Stop the Spread of Infectious Disease

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By Dawn Shoemaker and Robert Kravitz

Published: 10/05/2009

Dr. Joseph Bick has established quite a name for himself in the corrections industry. When Bick, an infectious disease specialist, became the chief medical officer at the California Medical Facility, Vacaville, CA, in 1993, he discovered a chaotic situation: years of neglect of inmates and prison facilities, a medical staff that was demoralized, and HIV-positive inmates whom he described as being in “open rebellion” due to poor medical care as well as a lack of access to treatment drugs.

Over the years, he has helped improve the facility considerably, according to most accounts, some say even making it a model prison for the treatment and prevention of various diseases. He implemented prevention strategies to help stop the transmission of illnesses common in prisons, such as Hepatitis A and C, as well as other infectious diseases, some of which, such as MRSA,* were likely not even an issue when Bick started his career.

According to Bick, prisons and jails provide an ideal environment for the transmission of contagious diseases. This is due to a variety of factors, some of which are beyond administrators' control. One such factor is the transient status of inmates in many facilities. They are often moved from one location to another, increasing the likelihood of an illness spreading and making it hard to isolate the origin of the outbreak.

Additionally, there are a number of hygiene issues that can spread disease in facilities if protocol is not followed properly. Fortunately, many of these--from the wearing and proper use of gloves to increased hand washing by staff and inmates to more thorough, hygienic cleaning--can help slow the transmission of disease and benefit and protect the health of inmates and, because most of the inmates will eventually be released, the public at large.

Proper Use of Gloves

Most corrections administrators, health care providers, and staffers are well aware of the importance of wearing gloves. Unfortunately, in prisons, just as in medical facilities, gloves are often not worn as frequently as they should be or as required.

Gloves should be worn whenever one is likely to come in contact with blood or other bodily fluids, including cuts and bruises on the skin of inmates and staff members. Gloves should also be worn when touching contaminated surfaces. These guidelines apply to both health care administrators in the prison as well as correctional staffers.

According to Bick, the proper selection of gloves is also critical, and the type chosen depends on where and how they are to be used. For instance, he suggests the following:

Thick utility gloves should be worn when handling, examining, or cleaning potentially infected surfaces. These gloves also provide an added measure of protection when searching inmates' cells.
When handling used linens, towels, and similar items, examination gloves should be worn. Often used in medical settings, these are vinyl gloves that are worn once and then disposed of.
If examining a wound, a sore, or open tissue on an inmate or staff member, sterile or surgical gloves are called for. These gloves provide an added level of protection, have more precise sizing than other types of gloves, and are typically made of latex powdered with cornstarch to lubricate the gloves. These are also single-use gloves.

Removing the gloves can be almost as important as wearing them in the first place. If proper removal procedures are not followed, hands can become contaminated, potentially spreading disease. The proper way to remove gloves is as follows:

Grasp the outside edge of the left-hand glove at the highest point near the wrist.
Peel the glove off the hand, essentially turning the glove inside out.
Keep the removed glove in the gloved right hand and discard.
For the right-hand glove, slide the index finger under the glove at the highest point near the wrist.
Peel the glove off from the inside and then discard.
Wash hands using soap and water.

The Importance of Hand Washing

It cannot be overstated how important proper hand hygiene is in a prison setting. Washing with warm, soapy water for approximately 20 seconds is recommended. Additionally, rubbing fingernails against the palm of the opposite hand helps remove bacteria lodged under the nails.

Along with proper hand washing, it is vitally important to use alcohol-based hand sanitizers. However, hand washing and the use of sanitizers are not the same. Hand washing removes soils and contaminants from hands. Sanitizers kill germs and bacteria, but they do not clean hands. They should be used as an interim, temporary measure to supplement frequent hand washing.

Additionally, to stop the spread of disease in a crowded prison setting, inmates must also be educated about the importance of washing their hands frequently. Unfortunately, many correctional facilities lack adequate facilities for washing hands with soap and water—making frequent and proper hand washing by inmates and staffers difficult.

Health-Based Cleaning

Proper housekeeping procedures and cleaning systems are paramount in a correctional facility, and this is of even greater importance today than in the past. According to Peter Sheldon, veteran of the building service contracting industry and vice president of operations for Coverall Cleaning Concepts, health-based or hygienic cleaning typically found in health care settings to control the spread of infection should now be considered in other types of settings, from schools and office buildings to correctional facilities. “Because of the growing number of pathogenic threats showing up in these facilities, it has become clear that there is a significant need for this type of microbial-focused cleaning to extend to all facilities.”

Sheldon explains that some of the most crucial elements to a health-based or hygienic cleaning system include:

Strict color-coding methodology in all cleaning to avoid cross-contamination. This system designates different-colored microfiber cleaning cloths, for instance, for specific cleaning tasks.
Microfiber technology in all cleaning cloths and mopping programs to increase soil and matter containment and removal. Additionally, one manufacturer markets flip and fold “smart-towel” microfibers cloths. These allow the user to fold the towel into quadrants so a fresh surface is always readily available.
Flat mopping technology to increase efficiency, improve soil removal, and further eliminate cross-contamination.
Hospital-grade disinfectant chemistry in all cleaning compounds.
The use of spray-and-vac cleaning systems wherever possible. According to Wikipedia encyclopedia, with these systems, surfaces do not need to be touched by the custodial worker. The equipment applies a chemical to surfaces to be cleaned and is then rinsed away. Select machines have a built-in wet-vac system to remove liquids and contaminants and expedite drying time.

The Recession, Correctional Facilities, and Health

As states around the country prepare their budgets for the coming fiscal year, one after another is looking for ways to cut costs related to correctional facilities. One state, California, would even like to sell one or more of its prisons, in the hopes that private industry might be able to run them more efficiently and less expensively.

However, with these cuts and proposals, questions are arising about the impact on the health of the inmates incarcerated in these facilities. And according to Bick, this is more than just a correctional-facility issue. Because most inmates will eventually be released, focusing more attention on the health of those incarcerated as well as the health and cleanliness of correctional facilities will help prevent the spread of disease to the general public as well.

Sidebar:
Worker Productivity Issues

With budget cuts, correctional managers are not only looking to clean more hygienically, but to find ways to improve worker productivity. According to a study conducted at North Carolina State University, which has more than 32,500 students and 10 million square feet of campus facilities, using spray-and-vac cleaning systems were two-thirds faster than the conventional cleaning systems ─ mops, buckets, cleaning cloths - used previously.

This corresponds with studies conducted by ISSA, the leading trade association for the professional cleaning industry. Their studies found surfaces could be cleaned in approximately a third the time using a spray-and-vac cleaning system.

*Methicillin-resistant Staphylococcus aureus

Dawn Shoemaker and Robert Kravitz are writers for the professional cleaning industry. They can be reached at info@alturasolutions.com

Other articles by Robert Kravitz

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