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.

1. Humanosis
Keeping therapy dogs safe at work
(protecting dogs from human pathogens)
Dr. Christine King
Anima Vet – Winston-Salem, NC
animavet.com

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. 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. 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. Keeping therapy dogs safe at work
 What’s the difference?

6. Keeping therapy dogs safe at work
 Colonization = colonies of microbes are present
on a body surface

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. 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. 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. 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. 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. 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. Keeping therapy dogs safe at work
 Colonization = colonies of microbes are present
on a body surface
 Colonization may be temporary or permanent

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. 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. Keeping therapy dogs safe at work
 Infection = colonies of microbes are present

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. 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. 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. 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. 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. Keeping therapy dogs safe at work
 Transient contamination = transfer of microbes
from contact with a contaminated substance

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. 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. Keeping therapy dogs safe at work
 In summary…

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. Keeping therapy dogs safe at work
 Whether contamination  colonization…

28. Keeping therapy dogs safe at work
 Whether contamination  colonization…
 Or colonization  infection depends on several
factors

29. Keeping therapy dogs safe at work
1. Number of microbes transferred

30. Keeping therapy dogs safe at work
1. Number of microbes transferred
2. Resident microflora, particularly their diversity

31. Keeping therapy dogs safe at work
1. Number of microbes transferred
2. Resident microflora, particularly their diversity
3. Health of the dog

32. Keeping therapy dogs safe at work
…take a breather…

33. Keeping therapy dogs safe at work
 Many different microbes (bacteria, viruses, fungi)
can be spread from animals to humans

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. Keeping therapy dogs safe at work
 Many of these same microbes can also be spread
from humans to animals

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. 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. Keeping therapy dogs safe at work
 Some of these microbes can be spread back
to humans

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. 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. 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. 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. 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. Keeping therapy dogs safe at work
 A simpler way to remember it is this:

45. Keeping therapy dogs safe at work
 A simpler way to remember it is this:
MRSAdog human

46. Keeping therapy dogs safe at work
Er, what’s up,
doc?

47. Keeping therapy dogs safe at work
 Now let’s look at some studies of potential pathogens in
therapy dogs…

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. Keeping therapy dogs safe at work
 This study involved 194 dogs in animal-assisted
intervention (AAI) programs in Ontario and Alberta

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. 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. 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. Keeping therapy dogs safe at work
 Nasal swabs and fecal samples were collected
at the start and every 2 months for 1 year

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. 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. 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. 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. 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. 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. Keeping therapy dogs safe at work
 The dog owners kept a log of all relevant activities
and events

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. 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. 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. 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. Keeping therapy dogs safe at work
 Let’s go through the findings in detail…

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Keeping therapy dogs safe at work
 Here are the key points again:

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. 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. 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. Keeping therapy dogs safe at work
 The incidence of illness in therapy dogs was low

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. 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. Keeping therapy dogs safe at work
 There was no association between illness and
a positive sample for any of the pathogens, but…

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. 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. Keeping therapy dogs safe at work
 What role did stress play?

134. Keeping therapy dogs safe at work

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. Keeping therapy dogs safe at work
 This study involved 1 dog and 11 cats living in
a long-term care facility

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. 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. Keeping therapy dogs safe at work
 2 cats were colonized with MRSA

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. 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. 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. 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. Keeping therapy dogs safe at work
Next, please.

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. Keeping therapy dogs safe at work
 This report involved an 11-year-old Border Collie

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. 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. Keeping therapy dogs safe at work
 Swabs taken before the visit were negative for MRSA

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. 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. Keeping therapy dogs safe at work
 The dog was negative for MRSA 2 weeks later

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. 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. 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. Keeping therapy dogs safe at work
 This study involved 26 pet therapy dogs and their
handlers

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. 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. Keeping therapy dogs safe at work
 The dog’s front paws and the handler’s hands
were sampled before and after each visit

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. 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. 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. Keeping therapy dogs safe at work
 All 26 dogs’ paws and coats were negative for all
tested pathogens before visits

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. 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. 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. 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. 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. 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. Keeping therapy dogs safe at work
If you simply must pat
me, for goodness’ sake
wash your hands first!

171. Keeping therapy dogs safe at work
 While infection of a therapy dog is improbable,
it’s not impossible

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. 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. Keeping therapy dogs safe at work
 How can we keep therapy dogs safe at work?

175. Keeping therapy dogs safe at work
1. Take extra care around people with nasal discharge
(runny nose)

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. 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. 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. 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. Keeping therapy dogs safe at work
2. Take extra care around patients with infected wounds

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. 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. 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. Keeping therapy dogs safe at work
3. Limit visits in surgical wards and ICUs

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. 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. Keeping therapy dogs safe at work
4. Limit visits with immunocompromised patients

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. 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. 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. 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. Keeping therapy dogs safe at work
5. Limit visits with long-term care patients

193. Keeping therapy dogs safe at work
5. Limit visits with long-term care patients
o as above for immunocompromised patients

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. Keeping therapy dogs safe at work
6. Wash your own hands often

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. 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. 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. Keeping therapy dogs safe at work
7. Avoid using antiseptic soaps and hand-sanitizers

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. 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. 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. 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. Keeping therapy dogs safe at work
7. Avoid using antiseptic soaps and hand-sanitizers
o these genes code for resistance to…

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. 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. Keeping therapy dogs safe at work
7. Avoid using antiseptic soaps and hand-sanitizers
o plain ol’ soap & water (warm) is sufficient

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. 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. 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. 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. Keeping therapy dogs safe at work
 Remember the surgeon’s adage:
The solution to
pollution is dilution!

213. Keeping therapy dogs safe at work
8. Politely discourage people from hugging or kissing
the dog

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. 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. 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. 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. 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. 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. 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. 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. Keeping therapy dogs safe at work
10. Healthy diet, healthy dog!

223. Keeping therapy dogs safe at work
10. Healthy diet, healthy dog!
o the best defense against infection is a healthy body

224. Keeping therapy dogs safe at work
“The germ is nothing, the terrain is everything.”
attributed to Louis Pasteur

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. 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. 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. 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. 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. Keeping therapy dogs safe at work
“Healthy bodies are less vulnerable to infection.”
attributed to Chris King

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. 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. 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. 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. Keeping therapy dogs safe at work
“Healthy bodies are less vulnerable to infection.”
attributed to Chris King
Resilience comprises:

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. 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. 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. 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. 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. 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. 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. Keeping therapy dogs safe at work
the end
Fresh meat &
veg, please!