Human Behaviors, Hand Hygiene, and Environmental Contamination Associated with Petting Zoos
Marcy McMillian1, JR Dunn1,3, JE Keen2, KL Brady1, TF Jones1.
Department of Health, Nashville, TN, 2United States Department of Agriculture, Clay Center, NE., 3CDC, Atlanta, GA.

1Tennessee

Background
Outbreaks of disease associated with animal contact in petting zoos are well described. Human behaviors that impact fecal-oral transmission of pathogens in such venues have not been well-studied. CDC has provided recommendations for diseasecontrol and for minimizing risks associated with animals in public settings

METHODS

Collected data at 6 petting zoos across Middle Tennessee August September 2005 Observed visitors to petting zoos for animal contact, contact with environmental surfaces, hand-to-face contact (i.e. mouth, nose, eyes), eating or drinking, and hand sanitizer use. Collected 150 hand-wipes from randomly selected visitors upon exiting the petting zoo. Sampled soil, livestock feces, bedding, and surfaces from 3 petting zoos. Analyzed both environmental samples and hand-wipes for E. coli O157 and Salmonella from 3 petting zoos.
Petting Zoo Crew Volunteers
Behaviors of Visitors to Petting Zoos

Touching Animals 74%

Contact with an Environmental Surface - 87%

Eating or Drinking 22%

Hand to Face contact 49%

Hand Sanitizer Use 38%

Hand Sanitizer Use in Visitors Exiting Petting Zoos

Yes 38%

No 62%
Hand Sanitizer Use by Age
Hand Sanitizer Use Children Hand Sanitizer Use - Adults

Yes 35%

Yes 42% No 58%

No 65%

Children were significantly more likely to use hand sanitizer than adults: RR 1.2 (1.06, 1.35) p-value 0.004
Hand Sanitizer Use in Visitors by Petting Zoo

Petting Zoo A

Petting Zoo B

Petting Zoo C

Petting Zoo D

Petting Zoo E

90 100
Percentage of visitors using hand sanitizer
Hand sanitizer use was influenced by :
Presence of signs reminding visitors to wash hands
Visibility and readability of signs regarding hand-washing Verbal reminders to wash hands by petting zoo operators Visibility of hand sanitizer stations Convenience of hand sanitizer stations for visitor use

near exit vs. at exit

Number of hand sanitizer stations available
Petting Zoo F did not have hand-sanitizers or hand-washing available to visitors upon exiting the petting zoo

Hand Sanitizer Stations

Collecting Environmental Samples
Proportion of Positive Environmental Samples for Salmonella and E. coli O157

Salmonella

Fair A Fair B Fair C

E. Coli O157

CONCLUSIONS
Visitors to petting zoos engage in a number of modifiable behavioral risk factors for disease transmission. Environmental contamination with potential pathogens is common in such settings. Preventive measures targeting modification of human behaviors associated with fecal-oral transmission might reduce disease risks to visitors.

Hard at work

Acknowledgments
John Dunn, Tim Jones, Karen Brady, Jim Keen
Kathy Billings Effie Boothe Rand Carpenter Tamara ChavezLindell Luz Cummings Greg Galfano Katie Garman Robb Garman
Samir Hanna Amanda Ingram Leo Lindsay Susan Miller Kelly Tomlin Amanda Turner