Are animals permitted in your facility? That question may be too simple. The Society for Healthcare Epidemiology of America (SHEA) issued a white paper1 that provides guidance for animal visitations in hospitals. The recommendations are stratified by the animal’s role: animal-assisted activities, service animal, research animal, and personal pet visitation.
The conundrum for the infection preventionist (IP) is whether to allow personal and therapy pets, which are good for the morale of patients and staff, while also keeping everyone safe. What makes this issue difficult is the paucity of scientific studies that address the potential risk of animal to human transmission of pathogens in the healthcare setting.
Nosocomial zoonotic outbreaks are rare since animals are often excluded from the hospital. However, methicillin-resistant Staphylococcus aureus (MRSA) has been described in cats, dogs, horses, and pigs, so animals could potentially act as sources of MRSA exposure in healthcare facilities.2 Many other pathogens have the potential to be transmitted from pets to people, such Clostridium difficile, multidrug-resistant enterococci, extended spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and common zoonotic pathogens such as Campylobacter or Salmonella (the APIC Text3 has a more inclusive list).
On the other hand, animals can provide comfort to patients, reduce stress, and even decrease blood pressure.4 One hospital where I worked developed a pet therapy program (dogs only) and it was amazing to see the change come over a patients’ faces when they saw and petted the dog. Some patients who did not want to get out of bed, would do so just to come over and touch the pet. The staff was equally excited to have the dog and his trainer make rounds. Each institution should evaluate their desire and commitment to provide a pet therapy program.
What is not optional in terms of allowing dogs access to the hospital is compliance with the American Disabilities Act (ADA). The ADA defines a service animal as a dog that is trained to do work or perform tasks for a person with a disability.5 Even if your facility does not want to implement a pet therapy program or allow a patient’s personal pet to visit, your facility will need to have a policy and procedure in place to accommodate a service animal. The updated SHEA recommendations are a good place to develop a policy, if you do not currently have one.
Other issues that must be addressed include record keeping and checking the pet. A multidisciplinary team should be formed to go through all of the SHEA and APIC recommendations and determine the person(s) and/or department responsible for collecting immunization records, and handler/pet training records, as well as deciding who will clean up after the pet if there is an accident, among other responsibilities.
There is a risk of transmitting a pathogen from the pet to patient, whether it is a therapy or service animal or the patient’s own pet, just as there is a risk of transmitting an organism from a person or piece of equipment to a patient. Policies and procedures implemented using SHEA’s recommendations, which were endorsed by the Association for Professionals in Infection Control and Epidemiology, will mitigate this possibility and provide the social benefits of interacting with a pet. More research is needed to ascertain if there is a serious risk of zoonotic disease transmission of MRSA, C. difficile, or other organisms to patients and healthcare workers in the healthcare setting.
Do you have an animal assisted therapy program? Do you allow personal pets? Any words of wisdom to share for those IPs starting a new program?
Rekha Murthy, Gonzalo Bearman, Sherrill Brown, Kristina Bryant, Raymond Chinn, Angela Hewlett, B. Glenn George, Ellie J.C. Goldstein, Galit Holzmann-Pazgal, Mark E. Rupp, Timothy Wiemken, J. Scott Weese and David J. Weber Animals in Healthcare Facilities: Recommendations to Minimize Potential Risks. Infection Control & Hospital Epidemiology, Available on CJO 2015 doi:10.1017/ice.2015.15.http://journals.cambridge.org/abstract_S0899823X1500015X
Weese JS, Caldwell F, Willey BM, et al. An outbreak of methicillin-resistant Staphylococcus aureus skin infections resulting from horse to human transmission in a veterinary hospital. Vet Microbiol 2006;114:160–164.
APIC Text. Chapter 122: Animals visiting in healthcare facilities. Retrieved from the internet September 28, 2015. http://text.apic.org/item-125/chapter-122-animals-visiting-in-healthcare-facilities/all
Wells DL. The effects of animals on human health and well-being. J Soc Issues 2009;65(3): 523-543.
U.S. Department of Justice, Civil Rights Division, Disability Rights Section. ADA Requirements, Service Animals. 2011. Retrieved from the Internet September 28, 2015: http://www.ada.gov/service_animals_2010.htm