Infection control experts outline guidance for animal visitations in hospitals

New expert guidance by the Society for Healthcare Epidemiology of America (SHEA) outlines recommendations for developing policies regarding the use of animals in healthcare facilities, including animal-assisted activities, service animals, research animals and personal pet visitation in acute care hospitals. The guidance was published online in Infection Control & Hospital Epidemiology.

"Animals have had an increasing presence in healthcare facilities," said David Weber, MD, MPH, a lead author of the recommendations. "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."

Since evidence on the role animals play in the transmission of pathogens in healthcare facilities is largely unknown, the SHEA Guidelines Committee comprised of experts in infection control and prevention developed the recommendations based on available evidence, practical considerations, a survey of SHEA members, writing group opinion and consideration of potential harm where applicable. The guidance was also endorsed by the Association for Professionals in Infection Control and Epidemiology (APIC), a professional association of more than 15,000 infection preventionists.

Guidance is grouped by the role of animals - animal-assisted activities (i.e., pet therapy and volunteer programs), service animals, research animals and personal pet visitation. Select recommendations are highlighted below.

Animal-Assisted Activities

• Facilities should develop a written policy for animal-assisted activities. An animal-assisted activity visit liaison should be designated.
• Allow only dogs 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 the 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 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 activities visits including rooms and persons visited for potential contact tracing.

Service Animals

• The policy allowing service animals of patients and visitors into the facility should be compliant with the Federal Americans for Disability Act (ADA), other applicable state and local regulations and include a statement that only dogs and miniature horses are recognized as Service Animals under federal law.
• If an inpatient has a service animal, notification should be made to the Infection Prevention and Control Team, followed by 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.
• 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.

The authors note that as the role of animals in healthcare evolves, there is a need for stronger research to establish evidence-based guidelines to manage the risk to patients and healthcare providers.

This guidance on animals in healthcare facilities has been endorsed by the Association for Professionals in Infection Control and Epidemiology (APIC), the leading professional association for infection preventionists with more than 15,000 members.