CorrectCare

Infection Control Nursing:
A Critical Role in Disease Prevention and Effective Intervention

by Lorry Schoenly, DNSc, RN, CCHP

The specialty practice of infection control nursing in the corrections setting is varied and challenging. Yet the community of inmates served, the corrections environment and the unique patterns of illnesses seen respond favorably to the coordinated interventions of the IC nurse. Nurses who focus their practice in this discipline are building healing relationships across many boundaries to improve health and prevent disease for their inmate-patients, fellow employees and corrections colleagues. They do this through the application of nursing principles within the focused area of infectious disease management. This article presents a sampling of the important work they do.

Education
More and more, infection control nurses focus their efforts on preventive strategies. Take Linda Graham, RN, infection control nurse at Bayside State Prison in Leesburg, NJ. She has developed a program for instructing inmate workers on good infection control practices such as hand washing, maintaining a clean work environment and safely cleaning up spills.

“Everyone needs to be educated in proper hygiene practices and bloodborne pathogen precautions,” Graham explains. “Therefore, all inmate barbers, kitchen workers, porters and laundry workers receive job-specific instructions in these areas.”

Graham was careful to gear her information to the reading level of her patient community and eliminate as much of the “medicalese” as possible. She also has prepared Spanish versions of her instruction packages.

IC nurses also provide in-depth education about the mode of infection transmission to staff members, in particular correctional officers, who often come into contact with body fluids in the course of their work.

“There is a lot of inaccurate information in the community about how bloodborne infections such as HIV and hepatitis are transmitted,” says Kathy Wells, RN, regional director of nursing for Correctional Medical Services, which provides health services in Arkansas. “We have an opportunity to ease fears by sharing factual information and instructing officers on the use of standard precautions such as gloves and masks when appropriate.”

Wells prepares standard informational materials used throughout the state for officer instruction on infection control.

A key area of staff education is prevention of bloodborne pathogen transmission. BBP training is dictated by the federal Occupational Safety and Health Administration standard for both initial and ongoing education. The use of safety devices greatly reduces staff exposure to these diseases, but training is essential to ensure correct usage of these products.

Knowing how to respond should a BBP exposure occur is just as important. Staff must know the process to provide follow-up as quickly as possible following guidelines of the Centers for Disease Control and Prevention. This follow-up must be provided in a manner that protects the employee’s confidentiality.

In addition, the IC nurse in corrections frequently is involved in administering hepatitis B vaccine and annual tuberculin skin testing to correctional officers.

Building relationships with health care peers is an important part of infection control nursing practice. Strong relationships allow for an open and honest discussion of clinical practices, which can lead to improved application of infection control principles and better patient care for specific infectious diseases.

Disease Management
Disease management has always been a major focus for infection control nursing in corrections. However, the surge in incidents of community-acquired methicillin-resistant Staphylococcus aureus has intensified infection control activities in many facilities.

The Federal Bureau of Prisons has developed excellent clinical practice guidelines on this topic for use in the correctional setting. They address the challenges of caring for the inmate with MRSA not only in the medical unit but also in the housing areas. Recommendations are provided for assessment and treatment, as are guidelines for assessment of the environment.

The IC nurse also has a great need to be knowledgeable about prevention, assessment and treatment of diseases in the following categories:
  • Bloodborne pathogens: hepatitis B, hepatitis C, HIV
  • Sexually transmitted diseases
  • Tuberculosis

The CDC and Infectious Diseases Society of America have developed treatment guidelines for these diseases that can help direct the care of the inmate. State departments of health are also involved in the direction of care of these diseases and mandate routine updates from the IC nurse on inmate progress. Sensitivity to potential methods of transmission of these diseases among inmates is essential in both developing prevention strategies and educational programs and assuring that appropriate postexposure follow-up is available. Both the CDC and state health departments provide written materials to assist in education of inmates and staff.

Data Tracking and Reporting
The IC nurse is often responsible for tracking and reporting data to the state departments of correction and health as well as other public health entities. This data helps to guide care of the inmate and to determine the need for broader facility or region-based intervention. Regular and standardized reporting processes assist the nurse in determining when an outbreak is occurring. Collaboration with these agencies supports the nurse in outbreak investigation and follow-up. Monitoring of laboratory results and treatment strategies are part of the IC nurse’s role, along with reporting to the health department the status of the inmate’s progress.

Environmental Scanning
Once primarily focused on containing or isolating the spread of infections in a facility, IC nurses now spend much more time on proactive activities such as environmental scanning. Nancy Smith, LPN, IC nurse at Southern New Mexico Correctional Facility in Las Cruces, has seen the benefit of monitoring the environment.

“We regularly walk through our facility with an eye toward infection prevention,” she says. “The rounds may pick up such things as mold in shower stalls, empty paper towel and soap dispensers or ineffective laundry water temperatures. Left unaddressed, these situations could lead to the unnecessary spread of infection.”

Specific areas to inspect during an environmental scan are noted in NCCHC standard B-01 Infection Control Program. Additional information can be adapted from CDC guidelines. Environment responsibilities for IC nurses might also include monitoring the proper function of negative pressure rooms used for airborne isolation.

— About the author: Lorry Schoenly, DNSc, RN, CCHP, is a clinical education manager with Correctional Medical Services and is based in Pennsylvania.

[This article first appeared in the Spring 2008 issue of CorrectCare.]