In northern and central Europe, pets stay outside hospitals. At São João, a flexible model combines benefits and safety; no infections yet. "Fear is overblown," says the doctor behind the project.
Since 9 July, São João, one of Portugal's leading public university hospitals, has been opening its ward doors to visits from pets.
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The "Pets and Company" project brings together professionals from the One Health São João (source in Portuguese) programme, as well as from the Infection Prevention and Control and Antimicrobial Resistance Unit and the hospital's Humanisation Service. The initiative is part of a wider strategy designed to break isolation and ease the exhaustion caused by long 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 and physical rehabilitation treatments for humans since the 19th century. The term "pet therapy" (animal-assisted therapy) was introduced into the scientific literature in the 1960s by a US psychologist who stumbled upon the healing benefits of these interventions.
In Portugal, trained and certified dogs providing emotional-support sessions have been working for years in hospitals, including 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 received a visit from her own dog, in a reunion that took place in an outdoor area of the health unit.
This unprecedented experience is now being scaled up at São João through a comprehensive protocol drawn up from scratch, which goes a step further and normalises the practice of bringing pets into inpatient areas, recognising them as part of the patient's immediate family and offering those who have been away from home for a long time moments of comfort under safe sanitary conditions.
What does the protocol say?
Visits are requested by the health professional, doctor or nurse, who is following the patient and is responsible for flagging up cases, and they are not available to everyone who is in hospital. A case-by-case assessment of risks and benefits is always carried out.
Once informed, the team in charge of the programme assesses whether there is a clinical need and whether infection-control conditions are met in the area chosen for the visit. Other patients are also asked if they are comfortable with the presence of animals.
Once approval is given, the patient's family must provide a veterinary medical certificate proving that the animal's vaccinations and deworming are up to date and that it has behaviour compatible with the demands associated with remaining in hospital facilities.
"Any member of staff, from security guards to doctors or nurses, who sees that something is not in line with the protocol can stop the visit," Filipa Ceia, spokesperson for the One Health São João Group, tells Euronews.
If the animal is "anxious" because of the "noise on the ward", if it appears "aggressive" or "visibly dirty", the visit is "immediately aborted", the infectious-disease specialist and veterinarian warns.
Dogs, cats and even "more exotic species" are allowed, as long as "all the conditions are met", says Filipa Ceia. While it is on hospital premises, the animal must be accompanied by an adult.
Each patient can enjoy these half-hour encounters once every seven days. The project prioritises those who are terminally ill or undergoing long periods of hospitalisation.
To the team's surprise, it is male patients who have most frequently asked to have their pets with them in hospital, although the small sample size does not allow firm conclusions to be drawn. "The fragility in sick men is probably greater. They realise that there are things that matter a great deal in life and they want to have them nearby during their hospital stay," says Ceia.
Benefits for the patient and the animal
Studies on interventions involving 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 patient's own pet is involved, there is "an even greater benefit", stresses Filipa Ceia.
Euronews followed the visit by Princesa, who went to São João for the second time in 15 days to see her owner, António, who has been in hospital for three months. The dog was brought 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 the same happened with António.
"My heart was beating with joy. She is like family. She is a daughter to me," confessed the 65-year-old man, who is in rehabilitation because of problems with balance and walking.
His diagnosis has not yet been confirmed, but doctors suspect he suffers from a rare blood disease. The reunion with the dog, who was given to him five years ago after being rescued from the streets, is a balm for the soul.
"It even makes me want to walk better and everything. This is the joy a person gets," he said. These reunions bring "smiles, cooperation with treatment and an incentive to leave hospital", notes Filipa Ceia, who also identifies benefits for the animal itself and even for health professionals.
"Residual" risk
The initiative was launched at the beginning 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 shortcomings. Given the procedures in place, a scenario involving "incidents" is, however, "highly unlikely", underlines Filipa Ceia.
In northern and central Europe, infection-control and public-health regulations are stricter. Priority is given to interventions by assistance dogs, and visits from patients' own animals, when they are authorised, usually for those in palliative care, take place in isolated facilities, such as open courtyards or gardens attached to the main building.
Take the example of Sint-Trudo Hospital in Sint-Truiden, Belgium. In July 2023, this health unit opened an independent pavilion (source in Portuguese), connected to but separate from the main building, so that terminally ill patients or those with long hospital stays could interact with their pets. The access (source in Portuguese) for the animals is from outside, via a courtyard, and they are strictly forbidden, in any circumstances, from passing through the interior of the hospital.
Instead of putting up physical barriers by building secondary structures, São João has drawn up a set of rules that, while maintaining clinical rigour, are built into a flexible protocol shaped by scientific evidence.
"There is an excessive fear of zoonotic transmission that is not borne out by studies," says Filipa Ceia. In fact, the infectious-disease doctor notes, "most diseases are more easily transmitted from human to human than from an animal to a human."
"Since we do everything possible to keep safety intact, and since the patient will live with their animal once they go home, the risk really is residual. We need to understand whether, in trying to mitigate risk, we are not depriving patients of 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 capacity to humanise care without waiting for lawmakers, unlike in Italy, for example, where progress has been driven by decrees from regional governments.
