A formidable challenge in correctional health, infection control is perhaps one of the most effective ways we can benefit our communities. Most of our patients have had inadequate health care before incarceration, which, combined with life patterns of risk-taking that have brought them to jail or prison, results in significantly higher rates of conditions of public health significance, particularly infections.
Incarceration, however, presents us with several opportunities: we are able to find our patients, our inmates have the time to attend to their treatment, and there is a source of payment for their care. Thus, we should be able not only to minimize transmission of disease within jail or prison, but also to release people back into the community who are in better health than before their incarceration.
The key to infection control is education of all staff. Correctional officers are not expected to know everything about a given disease. Yet, they should know what signs and symptoms should lead them to ensure that an inmate gets to health services. They should also know enough to avoid or prevent dangerous practices and when they do NOT have to be concerned about a particular health-related issue.
Health care staff must have a high index of suspicion for communicable diseases and they should know how to stop transmission. Successful disease prevention interventions must fit the culture in which they are implemented. For example, control of drug supplies in corrections is much more feasible than in the general public. Needle exchange programs, on the other hand, may not be. Acceptable interventions require joint support by both health services and security.
Infection control in corrections is very possible. With careful attention to infection control it is possible, for instance, even in prisons with congregate living, to lower tuberculosis disease rates to those seen in the outside community.
Lester Wright, M.D.