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Animals that routinely visit healthcare institutions include dogs and cats. They are taken into nursing or residential homes, hospital wards, hospices and long term care facilities. There is no doubt that this can benefit mental wellbeing and recovery from illness. However, there is the possibility that these animals could be carriers of MRSA or other zoonoses, or act as mechanical vectors for transmission between patients and staff. The risk of this compared to the risk from other patients, staff and visitors should, however, be kept in proportion. For example, a small percentage of healthy dogs carry MRSA. This is a similar proportion to healthy people and it is likely that dogs and cats pose no more risk to patients than human visitors and staff.

It is impractical to suggest that animals are bathed or otherwise treated between patients, but steps that could be taken to minimise any risk should include:

  • Ensuring that the animals are clinically healthy, vaccinated and thorough endo- and ectoparasites control programmes, preferably under the supervision of a veterinary surgeon.
  • Screening for dermatophytes in the absence of clinical lesions is not practical. Wood’s lamps have low sensitivity and specificity, and fungal culture takes too long and may simply represent transient contamination from the environment.
  • Empirical systemic or topical antibiotic therapy for the treatment of MRSA colonisation is not recommended because of the likelihood of rapid recolonisation and the development of antibiotic resistant strains of bacteria.
  • Grooming to remove loose hairs and scale, and, where possible, bathing with an effective antibacterial shampoo prior to visiting may reduce dissemination of bacteria onto the environment. Ideally, this should be done at separate premises and by handlers other than those who will accompany the animal on its visit or clothing should be changed to reduce the carriage of loose hair and scale onto the visited site.
  • Preventing access to sites and/or patients known to be colonised or contaminated by MRSA, critical care, immunocompromised and other high-risk patients such as those with implants and epidermal or mucosal barrier defects that require isolation or barrier nursing.
  • Staff and patients should and must disinfect their hands immediately before and after handling an animal. This should be done before to reduce the risk of transmission of MRSA (and other microorganisms) to the animal, and after to reduce the risk of transmission of microorganisms from the animal to the person. The floor should be cleaned and disinfected if it becomes soiled, but animal’s feet are otherwise no more risk than shoes.
  • Licking and other forms of mucosal contact should be avoided.
  • Animals should not climb on beds or other furniture. Where this is necessary (e.g. with cats and other small animals or bedridden patients) an impermeable pad (e.g. incontinence pad) should be placed under the animal. If contamination is suspected the surface should be disinfected or the bedding changed as appropriate.
  • Animals should not be present when patients are eating, during cleaning and changes of bedding, and when any medical or surgical procedures are undertaken.
  • Routine surveillance of visiting animals for MRSA carriage has little logical rationale and is unlikely to be of any benefit. Visiting or resident animals could be included with other regular (i.e. human) visitors, staff and patients if culture and monitoring of MRSA is undertaken for defined epidemiological purposes, but the same caveats about transient contamination versus colonisation applied to humans should be considered.

Dr Tim Nuttall
Senior Lecturer in Veterinary Dermatology
Head of the Dermatology Service
The University of Liverpool School of Veterinary Science


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