Animals in healthcare settings policy

1 Policy summary

This policy is to provide staff with the procedures to follow in relation to animals in healthcare. Be that animals (pets) that live on the ward, assistance dogs and pets as therapy (PAT) animals, or a patient’s own animal (pet) that would visit them in the grounds or on inpatient wards in exceptional circumstances, such as those without leave into the grounds or on end of life care.

2 Introduction

Contact with animals has been shown to have positive health benefits for some people, particularly children, the elderly and patients with mental illness. The benefits include improved physical, social, emotional or cognitive functioning.

The therapeutic benefits of contact with animals should be based on clinical judgement and any risks should be continually assessed.

3 Purpose

This policy has been developed to allow patients the benefit of contact with animals (if desired and appropriate) under supervision, and to reduce the risk of acquisition of zoonoses. The policy content is based on sound infection prevention and control (IPC) principles and national guidance. This policy is to support therapeutic benefits while managing the small risk of cross infection. In order to safeguard the wellbeing of all patients, staff and the animals, the following policy must be observed.

3.1 Explanations or definitions of terms used

Definitions
Term	Definition
Cognitive functioning	The process of acquiring knowledge and understanding through thought, experience, and the senses
Protective isolation	A range of practices used to protect highly susceptible patients from infection
Source isolation	A range of practices to confine an infectious agent or patient and prevent its spread to susceptible patients
Zoonoses	Diseases that can be transmitted from animals to humans

4 Scope

This policy applies to all staff having contact with patients under the care of the trust, whether in a direct or indirect patient care role regardless of the care environment. Adherence to this policy is the responsibility of all staff employed by the trust, including agency, locum and bank staff contracted by the trust.

This policy should be read in conjunction with the IPC manual, health and safety policies and clinical risk assessment and management policy.

This policy should be considered and included in services that are contracted and commissioned by the trust.

5 Responsibilities, accountabilities and duties

5.1 Consultant medical staff or medical staff

Consultant medical staff are responsible for the supervision of junior medical staff and all medical staff must:

ensure compliance with IPC policies
liaise with the microbiologist for advice when required
contribute to and participate in reports, including attendance at relevant meetings
complete relevant actions required from reports

5.2 Modern matrons or service managers

Membership at the IPCC.
On-going compliance with this policy within their clinical areas and reporting non-compliance to the DIPC.
Reporting all matters relating to IPC to the DIPC.
Facilitating feedback of information related to surveillance data and identified cases of infection or alert organisms and conditions.
Reporting confirmed cases of HCAI through the trust’s IR1 system.
Ensuring that situation reports are completed to deadline as requested.

5.3 Staff

All staff must comply with this policy and related guidance.

6 Procedure or implementation

6.1 Quick guide

6.1.1 Risk assessment

A risk assessment must be completed by the matron or ward manager prior to purchasing the animal and must be completed for anyone handling the animal.

6.1.2 Blanket restriction

In line with the blanket restrictions policy once a person becomes an inpatient the organisation does not allow their own animals (pets) to stay with them on the inpatient ward during their inpatient stay.

6.1.3 Visiting in grounds

Visits from the patient’s own animal (pet) or families pet to take place within the trusts grounds.
Permission to bring a patient’s own animal into the grounds must be sought from the ward manager. See section 5.6.1.

6.1.4 Therapy animals

All visits must be pre-arranged and ward staff notified. The PAT member must produce their valid photo ID card at each visit.
People wishing to visit patients on a voluntary basis and bring their own animals as part of the PAT scheme (or other similar organisation) must first contact the voluntary services manager (VSM).

6.1.5 IPC

The risk to the patient being visited and other patients on the ward (for example, their immunosuppressed status, mental health status) should be assessed by medical and nursing staff (in consultation with the IPC team, if required) prior to authorisation of the visit of the animal.
Any skin lesions or cuts or abrasions are covered with an appropriate dressing. If this is not possible, they must not handle the animal.

6.2 Animals within the clinical environment

The modern matron or clinical manager and head of service must agree and take responsibility for any animals that promote the wellbeing and recovery of inpatients, in their clinical environment.

For health and safety and infection prevention and control standards animals should not live on the actual in-patient unit. Certain animals may live outside in a secure environment. In line with the blanket restrictions policy once a person becomes an inpatient the organisation does not allow their own animals (pets) to stay with them on the inpatient ward during their inpatient stay. The modern matron or clinical manager and head of service must agree and take responsibility to carry out an individual risk assessment for any pets that visit their owners either in the grounds or on the inpatient area in circumstances such as end of life care, or should a patient not be able to access leave in the hospital grounds.

6.3 General guidance

A risk assessment must be completed prior to purchasing the animal.
A risk assessment must be completed for anyone handling the animal.

There must be a named employee or team allocated to oversee the care of the animals or fish and make sure the following is adhered to (as appropriate):

registration with a vet
records of vaccinations
ward pets should have annual health checks
the animal must not visit if unwell in any way
records of worming and flea control if necessary according to veterinary instructions patients and staff must decontaminate their hands using liquid soap and water or alcohol hand rub prior to touching the animal
patients and staff must always wash their hands thoroughly with liquid soap and water immediately after contact with animals, alcohol hand rub may be used as an interim measure to reduce contamination until hands can be washed using liquid soap and water
any skin lesions or cuts or abrasions are covered with an appropriate dressing. If this is not possible, they must not handle the animal
contact must not be allowed between the patient or animal if either has a known or suspected illness especially diarrhoeal symptoms
staff must refrain from holding pets against their uniform or clothing, however where this is unavoidable disposable aprons or other protective items should be worn or used for example, towels for a pet sitting on a lap
disposable gloves and plastic aprons must be worn when cleaning up animal bedding, urine and faeces
management and disposal of animal body fluids is the responsibility of the ward or in-patient staff
shampooing and steam cleaning of soft furnishings and carpets may
be required
all waste material should be disposed of immediately in an offensive waste bag
a cleaning schedule or checklist must be in place
consent should be sought from the patient prior to handling any pets, patients should be continually supervised while handling ward pet
in the event of an animal licking staff or patients the area licked must always be thoroughly cleaned with liquid soap and water immediately afterwards

Any service that decides to have a ward animal (pet) must have plans in place to:

manage and assess any risk individual patients may pose to the animal, including historical risks to animals, if there is a risk to the animal how this will be managed
manage a patient who becomes particularly attached to the animal and is due for discharge
manage a patient or patient groups distress should the animal become unwell or die

6.4 Guidance on keeping fish

Consider any risk posed to the fish by the patient group.
Consider the risk posed by the fish tank by the patient group should it become damaged or broken.
Determine the safest position for the tank, including access to an electrical supply.
Fish foods and aquarium treatments must be kept safe and secure.
Where contractual arrangements (for example, Aqualease) are in place for the management of aquariums the cleaning of the aquarium will be undertaken by the contractor.
For services where there are no contractual arrangements for the
management of the aquarium the following advice should be followed:
- equipment used must be for the sole use of cleaning the aquarium and cleaned thoroughly after use; water should be disposed of via the sluice,. replacement water must be from a clean water supply, this should be done regularly in accordance
  with advice from aquatic supplier
- a risk assessment is needed to identify hazards in connection
  with the moving and handling of water

6.5 Animals kept outdoors

Consider any risk posed to the animal by the patient group.
The cage needs to be in a safe, secure environment away from predators.
The cage needs to be made of appropriate, robust and weatherproof material, with consideration given to periods of particularly hot weather and what shelter the animal will have.
The cage needs to be cleanable.
Consideration is needed to frequency of cleaning out cages and tanks.
The cage needs to be large enough for the animal size.
The animal will need an adequate food or equipment supply (for example, hay for rabbits, fresh food).
The responsibilities for feeding of the animal needs to be agreed at a local level with staff or patients identified to ensure this happens in keeping with the animals feeding regime.
The animal will need a supply of clean water at all times.
The animal should have its own food and water dishes or bottles and be fed outside the ward or in the cage.
Animal foods should be stored separately to food for humans, be prepared and served with separate utensils which are then washed separately in neutral detergent and hot water.
On-going costs will need to be financed.
Alternative arrangements must be in place for very extreme weather for example, temporary indoor cage for extreme heat or winter weather or frozen water bottles for cooling outdoor hutches in heatwave conditions.

6.6 Visiting animals

Patients in source or protective isolation are not suitable candidates for pet visits as animals may act as a source of infection or carry pathogens from areas of source isolation. For the protection of animals and to eliminate their potential role as vectors of disease visits are generally not recommended to patients who are infected or colonized with:

Tuberculosis
Salmonella
Campylobacter
Shigella
Group A Streptococcus
Methicillin Resistant Staphylococcus Aureus Ringworm
Gardia
Amoebiasis

Pet visits should also be avoided in areas containing patients or staff who are allergic to the animal concerned.

6.6.1 Visits from patient’s own animal within trust grounds or inpatient ward 7

Visits to take place within the trusts grounds or Inpatient ward from the patient’s own animal (pet) or families pet. Permission to bring a patient’s own animal into the grounds or inpatient ward must be sought from the ward manager who must take into account the following:

the risk to the patient being visited and other patients on the ward (for example, their immunosuppressed status, mental health status) should be assessed by medical and nursing staff (in consultation with the IPC team, if required) prior to authorisation of the visit of the animal
where the visiting animal is a dog, ask the breed and check against against Legislation such as The Dangerous Dogs Act (1991). The current list of banned breeds in the UK is:
- Pit Bull Terrier
- Japanese Tosa
- Dogo Argentino
- Fila Brasileiro
an individual assessment of each dog’s behaviour (and any aggression shown towards others) should be carried out regardless of their breed or size as small dogs can also be aggressive and cause harm
all the patient’s wounds or lesions must be covered
other patients or staff must be told of the animal visit, in case of any fears or allergies they may have
if any patients or staff are known to have a fear or allergy to animals, the pet visit must take place in a separate area (preferably one not normally frequented by patients)
animal visits must not be allowed if the animal is ill or has diarrhoea or vomiting
the owner must take responsibility for supervising the animal at all times or provide another responsible person to do this
the owner or nominated person must provide a bowl for food or water (and drinking water must be used) for the animal
the pet must be exercised prior to the visit to lessen the risk of elimination on site
dogs must be kept on a leash at all times and remain under supervision of the person bringing it to the visit
the animal may only visit its owner and no other patient
in the event that the animal or any other patient becomes distressed whilst the pet is in the grounds staff are to ask for it to be removed and make it clear that any future visits cannot be facilitated
animals should only be fed pre-packed food or treats

6.6.2 Trained assistance dogs or animals

Should a visitor who uses an assistance dog or animal, wish to visit a relative in hospital, this should be discussed with the ward manager. The patient’s clinical status and location on the ward will be fully considered and a risk assessment made.

6.6.3 Pets at therapy (PAT scheme) or other visiting animals

People wishing to visit patients on a voluntary basis and bring their own animals as part of the PAT scheme (or other similar organisation) must first contact the voluntary services manager (VSM). PAT members must contact the VSM and arrange a meeting to confirm their

PAT membership by producing their photo ID and bring their animal so that the VSM and wider teams knows what animal will be visiting.

Note in some areas it is RDaSH staff who initiate visits from PAT scheme organisations for example, PAT dogs charity. In these cases the staff member will follow the procedures of the particular organisation and liaise accordingly with the ward or service manager and VSM to support the visit in line with the VSMs advice and any required procedures for volunteers.

The VSM will ensure that membership of the PAT scheme is up to date and keep a copy of the PAT photo ID badge, along with contact details of the PAT member.

All visits must be pre-arranged and ward staff notified. The PAT member must produce their valid photo ID card at each visit.

On the first visit, the PAT member will have a form, PAT7. This form is included in the volunteer handbook provided by pets as therapy and informs the charity where the volunteer is visiting. The PAT member will complete the appropriate part and ask the authorised contact (this could be the nurse in charge of the ward or VSM) at RDaSH to complete the appropriate section(s) and sign the reverse. The RDaSH site should keep a copy of the PAT7 which is to be held by the VSM. The nurse in charge of the clinical area will determine whether the PAT animal will be allowed into the area and whether any conditions or restrictions are necessary. Any PAT animal visiting a clinical area should be accompanied at all times by its registered owner.

If there are patients, members of staff or other visitors with allergies to animals this must be taken into consideration and may prevent the visit of the animal.

6.6.4 PAT animal management

Visits to take place within the trusts grounds from a PAT animal. Permission to bring a patient’s own animal into the grounds must be sought from the ward manager who must take into account the following:

the risk to the patient being visited and other patients on the ward (for example, their immunosuppressed status, mental health status) should be assessed by medical and nursing staff (in consultation with the IPC team, if required) prior to authorisation of the visit of the animal
all the patient’s wounds or lesions must be covered
other patients or staff must be told of the animal visit, in case of any fears or allergies they may have
if any patients or staff are known to have a fear or allergy to animals, the PAT animal visit must take place in a separate area (preferably one not normally frequented by patients)
animal visits must not be allowed if the animal is ill or has diarrhoea or vomiting
the owner or nominated person must take responsibility for supervising the animal at all times
the owner or nominated person must provide a bowl for food or water (and drinking water must be used) for the animal
the PAT animal must be exercised prior to the visit to lessen the risk of elimination on site
dogs must be kept on a leash at all times and remain under supervision of the person bringing it to the visit
in the event that the animal or any other patient becomes distressed whilst the PAT animal is on the ward, staff are to ask for it to be removed and make it clear that any future visits cannot be facilitated
PAT animal should only be fed pre-packed food or treats
the PAT animal must not be allowed on to the patient’s bed or chair
the PAT animal can visit more than one patient but the patient (and staff) must decontaminate their hands before and after touching the animal
PAT animals should not visit patients who are in isolation for an infectious reason

Animals visiting as part of therapeutic activities facilitated by RDaSH staff should adhere to section 5.3 in conjunction with any local standard operational procedures. Staff should include clinical judgement and all sessions should be documented in the care record.

6.7 Unsuitable animals

Certain animals should not be brought onto an inpatient area. These include:

aggressive and exotic pets (including reptiles and snakes)
juvenile animals such as puppies and kittens
non-house trained cats or dogs
animals that hunt and eat wild prey
unwell animals

Stray or wild animals must not be encouraged by feeding. Some animals may carry infection. Staff should be aware of these potential infections. (see appendix A)

6.8 Incident reporting

Any incident involving any animal and patient, visitor or member of staff must be reported on the trusts Ulysses Safeguard IR1 system.

6.9 Allergies

Some individuals are allergic to the fur and feathers of certain animals. This often manifests itself as a rhinitis or wheeze. The ward should be mindful of this and take appropriate action if this occurs.

6.10 Deceased animals

Advice should be sought from a veterinary practitioner to advise the best course of action. Animals on the ward through a lease programme, such as Aqualease, should be disposed of in line with their policies and procedures.

7 Training implications

There are no specific training needs in relation to this policy, but the following staff will need to be familiar with its contents, all staff working within the trust in patient areas and any other individual or group with a responsibility for implementing the contents of this policy.

As a trust policy, all staff need to be aware of the key points that the policy covers. Staff can be made aware through:

local induction
trust wide email
special meetings
team meetings
one to one meetings or supervision
posters
local induction

8 Monitoring arrangements

8.1 Compliance with the policy

How: Breaches to be reported.
Who by: Managers or matrons in clinical services. Complaints and PALs in relation to this policy by complaints team.
Reported to: Modern matron.
Frequency: As they occur.

8.2 Reported incidents

How: Via IR1s.
Who by: Managers or matrons in clinical services. Complaints and PALs in relation to this policy by complaints team.
Reported to: Modern matron.
Frequency: As they occur.

9 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

9.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

Consequently, the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity, and respect, (when appropriate this should also include how same sex accommodation is provided).

9.1.1 How this will be met

No issues have been identified in relation to this policy.

9.2 Mental Capacity Act

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individual’s capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all employees working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason, all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005)to ensure that the rights of individual are protected, and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

9.2.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act (2005) (section 1).

10 Links to any other associated documents

11 References

Brodie S and Biley F (1999) An exploration of the potential benefits of pet facilitated therapy. Journal of Clinical Nursing. 8 329-337.
Khan MA, Farrag N. Animal-assisted activity and infection control
implications in a healthcare setting. J Hosp Infect 2000; 46: 4-11.
Guay DRP. Pet-assisted therapy in the nursing home setting: Potential for zoonosis. Am J Infect Control 2001; 29: 178-86.
Pro Dogs National Charity, PAT Dog Scheme, Rocky Bank, 4 New
Road, Ditton, Kent, ME20 6AD.
Wilson J (2006) Infection Control in Clinical Practice. London: Balliere Tindall.

12 Appendices

12.1 Appendix A Common diseases related to animals

12.1.1 Dogs and cats

Salmonella
Campylobacter
Toxocara
Toxoplasmosis
Yersinia

12.1.2 Birds

Birds Chlamydia psittaci

12.1.3 Terrapins

Salmonella

12.1.4 Exotic pets for example, snakes, lizards, turtles and iguanas

Salmonella

Document control

Version: 9.
Unique reference number: 355.
Approved by: Clinical policies review and approval group.
Date approved: 7 February 2023.
Name of originator or author: Clinical effectiveness lead.
Name of responsible individual: Executive director of nursing and allied health professionals.
Date Issued: 14 February 2023.
Review date: 28 February 2026.
Target audience: All staff in in-patient areas.

Page last reviewed: April 30, 2024
Next review due: April 30, 2025

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