Table 2.

Overview of the Articles Examined: Reviews, Guidelines, and Commentaries, listed by type and chronologically

First Author, Year	Study Design	Goals	Evaluated	Measurements	Covariates	Findings
(Bert et al., 2016)	Systematic Review	Review current literature of positive clinical outcomes and negative risk to patients from therapy animals	11 papers looking at the risk of therapy animals, which include both epidemiological studies and protocol guidelines.	N/A	N/A	Concluded AAI for hospitalized patients useful and safe for a wide range of diseases
(Chalmers & Dell, 2016)	Commentary	Applying One Health principles to decrease risk in therapy dog programs and further research	Did not include number of papers formally reviewed	N/A	N/A	Author gives a framework for studying therapy programs in the animal-human-environment interface.
(Hardin et al., 2016)	Commentary	Describe implementation of a pet therapy program that includes guidelines for the prevention of transmitted infections.	Did not include number of papers formally reviewed	N/A	N/A	Guidelines were in place in a hospital for sixteen years with no documented cases of disease transmission, supporting that a pet therapy program can be put into place safely with proper regulation
(Cimolai, 2015)	Letter to the Editor: Brief Review	Short review of current studies/case reports of zoonotic infections from pets	Did not include number of papers formally reviewed	N/A	N/A	Author concludes that therapy programs do provide opportunities for patients to become exposed to zoonotic infections and requires strict infection control policies, not a relaxation of guidelines.
(Murthy et al., 2015), Society of Healthcare Epidemiology of America (SHEA) Writing Group	Commentary	Provide general guidance to the medical community regarding management of animals in healthcare, specifically in terms of hazard reduction.	Did not include number of papers formally reviewed	N/A	N/A	Created guidelines for animal-assisted therapies, service animals, research animals, and personal pet visitation. Also recommends additional research be performed to better understand the risks and benefits of allowing animals in the healthcare setting for specific purposes
(Snipelisky & Burton, 2014)	Review	Review current published information regarding the efficacy of AAI in the inpatient population, and to review safety concerns associated with AAI.	Reviewed 44 articles (26 clinical studies, 15 review articles, 1 case report and 2 letters to the editor). Five studies addressed infection concerns.	N/A	N/A	The authors’ review of the literature showed that, in the inpatient setting, AAI is an effective therapy among patients of all ages and with various medical problems and is safe, with no transmitted infections reported. Found only 5 studies that addressed infection concerns in the inpatient setting.
(Silveira et al., 2011)	Commentary	Guidelines for a hospital-based AAI program, which has been effective for a hospital in San Paolo, Italy	Did not include number of papers formally reviewed	N/A	N/A	AAI programs can be properly implemented in hospitals if strict attention is paid to animal inclusion criteria and infection control.
(Lefebvre et al., 2008a)	Commentary	Provides standard guidelines for animal-assisted interventions in health care facilities, considering the available evidence.	Did not include number of papers formally reviewed	N/A	N/A	Created strict guidelines, centered on evidenced-based literature, for AAI programs to reduce risk of colonization and transmission of hospital-associated infections for the animals and people.
(Disalvo et al., 2006)	Commentary	Compared guidelines for therapy animals in hospitals to guidelines for service dogs and family pet visitation	Did not include number of papers formally reviewed	N/A	N/A	Argued that therapy animals should have strict guidelines to reduce adverse events such as phobias, allergies, and zoonotic diseases.
(Sehulster & Chinn, 2003)	Review	Centralized CDC guidelines for environmental infection-control strategies and engineering controls to effectively prevent nosocomial infections in healthcare fields.	Did not include number of papers formally reviewed	N/A	N/A	Discussed general infection control policies, but also included therapy animal programs. Recommended minimizing contact with animal bodily fluids, and implementing hand hygiene after each contact. Recommended careful selection of therapy animals and bathing to reduce allergens.
(Brodie et al., 2002)	Review	Review of current literature focusing on health risk to patients	Did not include number of papers formally reviewed	N/A	N/A	Zoonoses, allergies and bites - the three issues surrounding pet therapy causing greatest concern - have the potential to be controlled in a supervised health care setting, and can be minimized by taking simple measures.
(Guay, 2001)	Review	Review of the most common zoonotic infections that might be expected in the long-term care setting from AAI, with recommendations for prevention and control.	Did not include number of papers formally reviewed	N/A	N/A	Recommends infection control policies and procedures, geared toward management and prevention of the different zoonotic illnesses discussed, should be developed and implemented in all nursing homes offering pet-assisted therapy.
(Khan & Farrag, 2000)	Commentary	Critique of current animal therapy programs guidelines in the context of hazard reduction	Did not include number of papers formally reviewed	N/A	N/A	If put into place properly, animal therapy programs can have significant benefit to patients, with minimal risk of animal associated health hazards.