Infection Control Insights for Hospital Animal-Assisted Intervention Program Implementation: From Stakeholder Perspectives to Microbial Dynamics

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Date
2020-10-20
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Johns Hopkins University
Abstract
Background: While animal-assisted intervention (AAI) programs have shown significant benefits to patients, there are concerns regarding their use in healthcare settings limiting utilization. This works aims to enhance the adoption and use of hospital AAI programs and understand the positive and negative outcomes of implemented control measures. We hypothesize that a One Health framework will aid in the understanding and improvement of hospital AAI infection control concerns. This dissertation will 1) collect perspectives on concerns and control measures to understand perceived risks, and 2) examine microbial dynamics to understand actual risks. Methods: The first two chapters are literature reviews to identify knowledge gaps and provide rationale for the thesis research. The next two chapters are based on a qualitative study interviewing key stakeholders in hospital AAI programs. The last two chapters describe research that sampled for both hospital pathogens and whole microbial communities to pilot test a canine decolonization approach as an infection control intervention. Results: The literature reviews revealed a lack of data on the risks associated with hospital AAI, and a One Health approach can be used to address this knowledge gap. The qualitative findings indicated occupational health benefits are limited by administrative and infection risk barriers, but these could be overcome through collaboration and leadership. Microbial findings suggest the canine decolonization intervention blocked the microbial contribution from the therapy dog and reduced rare microbiota on the dog, yet did not prevent all microbial sharing, indicating the dog as only one possible pathway for transmission. Conclusions: The results from this thesis support the hypothesis that a holistic One Health approach can assist in understanding and designing interventions to improve hospital AAI programs. The qualitative findings stress the importance of understanding practical considerations for program implementation. In the quantitative study, allocation of the relative contribution for all potential microbial transmission pathways, and the determination of potentially negative unintended consequences of infection control policies, can inform the design of appropriate and effective control measures. This thesis suggests that a One Health framework should be used for future research in hospital AAI to ensure the sustainability of these valuable programs.
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Keywords
animal-assisted interventions, hospital epidemiology, infection control, microbiome, qualitative studies
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