Monday, December 03, 2018 Study: Clinic Ball Pits Carry Bacterial Risks It's no secret that when it comes to their potential for bacterial awfulness, the children's ball pits often found in fast food restaurants are the stuff of a germaphobe's nightmares. Now it turns out that if not properly maintained, ball pits in physical therapy clinics are capable of inducing shudders too. In a study recently published in the American Journal of Infection Control (abstract only available for free), researchers tested 6 ball pits in inpatient and outpatient physical therapy clinics in Georgia to find out what, if anything, those pits were harboring at a microbial level. Authors hope that the study will help to spark a conversation about standards for cleaning the enclosures—standards that they say have remained "elusive" to date. To conduct the analysis, researchers collected 9 to 15 balls taken from different depths in each ball pit, and then swabbed the entire surface of each ball. Samples were then inoculated on agar plates and allowed to grow for 24 hours at 91.4 degrees Fahrenheit. After the incubation, samples were tested for the number of colony-forming units (CFUS) present. Here's what researchers found: Researchers identified 31 bacterial species and 1 species of yeast, with 9 organisms identified as "opportunistic pathogens." These organisms included bacteria associated with endocarditis, septicemia, urinary tract infections, meningitis, respiratory distress syndrome, streptococcal shock, and skin infections. The variety of yeast found on the balls—rhodotorula mucilaginosa—has "a high affinity for plastics" and has been associated with "multiple cases of fungemia in immunocompromised individuals," authors write. There was "considerable variability" among the clinics, ranging from 36% to 93% of balls tested that produced recoverable CFUs, suggesting that clinics "utilize different protocols" for maintaining their ball pits, according to authors. In the worst instance, bacterial colonization was found at the rate of "thousands of cells per ball, which clearly demonstrates an increased potential for transmission of these organisms to patients and the possibility of infection in these exposed individuals," authors write. Lead author and APTA member Mary Ellen Oesterle, PT, EdD, says the results should give clinics pause. "Clinics should be concerned about these findings," Oesterle said in an interview with PT in Motion News. "I would not recommend using a ball pit in a clinic until proper cleaning has occurred—and until the clinic verifies that the cleaning procedure effectively cleans the balls." Oesterle wasn't necessarily surprised by the findings, both in terms of the presence of pathogens and the variability among clinics. "In my own experience doing early intervention physical therapy for over 10 years, I encountered children who I suspected had contracted infections from ball pits, so this study confirmed something that rang true," Oesterle said. "The variability isn't surprising either," she added. "Each facility has different exposures, environments, and cleaning procedures, so I would expect the results to reflect that." And although concerning, Oesterle believes the problem is a solvable one. "I don't think it would be that difficult for clinics to reduce risk significantly," Oesterle said. "There are several approaches that may work well—for example, one clinic hangs balls in a mesh bag and disinfects them that way. We would like to do a follow-up study on the best cleaning method." Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.