Correctional Facilities

Author(s):
Alexander Tomich, DNP, RN, CIC Director, Infection Prevention and Control

Rush University Medical Center
Chicago, IL

Published:
October 3, 2014

Abstract

The correctional setting includes a wide range of penal institutions: jails, state and federal prisons, and juvenile detention centers. Each correctional system has its own internal culture that presents unique challenges to the infection preventionist. The demographics of the population in each system are often similar: inmates are disproportionately poor, male, medically underserved, and from minority groups. The 7 percent (approximately) female prison population has added issues of being victims of domestic violence and/or having a history of sexual abuse. Prison healthcare provides a window of opportunity for inmates to receive medical care and risk-reduction information that they might not otherwise obtain. Most inmates eventually do return to their communities, and those communities can directly benefit from these disease prevention and treatment efforts.

In this setting, the infection control program faces issues such as overcrowding, a population with increased risk of infection with bloodborne pathogens and other infectious diseases, frequent inmate movement, and an environment that is primarily restrictive. Inmates are a challenging population to work with and may exhibit characteristics such as extreme manipulativeness, dishonesty, and violence. They may be bored or exhibiting attention-seeking behavior and may not be receptive to medical interventions or education. Any medical care provided to inmates is an additional cost to the system and not aligned to the primary purpose of incarceration. When looking at trends in prison management, there are comparable issues seen throughout the healthcare setting involving medical staffing. Prisons are generally extremely short-staffed and because of chronic shortages of registered nurses, licensed vocational nurses may provide significant portions of the care.