1. Murthy R, Bearman G, Brown S, et al. Animals in healthcare facilities: recommendations to minimize potential risks. Infect Control Hosp Epidemiol. 2015 Mar 12. [Epub ahead of print]. Accessed April 29, 2015.
  2. Snipelisky D, Burton MC. Canine-assisted therapy in the inpatient setting. South Med J. 2014;107:265-273.

Contributor Information


Laura A. Stokowski, RN, MS
Clinical Editor

Disclosure: Laura A. Stokowski, RN, MS, has disclosed no relevant financial relationships.


Rekha Murthy, MD
Medical Director, Department of Hospital Epidemiology;
Professor of Medicine, Cedars Sinai Medical Center;
Professor of Clinical Medicine
UCLA David Geffen School of Medicine
Los Angeles, California

David J. Weber, MD, MPH
Professor of Medicine and Pediatrics, School of Medicine;
Professor of Epidemiology, School of Public Health
University of North Carolina at Chapel Hill;
Associate Chief Medical Officer, UNC Health Care;
Medical Director, Departments of Hospital Epidemiology (Infection Control), Occupational Health, and Environmental Health and Safety
UNC Health Care System, Chapel Hill, North Carolina


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Animals and Healthcare Facilities: A Healthy Match?

Laura A. Stokowski, RN, MS; Reviewers: Rekha Murthy, MD; David J. Weber, MD, MPH  |  May 14, 2015

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Slide 1

Animals in the House

Although teeming with unseen disease-causing pathogens, the hospital has traditionally been viewed as a clean, even sterile environment—no place for animals. With increasing recognition of the strength of the human/animal bond and research showing the benefits of animal-assisted therapy, however, animals are now finding their way into diverse healthcare settings. The four primary uses of animals in healthcare settings are:

  • Animal-assisted activities (pet therapy);
  • Service animals;
  • Personal pet visitation; and
  • Research or education.

Images (L to R) courtesy of Science Source(1); AP Photo/M. Spencer Green (2); iStock(3, 4)

Slide 2

Risks Associated With Animals in HCFs

Allowing animals in healthcare facilities (HCFs) is not without risks to patients, visitors, and staff. Notwithstanding the potential for injuries should the animal react with aggression, humans are at risk for infection from the transmission of pathogens through direct or indirect contact with the animal and its secretions or excretions. Animals can carry and transmit a wide range of pathogens, including methicillin-resistant Staphylococcus aureus, Clostridium difficile, multidrug-resistant enterococci, extended-spectrum beta-lactamase–producing Enterobacteriaceae, Campylobacter, Salmonella, dermatophytes, and others.

Image from Wikimedia

Slide 3

Recommendations to Minimize Potential Risks

The idea of using animals in a therapeutic setting is relatively new, and to date, HCFs have lacked guidance on how to prevent infectious consequences of this activity. The Society for Healthcare Epidemiology of America (SHEA) recently addressed this deficit by publishing a set of recommendations, "Animals in Healthcare Facilities: Recommendations to Minimize Potential Risks."[1]

To come up with these recommendations, SHEA surveyed its members to find out how many HCFs had formal policies about the presence of animals in acute care or ambulatory care settings. The survey found substantial variation in practice across US hospitals, as shown on the slide.

Images from iStock

Slide 4

Animals in HCFs: Guidance From SHEA

A working group collated policies contributed by members to develop the current informational recommendations. SHEA emphasizes that their recommendations constitute guidance, not evidence-based guidelines. These are practical, expert, opinion-based suggested actions to consider in the absence of recognized standards, regulations, or robust evidence to support practice. The only clear mandates in the United States are those relating to service animals under the Americans With Disabilities Act.

This guidance document is intended to help acute care hospitals and ambulatory care facilities develop their own policies related to animals. It does not apply to assisted living, nursing homes, or extended care facilities.

Image from iStock

Slide 5

Animal-Assisted Therapy

"Pet therapy," more precisely known as "animal-assisted therapy" (AAT), refers to activities involving animals (primarily dogs) designed to improve patient outcomes. A recent review of the literature concluded that in the inpatient setting, AAT is effective in patients of all ages and with various medical problems and is safe, with no evidence of animal-associated transmission of infection.[2] Among the benefits of AAT are improving psychological health, pain management, and lowering of blood pressure, although no rigorous studies have demonstrated these outcomes.

AAT dogs are not service animals, and as such, their use is not covered by Federal law. Nor are AAT animals patient-owned pets; rather, they are trained specifically as therapy animals. Only dogs are recommended, because cats can't be trained to provide safe interactions. The qualifications and behavior of the handlers are of utmost importance. Handlers must agree to comply with the facility's policies, including standard precautions, hand hygiene, and environmental cleaning associated with animal excretions. No casual contact is permitted between the AAT dog and staff, visitors, or other patients.

Certain areas of the HCF should be off-limits to animals: intensive care, isolation rooms, newborn/neonatal units, treatment rooms, kitchens/formula rooms, pharmacies, and rooms of immunocompromised patients.

Image from iStock

Slide 6

Ensuring Safety During AAT

The SHEA guidance document provides an extensive list of suggestions for safely incorporating AAT into the HCF. The following areas are covered:

  • Requirements for acceptable animals (including health and temperament screening and regular veterinarian examinations);
  • How handlers should manage the animal within the HCF and during activities with the patient;
  • What contact is/is not allowed with the animal in the HCF;
  • Under what circumstances the visit should be terminated or suspended;
  • How animals should be prepared for visits; and
  • The appropriate response to animal behaviors (aggression, fear, fatigue hunger, thirst, or need to defecate or urinate).

The guidance emphasizes that during AAT with patients, animals should not come into contact with sites of invasive devices, open or bandaged wounds, surgical incisions, or medical equipment. If animals will climb onto the patient's bed, the bed should first be protected with a disposable barrier (or item of linen). The patient must practice hand hygiene before and after touching the animal.

Image courtesy of AP Photo/Fernando Vergara

Slide 7

Americans With Disabilities

Federal law protects the rights of qualified persons with disabilities to be accompanied by service animals under the Americans With Disabilities Act (ADA). Only dogs and miniature horses can be service animals, and they must be permitted to accompany their owners wherever the public would normally be allowed to go. HCFs should develop policies on service animals that are consistent with the ADA.

When it is not obvious what service an animal provides, only limited inquiries are allowed under the law. Staff may ask two questions: (1) Is the dog a service animal that is required because of a disability, and (2) What work or task has the dog been trained to perform? Staff cannot ask about the person's disability, require medical documentation, require a special identification card or training documentation for the dog, or ask that the dog demonstrate its ability to perform the work or task. A dog whose sole function is to provide emotional support is not considered a service animal under the ADA. Service animals are not pets, and they should not be approached, bothered, or petted.

Image from iStock

Slide 8

Service Animals

Hospital policy should define the locations where service animals are and are not permitted (generally, areas where invasive procedures are performed, or where sterility is required; food and medication preparation areas, and areas where the animal is at risk for harm (eg, MRI). Service animals cannot visit other patients' rooms. Animals that exhibit aggressive behavior or excessive noise, and those that are not housebroken, should be excluded from the HCF. Animals that appear ill should be evaluated by a veterinarian. Legal counsel should be consulted before barring service animals from a HCF.

A patient's service animal is the responsibility of the patient or designated visitor; staff are not responsible to feed, exercise, care for, or clean up after service animals. The patient or designee is responsible for the health of the animal and for accepting risks to the animal's health from visiting or residing in a HCF.

Visitors with service animals must check with staff before taking the animal into a patient's room to ensure that the room's occupants are not allergic to or fearful of the animal. When patients with service animals are assigned to semi-private rooms, the roommate must be screened for allergies, as well.

Image from iStock

Slide 9

Personal Pet Visitation

A personal pet is a domestic animal that is owned by a patient. Because personal pets are not trained as service animals or for AAT, they do not undergo the same level of training or scrutiny imposed on other animals seen in HCFs. Generally, pets are prohibited from HCFs unless the healthcare team determines that a pet visit would benefit the patient, with minimal risk to the patient or others. Such situations might include the following:

  • A terminally ill patient;
  • Patients for whom a visit with a pet might improve their physical or mental health; or
  • A patient who has been hospitalized for a prolonged period.

Approval for a visit should be granted by the patient's physician, nursing staff, and infection prevention and control department, and documented in the medical record.

Image from iStock

Slide 10

Only Dogs for Pet Visits

Only dogs should be permitted to make visits. Dogs should be older than 1 year (or "social adults"). Cats should be excluded from routine visits because they cannot be trained to reliably provide safe interactions with patients in the healthcare setting and can behave unpredictably, which may result in increased risk for bites and scratches. However, the guidance document does not preclude HCFs from allowing a personal pet visit with a cat on a case-by-case basis.

Images from iStock

Slide 11

Other Considerations for Visiting Pets

In most circumstances, personal pets should not be permitted to make visits to patients on contact or droplet isolation, those in intensive care, those whose cognitive status might make then unable to safely interact with the animal, those who have undergone recent solid-organ or stem cell transplantation, and those who are immunocompromised.

The ideal location for a personal pet visit is outside of the HCF, but if this isn't possible, the visit should take place in a private room. If a roommate is present, permission from the roommate must be obtained. The animal should be taken directly to the visit area on a leash or in a carrier, and not interact with other patients, visitors, or staff. Animals should not be allowed to roam freely, and if they become aggressive, fearful, or disruptive, they should be removed from the HCF immediately.

Patients must perform hand hygiene before and after contact with their dogs, and if the dog is to have contact with the patient's bed, the bed should be protected with a barrier.

The staff of HCFs should not bring their own pets to the HCF.

Image from iStock

Slide 12

Other Uses of Animals in Healthcare

Health science centers often use animals for biomedical research, activities that might take place in the same facility used to care for patients because the HCF's resources and equipment are required for the research. These HCFs must have comprehensive policies in place to ensure patient and public safety, because animals can serve as a reservoir and vehicle for infectious pathogens and humans can be harmed by animals during the conduct of research. The SHEA guidance document provides examples of animal-to-human transmission of infection and provides a list of considerations that should be included in the HCF's policies related to animal research.

Some HCFs also use animals for medical therapies. For example, leeches are used to manage vascular congestion in patients with reimplantation of digits and ears and for other purposes. Medicinal leeches can be associated with wound infections, and used leeches must be handled as hazardous waste. The HCF's policies should address these and other issues related to the use of leeches or larvae for medical purposes.

Image from iStock

Slide 13

Take Our Poll

We want to learn about your views. Please take our 1-minute poll about the use of animals in your own workplace, and leave us a comment too, if you wish.

Image from iStock

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