Beware of Toys!

Jay Moore, for HealthLeaders Media, January 15, 2009

First, let me say that controlling the spread of healthcare-associated infections is important. Nearly 100,000 people die in U.S. hospitals every year from some sort of HAI. Providers around the world consider infection control to be an extremely serious matter, and so do I.

That said... looking back on 2008, the prize for Most Misguided Patient Safety Initiative of the Year has to be this item from the other side of the Atlantic: A public health trust in Great Britain ordered toys removed from all of its clinics because of the risk of spreading infections among children. The move was reportedly an effort to follow a Department of Health guideline requiring health trusts to ensure "a clean and appropriate environment for healthcare," according to a story in The Daily Mail.

Part of me wasn't, and still isn't, surprised by this. The British have shown a willingness in the past to take aggressive action to prevent infections from spreading; in April of last year, we ran a story in HealthLeaders magazine about British hospitals banning below-the-elbow clothing for physicians—everything from neckties to fake fingernails—because of the infection risk. With HAIs affecting more and more people, merely maintaining the same prevention efforts is no longer acceptable. So in some ways, I applaud the attempts at meaningful change. And I should mention that since the story ran, the health trust in question has purchased plastic toys (easier to clean, I presume) to replace the soft toys and wooden toys that were removed.

But this issue got me thinking about the fine line between caution and paranoia. I'm sure kids can spread plenty of nasty little bugs by touching and coughing on toys. Just like kids (or adults, for that matter) can spread plenty of nasty little bugs by touching and coughing on books, magazines, chairs, doorknobs, and everything else in the waiting room. If the toys are cleaned thoroughly and regularly, why are they a greater threat than anything else? In fact, at least you can disinfect a toy. How do you disinfect a newspaper? To the physicians among you: Am I oversimplifying here? If the toys are kept as clean as possible, help kids feel better about visiting the doctor, and give parents a little help during long waits in a crowded room... the benefits, to me, outweigh the risks.

The broader point is that taking the task of infection control seriously and living in fear are two different things. As 2009 brings continued challenges in the fight against organisms that are growing ever more drug-resistant, irresponsible behavior like failing to wash one's hands or skipping a surgical timeout or neglecting to disinfect the toys in a waiting room can't be tolerated—the cost is just too high. But risk can never be truly eliminated. And there is such a thing as going too far.

Jay Moore is managing editor for HealthLeaders magazine. He can be reached at
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