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Should Fido follow the rules, too?


We all love our animal companions. But do they belong in the hospital, or are they a security risk?

Should Fido follow the rules, too?

We all love our animal companions. But do they belong in the hospital, or are they a security risk?

There will never be debate about the joy of creating a bond with a good companion animal, but let's face it, dogs and other creatures that humans choose to have as pets are not the cleanest creatures around.

With as many as 90% of U.S. hospitals saying they allow companion animals, therapy animals, research and service animals, or domestic animals through their doors, the question has arisen as to whether the practice is a security or infection control risk.

A study published in the March 2015 issue of the journal Infection Control and Hospital Epidemiology, the Society for Healthcare Epidemiology of America (SHEA) seeks to address this issue and offers guidelines for hospitals, many of which don't have written policies for pet animal visitations. At the same time, however, authors of the study stop short of a definitive ruling on whether animals should be allowed in the acute care hospital environment.

"Animals have had an increasing presence in healthcare facilities," said David Weber, MD, MPH, a lead author of the study. "While there may be benefits to patient care, the role of animals in the spread of bacteria is not well understood. We have developed standard infection prevention and control guidance to help protect patients and healthcare providers via animal-to-human transmission in healthcare settings."

SHEA pointed out in its findings that evidence of the role animals play in the transmission of pathogens in healthcare facilities is largely unknown, and so its recommendations were largely developed by consulting "available evidence, practical considerations, a survey of SHEA members, writing group opinion and consideration of potential harm where applicable."

So what does this mean for your facility? You're going to have to make your own judgment. On the one hand, hospitals are a sterile environment, and animals aren't well-known for good hand hygiene?a major hang-up for hospitals trying to cut down on infections. On the other, there's something to be said for the healing power of letting grandma's pooch visit when she's sick in the hospital. From a patient relations perspective, there aren't many hospitals that would argue against some animals being allowed inside. But some healthcare safety experts say a degree of caution is appropriate when deciding on a facility policy.

"There most definitely should be a level of infection control regarding animals within a hospital," says Charlene Sirowitz, nurse and safety expert with Summer Street Ambulatory Surgical Center in Stamford, Connecticut. "Dogs do not get cleaned after going to the bathroom, thus I am certain that if a culture stick were to be used there would be bacteria on their skin and fur. Thus, they enter a patient's room, sit on the floor, and something may drop, or a patient walks upon the floor and then goes back to bed with bacteria on the soles of either their feet and/or socks. That makes no sense to me; and they wonder why there is such an increase in hospital-acquired infections."

Others say that animals in the healthcare environment may not be such an infection control issue, but there should be some precaution taken regarding their unpredictable behavior.

"I am not sure that there is widespread evidence of transmission of animal infections to humans," says Ken Weinberg, BA, MSc, PhD, consultant in environmental health, safety, and toxicology for Safdoc Systems, LLC, in Stoughton, Massachusetts, and a former director of safety at Massachusetts General Hospital in Boston. "That being said, the only animals we ever allowed in the hospital were those that were trained to be companions for ill persons, not their pets from home who could pose a danger from biting or becoming violent in strange circumstances and whose owners, as much as they might protest, really don't have a clue."

Weinberg says that when considering whether to allow animals into the healthcare environment, hospitals should consider the need for the animal's presence, the animal's background, and its proximity to both the general population and other animals.

"I think from a safety perspective, untrained dogs?that is, dogs that are not specifically trained to work with and be around large groups of people and sick people?especially are not qualified to be allowed into healthcare facilities," he says. "These untrained dogs pose a safety risk to all involved. They could growl and bark and scare people, or worse yet, bite people. Also, what happens if there are two dogs present in the same space?"


So what should you do?

While SHEA may not have issued any specific recommendations about allowing animals in the hospital, the group has issued a set of guidelines that can be used when designing policies.

"There should be policies about who is allowed to bring a dog in, what professional training the dogs have received, and when dogs should be allowed," Weinberg says. "There also needs to be a sign-in policy. Some people, me included, think that some breeds should be disqualified from the start. Pit bulls, for example, are typically bred to be aggressive. Small dogs, like terriers, are typically jittery and bark a lot, and so on."

Check out the entire document of SHEA's suggestions as well as quick reference cards that you can print out to use when considering your own animal policy at http://eguideline.guidelinecentral.com/i/517746-animals-in-healthcare-facilities-shea. Also, for an example of what the U.S. government says should be included in an animal security policy, please see the checklist from the U.S. Department of Health and Human Services on p. 4.

SHEA's report suggests that facility policies address at least some of the following.

  • Animal-assisted activities. Facilities should develop a written policy for animal-assisted activities that sets forth the following requirements:
    • An animal-assisted activity visit liaison should be designated
    • Only dogs should be allowed to serve in animal-assisted activities, such as pet therapy
    • Animals and handlers should be formally trained and evaluated
    • Animal interaction areas should be determined in collaboration with an infection prevention and control team, and clinical staff should be educated about the program
    • Animal handlers must have all required immunizations, restrict contact of their animal to the patient(s) visited and prevent the animal from having contact with invasive devices, and require that everyone who touches the animal to practice hand hygiene before and after contact
    • The hospital should maintain a log of all animal-assisted activity visits, including rooms and persons visited for potential contact tracing
  • Service animals. SHEA recommends that any service animals allowed into the hospital should be compliant with the federal Americans with Disabilities Act and other applicable state and local regulations, and the hospital's policy should include a statement that only dogs and miniature horses are recognized as service animals under federal law.

If an inpatient has a service animal, your infection prevention team should be notified, followed by a discussion with the patient to make sure the owner of the service animal complies with institutional policies. Healthcare providers or staff may ask the patient or visitor to describe what work/tasks the dog performs for the patient, but may not ask for a "certification" or "papers."

  • Personal pet visitation. Pets should, in general, be prohibited from entering the healthcare facility, SHEA's report suggests.

Exceptions can be considered if the healthcare team determines that visitation with a pet would be of benefit to the patient and can be performed with limited risk. Even then, visitation should be restricted to dogs. The patient must perform hand hygiene immediately before and after contact with the animal.

If you are going to allow pets to visit, SHEA guidelines suggest that any dog visiting a hospital should be vaccinated against rabies, and animal handlers should have all required immunizations as well. Before entering the hospital, the dog should be combed to prevent dander and loose hair from being left in the facility.

In addition, the group suggests that when dogs visit the facility, patients who want to play with them shouldn't be allowed to eat or drink during the visit. In addition, patients should be required to wash their hands both before and after touching or petting a dog. To further minimize infection risk, handlers should keep dogs away from invasive medical devices, bandages, and body parts with damaged skin.

Cats shouldn't be allowed for various reasons, SHEA suggests: They typically can't be trained as well as dogs can, and they are more likely to bite and scratch humans than trained dogs are. Cat injuries also tend to spread more bacteria, and people are generally more likely to be allergic to cats than dogs.

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