Journal Citation
Hardin P, Brown J, Wright ME. Prevention of transmitted infections in a pet therapy program: An exemplar. Am J Infect Control. 2016 Jul 1;44(7):846-50.
Published Abstract
The focus of the patient experience in health care delivery has afforded the opportunity to integrate pet therapy as a part of patient care. The purpose of this article is to present the implementation of a pet therapy program that includes guidelines for the prevention of transmitted infections. Consideration of infection prevention strategies has resulted in a 16-year program with no documented incidences of transmitted infections, averaging 20,000 pet therapy interactions per year.
Context
Transmission of infections from animals to humans (zoonoses) poses a risk for patients exposed to service and companion animals. The risks rise dramatically when those patients suffer from immunocompromising illnesses, and rises further when the animals are brought into institutions housing other immunocompromised patients, even though they themselves may not participate directly in the animal companion or service program. Therefore, those entertaining the idea of pet therapy in a medical facility must be cognizant of these risks, and implement policies that minimize them.
The Society for Healthcare Epidemiology of America (SHEA) issued guidelines to that effect in 2015. The purpose of the present study was to explore and share the experience of a large pet therapy program that had no transmissions of infection over its 16-year history.
The authors reviewed individual aspects of their pet therapy program (the Pet Therapy Team, preparation of handlers and dogs, policy planning, individual visit process), and then compared their practices with the SHEA guidelines.
Findings
The Pet Therapy Team was interdisciplinary, comprised of veterinarians, infection control staff, physicians, child life specialists, volunteer services, risk management, security and safety officers, and administrators. This interdisciplinary team enacted policies and procedures, in consultation with the existing literature and with pet therapy centers already in operation.
Handler-dog teams must comply with strict requirements set by the facility and by regional and national agencies. The handler-dog team must be registered with either Pet Partners or Therapy Dog Inc, (national animal human bond registration organizations), and the handler must pass an online course and in-person interview by a licensed evaluator. Only then is the human-dog team able to apply for facility privileges. Handler-dog teams applying to the hospital were evaluated through a rigorous set of interviews, background checks and orientations, and then the handler was required to shadow an experienced team before bringing their own dog into the facility. Immunization records were checked and maintained for both the handlers and the dogs. Both were required to wear identification badges while working, and to follow their respective behavior and dress code that included grooming prior to their visits.
In order to receive pet therapy, patients’ physicians had to issue an order (prescription) after evaluating the patient for infection risk, which included not only an assessment of their immunological status but also of their pre-or post-surgical status, existing wounds, pet allergies, and the like. At least one member of the Pet Therapy Team also was required to evaluate the patient and give approval. Infection risk was re-evaluated throughout the course of therapy, in case of relevant changes in patient status (i.e. surgical intervention or depressed white blood cell count as a result of chemotherapy).
Pet therapy visits were also highly orchestrated affairs. Treatments were conducted in specific designated areas of the hospital, and each handler-dog team had specific areas and times assigned for their visits. Pet therapy visits began with the patient meeting a program “leash-less volunteer” at the treatment site, at which time the volunteer would review the program and consent the patient. The leash-less volunteer would then go to the hospital lobby to meet the handler-dog team, and escort the team to the treatment area or patient room. Clean sheets were placed on the bed or lap prior to the dog’s visit. Alcohol-based hand hygiene solution was used to clean hands before and after petting the dogs. After the visit, the sheet was folded carefully and placed with the dirty linen. Environmental Services followed up to clean the entire area after each animal visit.
This program began with one ward (pediatrics) and grew over the next 16 years to include 28 areas of the hospital. Despite an average of 20,000 contacts per year (counting patients, handlers and staff), not a single infection has been transmitted as a result of this pet therapy program.
Discussion
The authors have reviewed the infection control elements of their pet therapy program in an effort to share their knowledge and experience. They have also provided a table listing the SHEA recommendations alongside their programmatic elements that address those recommendations. This table is very effective in communicating in a concrete way how the recommendations can be put into practice. Overall, the have contributed a useful and inspiring publication to the pet therapy literature.
In reviewing the extreme policies and procedures used by this facility to minimize the risk of infection, some might argue that not all of those procedures are necessary. However, I would remind such opponents that even a single infection could be devastating, and could result in significant health costs and/or financial costs. Those costs far outweigh the costs of all of the time-consuming interventions described. Indeed, the financial and legal costs would be even greater if every manageable effort to prevent such an infection were not taken. This publication gives us all an “exemplar” to inspire us and to guide us in how to best implement pet therapy.
-Reviewed by Ronald Sherman, MD