Table 4.3.

Recommendations related to animal-assisted interventions

Stakeholders	Recommendation
Prior to hospital visit
Hospital or healthcare facilities	Individual facilities should develop guidelines and policies to minimize the risks of injury or transmission of pathogens from animals to humans in the healthcare setting. Policies should be developed in consultation with physicians, nursing staff, infection control specialists, risk management, and veterinarians
Medical providers	Animal visits to patients should be approved by the primary medical provider after consideration of the risks and benefits. A history of allergic reactions with animal contact, a fear of animals, and the patient’s medical condition should be part of this consideration Verbal or written consent should be obtained from patients or caretakers prior to visitation from facility animals and their handlers
Animal handlers and veterinarians	Visiting animals should have veterinary documentation of good health including a certificate of immunization from a licensed veterinarian and an annual fecal exam for enteric parasites. The animal should be checked for any skin infections, including those caused by bacteria, ectoparasites such as fleas and ticks, or superficial dermatophytes Animals used in AAT and volunteer pet programs should have documentation of temperament testing or prior behavior assessment by a trained volunteer or employee Animals should be well groomed and recently bathed prior to facility visitation
Precautions and visitation exclusions
Hospital or healthcare facilities, medical providers, animal handlers	Patients should be excluded if there are isolation restrictions, undressed wounds, and/or burns, if there is a sterile field present, or if there is a severe immunodeficiency Animal interaction in high-risk patient areas such as the intensive care units (including cardiac intensive care), hematology-oncology unit, and transplant units should be considered cautiously and approved by medical leadership
Medical providers	Patients with medical devices including indwelling catheters, feeding tubes, tracheostomy tubes, or oxygen delivery devices should undergo preparation to secure and cover devices prior to animal visits in order to prevent body or mouth contact and/or dislodgement of the device
Hospital or healthcare facilities, animal handlers	Animals excluded from visitation should include reptiles and amphibians, nonhuman primates, hamsters, gerbils, mice, rats or other rodents, and other animals that have not been litter trained, such as birds. Fish may be considered on a case-by-case basis
During animal visit
Animal handlers	Animals should be transported around the facility by a trained handler or employee familiar with the animal. Pet carriers or a short leash (4 feet or less) should be used. In the cases of personal pet visitation, it may be appropriate that a family member carries or walks the animal with direct facility employee supervision Contact with animal dander, saliva, urine, or feces should be minimized
Medical providers	Facility personnel should supervise all animal visits. Child life staff may be trained in patient-animal interactions and may provide guidance and oversight. Supervisors should be trained in facility policies including how to respond to cases of animal bites or animal defecation or vomiting
Medical providers and animal handlers	Before and after animal contact, patients, staff, and visitors should perform hand hygiene with facility-approved alcohol-based foams or gels or wash their hands with soap and water if their hands are visibility soiled. Areas of the facility with animal contact should be cleaned and disinfected after the animal visit is complete Take prompt action if an animal bite or scratch occurs. The animal should be removed from the facility, and the event should be reported to appropriate authorities including infection control staff and animal program coordinators. The bite or scratch should be quickly treated according to medical best practices