Animals in Healthcare Facilities: Recommendations to Minimize Potential Risks

Probably not a substantial claim. The paper may give no reason why it holds.

Little published literature exists on the management of animals in healthcare.

“Although little published literature exists on this topic, we provide guidance on the management of AHC in four categories: animal-assisted activities, service animals, research animals, and personal pet visitation.”

Probably not a substantial claim. The paper may give no reason why it holds.

The role of animals in the transmission of zoonotic pathogens and cross-transmission of human pathogens in healthcare settings remains poorly studied.

“The role of animals in the transmission of zoonotic pathogens and cross-transmission of human pathogens in these settings remains poorly studied.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

In general, service animals were prohibited from drinking out of public water areas, from having contact with persons with non-intact skin, and being kept overnight.

“In general, service animals were prohibited from drinking out of public water areas (eg, toilets, sinks), from having contact with persons with non-intact skin, and being kept overnight.”

It may state two separate claims as one.

All facilities (279) that permitted animal-assisted activities allowed dogs, with 21% of facilities also allowing cats, 5% allowing miniature horses, and 2% allowing primates.

“All facilities (279) that permitted animal-assisted activities allowed dogs, with 21% of facilities also allowing cats, 5% allowing miniature horses, and 2% allowing primates.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Only one-third of the policies discussed research animals.

“Only one-third of the policies discussed research animals.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Most policies defined an animal-assisted activities animal as a personal pet that, with its owner or handler, provides comfort to patients in healthcare facilities.

“Most policies defined an animal-assisted activities animal as a personal pet that, with its owner or handler, provides comfort to patients in healthcare facilities.”

It may state two separate claims as one.

Most policies mentioned that service animals are not pets, and a few institutions specified that comfort and companionship animals are not service animals.

“Most policies mentioned that service animals are not pets, and a few institutions specified that comfort and companionship animals are not service animals.”

Probably not a substantial claim.

The topic of animals in healthcare lacks the level of evidence required for a more formal guideline using GRADE or a similar system.

“Because this topic lacks the level of evidence required for a more formal guideline using the GRADE 10 or a similar system for quantitating scientific papers, no grading of the evidence level is provided for individual recommendations.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

In general, animal-assisted activities animals were required to be >1-2 years of age, be fed a fully cooked diet for the preceding 90 days, not be in estrus, have lived with their owner in a residence for >6 months, and be housebroken, well mannered, obedient, easily controlled by voice command, and restrained by a short (4-6 feet) leash or lead.

“In general, animal-assisted activities animals were required to be >1-2 years of age, be fed a fully cooked diet for the preceding 90 days, not be in estrus, have lived with their owner in a residence for >6 months, and be housebroken, well mannered, obedient, easily controlled by voice command, and restrained by a short (4-6 feet) leash or lead.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

Requirements of service animals consistently included up-to-date vaccinations and certification of good health, and that service animals are required to be housebroken and under the control of the handler at all times, usually with a leash.

“Requirements of service animals consistently included up-to-date vaccinations and certification of good health, and that service animals are required to be housebroken and under the control of the handler at all times, usually with a leash.”

Probably not a substantial claim. It may state two separate claims as one.

The authors reviewed and compared hospital policies submitted from various institutions and summarized policies and procedures submitted by 23 healthcare facilities.

“We reviewed and compared hospital policies that were submitted from various institutions by the writing group and members of the SHEA Guidelines Committee and summarized the policies and procedures submitted by 23 healthcare facilities.”

It may state two separate claims as one.

Dogs were almost exclusively utilized in animal-assisted activities; however, three policies allowed cats or miniature horses as animal-assisted activities animals.

“Dogs were almost exclusively utilized in animal-assisted activities; however, three policies allowed cats or miniature horses as animal-assisted activities animals.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Most policies clearly stated that care of the service animal was the complete responsibility of the patient, or his or her designee.

“Most policies clearly stated that care of the service animal was the complete responsibility of the patient, or his or her designee.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

Policies stated that all animal research must be approved by the institution's IACUC and, when research animals must be present in patient care areas, animal visits must be scheduled to minimize overlap with patient care activities.

“These policies stated that all animal research must be approved by the institution's IACUC and, when research animals must be present in patient care areas, animal visits must be scheduled to minimize overlap with patient care activities.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

A total of 337 SHEA members and members of the SHEA Research Network (21.7% response of 1,550 members) responded to the survey regarding their institutions' policies for AHC.

“A total of 337 SHEA members and members of the SHEA Research Network (21.7% response of 1,550 members) responded to the survey regarding their institutions' policies for AHC (Table 6).”

It may state two separate claims as one.

Almost all policies required that the animals undergo regular (usually annual) evaluation by a veterinarian confirming their good health, that they be up-to-date on vaccinations, and that they have normal laboratory work.

“Almost all policies required that the animals undergo regular (usually annual) evaluation by a veterinarian confirming their good health, that they be up-to-date on vaccinations, and that they have normal laboratory work (2 policies required routine negative stool cultures prior to participation).”

It may state two separate claims as one.

The percentage of facilities that allowed animals but had no formal policy was: animal-assisted activities 5.8% (18 of 306), service animals 4.3% (12 of 279), research animals 8.5% (11 of 130), personal pet visitation 5.8% (7 of 121).

“The following is the percentage of facilities that allowed animals but had no formal policy: animal-assisted activities (5.8%, 18 of 306), service animals (4.3%, 12 of 279), research animals (8.5%, 11 of 130), personal pet visitation (5.8%, 7 of 121).”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

These 14 policies required staff members, visitors, and patients to perform hand hygiene both prior to and after interacting with animal-assisted activities animals.

“These 14 policies required staff members, visitors, and patients to perform hand hygiene both prior to and after interacting with animal-assisted activities animals.”

It may state two separate claims as one.

Although most policies specifically allowed dogs, some also allowed the use of cats and miniature horses as service animals.

“Although most policies specifically allowed dogs, some also allowed the use of cats and miniature horses.”

It may state two separate claims as one.

Human strains of methicillin-resistant Staphylococcus aureus (MRSA) have increasingly been described in cats, dogs, horses, and pigs, with animals potentially acting as sources of MRSA exposure in healthcare facilities.

“human strains of methicillin-resistant Staphylococcus aureus (MRSA) have increasingly been described in cats, dogs, horses, and pigs, with animals potentially acting as sources of MRSA exposure in healthcare facilities. 2”

• cites [2]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

Restriction of access to service animals is permitted where public health may be compromised, but allergies or fear of dogs by staff or other patients generally are not acceptable reasons for denying access.

“While restriction of access to service animals is permitted in situations where public health may be compromised, allergies or fear of dogs by staff or other patients generally are not acceptable reasons for denying access.”

Probably not a substantial claim.

Animal-assisted activities animals are not service animals.

“Animal-assisted activities animals are not service animals.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

The facility is required to make adjustments as needed to accommodate the service animal.

“The facility is required to make adjustments as needed to accommodate the animal.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

Federal law, which protects the rights of qualified persons with disabilities in terms of service animals, has no provision for animal-assisted activities animals.

“Federal law, which protects the rights of qualified persons with disabilities in terms of service animals, has no provision for animal-assisted activities animals.”

It may state two separate claims as one.

A large number of pathogens can be carried in the blood and body fluids of research and veterinary animals and have on occasion been spread to laboratory workers or healthcare providers.

“A large number of pathogens can be carried in the blood and body fluids of research and veterinary animals and have on occasion been spread to laboratory workers or healthcare providers.”

• cites [19]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [20]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [21]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim.

Risks from visitation by patients' pets may be increased because there is no formal training of the owner or designee as with an animal-assisted activities handler.

“There is no formal training of the owner/designee, as with an animal-assisted activities handler(s).”

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

The American Heart Association published a scientific statement regarding pet ownership and cardiovascular risk and concluded that pet ownership, particularly dog ownership, is probably associated with and may have some causal role in decreased cardiovascular disease risk.

“Recently the American Heart Association (AHA) published a scientific statement regarding pet ownership and cardiovascular risk and concluded that pet ownership, particularly dog ownership, “is probably associated with” and “may have some causal role” in decreased cardiovascular disease risk.”

It may state two separate claims as one.

While visitation with pets can be restricted in theory to only the individual patient, in practice this may not be the case because pets could encounter various healthcare personnel, visitors, and patients during their time in the facility.

“Further, while visitation with pets can be restricted, in theory, to only the individual patient, in practice, this may not be the case, as pets could encounter various HCP, visitors, and patients during their time in the facility.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Legal protection under the ADA extends only to individuals who are disabled as defined under the ADA, not all patients with medical or psychological conditions.

“Legal protection extends only to individuals who are disabled, as defined under the ADA, not all patients with medical or psychological conditions.”

• cites [9]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Under the ADA, service animals are defined as dogs that are individually trained to do work or perform tasks for people with disabilities.

“Under the ADA, “service animals” are defined as “dogs that are individually trained to do work or perform tasks for people with disabilities.”9”

• cites [9]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim. It may state two separate claims as one.

While pets are less scrutinized and would not necessarily fulfill the requirements for animal-assisted activities visitation programs, the potentially strong human-animal bond and corresponding potential positive impact on the patient leads many facilities to permit this activity.

“While pets are less scrutinized and would not necessarily fulfill the requirements for animal-assisted activities visitation programs, the potentially strong human-animal bond and corresponding potential positive impact on the patient leads many facilities to permit this activity.”

• AssumptionRests on an assumption: Visitation with a personal pet can benefit the patient.

Probably not a substantial claim. It may state two separate claims as one.

Healthcare providers or staff may ask a patient to describe what work or tasks the dog performs, but may not ask for a certification or papers.

“Healthcare providers or staff may ask the patient to describe what work/tasks the dog performs for the patient, but may not ask for a “certification” or “papers.””

• AssumptionRests on an assumption: There are no formal certification or registration programs for service animals, and certificates and paperwork can be readily purchased for any pet from various agencies.

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

Guidance from the Department of Justice makes clear that service animals under the ADA are working animals and not pets, trained to perform specific duties or tasks.

“Guidance provided by the Department of Justice makes clear that service animals under the ADA are “working animals” and not pets, and they are trained to perform specific duties or tasks.”

• cites [18]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim.

Risks from visitation by patients' pets may be increased because pets do not typically undergo the same degree of health assessment or exclusion practices, such as age, as animals used in animal-assisted activities.

“Pets do not typically undergo the same degree of health assessment or exclusion practices (eg, age) as compared to animals used in animal-assisted activities.”

Probably not a substantial claim.

Cats are not included in the recommendation for animal-assisted activities animals due to concerns for increased potential allergenicity, potential increased risk of bites and scratches, and lack of data demonstrating advantages over dogs.

“Cats are not included in the recommendation due to concerns for increased potential allergenicity, potential increased risk of bites and scratches, and lack of data demonstrating advantages over dogs.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

A dog whose sole function is comfort or emotional support is not considered a service dog under the ADA.

“however, a dog whose sole function is comfort or emotional support is not considered a service dog.”

It may state two separate claims as one.

Laboratory animals may harbor ectoparasites such as fleas, and these may serve as vectors for transmission of various pathogens to human laboratory personnel or healthcare providers.

“Occasionally, laboratory animals may harbor ectoparasites (eg, fleas), and these may serve as vectors for transmission of various pathogens to human laboratory personnel or HCP.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

Some animal species may pose additional threats, such as physical injury from large animals or envenomation.

“some animal species may pose additional threat, such as physical injury from large animals or envenomation.”

Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.

The stronger bond with a personal pet could accentuate positive impacts on the patient, and the pre-established relationship between pet and person could reduce the risk of adverse events such as bites and scratches.

“The stronger bond with the pet could accentuate the positive impacts on the patient, and the pre-established relationship between pet and person could reduce the risk of adverse events such as bites and scratches;”

Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.

A large number of pathogens may be carried subclinically in the gastrointestinal tracts of laboratory animals and can potentially be transmitted via the fecal-oral route.

“A large number of pathogens may be carried subclinically in the gastrointestinal tracts of laboratory animals and can potentially be transmitted via the fecal-oral route.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

Only dogs and miniature horses are recognized as Service Animals under federal law.

“A statement that only dogs and miniature horses are recognized as Service Animals under federal law.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.

The facility is not required to permit animals in training to become service animals to enter, but may choose to do so and may reserve the right to exclude them at its discretion.

“The facility is not required to permit animals in training to become service animals to enter the facility, but may choose to do so, reserving the right to exclude such animals at its discretion.”

Probably not a substantial claim.

The term Service Animal as defined under the ADA does not include dogs used for emotional support, well-being, comfort, or companionship.

“The facility's policy should note that the term “Service Animal,” as defined under the ADA, does not include dogs used for the provision of emotional support, well-being, comfort, or companionship.”

Probably not a substantial claim. The paper may give no reason why it holds.

Animals can serve as a reservoir and vehicle for potentially infectious pathogens.

“animals can serve as a reservoir and vehicle for potentially infectious pathogens”

Probably not a substantial claim.

Visitation by a pet is different than animal-associated activities or similarly structured activities.

“Visitation by a pet is different than animal-associated activities or similarly structured activities.”

Probably not a substantial claim.

Choke chains or prong collars may trap and injure patients' fingers.

“Not use choke chains or prong collars, which may trap and injure patients' fingers.”

Probably not a substantial claim. The paper may give no reason why it holds.

Pets and their owners typically do not undergo the same or any form of training and scrutiny as animal-assisted activities teams.

“however, pets and their owners typically do not undergo the same (or any) form of training and scrutiny as compared to animal-assisted activities teams.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

The ADA provides a limited exception for miniature horses if they otherwise satisfy the definition of a service animal, are housebroken, and do not create safety concerns.

“The ADA provides a limited exception for miniature horses if these animals otherwise satisfy the definition of a “service animal,” are housebroken, and do not create safety concerns.”

• cites [9]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

It may state two separate claims as one.

A large number of bacterial infections may be acquired by trauma sustained in water or by injuries caused by water-dwelling animals.

“A large number of bacterial infections may be acquired by trauma sustained in water or by injuries caused by water-dwelling animals.[39][40][41]”

• cites [39]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [40]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [41]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

It may state two separate claims as one.

Federal guidelines limit the inquiries staff may make when it is not obvious that a person is disabled and using a service dog; staff may not require documentation about the disability or the animal's training but may ask two specified questions.

“Federal guidelines limit the inquiries that staff may make when it is not obvious that the person is disabled and is using a service dog, as defined by the ADA.Staff may not require documentation about the person's disability or the animal's training but may ask: (1) “Is the dog a service animal required because of a disability?” and ( 2) “What work or task is the dog trained to perform?””

• cites [18]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim.

Because of logistics and expense, some equipment items and facilities may not be dedicated solely for animal use, so research animals may need to be studied in human healthcare institutions using equipment and facilities also used for humans.

“Because of logistics and expense, some equipment items and facilities may not be able to be dedicated solely for animal use; thus, research animals may need to be studied in human healthcare institutions using equipment and facilities that are also used for humans.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Larval debridement therapy has been used around the world to promote wound healing.

“Larval debridement therapy has been used around the world to promoted wound healing.55”

• cites [55]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Larval debridement therapy generally uses disinfected fly larvae of Lucilia sericata in the treatment of wounds resistant to conventional therapy.

“Generally, larval debridement therapy has used the disinfected fly larvae of Lucilia sericata in the treatment of wounds resistant to conventional therapy.56,57”

• cites [56]Not matched

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• cites [57]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.