Safety first when dogs visit pa­tients

Modern Healthcare - - BEST PRACTICES - By Mau­reen McKin­ney

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 in­fec­tion­pre­ven­tion staff and which ar­eas of the hos­pi­tal should be off-lim­its to four­legged 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 im­muno­com­pro­mised 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.”

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