Recommendations For Handling Pets in the ESRD Setting

By Dean A. Kujubu, MD

Handling Pets for the dialysis or transplant patient

Introduction
Pets have been part of man’s household for thousands of years. They provide us with unconditional affection and companionship. Recent studies suggest that, in addition to providing a social support, pets lower one’s stress response, improve the sense of well-being, and reduce depression. As a result of these studies, pets have been introduced into the hospital and nursing home settings with beneficial effects on patients. In many cases, blood pressure or antidepressant medications have been reduced in some patients as a result of pet therapy.

In addition to definite health benefits however, pets pose some health risks, particularly to those with compromised immune function. These risks are especially important for individuals with renal transplants.

“Some General Precautions”
Some general precautions include the following:

  • Make sure your animal is current on vaccinations. An animal with diarrhea, coughing, or sneezing, or is not eating well should be examined by a veterinarian.
  • If you have a renal transplant, have someone else clean litter boxes or birdcages. That person should use disposable masks and gloves. Disposable pan liners should be used and changed with each change in litter. Litter boxes should be scooped daily. Avoid direct contact with animal feces, urine, and saliva. Gloves should be used when cleaning fish tanks.
  • Prevent flea and tick infestations to your animals. Fleas and ticks may harbor infections.
  • Feed your animal only commercially prepared foods. Avoid feeding animals raw eggs or meats.
  • Do not let your animal wander outside unsupervised where it may be in contact with other animals. Avoid contact with wild or exotic animals.
  • Keep you pet’s nails short to prevent the risk of infection from scratches.
  • Reptiles may carry Salmonella. Wear gloves when handling them.
  • Any animal bites or deep scratches require prompt medical attention.
  • Patients using peritoneal dialysis (PD) require a clean environment in which to perform their exchanges. Animals should be kept out of the room dedicated to performing exchanges.
  • Keep the PD catheter protected from animal contact. Peritonitis has resulted from cats or other pets chewing on the tubing or the catheter itself.
  • Wash your hands thoroughly after handling your animal


CDC Control Measures

The June 6, 2003, edition of the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report provided recommendations for handling animals in healthcare settings. Following are some “General Infection-Control Measures for Animal Encounters”:

  • Contact with animal saliva, dander, urine, and feces should be minimized or avoided.
  • Thorough hand hygiene following contact with any animal should be practiced. Hands should be washed thoroughly with soap and water. When the hands are not visibly soiled or contaminated, use alcohol-based hand rubs.

CDC: Animal-Assisted Activities/Resident Programs

  •  Avoid choosing nonhuman primates and reptiles in animal-assisted activities, therapy, or resident animal programs.
  • Enroll only those animals “that are fully vaccinated and that are healthy, clean, well-groomed, and negative for enteric parasites or otherwise have completed recent anthelmintic [destroying or expelling intestinal worms] treatment under the regular care of a veterinarian.
  • Enroll only animals that are trained by those experienced in the field.
  • Animals should be controlled only by personnel trained in “providing activities or therapies safely and who know the animal’s health status and behavior traits.”
  • Prompt action should be taken following a biting or scratching incident. The animal should be permanently removed from the program, and the incident should be promptly reported to the proper authorities such as infection control staff, program coordinator, or local animal control officials. Any scratches, bites, or other skin breaks should be promptly cleaned and treated.
  • Precautions should also be taken to minimize allergic responses to animals. Shedding can be minimized by bathing animals less than 24 hours before a visit. Animals should be groomed to remove loose hair before a visit.
  • Animals should be restricted from access to patient care and food preparation areas, dining rooms, laundry, sterile supply and storage areas, medication preparation areas, operating rooms, and isolation areas.


CDC: Protecting Immunocompromised Patients

  •  As in the general recommendations, patients should be advised to avoid contact with animal feces, urine, saliva, or solid litter box material.
  • Any scratches, bites, or other wounds should be promptly cleaned and treated.
  • Patients should be advised to avoid direct or indirect contact with reptiles.
  • “A case-by-case assessment to determine if animal-assisted activities or animal-assisted therapy programs are appropriate for immunocompromised patients.”

For more information, log onto: www.cdc.gov/healthypets/.

Conclusion
Americans, in particular, love their pets, and many people consider them as much a part of their families as their human counterparts. Loving their pets, petting and stroking them, feeding them, and cleaning their litter boxes and cages are all par for the course for the healthy, non-immunocompromised individual. For the dialysis or transplant patient, however, the special precautions listed above must be taken. Otherwise, serious, even fatal, infections can occur.

Pets, particularly dogs and cats, can bring unconditional love into the mix of patient care. But they can also bring diseases and infections. So, love your pets and be careful, and the experience of having—and relating to—a beloved pet, or even a visiting one, can bring stress relief, a lowering of one’s blood pressure, and, in some cases, even a reason to continue living.

About the Author
Dean Kujubu, MD, is a staff nephrologist and Assistant Program Director for the Nephrology Fellowship program at Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA. This article was originally published on the iKidney.com website, supported by Watson Pharma, Inc.

Listen to this KidneyTalk podcast about keeping your pets and staying healthy.

01/31/2012

Web ID 395

 

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