As things continue to gradually open up (more gradually in some areas than others), myriad questions of “can we do…” or “how do we do…” come up. One that I’m getting increasingly is about pet visitation or pet therapy programs. These programs can be very valuable to patients in hospitals and residents in long-term care homes and other settings; however, they always come with some degree of risk from interaction with the animal, and the handler.
Currently, most places have these kinds of visits on hold, which is reasonable in this phase of the COVID-19 pandemic. Fewer people coming in means fewer potential sources of infection. However, some programs are restarting, so thought needs to go into doing this safely.
What are the risks?
While we often try to get people to think about the various pathogens that pets (particular dogs in this case) can leave behind or pick up in these settings, right now the main risk with pet visitation programs is SARS-CoV-2 from the human handlers. This virus likes people a lot better than dogs – the COVID-19 pandemic is being propagated almost exclusively through human-to-human transmission. While there is some potential for dogs to be infected or for them to act as fomites (i.e. tracking virus around on their haircoats), the far greater susceptibility of people means that dogs are probably the lower-risk component of visitation teams.
Routine prevention measures:
- Standard pet therapy program measures, as outlined in the 2015 SHEA guidelines on animals in healthcare facilities, are still key, with particular emphasis on making sure:
- Handlers self-screen and are healthy before entering a facility.
- Everyone involved pays close attention to hand hygiene. Patients should use hand sanitizer before and after animal contact. Handlers should use hand sanitizer before and after every visitation, regardless of whether they touched the person or any part of the person’s environment.
Added COVID-19 measures:
- Ensure the patient has no signs of COVID-19 and is not being isolated. (Yes, that sounds like common sense, but you’d be amazed how often things like that get missed.)
- Ensure the handler and animal have not had exposure to an infected person in the past 14 days.
- Have everyone involved (that is to say the people, not the dogs) wear a mask.
- Remember the 3 C’s to avoid: closed spaces, crowded spaces, close contact. (I also talk about a fourth C, “continuous,” with regard to time.)
- Limit person-to-person contact. Handlers should stay as far back from patients as possible.
- Have the visit outside in an open space, when possible.
- Keep the visits relatively short – 15 minutes is typically used as the time when risk goes up.
- Have handlers use a tracking app, like Canada’s COVID Alert app. Anyone involved with pet therapy in a region with an app like this should use it. It might help pick up exposure in a facility, but more importantly, it helps identify other community exposures, so exposed people know when they’ve been exposed and can suspend their visitation activities.
- Stick to one facility. Some visitation teams typically visit multiple facilities. That’s probably best avoided, especially now. Teams should focus on one facility, to reduce the risk of cross-transmission.
- Consider limiting visits to one person per team per day, especially as programs restart and while there’s less risk tolerance. Limiting a visit to a single patient each time reduces the risk of encountering or spreading the virus between patients.
How to respond to an outbreak or exposure
- The key here is being able to identify exposed individuals quickly and easily. One recommendation we’ve had since our very first guidelines on pet therapy is keeping track of who gets visited when, and by whom. This has been very hard to get implemented, but it’s especially critical now. Tracking can be as simple as having handlers write down the date and the rooms/patients they visited, and leave the log with the facility as they depart.
- An additional component of this tracking should be recording the duration of the visit, since the time spent with the infected person plays a role in determining whether exposure was likely. With basic practices like hand hygiene, mask use, and distancing, it’s unlikely a handler would be considered exposed if they visited an infected patient for a short time. However, some visits could end up stretching beyond that typical 15 minute limit, and some could end up involving direct contact between the handler and patient. If the handler fits the criteria for exposure, the response would depend on the local public health directives for exposed people (e.g. self-monitoring vs isolation). However, given the severe implications of COVID-19 in most populations where pet therapy is used, handlers with any plausible degree of exposure should suspend visitation for 14 days. If a dog had direct contact with an infected person, then I’d isolate the dog for 14 days as well, to be safe.
- Handlers also need to have an established means of communication with the facility and must be able to report illness. If a handler develops COVID-19 (probably acquired in the community, not during visitation), the person needs to be able to contact the facility as soon as possible, so they can then determine if any of the patients/residents might have been exposed, based on the timing of illness and visitation.
None of this is rocket science, or expensive. It’s use of basic infection control practices and good communication. Unfortunately, those are often lacking.
The risk from a well-run pet visitation program following these precautions is low, but not zero. There’s never going to be risk-free pet visitation. The key is limiting the risk as much as possible, while maximizing the benefits. The implications of tracking SARS-CoV-2 to, within or between facilities (especially long-term care homes) can be huge, so serious thought needs to go into when and how to restart these programs.