TORONTO - Hedgehogs, prairie dogs, non-human primates and alpacas shouldn't be making rounds in hospitals and long-term care facilities, according to new infection control advice for popular animal visitation programs.
Therapy animals shouldn't be permitted access to patients' bathrooms, where they could pick up bugs like Clostridium difficile by licking surfaces or drinking from toilet bowls. And animals at high risk of carrying salmonella - turtles and dogs fed a raw food diet - should be barred from participating in animal therapy programs, the guidelines say.
The lengthy list of recommendations, recently published in the American Journal of Infection Control, was the product of a consensus conference held in Toronto in January 2007.
The conference, which drew in animal and human health experts, therapy animal program operators and infection control specialists, was sponsored by the Public Health Agency of Canada and the University of Guelph's Centre for Public Health and Zoonoses. (Zoonoses are the diseases that move back and forth between two-and four-legged animals.)
The idea behind the guidelines is to minimize the risk that visiting animals will spread more than love as they make their way from patient to patient.
"This is actually, in my mind, a great attempt to try to provide some practical measures to deal with the issue of animal assisted therapy dogs," said Dr. Jeff Bender, program director for veterinary population medicine at the University of Minnesota.
Bender was not involved in the process, but welcomed the guidelines, noting he'd participated in an earlier effort about 10 years ago that got bogged down by the scope of the task and the lack of scientific evidence.
Since that time, scientists - including those at the Ontario Veterinary College in Guelph - have published studies showing a variety of domestic animals can carry a range of bacteria that also infect people. Things like methicillin-resistant Staphylococcus aureus (MRSA) and C. difficile.
Using all the data they could find, the group drew up recommendations for programs aimed at safeguarding the health of both the people being visited and their furry visitors.
One of the primary points they make is that these programs should avoid the exotic and stick to the tried and true - dogs and maybe cats, said Dr. Scott Weese, a veterinarian and scientist who conducted a number of the studies referred to by the group.
Facilities can safely allow personal pets - again, not the exotic types - to visit hospitalized owners. But they should not be allowed to visit other people while there, the recommendations say.
"Basically what the guidelines say is that for an animal to be appropriate we need to know a lot about it," said Weese, who is also a professor at Guelph.
"We know, for dogs and cats, pretty much what bugs they tend to carry and don't tend to carry. What the risk factors are for a lot of things. How to assess their temperaments. How to handle them."
"We don't know that with most other species. How do you temperament test a llama? An iguana?"
That might sound like hyperbole, but Weese said he has photos of miniature ponies and alpacas being led around hospital wards.
And while many of the guidelines are so common-sensical that it seems surprising they need to be enumerated, Weese said not everyone thinks these things through.
"Strange things happen. Lots of dogs go visit people under contact precautions - people with MRSA."
Hospital patients with MRSA are isolated to keep them from spreading the dangerous bacteria to others. Sending a therapy dog in to visit a lonely patient in isolation and then allowing the dog to visit other patients can render the isolation order irrelevant.
The recommendations suggest one handler per animal. They also suggest that the handler ensures that people who want to touch the animal cleanse their hands with an alcohol gel product first.
Animals should be kept out of burn units and dialysis clinics, where the risk of infection is both high and potentially life-threatening.
Limiting the type of contact makes sense, said Dr. Andrew Simor, head of microbiology at Toronto's Sunnybrook Health Sciences Centre and co-chair of the Canadian Hospital Epidemiology Committee, a group representing infection control specialists.
"When you're at home, there's obviously nothing wrong with a cat or dog nuzzling you or getting really close. It's a very different story if you've got a big gaping wound in front of you," Simor said.
Simor said many of the recommendations may already be standard procedure in some facilities, but would be important guidance for others.
"I would think there are many hospitals that probably haven't thought about a few of these issues," he said.
"And so I think that's another important role of the guidelines - to make people in hospitals, and in particular the infection prevention and control programs ... to make sure that they've at least thought of these issues."
Weese said the committee that drafted the guidance hopes it will be adopted by infection control groups in Canada and the U.S. and will serve as a template for hospitals and groups that provide animals for therapy programs.
