You may be overjoyed to hear that interacting with dogs can have a variety of health benefits to people.

However, before you invite man’s best friend into your care facility, there are several considerations that need to be made in order to ensure that clients, volunteers, visitors, staff and dogs can all have a safe and enjoyable experience.

Types of Dogs in Healthcare Settings

The main types of dogs that you may encounter in healthcare settings are:

• Assistance dogs that are specifically trained to perform tasks in order to assist a person living with disability. Examples of such tasks include:
  • Assisting people with vision or hearing impairment
  • Pulling wheelchairs
  • Assisting with balance
  • Turning lights on and off
  • Opening and closing doors, drawers and fridges
  • Assisting with making beds
  • Retrieving or picking up objects or clothing
  • Pushing pedestrian crossing buttons
  • Alerting to danger
  • Alerting to seizures, low blood sugar or other medical issues
  • Alerting to allergens
  • Finding and leading others to the owner
  • Preventing impulsive or destructive behaviours related to psychiatric or neurological disability
• Animal-assisted therapy dogs that are trained to assist in individualised programs (under professional supervision) to improve the physical, social, emotional and/or cognitive functioning of a client
• Therapy dogs that attend the premises alongside handlers for ‘meet and greet’ activities aimed to reduce clients’ anxiety, improve self-esteem and encourage interaction
• Visiting or resident companion dogs (pets).

(Healthdirect 2020; NSW Health 2020)

Are Dogs Allowed in Healthcare Settings?

Under the Commonwealth Disability Discrimination Act 1992, assistance dogs have the right to be taken into any public place (Healthdirect 2020). However, there may be an exception if the owner is in a space where their disability is being addressed by means other than the dog, or where there are strict sterility requirements (e.g. an operating theatre) (Assistance Dogs Australia 2022; Agriculture Victoria 2022).

Assistance dogs may also need to pass a Public Access Test (PAT) (depending on the jurisdiction) in order to prove they meet the minimum standards for public access rights. These include:

• Being non-aggressive
• Obeying commands
• Being quiet (not barking)
• Having experience in real-life situations
• Being calm in confined and crowded spaces
• Being calm in noisy and stressful situations.

(PTV 2019)

Unlike assistance dogs, ‘companion’, 'therapy' and 'emotional support' dogs are not recognised by Australian legislation and have no public access rights (Dog and Cat Management Board 2021; Canine Essentials 2016). Therefore, whether or not these dogs are permitted in healthcare settings and for what purposes is up to the discretion of an individual organisation.

Despite this, it’s reasonable to expect that other non-assistance dogs have basic ‘good manners’ and meet the same standards as assistance dogs when in public (Canine Essentials 2016).

What are the Benefits of Dogs in Healthcare Settings?

As well as offering practical assistance with daily tasks (in the case of assistance dogs), there are several other physical, psychological and social benefits associated with animal interaction.

Studies have found that interacting with, stroking and petting animals lowers blood pressure and reduces levels of the stress hormone cortisol. Animals may also decrease loneliness, improve mood and help people feel socially supported (Better Health Channel 2015; NIH 2018).

Furthermore, people who own or interact with animals are overall more healthy than those who do not. Older adults who interact with animals have been found to recover from illness and surgery more quickly and deal with stress more easily, and are less likely to experience heart disease (Aged Care Guide 2021).

In healthcare settings, interacting with animals may:

• Increase quality of life
• Encourage positive emotions and attitudes
• Increase energy levels
• Decrease tension, fatigue and confusion
• Re-engage clients who are unresponsive to other therapies
• Help clients feel needed and comforted
• Make a sterile healthcare environment feel more homely
• Have a soothing and calming effect
• Delay the effects of ageing by increasing physical activity, socialisation and mental function.

(Aged Care Guide 2021)

Risks Associated With Dogs in Healthcare Settings

While there are several benefits associated with the presence of dogs in healthcare settings, there are also three main areas of risk:

1. Infection
2. Allergies
3. Health and safety.

(RCN 2019)

Let’s look at how each of these risk areas can be addressed.

Infection Control

It's possible, albeit highly unlikely, for dogs to transmit zoonotic pathogens such as methicillin-resistant Staphylococcus aureus, Clostridioides difficile, Campylobacter, Salmonella and even rabies virus to humans (Smith 2012; Murthy et al. 2015).

To reduce this risk, dogs visiting healthcare settings should receive all recommended vaccinations and undergo screening for parasites and skin issues, three-monthly worming and monthly flea control (WA Country Health Service 2019).

Clients who are immunocompromised may need to be assessed on a case-by-case basis before having access to dogs (WA Country Health Service 2019). Furthermore, precautions may need to be taken for clients who have very recently received a bone marrow transplant or are severely neutropenic (RCN 2019).

In order to minimise the risk of infection, it’s recommended that healthcare organisations:

• Disallow dogs experiencing illness or diarrhoea from entering the premises until they have received treatment and are cleared of their illness
• Ensure dogs are house-trained
• Ensure all clients, volunteers, visitors and staff perform hand hygiene after touching or toileting dogs
• Ensure healthcare staff always perform hand hygiene prior to and after entering clinical areas
• Ensure healthcare staff do not hold dogs against their uniform (to prevent contamination)
• Never allow dogs to sit fully on a client’s bed, and always use barriers such as sheets or towels if a dog is to put its feet on a bed
• Never allow dogs near people’s faces
• Perform routine environmental cleaning and disinfection after dog visits
• Don PPE when cleaning dog urine or faeces, and immediately dispose of excretions in a sealed clinical waste bag
• Steam clean any furniture that is soiled by dog urine or faeces
• Have an action plan in place in the event of transmissible diseases
• Follow standard precautions when handling dogs, preparing dog food and cleaning dogs
• Only allow dogs to visit clients with surgical wounds if the wounds are sufficiently covered
• Disallow dogs from licking anyone
• Ensure dogs are clean and well-groomed prior to visitation
• Disallow dogs from entering intensive care units, emergency departments, operating theatres, sterile areas, food preparation areas, dining areas, maternity units and special care nurseries.

(WA Country Health Service 2019; SESLHS 2020; RCN 2019)

Allergies

Dog allergies are common. Before a dog is allowed into the premises, it should be determined whether any person in the facility has a significant dog allergy, and if so, it’s important to consider where interactions with the dog will occur to reduce the risk of adverse reactions (RCN 2019).

If the dog is visiting one specific person only, it might be most suitable for the interaction to take place within a separate room or cubicle. If the dog is visiting a group, a communal dayroom might be the most appropriate option (RCN 2019).

Health and Safety

Healthcare organisations allowing dogs into the premises should take reasonable steps to ensure the safety of clients, volunteers, visitors, staff and the dog itself (RCN 2019).

Visiting or resident dogs should be behaviourally sound. Ideally, dogs should be assessed by a qualified behavioural trainer to determine:

• The risk of injury (e.g. bites) to other animals and people
• The dog’s temperament
• Whether the dog is suitable to visit the specific healthcare environment
• Reactivity to noises, other animals and unfamiliar people.

(WA Country Health Service 2019)

It’s also essential to consider potential barriers clients may have in relation to interacting with dogs, for example:

• Animal phobias or fears
• Religious or cultural beliefs
• Confusion or hallucination.

(WA Country Health Service 2019)

Staff and clients (or their carers) must consent to animal interaction. This consent can be withdrawn at any time, and if any person (or the dog) becomes distressed, the dog should be removed immediately (WA Country Health Service 2019).

In order to minimise the risk of harm to people or dogs, it’s recommended that healthcare organisations:

• Always ensure dog visits are agreed to and consented to in advance
• Ensure dogs are on-leash and under control at all times
• Require dogs to wear ID tags or jackets identifying them as assistance or therapy dogs
• Never leave dogs alone with any person other than their owner or handler
• Monitor the dog’s body language and behaviour to ensure it is comfortable at all times
• Immediately remove the dog from any situation that puts a person or the dog at risk of harm
• Limit visitation time (dogs should only work for up to three hours per day)
• Always ensure dogs are being treated appropriately
• Assess factors such as room layout, space, size of the dog etc. prior to visitation
• Ensure the dog has access to shade, water and shelter, and that there are no toxic plants that could harm the dog.

(RCN 2019; WA Country Health Service 2019)

If there is any doubt about the dog, it should not visit (RCN 2019).

Any injuries involving a dog must be addressed immediately, and an appropriate incident reporting process may need to take place (WA Country Health Service 2019).