Many correctional facilities have inadequate information technology, and the linkages between different jurisdictions and agencies responsible for the care of inmates are often poor. Published guidelines for prevention, diagnosis and treatment of communicable diseases are not always readily applicable to the correctional setting.
This article is the second in a two-part series, the first of which appeared in the IDCR July/August 2004 issue.1 This article will address the following correctional infection control topics: gloves and hand washing, food handling hygiene, keeping food safe during an emergency, ice machines, vending machines, housekeeping and infectious waste. The July/August 2004 issue reviewed the infection control committee, personal protective equipment, blood borne pathogen exposures, post-exposure prophylaxis (PEP), standard precautions and isolation concepts, culinary services, food handlers, laundry and barbering.1
Careful attention to the infection control measures discussed in this article will benefit the health of inmates, those who interact with them during their incarceration and the public health at large.
The proper selection of glove depends upon the job being performed. Types of gloves include:
Utility gloves: These thick gloves are used while handling and cleaning potentially infectious wastes and can be decontaminated for re-use if still intact. Utility gloves may provide an extra measure of protection from sharps injury during cell searches.
Examination gloves: These gloves are used during procedures such as bathing patients, handling contaminated linen and other procedures during which contact with body fluids is likely. These gloves are to be disposed of after single use.
Sterile or surgical gloves: These gloves are used for procedures that involve contact with a patient's organs or open tissues and should be disposed of after single use.
Hands should be washed or decontaminated after gloves are removed.7 Health care staff should be reminded that failure to remove gloves between patients might lead to transmission of organisms.8 Wearing rings and artificial nails leads to an increase in bacterial colonization of the hands, although it is not clear whether this leads to an increased rate of transmission of organisms.9,10 Even after careful hand washing, a significant number of pathogenic bacteria can be found under fingernails.11
Many jails and prisons lack adequate facilities for hand washing with soap and water. Studies have demonstrated that alcohol based hand cleansers can be more effective than soap and water in reducing bacterial counts on hands. These cleansers are available as foams, gels, and liquids. Although these products are flammable, they have been approved for use in hospital settings. If used in a correctional setting,7 policies should be in place to minimize the potential for misuse of these products by inmates.
As the use of gloves by health care staff has increased, an increasing prevalence of latex sensitivity has been documented. Many officers in the correctional setting wear gloves throughout much of their assigned shift. As a result, the frequency of latex sensitivity among custody staff is likely to increase. Latex gloves with reduced protein contents and non-latex gloves are now available for use by latex-sensitive employees. Additionally, the use of non-latex gloves may help prevent latex-sensitivity from developing. Hence, the use of latex gloves should be minimized to only those applications where they are essential. Gloves should be readily available and staff should be encouraged to carry gloves with them at all times.1
To avoid contamination by floodwaters and sewer back-ups, all food should be stored on shelves that are safely above floor level. In the event of a flood, all foods that came into contact with water should be discarded, including canned goods, because surfaces have been contaminated by floodwaters.
A thermometer should be kept in all refrigerators and freezers at all times. If refrigerated food rises to a temperature greater than 40°F, it should be discarded. Exceptions include butter, margarine, fresh fruits, raw vegetables, bread, cookies, pasta, peanut butter, jelly, relish, hot sauce, barbecue sauce, soy sauce, mustard, catsup and oil and vinegar salad dressings. If frozen food fully thaws, it should be immediately cooked or discarded rather than refrozen. If frozen meats, cheeses, fruits, vegetables or bread products still contain ice crystals and feel as cold as if refrigerated, they can be safely refrozen.
Regulated waste refers to materials such as blood, any visibly bloody fluid, or other potentially infectious materials (OPIM) such as pleural fluid, peritoneal fluid, cerebrospinal fluid, semen and vaginal secretions. Regulated waste also includes contaminated sharps, surgical waste such as body tissues, materials that are saturated with dried blood or OPIMs, and dressings, towels or bandages from which blood or OPIMs can be expressed by squeezing. Regulated waste must be disposed of by being placed in containers that can be closed, are leak proof and puncture proof, are designed for safe transportation and are labeled or color coded (i.e., red bags).14
Spills of blood or other potentially infectious materials should be cleaned by trained staff, utilizing an approved sanitizing agent such as a solution of one part bleach to 10 parts water. During the cleaning of contaminated spills, appropriate personal protective equipment (PPE) should be worn.14
Correctional health care professionals can play an important role in the prevention, diagnosis and treatment of infectious diseases among prisoners and correctional employees. A well-planned infection control program will benefit the health of inmates, those who interact with them during their incarcerations and the public health at large.
Table 1 outlines some of the most important concepts of food handling hygiene. Adherence to these guidelines will decrease the likelihood of food borne outbreaks in institutional congregate living environments.
|Table 1: Important Concepts of Food Handling Hygiene|
|Food Initial Inspection||Upon receipt, all food should be inspected for spoilage and rodent or insect infestation. Observe for broken packages or swollen cans.|
|Food Storage||Food should be stored in a manner that will decrease the likelihood of contamination and infestation.|
|Location||Food should be stored above the level of the floor and away from walls.|
|Temperature||Bacteria multiply rapidly at temperatures above 40°F. Always keep meat, poultry, fish, dairy products and eggs refrigerated at or below 40°F and frozen food at or below 0°F. A record should be maintained of all refrigerator and freezer temperatures.|
|Food Preparation||At time of preparation, re-inspect food as above during initial inspection.|
|Washing||Raw unprocessed fruits and vegetables should be thoroughly washed under clean running water.|
|Handling and Processing||All workers should wear gloves when handling food. Use different sinks, counters, knives, utensils and cutting boards for raw/uncooked meats and for fruits/vegetables. Food handlers should remove gloves, thoroughly wash hands with hot soapy water and put on a clean pair of gloves when moving from uncooked meats to fruits and vegetables and also when moving from uncooked meats to cooked meats.|
|Cooking||Use a food thermometer to check the internal temperature of meat, poultry and other food. Check temperature in several places to be sure the food is evenly heated. Fresh poultry (chicken, turkey) is to be cooked until it reaches an internal temperature of at least 180°F. Ground chicken and turkey are to be cooked until they reach an internal temperature of at least 165°F. Fresh or ground beef, fresh or ground pork, eggs and egg dishes are to be cooked until they reach an internal temperature of at least 160°F.|
|Kitchen and Dining Hall Cleaning||All surfaces should be cleaned and sanitized at least daily.|
|Outbreak Investigation||To facilitate the investigation of an outbreak of food borne illness, a portion of each meal should be refrigerated and saved for 48-72 hours.|
Joseph Bick, M.D., C.C.H.P., has nothing to disclose.