A Pilot Study on the Contamination of Assistance Dogs’ Paws and Their Users’ Shoe Soles in Relation to Admittance to Hospitals and (In)Visible Disability
2. Materials and Methods
2.2.2. Sampling and Preservation
2.2.3. Processing of Enterobacteriaceae Samples
2.2.4. Processing of Clostridium difficile Samples
3.1. Sampling Results
3.1.1. Enterobacteriaceae: Comparing of Groups
- Dog versus human. When comparing the mean recovered CFUs between humans and dogs, the two groups differed significantly (p < 0.05 and p < 0.01). As shown in Table 3, the mean of dogs is lower than that of humans, and thus the general hygiene of dog paws can be considered to be better than that of shoe soles.
- PD owner versus AD user. When comparing the mean recovered CFUs between PD owners and AD users, the two groups did not differ significantly (p > 0.05). The general hygiene of the shoe soles of PD owners and AD users can be considered equal.
- PD versus AD. When comparing the mean recovered CFUs between PDs and ADs, the two groups did not differ significantly (p > 0.05). The general hygiene of the paws of PDs and ADs can be considered equal.
3.1.2. Enterobacteriaceae: Comparing of Couples
- PD and PD owner couples. The p-value that was found for this comparison was very small (p < 0.05 and p < 0.01), which makes it very unlikely for the mean of the differences to be equal to zero. The general hygiene of the paws of PDs is considered to be better than the shoe soles of their owners.
- AD and AD user couples. Although the mean recovered CFUs of ADs was found to be lower than that of their users, it was calculated that p > 0.05. The general hygiene of the paws of ADs and the shoe soles of their users can be considered equal.
3.1.3. C. difficile
3.1.4. Pseudomonas spp.
3.2. Enterobacteriaceae and Possible Factors
3.3. Experiences of AD Users in Public Places (Including Hospitals)
3.4. Hospitals and Visitor Numbers
3.4.2. Visitor Numbers
4.1.1. Sampling Results
Enterobacteriaceae and General Hygiene
4.1.2. Sample Size, Sampling Materials, and Methods
4.2. Factors: Linkage to Recovered CFUs
4.2.1. Identified Factors
4.2.2. Geological Location
4.2.4. Raw Meat as a Part of a Dog’s Diet
4.3. Experiences of AD Users
4.3.1. Results Experience Questionnaires
4.3.2. Improvements Suggested by Participants
4.4. Results of Hospital Questionnaires
4.5. Trifecta of Law, Study Results, and Visitor Numbers
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
|Couple Code||Individual Code||Recovered CFUs Enterobacteriaceae||C. difficile Presence|
|Suspected||UV Light Fluorescence|
|AD-02||AD-02-D||1.5 × 103||-||-|
|AD-02-O||9.0 × 102||-||-|
|AD-04||AD-04-D||3.0 × 103||yes||-|
|AD-04-O||8.7 × 105||yes||-|
|AD-05||AD-05-D||2.2 × 103||-||-|
|AD-05-O||0 (<7 × 102)||-||-|
|AD-06||AD-06-D||1.9 × 103||-||-|
|AD-06-O||0 (<7 × 102)||-||-|
|AD-07-O||1.0 × 103||-||-|
|AD-08-O||0 (<7 × 102)||yes||-|
|AD-09||AD-09-D||7.0 × 102||-||-|
|AD-09-O||1.0 × 103||-||-|
|AD-10||AD-10-D||0 (<7 × 102)||-||-|
|AD-11||AD-11-D||0 (<7 × 102)||yes||-|
|AD-11-O||2.2 × 103||-||-|
|AD-13-O||0 (<7 × 102)||yes||-|
|AD-14-O||6.0 × 103||-||-|
|AD-15-O||0 (<7 × 102)||-||-|
|AD-16||AD-16-D||0 (<7 × 102)||-||-|
|AD-16-O||0 (<7 × 102)||-||-|
|AD-17-O||8.0 × 102||yes||-|
|AD-18||AD-18-D||0 (<7 × 102)||-||-|
|AD-18-O||6.0 × 104||yes||yes|
|AD-19||AD-19-D||4.2 × 103||-||-|
|AD-20||AD-20-D||1.2 × 103||-||-|
|AD-20-O||7.1 × 103||-||-|
|AD-21-O||0 (<7 × 102)||-||-|
|AD-22||AD-22-D||1.5 × 104||-||-|
|AD-22-O||7.0 × 102||-||-|
|AD-23-O||4.6 × 103||-||-|
|AD-25||AD-25-D||1.0 × 103||-||-|
|AD-25-O||4.8 × 103||-||-|
|Couple Code||Individual Code||Recovered CFUs Enterobacteriaceae||C. difficile Presence|
|Suspected||UV Light Fluorescence|
|PD-01||PD-01-D||1.3 × 105||yes||-|
|PD-01-O||4.3 × 106||yes||-|
|PD-04-O||3.6 × 103||-||-|
|PD-05||PD-05-D||0 (<7 × 102)||-||-|
|PD-05-O||0 (<7 × 102)||-||-|
|PD-06||PD-06-D||8.5 × 103||-||-|
|PD-06-O||1.1 × 104||-||-|
|PD-07||PD-07-D||0 (<7 × 102)||-||-|
|PD-07-O||4.9 × 103||-||-|
|PD-08||PD-08-D||1.3 × 103||-||-|
|PD-08-O||3.3 × 103||-||-|
|PD-09||PD-09-D||0 (<7 × 102)||-||-|
|PD-10||PD-10-D||0 (<7 × 102)||-||-|
|PD-10-O||7.0 × 104||-||-|
|PD-11-O||1.0 × 103||-||-|
|PD-13-O||7.0 × 102||-||-|
|PD-14-O||2.7 × 103||-||-|
|PD-15-O||1.4 × 103||-||-|
|PD-16-O||3.0 × 103||-||-|
|PD-17-O||3.0 × 103||-||-|
|PD-18||PD-18-D||0 (<7 × 102)||-||-|
|PD-19||PD-19-D||8.0 × 102||-||-|
|PD-19-O||2.7 × 103||-||-|
|PD-20||PD-20-D||0 (<7 × 102)||-||-|
|PD-20-O||7.7 × 103||-||-|
|PD-21||PD-21-D||0 (<7 × 102)||-||-|
|PD-21-O||7.1 × 103||-||-|
|PD-22||PD-22-D||9.0 × 102||-||-|
|PD-22-O||1.7 × 103||-||-|
|PD-24||PD-24-D||0 (<7 × 102)||-||-|
|PD-24-O||1.7 × 102||-||-|
|PD-25||PD-25-D||0 (<7 × 102)||-||-|
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|t-tests||Human vs. dog||H0 = there is no difference between the mean number of colony-forming units of bacteria of the Enterobacteriaceae family recovered from the right front paws of dogs and the right shoe soles of humans.|
|H1 = there is a difference between the mean number of colony-forming units of bacteria of the Enterobacteriaceae family recovered from the right front paws of dogs and the right shoe soles of humans.|
|Pet dog owners vs. assistance dog users||H0 = there is no difference between the mean number of colony-forming units of bacteria of the Enterobacteriaceae family recovered from the right shoe soles of pet dog owners and the right shoe soles of assistance dog users.|
|H1 = there is a difference between the mean number of colony-forming units of bacteria of the Enterobacteriaceae family recovered from the right shoe soles of pet dog owners and the right shoe soles of assistance dog users.|
|Pet dogs vs. assistance dogs||H0 = there is no difference between the mean number of colony-forming units of bacteria of the Enterobacteriaceae family recovered from the right front paws of pet dogs and the right front paws of assistance dogs.|
|H1 = there is a difference between the mean number of colony-forming units of bacteria of the Enterobacteriaceae family recovered from the right front paws of pet dogs and the right front paws of assistance dogs.|
|Paired t-tests||Pet dog vs. pet dog owner||H0 = the mean of the differences, between the number of colony-forming units of bacteria of the Enterobacteriaceae family recovered from pet dogs’ right front paws and their owners’ right shoe sole, is zero.|
|H1 = the mean of the differences, between the number of colony-forming units of bacteria of the Enterobacteriaceae family recovered from pet dogs’ right front paws and their owners’ right shoe sole, is not zero.|
|Assistance dog vs. assistance dog user||H0 = the mean of the differences, between the number of colony-forming units of bacteria of the Enterobacteriaceae family recovered from assistance dogs’ right front paws and their users’ right shoe sole, is zero.|
|H1 = the mean of the differences, between the number of colony-forming units of bacteria of the Enterobacteriaceae family recovered from assistance dogs’ right front paws and their users’ right shoe sole, is not zero.|
|Type of Disability||Examples of Visible or Invisible Disabilities||Examples of Frequently Used Types of ADs|
|Visible||Visual impairment (usage of red and white cane);||Guide dogs;|
|Impaired mobility (usage of wheelchair)||Mobility assistance dogs|
|Invisible||Hearing impairment;||Hearing dogs;|
|Impaired mobility (usage of walker or normal cane);||Mobility assistance dogs;|
|Epilepsy, diabetes;||Alert service dogs, response service dogs;|
|PTSD, autism||Psychiatric service dogs|
|Group||Recovered CFUs * Enterobacteriaceae||C. difficile Presence|
|Mean (Absolute Numbers)||Mean (Logarithms)||Suspicion||UV Light Fluorescence|
|Assistance dog users||38,364||1.7496||6||1|
|Pet dog owners||177,422||2.5076||3||0|
|Factors||Number of Dogs||Factors||ORs||95% CIs||p-Values|
|CFUs Present (n = 14)||CFUs Absent (n = 36)|
|Dog type: assistance dog||9 (36%)||16 (64%)||Being a pet dog||0.4||0.1–1.6||0.2|
|Dog type: pet dog||5 (20%)||20 (80%)|
|Worm control||13 (37%)||22 (63%)||Not being on worm control||0.1||0.006–0.7||0.05|
|No worm control||1 (7%)||14 (93%)|
|Other elements present in diet||4 (50%)||4 (50%)||Not having other elements in their diets||0.3||0.06–1.5||0.1|
|No other elements present (other than kibble, canned food, or raw meat)||10 (24%)||32 (76%)|
|Neighbourhood as visited location during walks||11 (24%)||34 (76%)||Not having “neighbourhood” as a location visited||4.6||0.7–38.8||0.1|
|No neighbourhood as visited location||3 (60%)||2 (40%)|
|Age (in years): 0–1||2 (18%)||9 (82%)|
|Age: 2–5||3 (20%)||12 (80%)||Age: 2–5||1.1||0.2–9.9||0.9|
|Age: 6–7||3 (25%)||9 (75%)||Age: 6–7||1.5||0.2–13.6||0.7|
|Age: 8–13||6 (50%)||6 (50%)||Age: 8–13||4.5||0.7–38.6||0.1|
|Vaccinated against rabies||10 (37%)||17 (63%)||Not being vaccinated against rabies||0.4||0.09–1.3||0.1|
|Not vaccinated against rabies||4 (17%)||19 (83%)|
|Sleeping place: bench or dog bed/blanket||12 (26%)||35 (74%)||Not having bench or dog bed/blanket as sleeping place||5.8||0.5–132.4||0.2|
|Sleeping place: not bench or dog bed/blanket||2 (67%)||1 (33%)|
|Not being on worm control||0.04||0.001–0.4||0.007|
|Not having other elements in their diets (other than kibble, canned food, or raw meat)||0.06||0.002–0.5||0.007|
|Not having “neighbourhood” as a location visited during walks||15.8||1.4–339.0||0.04|
|Public knowledge||For whom?||Civilians visiting public places.|
|People working in the hospitality industry.|
|About what?||The fact that every AD or AD in training has an identification card, that shows that it is a certified AD, coming from an official and licensed organisation, and the name of its user.|
|Education about hygiene and the impact of ADs on hygiene.|
|Education about the reason and need for an AD, and the fact that an AD is something completely different to a pet dog.|
|Education about the types of ADs, as people are often only familiar with the guide dog type.|
|Dealing with ADs as a non-user: no touching, no talking, no eye contact, ignore the AD (even when it approaches you), keep yourself and your own dog at a distance.|
|Education about invisible diseases, as people tend to not recognise these diseases and are often biased.|
|Education about the used terms regarding ADs, and the use of standardised terms, set up by Assistance Dogs International (ADI).|
|More research on the effect of ADs on their users and corresponding publicity.|
|Overall understanding, clarity, and acceptance.|
|Infrastructure public space||What?||More space for ADs on public transport; they often have to lie down in the aisle, which can be potentially dangerous, for both people and ADs.|
|Not constructing shared places in traffic, especially for people with a visual impairment; they have no orientation and they cannot make eye contact with motorists.|
|The availability of an elevator at all times; this is obviously important for wheelchair users, but also when there are only escalators (the fur on dog paws can get caught between the steps).|
|Facilitating vacations for ADs and their users; they are often denied in dog-free accommodations. This limits the range of choice and makes the AD user very dependent on certain resorts, hotels, organisations, et cetera. This also applies to transport by taxi.|
|It should be noted that revolving doors are an issue for guide dog users.|
|Identification and welcoming of ADs||What?||Stickers near the entrances of public buildings, indicating that ADs are welcome. These stickers already exist, but they are only present in small numbers, and frequently targeted at a single type of ADs, most often guide dogs.|
|Uniform AD harnesses for every type of AD, regardless of which organisation they are from, which can be recognised by any civilian.|
|Education and publicity on these stickers and harnesses, plus information about imitation harnesses of non-official ADs (sometimes even pet dogs).|
|Education about communication with AD users: how to handle the situation correctly?|
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Vos, S.J.; Wijnker, J.J.; Overgaauw, P.A.M. A Pilot Study on the Contamination of Assistance Dogs’ Paws and Their Users’ Shoe Soles in Relation to Admittance to Hospitals and (In)Visible Disability. Int. J. Environ. Res. Public Health 2021, 18, 513. https://doi.org/10.3390/ijerph18020513
Vos SJ, Wijnker JJ, Overgaauw PAM. A Pilot Study on the Contamination of Assistance Dogs’ Paws and Their Users’ Shoe Soles in Relation to Admittance to Hospitals and (In)Visible Disability. International Journal of Environmental Research and Public Health. 2021; 18(2):513. https://doi.org/10.3390/ijerph18020513Chicago/Turabian Style
Vos, S. Jasmijn, Joris J. Wijnker, and Paul A. M. Overgaauw. 2021. "A Pilot Study on the Contamination of Assistance Dogs’ Paws and Their Users’ Shoe Soles in Relation to Admittance to Hospitals and (In)Visible Disability" International Journal of Environmental Research and Public Health 18, no. 2: 513. https://doi.org/10.3390/ijerph18020513