Best Practices: Safety first when dogs visit patients

For a hospitalized patient, a visit from a furry companion can raise flagging spirits, reduce anxiety and depression, improve cooperation with treatment, and even lessen pain.

While nearly 90% of U.S. hospitals say they allow animal therapy or animal visits in their facilities, there's little concrete data available about the associated health risks, including the potential for infection. Many hospitals lack any formal policy governing animal visits in their facilities.

“There are many things for which we have scientific data and clear-cut guidelines,” said Dr. Rekha Murthy, medical director of the hospital epidemiology department at Cedars-Sinai Medical Center in Los Angeles. “This isn't one of those areas.”

To fill that gap, Murthy and her colleagues recently released a set of recommendations aimed at reducing the health risks associated with animals in healthcare facilities.

Murthy acknowledged that the chance of infection is probably small, but she pointed to anecdotal reports of animals linked to hospital outbreaks of Methicillin-resistant Staphylococcus aureus, or MRSA, and Clostridium difficile. “As we have sicker and sicker patients, we need do everything we can to identify ways to mitigate those risks,” she said.

Their suggestions cover the types of animals that should be allowed in hospitals, how animals should be trained and screened, the role of infection-prevention staff and which areas of the hospital should be off-limits to four-legged visitors.

For instance, they recommend that hospitals allow only dogs in their visiting and therapy programs, though some facilities permit cats and even miniature horses. Cats should be kept out of the hospital because they can't be reliably trained and are more likely to bite and scratch, they said.

They also advise hospitals to develop written policies for animal-assisted activities, document all animal visits to track outcomes, and keep animals out of high-risk areas such as operating rooms and newborn nurseries, they said.

In addition, dog handlers should be well-trained in hospital infection-control practices, Murthy and her colleagues said. That includes making sure animals are kept away from patients' catheter insertion sites, bandages and medical devices. And it means watching carefully to see whether hand hygiene protocols are being followed.

The recommendations, which appeared in the March issue of the journal Infection Control & Hospital Epidemiology, are based on a review of available data and a survey of several hundred members of the Society for Healthcare Epidemiology of America. They are not formal guidelines because there's not yet enough evidence-based literature available.

“In the absence of hard and fast data, we provided practical recommendations based on the consensus of experts,” Murthy said. “Our intention was to give hospitals guidance they could use while also making their own judgments.”

Phoenix Children's Hospital allows for just that kind of flexibility, said Mary Lou Jennings, coordinator of its animal-assisted therapy program. The hospital has a stringent policy, developed with the infection-control staff, that's designed to keep interactions between dogs and the hospital's pediatric patients safe. “We're constantly hand sanitizing,” she said. “Before and after anyone pets a dog, they have to do it. It's not a question.”

The hospital's 53 volunteer dog handlers also are trained to comply with contact precautions and use sheets or towels laid across patients' laps or on their beds as a barrier between the dog and the patient.

The hospital makes exceptions to its policies if the benefits outweigh the risks, Jennings said. For instance, handlers and their dogs as a rule don't visit patients in any form of isolation. But for a young patient who is immuno-compromised and severely depressed and whose recovery is not progressing, a visit from a dog can make a tremendous difference.

In a case like that, the therapy team will follow a special set of rules—ensuring no one but the handler touches the dog before the visit, requiring the use of gowns and masks, and conducting the visit in an enclosed patio with cross-ventilation.

“A visit with a dog can do so much to elevate mood and help them put up with their treatment,” Jennings said. “It's really amazing.”