Volume 30, Supplement - Infectious Diseases and Carceral Health
SUPPLEMENT ISSUE
Policy
Infection Prevention and Control in Correctional Settings
Newton E. Kendig
, Sarah Bur, and Justin Zaslavsky
, Sarah Bur, and Justin Zaslavsky
Table
Correctional infection prevention and control challenges, United States*
| Infection prevention and control domains | Infection prevention and control challenges |
|---|---|
| Outbreak risk and management | Correctional facilities are high-risk congregate settings for infectious disease outbreaks, such as influenza, COVID-19, tuberculosis, norovirus, varicella, and ectoparasites. |
| Incarcerated residents may be more vulnerable to communicable diseases, including vaccine-preventable illnesses. | |
| Outbreak management is complicated by limited isolation capacity and the frequent movement of residents within and between correctional facilities. |
|
| Admission screening |
Implementing evidence-based screening recommendations for infectious diseases may be complicated by the high volume of new admissions, brief periods of detention, health literacy barriers to patient history taking, cursory physical examinations, and lack of rapid testing capabilities. |
| Social distancing |
Overcrowding and dormitory housing of incarcerated resident populations facilitate disease transmission and limit the feasibility of social distancing. |
| Hand hygiene | Resident access to liquid or foam soap, running water, and disposable paper towels may be limited. |
| Access to flammable alcohol-based hand sanitizer may be restricted or prohibited due to fire safety concerns and risk of consumption by residents. |
|
| Sanitation and laundry | Cleaning of housing units is routinely performed by the residents themselves who may not have adequate training or supplies. |
| Cleaning of common areas and shared equipment may be inadequate, e.g., intake processing areas, programming spaces, telephones, computers, recreational equipment, and security restraints. | |
| Residents commonly handwash and air dry their clothing which provides inadequate disinfection. |
|
| Bloodborne pathogen exposures | Resident access to bleach is routinely prohibited. |
| Correctional staff and residents may be unexpectedly exposed to blood and other potentially infectious materials through physical assaults and altercations. | |
| Correctional staff may be exposed to sharps, such as tattoo needles and homemade shanks, during body searches of residents. | |
| Residents may be exposed to bloodborne pathogens from sharing needles for tattooing and injection drug use and from having sexual exposures without barrier protections. |
|
| Harm reduction |
Harm reduction strategies to reduce infectious disease transmission, such as condom distribution, certified tattooing for residents, and needle exchange programs, are largely prohibited for security or regulatory reasons. |
| Housing challenges | Airborne isolation units and medical isolation single cell capacity may be nonexistent or very limited in number. |
| Quarantining residents may be difficult due to overcrowding and lack of housing options. | |
| The conditions of confinement associated with medical isolation, quarantine, and facility-wide lockdowns can negatively impact the mental health of residents and limits their access to correctional programs. | |
| Long-term housing options, that are not socially isolating, may be unavailable for residents with healthcare-acquired infections, such as C. auris. |
|
| Resident transport | Security vehicles are not configured to prevent the transmission of infectious diseases. |
| Disinfection of security vehicles may be inadequate due to operational constraints and lack of evidence-based protocols. |
|
| Correctional operational factors | The movement of residents and correctional staff between correctional facilities, courts, and the community is highly dynamic and difficult to minimize. |
| Frequent personnel shortages of correctional staff negatively impact the implementation of infection prevention and control policies and procedures. | |
| The carceral environment may discourage symptomatic residents with contagious diseases from seeking medical attention due to stigma, medical co-pays, fear of disciplinary action, or fear of placement in medical isolation. | |
| Implementing occupational health recommendations for correctional staff, such as guidance on immunizations and personal protective equipment, may be complicated by challenging labor-management relations. |
|
| Discharge planning | Discharge planning of residents to prevent further transmission of communicable diseases may be complicated by a lack of continuity for antimicrobial treatments, insufficient medical insurance coverage, inconsistent access to harm reduction strategies, and difficulties securing substance use disorder treatments, safe housing, and psychosocial support. |
*Adapted from (46).
Page created: March 31, 2024
Page updated: March 31, 2024
Page reviewed: March 31, 2024
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