Prison Security Constraints May Compromise Safety Of Health Care Workers

The study found, for instance, that nearly 29 percent ofcorrectional health care workers (CHCWs) "frequently or always" recappedused needles—that is, replaced the needles' protective plastic cap—abehavior that greatly increased their chances of getting pricked by acontaminated needle. The report, which appeared in the February issue ofthe Journal of Occupational and Environmental Medicine, suggested that thehigh rate of needle recapping among CHCWs was due in part to having to keepused-needle containers locked away in secure rooms. Similarly, theresearchers found that hand washing rates were below average among CHCWs,and laid some of the blame on prison employees' diminished access to sinksand 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 especiallyimportant in the prison setting because incarcerated inmate-patientsgenerally have much higher rates of infection for bloodborne pathogens,such as human immunodeficiency virus and hepatitis, than do patients incommunity-based hospitals."

The scientists conducted a cross-sectional survey of Maryland Statecorrectional health care workers (CHCWs) by using a questionnaire targetingfour main areas: demographics; psycho-social factors such as risk-takingtendencies and attitudes toward HIV/AIDS patients; work-related factorssuch as security constraints and job satisfaction; and worker compliancewith universal safety precautions against exposures to blood.

Most of the 216 health care workers who responded were women, the majorityemployed as nurses. The average age was 44 years, and most had worked inthe correctional health care field for an average of 4.8 years. Only one demographicvariable was associated with compliance: Younger workers (under age 40)obeyed universal precautions more closely than did older workers, perhapsbecause of more recent training.

Twenty-eight CHCWs reported a total of 73 exposures to patient blood inthe previous six months, a rate of 13 percent—non-correctional health careworkers generally report a rate of less than 10 percent. Remarkably, only39 of the 73 exposures had been reported to the Department of Correctionsinfection control office, a finding that suggested some CHCWs may lackinformation on the risk of bloodborne infections or the effectiveness ofpost-exposure treatments.

Many CHCWs reported that they perceived a poor organizational response tosafety within their facility. In fact, 66 percent of respondents said thatthe 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 allprisons—complex procedures for entering and exiting the facility,prohibitions against bringing in personal items, and the need to bevigilant about personal safety—may be associated with high levels of workerstress, and that employees who were bothered by security constraints wereless likely to comply with universal precautions than those who were not.

Adverse working conditions—temperature extremes, crowdedness, poor airquality, and elevated noise levels—were also associated with increasedstress, and thus with unsafe practices. Over 50 percent of CHCWs were"often/always" bothered by temperature extremes at work; 44 percent by poorair quality; 32 percent by loud noises; and 23 percent by unpleasant odors.Verbal abuse (23 percent reported frequent verbal abuse from inmates, 7.9percent from co-workers, and 3.7 percent from correctional officers) alsoadversely affected safety compliance.

Among other things, the researchers recommended that senior health caremanagement in prisons enforce a zero tolerance policy for unsafe behaviorand set the tone by themselves adhering strictly to safety policies; thatsafer needled devices be used to reduce needlestick injuries, especiallygiven the inaccessibility of disposal containers in correctional healthcare facilities; and that well-trained safety officers and safetycommittees maintain a high profile and be fully functioning.

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Support for this study was provided by a grant from the National Institutefor Occupational Safety and Health.