DOCUMENT CONTROL:
Version: 8
Ratified by: Clinical Policies Review and Approval group
Date ratified: 5 November 2019
Name of originator/author: Clinical Lead Occupational therapist
Name of responsible committee/individual:
Clinical Policies Review and Approval group
Date issued: 8 November 2019
Review date: November 2022
Target Audience All staff in in-patient areas
Animals in Health Care Settings:
(Care and Management) Policy
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CONTENTS
Section Page No
1. INTRODUCTION 3
2. PURPOSE
2.1 Explanations/Definitions of Terms Used
3
3
3. SCOPE 3
4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES
4.1 Director of Infection Prevention and Control
4.2 Infection Prevention & Control Clinical Nurse Specialists
4.3 Consultant Medical Staff/Medical Staff
4.4 Modern Matrons/Service Managers
4.5 Staff
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4
4
4
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5
5. PROCEDURE/IMPLEMENTATION
5.1 Animals within the Clinical Environment
5.2 General Guidance
5.3 Guidance on Keeping Fish
5.4 Animals Kept Outdoors
5.5 Visiting Animals
5.6 Unsuitable Animals
5.7 Incident Reporting
5.8 Allergies
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5
6
6
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9
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6. TRAINING IMPLICATIONS 10
7 MONITORING ARRANGEMENTS 10
8. EQUALITY IMPACT ASSESSMENT SCREENING
8.1 Privacy, Dignity and Respect
8.2 Mental Capacity Act
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10
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9. LINKS TO ANY ASSOCIATED DOCUMENTS 11
10 REFERENCES 11
11 APPENDICES
Appendix 1: Common diseases related to animals
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1. 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. Occasionally it will prove detrimental to separate an animal from its owner e.g. assistance dogs. The therapeutic benefits of contact with animals should be based on clinical judgement and any risks should be continually assessed.
2. 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 all patients, staff and the animals, the following policy must be observed.
2.1 Explanations/Definitions of Terms Used 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/patient and prevent its spread to susceptible patients. Zoonoses - diseases that can be transmitted from animals to humans.
3. 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.
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4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES
4.1 Director of Infection Prevention and Control The Director of Nursing and Allied Health Professionals has delegated responsibility as Director of Infection Prevention and Control (DIPC) acts on legislation, national policies and guidance ensuring effective policies are in place and audited and directly reports to the Chief Executive and the Board:
Any outbreaks of infection
The organisations performance in relation to Healthcare Associated Infection’s (HCAI), providing regular reports including an annual report and an annual IPC programme
All incidents requiring a post infection review (PIR)
4.2 Infection Prevention & Control Clinical Nurse Specialists (IPCCNS) The IPCCNS role is to:
Provide expert professional advice and education on the prevention and control of infection to other professionals, multi-disciplinary groups, patients and carers
Report findings to the DIPC and the Infection and Prevention and Control Committee (IPCC)
Lead in the investigation of identified cases of infection/alert organisms and conditions
Advise on control measures, delegating responsibility to Trust staff as appropriate
Report any breaches in policy compliance through the IR1 system
4.3 Consultant Medical Staff/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
4.4 Modern Matrons/Service Managers All Service Managers and Modern Matrons are responsible for:
Membership at the IPCC
On-going compliance with this policy within their clinical areas and reporting non-compliance to the DIPC
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Reporting all matters relating to IPC to the DIPC
Facilitating feedback of information related to surveillance data and identified cases of infection/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
4.5 Staff All staff must comply with this policy and related guidance.
5. PROCEDURE/IMPLEMENTATION
5.1 Animals within the Clinical Environment The Modern Matron/Clinical Manager and Head of Service must agree and take responsibility for animals in their clinical environment. For health and safety and infection control standards animals should not live on the ward/in-patient unit. Certain animals may live outside in a secure environment.
5.2 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/fish and make sure the following is adhered to (as appropriate):
Registration with a vet
Records of vaccinations
Ward pets should have occasional 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/cuts/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/animal if either is ill especially if either have diarrhoea
Staff must refrain from holding pets against their uniform/clothing. However where this is unavoidable disposable aprons or other protective items should be worn/used e.g. towels for a pet sitting on a lap
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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/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/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 pets
Animals must not lick staff/patients Any service that decides to have a ward animal must have plans in place to:
Manage and assess any risk individual patients may pose to the animal. 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
5.3 Guidance on Keeping Fish:
Consider any risk posed to the fish by the patient group
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 (e.g. 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:
o 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
o A risk assessment is needed to identify hazards in connection with the moving and handling of water
5.4 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 weather proof material
The cage needs to be cleanable
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The cage needs to be large enough for the animal size
The animal will need an adequate food/equipment supply (i.e. hay for rabbits, fresh food)
The animal will need a supply of clean water at all times
The animal should have its own food and water dishes/bottles and be fed outside the ward/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 e.g. temporary indoor cage for extreme winter weather or frozen water bottles for cooling outdoor hutches in heatwave conditions
5.5 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, or Amoebiasis. Pet visits should also be avoided in areas containing patients/staff who are allergic to the animal concerned.
5.5.1 Visits from a Patient’s Own Animal Permission to bring a patient’s own animal onto the 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 (e.g. 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/lesions must be covered
The suitability of the clinical area for the visit
Other patients/staff must be told of the animal visit, in case of any fears or allergies they may have
If any patients/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)
The room must be thoroughly cleaned and/or vacuumed afterwards
Animal visits must not be allowed if the animal is ill or has diarrhoea
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
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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 on the ward staff are to ask for it to be immediately removed and make it clear that any future visits cannot be facilitated
The animal should only be allowed in non-clinical areas e.g. lounge, and never be allowed in the kitchen or clinical areas e.g. treatment room
The animal must not have access to any food preparation or eating areas
Animals should only be fed pre-approved food/treats
5.5.2 Trained Assistance Dogs/Animals Should a visitor who uses an assistance dog/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.
5.5.3 Pets as Therapy (PAT Scheme)/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 e.g. PAT Dogs Charity. In these cases the staff member will follow the procedures of the particular organisation and liaise accordingly with the ward/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
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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. PAT animal management is the same as the management in the section above (visits from a patient’s own animal) and:
The animal must not be allowed on to the patient’s bed or chair
The 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 5.2 in conjunction with any local Standard Operational Procedures. Staff should include clinical judgement and all sessions should be documented in the care record.
5.6 Unsuitable Animals Certain pets should not be brought into the hospital. 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 1)
5.7 Incident Reporting Any incident involving any animal and patient, visitor or member of staff must be reported using an IR1 form.
5.8 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.
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5.9 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.
6. 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/supervision
Posters
Local Induction
7. MONITORING ARRANGEMENTS
Area for Monitoring
How Who by Reported to Frequency
Compliance with the policy
Breaches to be reported via Modern Matrons
Managers/ Matrons in clinical services
IPC Committee
As they occur
Reported incidents
Via IR1s Managers/ Matrons in clinical services
IPC Committee
As they occur
8. EQUALITY IMPACT ASSESSMENT SCREENING
The completed Equality Impact Assessment for this Policy has been published on this Policy’s webpage on the Trust website.
8.1 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’.
As a consequence the Trust is required to articulate its intent to
Indicate how this will be met No issues have been identified in relation to this policy.
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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).
8.2 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 individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individuals 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 staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act. 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 interests of an individual whose capacity is in question can continue to make as many decisions for themselves as possible.
Indicate how this will be achieved.
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)
9. LINKS TO ANY ASSOCIATED DOCUMENTS
All related policies can be found in the Clinical Policies section of the RDaSH website. Additionally please refer to:
Infection Prevention and Control Manual
10 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
11 APPENDICES
Appendix 1 – Common diseases related to animals
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APPENDIX 1
Common diseases related to animals
Animal Associated Disease
Dogs and Cats Salmonella Campylobacter Toxocara Toxoplasmosis Yersinia
Birds Chlamydia psittaci
Terrapins Salmonella
Exotic Pets e.g. Snakes, Lizards, Turtles and Iguanas
Salmonella
