Feb. 10, 1999 A study from the Johns Hopkins School of Public Health has found that the security constraints common to most prisons may lead health care workers to engage in risky behaviors that increased their risk of bloodborne infections.
The study found, for instance, that nearly 29 percent of correctional health care workers (CHCWs) "frequently or always" recapped used needles—that is, replaced the needles' protective plastic cap—a behavior that greatly increased their chances of getting pricked by a contaminated needle. The report, which appeared in the February issue of the Journal of Occupational and Environmental Medicine, suggested that the high rate of needle recapping among CHCWs was due in part to having to keep used-needle containers locked away in secure rooms. Similarly, the researchers found that hand washing rates were below average among CHCWs, and laid some of the blame on prison employees' diminished access to sinks and soap.
Lead author Robyn Gershon, RM, PhD, senior research associate, Environmental Health Sciences, Johns Hopkins School of Public Health, said, "Identifying the barriers to safe health care practices is especially important in the prison setting because incarcerated inmate-patients generally have much higher rates of infection for bloodborne pathogens, such as human immunodeficiency virus and hepatitis, than do patients in community-based hospitals."
The scientists conducted a cross-sectional survey of Maryland State correctional health care workers (CHCWs) by using a questionnaire targeting four main areas: demographics; psycho-social factors such as risk-taking tendencies and attitudes toward HIV/AIDS patients; work-related factors such as security constraints and job satisfaction; and worker compliance with universal safety precautions against exposures to blood.
Most of the 216 health care workers who responded were women, the majority employed as nurses. The average age was 44 years, and most had worked in the correctional health care field for an average of 4.8 years. Only one demographic variable was associated with compliance: Younger workers (under age 40) obeyed universal precautions more closely than did older workers, perhaps because of more recent training.
Twenty-eight CHCWs reported a total of 73 exposures to patient blood in the previous six months, a rate of 13 percent—non-correctional health care workers generally report a rate of less than 10 percent. Remarkably, only 39 of the 73 exposures had been reported to the Department of Corrections infection control office, a finding that suggested some CHCWs may lack information on the risk of bloodborne infections or the effectiveness of post-exposure treatments.
Many CHCWs reported that they perceived a poor organizational response to safety within their facility. In fact, 66 percent of respondents said that the institution where they worked did not even have a safety committee, although each Maryland prison is required to maintain one.
The researchers found that the locked-down environment necessary in all prisons—complex procedures for entering and exiting the facility, prohibitions against bringing in personal items, and the need to be vigilant about personal safety—may be associated with high levels of worker stress, and that employees who were bothered by security constraints were less likely to comply with universal precautions than those who were not.
Adverse working conditions—temperature extremes, crowdedness, poor air quality, and elevated noise levels—were also associated with increased stress, and thus with unsafe practices. Over 50 percent of CHCWs were "often/always" bothered by temperature extremes at work; 44 percent by poor air quality; 32 percent by loud noises; and 23 percent by unpleasant odors. Verbal abuse (23 percent reported frequent verbal abuse from inmates, 7.9 percent from co-workers, and 3.7 percent from correctional officers) also adversely affected safety compliance.
Among other things, the researchers recommended that senior health care management in prisons enforce a zero tolerance policy for unsafe behavior and set the tone by themselves adhering strictly to safety policies; that safer needled devices be used to reduce needlestick injuries, especially given the inaccessibility of disposal containers in correctional health care facilities; and that well-trained safety officers and safety committees maintain a high profile and be fully functioning.
Support for this study was provided by a grant from the National Institute for Occupational Safety and Health.
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