Cited by 144Infection Control in HealthcareZoonotic diseases and public healthInfection Control and Ventilation

The DOI matches its Crossref record; 89 of the 89 references it cites were found in a registry or an index; none of the 69 sources its claims cite is checked for support yet.

Animals in Healthcare Facilities: Recommendations to Minimize Potential Risks

Open access

Abstract

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. Review and interpret the medical literature regarding risks and evidence for animal-to-human transmission of pathogens in the healthcare setting, along with the potential benefits of animal-assisted activities in healthcare.2. Review hospital policies related to AHC, as submitted by members of the SHEA Guidelines Committee.3. Summarize a survey that assessed institutional AHC policies.4. Offer specific guidance to minimize risks associated with the presence of AHC settings.Recommendations for the safe oversight and management of AHC should comply with legal requirements and minimize the risk of transmission of pathogens from animals to humans when animals are permitted in the healthcare setting.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.Institutions considering these programs should have policies that include well-organized communication and education directed at healthcare personnel (HCP), patients, and visitors.Appropriately designed studies are needed to better define the risks and benefits of allowing animals in the healthcare setting for specific purposes.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This SHEA white paper offers expert-opinion guidance for managing animals in acute care and ambulatory facilities—animal-assisted activities, service animals, research animals, and personal pet visitation—to reduce pathogen transmission risks. It synthesizes limited literature, 23 submitted hospital policies, and a 2013 SHEA survey (337 respondents, 21.7% response) and concludes that evidence is insufficient for formal guidelines.

Key findings

  • The evidence base is weak: the paper states few scientific studies address animal-to-human transmission in healthcare and insufficient studies exist for generalizable, evidence-based recommendations; recommendations are expert-opinion-based and not GRADE-graded.
  • Survey of SHEA membership/SHEA Research Network: 337 respondents (21.7% of 1,550); 93% acute care, 77% US. Among facilities allowing animals, some lacked formal policies: animal-assisted activities 5.8% (18/306), service animals 4.3% (12/279), research animals 8.5% (11/130), personal pet visitation 5.8% (7/121); 8 US facilities, including a Veterans Hospital, reported not allowing service animals.
  • Policy review: 23 facilities submitted policies; 20 addressed animal-assisted activities, 18 service animals, one-third research animals, and 13 allowed personal pet visitation. Most animal-assisted activities used dogs almost exclusively, though 3 policies allowed cats or miniature horses; service-animal policies commonly required vaccination/health certification, housebreaking, leash control, and patient/designee responsibility for care.
  • Risk examples: in one study of 102 healthy visitation dogs, zoonotic agents were isolated from 80%, including toxigenic *Clostridium difficile* 40.1%, *Salmonella* spp. 3%, ESBL/cephalosporinase *E. coli* 4%, *Pasteurella* spp. 29%, *Malassezia pachydermatis* 8%, *Toxocara canis* 2%, and *Ancylostoma caninum* 2%. An ICU nursery outbreak of *M. pachydermatis* involved 15 case patients, 9 colonized infants, 1 healthcare worker, and 3 pet dogs, with 8 bloodstream infections, 2 urinary tract infections, 1 meningitis, and 4 asymptomatic colonizations.

Methods

  • Design: SHEA white paper/guidance document with narrative literature review, review of submitted institutional policies, and cross-sectional survey.
  • Data/sample: 23 healthcare facility policies submitted by writing group/SHEA Guidelines Committee members; SHEA Membership and SHEA Research Network survey February–May 2013, 337 respondents (21.7% of 1,550), mostly acute care (93%) and US (77%); only 24 non-US respondents linked to institution-identifying information were analyzed.
  • Analysis: synthesized limited evidence, theoretical rationale, practical considerations, survey results, and writing group opinion; no formal evidence grading (e.g., GRADE) was used.

Limitations

  • Stated: the topic lacks the level of evidence required for a formal guideline; no grading of evidence is provided; recommendations are suggested actions, not recognized standards or regulations, and adoption is at institutional discretion.
  • Stated: few scientific studies and minimal case-report/outbreak experience exist; insufficient studies are available for generalizable, evidence-based recommendations; the document is intended only for acute care hospitals and ambulatory facilities, not assisted living, nursing homes, or extended care facilities.
  • Stated/evident: the survey had a 21.7% response rate and only 24 non-US institutions were analyzed; the policy review relied on submitted policies, and not all facilities with animal programs had formal policies, so findings may reflect self-selection and variation in practice.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1017/ice.2015.15

Cites

89 of 89 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

32 Sources not found · 30 No basis given · 20 Own result · 13 Own interpretation · 2 Not checked yet

Show all 44 claims

  • Probably not a substantial claim. 41
  • It may state two separate claims as one. 25
53 of 53
  • The paper relies on this without support.

    Cats cannot be trained to reliably provide safe interactions with patients in the healthcare setting.

    “Cats should be excluded because they cannot be trained to reliably provide safe interactions with patients in the healthcare setting.”
  • The paper relies on this without support.

    Standard infection prevention and control measures prevent animal-to-human transmission in healthcare settings.

    “use of standard infection prevention and control measures to prevent animal-to-human transmission in healthcare settings.”
  • The paper relies on this without support.

    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.

    “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.'”
  • The paper relies on this without support.

    Visiting or residing in a healthcare facility likely increases the risk of the animal acquiring certain pathogens.

    “Visiting or residing in a healthcare facility likely increases the risk of the animal acquiring certain pathogens.”
  • The paper relies on this without support.

    Visitation with a personal pet can benefit the patient.

    “Exceptions can be considered when the healthcare team determines that visitation with a pet would be of benefit to the patient and can be performed with limited risk to the patient, other patients, and healthcare facility as a whole.”
  • The paper relies on this without support.

    Miniature horses generally range in height between 24 inches and 34 inches measured to the shoulders and generally weigh between 70 and 100 pounds.

    “Miniature horses generally range in height between 24 inches and 34 inches measured to the shoulders and generally weigh between 70 and 100 pounds.”
  • The paper relies on this without support.

    MRSA has been noted to colonize various domestic animal species.

    “Similarly, MRSA has been noted to colonize various domestic animal species.”
  • The paper relies on this without support.

    On occasion, zoos or veterinary facilities may appeal for use of human healthcare facilities to diagnose or treat sick or injured animals.

    “Similarly, on occasion, zoos or veterinary facilities may appeal for use of human healthcare facilities to diagnose or treat sick or injured animals.”
  • The paper relies on this without support.

    Large controlled clinical trials assessing benefits and risks of larval debridement therapy have not been performed.

    “However, large controlled clinical trials assessing benefits and risks of this therapy have not been performed.”
  • The paper relies on this without support.

    Petting zoos and animal exhibits have been associated with multiple outbreaks.

    “Petting zoos and animal exhibits have been associated with multiple outbreaks.”
  • The paper relies on this without support.

    Used engorged leeches are capable of transmitting bloodborne pathogens.

    “Used engorged leaches should be consider capable of transmitting bloodborne pathogens and should be disposed of as hazardous waste.”
11 of 11

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

1 of 1

Citations

Cites

Show all 88 references

Research works printed but not linked: 2

  1. Swall, Can therapy dogs evoke awareness of one’s past and present life in persons with Alzheimer’s disease?, Int J Older People Nurs
  2. 10.1001/archderm.1986.01660180104026 · DOI

Cited by

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Metadata

Authors
Murthy, R., Bearman, G., Brown, S., Bryant, K., Chinn, R., Hewlett, A., George, B. G., Goldstein, E. J. C., Holzmann-Pazgal, G., Rupp, M. E., Wiemken, T., Weese, J. S., & Weber, D. J.
Affiliations
  • Cedars-Sinai Medical Center (US)
  • Virginia Commonwealth University (US)
  • Kaiser Permanente (US)
  • University of Louisville (US)
  • Nebraska Medical Center (US)
  • University of North Carolina at Chapel Hill (US)
  • University of California, Los Angeles (US)
  • The University of Texas Health Science Center at Houston (US)
  • University of Guelph (CA)
Corresponding author
Weber, David J.
Venue
Infection Control & Hospital Epidemiology
Published
2015-03-02
Volume
36
Issue
5
Pages
495-516
ISSN
  • 0899-823X (ISSN-L)
  • 1559-6834
OpenAlex
W2105256692
Cited by
142
References
88
Citations by year
2026: 14 · 2025: 8 · 2024: 12 · 2023: 13 · 2022: 11 · 2021: 16 · 2020: 15 · 2019: 26 · 2018: 6 · 2017: 10 · 2016: 7 · 2015: 4
FWCI
1.24
Type
journal article
Language
en
Open access
Locations
  • Infection Control and Hospital Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • UNC Libraries
Topics
  • Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Zoonotic diseases and public health
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
Keywords
zoonotic pathogens, service animals, animal-assisted activities, laboratory animals, infection control, healthcare worker safety, patient safety
MeSH terms
Animals, Cross Infection, Dogs, Health Facilities, Humans, Zoonoses, Organizational Policy, Animal Assisted Therapy, Pets

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