Animals in Healthcare Facilities: Recommendations to Minimize Potential Risks

Animals may be present in healthcare facilities for multiple reasons. Although specific laws regarding the use of service animals in public facilities were established in the United States in 1990, the widespread presence of animals in hospitals, including service animals to assist in patient therapy and research, has resulted in the increased presence of animals in acute care hospitals and ambulatory medical settings. The role of animals in the transmission of zoonotic pathogens and cross-transmission of human pathogens in these settings remains poorly studied. Until more definitive information is available, priority should be placed on patient and healthcare provider safety, and the use of standard infection prevention and control measures to prevent animal-to-human transmission in healthcare settings. This paper aims to provide general guidance to the medical community regarding the management of animals in healthcare (AHC). The manuscript has four major goals:

[1]  G. Mathisen,et al.  Mycobacterium marinum infection in a patient with cryptosporidiosis and the acquired immunodeficiency syndrome. , 1988, Cutis.

[2]  S. Tyring,et al.  Tropical dermatology: marine and aquatic dermatology. , 2009, Journal of the American Academy of Dermatology.

[3]  Samantha Abate,et al.  Impact of Canine-Assisted Ambulation on Hospitalized Chronic Heart Failure Patients' Ambulation Outcomes and Satisfaction: A Pilot Study , 2011, The Journal of cardiovascular nursing.

[4]  Yoshiteru Mutoh,et al.  Effectiveness of animal-assisted therapy: A systematic review of randomized controlled trials. , 2014, Complementary therapies in medicine.

[5]  Y. Barak,et al.  Animal-assisted therapy for elderly schizophrenic patients: a one-year controlled trial. , 2001, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[6]  M. Alkan,et al.  Nosocomial Dermatophytosis Caused by Microsporum canis in a Newborn Department , 1986, Infection Control.

[7]  J. Bender,et al.  Compendium of measures to prevent disease associated with animals in public settings, 2011: National Association of State Public Health Veterinarians, Inc. , 2011, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[8]  Carol Haertlein Sells,et al.  The effects of animal-assisted therapy on wounded warriors in an Occupational Therapy Life Skills program. , 2012, U.S. Army Medical Department journal.

[9]  D. Morgan,et al.  The Expanding Role of the Hospital Epidemiologist in 2014: A Survey of the Society for Hospital Epidemiology of America (SHEA) Research Network , 2015, Infection Control & Hospital Epidemiology.

[10]  S. Ichiyama,et al.  Infection by Chlamydophilia avium in an Elderly Couple Working in a Pet Shop , 2005, Journal of Clinical Microbiology.

[11]  R. Snider,et al.  The ringworm riddle: an outbreak of Microsporum canis in the nursery. , 1993, The Pediatric infectious disease journal.

[12]  L. Sehulster,et al.  Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). , 2003, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[13]  G. Angelini,et al.  Aquarium-borne Mycobacterium marinum skin infection. Report of 15 cases and review of the literature. , 2013, European journal of dermatology : EJD.

[14]  J. S. Henning,et al.  Subcutaneous nodules with sporotrichoid spread. , 2009, Dermatology online journal.

[15]  E. Friedmann,et al.  The human-companion animal bond: how humans benefit. , 2009, The Veterinary clinics of North America. Small animal practice.

[16]  G. Leung,et al.  Maggot debridement therapy in chronic wound care. , 2007, Hong Kong medical journal = Xianggang yi xue za zhi.

[17]  J. Weese,et al.  Guidelines for animal-assisted interventions in health care facilities. , 2008, American journal of infection control.

[18]  J. Malone,et al.  The use of medicinal leeches in the salvage of flaps with venous congestion. , 1992, Annals of plastic surgery.

[19]  T. A. O. Cardoso,et al.  Viral infections in workers in hospital and research laboratory settings: a comparative review of infection modes and respective biosafety aspects , 2011, International Journal of Infectious Diseases.

[20]  L. Lehane,et al.  Topically acquired bacterial zoonoses from fish: a review , 2000, The Medical journal of Australia.

[21]  R. Aly.  Ecology and epidemiology of dermatophyte infections. , 1994, Journal of the American Academy of Dermatology.

[22]  G. Fisher,et al.  Resident and therapist views of animal-assisted therapy: Implications for occupational therapy practice , 2005 .

[23]  D. Marcus.  The Science Behind Animal-Assisted Therapy , 2013, Current Pain and Headache Reports.

[24]  M. Wax,et al.  Vibrio fluvialis wound infection associated with medicinal leech therapy. , 1996, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[25]  M. Wells,et al.  The medical leech: An old treatment revisited , 1993, Microsurgery.

[26]  F. Biley,et al.  An exploration of the potential benefits of pet-facilitated therapy. , 1999, Journal of clinical nursing.

[27]  H. Richet,et al.  A cluster of Rhodococcus (Gordona) Bronchialis sternal-wound infections after coronary-artery bypass surgery. , 1991, The New England journal of medicine.

[28]  F. Morinet,et al.  Erythroid hypoplasia due to chronic infection with parvovirus B19. , 1990, The New England journal of medicine.

[29]  K. Dawson,et al.  The effects of animal-assisted therapy on anxiety ratings of hospitalized psychiatric patients. , 1998, Psychiatric services.

[30]  V. Temper,et al.  Elimination of symbiotic Aeromonas spp. from the intestinal tract of the medicinal leech, Hirudo medicinalis, using ciprofloxacin feeding. , 2010, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[31]  G. L. White,et al.  Atypical mycobacterial infection caused by Mycobacterium marinum. , 1990, The New England journal of medicine.

[32]  J. Gerber,et al.  Staphylococcus aureus Bacteremia in Hospitalized Children: Incidence and Outcomes , 2015, Infection Control & Hospital Epidemiology.

[33]  C. Hanish,et al.  “Bringing Down the Flag”: Removing the Contact Precautions Label for Non-hospitalized Patients with Prior Methicillin-Resistant Staphylococcus aureus Infection or Colonization , 2015, Infection Control & Hospital Epidemiology.

[34]  D. Willis.  Animal therapy. , 1997, Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses.

[35]  S. Pitlik,et al.  Aquarium-borne Mycobacterium marinum skin infection. Report of a case and review of the literature. , 1986 .

[36]  G. Levine,et al.  Pet Ownership and Cardiovascular Risk: A Scientific Statement From the American Heart Association , 2013, Circulation.

[37]  S. Frangos,et al.  Aeromonas septicemia after medicinal leech use following replantation of severed digits. , 2010, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[38]  J. Serpell,et al.  Animal Companions and Human Well-Being: An Historical Exploration of the Value of Human—Animal Relationships , 2000 .

[39]  A. Peregrine,et al.  Prevalence of zoonotic agents in dogs visiting hospitalized people in Ontario: implications for infection control. , 2006, The Journal of hospital infection.

[40]  I. Fagerberg,et al.  Can therapy dogs evoke awareness of one's past and present life in persons with Alzheimer's disease? , 2015, International journal of older people nursing.

[41]  William A Banks,et al.  The effects of animal-assisted therapy on loneliness in an elderly population in long-term care facilities. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[42]  Dabb Rw,et al.  The use of medicinal leeches in the salvage of flaps with venous congestion. , 1992 .

[43]  C. N. Stewart,et al.  Animal-Assisted Activity: Effects of a Complementary Intervention Program on Psychological and Physiological Variables , 2014, Journal of evidence-based complementary & alternative medicine.

[44]  M. Alfa.  Intra-cavitary Ultrasound Probes: Cleaning and High-Level Disinfection Are Necessary for Both the Probe Head and Handle to Reduce the Risk of Infection Transmission , 2015, Infection Control & Hospital Epidemiology.

[45]  J. Anthony,et al.  Aeromonas hydrophila Infections Following Use of Medicinal Leeches in Replantation and Flap Surgery , 1992, Annals of plastic surgery.

[46]  N. Eldridge,et al.  Healthcare-Associated Myiasis: Prevention and Intervention , 2005, Infection Control & Hospital Epidemiology.

[47]  N. Garrett,et al.  US Outbreak of Human Salmonella Infections Associated With Aquatic Frogs, 2008–2011 , 2013, Pediatrics.

[48]  A. Gawlinski,et al.  Animal-assisted therapy in patients hospitalized with heart failure. , 2007, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[49]  M. Drancourt,et al.  Nosocomial Infections with Aeromonas hydrophila from Leeches. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[50]  Notes from the field: outbreak of salmonellosis associated with pet turtle exposures--United States, 2011. , 2012, MMWR. Morbidity and mortality weekly report.

[51]  B. Ljungberg,et al.  Failure of doxycycline treatment in aquarium-associated Mycobacterium marinum infections. , 1987, Scandinavian journal of infectious diseases.

[52]  D. Ashford,et al.  An epidemic of Malassezia pachydermatis in an intensive care nursery associated with colonization of health care workers' pet dogs. , 1998, The New England journal of medicine.

[53]  W. Snelling,et al.  Zoonoses associated with petting farms and open zoos. , 2008, Vector borne and zoonotic diseases.

[54]  G. Guyatt,et al.  GRADE: an emerging consensus on rating quality of evidence and strength of recommendations , 2008, BMJ : British Medical Journal.

[55]  L. G. Lukin.  Human cutaneous myiasis in Brisbane: a prospective study , 1989, The Medical journal of Australia.

[56]  F. Vecchini,et al.  Sporothricoid mycobacterial infection. A case report. , 1993, Acta dermato-venereologica.

[57]  J. Weese,et al.  Incidence of acquisition of methicillin-resistant Staphylococcus aureus, Clostridium difficile, and other health-care-associated pathogens by dogs that participate in animal-assisted interventions. , 2009, Journal of the American Veterinary Medical Association.

[58]  V. Fa.  The use of medicinal leeches in microsurgery. , 1991 .

[59]  W. Lineaweaver.  Aeromonas hydrophila infections following clinical use of medicinal leeches: a review of published cases. , 1991, Blood Coagulation and Fibrinolysis.

[60]  Cheng-I Chu,et al.  The effect of animal-assisted activity on inpatients with schizophrenia. , 2009, Journal of psychosocial nursing and mental health services.

[61]  I. Gordon,et al.  An outbreak of Legionnaires’ disease at the Melbourne Aquarium, April 2000: investigation and case–control studies , 2004, The Medical journal of Australia.

[62]  S. Antony,et al.  Acute infection of a total knee arthroplasty caused by Pasteurella multocida: a case report and a comprehensive review of the literature in the last 10 years. , 2010, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[63]  B. Cairns,et al.  Rates of Hospital-Associated Respiratory Infections and Associated Pathogens in a Regional Burn Center, 2008–2012 , 2015, Infection Control & Hospital Epidemiology.

[64]  Jennifer Jorgenson,et al.  Therapeutic use of companion animals in health care. , 1997, Image--the journal of nursing scholarship.

[65]  D. Rimland,et al.  Longitudinal Evaluation of Clinical and Colonization Methicillin-Resistant Staphylococcus aureus Isolates Among Veterans , 2015, Infection Control & Hospital Epidemiology.

[66]  E. Goldstein,et al.  Microbiology of Animal Bite Wound Infections , 2011, Clinical Microbiology Reviews.

[67]  D. De Ronchi,et al.  Pet therapy in elderly patients with mental illness , 2011, Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society.

[68]  G. Gerber,et al.  Defining the role of pet animals in psychotherapy. , 1990, Psychiatric journal of the University of Ottawa : Revue de psychiatrie de l'Universite d'Ottawa.

[69]  W. Lineaweaver,et al.  Clinical leech use in a microsurgical unit: the San Francisco experience. , 1991, Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.

[70]  N. Marano,et al.  Exposure to nontraditional pets at home and to animals in public settings: risks to children. , 2008, Pediatrics.

[71]  A. Sundsfjord,et al.  [Maggot therapy in wound management]. , 2009, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[72]  S. Barker,et al.  Effects of Animal-Assisted Therapy on Patients' Anxiety, Fear, and Depression Before ECT , 2003, The journal of ECT.

[73]  E. Julian,et al.  An epidemic of resistant Salmonella in a nursery. Animal-to-human spread. , 1980, JAMA.

[74]  N. Edwards,et al.  Influence of Aquariums on Resident Behavior and Staff Satisfaction in Dementia Units , 2014, Western journal of nursing research.

[75]  B. Wilson,et al.  Pasteurella multocida: from Zoonosis to Cellular Microbiology , 2013, Clinical Microbiology Reviews.

[76]  W. Lineaweaver,et al.  Postprandial Aeromonas hydrophila Cultures and Antibiotic Levels of Enteric Aspirates from Medicinal Leeches Applied to Patients Receiving Antibiotics , 1992, Annals of plastic surgery.

[77]  S. Leroy,et al.  Reducing Transmission Risk Through High-Level Disinfection of Transvaginal Ultrasound Transducer Handles , 2015, Infection Control & Hospital Epidemiology.

[78]  J. Weese,et al.  An outbreak of methicillin-resistant Staphylococcus aureus skin infections resulting from horse to human transmission in a veterinary hospital. , 2006, Veterinary microbiology.

[79]  H. Woolfson,et al.  Fish tank granuloma. , 1976, The British journal of clinical practice.

[80]  D. Mak,et al.  Adverse Events Following Influenza Immunization Reported by Healthcare Personnel Using Active Surveillance Based on Text Messages , 2015, Infection Control & Hospital Epidemiology.

[81]  N. Edwards,et al.  Animal-Assisted Therapy and Nutrition in Alzheimer’s Disease , 2002, Western journal of nursing research.

[82]  R. Oehler,et al.  Bite-related and septic syndromes caused by cats and dogs. , 2009, The Lancet. Infectious diseases.

[83]  D. Pritchard,et al.  Maximising the secondary beneficial effects of larval debridement therapy. , 2013, Journal of wound care.

[84]  D. Johnson,et al.  Diagnosis and management of human B virus (Herpesvirus simiae) infections in Michigan. , 1994, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[85]  G. Scott,et al.  Cross-infection between animals and man: possible feline transmission of Staphylococcus aureus infection in humans? , 1988, The Journal of hospital infection.

[86]  M. Schleiss,et al.  Facial sporotrichoid infection with Mycobacterium marinum. , 1997, The Journal of pediatrics.

[87]  D. T. Allen,et al.  Effects of dogs on human health. , 1997, Journal of the American Veterinary Medical Association.

[88]  S. A. Shulman,et al.  Reports of zoonotic disease outbreaks associated with animal exhibits and availability of recommendations for preventing zoonotic disease transmission from animals to people in such settings. , 2004, Journal of the American Veterinary Medical Association.

[89]  J. Estavoyer,et al.  [Mycobacterium marinum infection]. , 1990, Annales de medecine interne.

[90]  L. C. Anderson,et al.  Rat-bite fever in animal research laboratory personnel. , 1983, Laboratory animal science.

[91]  E. Sobo,et al.  Parent-identified barriers to pediatric health care: a process-oriented model. , 2006, Health services research.