Pediatric Waiting Rooms: A Haven for Germs

A recent study presented at a joint meeting of the American Society for Microbiology and the Infectious Diseases Society of America confirmed what parents have long suspected—toys in the pediatrician’s waiting room could be exposing children to cold viruses. One in five of the toys sampled tested positive for rhinoviruses or influenza B, according to the researchers. And even more concerning is that cleaning the toys provided only modest germ-killing effect.
For the study, Dr. Diana Pappas, of the University of Virginia Children’s Hospital and her colleagues took 20 swab samples from toys in a four-pediatrician office on three different occasions during the fall and winter of 2006 and 2007. They tested for viruses common at the given time of year; rhinovirus in October, January and March, respiratory syncytial virus in January, and influenza A and B in March. They also collected 15 swabs from the toys in the sick waiting area before and after they were cleaned.
Using polymerase chain reaction (PCR), the researchers found viral RNA on 12 of the 60 toys sampled, three of which were from a “new toy grab bag,” that had been searched through by many children while selecting a toy. Six of the toys from the sick-child waiting area were contaminated with virus and two contaminated toys came from the well-child waiting room. Toys from exam rooms were not found to have viral RNA on them.
Although nurses wiped down the toys twice a week using germicidal wipes, six of the 14 toys tested before cleaning had rhinovirus RNA and four of the toys still did after cleaning. Two toys that were not contaminated before cleaning became contaminated afterwards. “Cleaning the toys per office protocol with a commercially available disinfectant cloth only minimally decreased the presence of viral remnants, from 40 to 26 percent,” said Dr. Pappas. “What was really discouraging was that two toys that tested negative before they were cleaned were positive afterward. We don’t know how, but the virus is somehow being transferred.” She also cautioned that the presence of viral RNA does not necessarily mean the toys are infectious.
Parents who are concerned about germs in the pediatrician’s office also need to be worried about them at home or on play dates, according to a separate study by Owen Hendley, M.D., also of University of Virginia Children’s Hospital and a researcher on both studies. Dr. Hendley was involved in a study two years ago that showed cold viruses could linger on surfaces in hotel rooms for 24 hours after an infected guest leaves, waiting to be picked up by the next unsuspecting guest. His new study involved 30 adults who were beginning to show signs of the common cold. Nasal secretions from 16 of the participants tested positive for rhinovirus by PCR, but rhinovirus was detected via culture in just seven of them.
The sixteen who had tested positive were then asked to identify 10 places in their homes they had touched in the preceding 18 hours, which the researchers subsequently tested for the presence of rhinovirus. Of the 160 surfaces sampled, 66 (41 percent) tested positive. The most commonly infected surfaces included door knob (6 of 18), refrigerator door handles (8 of 14), television remotes (5 of 10), and bathroom faucets (8 of 10). However, the biggest germ hotspots turned out to be salt and pepper shakers; all three tested were positive.
Dr. Hendley also wanted to know whether an infectious virus could be transferred to fingertips, where it could then make its way to the mouth or nose and cause infection. To find out, the researchers asked six of the infected participants to flip a light switch, touch a number on the phone keypad, and hold a telephone handset—all of which had been contaminated with the participants’ own mucus. An hour after they touched the surfaces, 22 percent of the samples taken from the fingertips contained rhinovirus. However, after a day, the number fell dramatically to just 3 percent, and after two days, there were no traces of rhinovirus detected. “I was pretty happy that the infectivity of the virus decays over time,” said Dr. Hendley. “But if you come home and turn on a light switch that (a cold sufferer) just shut off, you’ll have a pretty good chance of catching it.”
The researchers say there is no evidence to support that wiping down household surfaces gets rid of rhinovirus. Their recommendation for protecting yourself from infection is the same advice that has been passed down for generations: wash your hands frequently during cold and flu season, especially before touching your eyes or mouth