Communicable Diseases
Enacted: Jan 2003
Revised:
Introduction
Probation, parole, and community corrections staff are at increased health risk for contracting certain communicable diseases. With the increase in the number of individuals on probation and parole, combined with the lack of meaningful health care available to many of them, we in community corrections must remain cognizant of the dangers of exposure to certain communicable diseases. Probation, parole and community corrections personnel work in and visit environments that may be conducive to the spread of these diseases. Therefore, community correctional agencies must do all they can to minimize the health risks to staff while still allowing personnel to perform their duties effectively.
Position
The American Probation and Parole Association considers the health of its members a critical issue and recommends that all probation, parole, and community corrections agencies have programs in place to assess the risk of communicable diseases; to train staff about the risks of such diseases as well as how to avoid them and how to treat them; to maintain clear and decisive policies and procedures pertaining to potential exposures to communicable diseases; and to investigate and respond to all incidents involving exposure or potential exposure.
All probation, parole, and community corrections departments should comply with OSHA’s Bloodborne Pathogens Standard CFR 1910.1030, OSHA’s Occupational Exposure to Tuberculosis Enforcement Guidelines and the U.S. Centers for Disease Control guidelines on Tuberculosis, Occupational Exposure to HIV and Hepatitis B and C.
Consistent with federal guidelines, APPA supports the mandatory purchase of any and all equipment necessary to protect staff and reduce the risk of exposure to communicable diseases.
Recommended Action
APPA recommends that each probation, parole, and community corrections agency establish a Health and Safety Committee that includes all levels of staff to develop guidelines that meet the needs of their particular agency. The guidelines should include, but not be limited to the following:
TUBERCULOSIS (TB)
Guidelines should include four elements to TB control:
Testing – establish a comprehensive skin testing program with appropriate follow up of those who tested positive. The appropriate test is the Mantoux PPD. The test identifies those employees at risk of disease due to latent TB infection. Testing should be conducted on a yearly basis. As per OSHA Enforcement Directive, a two step baseline shall be used for new employees whose initial PPD results are negative, but have not had a documented negative test during the preceding twelve months. The test should be offered at a time and location convenient for employees. Follow up evaluation and treatment, where necessary, are to be offered at no cost to the employee.
Prevention – prevent the spread of TB by encouraging the early identification, isolation and treatment of people with active TB as well as identifying new converters. Offenders released from jails and correctional facilities should be included if they are known or suspected to have active TB, as well as those who are on preventative or active TB therapy.
Education – prevent exposure to TB through employee education. A training program should be established that includes but is not necessarily limited to explaining the differences between latent TB infection and TB disease, mode of transmission, signs and symptoms, history of TB, TB testing, TB control, the relationship between TB and HIV infection and Multi-drug Resistant (MDR) TB.
Building Examination – conduct an examination of physical plants to determine proper design and maintenance of ventilation systems. A review to determine the need for a study of personal protective equipment should also be considered.
HEPATITIS A, HEPATITIS B (HBV) AND HEPATITIS C
Guidelines should include two elements for Hepatitis control:
Training – Hepatitis A, B and C are bodily fluid viruses. The community corrections’ population is classified as high risk due to the rate of drug abuse. Training curricula should include information about transmission of Hepatitis A, B and C (formerly known as non-A non-B Hepatitis), symptoms, who is at risk, personal protection, universal precautions, and an explanation of the HBV vaccine. There is currently no vaccine to prevent hepatitis C.
Vaccination A and HBV – establish and encourage an agency sponsored vaccination program. The vaccine should be offered to all personnel who have the possibility of direct physical contact with the offender population. The vaccine should be offered on a voluntary basis with provisions to offer it periodically to those who may initially decline it but subsequently change their mind. An antibody test must be offered within two months following completion of the vaccination series. The vaccination and the antibody test should be offered at no cost to the employee.
AIDS / HIV
Guidelines should include four elements to AIDS / HIV control:
Training – HIV is a virus carried in bodily fluid. As with HBV, the community corrections’ population is classified as high risk. While transmission does not occur from every contact with infected bodily fluid, the fact that infection frequently results in death makes HIV a serious threat. Training curriculums should include modes of transmission, post-exposure procedures, prevention, personal protection, who is at risk and universal precautions.
Universal Precautions – all blood exposure is to be treated as if the blood is contaminated.
Post Exposure Procedures – if someone is exposed to blood, i.e. stuck with a needle, it is to be assumed that it is contaminated. A post exposure plan must be in place that includes clean up, immediate medical treatment for exposed employees (to be strongly encouraged, but not mandatory), post exposure evaluation and a determination of source patient and counseling. A mechanism must be in place to provide post-exposure prophylaxis within two hours of exposure at no cost to the employee. Written agreements with local health care providers are an effective way to accomplish this.
Confidentiality – jails and prisons must provide probation and parole agencies with information regarding the HIV status of offenders released to their supervision. Legislation that would allow probation and parole agencies to disclose HIV status to the offenders’ victims and family or friends with whom an offender will reside should be supported. The federal Ryan White Act and various state laws should be considered.
Bibliography
Guidelines for Preventing the Transmission of Mycrobacterium tuberculosis in Health-Care Facilities, 1994 – Published by U.S. Department of Health & Human Services, Centers for Disease Control (CDC), Vol. 43/#RR 13.
Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease, 1998 – Published by U.S. Department of Health & Human Services, Centers for Disease Control (CDC), Vol. 47/#RR-19.
Prevention and Control of tuberculosis in Correctional Facilities / Recommendations of the Advisory Council for the Elimination of Tuberculosis, 1996 – Published by U.S. Department of Health & Human Services, Centers of Disease Control (CDC), Vol. 45/#RR-8.
Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexsposure Prophylaxis, 1998 – Published by U.S. Department of Health & Human Services, Centers for Disease Control (CDC), Vol. 47/#RR-7.