Portuguese hospital lets pets visit owners in wards: a paradigm shift?

In northern and central Europe, pets stay outside hospitals. São João’s flexible model balances benefits and safety, with no infections so far. "There is excessive fear", says the doctor who helped draft the rules. Since 9 July, São João, one of the leading public university hospitals in Portugal’s health system, has been opening its wards to visits from pets. The "Pets and Company" project brings together different professionals from the One Health São João (source in Portuguese) programme, as well as from the Unit for Infection Prevention and Control and Antimicrobial Resistance and the hospital’s Humanisation service. The initiative forms part of a strategy designed to break isolation and ease the exhaustion caused by prolonged hospital stays. The therapeutic potential of animals is far from a recent discovery. Countries such as the United Kingdom and Germany have been using them in psychiatric treatment and for human physical conditions since the 19th century. The term "pet therapy" (animal-assisted therapy) was scientifically defined in the 1960s by an American psychologist, who discovered the healing qualities of these interventions by chance. In Portugal, dogs trained and certified for emotional-support sessions have been working in hospitals for several years, including at São João, in partnership with handlers from associations. On 30 May 2023, a 77-year-old patient admitted to Cascais Hospital while recovering from a haemorrhagic stroke (cerebrovascular accident) received a visit from her own dog, in a reunion that took place in the outdoor area of the facility. This unprecedented experience is now being expanded by São João through a comprehensive protocol, created from scratch, which goes a step further and normalises the practice of taking pets into inpatient areas, recognising them as part of the patient’s family circle and providing people who have long been away from home with moments of comfort under safe public-health conditions. What does the protocol say? Visits are requested by the healthcare professional (doctor or nurse) who is following the patient and responsible for flagging the case; they are not available to everyone who is in hospital. An individual assessment of risks and benefits is always carried out. Once informed, the team responsible for the programme assesses whether there is a clinical need and whether there are conditions to proceed with the visit in terms of infection control at the chosen location. Other patients are also asked whether they feel comfortable with the presence of animals. Once approval is given, the patient’s family must provide a veterinary certificate proving that the animal’s vaccinations and deworming are up to date, and that it has behaviour compatible with the requirements associated with staying in hospital premises. "Any professional, from security staff to doctors or nurses, who sees that something is not in line with the protocol can interrupt the visit," Filipa Ceia, spokesperson for the One Health São João Group, tells Euronews. If the animal is "anxious" because of the "noise of the ward", appears "aggressive" or is "visibly dirty", the visit is "immediately called off", the infectious-disease specialist and vet warns. Dogs, cats and even "more exotic species" are allowed, provided that "all the conditions are met", adds Filipa Ceia. While in hospital areas, the animal must be accompanied by an adult. Each patient can enjoy these meetings, lasting half an hour, once every seven days. The project gives priority to people who are in a terminal phase or undergoing prolonged hospitalisation. To the surprise of those in charge, it is male patients who have most often requested the presence of their pets in hospital, although the small sample does not allow definitive conclusions. "Men may be more fragile when they are ill. They realise there are things of great importance in life and want to have them close during their stay," says Ceia. Benefits for the patient and for the animal Studies carried out on interventions assisted by trained animals show clear improvements in patients’ clinical condition: blood pressure drops and the production of hormones linked to stress and anxiety is inhibited. When the household pet is involved, there is "a greater benefit", highlights Filipa Ceia. Euronews accompanied the visit of Princesa, who went to São João for the second time in 15 days to ease the longing for her owner, António, who has been in hospital for three months. The dog was taken to the hospital by the patient’s wife, who led her on a lead to the ward. As soon as the lift doors opened, Princesa could not contain her excitement, and António felt the same. "My heart beat wildly with joy. It is like having family here. She is a daughter to me," confessed the 65-year-old man, who is in rehabilitation because of balance and walking difficulties. The diagnosis has not yet been confirmed, but it is suspected that he suffers from a rare blood disease. The reunion with the dog, which was given to him five years ago after being rescued from the street, is a balm for the soul. "It feels as if I want to walk better and everything. This is the joy a person has," he said. These reunions bring "smiles, engagement with treatment and an incentive to leave hospital", notes Filipa Ceia, pointing out further benefits for the animal itself and even for healthcare professionals. "Residual risk" This initiative began at the start of July and, so far, there have been no recorded infections. The team behind the project wants to review the protocol at a later stage to correct any possible flaws. Given the procedures adopted, a scenario involving "incidents" is, however, "highly unlikely", stresses Filipa Ceia. In northern and central Europe, infection-control and public-health rules are stricter. Assistance dogs are prioritised and, when visits by privately owned animals are authorised (normally for patients in palliative care), they take place in isolated facilities, namely open courtyards or gardens attached to the main structure. Take the example of Sint-Trudo Hospital in Sint-Truiden, Belgium. In July 2023, this health facility opened an independent pavilion (source in Portuguese), separate from the main building but connected to the hospital, so that terminal patients or those in long-term stays could interact with their pets. The access (source in Portuguese) for pets is via an outside courtyard, and they are strictly forbidden, under any circumstances, from passing through the interior of the hospital grounds. Instead of erecting physical barriers by building secondary structures, São João has drawn up a set of rules which, while maintaining clinical rigour, are integrated into a flexible protocol shaped by scientific evidence. "There is an excessive fear of transmitting zoonoses that is not borne out by studies," says Filipa Ceia. In fact, the infectious-disease doctor notes, "it is easier for most diseases to be transmitted from human to human than from an animal to a human". "As we try as much as possible to preserve safety and, since the patient, when they go home, will be living with their animal, the risk really is residual. We have to understand whether, in trying to mitigate the risk, we are not preventing patients from enjoying the benefit," she adds. São João’s boldness lies not only in the balance between empathy and sanitary control, but also in its autonomy and ability to humanise care without waiting for legislators, unlike Italy, for example, where progress has come through decrees issued by regional governments.