Examining ball pits as a playground for pathogenic germs


Arlington, Va., March 21, 2019

Beware the ball pit. Ball pits used in children’s physical therapy – similar to those made popular by restaurants catering to families – may contribute to germ transmission between patients, according to new research published in the American Journal of Infection Control (AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology, published by Elsevier.

The popularity of ball pits has increased since mainstream commercial restaurants installed them nationwide for children in the 1980s, and they are often found to be contaminated with visible dirt, vomit, feces, or urine, providing a permissive environment for contamination. Similar ball pits are commonly used in pediatric physical therapy to provide stimulation to children with sensory or motor impairments. According to the study, clinics may go days or even weeks between cleanings, allowing time for microorganisms to accumulate and grow to levels capable of giving children infections and making them sick.

Investigators from the University of North Georgia examined six ball pits located in inpatient physical therapy clinics or outpatient clinics in the state of Georgia. Nine to 15 balls were randomly selected from different depths of each sampled ball pit.

The study found considerable microbial colonization in ball pits that were tested, including eight bacteria and one yeast that could cause disease. Bacterial colonization was found to be as high as thousands of cells per ball, clearly demonstrating an increased potential for transmission of these organisms to patients and an increased possibility of infection.

“We found considerable variation in the number of microorganisms between the different ball pit samples,” said the study’s lead researcher Mary Ellen Oesterle, EdD, PT, Department of Physical Therapy, University of North Georgia, Dahlonega, GA, USA. “This suggests that clinics utilize different protocols for cleaning and maintenance, potentially representing a broader need to clarify and establish standards that reduce the risk of transmission.”

Overall, researchers identified 31 bacterial species and one species of yeast. The human-associated bacteria found in the ball pits included:

  • Enterococcus faecalis, which can cause endocarditis, septicemia, urinary tract infection, and meningitis;
  • Staphylococcus hominis, a cause of bloodstream infections and reported as a cause of sepsis in a neonatal intensive care unit;
  • Streptococcus oralis, known to cause endocarditis, adult respiratory distress syndrome, and streptococcal shock; and
  • Acinetobacter lwofii, which has been reported to cause septicemia, pneumonia, meningitis, and urinary tract and skin infections.

“This research shows that ball pits may pose an infection hazard,” said 2019 APIC President Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC. “Facilities should establish a program for regular cleaning to protect patients and healthcare workers from potential infection risks.”

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Notes for editors
The article is “Are ball pits located in physical therapy clinical settings a source of pathogenic microorganisms?” by Mary Ellen Oesterle, Kimberly Wright, Marissa Fidler, Paul Johnson, and Dobrusia Bialonska (https://doi.org/10.1016/j.ajic.2018.09.031). It will appear in the American Journal of Infection Control, volume 47, issue 4 (April 2019) published by Elsevier.

This study was published online in November 2018 ahead of final publication in print scheduled for April 2019.

About AJIC: American Journal of Infection Control
AJIC: American Journal of Infection Control covers
key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. AJIC is included in MEDLINE and CINAHL. www.ajicjournal.org

About APIC
APIC’s mission is to create a safer world through prevention of infection. The association’s more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at www.apic.org. Follow APIC on Twitter: www.twitter.com/apic and Facebook: www.facebook.com/APICInfectionPreventionandYou. For information on what patients and families can do, visit APIC’s Infection Prevention and You website at www.apic.org/infectionpreventionandyou. apic.org

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

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