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Thhis policy has been adopted by UNC Health Care for its use in infection control.

It is provided to you as information only.

Administrative Manual
Policy Name
Policy Number
Date this Version
Effective
Responsible for Content

I.

Animal Assisted Activities and Animal


Assisted Therapy
ADMIN 0018
August 2013
Recreational Therapy and Child Life

Description
Requirements and procedures for using animals in activities and therapy

II. Rationale
The purpose of this program is to provide children and adults who are obtaining care from UNC
Health Care System (UNC HCS) the opportunity to interact with animals, and in so doing, reduce
stress, including the stress associated with hospitalization. The animal/human bond may be
utilized to achieve functional outcomes, reminisce, socialize, and learn about pet care.
There are two separate components to this program:
Animal Assisted Activities (AAA) will provide opportunities for motivational, educational,
recreational, and/or therapeutic benefits to enhance quality of life. AAA is delivered by specially
trained professionals, para-professionals, and/or volunteers, in association with animals that
meet specific criteria.
Animal Assisted Therapy (AAT) is a goal-oriented intervention in which an animal that meets set
criteria is an integral part of the patients treatment process. AAT is directed and delivered by a
credentialed therapist or health care professional within the scope of practice of his/her
profession. AAT is designed to promote improvement in human physical, social, emotional,
cognitive, and/or leisure functioning. AAT may be group or individual in nature. The process is
documented and evaluated.

III. Policy
A. The AAA and AAT Programs
The coordination of the AAA and AAT Programs (sometimes referred to collectively as
AAA/T) shall be the responsibility of the Department of Recreational Therapy and Child Life
and Volunteer Services.
All clinical areas that desire to participate in the AAA/T program are required to do the
following:
1. Each new clinical area must be approved by the Nurse Manager of the unit requesting
the program and the Director of Volunteer Services.
2. Each clinical area for which an AAA/T program is approved must have a designated staff
member to coordinate the program.
3. The coordinating staff member must complete a Competency Assessment of knowledge,
skills, and abilities necessary for AAA or AAT.

B. Permissible Pet Partner Animals


1. Currently, only dogs may participate in AAA/T programs. In the event other animals
are considered, prior to visitation the requestor must contact UNC Hospitals Associate
Director of Epidemiology, or his/her designee (the IC RN on-call), for guidelines
regarding medical screening of the animal.

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Animal Assisted Activities and Animal Assisted Therapy

2. There are a great many species that can make wonderful visiting animals and can form a
strong human-animal bond. Only domesticated animals may become Pet Partners.
Examples of other future potential Pet Partners include: declawed cats; guinea pigs;
rabbits; hamsters; domesticated rats; house-broken miniature horses; house-broken
potbellied pigs; house-broken miniature pigs. These animals will require prior approval
through the AAA/T Committee before they will be permitted to be part of the program and
assigned to a clinical area.
3. Wild or exotic animals (e.g., birds, snakes, ferrets, prairie dogs, lizards) may not be Pet
Partners. Reptiles may be used in AAT, but only if they remain confined in their
cage/aquarium, are not touched by the patients, and have obtained appropriate advance
approval (as described above).

C. Requirements for Pet Partners


1. Registered Pet Partners will visit hospitalized patients under the supervision of a staff
liaison who has completed the AAA/T Competency Assessment, as verified by the
AAA/T Committee Chair or designee. All animals must satisfactorily complete the Pet
Partners training program and periodic medical screening, as specified in this policy.
2. Pets are not allowed within UNC HCS unless they are registered as Pet Partners in
accordance with this policy.
3. If a Pet Partner team member is an employee at UNCH, then that Pet Partner team may
NOT visit the unit on which the employee works.
4. Pet Partner team visits are restricted to a 1 hour session to reduce animal fatigue. If a
team plans to visit 2 units within the same day (or remain longer on the same unit), then
the team must take a break for a minimum of 30 minutes after the first hour. A Pet
Partner team may not visit more than 2 hours as a combined total on the same day.
5. Pet volunteers and their dogs must be registered Pet Partners with the Pet Partners
Therapy Animal Program. The UNCH Department of Volunteer Services and the AAA/T
Committee Chair will screen potential pet volunteers and their dogs, using the health and
behavioral screening tools of the Pet Partners Therapy Animal Program. In addition,
each pet volunteer must complete UNCH volunteer training and become an approved
UNCH volunteer.
a. The Department of Volunteer Services will provide information about requirements,
contacts for completion of the competency, and copies of the competencies needed
to supervise the Pet Partners. Final approval for new programs will be the
responsibility of the AAA/T Committee.
b. The Department of Volunteer Services will be responsible for the initial screening of
interested Pet Partner teams and referral of appropriate candidates to the AAA/T
Committee Chair for further evaluation. Once the Pet Partner team has been
accepted into the AAA/T program, each Pet Partner human must become a UNC
Hospitals volunteer and complete the Volunteer Services training program.
Volunteer Services will provide orientation for the Pet Partner teams, will verify the
Pet Partners credentials, and will ensure completion of all initial and ongoing
requirements for volunteers.
c. Medical Screening of Animal Pet Partners
i.

ADMIN 0018

The pet owners licensed veterinarian must complete a medical screening of the
Pet Partners animal. A medical screening is required at least once (optimally
twice) per year. The Pet Partners Skills Test (PPST) and Pet Partners Aptitude
Test (PPAT) must be completed by Pet Partners-Licensed Team Evaluators
associated with the Pet Partners program.

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ii. The Pet Partner team obtains a health history. After receiving the medical
screening results for each of the Pet Partner teams from Volunteer Services,
Recreational Therapy and Child Life will be responsible for determining whether
each Pet Partner team has met the health and screening requirements. Records
will be maintained in both areas.
iii. Routine screening for specific, potentially zoonotic microorganisms, including
group A streptococci, Clostridium difficile, VRE, and MRSA is not recommended.
If screening is required for special circumstances noted in the APIC (Association
for Professionals in Infection Control and Epidemiology) article Guidelines For
Animal-assisted Interventions in Health Care Facilities, the Associate Director
from UNCH Epidemiology will assist with interpretation of lab results. If the lab
results contraindicate visitation, Hospital Epidemiology will notify Recreational
Therapy and Child Life and Volunteer Services via email.
iv. Because of a potential exposure or risk of exposure, a canine Pet Partner may
be required to go to a veterinarian for special testing to maintain the safety of the
pet and/or UNC HCS patients. When this is deemed necessary by UNCH
Epidemiology, then UNCH will be responsible for the cost of testing.
v. Pet Partner teams will complete the Pet Partner Health Checklist prior to
visitation and will bring the completed record with them. The record will be given
to the staff liaison, who will make a copy to keep on the unit with the visitation
record. The original record goes to Volunteer Services.
vi. Volunteer Services and Recreational Therapy and Child Life will maintain records
of medical screening results for each animal. The AAA/T Committee Chair or
designee will then notify Volunteer Services, who will be responsible for
communicating the results with the Pet Partner team and maintaining visitation
records for each of the Pet Partner teams.
Medical Screening Requirements (see Volunteer Dog History form for details):

ADMIN 0018

Proof of up-to-date vaccinations (distemper, parainfluenza, parvovirus,


and rabies)

Receiving routine medication for the prevention of heartworm

Receiving routine flea and tick prevention (Frontline or Advantix) and


inspected for signs of fleas or ticks prior to the visit, OR completion of a
flea/tick dip and receipt of a Capstar 24 hours prior to the visit, with
inspection for signs of fleas or ticks prior to the visit.

Animals should not enter the hospital starting from the onset of and until
at least 1 week beyond the resolution of:
o Episodes of vomiting or diarrhea
o Urinary or fecal incontinence
o Episodes of sneezing or coughing of unknown or suspected
infectious origin
o Treatment with nontopical antimicrobial or with any
immunosuppressive doses of medication
o Open wounds
o Ear infections
o Skin infections or hot spots (acute moist dermatitis)
o Orthopedic or other conditions that, in the opinion of the animals vet,
could result in pain or distress to the animal during handling and/or
when maneuvering within the facility
o Demonstrating signs of heat

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6. Behavioral Screening must be done in accordance with the Pet Partners Therapy
Animal Program guidelines, determined by the re-evaluation date of the Pet Partner.
Potential pet volunteers and their dogs will be screened by the Department of Volunteer
Services.
7. Other requirements for the dogs:
a. They must be bathed within 24 hours of the hospital visit.
b. They must wear a UNC ID badge attached to their collars to identify them as UNC
Hospitals Canine Volunteer.
c. They must be under direct supervision of their handler at all times.
8. Volunteer Services will be responsible for assuring that the Pet Partner team has
completed all of the requirements prior to each visit. Additionally, the AAA/T coordinator
and the Director of Volunteer Services will assist with the assignments for the Pet
Partner teams. Once assignments have been made, the credentialed staff liaison will
schedule the visits with the Pet Partner team assigned to their unit. Volunteer Services
will notify the Pet Partner team and corresponding staff liaisons when the Pet Partner
team is due for their health screening and when they have been cleared to resume
hospital visits. This is to ensure that all of the Pet Partners have up to date credentials
and health screening when visiting UNCH. Volunteer Services will be responsible for
maintaining the records for each visit for all of the Pet Partner teams.
9. Visitation Routes/Escorts
a. The Pet Partner team will be allowed to enter UNCH through any public access point.
Upon entering UNCH, the Pet Partner team must follow the approved process for
visitation.
b. For health and safety reasons, the Pet Partner team may not enter any food venue.
c. The Pet Partner team may walk in the hallways and ride the elevators without special
precautions. Prior to getting on the elevator, the staff liaison with the AAA/T
competency (or Pet Partner team if they have completed the requirements to visit
independently while staff liaison is on the unit) should check that there are no people
on the elevator that may be scared of or allergic to the animal.
d. Once the Pet Partner team has completed the precepting requirements, the Pet
Partner team may conduct AAA without direct staff supervision; The Pet Partner
team must check in with the staff liaison on the unit with the AAA/T credentials and
confirm that all paperwork has been completed for the visit. The staff liaison with the
AAA/T competency must remain on the unit during a Pet Partner visit. In order to
conduct unescorted visits as stated above, the Pet Partner team must have
successfully completed (as determined by both the AAA/T Competency Specialist
and the precepted Pet Partner) two precepting visits on the applicable unit.
Precepting must be repeated on each unit by the Pet Partner team prior to visiting a
new unit. Exception: For Psychiatry units or units with closed head injury patients,
the Pet Partner team must have the staff liaison with the AAA/T competency
accompany them at all times during the visit.
10. Physician Orders
a. UNC HCS Patients
i.

ADMIN 0018

For patients who are neutropenic, on protective precautions, in the Bone Marrow
Transplant Unit, or in an Intensive Care Unit, participation in AAA/T programs
requires an order from the patients attending physician indicating that an
exception is allowed. A new order must be written by the attending physician for

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each visit throughout the patients hospitalization and the Process for
Exceptions checklist must be utilized. This checklist is available and should be
requested through the Department of Volunteer Services.
ii. For other inpatients, no physician order is required, but written consent (as set
forth below) should be sought prior to any interaction between the patient and the
Pet Partner team.
iii. For outpatients, no written consent is required.
11. Consent for Participation
a. All inpatients must have a consent form (see Authorization for Participation in AAA/T,
attached to this policy) signed by the patient or legal guardian prior to participating in
AAA/T. The signed consent should be maintained in the front of the patients
medical chart behind the Consents section, and should be sent to Medical Records
to be scanned in the patients medical record.
b. For most patients, the AAA/T Authorization may be part of the admissions packet,
which is given to the patient of the patients legal representative at admission.
However, for inpatients who have a medical or behavioral condition or disorder that
may make participation in AAA/T a concern, a licensed nurse or physician
knowledgeable about the patient's condition must have an informed consent
discussion with the patient or the patients legal representative. The provider must
document the discussion in the patients medical record. In addition to the informed
consent discussion, the attending physician must enter an order for AAA/T for the
patient.
12. Exclusion Criteria
The following patients will be excluded from participation in the AAA/T Program:
a. Patients with open sores on exposed area of skin
b. Patients exhibiting aggressive behavior
c. Patients with HIV infection
d. Patients with immunoglobulin deficiencies
e. Patients on Isolation Precautions (Airborne, Droplet, Contact, Enteric, Protective). If a
patient is on protective isolation, the patient may participate with a physicians order
written by the patients attending physician.
f.

Patients with known allergies to visiting animals

13. Neutropenic patients (ANC <1000) may participate in AAA/T with a written order by the
patients attending physician. For patients with an ANC between 500 and 900, the
patient must wear a mask during the therapy and will need to perform hand hygiene after
direct contact with the Pet Partner. For neutropenic patients with an ANC <500, the Pet
Partner must remain on the floor.
14. For patients with other conditions that may result in immunosuppression (e.g.,
splenectomy, high dose steroids, organ transplant), it is recommended that the staff
liaison with the AAA/T competency consult with the attending physician to determine the
appropriateness of participation.
15. Adult and pediatric patients must wash their hands or use a waterless hand wash (e.g.,
alcohol-based hand sanitizer) after petting/feeding the dog. It is the responsibility of the
staff liaison with the AAA/T competency attending the patient visit (or Pet Partner team if
they have completed the requirements to visit independently) to ensure that hand
hygiene is done appropriately.

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16. The staff liaison with the AAA/T competency attending the patient visit (or the Pet Partner
team if they have completed the requirements to visit independently) will clean the visibly
soiled surfaces that may have been contaminated during the AAA/T sessions with the
appropriate disinfectant/detergent (e.g., alcohol, sanitizing wipes) after the session.
17. For patients who are able to sit in a chair, the animal may sit in the patient's lap. The
patient's clothing should be covered (e.g., with a clean sheet, blanket or isolation gown).
For patients who are unable to get out of bed, a clean sheet or blanket should be placed
over the bedcovers prior to allowing the Pet Partner on the bed. After the visit, this top
cover should be carefully removed (rolling the sheet inward toward the center) and
disposed of in the linen hamper. This will be the responsibility of the staff liaison with the
AAA/T competency attending the patient visit (or Pet Partner team if they have
completed the requirements to visit independently). For neutropenic patients with an
ANC <500, the Pet Partner must remain on the floor.

ADMIN 0018

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UNC HOSPITALS
CHAPEL HILL, NORTH CAROLINA 27514
AUTHORIZATION FOR PARTICIPATION IN AAA/T PROGRAM
MIM #407s
I hereby certify that _______________________________ [patient name] has no known
allergies that would prevent interaction with Pet Partners. I hereby give permission for the
above-named patient to participate in the Animal Assisted Activities/Therapy Program at the
University of North Carolina Hospitals. I understand that this program may be provided as a
part of the therapeutic process, or simply to enhance quality of life during hospitalization at
UNC Hospitals. A Pet Partners Team, which will include an owner and his/her animal that
has been carefully screened for good health and safe behaviors by The Pet Partners
Therapy Animal Program and local veterinarians, will visit the patient at UNC Hospitals,
accompanied by an approved UNC Hospitals representative. The sessions may include
educational presentation opportunities to practice animal care-taking and safety skills,
socialization with the pets and treatment-oriented activities. The Pet Partners will be
accompanied and supervised at all times. I also understand I may withdraw this permission
by contacting the charge nurse at any time. Refusal to sign this consent form will not prevent
participation in other activities at UNC Hospitals.
I have had an opportunity to ask questions and have had those questions answered, and have
received sufficient information so that I have a general understanding of the nature of this type
of therapy and its potential risks and benefits. Based upon this information, I consent to the
patients participation in this program. I confirm that I have read this form and understand it.

Signature

Date

Time

Date

Time

Relationship, if a legal representative of the


patient

Witness