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Service Dogs in Health Care Facilities

Clipped from the Center for Disease Control's Guidelines for Environmental Infection Control

3. Service Animals
Although this section provides an overview about service animals in health-care settings, it cannot
address every situation or question that may arise (see Appendix E - Information Resources). A service
animal is any animal individually trained to do work or perform tasks for the benefit of a person with a
disability.1366, 1376 A service animal is not considered a pet but rather an animal trained to provide
assistance to a person because of a disability. Title III of the “Americans with Disabilities Act” (ADA)
of 1990 mandates that persons with disabilities accompanied by service animals be allowed access with
their service animals into places of public accommodation, including restaurants, public transportation,
schools, and health-care facilities.1366, 1376 In health-care facilities, a person with a disability requiring a
service animal may be an employee, a visitor, or a patient.
An overview of the subject of service animals and their presence in health-care facilities has been
published.1366 No evidence suggests that animals pose a more significant risk of transmitting infection
than people; therefore, service animals should not be excluded from such areas, unless an individual
patient’s situation or a particular animal poses greater risk that cannot be mitigated through reasonable
measures. If health-care personnel, visitors, and patients are permitted to enter care areas (e.g., inpatient
rooms, some ICUs, and public areas) without taking additional precautions to prevent
transmission of infectious agents (e.g., donning gloves, gowns, or masks), a clean, healthy, wellbehaved
service animal should be allowed access with its handler.1366 Similarly, if
immunocompromised patients are able to receive visitors without using protective garments or
equipment, an exclusion of service animals from this area would not be justified.1366
Because health-care facilities are covered by the ADA or the Rehabilitation Act, a person with a
disability may be accompanied by a service animal within the facility unless the animal’s presence or
behavior creates a fundamental alteration in the nature of a facility’s services in a particular area or a
direct threat to other persons in a particular area.1366 A “direct threat” is defined as a significant risk to
the health or safety of others that cannot be mitigated or eliminated by modifying policies, practices, or
procedures.1376 The determination that a service animal poses a direct threat in any particular healthcare
setting must be based on an individualized assessment of the service animal, the patient, and the
health-care situation. When evaluating risk in such situations, health-care personnel should consider the
nature of the risk (including duration and severity); the probability that injury will occur; and whether
reasonable modifications of policies, practices, or procedures will mitigate the risk (J. Wodatch, U.S.
Department of Justice, 2000). The person with a disability should contribute to the risk-assessment
process as part of a pre-procedure health-care provider/patient conference.
Excluding a service animal from an OR or similar special care areas (e.g., burn units, some ICUs, PE
units, and any other area containing equipment critical for life support) is appropriate if these areas are
considered to have “restricted access” with regards to the general public. General infection-control
measures that dictate such limited access include a) the area is required to meet environmental criteria to
minimize the risk of disease transmission, b) strict attention to hand hygiene and absence of
dermatologic conditions, and c) barrier protective measures [e.g., using gloves, wearing gowns and
masks] are indicated for persons in the affected space. No infection-control measures regarding the use
of barrier precautions could be reasonably imposed on the service animal. Excluding a service animal
that becomes threatening because of a perceived danger to its handler during treatment also is
appropriate; however, exclusion of such an animal must be based on the actual behavior of the particular
animal, not on speculation about how the animal might behave.
Another issue regarding service animals is whether to permit persons with disabilities to be
accompanied by their service animals during all phases of their stay in the health-care facility. Healthcare
personnel should discuss all aspects of anticipatory care with the patient who uses a service animal.
Health-care personnel may not exclude a service animal because health-care staff may be able to
perform the same services that the service animal does (e.g., retrieving dropped items and guiding an
otherwise ambulatory person to the restroom). Similarly, health-care personnel can not exclude service
animals because the health-care staff perceive a lack of need for the service animal during the person’s
stay in the health-care facility. A person with a disability is entitled to independent access (i.e., to be
accompanied by a service animal unless the animal poses a direct threat or a fundamental alteration in
the nature of services); “need” for the animal is not a valid factor in either analysis. For some forms of
care (e.g., ambulation as physical therapy following total hip replacement or knee replacement), the
service animal should not be used in place of a credentialed health-care worker who directly provides
therapy. However, service animals need not be restricted from being in the presence of its handler
during this time; in addition, rehabilitation and discharge planning should incorporate the patient’s
future use of the animal. The health-care personnel and the patient with a disability should discuss both
the possible need for the service animal to be separated from its handler for a period of time during nonemergency
care and an alternate plan of care for the service animal in the event the patient is unable or
unwilling to provide that care. This plan might include family members taking the animal out of the
facility several times a day for exercise and elimination, the animal staying with relatives, or boarding
off-site. Care of the service animal, however, remains the obligation of the person with the disability,
not the health-care staff.
Although animals potentially carry zoonotic pathogens transmissible to man, the risk is minimal with a
healthy, clean, vaccinated, well-behaved, and well-trained service animal, the most common of which
are dogs and cats. No reports have been published regarding infectious disease that affects humans
originating in service dogs. Standard cleaning procedures are sufficient following occupation of an area
by a service animal.1366 Clean-up of spills of animal urine, feces, or other body substances can be
accomplished with blood/body substance procedures outlined in the Environmental Services section of
this guideline. No special bathing procedures are required prior to a service animal accompanying its
handler into a health-care facility.
Providing access to exotic animals (e.g., reptiles and non-human primates) that are used as service
animals is problematic. Concerns about these animals are discussed in two published reviews.1331, 1366
Because some of these animals exhibit high-risk behaviors that may increase the potential for zoonotic
disease transmission (e.g., herpes B infection), providing health-care facility access to nonhuman
primates used as service animals is discouraged, especially if these animals might come into contact
with the general public.1361, 1362 Health-care administrators should consult the Americans with
Disabilities Act for guidance when developing policies about service animals in their facilities.1366, 1376
Requiring documentation for access of a service animal to an area generally accessible to the public
would impose a burden on a person with a disability. When health-care workers are not certain that an
animal is a service animal, they may ask the person who has the animal if it is a service animal required
because of a disability; however, no certification or other documentation of service animal status can be