Promotion of a Safe and Secure Health Care Environment


Correctional nurses have an active role in creating and maintaining a safe and secure environment for health care delivery in a correctional facility. Nurses play a vital role through use of infection control principles, control of sharps and hazardous materials, and involvement in emergency procedures. 

Environmental Safety and Public Health
An important safety issue is that of infection control. Correctional nurses consistently adhere to the principles of standard precautions and are alert to the use of these principles by others in the facility. Effective and frequent hand washing is a primary way to reduce the spread of infection in this vulnerable environment. Nurses are alert at all times for ways to encourage this practice among health care and custody staff. 

Correctional nurses are also knowledgeable about the use of isolation to prevent infection entry and spread within a facility. For example, suspected TB would be a key concern, as would MRSA in an open wound. 

Correctional nurses are instrumental in providing infection control information to others in the facility. Accurate information could make the difference between understanding an infection control concern and the hysteria that might come from lack of knowledge. 

Other nursing responsibilities include public health reporting for certain classes of infectious disease. Correctional nurses are aware of reporting requirements of the Centers for Disease Control and Prevention and state and local health department regarding the various infectious diseases that may emerge. 

Sharps and Hazardous Materials
Sharps are of particular concern in a corrections environment. The secure maintenance of needles, blades and instruments requires the use of declining inventories and key control. New medical and dental staff members must be informed about the contraband system. Correctional nurses continually guard against complacency in the control of these materials. 

In addition, biohazard waste must be treated as infectious material requiring proper tracking of disposal and destruction. 

Safety and Security Policies and Procedures
Security is the No. 1 priority in a correctional facility. Correctional officers not only prevent inmates from escaping but also protect all within the facility from harm. Correctional nurses must be fully aware of safety and security procedures. Common policies address items deemed contraband, metal detectors, proper identification on each person and response to security breaches. 

Correctional nurse also must be aware of the surroundings at all times. This includes the facility layout and the individuals in close proximity. Any unsafe areas or events should be resolved immediately. One example might be during diabetic call and administration of insulin, if the nurse is left alone with numerous inmates and syringes are in use. Another is a “man-down” call in which other inmates are not removed from the area before medical staff begin treating the injured. These examples suggest opportunities for health care staff to work with custody to reach a mutually agreeable solution for a safe environment. 

Every facility should have an emergency response plan. The correctional nurse should be familiar with this plan and know what part to play. Nurses may have responsibilities to triage and care for sick and wounded in internal or external disasters, riot/hostage situations and cell extractions. 

— Susan Laffan, RN, CCHP-A/RN, is co-owner of Specialized Medical Consultants, based in New Jersey, and also works in the emergency department of a hospital in that state. 

[This column appeared in the Spring 2010 issue of CorrectCare.]

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