The state of infectious diseases in correctional facilities in the United States is a concern to the public health sector. The susceptibility of the inmates to infections is increased by factors such as overcrowding resulting from the growing inmate population, a problem which may be the most intractable in most of the correctional facilities. Other factors include the exposure to blood and other bodily fluids, poor health care, and high-risk behaviors. The most common infections found in the correctional facilities include HIV/AIDS and other sexually transmitted infections, Tuberculosis, hepatitis C, and hepatitis B which mostly result from needle-sharing as well as consensual and non-consensual sex among the inmates. The prison conditions happen to be an ideal breeding grounds for these infections as well as for onward transmissions of these infections (Bick, 2007). In many places, appropriate health services in correction facilities are mostly limited or are simply unavailable, either due to failed government policy or a lack of sufficient resources, hindering management. An inadequate health care system is a barrier to reintegration into the community. Treatment of communicable illnesses during incarceration and post-release should decrease recidivism, reduces disease transmission, and reduce costs of future treatment or incarceration. These positive outcomes, however, are not realized due in part to a health care system that does not provide adequate services for all those in need, particularly in low-income areas, or provides insufficient treatment due to restrictive eligibility requirements based on agency funding mandates or mission. Improved management of severe conditions in corrections may have impressive implications for community health as well as reduce health care disparities. Therefore, reducing the transmission of infections in prisons is an important element in reducing the spread of infection in corrections, as well as society outside of prisons.
This paper is going to concentrate on how correctional facilities can improve their management, and policies, to lessen these risks for both inmates and staff. Solutions presented in this paper will concentrate on written exposure-control plans that include vaccination of at-risk staff and inmates, education programs on the use of personal protective equipment, and environmental controls. This paper will also focus on how correctional facilities can adequately share information technology between facilities and the different jurisdictions responsible for the care of inmates. The delivery of effective health care to inmates depends upon the partnership between health care providers and prison services. For example, telemedicine is one possible mode of delivery. To minimize risk, correctional facilities need to consult with local health departments regarding the development and implementation of guidelines for the prevention, testing, and treatment of infections that are easily transmitted (Bick, 2007). The focus of my paper in regard to solution will be to explain how/why management in correctional facilities can/need to establish collaborative relationships between correctional facilities and local health departments for purposes of infectious disease control, prevention, and surveillance.
As noted earlier, infectious diseases are a major problem in the correctional facilities and as such a concern to the public health. The responsibility of offering solution to this problem lies with both the government and the management team in these facilities. Although the government bears the biggest responsibility of providing solutions through policies and availing treatment resources needed, the prison management too has a responsibility of driving the process of treatment for these infections, especially where the government's contribution is wanting (Curtin, 2007). The problem of infections is not only exposed to the inmates but also to the staff working in these facilities. This creates the need for the collaboration between these two departments. The effectiveness of control to this pandemic can only be acquired if there exists efficient communication between the government and the prison administration. The prison management is more aware of the kind of help that they need for the inmates and the staff and is, therefore, better placed to guide the government agencies offering the treatment solutions on what and when to avail the help. The management can devise mechanisms that reduce the risk of infection or the transmission by coming up with policies and control mechanisms as will be discussed below.
One of the most effective solutions for the management is having an infection control program in the facility they manage. This program should include activities such as one, educating staff and inmates. The education is in regard to the infectious diseases and their spread, good hygiene, and how to prevent the transmissions (Infection Control, 2007). The staff and any other inmate who has been assigned a health-related responsibility are trained on how best to render their services without increasing the risk of either contracting or spreading the infections. Two, there should be written control plan for the prevention of blood borne pathogen (BBP) exposure. These exposures are created by sharp objects such as needles. Needle stick or other kinds of sharp injuries are likely to occur during a variety of activities such as when disposing used needles, administering injections or drawing blood for testing, passing sharp objects from one inmate to another, when handling trash or dirty linen, intentional use of sharp objects as weapons by the inmates, and during cell or body search (Bick, 2007). Inmates are also at the risk of BBP exposures through unprotected sexual activities in addition to a unique risk which involves inmates throwing body fluids to others. The standard precautions as defined for the hospital setting should be adapted to the correctional facility and incorporated to the institution policies and procedures. Additionally, all inmates should be considered potentially contagious whenever there is anticipated direct contact with blood and body fluids.
Three, there is need to promote immunization for both the staff and inmates. For example, there should be vaccinations for hepatitis B. The vaccination should be for all except those who have documented immunity. The program should make use of a 4-month schedule. There should be a periodic serologic surveys for the incoming inmates to determine the prevalence of the HBV immunity. There should be periodic vaccinations for persons who have been in contact with persons who are HBV positive whether they are ex-cellmates or sharing the same cell block (He, Li, Roberts, Spaulding, Ayer, Grefenstette, & Chhatwal, 2016). This program applies to all the infectious diseases. Each should be monitored through the prescribed procedures by the health providers. This program is applicable to both the inmates and the staff who interact with them. The fourth control mechanism is providing personal protective equipment (PPE). These include masks, respirators, hoods, gowns, face shields, gloves, and foot coverings. These equipment should be available and accessible in all patient care areas, housing units, transportation vehicles, laundry areas, and all places where the employees come into contact with inmates. Gloves especially should be available in areas where the custody staff sign in every day and should be carried everywhere by the staff to be able to protect themselves when responding to situations such as altercations, self-mutilators, suicide attempts, or any other medical emergencies whenever and wherever they occur in the correctional facility.
There is a high prevalence of AIDS in correctional facilities in the United States, projected to be five times higher than that in the general population. HIV/AIDS is one of the major causes of deaths of inmates in the United States. Reports indicate that about 25% of the population living with HIV/AIDS have at some point spent time in jails or prisons. Unfortunately, even in the wake of this reality, only a few prison systems and jails provide a routine HIV testing on the entry of inmates. Identifying inmates with HIV is one way of prompting partner counseling and referral services and encouraging others to get tested which helps reduce the spread of the virus (Flanigan, Zaller, Beckwith, Bazerman, Rana, Gardner, & Altice, 2010). This is both for the inmates, employees, as well as for the people who visit the prisons. The inmates who are aware of their HIV testing will minimize the spread of the virus both while inside the facility and after incarceration once they join the general population.
A fifth solution is isolation, either temporary or permanent. Whether a case necessitates a temporary or permanent solution depends on the severity of the case and the level of risk it exposes the inmates or the staff. First, there is a need for screening for the individuals offering sensitive services such as the culinary department. The screening should be on a daily basis to exclude any health threat that would be passed on to the other people in the correctional facility either consciously or unconsciously (Greifinger, 2007). Routine inspections should be conducted to ensure that there is compliance with the recommendations concerning hygiene such as toilet and hand washing facilities, recommended temperatures for storing food, vermin control, as well as other infection-control standards. Cases that warrants for temporary exclusion/isolation include those persons with sores on their hands or any other exposed part of the body, those with active respiratory infection, and illnesses that include vomiting or diarrhea. Such cases are easily transmitted to other individuals and at the same time not very severe. As such, these individuals should be isolated until they fully recover, after which they can be allowed to mix with the rest. Permanent exclusion is for the individuals with serious health problems such as those with mental illness which makes it difficult for them to observe and adhere to proper hygiene, and which poses a risk to themselves and the rest of the people. Besides isolation, there should also be comprehensive education on the importance of good hygiene as well as observing general cleanliness.
The sixth solution is policies in line with laundry, general cleanliness activities such as barbering, and the search activities. There is a reported insufficiency of clean clothes and linen to the inmates in most correctional facilities. Some are even reported to be infested with lice. Inmates also misuse their clothes and linen to make curtains or escape ropes. To ensure hygiene and thus minimize the spread of infections in correctional facilities, inmates should be provided with adequate supply of clothing and linen. When handling laundry, the individuals should be provided with PPE such as gloves, masks, gowns, and feet protectors to avoid any form of contamination. There should also be adequate ventilation in the laundry area to avoid suffocation and to allow the clothes to dry properly. Proper labeling for soiled clothes or those contaminated with BBP leak should be ensured. The recommended temperature is at least 71 degrees Celsius to ensure that there is proper decontamination unless when large amounts of chlorine are used for disinfection (Infection Control, 2007). For the barbering operation, the inmates are reported to perform most of the haircuts. These inmate barbers usually have little or no training. Again, the barbering tools are often reused without proper disinfection. These activities increase the risk of exposure to infections for those receiving the haircut as well as the barbers.
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