Copyright 1999 The Washington Post
The Washington
Post
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March 09, 1999, Tuesday, Final Edition
SECTION: HEALTH; Pg. Z09
LENGTH: 823 words
HEADLINE:
Increasing the Chances of Infection; Study Shows Health-Care Workers Take Risks
in Maryland State Prisons
BYLINE: Sandra G. Boodman,
Washington Post Staff Writer
BODY:
A new
study of physicians, nurses and other health-care workers in Maryland state
prisons has found that many engage in risky practices on the job that may
increase their chances of contracting blood-borne infections, including AIDS.
Researchers at the Johns Hopkins School of Public Health found that nearly 29
percent of 216 workers surveyed said they recapped used syringes, a practice
that greatly increases the chances of an accidental
needle-stick, and about half said they did not don protective
eyewear, masks or clothing while treating prisoners.
The study, which
appears in the March issue of the Journal of Occupational and Environmental
Medicine, was conducted by Robyn Gershon, a senior research associate in the
Department of Environmental Health Sciences at Hopkins. Gershon and her
colleagues mailed detailed questionnaires to 400 full-time correctional
health-care workers in 28 state prisons around the state. Most of those who
responded were women and many of them were nurses. Their average age was 44 and
most had worked in the field of prison medicine slightly less than five years.
The goal of the study, which was funded by the National Institute for
Occupational Safety and Health (NIOSH), was to determine in a prison setting the
extent of compliance with "universal precautions"--procedures recommended by the
federal Centers for Disease Control and Prevention (CDC) and other medical
groups to prevent accidental exposure to the human immunodeficiency virus (HIV)
that causes AIDS and other blood-borne infections.
Although all
health-care workers are supposed to adhere to these precautions, their
importance in a correctional setting is undisputed. The prevalence of serious
infections among Maryland prisoners is high, the authors noted. About 8 percent
of 19,000 inmates in Maryland state prisons are HIV positive and 39 percent are
infected with hepatitis C, a virus that causes liver damage, is difficult to
treat and can be fatal.
Because medical settings in prisons operate
under fundamentally different constraints than those in community settings,
Gershon and her colleagues sought to quantify the extent of compliance with
various safety practices and to determine specific factors that might undermine
adherence.
"Unlike community health-care settings," the authors noted,
"security-related concerns always have priority and this may impede health-care
workers' ability to not only deliver health care but to do it safely."
Another factor that may affect cooperation with universal precautions is
worker stress, they wrote. The locked-down environment in prisons, which
prohibits workers from bringing in personal items and requires them to be
vigilant at all times about their personal safety, can contribute to worker
stress and thereby reduce compliance.
Gershon and her colleagues found
that while 93 percent of those surveyed said they wore gloves when drawing
blood, only 34 percent wore disposable gowns when indicated. Nearly 29 percent
said they frequently or always recapped needles used to draw blood, while 30
percent said they often ate or drank in potentially contaminated areas such as
treatment rooms.
The reason for high rates of recapping syringes may be
security-related, the authors reported. Access to "sharps" containers that are
routinely used to dispose of needles and other objects is limited in prisons,
they noted. These containers are "generally kept under lock and key in a secure
treatment or storage room" to prevent prisoners from taking them, they wrote.
Until health-care workers could dispose of them properly in sharps containers,
workers often replaced the protective plastic cap as an interim safety measure.
But this is a risky practice. A total of 28 health workers, or 13
percent of those surveyed, reported 73 exposures to patient blood in the
previous six months. Noncorrections workers report a rate of less than 10
percent.
Only 39 of these 73 exposures had been reported to the
Corrections Departments' infection control program. The authors suggest that
this may reflect a lack of knowledge of the effectiveness of post-exposure
treatments, such as anti-HIV drugs that can be taken immediately after exposure
to prevent infection.
The study also found an association between poor
working conditions, increased stress and unsafe practices. More than 50 percent
of workers said they were "often or always" bothered by the temperatures in
which they worked, while 44 percent complained of poor air quality, 32 percent
of noise and 23 percent said "unpleasant odors" were a common problem. In
addition 23 percent of those polled reported they were the targets of frequent
verbal abuse from inmates.
Gershon and her colleagues recommended that
prison administrators adopt a zero tolerance policy for deviations from safety
standards and that the prison system acquire safer needles to reduce
needle-stick injuries.
GRAPHIC: Illustration,
JAMES YANG for The Washington Post
LOAD-DATE: March 09,
1999 
