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Humanosis - Keeping therapy dogs safe at work

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Holistic veterinarian, Dr. Chris King, discusses ways to protect therapy dogs from human pathogens at work in healthcare facilities and other settings. (This presentation was prepared in 2014 for the therapy dog group at the Winston-Salem Dog Training Club.) Please enjoy, and make your way through the slideshow at your own pace.

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Humanosis - Keeping therapy dogs safe at work

  1. 1. Humanosis Keeping therapy dogs safe at work (protecting dogs from human pathogens) Dr. Christine King Anima Vet – Winston-Salem, NC animavet.com
  2. 2. Keeping therapy dogs safe at work  There have been NO documented cases of infection in a therapy dog traced to exposure at work
  3. 3. Keeping therapy dogs safe at work  There have been NO documented cases of infection in a therapy dog traced to exposure at work  But colonization of therapy dogs from exposure at work IS well documented
  4. 4. Keeping therapy dogs safe at work  There have been NO documented cases of infection in a therapy dog traced to exposure at work  But colonization of therapy dogs from exposure at work IS well documented  Transient contamination of therapy dogs at work may also be quite common
  5. 5. Keeping therapy dogs safe at work  What’s the difference?
  6. 6. Keeping therapy dogs safe at work  Colonization = colonies of microbes are present on a body surface
  7. 7. Keeping therapy dogs safe at work  Colonization = colonies of microbes are present on a body surface o so, bacteria may be cultured from the skin or the membranes lining the mouth, nostrils, rectum, etc.
  8. 8. Keeping therapy dogs safe at work  Colonization = colonies of microbes are present on a body surface o so, bacteria may be cultured from the skin or the membranes lining the mouth, nostrils, rectum, etc. o … and from secretions such as saliva and nasal discharge (snot)
  9. 9. Keeping therapy dogs safe at work  Colonization = colonies of microbes are present on a body surface o so, bacteria may be cultured from the skin or the membranes lining the mouth, nostrils, rectum, etc. o … and from secretions such as saliva and nasal discharge (snot) o …and excretions such as feces (poop)
  10. 10. Keeping therapy dogs safe at work  Colonization = colonies of microbes are present on a body surface o BUT the bacteria are confined to the body surface by the dog’s defenses
  11. 11. Keeping therapy dogs safe at work  Colonization = colonies of microbes are present on a body surface o BUT the bacteria are confined to the body surface by the dog’s defenses o they do not invade or damage the tissues
  12. 12. Keeping therapy dogs safe at work  Colonization = colonies of microbes are present on a body surface o BUT the bacteria are confined to the body surface by the dog’s defenses o they do not invade or damage the tissues o so, their presence does not cause inflammation
  13. 13. Keeping therapy dogs safe at work  Colonization = colonies of microbes are present on a body surface  Colonization may be temporary or permanent
  14. 14. Keeping therapy dogs safe at work  Colonization = colonies of microbes are present on a body surface  Colonization may be temporary or permanent o the dog may clear itself of the bacteria in days or weeks
  15. 15. Keeping therapy dogs safe at work  Colonization = colonies of microbes are present on a body surface  Colonization may be temporary or permanent o the dog may clear itself of the bacteria in days or weeks o or the bacteria may remain as part of the dog’s resident microflora (e.g., the normal skin microbes)
  16. 16. Keeping therapy dogs safe at work  Infection = colonies of microbes are present
  17. 17. Keeping therapy dogs safe at work  Infection = colonies of microbes are present o they may be cultured from a body surface or from a secretion or excretion
  18. 18. Keeping therapy dogs safe at work  Infection = colonies of microbes are present o they may be cultured from a body surface or from a secretion or excretion o BUT they were not confined to the body surface by the dog’s defenses
  19. 19. Keeping therapy dogs safe at work  Infection = colonies of microbes are present o they may be cultured from a body surface or from a secretion or excretion o BUT they were not confined to the body surface by the dog’s defenses o they have invaded and damaged the tissues
  20. 20. Keeping therapy dogs safe at work  Infection = colonies of microbes are present o they may be cultured from a body surface or from a secretion or excretion o BUT they were not confined to the body surface by the dog’s defenses o they have invaded and damaged the tissues o so, their presence has caused inflammation
  21. 21. Keeping therapy dogs safe at work  Infection = colonies of microbes are present  Infection may require some type of antibiotic therapy to help the dog resolve it
  22. 22. Keeping therapy dogs safe at work  Transient contamination = transfer of microbes from contact with a contaminated substance
  23. 23. Keeping therapy dogs safe at work  Transient contamination = transfer of microbes from contact with a contaminated substance o the bacteria do not colonize the body surface
  24. 24. Keeping therapy dogs safe at work  Transient contamination = transfer of microbes from contact with a contaminated substance o the bacteria do not colonize the body surface o they can, however, be transferred to another body or surface for a brief period (hours)
  25. 25. Keeping therapy dogs safe at work  In summary…
  26. 26. Keeping therapy dogs safe at work Contamination Colonization Infection culture of microbes (✔) ✔ ✔ immune response ✗ (✔) ✔ tissue damage ✗ ✗ ✔ inflammation (signs of infection) ✗ ✗ ✔ healthy or sick healthy healthy sick transmission (✔) ✔ ✔ Possible Dog-Microbe Dynamics
  27. 27. Keeping therapy dogs safe at work  Whether contamination  colonization…
  28. 28. Keeping therapy dogs safe at work  Whether contamination  colonization…  Or colonization  infection depends on several factors
  29. 29. Keeping therapy dogs safe at work 1. Number of microbes transferred
  30. 30. Keeping therapy dogs safe at work 1. Number of microbes transferred 2. Resident microflora, particularly their diversity
  31. 31. Keeping therapy dogs safe at work 1. Number of microbes transferred 2. Resident microflora, particularly their diversity 3. Health of the dog
  32. 32. Keeping therapy dogs safe at work …take a breather…
  33. 33. Keeping therapy dogs safe at work  Many different microbes (bacteria, viruses, fungi) can be spread from animals to humans
  34. 34. Keeping therapy dogs safe at work  Many different microbes (bacteria, viruses, fungi) can be spread from animals to humans  This phenomenon is known as zoonosis, or zoonotic infection zoonosisdog human
  35. 35. Keeping therapy dogs safe at work  Many of these same microbes can also be spread from humans to animals
  36. 36. Keeping therapy dogs safe at work  Many of these same microbes can also be spread from humans to animals  This phenomenon is known as reverse zoonosis, anthropozoonosis, or…
  37. 37. Keeping therapy dogs safe at work  Many of these same microbes can also be spread from humans to animals  This phenomenon is known as reverse zoonosis, anthropozoonosis, or… “humanosis”human dog “Methicillin-resistant Staphylococcus aureus and animals: zoonosis or humanosis?” Marina Morgan Department of Medical Microbiology, Royal Devon & Exeter Foundation NHS Trust, UK Journal of Antimicrobial Chemotherapy, 2008
  38. 38. Keeping therapy dogs safe at work  Some of these microbes can be spread back to humans
  39. 39. Keeping therapy dogs safe at work  Some of these microbes can be spread back to humans  This phenomenon is also known as zoonosis, even though the microbe began as a human pathogen
  40. 40. Keeping therapy dogs safe at work  Some of these microbes can be spread back to humans  This phenomenon is also known as zoonosis, even though the microbe began as a human pathogen  MRSA (methicillin-resistant Staphylococcus aureus) is a good example
  41. 41. Keeping therapy dogs safe at work “MRSA strains in pets tend to closely reflect those in people in any given region… These findings provide much support to the hypothesis that MRSA in pets is ultimately human in origin.” “Methicillin-resistant Staphylococcus aureus in animals.” J Scott Weese Ontario Veterinary College, University of Guelph, Canada Institute of Laboratory Animal Resources (ILAR) Journal, 2010
  42. 42. Keeping therapy dogs safe at work “…human hospital-associated MRSA lineages are most commonly involved in pet infection and carriage…” “Are all meticillin-resistant Staphylococcus aureus (MRSA) equal in all hosts? Epidemiological and genetic comparison between animal and human MRSA.” AJ McCarthy, JA Lindsay, A Loeffler Centre for Infection, St. George’s University of London, UK Veterinary Dermatology, 2012
  43. 43. Keeping therapy dogs safe at work  Some of these microbes can be spread back to humans  This phenomenon is also known as zoonosis, even though the microbe began as a human pathogen  MRSA (methicillin-resistant Staphylococcus aureus) is a good example human dog human strain human or animal strain
  44. 44. Keeping therapy dogs safe at work  A simpler way to remember it is this:
  45. 45. Keeping therapy dogs safe at work  A simpler way to remember it is this: MRSAdog human
  46. 46. Keeping therapy dogs safe at work Er, what’s up, doc?
  47. 47. Keeping therapy dogs safe at work  Now let’s look at some studies of potential pathogens in therapy dogs…
  48. 48. Keeping therapy dogs safe at work “Incidence of acquisition of methicillin-resistant Staphylococcus aureus, Clostridium difficile, and other healthcare-associated pathogens by dogs that participate in animal-assisted interventions” Sandra Lefebvre, Richard Reid-Smith, David Waltner-Toews, and J. Scott Weese Ontario Veterinary College, University of Guelph, Canada Journal of the American Veterinary Medical Association, 2009
  49. 49. Keeping therapy dogs safe at work  This study involved 194 dogs in animal-assisted intervention (AAI) programs in Ontario and Alberta
  50. 50. Keeping therapy dogs safe at work  This study involved 194 dogs in animal-assisted intervention (AAI) programs in Ontario and Alberta o 96 dogs were “exposed” to patients in healthcare facilities (hospitals or long-term care)
  51. 51. Keeping therapy dogs safe at work  This study involved 194 dogs in animal-assisted intervention (AAI) programs in Ontario and Alberta o 96 dogs were “exposed” to patients in healthcare facilities (hospitals or long-term care) o 98 dogs were “unexposed” to healthcare settings; they worked in schools, libraries, group homes, etc.
  52. 52. Keeping therapy dogs safe at work  This study involved 194 dogs in animal-assisted intervention (AAI) programs in Ontario and Alberta o 96 dogs were “exposed” to patients in healthcare facilities (hospitals or long-term care) o 98 dogs were “unexposed” to healthcare settings; they worked in schools, libraries, group homes, etc. o the study excluded dogs who were already working in healthcare facilities
  53. 53. Keeping therapy dogs safe at work  Nasal swabs and fecal samples were collected at the start and every 2 months for 1 year
  54. 54. Keeping therapy dogs safe at work  Nasal swabs and fecal samples were collected at the start and every 2 months for 1 year  Samples were tested for these 5 pathogens:
  55. 55. Keeping therapy dogs safe at work  Nasal swabs and fecal samples were collected at the start and every 2 months for 1 year  Samples were tested for these 5 pathogens: o MRSA - methicillin-resistant Staph. aureus
  56. 56. Keeping therapy dogs safe at work  Nasal swabs and fecal samples were collected at the start and every 2 months for 1 year  Samples were tested for these 5 pathogens: o MRSA - methicillin-resistant Staph. aureus o MRSI - methicillin-resistant Staph. intermedius
  57. 57. Keeping therapy dogs safe at work  Nasal swabs and fecal samples were collected at the start and every 2 months for 1 year  Samples were tested for these 5 pathogens: o MRSA - methicillin-resistant Staph. aureus o MRSI - methicillin-resistant Staph. intermedius o C. diff. - Clostridium difficile and its enterotoxins
  58. 58. Keeping therapy dogs safe at work  Nasal swabs and fecal samples were collected at the start and every 2 months for 1 year  Samples were tested for these 5 pathogens: o MRSA - methicillin-resistant Staph. aureus o MRSI - methicillin-resistant Staph. intermedius o C. diff. - Clostridium difficile and its enterotoxins o VRE - vancomycin-resistant Enterococcus species
  59. 59. Keeping therapy dogs safe at work  Nasal swabs and fecal samples were collected at the start and every 2 months for 1 year  Samples were tested for these 5 pathogens: o MRSA - methicillin-resistant Staph. aureus o MRSI - methicillin-resistant Staph. intermedius o C. diff. - Clostridium difficile and its enterotoxins o VRE - vancomycin-resistant Enterococcus species o E. coli - Escherichia coli (2 drug-resistant strains)
  60. 60. Keeping therapy dogs safe at work  The dog owners kept a log of all relevant activities and events
  61. 61. Keeping therapy dogs safe at work  The dog owners kept a log of all relevant activities and events  Owners of “exposed” dogs also filled out a questionnaire about the dog’s behaviors at work
  62. 62. Keeping therapy dogs safe at work  The dog owners kept a log of all relevant activities and events  Owners of “exposed” dogs also filled out a questionnaire about the dog’s behaviors at work o most dogs did therapy work 2 times/week
  63. 63. Keeping therapy dogs safe at work  The dog owners kept a log of all relevant activities and events  Owners of “exposed” dogs also filled out a questionnaire about the dog’s behaviors at work o most dogs did therapy work 2 times/week o but it ranged from once a month to 6 times/week
  64. 64. Keeping therapy dogs safe at work  The dog owners kept a log of all relevant activities and events  Owners of “exposed” dogs also filled out a questionnaire about the dog’s behaviors at work o most dogs did therapy work 2 times/week o but it ranged from once a month to 6 times/week o most visited at least 2 different healthcare facilities in any given month
  65. 65. Keeping therapy dogs safe at work  Let’s go through the findings in detail…
  66. 66. Keeping therapy dogs safe at work  Let’s go through the findings in detail… o remember that exposed = working in healthcare (hospitals or long-term care) facilities
  67. 67. Keeping therapy dogs safe at work  Let’s go through the findings in detail… o remember that exposed = working in healthcare (hospitals or long-term care) facilities o unexposed = not working in healthcare facilities
  68. 68. Keeping therapy dogs safe at work Before During study MRSA (nasal) 0 3 dogs MRSA (fecal) 0 6 dogs MRSA (nasal + fecal) 0 0 MRSI (nasal) 1 dog 0 C. diff. (fecal) 9 dogs 39 dogs VRE (fecal) 0 1 dog E. coli (fecal) 22 dogs 37 dogs Positive samples from 194 therapy dogs
  69. 69. Keeping therapy dogs safe at work Before During study MRSA (nasal) 0 3 dogs MRSA (fecal) 0 6 dogs MRSA (nasal + fecal) 0 0 MRSA Of the 3 dogs with positive nasal swabs during the study…
  70. 70. Keeping therapy dogs safe at work Before During study MRSA (nasal) 0 3 dogs MRSA (fecal) 0 6 dogs MRSA (nasal + fecal) 0 0 MRSA Of the 3 dogs with positive nasal swabs during the study… o 2 exposed, 1 unexposed
  71. 71. Keeping therapy dogs safe at work Before During study MRSA (nasal) 0 3 dogs MRSA (fecal) 0 6 dogs MRSA (nasal + fecal) 0 0 MRSA Of the 3 dogs with positive nasal swabs during the study… o 2 exposed, 1 unexposed o all 3 dogs were positive only ONCE
  72. 72. Keeping therapy dogs safe at work Before During study MRSA (nasal) 0 3 dogs MRSA (fecal) 0 6 dogs MRSA (nasal + fecal) 0 0 MRSA Of the 3 dogs with positive nasal swabs during the study… o so, either transient contamination or temporary colonization of the nostrils by MRSA
  73. 73. Keeping therapy dogs safe at work Before During study MRSA (nasal) 0 3 dogs MRSA (fecal) 0 6 dogs MRSA (nasal + fecal) 0 0 MRSA Of the 6 dogs with positive fecal samples during the study…
  74. 74. Keeping therapy dogs safe at work Before During study MRSA (nasal) 0 3 dogs MRSA (fecal) 0 6 dogs MRSA (nasal + fecal) 0 0 MRSA Of the 6 dogs with positive fecal samples during the study… o 5 exposed, 1 unexposed
  75. 75. Keeping therapy dogs safe at work Before During study MRSA (nasal) 0 3 dogs MRSA (fecal) 0 6 dogs MRSA (nasal + fecal) 0 0 MRSA Of the 6 dogs with positive fecal samples during the study… o 5 exposed, 1 unexposed o all 6 dogs were positive only ONCE
  76. 76. Keeping therapy dogs safe at work Before During study MRSA (nasal) 0 3 dogs MRSA (fecal) 0 6 dogs MRSA (nasal + fecal) 0 0 MRSA Of the 6 dogs with positive fecal samples during the study… o so, either transient contamination (pass-through) or temporary colonization of the gut by MRSA
  77. 77. Keeping therapy dogs safe at work Before During study MRSA (nasal) 0 3 dogs MRSA (fecal) 0 6 dogs MRSA (nasal + fecal) 0 0 MRSA NO dogs were positive for MRSA in both nasal and fecal samples
  78. 78. Keeping therapy dogs safe at work Before During study MRSI (nasal) 1 dog 0 Methicillin-resistant Staph. intermedius One dog was positive for MRSI, but only ONCE
  79. 79. Keeping therapy dogs safe at work Before During study MRSI (nasal) 1 dog 0 Methicillin-resistant Staph. intermedius One dog was positive for MRSI, but only ONCE o so, either transient contamination or temporary colonization of the nostrils by MRSI
  80. 80. Keeping therapy dogs safe at work Before During study C. diff. (fecal) 9 dogs 39 dogs Clostridium difficile C. diff. was found in the feces of 9 dogs (4.6%) at the start of the study
  81. 81. Keeping therapy dogs safe at work Before During study C. diff. (fecal) 9 dogs 39 dogs Clostridium difficile C. diff. was found in the feces of 9 dogs (4.6%) at the start of the study o remember that none of the 194 dogs had worked in healthcare facilities before the study began
  82. 82. Keeping therapy dogs safe at work Before During study C. diff. (fecal) 9 dogs 39 dogs Clostridium difficile C. diff. was found in the feces of 39 dogs (20%) during the study
  83. 83. Keeping therapy dogs safe at work Before During study C. diff. (fecal) 9 dogs 39 dogs Clostridium difficile C. diff. was found in the feces of 39 dogs (20%) during the study o 23 exposed (59%), 16 unexposed (41%) to healthcare facilities
  84. 84. Keeping therapy dogs safe at work Before During study C. diff. (fecal) 9 dogs 39 dogs Clostridium difficile C. diff. was found in the feces of 39 dogs (20%) during the study o of the 23 exposed dogs… o 6 dogs (26%) were positive in 2 or 3 consecutive samples
  85. 85. Keeping therapy dogs safe at work Before During study C. diff. (fecal) 9 dogs 39 dogs Clostridium difficile C. diff. was found in the feces of 39 dogs (20%) during the study o of the 23 exposed dogs… o 6 dogs (26%) were positive in 2 or 3 consecutive samples o 17 dogs (74%) were positive only ONCE
  86. 86. Keeping therapy dogs safe at work Before During study C. diff. (fecal) 9 dogs 39 dogs Clostridium difficile C. diff. was found in the feces of 39 dogs (20%) during the study o of the 16 unexposed dogs… o 1 dog (6%) was positive in 2 consecutive samples
  87. 87. Keeping therapy dogs safe at work Before During study C. diff. (fecal) 9 dogs 39 dogs Clostridium difficile C. diff. was found in the feces of 39 dogs (20%) during the study o of the 16 unexposed dogs… o 1 dog (6%) was positive in 2 consecutive samples o 15 dogs (94%) were positive only ONCE
  88. 88. Keeping therapy dogs safe at work Before During study C. diff. (fecal) 9 dogs 39 dogs Clostridium difficile None of the dogs who were positive for C. diff. had diarrhea
  89. 89. Keeping therapy dogs safe at work Before During study C. diff. (fecal) 9 dogs 39 dogs Clostridium difficile None of the dogs who were positive for C. diff. had diarrhea o so, either transient contamination (pass-through) or temporary colonization of the gut by C. diff in all of these dogs
  90. 90. Keeping therapy dogs safe at work Before During study VRE (fecal) 0 1 dog Vancomycin-resistant Enterococcus species One dog was positive for VRE, but only ONCE
  91. 91. Keeping therapy dogs safe at work Before During study VRE (fecal) 0 1 dog Vancomycin-resistant Enterococcus species One dog was positive for VRE, but only ONCE o this dog visited a hospital once a week
  92. 92. Keeping therapy dogs safe at work Before During study VRE (fecal) 0 1 dog Vancomycin-resistant Enterococcus species One dog was positive for VRE, but only ONCE o this dog visited a hospital once a week o so, either transient contamination (pass-through) or temporary colonization of the gut by VRE
  93. 93. Keeping therapy dogs safe at work Before During study E. coli (fecal) 22 dogs 37 dogs E. coli E. coli was found in the feces of 22 dogs (11%) at the start of the study
  94. 94. Keeping therapy dogs safe at work Before During study E. coli (fecal) 22 dogs 37 dogs E. coli E. coli was found in the feces of 22 dogs (11%) at the start of the study o E. coli is normally found in the feces, but these particular strains were drug-resistant E. coli that are a problem in human medicine
  95. 95. Keeping therapy dogs safe at work Before During study E. coli (fecal) 22 dogs 37 dogs E. coli E. coli was found in the feces of 37 dogs (19%) during the study
  96. 96. Keeping therapy dogs safe at work Before During study E. coli (fecal) 22 dogs 37 dogs E. coli E. coli was found in the feces of 37 dogs (19%) during the study o 21 exposed dogs (57%), 16 unexposed dogs (43%)
  97. 97. Keeping therapy dogs safe at work Before During study E. coli (fecal) 22 dogs 37 dogs E. coli E. coli was found in the feces of 37 dogs (19%) during the study o 21 exposed dogs (57%), 16 unexposed dogs (43%) o 84 fecal samples were positive during the study, as there was an average of 2 or 3 positive samples per dog
  98. 98. Keeping therapy dogs safe at work Before During study E. coli (fecal) 22 dogs 37 dogs E. coli None of the dogs who were positive for E. coli had diarrhea
  99. 99. Keeping therapy dogs safe at work Before During study E. coli (fecal) 22 dogs 37 dogs E. coli None of the dogs who were positive for E. coli had diarrhea o so, either transient contamination (pass-through) or temporary colonization of the gut by these pathogenic strains of E. coli
  100. 100. Keeping therapy dogs safe at work Incidence in exposed dogs MRSA 4.7 times higher than in unexposed dogs C. diff. 2.4 times higher than in unexposed dogs E. coli 1.8 times higher, but not statistically different VRE too few incidents to calculate MRSI no incidents Likelihood of a positive sample MRSA and C. diff. were more likely to be found in nasal swabs or feces from dogs working in healthcare than in dogs doing other therapy work
  101. 101. Keeping therapy dogs safe at work Exposure to… Odds of a positive sample* human healthcare facilities 6.3 times higher hospitals only 3.7 times higher, but NSD long-term care facilities only 4.9 times higher groups of children 7.1 times higher antibiotic use by dog same antibiotic use by others at home same MRSA risk factors * compared with dogs not exposed to that factor; NSD = not statistically different
  102. 102. Keeping therapy dogs safe at work Exposure to… Odds of a positive sample human healthcare facilities 6.3 times higher long-term care facilities only 4.9 times higher groups of children 7.1 times higher MRSA risk factors Exposure to long-term care facilities or to groups of children increased the risk of having a positive nasal or fecal sample (MRSA)
  103. 103. Keeping therapy dogs safe at work Exposure to… Odds of a positive sample* human healthcare facilities 3.3 times higher hospitals only 2.2 times higher long-term care facilities only 2.3 times higher groups of children 3.5 times higher antibiotic use by dog 2.2 times higher antibiotic use by others at home 3.2 times higher C. diff. risk factors * compared with dogs not exposed to that factor
  104. 104. Keeping therapy dogs safe at work Exposure to… Odds of a positive sample human healthcare facilities 3.3 times higher groups of children 3.5 times higher antibiotic use by dog 2.2 times higher antibiotic use by others at home 3.2 times higher C. diff. risk factors Exposure to healthcare facilities, children, and antibiotics each increased the risk of having a positive fecal sample (C. diff.)
  105. 105. Keeping therapy dogs safe at work Exposure to… Odds of a positive sample* human healthcare facilities 1.3 times higher but NSD hospitals only 1.2 times higher but NSD long-term care facilities only 1.5 times higher but NSD groups of children 1.2 times higher but NSD antibiotic use by dog 2.6 times higher antibiotic use by others at home 1.6 times higher but NSD E. coli risk factors * compared with dogs not exposed to that factor; NSD = not statistically different
  106. 106. Keeping therapy dogs safe at work Exposure to… Odds of a positive sample antibiotic use by dog 2.6 times higher E. coli risk factors Treating the dog with antibiotics was the only factor that significantly increased the risk of having a positive fecal sample (E. coli)
  107. 107. Keeping therapy dogs safe at work Behavior Odds of a positive sample* At home MRSA C. diff. E. coli eating feces (coprophagia) − 0.1 − drinking from the toilet − − − At work visiting incontinent patients 5.6 − 2.5 licking patients 18.8 3.5 − taking treats from patients 11.2 − − on the patient’s bed without a barrier − 1.5 − Risky behaviors by dogs * compared with dogs not showing that behavior
  108. 108. Keeping therapy dogs safe at work Behavior Odds of a positive sample At home MRSA C. diff. E. coli eating feces (coprophagia) − 0.1 − Risky behaviors by dogs Dogs who eat poop were significantly less likely to be positive for C. diff. (fecal sample) than dogs who do not eat poop
  109. 109. Keeping therapy dogs safe at work Behavior Odds of a positive sample At home MRSA C. diff. E. coli eating feces (coprophagia) − 0.1 − Risky behaviors by dogs Dogs who eat poop were significantly less likely to be positive for C. diff. (fecal sample) than dogs who do not eat poop o this behavior did not significantly change the odds of being positive for MRSA (nasal/fecal) or E. coli (fecal)
  110. 110. Keeping therapy dogs safe at work Behavior Odds of a positive sample At home MRSA C. diff. E. coli eating feces (coprophagia) − 0.1 − Risky behaviors by dogs Dogs who eat poop were significantly less likely to be positive for C. diff. (fecal sample) than dogs who do not eat poop o this behavior did not significantly change the odds of being positive for MRSA (nasal/fecal) or E. coli (fecal) o drinking from the toilet did not significantly change the odds of having a positive nasal/fecal sample for any of these pathogens
  111. 111. Keeping therapy dogs safe at work Behavior Odds of a positive sample At work MRSA C. diff. E. coli visiting incontinent patients 5.6 − 2.5 Risky behaviors by dogs Visiting incontinent patients did not significantly change the odds of having a positive nasal/fecal sample for any of these pathogens
  112. 112. Keeping therapy dogs safe at work Behavior Odds of a positive sample At work MRSA C. diff. E. coli visiting incontinent patients 5.6 − 2.5 Risky behaviors by dogs Visiting incontinent patients did not significantly change the odds of having a positive nasal/fecal sample for any of these pathogens o although this behavior increased the odds of being positive for MRSA or E. coli, these values were not statistically significant
  113. 113. Keeping therapy dogs safe at work Behavior Odds of a positive sample At work MRSA C. diff. E. coli licking patients 18.8 3.5 − Risky behaviors by dogs Dogs who licked patients were significantly more likely to be positive for MRSA (nasal/fecal) or C. diff. (fecal) than dogs who did not lick
  114. 114. Keeping therapy dogs safe at work Behavior Odds of a positive sample At work MRSA C. diff. E. coli licking patients 18.8 3.5 − Risky behaviors by dogs Dogs who licked patients were significantly more likely to be positive for MRSA (nasal/fecal) or C. diff. (fecal) than dogs who did not lick o the odds of having a positive MRSA sample were almost 19 times higher in dogs who licked patients
  115. 115. Keeping therapy dogs safe at work Behavior Odds of a positive sample At work MRSA C. diff. E. coli licking patients 18.8 3.5 − Risky behaviors by dogs Dogs who licked patients were significantly more likely to be positive for MRSA (nasal/fecal) or C. diff. (fecal) than dogs who did not lick o the odds of having a positive MRSA sample were almost 19 times higher in dogs who licked patients o the odds of having a positive C. diff. sample were 3.5 times higher in dogs who licked patients
  116. 116. Keeping therapy dogs safe at work Behavior Odds of a positive sample At work MRSA C. diff. E. coli licking patients 18.8 3.5 − Risky behaviors by dogs Dogs who licked patients were significantly more likely to be positive for MRSA (nasal/fecal) or C. diff. (fecal) than dogs who did not lick o this behavior did not significantly change the odds of being positive for E. coli (feces)
  117. 117. Keeping therapy dogs safe at work Behavior Odds of a positive sample At work MRSA C. diff. E. coli taking treats from patients 11.2 − − Risky behaviors by dogs Dogs who took treats from patients were significantly more likely to be positive for MRSA (nasal/fecal) than dogs who did not take treats
  118. 118. Keeping therapy dogs safe at work Behavior Odds of a positive sample At work MRSA C. diff. E. coli taking treats from patients 11.2 − − Risky behaviors by dogs Dogs who took treats from patients were significantly more likely to be positive for MRSA (nasal/fecal) than dogs who did not take treats o the odds of being positive for MRSA were 11 times higher in dogs who took treats from patients
  119. 119. Keeping therapy dogs safe at work Behavior Odds of a positive sample At work MRSA C. diff. E. coli taking treats from patients 11.2 − − Risky behaviors by dogs Dogs who took treats from patients were significantly more likely to be positive for MRSA (nasal/fecal) than dogs who did not take treats o the odds of being positive for MRSA were 11 times higher in dogs who took treats from patients o this behavior did not significantly change the odds of being positive for C. diff. (fecal) or E. coli (fecal)
  120. 120. Keeping therapy dogs safe at work Behavior Odds of a positive sample At work MRSA C. diff. E. coli on the patient’s bed without a barrier − 1.5 − Risky behaviors by dogs Dogs who got on the bed without a barrier between dog and bedding were significantly more likely to be positive for C. diff. (fecal)
  121. 121. Keeping therapy dogs safe at work Behavior Odds of a positive sample At work MRSA C. diff. E. coli on the patient’s bed without a barrier − 1.5 − Risky behaviors by dogs Dogs who got on the bed without a barrier between dog and bedding were significantly more likely to be positive for C. diff. (fecal) o the odds of being positive for C. diff. were 1.5 times higher in dogs who got on the bed without a protective barrier
  122. 122. Keeping therapy dogs safe at work Behavior Odds of a positive sample At work MRSA C. diff. E. coli on the patient’s bed without a barrier − 1.5 − Risky behaviors by dogs Dogs who got on the bed without a barrier between dog and bedding were significantly more likely to be positive for C. diff. (fecal) o the odds of being positive for C. diff. were 1.5 times higher in dogs who got on the bed without a protective barrier o this behavior did not significantly change the odds of being positive for MRSA (nasal/fecal) or E. coli (fecal)
  123. 123. Keeping therapy dogs safe at work  Here are the key points again:
  124. 124. Keeping therapy dogs safe at work  The odds of a dog picking up MRSA were almost 5 times greater when working in healthcare
  125. 125. Keeping therapy dogs safe at work  The odds of a dog picking up MRSA were almost 5 times greater when working in healthcare  The odds of a dog picking up C. diff. were almost 2.5 times greater when working in healthcare
  126. 126. Keeping therapy dogs safe at work  The odds of a dog picking up MRSA were almost 5 times greater when working in healthcare  The odds of a dog picking up C. diff. were almost 2.5 times greater when working in healthcare  Licking patients and accepting treats during a visit were the riskiest behaviors by dogs
  127. 127. Keeping therapy dogs safe at work  The incidence of illness in therapy dogs was low
  128. 128. Keeping therapy dogs safe at work  The incidence of illness in therapy dogs was low o 21 dogs (11%) had diarrhea during the year
  129. 129. Keeping therapy dogs safe at work  The incidence of illness in therapy dogs was low o 21 dogs (11%) had diarrhea during the year o 9 dogs (4.6%) had a urinary tract infection (UTI) during the year
  130. 130. Keeping therapy dogs safe at work  There was no association between illness and a positive sample for any of the pathogens, but…
  131. 131. Keeping therapy dogs safe at work  There was no association between illness and a positive sample for any of the pathogens, but… o diarrhea was 4 times more likely in dogs working in healthcare facilities
  132. 132. Keeping therapy dogs safe at work  There was no association between illness and a positive sample for any of the pathogens, but… o diarrhea was 4 times more likely in dogs working in healthcare facilities o UTI was 6.5 times more likely in dogs working in healthcare facilities
  133. 133. Keeping therapy dogs safe at work  What role did stress play?
  134. 134. Keeping therapy dogs safe at work
  135. 135. Keeping therapy dogs safe at work “Methicillin-resistant Staphylococcus aureus in resident animals of a long-term care facility” K Coughlan, KE Olsen, D Boxrud, JB Bender Veterinary Public Health, University of Minnesota Zoonoses and Public Health, 2010
  136. 136. Keeping therapy dogs safe at work  This study involved 1 dog and 11 cats living in a long-term care facility
  137. 137. Keeping therapy dogs safe at work  This study involved 1 dog and 11 cats living in a long-term care facility  Nasal swabs were collected each week for 8 weeks
  138. 138. Keeping therapy dogs safe at work  This study involved 1 dog and 11 cats living in a long-term care facility  Nasal swabs were collected each week for 8 weeks  Swabs were tested for MRSA and compared with the Minnesota Department of Health database
  139. 139. Keeping therapy dogs safe at work  2 cats were colonized with MRSA
  140. 140. Keeping therapy dogs safe at work  2 cats were colonized with MRSA o 1 cat was positive in 5 of 8 weekly samples
  141. 141. Keeping therapy dogs safe at work  2 cats were colonized with MRSA o 1 cat was positive in 5 of 8 weekly samples o 1 cat was positive in 2 of 8 weekly samples
  142. 142. Keeping therapy dogs safe at work  2 cats were colonized with MRSA o 1 cat was positive in 5 of 8 weekly samples o 1 cat was positive in 2 of 8 weekly samples  All positive samples were a human healthcare- associated strain (USA100)
  143. 143. Keeping therapy dogs safe at work  2 cats were colonized with MRSA o 1 cat was positive in 5 of 8 weekly samples o 1 cat was positive in 2 of 8 weekly samples  All positive samples were a human healthcare- associated strain (USA100)  The dog and the other 9 cats remained negative
  144. 144. Keeping therapy dogs safe at work Next, please.
  145. 145. Keeping therapy dogs safe at work “MRSA carriage in a pet therapy dog” DA Enoch, JA Karas, JD Slater, et al. Clinical Microbiology and Public Health Laboratory, Cambridge UK Letters to the Editor, Journal of Hospital Infection, 2004
  146. 146. Keeping therapy dogs safe at work  This report involved an 11-year-old Border Collie
  147. 147. Keeping therapy dogs safe at work  This report involved an 11-year-old Border Collie  The dog regularly visited a district general hospital care-of-the-elderly ward
  148. 148. Keeping therapy dogs safe at work  This report involved an 11-year-old Border Collie  The dog regularly visited a district general hospital care-of-the-elderly ward  Swabs from the dog’s nose, head, and feet were taken before and after visiting the ward
  149. 149. Keeping therapy dogs safe at work  Swabs taken before the visit were negative for MRSA
  150. 150. Keeping therapy dogs safe at work  Swabs taken before the visit were negative for MRSA  Only the swabs taken after the visit grew MRSA
  151. 151. Keeping therapy dogs safe at work  Swabs taken before the visit were negative for MRSA  Only the swabs taken after the visit grew MRSA  The antibiotic susceptibility profile was typical of the human MRSA strains found in the hospital
  152. 152. Keeping therapy dogs safe at work  The dog was negative for MRSA 2 weeks later
  153. 153. Keeping therapy dogs safe at work  The dog was negative for MRSA 2 weeks later  This profile suggests either transient contamination or temporary colonization by contact with MRSA in the hospital
  154. 154. Keeping therapy dogs safe at work  The dog was negative for MRSA 2 weeks later  This profile suggests either transient contamination or temporary colonization by contact with MRSA in the hospital  It is a clear case of human  dog transmission
  155. 155. Keeping therapy dogs safe at work “Contamination of pet therapy dogs with MRSA and Clostridium difficile” SL Lefebvre and JS Weese University of Guelph, Ontario, Canada Letters to the Editor, Journal of Hospital Infection, 2009
  156. 156. Keeping therapy dogs safe at work  This study involved 26 pet therapy dogs and their handlers
  157. 157. Keeping therapy dogs safe at work  This study involved 26 pet therapy dogs and their handlers o 12 visited acute care (hospital) facilities
  158. 158. Keeping therapy dogs safe at work  This study involved 26 pet therapy dogs and their handlers o 12 visited acute care (hospital) facilities o 14 visited long-term care facilities
  159. 159. Keeping therapy dogs safe at work  The dog’s front paws and the handler’s hands were sampled before and after each visit
  160. 160. Keeping therapy dogs safe at work  The dog’s front paws and the handler’s hands were sampled before and after each visit  The dog’s coat was also sampled by stroking the dog from head to tail for 1 minute
  161. 161. Keeping therapy dogs safe at work  The dog’s front paws and the handler’s hands were sampled before and after each visit  The dog’s coat was also sampled by stroking the dog from head to tail for 1 minute  Samples were cultured for MRSA, C. diff., and VRE
  162. 162. Keeping therapy dogs safe at work  The dog’s front paws and the handler’s hands were sampled before and after each visit  The dog’s coat was also sampled by stroking the dog from head to tail for 1 minute  Samples were cultured for MRSA, C. diff., and VRE o methicillin-resistant Staph. aureus (MRSA) o Clostridium difficile (C. diff.) o vancomycin-resistant Enterococcus species (VRE)
  163. 163. Keeping therapy dogs safe at work  All 26 dogs’ paws and coats were negative for all tested pathogens before visits
  164. 164. Keeping therapy dogs safe at work  All 26 dogs’ paws and coats were negative for all tested pathogens before visits  1 dog picked up C. diff. on its paws during a hospital visit
  165. 165. Keeping therapy dogs safe at work  All 26 dogs’ paws and coats were negative for all tested pathogens before visits  1 dog picked up C. diff. on its paws during a hospital visit  1 dog picked up MRSA on its coat during a visit to a long-term care facility
  166. 166. Keeping therapy dogs safe at work  All 26 dogs’ paws and coats were negative for all tested pathogens before visits  1 dog picked up C. diff. on its paws during a hospital visit  1 dog picked up MRSA on its coat during a visit to a long-term care facility  All 26 handlers were negative for all tested pathogens before and after the visits
  167. 167. Keeping therapy dogs safe at work  The dog that picked up C. diff. on its paws had been encouraged to shake hands with patients
  168. 168. Keeping therapy dogs safe at work  The dog that picked up C. diff. on its paws had been encouraged to shake hands with patients  The dog that picked up MRSA on its coat had been repeatedly placed on patients’ beds…
  169. 169. Keeping therapy dogs safe at work  The dog that picked up C. diff. on its paws had been encouraged to shake hands with patients  The dog that picked up MRSA on its coat had been repeatedly placed on patients’ beds…  and was kissed on the head by 2 patients
  170. 170. Keeping therapy dogs safe at work If you simply must pat me, for goodness’ sake wash your hands first!
  171. 171. Keeping therapy dogs safe at work  While infection of a therapy dog is improbable, it’s not impossible
  172. 172. Keeping therapy dogs safe at work  While infection of a therapy dog is improbable, it’s not impossible  Most of the safeguards already in place to protect the humans from the dogs also protect the dogs
  173. 173. Keeping therapy dogs safe at work  While infection of a therapy dog is improbable, it’s not impossible  Most of the safeguards already in place to protect the humans from the dogs also protect the dogs  However, there is still some risk to the dogs that is not accounted for in these protocols
  174. 174. Keeping therapy dogs safe at work  How can we keep therapy dogs safe at work?
  175. 175. Keeping therapy dogs safe at work 1. Take extra care around people with nasal discharge (runny nose)
  176. 176. Keeping therapy dogs safe at work 1. Take extra care around people with nasal discharge (runny nose) o MRSA often colonizes the nasal passages
  177. 177. Keeping therapy dogs safe at work 1. Take extra care around people with nasal discharge (runny nose) o MRSA often colonizes the nasal passages o healthy people who are colonized by MRSA are considered silent “carriers”
  178. 178. Keeping therapy dogs safe at work 1. Take extra care around people with nasal discharge (runny nose) o MRSA often colonizes the nasal passages o healthy people who are colonized by MRSA are considered silent “carriers” o if possible, ask these people to wash their hands before patting the dog
  179. 179. Keeping therapy dogs safe at work 1. Take extra care around people with nasal discharge (runny nose) o MRSA often colonizes the nasal passages o healthy people who are colonized by MRSA are considered silent “carriers” o if possible, ask these people to wash their hands before patting the dog o avoid people with frequent coughing or sneezing
  180. 180. Keeping therapy dogs safe at work 2. Take extra care around patients with infected wounds
  181. 181. Keeping therapy dogs safe at work 2. Take extra care around patients with infected wounds o MRSA is a common cause of wound infection in hospitals
  182. 182. Keeping therapy dogs safe at work 2. Take extra care around patients with infected wounds o MRSA is a common cause of wound infection in hospitals o VRE is increasingly showing up in wound infections in humans and animals
  183. 183. Keeping therapy dogs safe at work 2. Take extra care around patients with infected wounds o MRSA is a common cause of wound infection in hospitals o VRE is increasingly showing up in wound infections in humans and animals o avoid all contact with wound dressings, on or off the patient
  184. 184. Keeping therapy dogs safe at work 3. Limit visits in surgical wards and ICUs
  185. 185. Keeping therapy dogs safe at work 3. Limit visits in surgical wards and ICUs o hospital-acquired (“nosocomial”) infections are common in these wards
  186. 186. Keeping therapy dogs safe at work 3. Limit visits in surgical wards and ICUs o hospital-acquired (“nosocomial”) infections are common in these wards o community-acquired infections also show up in these wards, as these patients are especially vulnerable to infection
  187. 187. Keeping therapy dogs safe at work 4. Limit visits with immunocompromised patients
  188. 188. Keeping therapy dogs safe at work 4. Limit visits with immunocompromised patients o these patients are much more likely to develop infections than any other patient
  189. 189. Keeping therapy dogs safe at work 4. Limit visits with immunocompromised patients o these patients are much more likely to develop infections than any other patient o cancer patients fit here if chemo, radiation, or other therapy has compromised immune function
  190. 190. Keeping therapy dogs safe at work 4. Limit visits with immunocompromised patients o these patients are much more likely to develop infections than any other patient o cancer patients fit here if chemo, radiation, or other therapy has compromised immune function o bearing in mind that these are some of the patients who can most benefit from pet therapy…
  191. 191. Keeping therapy dogs safe at work 4. Limit visits with immunocompromised patients o these patients are much more likely to develop infections than any other patient o cancer patients fit here if chemo, radiation, or other therapy has compromised immune function o bearing in mind that these are some of the patients who can most benefit from pet therapy… o simply take extra care with these patients
  192. 192. Keeping therapy dogs safe at work 5. Limit visits with long-term care patients
  193. 193. Keeping therapy dogs safe at work 5. Limit visits with long-term care patients o as above for immunocompromised patients
  194. 194. Keeping therapy dogs safe at work 5. Limit visits with long-term care patients o as above for immunocompromised patients o nosocomial infections become more likely the longer the patient is hospitalized
  195. 195. Keeping therapy dogs safe at work 6. Wash your own hands often
  196. 196. Keeping therapy dogs safe at work 6. Wash your own hands often o you handle your dog much more than any patient will do, so practice good hygiene
  197. 197. Keeping therapy dogs safe at work 6. Wash your own hands often o you handle your dog much more than any patient will do, so practice good hygiene o also take care what you touch while in the hospital…
  198. 198. Keeping therapy dogs safe at work 6. Wash your own hands often o you handle your dog much more than any patient will do, so practice good hygiene o also take care what you touch while in the hospital… o inanimate objects and surfaces can harbor potentially pathogenic microbes as well
  199. 199. Keeping therapy dogs safe at work 7. Avoid using antiseptic soaps and hand-sanitizers
  200. 200. Keeping therapy dogs safe at work 7. Avoid using antiseptic soaps and hand-sanitizers o these products wipe out the normal microflora (the microbes that are normally found on the skin)
  201. 201. Keeping therapy dogs safe at work 7. Avoid using antiseptic soaps and hand-sanitizers o these products wipe out the normal microflora (the microbes that are normally found on the skin) o the normal microflora are an important barrier to infection
  202. 202. Keeping therapy dogs safe at work 7. Avoid using antiseptic soaps and hand-sanitizers o these products wipe out the normal microflora (the microbes that are normally found on the skin) o the normal microflora are an important barrier to infection o antiseptic resistance is now showing up in MRSA and other pathogens
  203. 203. Keeping therapy dogs safe at work “…antiseptic resistance (AR) genes increasing tolerance to several disinfectants have been reported in S. aureus of human origin and from bovine, equine, and caprine staphylococcal isolates.” “Presence of antiseptic resistance genes in porcine methicillin-resistant Staphylococcus aureus” TZ Wong, M Zhang, M O’Donoghue, M Boost The Hong Kong Polytechnic University, Hong Kong Veterinary Microbiology, 2013 “…AR gene presence in these strains may increase their ability to persist in the environment.”
  204. 204. Keeping therapy dogs safe at work 7. Avoid using antiseptic soaps and hand-sanitizers o these genes code for resistance to…
  205. 205. Keeping therapy dogs safe at work 7. Avoid using antiseptic soaps and hand-sanitizers o these genes code for resistance to… o benzalkonium chloride – found in Lysol®, throat lozenges, antiseptic ointments, hand sanitizers, wet wipes, etc.
  206. 206. Keeping therapy dogs safe at work 7. Avoid using antiseptic soaps and hand-sanitizers o these genes code for resistance to… o benzalkonium chloride – found in Lysol®, throat lozenges, antiseptic ointments, hand sanitizers, wet wipes, etc. o chlorhexidine – found in Nolvasan®, Chlorhex®, Hibiclens®, mouthwash, contact lens solution, etc.
  207. 207. Keeping therapy dogs safe at work 7. Avoid using antiseptic soaps and hand-sanitizers o plain ol’ soap & water (warm) is sufficient
  208. 208. Keeping therapy dogs safe at work “Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species.” DJ Weber, WA Rutala, MB Miller, K Huslage, E Sickbert-Bennett Department of Medicine, University of North Carolina at Chapel Hill, NC American Journal of Infection Control, 2010 “Although the main source of nosocomial pathogens is likely the patient’s endogenous flora, an estimated 20% to 40% of HAI have been attributed to cross infection via the hands of health care personnel, who have become contaminated from direct contact with the patient or indirectly by touching contaminated environmental surfaces.” HAI = hospital-acquired infections
  209. 209. Keeping therapy dogs safe at work “Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species.” DJ Weber, WA Rutala, MB Miller, K Huslage, E Sickbert-Bennett Department of Medicine, University of North Carolina at Chapel Hill, NC American Journal of Infection Control, 2010 “Although the main source of nosocomial pathogens is likely the patient’s endogenous flora, an estimated 20% to 40% of HAI have been attributed to cross infection via the hands of health care personnel, who have become contaminated from direct contact with the patient or indirectly by touching contaminated environmental surfaces.” “…norovirus and C. difficile are relatively resistant to the most common surface disinfectants and waterless alcohol-based antiseptics.”
  210. 210. Keeping therapy dogs safe at work “Alcohol-based hand sanitizers can be used in addition to hand washing. But, they should not be used as a substitute for washing with soap and water.” Centers for Disease Control and Prevention “Preventing Norovirus Infection” August 30, 2013 http://www.cdc.gov/norovirus/preventing-infection.html
  211. 211. Keeping therapy dogs safe at work “Washing hands with soap and water is the best way to reduce the number of germs on them. … Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs.” Centers for Disease Control and Prevention “Handwashing: Cleaning Hands Saves Lives” August 30, 2013 http://www.cdc.gov/handwashing/
  212. 212. Keeping therapy dogs safe at work  Remember the surgeon’s adage: The solution to pollution is dilution!
  213. 213. Keeping therapy dogs safe at work 8. Politely discourage people from hugging or kissing the dog
  214. 214. Keeping therapy dogs safe at work 8. Politely discourage people from hugging or kissing the dog o avoid face contact between patient and dog
  215. 215. Keeping therapy dogs safe at work 8. Politely discourage people from hugging or kissing the dog o avoid face contact between patient and dog o particularly avoid nose-to-dog contact, including nose  hand  dog contact
  216. 216. Keeping therapy dogs safe at work 8. Politely discourage people from hugging or kissing the dog o avoid face contact between patient and dog o particularly avoid nose-to-dog contact, including nose  hand  dog contact o one option is to explain that some dogs find it intimidating or confronting
  217. 217. Keeping therapy dogs safe at work 8. Politely discourage people from hugging or kissing the dog o avoid face contact between patient and dog o particularly avoid nose-to-dog contact, including nose  hand  dog contact o one option is to explain that some dogs find it intimidating or confronting o another is to explain that your dog is not permitted to get in a person’s face
  218. 218. Keeping therapy dogs safe at work 9. If you simply must do something, wipe the dog’s coat and feet with a damp cloth after work
  219. 219. Keeping therapy dogs safe at work 9. If you simply must do something, wipe the dog’s coat and feet with a damp cloth after work o this step is not really necessary, and probably not very useful, but…
  220. 220. Keeping therapy dogs safe at work 9. If you simply must do something, wipe the dog’s coat and feet with a damp cloth after work o this step is not really necessary, and probably not very useful, but… o the goal is to pick up microbes left on the dog’s coat and feet by contact with the patient or setting (like an electrostatic duster or “tack cloth”)
  221. 221. Keeping therapy dogs safe at work 9. If you simply must do something, wipe the dog’s coat and feet with a damp cloth after work o then put the cloth in a plastic bag, take it home, and wash it in hot, soapy water
  222. 222. Keeping therapy dogs safe at work 10. Healthy diet, healthy dog!
  223. 223. Keeping therapy dogs safe at work 10. Healthy diet, healthy dog! o the best defense against infection is a healthy body
  224. 224. Keeping therapy dogs safe at work “The germ is nothing, the terrain is everything.” attributed to Louis Pasteur
  225. 225. Keeping therapy dogs safe at work “The germ is nothing, the terrain is everything.” attributed to Louis Pasteur o real or not, this apocryphal ‘deathbed concession’ is as unbalanced as Pasteur’s germ theory…
  226. 226. Keeping therapy dogs safe at work “The germ is nothing, the terrain is everything.” attributed to Louis Pasteur o real or not, this apocryphal ‘deathbed concession’ is as unbalanced as Pasteur’s germ theory… o “the microbe is the primary cause of infectious disease”
  227. 227. Keeping therapy dogs safe at work “The germ is nothing, the terrain is everything.” attributed to Louis Pasteur o real or not, this apocryphal ‘deathbed concession’ is as unbalanced as Pasteur’s germ theory… o “the microbe is the primary cause of infectious disease” o the microbe is not nothing (unimportant); but neither is it the primary determinant of disease
  228. 228. Keeping therapy dogs safe at work “The germ is nothing, the terrain is everything.” attributed to Louis Pasteur o it takes two to tango…
  229. 229. Keeping therapy dogs safe at work “The germ is nothing, the terrain is everything.” attributed to Louis Pasteur o it takes two to tango… o the dynamic between microbe and host determines whether infection occurs, and with what result
  230. 230. Keeping therapy dogs safe at work “Healthy bodies are less vulnerable to infection.” attributed to Chris King
  231. 231. Keeping therapy dogs safe at work “Healthy bodies are less vulnerable to infection.” attributed to Chris King o some microbes are pathogenic to most, if not all, individuals (e.g., enterohemorrhagic E. coli)
  232. 232. Keeping therapy dogs safe at work “Healthy bodies are less vulnerable to infection.” attributed to Chris King o some microbes are pathogenic to most, if not all, individuals (e.g., enterohemorrhagic E. coli) o but not everyone is affected to the same degree…
  233. 233. Keeping therapy dogs safe at work “Healthy bodies are less vulnerable to infection.” attributed to Chris King o some microbes are pathogenic to most, if not all, individuals (e.g., enterohemorrhagic E. coli) o but not everyone is affected to the same degree… o some have only mild symptoms and recover without treatment, others die despite intensive care
  234. 234. Keeping therapy dogs safe at work “Healthy bodies are less vulnerable to infection.” attributed to Chris King o some microbes are pathogenic to most, if not all, individuals (e.g., enterohemorrhagic E. coli) o but not everyone is affected to the same degree… o the difference lies in the state of health – in the body’s resilience in the face of microbial invasion
  235. 235. Keeping therapy dogs safe at work “Healthy bodies are less vulnerable to infection.” attributed to Chris King Resilience comprises:
  236. 236. Keeping therapy dogs safe at work “Healthy bodies are less vulnerable to infection.” attributed to Chris King Resilience comprises: 1. Innate immunity – what we’re born with
  237. 237. Keeping therapy dogs safe at work “Healthy bodies are less vulnerable to infection.” attributed to Chris King Resilience comprises: 1. Innate immunity – what we’re born with 2. Acquired immunity – what we develop through experience
  238. 238. Keeping therapy dogs safe at work “Healthy bodies are less vulnerable to infection.” attributed to Chris King Resilience comprises: 1. Innate immunity – what we’re born with 2. Acquired immunity – what we develop through experience 3. Microbial partnerships – our resident microflora
  239. 239. Keeping therapy dogs safe at work “Healthy bodies are less vulnerable to infection.” attributed to Chris King o the dog’s resident microflora are a first line of defense against potential pathogens…
  240. 240. Keeping therapy dogs safe at work “Healthy bodies are less vulnerable to infection.” attributed to Chris King o the dog’s resident microflora are a first line of defense against potential pathogens… o which may be picked up by casual contact, such as patting, coughing, or sneezing
  241. 241. Keeping therapy dogs safe at work “Healthy bodies are less vulnerable to infection.” attributed to Chris King o the dog’s resident microflora are a first line of defense against potential pathogens… o so, (a) don’t wipe them out with disinfectants!
  242. 242. Keeping therapy dogs safe at work “Healthy bodies are less vulnerable to infection.” attributed to Chris King o the dog’s resident microflora are a first line of defense against potential pathogens… o so, (a) don’t wipe them out with disinfectants! o and (b) encourage a diverse and robust population of species-appropriate microbes by feeding a species- appropriate diet
  243. 243. Keeping therapy dogs safe at work the end Fresh meat & veg, please!

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