soiled, once per week (routine cleaning) and when returned to general toy rotation.
o Mouthed toys should be cleaned and disinfected as soon as possible after use.
o When a patient is on Additional Precautions, toys should be dedicated and cleaned and
disinfected more frequently. Frequency of cleaning and disinfection is to be informed by the
type of Additional Precaution and or pathogen. Ensure that the product used for disinfection
is appropriate to any known pathogens (e.g., Clostridioides difficile, if applicable)
Playhouses/climbers: High-touch surfaces should be cleaned and disinfected daily when used, at a
minimum. A thorough cleaning and disinfection of the entire playhouse/climber should be done
according to a regular schedule based on frequency of use and when visibly soiled.
Shared electronic games, video equipment and computers should be cleaned between users, as per
manufacturer instructions. Computer keyboards should be either of the immersible type, have a
keyboard cover or be made of a material that can be cleaned and disinfected. These should be wiped
down prior to leaving the room (including the keyboard cover and all attachments). For a patient on
Additional Precautions, items are to be assigned and terminally cleaned upon discharge or when
precautions are discontinued.
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Shared books, magazines, puzzles, cards and comics should be limited, and if provided, these should
be refreshed on a regular basis and discarded when visibly soiled. These items should be dedicated to
patients on Additional Precautions and discarded or given to the patient to take home afterwards if
the items cannot be cleaned.
Sensory tables should be cleaned and disinfected after emptying and prior to refilling.
o Ideally patients are to be provided with their own sensory containers in place of
communal sensory tables
o If sand is used in sensory tables, this should be purchased as play sand and
replaced weekly
o Any water is used in sensory tables should be potable. Drain and replace water in
sensory tables after each use
Toys should be removed from general waiting rooms if an adequate process cannot be established to
ensure their daily inspection, cleaning and disinfection.
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4. Toy Storage
Play area 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.
Toy storage boxes/cupboards (including those from home) should be made of a material that is able
to be cleaned and disinfected and should be emptied and cleaned and disinfected weekly and when
visibly soiled.
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.
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Toys should be cleaned according to the manufacturer’s instructions or local practices (e.g., in hot,
soapy water) prior to being disinfected.
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Disinfection options include:
o Option 1: Use a dedicated commercial, NSF-approved dishwasher/cart washer that
sanitizes using either hot water (e.g., 82
o
C for 10 seconds) or a chemical sanitizing agent
(e.g., 100ppm chlorine, 200ppm quaternary ammonium).
o Do not clean toys in dishwashers normally used to clean and sanitize dishes and utensils
used for food service.
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o Option 2: Clean toys manually prior to disinfection, or use a 1-step cleaner/disinfectant
product. Products may include:
a. A hospital grade, low-level disinfectant approved by Health Canada (Drug
Identification Number (DIN) available on the product):
Ensure manufacturer’s recommendations regarding dilution and contact time
are met
Rinse with potable water and air dry
b. Alcohol (70%) (for small, minimally soiled toys): Wipe with alcohol swab(s), ensuring
the toy surface remains wet with disinfectant for 10 minutes, and allow to air dry
c. 1:100 dilution of household bleach and water for 10 minutes
d. A food-grade sanitizer for toys that will be used for younger children or for patients
that may ‘mouth’ toys. Follow manufacturer instructions for dilution, use and contact
time
Unless otherwise specified by the manufacturer, replace disinfectant solution after each use (i.e., only
use alcohol or diluted bleach solution once before replacement)
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. Auditing/Monitoring Compliance
b. An audit process should be in place to monitor adherence to the policies to further minimize potential
infection risk. Auditing may monitor process (e.g., observation of the cleaning and disinfection
process) or outcome (e.g., using a fluorescent marker) to assess if cleaning was effective.
Glossary/Definitions:
As per the Canadian Standard Association (CSA):
“SHALL” is used to express a requirement, i.e., a provision that the user is obliged to satisfy in order to comply
with the standard;
“SHOULD” is used to express a recommendation or that which is advised but not required; and
“MAY” is used to express an option or that which is permissible within the limits of the standard, an advisory
or optional statement.
Designated Support Person: An individual the patient wants involved in their care and can include family
members, close friends or other caregivers and are identified/designated by the patient or substitute decision
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maker (SDM). [Reference: Horizon Health Network (NB): https://horizonnb.ca/patients-visitors/designated-
support-person/]
Low-level disinfectants: Disinfectants suitable for processing non-invasive medical equipment (i.e., non-
critical equipment) and some environmental surfaces, after thorough cleaning. Low-level disinfectants kill
most vegetative bacteria (e.g., MRSA) and some fungi as well as enveloped (lipid) viruses (e.g., hepatitis B, C,
hantavirus, and HIV). Low level disinfectants do not kill mycobacteria (e.g. TB) or bacterial spores (e.g., C.
difficile). A low-level disinfectant has a drug identification number (DIN) from Health Canada indicating its
approval for use in Canadian hospitals.
References:
1. West K, Nyquist AC, Blair T, Berg W, Spencer S. APIC Text of Infection Control and Epidemiology, 4th ed.,
2014.Chapter 42, Pediatrics. p 42:1-19.
2. Well Beings: A Guide to Health in Child Care. 3rd edition ed. Grenier D, Leduc D, editors: Canadian
Paediatric Society; 2008.
3. Schutze GE, Willoughby RE, Committee on Infectious Diseases. Clostridium difficile Infection in Infants and
Children. Pediatrics. 2013 [cited 2022 Nov 22];131:196-200. Available from:
https://pubmed.ncbi.nlm.nih.gov/23277317/
4. Sammons JS, Tultzis P, Zaoutis TE. Clostridium difficile Infection in Children. JAMA Pediatr. 2013 [cited
2022 Nov 22];167(6):567-573. Available from: https://pubmed.ncbi.nlm.nih.gov/23460123/
5. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious
Diseases Advisory Committee. Best practices for hand hygiene in all health care settings [Internet]. 4th ed.
Toronto, ON: Queen’s Printer for Ontario; 2014 Jan [cited 2022 Nov 22]. Available from:
https://www.publichealthontario.ca/-/media/documents/b/2014/bp-hand-hygiene.pdf?sc_lang=en
6. Government of Canada. Toy safety [Internet]. 2017 Nov [cited 2022 Nov 22]. Available from:
https://www.canada.ca/en/health-canada/services/toy-safety.html
7. Smith L, Ross R, Weihrer S. Health Canada. Canadian safety requirements for children’s toys [Internet].
2013 Feb [cited 2022 Nov 20]. Available from:
https://www.toyassociation.org/App_Themes/tia/pdfs/safety/TF13Seminar/HealthCanada.pdf
8. Bradwell HL, Johnson CW, Lee J, Winnington R, Thill Serge, Jones RB. Microbial contamination and efficacy
of disinfection procedures of companion robots in care homes [Internet]. PLOS One. 2020 Aug [cited 2022
Nov 22]. Available from: https://doi.org/10.1371/journal.pone.0237069
9. Government of Canada. Recalls and safety alerts [Internet]. 2022 Oct [cited 2022 Nov 22]. Available from:
https://recalls-rappels.canada.ca/en
10. IPAC Canada. Practice recommendations for infection prevention and control related to electronic (IT)
devices in healthcare settings [Internet]. 2018 Jan [cited 2022 Nov 22]. Available from: https://ipac-
canada.org/photos/custom/Members/pdf/Electronic%20Devices_Jan2018_final_d.pdf
11. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious
Diseases Advisory Committee. Infection prevention and control for clinical office practice [Internet]. 1st
Revision. Toronto, ON: Queen’s Printer for Ontario; 2015 Apr [cited 2022 Nov 22]. Available from:
https://www.publichealthontario.ca/-/media/documents/b/2013/bp-clinical-office-
practice.pdf?sc_lang=en
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12. Merriman E, Corwin P, Ikram R. Toys are a potential source of cross-infection in general practitioners’
waiting rooms. British Journal of General Practice, 2002 Feb [cited 2022 Nov 22]; 52: 138-140. Available
from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314220/pdf/11885823.pdf
13. Moore DL. Canadian Paediatric Society position statement Infection prevention and control in paediatric
office settings. Paediatrics & Child Health, 2018 Nov [cited 2022 Nov 22]; 23(8):e176–e190 Available from:
https://www.cps.ca/en/documents/position/infection-prevention-and-control-in-paediatric-office-
settings
14. Hale CM, Polder JA. The ABC's of Safe and Healthy Child Care: A Handbook for Child Care Providers.
Atlanta, GA: Centers for Disease Control and Prevention; 1997 [cited 2022 Nov 22]. Available from:
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjX7pW94MX7AhU
qkokEHbpGACQQFnoECBEQAQ&url=https%3A%2F%2Fstacks.cdc.gov%2Fview%2Fcdc%2F23148%2Fcdc_2
3148_DS1.pdf&usg=AOvVaw0WhnTGTHptKP0GMsBS5a7z
15. American Academy of Pediatrics. Children in out-of-home child care. In: Pickering LK, Baker CJ, Kimberlin
DW, Long SS, eds. Red Book: 2012 Report of the Committee on Infectious Diseases. Elk Grove Village, IL:
American Academy of Pediatrics; 2012: 150 – 151.
16. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious
Diseases Advisory Committee. Best practices for environmental cleaning for prevention and control of
infections in all health care settings [Internet]. 3rd ed. Toronto, ON: Queen’s Printer for Ontario; 2018 Apr
[cited 2022 Nov 22]. Available from: https://www.publichealthontario.ca/-
/media/documents/B/2018/bp-environmental-cleaning.pdf
17. Health Protection and Promotion Act. Ontario Regulation 493/17 – Food Premises. 2020 Jan [cited 2022
Nov 22]. Available from: https://www.ontario.ca/laws/regulation/170493
Published
November 20, 2011
Reviewed and revised July 2016; Nov 2022
These practice recommendations were initially developed by IPAC Canada’s Paediatric and Neonatal
Interest Group and updated with Standards and Guidelines Committee
Chair: Lisa Snodgrass
Principle Authors: Anne Augustin, Carmen Bentley, Suzanne Desaulniers, Melonee Eng-Chong, Connie
Gittens-Webber Caroline Ivorra, Katherine Paphitis
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Appendix: Suggested frequency for toy cleaning and disinfection
Item
Frequency of cleaning and disinfection/laundering (as applicable)
Between Patient
Daily
Weekly
When visibly
soiled
Motorized
compassion/companion
pets
X
8
(if able to withstand
cleaning)
X
8
(if able to
withstand
cleaning)
Discard
Toys stored in
individual patient
rooms
x
x (if child is on
additional
precautions)
x
x
Toys in communal play
areas
x (preferred)
x
Playhouses/climbers in
communal play areas
x
x
Shared electronics
x
Water in sensory tables
x
x (after each use)
Sand in sensory tables
x
x
Puzzles, books,
magazines in
communal play or
waiting areas*
x (discard)
