In northern and central Europe, pets are usually kept outside hospitals. Sao Joao's flexible model balances clinical 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 healthcare system, has been opening the doors of its wards 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, the Infection and Antimicrobial Resistance Prevention and Control Unit and the hospital’s humanisation service. The initiative is part of a strategy designed to break patients’ isolation and ease the exhaustion associated with lengthy hospital stays.
The therapeutic potential of animals is far from a recent discovery. Countries such as the United Kingdom and Germany were already using them in psychiatric treatment and in rehabilitation for physical problems in humans as far back as the 19th century. The term "pet therapy" (animal-assisted therapy) was formally recorded in the 1960s by an American psychologist, who happened upon the healing benefits of these interventions by chance.
In Portugal, trained and certified dogs providing emotional support have for several years been working in hospitals, including São João, in partnership with handlers from associations.
On 30 May 2023, a 77-year-old patient admitted to Cascais Hospital as she recovered from a haemorrhagic stroke received a visit from her own dog, in a reunion that took place in the outdoor area of the facility.
São João is now extending that pioneering experience through a comprehensive protocol, drawn up from scratch, that 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 giving people who have been away from home for a long time moments of comfort under safe sanitary conditions.
What does the protocol say?
Visits must be requested by the health professional (doctor or nurse) responsible for the patient, who decides whether to flag up the case, so the option is not available to everyone in hospital. Each situation is subject to an individual assessment of risks and benefits.
Once notified, the team in charge of the programme assesses whether there is a clinical need and whether infection control conditions at the chosen location allow the visit to go ahead. Other patients are also asked whether they are comfortable with the presence of animals.
If approval is granted, the patient’s family is required to provide a veterinary medical certificate showing that the animal is fully vaccinated and dewormed and behaves in a way that is compatible with the demands involved in staying in hospital premises.
"Any professional, from security staff to doctors or nurses, who notices 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', appears 'aggressive' or is 'visibly dirty', the visit is 'immediately aborted'," the infectious disease specialist and veterinarian stresses.
Dogs, cats and even 'more exotic species' are allowed, as long as "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 half-hour encounters once every seven days. The project prioritises those who are terminally ill or in long-term hospitalisation.
To the team’s surprise, it is male patients who most often request the presence of their four-legged companions in hospital, although the small sample does not yet allow firm conclusions. "Male patients may be more vulnerable. They realise there are things of great importance in life and want them close by during their admission," notes Ceia.
Benefits for the patient and for the animal
Studies on interventions involving trained animals show clear improvements in patients’ clinical condition – blood pressure falls and the production of hormones linked to stress and anxiety is inhibited. When the household pet is involved, "the benefit is even greater", highlights 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 the lead to the ward.
As soon as the lift doors opened, Princesa could not contain her excitement – and neither could António.
"My heart was bursting with joy. It is as if she were family. She is like a daughter to me," confessed the 65-year-old man, who is undergoing rehabilitation for balance and walking difficulties.
His diagnosis has yet to be confirmed, but doctors suspect a rare blood disease. The reunion with the dog, who 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 can have," he said. According to Filipa Ceia, these reunions bring "smiles, collaboration in treatment and an incentive to leave the hospital", and she also identifies benefits for the animal itself and even for health professionals.
"Residual risk"
The initiative started 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 'complications' is nevertheless "highly unlikely", stresses Filipa Ceia.
In northern and central Europe, infection control and public health rules are stricter. Priority is given to interventions involving assistance dogs and, when authorised (usually for patients in palliative care), visits by people’s own animals take place in isolated facilities, namely open courtyards or gardens annexed to the main structure.
Take the example of Sint-Trudo Hospital in Sint-Truiden, Belgium. In July 2023, the institution opened an independent pavilion (source in Portuguese) connected to the hospital, so that terminally ill patients or those facing long stays could interact with their pets. Access (source in Portuguese) for the animals is from outside, via a courtyard, and they are strictly banned from entering the hospital interior under any circumstances.
Instead of building physical barriers through secondary structures, São João has devised a set of rules that, while maintaining clinical rigour, are integrated into an agile 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 specialist notes, "it is easier for most diseases to be transmitted from human to human than from an animal to a human".
"Because we do everything we can to preserve safety and because, once back home, patients will be living with their animals, the risk really is residual. We have to ask whether, in trying to reduce risk, we are not preventing patients from getting the benefit," she adds.
São João’s boldness lies not only in the balance it strikes between empathy and sanitary control, but also in its autonomy and capacity to humanise care without waiting for lawmakers – unlike Italy, for example, where progress has been driven by decrees from regional governments.
