By Joshua Mjolsness, PhD
Diseases do not respect walls, fences, or borders and do not discriminate based on race, sex, nationality, or religious beliefs. In the 20th century, the world experienced three global pandemics, of which 500,000 people in the U.S. died as a result and between 20 to 50 million people worldwide during the most severe of these pandemics in 1918. [1]
Correctional institutions are uniquely susceptible to the rapid spread of disease. The proximity of offenders to one another and correctional staff increases the potential for the spread of infectious disease.
Infectious disease response
No doubt, the current COVID-19 pandemic has correctional facilities re-evaluating policies and procedures surrounding responses to such events. One area of consideration especially critical is the creation of an Infectious Disease Rapid Response Team (IDRT). These teams would consist of specially trained members who can react and deploy quickly to facilities that have outbreaks.
The IDRT, at a minimum, should consist of members from:
- Security staff
- Health services
- Behavioral health
- Maintenance
- Environmental services
All members should be trained in area-specific operations during an outbreak and how to operate in a high-risk zone or “hot-zone” with different types of equipment.
Additional training should include but is not limited to:
- Underlying infectious disease pathology
- Epidemiological concepts such as the functions of contact tracing, disease vectors, clinical symptoms and transmission routes
Both classroom and hands-on instruction on how to set up and operate a decontamination zone between the high-risk zone and the low-risk zone is essential in curbing disease spread.
Modify policies, procedures
The development of such a team must occur in conjunction with the modification of existing policies and implementing new procedures to strengthen response efforts. For example, a plan on where to isolate positive cases makes it easier for the response team to identify cases and quickly move them to a pre-established isolation area. Likewise, teams can provide continuous monitoring of suspected cases in quarantine.
Infectious disease outbreaks do not absolve us in corrections from our responsibility to provide security and healthcare. We have to do it smarter and more deliberate while protecting ourselves, other offenders and the public.
Simple things like delivering meals and medications require modification in a high-risk zone. A specially trained team can perform these tasks while minimizing further contamination and spread.
Responding to high-risk offenders who require restraint within a high-risk zone requires being able to complete the security aspects of the job while maintaining a somewhat sterile environment. Equipment will become contaminated, such as duty belts, cuffs and keys. Frequently cleaning this equipment will aid in disease spread, or modifying the type of equipment can reduce the risk further. For example, it may be easier to utilize flex-cuffs and dispose of them rather than attempting to disinfect steel cuffs and all of their intricate grooves and openings without the need of having to submerge them in disinfectant completely.
Furthermore, arrangements for the disposal of contaminated waste must be made. Does it go in ordinary trash, or does it have to be handled appropriately to prevent further disease spread? Specially trained environmental services personnel assigned to the team can ensure that waste is dealt with and disposed of correctly. Disposal methods may be governed by policy and local, state and federal regulations surrounding biological waste.
During the Ebola outbreak in 2014, for example, the Federal Department of Transportation had to issue special permits for the transport of Ebola-associated waste from the hospital and a patient’s apartment. This action was due to the agency’s packaging requirement not being designed for the massive amounts of infectious material. [2]
Everything mentioned is crucial and time-sensitive in responding to an infectious disease outbreak. Figuring it out as we go deprives us of precious time to curb the spread. We must be more proactive and prepared to respond, to reduce staffing issues due to illness or fear, moderate medical costs associated with widespread offender illness, and, most importantly, save lives. This pandemic will not be our last. We will get through this with lessons learned. Stay safe, think smart and wash your hands.
References
1. Spaulding AC, McCallum VA, Walker D, Reeves A, Drenzek C, Lewis S, Berkelman RL. How Public Health and Prisons Can Partner for Pandemic Influenza Preparedness: A Report from Georgia. Journal of Correctional Health Care, 2009, 15(2), 118–128.
2. Wines M. Waste from Ebola poses challenge to hospitals. The New York Times.
About the author
Joshua Mjolsness, PhD, works in state corrections and is very passionate about staff wellness and emergency management preparedness. He currently holds a PhD in health services, a master’s in healthcare administration, and a bachelor’s in criminal justice and is currently pursuing a master’s in information technology. Dr. Mjolsness has experience and training in corrections, law enforcement, emergency management, emergency medical services, and fire service. His interests include infectious disease, epidemiology, public health, preparedness and devotion to line staff.