I was probably as horrified as you when news feeds and websites started to share the recent story of a Wisconsin man who ended up losing his lower legs and hands after a dog licked him. Explained very simply (by WebMD), it was the result of a “rare blood infection caused by bacteria in dog saliva.”
What had happened was that the man had been licked by a perfectly normal dog, but it developed into a life-threatening blood infection because the super common “Capnocytophagacanimorsus” bacteria in most dogs’ saliva, somehow got into his bloodstream. There,it wreaked havoc, caused the sepsis and led to blood clots forming in his extremities, which then led to emergency amputations.
What the news stories were not so great about conveying was the fact that the bacteria is in most dogs’ mouths and that the man who suffered the medical issue, had around eight pet dogs of his own at the time he was infected by the bacteria. To date, they are unsure which dog transferred the infection and even doctors for the man described the event as a “fluke”.
Typically, the bacteria is transferred via a dog bite and appropriate measures are taken by medical experts as soon as possible. As the CDC explains, “infections are more often linked to dog bites,” and people with weakened immune systems are the most vulnerable to the bacteria. It is emerging as a leading cause of sepsis in humans, but it can also cause endocarditis (a destructive inflammation of the lining of the heart) and abscesses (pus that gathers in the tissue) anywhere on the body. It can lead to inflammation in the brain membranes, lymph nodes, eyes or face, too.
So, if you are in contact with a dog and you have an abrasion, bite or a lot of saliva transfer, it is a good idea to get a health check. In fact, bites and abrasions are unquestionable times when medical intervention is a must!
And why am I even talking about this super tragic story? Well, it is because I recently read another headline (you know me, I’m always reading dog news) that reads, “New study scrutinizes hospitals’ therapy dog programs”. Of course, the somewhat dubious tone of that sentence made me want to know just what and why the “scrutiny” in question was occurring. As you probably guessed, it was not a good sort of scrutiny.
As I read the headline, I thought about the man who lost his limbs and figured it probably had something to do with bacterial transfer. Was I right? Kind of.
Dog Therapy Under the Spotlight
Essentially, the report looked at “patients who spent more time with therapy dogs” and the outcomes of that time together. The scientists were specifically worried that hospitals had not examined closely their policies relating to both therapy dogs and potential contaminant spread. As the article indicated, patients “increased their risk of contracting the superbug MRSA” the more time they were with therapy dogs.
MRSA or Methicillin-resistant Staphylococcus aureus is a bacteria that leads to bodily infections and is extremely difficult to treat because it is resistant to the most commonly used antibiotics. Staph infections are not a joke, and are unfortunately, a common issue in prolonged hospital stays. Usually manifesting as sores and boils on the skin, it can get into the bloodstream, urinary tract or lungs. Though it is not life threatening, it is difficult to treat and today it is resistant to more than methicillin. Recent studies have shown it is resistant to amoxicillin, penicillin, oxacillin, and many other common antibiotics, as well.
While it is most common in hospitals and care centers, perfectly healthy, non-hospitalized people develop it as well, and this is now known as CA MRSA for community assisted MRSA.
The study done with the therapy dogs looked at 5 kids in pediatric oncology units (outpatient treatments) who had received therapy dog visits during treatment. None of the kids had MRSA prior to dog therapy visits. However, after each of the kids did have a dog therapy visit, around 10% did seem to be carrying the bacteria.
End of Therapy Dogs?
Does this finding say what it sounds like it is saying? That dog’s coats pick up the MRSA and allow them to transfer it to the kids they are helping? In a word: yes.
Naturally, this might make you jump to the conclusion that it signifies a serious amount of restriction on where and whom therapy dogs can visit, but that is not the case. The good scientists who made the discovery did a bit of pre-emptive problem solving and decided to test a few fast fixes. As the report noted, “patients’ risk of contracting MRSA fell by 90% when the dogs were bathed with shampoo containing the antiseptic chlorhexidine prior to the visit and were wiped with disinfectant wipes throughout their hospital visit.”
In other words, therapy dogs can continue to visit sick kids (and adults) in all kinds of facilities, but there must be cleaning and safety protocols in place. This is essential information because most therapy dogs are also visiting some of the most compromised individuals – children and the elderly – who are both groups that are highly susceptible to infection and unlikely to easily overcome antimicrobial resistant bacteria.
What to Know
So, if you were a bit panicked over the whole idea of therapy dogs bringing harmful bacteria to those they are meant to help heal, you can stop panicking. There are actually hospitals that have already recognized the risks of therapy dogs and which have long-standing health protocols in place.
What are those protocols? Well, they are the three things you need to know about when someone challenges therapy dog visits to hospitals and/or medical centers. They include the best protocols for ensuring health, safety and protection of key therapeutic programs. The best practices include:
- Dogs must be bathed within 24 to 48 hours before each visit
- Caregivers must wash their hands before and after every dog encounter with a patient as well as patients wiping their hands with antibacterial gel before and after a visit
- Hospitals and facilities prohibiting dogs in intensive care units or to visit with patients with compromised immune systems
The Society for Healthcare Epidemiology of America also recommends a few additional steps on top of those above. These steps include “using only dogs because they can be formally trained and excluding any animal with wounds.” Other groups also suggest that a dog is wiped down with disinfectant during the visit, such as between patient or bed visits.
In a 2017 report done by the Tufts University, it was discovered that “4% of hospitals and 22% of elderly-care facilities had no policies in place for their animal-assistance programs”. The sample group was limited to around 125 different facilities, including hospitals, elderly care homes and therapy animal groups. Yet, the figures seem to be accurate in broader terms and across the healthcare spectrum.
I admit that I was a bit worried at the focus on the safety of AAI or animal assisted intervention programs in these reports. Yet felt a constant sense of relief because most kept accenting and emphasizing the benefits and the need to protect such programs. As the Tufts report noted, “programs, are increasing in popularity, and studies have shown they can result in positive physical and mental health outcomes for human participants, such as lowered blood pressure, improved mood and delayed onset of dementia.”
That report even went on to say that fixed protocols should exist for animal safety, too.
Yet, the Tufts study went beyond MRSA. It also looked at:
- Animal behaviors
- Stress experienced by a therapy animal
- Animal immunizations
- Dogs fed a raw meat diet which has a risk of contamination with “bacteria such as Campylobacter, Salmonella and Cryptosporidium. These pathogens may pose risks to both humans and animals, and especially immuno compromised patients”
The study found that few policies exist to overcome the issue, but instead of calling for a shutdown on such programs, the report described itself as a “call to action” to strengthen or simply create safety measures. Obviously, and is always the case with just about anything else in the world, education is the important part of the process. Knowing that risk exists is not the only thing that helps – it is both knowing there is risk AND knowing the protocols to erase it that are important.
I mean, I love dogs and I authentically believe that dog therapies and support dogs are changing the world. But, I can see exactly why someone heading up a hospital program might feel it necessary to hit the stop button the instant a child comes down with a superbug because of a dog visit.
That is why experts are calling for some sort of regulatory agency to monitor AAI programs and also enforce specific health and safety guidelines. The facility guidelines above are some of the best (mandatory baths using specific compounds designed to kill off potential harmful bacteria, use of antimicrobial compounds, and prohibitions when compromised patients are in a ward), but the therapeutic animal community should also be tasked with protective measures.
The study noted vet examines prior to any AAI program participation, prohibiting dogs on raw meat diets, fecal testing, vaccination requirements, basic AKC obedience skills training or even a “American Kennel Club Canine Good Citizen certificate”, and behavioral testing/re-testing, might all be ideal components of regulatory guidelines or standards.
The Heart of the Matter
I can see that we are now only at the beginning of a more formalized approach to AAI or therapy animals, particularly dogs, in hospitals and care facilities. And while it is always easiest to take the path of least resistance (i.e. ending such visits), the good news is that medical experts have already noted the benefits of AAI visits. As another report indicated, “For a hospitalized patient, a visit from a furry companion can raise flagging spirits, reduce anxiety and depression, improve cooperation with treatment, and even lessen pain. “Yet, a large number of hospitals allowing such visits still lack formal policies governing animal visits apart from “we don’t allow you to bring your mother’s dog to visit”.
I hate to admit that scientific evidence exists that dogs’ mouths, feet and coats can convey a tremendous number of infectious or harmful materials…but, they do. The data is there, and hospitals and other facilities must act. Currently, there are not many guidelines available to help therapeutic animal owners or medical facilities to ensure safety. A good set of guidelines or strategies would include:
- Creating written policies for AAI and ensuring that those policies include the kinds of animals allowed, the basic level of training the animals must have, the kinds of interactions they are permitted (i.e. in room but not on bed, etc.) and the safety protocols around everything from vaccinations to approvals on individual animals. Handlers should also be included in the policies and they too must demonstrate knowledge of infection control protocols, i.e. knowing how to keep animals away from bandages, devices, wounds, and so on.
- Choosing a designated staff member or volunteer to oversee all of the animal visits conducted. They would document each visit and ensure that any infectious outbreaks might be easily understood or tracked and sourced.
- Requiring that all animals and handlers have formal training. That might be unlucky for those who look at alternative animals like cats as ideal therapy animals, but unless a therapeutic visit can be entirely predictable and controllable, it is unsafe and unhealthy
Now there are six things to know! The first three and these three suggested guidelines. However, until facilities implement these steps, we might continue to see worrisome headlines about MRSA and other bugs spread by therapy visits.
Dogs are not the only creatures with harmful bacteria in their mouths. Cats have problematic bacteria, as to many other animals. However, study after study says that it is human bites that can be the worst, with a “a higher complication and infection rate than animal bites, with approximately 10-15% of human bites becoming infected.”
So, before you hesitate to let your dog give you a big sloppy kiss, you might also think about the risks they take by letting you give them one in return! The good news is that infection is rare and as time passes and we understand the mechanics behind it, we can all take steps to stay healthy and still enjoy the constant companionship of dogs.