Infection Prevention & Control

Title: SERVICE ANIMALS AND ANIMAL VISITORS Scope: This policy applies to all inpatient and outpatient areas of MultiCare Health System (locations include Tacoma General/Allenmore Hospitals, Mary Bridge Children’s Hospital, Good Samartian Hosptial, Auburn Medical Center, Covington Medical Center, Deaconess Hospital, Valley Hospital, all ambulatory areas, Retail and Administrative areas). It applies to animals belonging to patients, employees, visitors, volunteers, students and others. Policy Statement: MultiCare Health System (MHS) complies with the service animal provisions of the Americans with Disabilities Act. Animals and pets are not permitted in MultiCare facilities except under the following three exceptions: 1. Service animals. 2. Certified Animal Assisted Therapy animals and handlers. 3. An inpatient’s pet dog or cat only when the extended length of stay or terminal nature of the condition warrants a visit. Reptiles, birds, rodents and other zoo or exotic animals or pets are not appropriate for hospital visitation and may not enter MHS facilities. Only service animals and certified therapy animals participating in approved programs are permitted in MultiCare hospitals. Only service animals are allowed in clinics and outpatient areas. Pets and companion animals are not allowed. If the owner represents that a companion animal is a service animal it should follow the Service Animal procedure below. Employee pets are not permitted in any MHS facility at any time. Any animal, including a service animal, shall be excluded from MHS facilities when that animal's behavior poses a direct threat (not just a potential threat) to the health or safety of others. The risk to others must be immediate or reasonably foreseeable under the circumstances, and not remote or speculative. Animals must be in the care and under the control of a responsible individual all times while in the hospital. Procedure: I. Service Animals: A. Service animals are working animals, not pets. Service animals are defined as dogs or Miniature horses (See Definition Section for additional information) that are individually trained to do work or perform tasks for people with disabilities. The task(s) performed by the service animal must be directly related to the person’s disability. Examples of such work or tasks include guiding people who are blind, alerting people who are deaf, pulling a wheelchair, alerting and protecting a person who is having a seizure, reminding a person with mental illness to take prescribed medications, calming a person with Post Traumatic Stress Page 1 of 9 Animal Visitors Infection Prevention & Control Disorder (PTSD) during an anxiety attack, or performing other duties. Animals whose sole function is to provide comfort or emotional support do not qualify as service animals under the ADA. B. In attempting to determine if an animal is a service animal and it is not obvious what service the animal provides, limited inquiries are allowed. Staff may only ask the following two questions: (1) “Is the animal a service animal?”, And/or (2) “What has your animal been trained to do?”. Staff may not ask about the person’s disability, require medical documentation, require a special identification card or training documentation for the dog, or ask that the animal demonstrate its ability to perform the work or task. C. Employee service animals are permitted subject to suitability for the work environment as outlined below. D. Service animals must be under control and housebroken. Under the ADA, service animals must be harnessed, leashed, or tethered, unless these devices interfere with the service animal’s work or the individual’s disability prevents using these devices. In that case, the individual must maintain control of the animal through voice, signal, or other effective controls. E. The service animal must permit health care staff to care for the patient and to work in the room. F. A clean, healthy well-behaved service animal may accompany its handler to such areas as admissions and discharge offices, the emergency room, inpatient and outpatient rooms, examining and diagnostic rooms, clinics, rehabilitation therapy areas, the cafeteria and vending areas, the pharmacy, restrooms, and all other areas of the facility where healthcare personnel, patients, and visitors are permitted. Service animals are generally not allowed to enter areas where added precautions are required to enter these areas (e.g. surgical attire, gloves, gowns, masks, hair covering), but each case must be evaluated individually to ensure patient or handler needs and rights are being met. G. Service animals are not permitted in the operating rooms, preop or recovery areas, labor and delivery (LDRP-Labor and Delivery, Recovery, Post-Partum rooms will allow service animals once delivery is completed and room converts to post-partum status), intensive care units, procedure rooms, medication preparation areas, isolation rooms, kitchens or other food preparation areas unless approved by the Infection Prevention Operations Committee. H. If the animal does not meet the requirements outlind in D. and E. or presents a specific threat to other patients, staff or MHS property, the patient/handler will be asked to remove the animal from the facility. The threat must be immediate or reasonably foreseeable under the circumstances, and not remote or speculative. Allergies, fear of dogs or annoyance at the presence of a service animal do not justify removal of the animal. I. Training of service animals in MHS facilities is not permitted without express approval from Infection Prevention and Control.

Page 2 of 9 Animal Visitors Infection Prevention & Control J. For inpatient or overnight stays, place patients with service animals in a private room. If none is available, select a roommate who is not allergic or afraid of animals and consents to the presence of the animal in the room. Tape a “Service Animal” sign on the door of the room where the service animal is located to alert those with allergies to animals (see Attachment A). K. If the patient must be separated from his/her service animal while in the healthcare facility, ascertain from the patient what arrangements have been made for the supervision and care of the animal. Ensure that arrangements have been made then reassure the patient that appropriate arrangements have been made to address the patient’s needs in the absence of the service animal. Staff may state: “I’m sorry, your animal won’t be allowed in that patient care area. Is there anyone you could call to care for your animal while you are unable to?” If no arrangements have been made, or no other person may care for the animal, staff may say something like; “For the safety of your animal, we may arrange for its temporary housing at the Humane Society or with Animal Control as we cannot leave the animal alone”. L. The patient must have a capable adult available to ensure the animal’s needs, including outside toileting, are met. MHS staff shall not perform this function or have contact with animals. 1. Notify Environmental Services if a service animal urinates, defecates or vomits. Clean-up of the involved area will include: a. Provide the handler or responsible adult the materials to perform the initial clean-up if the handler is able. b. Use Standard Precautions and the appropriate personal protective equipment. Gloves must be worn. c. Discard the clean-up items in a plastic bag and then dispose of in a regular trash container located in a soiled utility room. d. Disinfect the surface with an MHS approved disinfectant. 2. If an incident of aggression, biting or scratching by an animal occurs: a) The animal will be removed permanently from the premises. b) The incident will be promptly reported to: i. The owner, if not present ii. Infection Prevention & Control iii. All bites will be reported to the county health department by Infection Prevention and Control as required by Reporting Communicable Diseases and Notifiable Conditions. iv. MHS Quality Management: 1) Patients/visitors- MeQIM 2) Staff: Employee OJI Form 3) Privacy & Civil Rights - Integrity Line (if there is a complaint about rights). v. Security

Page 3 of 9 Animal Visitors Infection Prevention & Control vi. Bites, scratches or other breaks in the skin will be promptly treated and cleaned by medical personnel following protocols for the type of injury, in an emergency or urgent care area. II. Certified Pet Therapy Animals: A. Director of Volunteer Services, or designee, is responsible for all aspects of the MHS Pet Therapy program where certified therapy dog and handler teams (PPT) visit selected patients on a scheduled basis. Patients will not have pet therapy visits if: 1. A patient’s condition contraindicates the presence of animals, including open, draining wounds or skin rashes, isolation precautions, etc. 2. The patient has fears, phobias, or allergies to animals, or does not desire to have a visit. B. Volunteer Services will handle administrative aspects of the Pet Therapy Program, including distributing and collecting forms, scheduling Pet therapy teams and maintaining files. Files are to include volunteer information, health certificates for animals and pet therapy certifications. 1. Volunteer Services will provide a MultiCare Volunteer Orientation to Pet Therapy volunteers and assure that department specific orientations and procedures are developed in user departments. 2. Pet handler must submit a completed volunteer application for consideration for the Pet Therapy Program. 3. Once selected, Volunteer/pet therapy teams must satisfactorily complete training outlined below to qualify as an MHS Pet Therapy team. Training for Pet Therapy Volunteers/ New MHS Pet Therapy teams must attend and satisfactorily complete the following: a. Completion of an approved pet therapy certification program. Additional shadow training from Volunteer Lead until the team is judged proficient. b. General MultiCare Health System volunteers’ orientation. c. A probationary period of three visitations, one observation by staff from Volunteer Services. Department specific orientation-initial competencies within first 90 days 4. Animals must pass a veterinary medical screening exam annually that includes up to date vaccinations and must be found clear of internal and external parasites. Documentation of the annual exam must be provided to Volunteer Services. Animals must pass behavioral screening examinations and demonstrate proficiency in basic obedience skills. Dogs must be housebroken. The volunteer who will be working with the animal must own the animal. Pet handler must have and maintain current certification from a licensing professional pet therapy organization. 5. Identification from licensing professional pet therapy organization must be displayed during each visit. The pet and the handler must wear MHS volunteer ID tags during visits. 6. Proof of liability insurance for the Pet Therapy Team must be provided and on

Page 4 of 9 Animal Visitors Infection Prevention & Control file with Volunteer Services. 7. MHS Pet Therapy teams must demonstrate special skills in appropriate and sensitive interaction with patients and in accommodating requests and individual needs. Staff from Volunteer Services and Lead Pet Therapy Volunteer will determine this proficiency. 8. Pet therapy animals may be in common areas with their handler as part of their training. C. User Department/Program Specific Orientation & Procedure: 1. Department specific orientation and procedures should include the following: a. Arrival – where Pet therapy team enters, designated route to specific area b. Infection prevention and control practices – use of hand sanitizing gel. Anyone that touches the animal shall sanitize their hands with sanitizing gel before and after each encounter c. Location of supplies – linens, soiled utility carts, sanitizing gel d. Use of cameras, photo consents e. Use of good judgment – alert to patient and staff restrictions, attitudes and responses, hand hygiene, etc. f. How and with whom to create assignment or visitation schedule for particular day. Identification of patients not suitable for visitation, isolation rooms, etc. g. Interactions – Will visits be primarily with individual patients or small group interactions? How will pet handler introduce self and animal? h. Competency – how will it be measured? i. How to report any unusual occurrences and or incidents. j. Departure – how will pet handler depart? Need to report out to staff to record observed responses. 2. Visiting procedures shall also address: a. How to ask the patient’s preference for placement of the animal: on bed, on a chair alongside the bed, or on the floor. If the patient requests the animal be on the bed, place a clean top sheet on the bed to protect bed linens, place in hamper when the dog departs. b. Recognizing special precautions (recent surgery, pain, medical or surgical equipment) to keep in mind related to placement. c. Infection control practices. Pet handlers must sanitize their hands before entering and upon exiting patient room. Sanitizing gel will need to be provided to each patient before and after the animal visit. d. What to do upon completion of the visit and what to do with linen that may have been used. Report out to nursing staff or designated department contact to record observed patient and staff responses, document attempted and completed visits. III. Patient’s Own Pet Visitation:

Page 5 of 9 Animal Visitors Infection Prevention & Control A. In unusual circumstances, such as a terminal patient who will not be going home, prolonged hospitalization, a patient’s own pet may be permitted a brief visit, at the discretion of the charge nurse. The pet may not remain overnight. B. The charge nurse, with input from the Nursing Supervisor or Manager on duty, is responsible for making the decision about a pet visit, based on the condition of the patient. C. The patient must be in a private room and not in isolation, have no open wounds, rashes or other significant skin disruptions. D. Only an adult dog or cat is permitted, and must be on a short leash or in a carrier at all times, except when in the patient’s room with the door closed. E. The pet must be clean, free of fleas or skin disorders. F. The pet must be under the direct control of a responsible adult at all times. G. A clean sheet will be placed on the bed of the patient if the pet is to get on the bed. H. The patient will sanitize hands before and after handling the pet. I. The pet will visit ONLY their owner/patient. J. No other patients, staff, or visitors shall have contact with the pet. IV. Special Instructions: A. It is MultiCare policy to accommodate service and therapy animals in a manner that is safe for patients, staff, visitors, and the animal. B. Animals may pose a risk of infection transmission to humans, and humans may pose a risk of infection to animals. The major communicable diseases include toxoplasma, echinococcus, Giardia, leptospirosis, salmonella, pasteurella, feline immunodeficiency virus, Bordetella bronchiseptica, chlamydia, and ringworm infection. MRSA has been cultured from the coat and mucous membranes of cats and dogs. C. The Americans with Disabilities Act (ADA) of 1990 mandates that persons with disabilities accompanied by service animals generally will be allowed in all areas where members of the public are allowed to go unless the presence of the animal creates a direct threat (not just a potential threat) to other persons or a fundamental alteration in the nature of services. 1. All inquiries or questions about service or companion animals should be directed to the nursing supervisor, Infection Prevention and Control or Legal Services 2. Patient complaints or concerns about ADA rights and service animals should be directed to Privacy & Civil Rights or to the Integrity Line. V. Definitions: Companion Animal: is an animal that provides companionship and support to its owner, but is not trained to perform a specific function or task. Companion animal has good working knowledge of obedience (i.e. “controlled walking on loose leash, sit, down and stay). Disability: Any sensory, physical or mental condition which substantially limits one or more major life activities, including but not limited to walking, seeing, talking, breathing,

Page 6 of 9 Animal Visitors Infection Prevention & Control hearing, learning, working and caring for oneself. Miniature Horses: In addition to the provisions about service dogs, the Department’s revised ADA regulations have a new, separate provision about miniature horses that have been individually trained to do work or perform tasks for people with disabilities. (Miniature horses generally range in height from 24 inches to 34 inches measured to the shoulders and generally weigh between 70 and 100 pounds.) Entities covered by the ADA must modify their policies to permit miniature horses where reasonable. The regulations set out four assessment factors to assist entities in determining whether miniature horses can be accommodated in their facility. The assessment factors are (1) whether the miniature horse is housebroken; (2) whether the miniature horse is under the owner’s control; (3) whether the facility can accommodate the miniature horse’s type, size, and weight; and (4) whether the miniature horse’s presence will not compromise legitimate safety requirements necessary for safe operation of the facility. Patient Pets: animals living in the household that are not service animals. "Service animal" means any dog or miniature horse, that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability. The work or tasks performed by the service animal must be directly related to the individual's disability. Examples of work or tasks include, but are not limited to, assisting individuals who are blind or have low vision with navigation and other tasks, alerting individuals who are deaf or hard of hearing to the presence of people or sounds, providing nonviolent protection or rescue work, pulling a wheelchair, assisting an individual during a seizure, alerting individuals to the presence of allergens, retrieving items such as medicine or the telephone, providing physical support and assistance with balance and stability to individuals with mobility disabilities, and helping persons with psychiatric and neurological disabilities by preventing or interrupting impulsive or destructive behaviors. The crime deterrent effects of an animal's presence and the provision of emotional support, well-being, comfort, or companionship do not constitute work or tasks. Therapy animal: is a certified animal that is privately owned and is brought into a healthcare facility for therapeutic reasons such as to enhance treatment of physical, cognitive, perceptual, mental or emotional impairments. A patient is not dependent upon the animal for work or to perform tasks for the benefit of a person with a disability. 1. PTP – Pet Therapy Program is a service provided by Volunteer Services. All inquiries and communications regarding the program should be directed to Volunteer Services. 2. PTT – Pet Therapy Team is the certified therapy dog and handler. User Department: Departments, units, programs or centers where pet therapy teams serve. References: ADA 2010 Revised Requirements Summary: Service animals. Available online: www.ada.gov/service_animals_2010.htm ADA National Network 2014; Service Animals and Emotional Support Animals, Where are they Allowed and Under What Conditions? Available online: https://adata.org/publication/service-animals-booklet ADA Frequently Asked Questions about Service Animals and the ADA; available online: https://www.ada.gov/regs2010/service_animal_qa.html Page 7 of 9 Animal Visitors Infection Prevention & Control CDC Guidelines for Environmental Infection Control in Health-Care Facilities, 2003. Available online: www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf Department of Justice, Civil Rights Division, Guidance on Revisions to ADA Regulation on Nondiscrimination on the Basis of Disability by Public Accommodations and Commercial Facilities (September 15, 2010), available at http://www.ada.gov/regs2010/titleIII_2010/titleIII_2010_regulations.htm Washington State Legislature https://app.leg.wa.gov/RCW/default.aspx?cite=49.60.040

Joint Commision Standards: IC 02.01.01, RI 01.01.01 CMS Standards: 482.13,482.42 State of WA Standards 246-320-016 Attachment: Attachment A: Service Animal Sign Point of Contact: Director, Infection Control 253-403-2903 Director, Privacy and Civil Rights, 253-459-7865 Approval By: Date of Approval: Infection Prevention & Control Committee 7/13, 2/17, 8/19, 11/19 Volunteer Services Program Coordinator 2/18; 8/19 EOCAB 9/19 VH Infection Prevention 7/19 VH PRC 7/19 DH Infection Prevention 8/19 DH PRC 8/19 Quality Safety Steering Committee 8/13, 3/17, 10/19, 12/19 Original Date: 10/98 Revision Dates: 3/08, 5/10; 10/10; 6/13, 12/14; 1/17, 9/19 Reviewed with no Changes Dates: 10/00 Distribution: MHS Intranet

Page 8 of 9 Animal Visitors Infection Prevention & Control Attachment A SERVICE ANIMAL PRESENT

Enter slowly

Do not enter if allergic

Please Do not touch animal

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