Establishing and Maintaining a Healthy Environment
in the Correctional Facility
Debbie Graham
A core responsibility of correctional staff is to provide care, custody, and control of incarcerated persons in their jails, as well as the safety and security of staff, inmates, visitors, and the community. Safety also includes the promotion of health and welfare within a correctional facility for all who interact with the jail system. Health and welfare can encompass staff well-being, the health of inmates, equipment safety, and the environmental health of the facility.
According to the U.S. Department of Justice, in December 2020, there were 5.5 million persons supervised by adult correctional systems in the U.S., of which 1,691,600 were incarcerated (1,215,800 in prison and 549,100 in local jails, minus 73,300 in dual correctional status). The remainder of the 5.5 million persons were in community supervision (probation/parole) (Kluckow & Zeng, BJS, 2022). In addition, the U.S. Bureau of Labor Statistics’ employment estimate for “Correctional Officers and Jailers” in the U.S. is 392,600 (U.S. BLS, 2022).
When support staff is added, the correctional employment numbers are higher, of course. Although the total population of jails and prisons has been declining for several years, these figures should still give us pause when considering the number of people interacting with correctional facilities and the environmental health of each facility.
Although the correctional environment poses a risk for the spread of disease, correctional administration and staff have plenty of opportunities to ensure the appropriate environmental health of the facility. It’s important to understand the level of risk within your facility, like what viruses and diseases are present or being diagnosed and which ones might be transferred over with inmates from other facilities. What happens if a dangerous pathogen is discovered in your facility? COVID-19 has certainly increased everyone’s awareness of how quickly a virus or dangerous pathogen can spread. But despite heightened awareness, and even best efforts, common mistakes can be made.
When you walk around your facility, does it appear clean or is it actually clean and environmentally healthy? Are you fully aware of the difference? Do you check floors, walls, and ceilings throughout the facility? What about sinks, showers, and toilets? And don’t forget inmate bunks and surrounding areas. What are the protocols for disinfecting your facility? What are the protocols and practices for cleaning, disinfecting, and sterilizing healthcare areas? What is in your janitorial closets and shared spaces such as law libraries, dining rooms, and recreation areas? Also, is your facility’s pest control sufficient?
There are some helpful practices and processes that can be used to help establish and maintain an environmentally healthy facility. They include cleaning and disinfecting in housing areas, healthcare clinics and housing, and shared areas as well as laundry practices and appropriate pest control.
Let’s review the following:
• Cleaning is the removal of visible soil from a surface using water and detergent and is an important first step before disinfecting and sanitizing.
• Disinfecting kills germs, but not necessarily spores, on a surface after proper cleaning.
• Sanitizing lowers the number of germs on a surface to a safe level that meets public health standards and requirements.
• Sterilization destroys or eliminates all forms of microbial life and is used in healthcare facilities.
Ensure chemicals used for disinfection are EPA registered and have “kill claims” sufficient for pathogens in your facility. The EPA-Registered Disinfectant lists (A-P) provide efficacy information for specific pathogens (EPA, 2022). For example, use chemicals from EPA’s List N for effectiveness against COVID-19. Chemicals may appear on more than one EPA list since many are effective against multiple pathogens. Consult with your chemical supplier and carefully read the labels to ensure appropriate chemicals are used for disinfecting your facility.
Housing Units
Generally, incarcerated persons spend the majority of their day inside a housing unit. Other than keeping their area tidy, they have limited control over the living environment and must rely on facility staff to provide necessary equipment and supplies to promote a healthy environment. In addition, many staff members spend the majority of their day inside of a housing unit, such as in direct supervision or in and out of housing units during rounds and tours.
All areas of a housing unit should be cleaned, followed by some areas being disinfected. It is important to remember to ensure the effectiveness of disinfecting, cleaning must occur first. It is not sufficient to simply spray disinfectant on a surface without cleaning it first.
Cleaning is usually sufficient for areas such as walls, air vents, light fixtures, window sills, and glass. Disinfecting is required for items such as tables, mattresses, telephones, doorknobs and handles, handrails, kiosks, tablets, TV remotes, and all hard surfaces in bathrooms. High-touch areas such as doorknobs and handles, handrails, faucets, and telephones should be cleaned and disinfected more often.
Always clean from the cleanest to the dirtiest and from the highest to the lowest area. For example, clean ceiling light fixtures or air vents before walls and floors. Clean and disinfect the general housing unit areas before the bathroom.
Methods of floor care in your facility will depend on the type of floor, like tile or sealed concrete, and the area of the facility including housing units, bathrooms, offices, kitchens, and healthcare areas. Consult with your chemical supplier to determine the best type of chemicals for your floor type and cleaning or disinfecting needs.
Mop floors starting with the innermost area of each room, and mop across the floor toward the exit. Divide large rooms into sections and start along an interior wall using a methodical pattern, such as a figure eight, to move across the area. Avoid mopping from the center of the room toward the wall since the floor by the wall won’t get mopped adequately and will soon appear dirty.
Individual rooms in a housing unit should be routinely and thoroughly cleaned and disinfected from top to bottom whenever an inmate leaves and before a new inmate is assigned to the room. For shared bunking areas, ensure the entire bunk, including rails, the mattress platform, drawers, and all sides of the mattress are thoroughly cleaned and disinfected every time an inmate is moved or released. This should be done even if a new inmate is not scheduled to be assigned to the bunk. If the bunks are metal, avoid using bleach solutions for disinfecting since they’ll cause the metal to rust. Consult your chemical supplier for the best non-corrosive disinfectant to use on metal bunks.
Be sure your housekeeping and sanitation plan covers all areas of the housing unit, ceiling to floor, and everything in between. Include in your plan a list of:
• All areas requiring cleaning or cleaning and disinfecting, as well as the frequency at which these tasks should be completed
• Chemicals and supplies needed to complete each task
• Exact steps to complete the cleaning and the disinfecting processes
• To whom each task has been assigned
List the steps regarding the use of mopheads and rags, including whether you discard mopheads and rags or repurpose them via the laundry. Do not share the same mophead or cleaning rags used in the bathroom with any other area, and avoid sharing cleaning supplies such as rags, mops, and mop buckets between housing units without disinfecting them first. This can be a mechanism for the spread of germs between the bathroom and other areas as well as between housing units. Always change mopheads at least once per day or when they appear dirty, and never leave wet mopheads stored in mop buckets, on the floor, or in mop sinks. Change the solution in mop buckets often, and always when it appears dirty.
Be sure to maintain a consistent schedule for cleaning and disinfecting practices in housing areas. If inmates complete the tasks, ensure they:
• Have been trained in the proper procedures and use of chemicals
• Are supervised while completing the tasks
• Use the appropriate PPE
Healthcare Clinics and Housing
Preventing the spread of disease is a top priority for healthcare areas. Reducing the potential for the spread of disease includes appropriate infection control, effective monitoring, and the comprehensive
training of staff. Policies and procedures should be written that follow infection control and healthcare standards. These should include, but are not limited to:
• Standards for cleaning, disinfecting, and sterilization
• Personal hygiene, handwashing practices, and use of hand sanitizers
• Use of PPE
• Standards for addressing contaminates such as bodily fluids
• Use of chemicals
• Handling of biohazard waste
Facility healthcare areas must have a well-written, comprehensive, and detailed housekeeping and sanitation plan that covers all areas of the clinics and medical housing. The plan should include:
• All areas requiring cleaning, cleaning and disinfection, and sterilization, as well as the frequency at which these tasks should be completed
• Chemicals, supplies, and equipment needed to complete each task
• Exact steps to complete the cleaning, disinfecting, and sterilization processes
• To whom each task has been assigned
• Mechanisms to be used for monitoring and verification, such as checklists and logs
In addition to cleaning and disinfecting, some healthcare items require sterilization. In healthcare, the determination of whether disinfection or sterilization of an item is required is based on the level of risk for infection (critical, semi-critical, or noncritical) (CDC, 2019). Critical items enter sterile tissue or the vascular system, semi-critical items contact mucous membranes or non-intact skin, and noncritical items come in contact with intact skin but not mucous membranes (CDC, 2019).
In order to achieve sufficient disinfection, various levels of disinfectant are required, based on the risk of infection. They include:
• High-level disinfectants-—kill all microorganisms except large numbers of bacterial spores
• Intermediate-level disinfectants—may kill mycobacteria such as Mycobacterium tuberculosis, vegetative bacteria, most viruses, and most fungi, but they don’t necessarily kill bacterial spores
• Low-level disinfectants—kill most vegetative bacteria, some fungi, and some viruses in a practical period (10 minutes) (CDC, 2019)
Medical staff must be fully trained and understand the level of risk for infection classifications, the level of disinfectant required, and sterilization criteria. Staff must recognize infection risks, follow all appropriate cleaning, disinfecting, and sterilization practices, and never take shortcuts or skip any steps. Practices and processes should follow the most up-to-date CDCGuideline for Disinfection and Sterilization in Healthcare Facilities(CDC, 2019) or their affiliated hospital criteria.
Sterilization Practices
Sterilization is a highly effective method of destroying microorganisms on critical items when all sterilization steps are followed, ensuring the process is completed properly. Failure to adequately sterilize critical items creates the potential for transmission of infections or diseases. Proper cleaning must occur before any sterilization processes begin.
There are multiple methods for sterilization. Which method is most appropriate depends on the facility, types of items requiring sterilization, equipment used, and staff training. Staff must be adequately trained and demonstrate competence with the facility’s sterilization methods and processes, the operation of the equipment being used, and the handling of sterilized items to prevent re-contamination. Quality assurance monitoring and testing of sterilization equipment should be an ongoing practice.
Surface Disinfection
Surfaces can be contaminated through exposure to other contaminated surfaces, hand contact, or other exposures. For example, a bedside table may become contaminated by medical staff through a hand coming into contact with a contaminated item and then touching the bedside table without handwashing first. Or, a surface can be contaminated through exposure to blood or bodily fluids. The cleaning and disinfecting practices in these two scenarios will vary in methods and disinfectants used. The bedside table may require cleaning, followed by the use of a low-level disinfectant. However, the surface contaminated with bodily fluids will require cleaning and disinfecting according to the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard (OSHA, 2019). It is advisable for facilities to always have on hand a biohazard spill kit for cleaning up spills such as blood, vomit, or other bodily fluids.
Cleaning with detergent and water may be adequate in non-patient care areas such as offices. High-level disinfectants should not be used on noncritical surfaces for routine cleaning.
All patient care areas and bathrooms should be thoroughly cleaned and disinfected regularly and whenever there is visible soil or spills. Exam tables should be covered with exam table paper, which should be changed out after each patient and cleaned and disinfected regularly, and always after soiling or spillage occurs. No exam table should be used if the padding is torn or somehow compromised.
Floors are to be mopped regularly with an appropriate floor cleaner and then disinfected in all areas where contamination might occur. Don’t share mops or cleaning rags used in bathrooms or medical housing rooms or to clean up bodily fluids in any area.
Shared Areas
Shared areas like the law library, dining rooms, barber shops, and recreation areas should be cleaned regularly, including light fixtures, vents, walls, tables, countertops, and barber chairs. These areas may contain high-touch items such as tables, chairs, computer equipment, or gym equipment, including basketballs and soccer balls. Barber shops also contain barber supplies that require cleaning and disinfecting.
High-touch items like computer keyboards and mice should be cleaned and disinfected regularly and more often than items that are touched less frequently. In addition, the law
library should be disinfected between each use. Consider using keyboard protective covers made of plastic or silicone to make the use of disinfectants easier and to protect the keyboard from damage. Tables in dining rooms should be cleaned and disinfected before and after meal service—between each use. Gym and recreational equipment should be disinfected between each use.
Barber supplies and equipment includes combs, brushes, clippers and attachments, nail clippers, and shaving equipment which must be cleaned and disinfected between each use. Disposable, single-use items should not be shared or reused.
Laundry Services
Fabrics often become contaminated from exposure to microorganisms or pathogens from various sources such as blood, urine, and other infectious materials.
OSHA defines contaminated as the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface. Contaminated laundry is laundry that has been soiled with blood or other potentially infectious materials or may contain sharps (OSHA, 2019).
Disease transmission is possible during the handling of contaminated laundry if it is not handled properly. Pay special attention to laundry from healthcare clinics and housing due to the potential for infectious materials.
To protect against the spread of disease, handle all laundry as if it is contaminated. Always wear appropriate PPE, like gloves, while handling laundry. Do not hand-carry laundry; rather, place soiled laundry in a designated container or bag. Do not shake soiled laundry. Always wash hands properly before applying and after removal of PPE. In addition, due to the nature of laundry contamination, ensure that OSHA Standard 29 CFR 1910.1030—Bloodborne Pathogens is followed.
Through a combination of soil removal, pathogen removal, and pathogen inactivation, contaminated laundry can be rendered hygienically clean (CDC, 2015). The antimicrobial action of the laundering process results from a combination of mechanical, thermal, and chemical factors (CDC, 2015). The effectiveness of the laundering process depends on many factors, including:
• Time and temperature
• Mechanical action
• Water quality (pH, hardness)
• The volume of the load
• Extent of soiling
• Types of washers and dryers (CDC, 2020)
Hot water of at least 160⁰F for a minimum of twenty-five minutes is commonly recommended for hot-water washing (CDC, 2015). The addition of chlorine bleach (50-150 ppm) enhances the effectiveness of the laundering process. Chlorine alternatives, such as activated, oxygen-based detergents, can be used for fabrics where chlorine bleach is not recommended.
Low-temperature washing (71⁰F–77⁰F) can reduce microbial contamination when the cycling of the washer, the washing detergent, and the amount of laundry additive are carefully monitored and controlled. Low-temperature laundry cycles rely heavily on the presence of chlorine or oxygen-activated bleach to reduce the levels of microbial contamination (CDC, 2015).
To ensure washing processes are effective and the proper amount of chemicals are used at the appropriate times in the wash cycles, it is best practice to utilize an auto-dispensing system on washing machines. Consult with your chemical supplier and the washing machine manufacturer’s instructions for the most effective use of the equipment.
Ensure tables for separating and folding laundry, laundry containers, transport carts, or any surfaces that may be exposed to dirty laundry are cleaned and disinfected regularly. Never mix clean laundry with dirty laundry. Always clean and disinfect laundry and transport carts after each use. Mop floors regularly and at the end of each laundry service shift or day.
Pest Control
An effective pest management program is an integral part of the environmental health of a facility. In many respects, pest control problems can contribute to poor sanitary conditions, and poor sanitary conditions can contribute to pest control problems.
Pests need food, water, and harborage to survive and thrive. Conditions that contribute to satisfying pests’ needs include:
• Lack of cleanliness and sanitation
• Areas of clutter inside and outside the building
• Food residues in kitchen and food consumption areas
• Accumulation of garbage
• Building and interior walls that may have holes, cracks, and penetrations
• Overgrown vegetation
• Standing water
• Leaks in pipes, walls, and ceilings
Pest problems contribute to poor sanitary conditions due to pathogens that pests may carry and the potential for disease transmission; contamination of food and food contact surfaces; damage to the physical plant; and the presence of urine, feces, and dander from other pests.
Effective pest control requires more than the use of pesticides to eliminate pests, reacting only when pests are found or anticipated, and/or establishing contracts that shift pest control responsibility to a pest control company. Effectiveness requires regular inspections of the facility, monitoring practices, and preventative measures.
The most effective prevention and management strategy for pest control is a well-planned and executed Integrated Pest Management (IPM) Program. IPM is not a single pest control method; rather, it involves integrating multiple control methods (EPA, 2021). It is a proactive approach that identifies why pests are there and focuses on strategies for denying pests food, water, and harborage, and the prevention of infestations.
The components of IPM include:
• Inspections and monitoring of all areas of the facility, both interior and exterior
• Identification of the types of pests or evidence of pests found to determine the most effective prevention and control measures
• Establishing an action threshold—the unacceptable level at which point action is required—levels may vary, i.e., a rodent seen in the kitchen is intolerable and cause for immediate action while a rodent running across a field exterior to the building may not be
• Prevention and control measures—actions taken to prevent, reduce, or eliminate infestations
• Evaluations—surveys or inspections to determine the IPM program’s effectiveness
IPM requires involvement and collaborative work between facility staff and the pest control contractor. Start with a policy that addresses pest management in your facility. The policy should include:
• Scope and Purpose, including the facility’s philosophy and commitment to effective pest management
• Goals and objectives of your IPM program
• Definitions
• IPM components and responsible parties
• Control methods and who can request them, i.e., how cracks in walls are reported and repaired
• How pest sightings are reported, documented, and managed
• Staff training content and frequency
• How the policy is updated and when it should be reviewed
If pest control is contracted out, ensure that the contract is comprehensive, clearly written, covers all areas of the facility, and details all expected services. Don’t assume that the lowest bid or price is the best contract for your facility’s needs. Set criteria for the successful award of a contract and review each bid against the criteria.
Details about IPM are readily available on the internet. The EPA’s website contains general information and resources on IPM at: https://www.epa.gov/ipm/introduction-integrated-pest-management.
Conclusion
The safety and security of your facility are the responsibility of everyone who comes in contact with the facility. The environmental health of your facility starts with the philosophy and expectations of the management and depends on a commitment to the environmental health of the facility by everyone. Well-written policies, procedures, and sanitation plans form the foundation for commitment and expectations. They also provide awareness, methods, practices, and steps to follow to establish and maintain environmental health in your correctional facility.
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Debbie Graham is a Registered Environmental Health Specialist/Registered Sanitarian and a Registered Dietitian. She spent 32 years in county government, with more than 28 of those years in corrections, retiring as a Division Chief in Miami, Florida. She can be contacted at fsbcmdrdebbie@yahoo.com.
References
Centers for Disease Control and Prevention. (2015). Guideline for Environmental Infection Control in Health-Care Facilities (2003), Background G. Laundry and Bedding. Retrieved from https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/laundry.html
Centers for Disease Control and Prevention. (2019). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, Updated May 2019. Retrieved from https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf
Centers for Disease Control and Prevention. (2020). Healthcare Associated Infections, Best Practices for Environmental Cleaning in healthcare Facilities: in RLS, Appendix D—Linen and laundry management. Retrieved from https://www.cdc.gov/hai/prevent/resource-limited/laundry.html
EPA (2021). Introduction to Integrated Pest Management. Washington, DC: United States Environmental Protection Agency. Retrieved from https://www.epa.gov/ipm/introduction-integrated-pest-management
EPA (2022). Selected EPA-registered disinfectants. Washington, DC: United States Environmental Protection Agency. Retrieved from https://www.epa.gov/pesticide-registration/selected-epa-registered-disinfectants.
Kluckow, R. & Zeng, Z (2022). Correctional Populations in the United States, 2020—Statistical Tables (NCJ 303184). Washington, DC: The Bureau of Justice Statistics, U.S. Department of Justice. Retrieved from https://bjs.ojp.gov/library/publications/correctional-populations-united-states-2020-statistical-tables
Occupational Health & Safety Administration. (2019). 1910.1030-Bloodborne Pathogens. (84 FR 21598, May 14, 2019). Washington, DC: U.S. Department of Labor. Retrieved from https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030
U.S. Bureau of Labor Statistics. (2022). Occupational Employment and Wage Statistics: Occupational Employment and Wages, May 2021. Washington, DC Retrieved from https://www.bls.gov/oes/current/oes333012.htm