Ball pits used children’s physical therapy â similar to those made popular by restaurants catering to families â 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.
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. “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 1 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;
- Acinetobacter lwofii, which has been reported to cause septicemia, pneumonia, meningitis, 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.”
Reference: “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 published in AJIC on Nov. 22, 2018.
Source: APIC
Stay prepared and protected with Infection Control Today's newsletter, delivering essential updates, best practices, and expert insights for infection preventionists.
Reducing Hidden Risks: Why Sharps Injuries Still Go Unreported
July 18th 2025Despite being a well-known occupational hazard, sharps injuries continue to occur in health care facilities and are often underreported, underestimated, and inadequately addressed. A recent interview with sharps safety advocate Amanda Heitman, BSN, RN, CNOR, a perioperative educational consultant, reveals why change is overdue and what new tools and guidance can help.
New Study Explores Oral Vancomycin to Prevent C difficile Recurrence, But Questions Remain
July 17th 2025A new clinical trial explores the use of low-dose oral vancomycin to prevent Clostridioides difficile recurrence in high-risk patients taking antibiotics. While the data suggest a possible benefit, the findings stop short of statistical significance and raise red flags about vancomycin-resistant Enterococcus (VRE), underscoring the delicate balance between prevention and antimicrobial stewardship.
What Lies Beneath: Why Borescopes Are Essential for Verifying Surgical Instrument Cleanliness
July 16th 2025Despite their smooth, polished exteriors, surgical instruments often harbor dangerous contaminants deep inside their lumens. At the HSPA25 and APIC25 conferences, Cori L. Ofstead, MSPH, and her colleagues revealed why borescopes are an indispensable tool for sterile processing teams, offering the only reliable way to verify internal cleanliness and improve sterile processing effectiveness to prevent patient harm.
The Next Frontier in Infection Control: AI-Driven Operating Rooms
Published: July 15th 2025 | Updated: July 15th 2025Discover how AI-powered sensors, smart surveillance, and advanced analytics are revolutionizing infection prevention in the OR. Herman DeBoard, PhD, discusses how these technologies safeguard sterile fields, reduce SSIs, and help hospitals balance operational efficiency with patient safety.
Targeting Uncertainty: Why Pregnancy May Be the Best Time to Build Vaccine Confidence
July 15th 2025New national survey data reveal high uncertainty among pregnant individuals—especially first-time parents—about vaccinating their future children, underscoring the value of proactive engagement to strengthen infection prevention.