Table 1 Examples of stakeholders and roles for an AAI program

Program Champion

1. Develops policy and procedures with the healthcare facility stakeholders

2. Provides training for facilitators of AAI interventions and ensures that protocol is adopted/followed

3. Coordinates and/or oversees visits

4. Oversees program evaluation

ICU team

1. Ensures patient/family appropriateness for visit. Recommended questions when evaluating patient for AAI:

 a. Is the patient interested?

 b. Is the patient able to benefit (e.g., assess cognitive status)?

 c. Is the patient on infection-related contact precautions?

2. Places consult request for AAI

3. Coordinates timing of AAI to fit patient schedule and ICU workflow

Risk management

1. Ensures patient privacy (HIPAA)

2. Provides guidance about prevention/management of patient injury; recommendations include:

 a. Using certified therapy animal teams

 b. Limiting length/number of patient visits per animal visit

 c. Ensuring liability insurance in place

3. Provides guidance about prevention/management of animal injury or death

Infection control

1. Protects patients from zoonotic infection; [15] recommendations include:

 a. Mandating annual veterinary examination, fecal test for infection and parasites, up-to-date vaccinations

 b. Bathing/grooming the animal before and after each hospital visit

 c. Prohibiting animals with any illness within 24 h of visit

 d. Prohibiting animals with an open wound

2. Protecting from fomite infection; recommendations include:

 a. Washing hands for patients, staff members and visitors before and after touching animal

 b. Cleaning animal toys after use

3. Excluding or using special precautions for specific patient groups, including those:

 a. Known to be colonized or infected with multi-drug resistance bacteria (e.g., methicillin-resistant Staphylococcus aureus), Clostridium difficile, or tuberculosis

 i. Special precaution: animal only visits one patient or visits the infected/colonized patient last (with approval from infection control)

 b. Who have open wounds or a wound vacuum

 i. Special precaution: cover wound; avoid animal having contact with wound

 c. Who are immunocompromised