How to properly organize the disinfection of toys and surfaces in a pediatric clinic (procedure template)

In a pediatric clinic, every surface touched becomes a potential vector for transmission. Children explore through touch, frequently put their hands to their mouths, and quickly exchange objects. In the absence of a clear procedure, the risk of respiratory, digestive, or cutaneous infections increases and affects both patients and staff.

A well-organized procedure provides you with control and traceability. You establish what you disinfect, with which product, at what interval, and who is responsible for each stage.

In practice, proper organization ensures:

• a reduction in the risk of cross-contamination;
• the correct use of approved biocidal products;
• compliance with recommended contact times and concentrations;
• clarity in responsibilities and easier internal audits;
• compliance with sanitary norms applicable to medical units, in particular Ministry of Health Order no. 1761/2021 regarding cleaning, disinfection, and sterilization in healthcare facilities.

Which surfaces and objects to include in the disinfection procedure

Start by mapping the space. Note all frequently touched areas and all objects that children manipulate. Classify each area according to its biological contamination risk (low, medium, or high), because the risk level determines the required level of disinfection (low, medium, or high) and the frequency of intervention.

Divide them into three clear categories:

Frequently touched surfaces (medium risk)

Door handles, grips, handrails, elevator buttons, light switches, reception desks, POS terminals, chairs in the waiting room. These concentrate microorganisms from multiple sources. You disinfect them several times a day by wiping with an impregnated cloth or by spraying, using a medium-level disinfectant.

Surfaces and equipment in the examination room (medium to high risk)

Examination tables, stethoscopes, otoscopes, thermometers, pediatric scales, keyboards, mice, phones. These come into direct or indirect contact with the patient. Disinfect them after each consultation. Pay attention to reusable devices that touch mucous membranes or skin with lesions (e.g., reusable otoscope specula): these are semi-critical instruments and require at least high-level disinfection, not just surface wiping.

Toys and objects manipulated by children (high contamination risk)

Hard plastic toys, laminated books, blocks, puzzles, rubber toys, play mats. In most cases, children put them in their mouths or drop them on the floor. You must include them in the protocol.

Remove porous objects from clinical spaces that do not allow for efficient cleaning and disinfection, such as textile toys that cannot withstand washing at a minimum of 60°C or hard-to-clean upholstery. Replace them with smooth materials that are resistant to disinfectants.

How to correctly choose disinfectant products for cleaning toys?

It is recommended to use only biocidal products approved by the Ministry of Health (National Commission for Biocidal Products), authorized in accordance with the BPR (Biocidal Products Regulation – Regulation (EU) No. 528/2012). Check the approval/authorization, the classification within the product type (PT1 for human hygiene/hands, PT2 for surface/object disinfectants), the medical field of use, and the tested EN standards. The European framework standard defining testing requirements is SR EN 14885:2022; it indicates which EN norms must be met for each application (hands, surfaces, instruments).

For surfaces in the medical environment, the product must demonstrate efficacy according to relevant European standards, such as:

• EN 13727 – bactericidal activity;
• EN 13624 – fungicidal (yeasticidal) activity;
• EN 14476 – virucidal activity;
• EN 16615 – test for surfaces with mechanical action (wiping, 4-field test), which evaluates bactericidal and yeasticidal activity;
• EN 16777 – virucidal activity on non-porous surfaces, without mechanical action;
• EN 14348 – mycobactericidal/tuberculocidal activity.

Consult the technical data sheet and the safety data sheet. There you will find the exact concentrations, contact times, and compatibility with materials.

For hard non-porous surfaces, choose solutions from the surface and floor disinfectant category, either ready-to-use or concentrates. For frequently touched surfaces and toys, a practical solution is Klintensiv disinfectant wipes for surfaces, which are ready to use, combine cleaning and disinfection in a single step, and reduce the risk of under- or over-dosing. Products based on quaternary ammonium compounds (QACs) act by destroying the cell membrane. Hydrogen peroxide oxidizes protein structures and nucleic acids.

For the hand hygiene of staff and companions, use solutions from the hand and skin disinfectant range (classified as PT1), with bactericidal and virucidal activity. Products intended for routine hygienic disinfection must be tested according to EN 1500 (for hygienic hand rub) and EN 1499 (for hygienic hand wash). In case the clinic performs invasive procedures or minor surgical interventions, medical staff will use disinfectants additionally tested according to EN 12791 (surgical hand disinfection). Observe the recommended volume and the rubbing time indicated by the manufacturer.

Model procedure: disinfecting toys and surfaces in a pediatric clinic

Implement the five-step procedure and post it in the cleaning area. The concentrations and contact times below are indicative; the mandatory parameter remains the one from the technical data sheet of the approved product you are using, correlated with the risk level of the area.

Step 1: Prepare materials and delimit areas

Ensure the daily stock of disinfectants, color-coded microfiber cloths, disposable gloves, and labeled containers.

Apply a consistent and posted color-coding system, aligned with the internal Standard Operating Procedure (SOP). For example: red for restrooms and high-risk areas, yellow for sinks and sanitary surfaces, blue for furniture and general surfaces in the waiting room, green for the examination room and clean areas. Use cloths and mops dedicated to each code and wash them separately.

Put on protective equipment (disposable gloves and, as needed, gown and mask), prepare solutions in a ventilated space, and only in the quantity needed for the current shift. Note the solution name, concentration, date, and time of preparation on each container.

Clearly establish which area you are cleaning and in what order. Start with less contaminated areas and end with those at higher risk, working from clean to dirty and from top to bottom. This reduces the risk of transferring microorganisms. Attention: this sequence does not imply using the same cleaning equipment! It is mandatory to change the cloth or mop for each new area/room and to exclusively use mops dedicated and color-coded for each risk level.

Step 2: Clean mechanically before disinfection

Remove dust and visible dirt with an appropriate detergent. Organic matter, such as secretions or food debris, can partially inactivate quaternary ammonium compounds and reduce the efficacy of alcohols. Cleaning does not replace disinfection, nor vice versa: they are two distinct and mandatory stages. Without prior cleaning, the disinfectant is consumed by organic matter before it can act on the microorganisms.

For detachable toys and heavily soiled items, use an enzymatic detergent, then rinse. Enzymes dissolve organic matter and incipient biofilm that simple wiping does not remove.

Insist on direct-contact areas: the edge of the examination table, chair handles, and toy corners.

Step 3: Apply the disinfectant correctly

Choose the level of disinfection according to the risk. For frequently touched surfaces and toys, a medium-level disinfectant, ready-to-use or disinfectant wipes, with a contact time of about 2 minutes, is sufficient. For surfaces contaminated with biological fluids or in an epidemiological context, apply a high-level disinfectant, respecting the contact time specified in the data sheet.

Apply the solution by controlled spraying or by wiping with an impregnated cloth. Respect the specified contact time, usually between 1 and 5 minutes, depending on the product and the target spectrum.

Use the unidirectional "S" wiping technique, with a single pass on each portion; change the face of the cloth or the cloth itself when it becomes dirty, and do not re-introduce the used cloth into the clean solution (two-bucket method or pre-impregnated cloth system). This avoids re-contaminating the surface already treated.

Do not wipe the surface before the time expires. If the solution evaporates too quickly, reapply to keep the surface wet for the necessary duration.

For plastic toys, you can use the immersion method if the technical data sheet allows it: complete immersion in the disinfectant solution, respecting the concentration and contact time indicated. After disinfection, rinse with potable water (or sterile water, where applicable) if the manufacturer requires it and let the objects dry completely before reuse.

Step 4: Drying and controlled re-introduction into the circuit

Allow for natural drying or use disposable paper towels; do not dry objects with reusable cloths. Avoid immediate handling with unhygienized hands. Store clean toys in a container clearly marked as distinct from those in use.

Establish a simple system: "disinfected" box and "to be used" box. Staff must follow the workflow without deviations.

Step 5: Managing used materials

Dispose of gloves and disposable consumables in dedicated containers, in accordance with Ministry of Health Order no. 1226/2012 regarding medical waste management — infectious waste in yellow bags, and sharp/piercing waste in rigid, puncture-resistant containers; do not mix hazardous medical waste with household waste. Wash reusable cloths at 90°C (thermal disinfection) and dry them completely. A wet cloth left in a bucket promotes bacterial multiplication.

For small units that work with a fast patient flow, this efficient disinfection protocol for small medical offices: clear steps between consultations may be useful.

Reusable instruments: the 3 mandatory decontamination phases

Even in a pediatric clinic, reusable devices appear that are not simple surfaces. These are decontaminated through a cycle of three consecutive phases, each conditioning the efficacy of the next:

1. Cleaning: immersion in an enzymatic/medical-use detergent, with disassembly of mobile parts and complete coverage, including lumens. The removal of organic matter is the condition without which disinfection does not work.
2. Medium-level disinfection: after cleaning and rinsing, immersion in a medium-level disinfectant, respecting the contact time indicated by the manufacturer.
3. High-level disinfection or cold chemical sterilization: for semi-critical/critical instruments; for heat-sensitive devices, the final phase is cold chemical sterilization. Heat-resistant instruments are sterilized by autoclaving, but only after completing the cleaning and disinfection phases.

Classify instruments according to the Spaulding model:

• critical (penetrates tissues — mandatory sterilization);
• semi-critical (contact with mucous membranes — at least high-level disinfection);
• non-critical (contact with intact skin — cleaning and low/medium-level disinfection).

Document each cycle in the disinfection/sterilization register: date, time of solution preparation, operator, and cycle number.

Frequency of disinfecting toys and surfaces in a pediatric clinic: indicative model

Adapt the frequency to the patient flow and the season.

During periods of increased incidence of respiratory or digestive infections, increase the frequency for frequently touched surfaces. In epidemic season, toys in the waiting room can be disinfected 2–3 times per day, and those that cannot be cleaned properly should be temporarily removed.

Traceability: the cleaning and disinfection register

Traceability transforms the procedure into an auditable process. Maintain a daily-hourly chart for each room in which you record: type of operation, time, responsible person, disinfectant used, concentration, date of solution preparation, and contact time. The basic principle in sanitary auditing is "if it is not documented, it did not happen." A completed and signed register is the first element checked during a DSP control, alongside proof that the products used are approved as biocides and used according to the technical data sheet.