Effective Hand Hygiene in Jails - Research Paper Example

Effective hand hygiene in jails Problem Identification Infection control is one of the issues in the prison system which is the most difficult to resolve. Infection is a major source of diseases in the prison systems and it is liable to cause major health issues for the inmates as well as the prison guards and administrators (Rohde, 2006). Infection issues and contamination can cause lead to health problems including skin infections, gastroenteritis, influenza, respiratory tract infections, and other diseases which are exacerbated by inadequate hygiene and infection control practices. Prison is a communal place where various diseases abound more than the numbers and rates seen in the community setting (Roodsari, et.al., 2007). The risk of being afflicted with contagious diseases like scabies, pediculosis, dermatophysis, and viral diseases is high in the prison setting. Moreover, stress in the jails also cause the exacerbation of skin diseases like psoriasis, seborrheic dermatitis, acne, and alopecia (Roodsari, et.al., 2007). Furthermore, high-risk behaviors within the prison systems including drug abuse, tattooing, and unprotected sex, are some of the health issues which exacerbate the health issues in the prison systems. Roodsari and colleagues (2007) were able to carry out a study reviewing common skin diseases among prison inmates and within the prisoners and jail institutions they covered, they were able to establish that common diseases include truncal, tinea versicolor, facial acne, dry skin, hand eczema, accessory nipple, and scabies. Most of those afflicted with scabies have spent about 0.25 to 5 years in prison, and those without scabies have spent an average of 2.8 to 2.2 years in prison (Roodsari, et.al., 2007). A history of addiction also exacerbated cases of facial acne. All in all, these are issues on infection which are very much prevalent in the prisons. They are also preventable. The prevention of skin infections in the prison systems is a major issue which boils down to the general infection control and hygiene practices within the system. Limited water and hygiene supplies for inmates is a crucial determinant in the infection control practices in jails. In many jails, the availability of water supplies is low and often prevents the application of adequate hand hygiene practices (Rohde, 2006). Limited soap supplies, as well as sanitizers also prevent the application of appropriate hand hygiene techniques. As a result, inmates are often unable to wash their hands before and after eating, after doing hard labor, and after performing other activities which may dirty their hands. The probability of ingesting or inhaling bacteria is therefore very high among inmates. Most surfaces would be high sources of bacteria for these inmates, and their hands would easily spread the bacteria to other inmates (Rohde, 2006). Lack of hand hygiene can easily lead to bacterial infections, including skin infections. For which reason, skin infections have a high incidence rate among inmates. These health issues are however, very much preventable. With the application of proper hand hygiene techniques, as well as infection control measures, skin infections, as well as other diseases can be prevented and easily managed. Specific interventions which include the use of proper hand washing techniques, as well as the use of soaps and hand sanitizers are some of these measures which can be implemented in the prison systems (Rohde, 2006). The efficacy of these measures shall be evaluated based on research and studies which have already been carried out in relation to these infection-control measures. This paper shall now consider effective hand hygiene techniques which help prevent the spread of skin infection in jails. It shall critically analyze research and evidence on hand hygiene and the application of such interventions in the prison system. A protocol shall also be formulated based on the results of research gathered, addressing clinically appropriate interventions, and specifying the application of such interventions within the prison systems. Review of Related Literature The literature review on effective hand hygiene in prisons was first started with a keyword search through the medical libraries of Texas Health Resource’s Harris Methodist Hospital, and through keyword searches at the Mayo Clinic, Texas Women’s University and the University of Texas Southwestern Medical Center. The CINAHL, Cochrane, PubMed, Science Direct, and OVID databases were also searched using the keywords: hand hygiene prisons, hand washing prisons, effective hand washing prisons, hand sanitizer prisoners, hand washing prisoners, effective techniques hand washing prisons and combinations of these terms. This search used medical subject heading terms and word combinations where appropriate. After the reference lists were reviewed, articles of interest were set aside. A deeper search of relevant materials was then carried out. Relevant information was also taken from medical references, online, interviews from jail wardens, and news feature articles published in magazines, newspapers, and other online materials. In the literature search, the latest relevant studies were established in relation to hand hygiene in prisons and among inmates. Articles were seen from the Texas State University publications, Indian Journal of Dermatology, Veneareology, and Leprology, Journal of Correctional Health Care, Infection Control and Hospital Epidemiology, Journal of Corrective Health care, American Journal of Infection Control, Journal of Clinical Infectious Diseases, The Lancet, and Infection Control and Hospital Epidemiology. The studies included in this review are applicable in the outpatient community setting, and in some instances, also the hospital settings. The studies includes in this review are current, published from January 2004 to August 2011. Critical Analysis and Evaluation of Literature A critical analysis and evaluation of the literature are presented in the attached Table. 1. Two of the studies presented were case-control studies, one is a descriptive prospective study, one is a systematic review, and one is a prospective cohort study. Three of the studies discussed the infection control involving MRSA (Methicilin-resistant staphylococcus aureus) in the prisons. One study highlighted the importance of skin disease screening, personal hygiene, wound care, and antimicrobial therapy in order to prevent and manage MRSA in the prisons (Wooton, et.al., 2004). One study also discussed the importance of antimicrobial therapy before prison admission. Sharing of personal products were also identified in one of the studies as a culprit in the spread of infection among prison inmates and that patients were less likely to get skin infections if they washed their personal items, instead of using the prison laundry (Turabelidze, et.al., 2007). Another study discussed the importance of implementing environmental controls, MRSA, treatment, personal hand washing habits, and educational remedies in the prison system in order to reduce MRSA and other types of infections (Webb and Czachor, 2009). The importance of decolonization was highlighted in the study by Buellman, et.al., (2004), where the authors discussed that applying the full decolonization treatment course was able to reduce and eliminate MRSA in areas of frequent MRSA infection areas including the nose, throat, perianal area, and the inguinal area. Finally, in the study Bloomfield, et.al., (2007) the importance of hand hygiene through the use of soap or waterless hand sanitizers help reduce contamination on hands and the removal of organisms in situ. Reducing infection was also able to reduce incidents of respiratory tract and skin infections. Formulation of Intervention Protocol for Clinical Problem Skin infections are one of the most common issues in the prison systems. With the prison conditions being less than desirable in terms of cleanliness or in terms of sanitation, the risk for infection from a variety of illnesses, including skin diseases is high (Rohde, 2006). These incidents of infection are however very much preventable. There are remedies, including hand washing and infection control procedures which help ensure that these diseases are prevented or easily managed (Rohde, 2006). Based on the review of studies, there are several interventions which have proven to be major and effective improvements in the reduction of infection and skin diseases among prison inmates. Proposed Intervention The proposed intervention for the topic of skin disease infection among prison inmates is the use of personal hand washing soaps without sharing these with other inmates. The specific components of this intervention include: 1. (Problem/population) Prisoners with or without an existing skin disease. 2. (Intervention) Prisoners using their personal soaps for their regular hand washing, without sharing it with other prisoners (Turabelidze, et.al., 2007). 3. Reducing spread of skin disease by preventing its spread from prisoner to prisoner can help contain the infection. Regular hand washing with soaps can also reduce the incidence of skin and other types of infections (Rohde, 2006). The evidence presented above highlights the importance of regular hand washing and preventing the spread of existing skin infections to other inmates. Outcomes and Associated Evaluation Criteria Prison facilities applying the above intervention are expected to decrease the incidents of skin diseases, and to contain existing skin diseases to current infected patients. Evidence highlights the fact that hand washing to prevent infection is one of the easiest and cheapest means of preventing and managing infection (Rohde, 2006). Some of the studies highlight the reduced incidents of infection with the application of hand washing techniques in the prison and the community setting. The outcome which calls for specific measurement when applying the personal soaps during hand washing is: the rate of skin and other types of infection among prisoners with or without existing skin or other infections. The measurement can be established by carrying out regular assessment of prisoners and their incidents of skin and other types of infection while incarcerated (Rohde, 2006). Numbers acquired from the assessment will provide the intervention the much-needed information to establish efficacy in terms of reduced incidents of skin and other infections, as well as contained infection in existing skin disease patients. Table 1 Critical Analysis of Research Articles 1. Title 2. Principal Investigator/First Author 3. Date 4. Country 5. Patient Population 6. Sample size 7. Intervention of Interest 8. Design 9. Level of Evidence 10. Comparison of Interest 11. Outcome of Interest 12. Results of study 13. Conclusion 14 Strengths 14. Limitations A.1. Intervention to Reduce the Incidence of Methicillin‐Resistant Staphylococcus aureus Skin Infections in a Correctional Facility in Georgia 2. Susan H. Wootton ,Kathryn Arnold, Holly A. Hill, Sigrid McAllister. 3. 2004 4. USA 5. Detainees with skin lesion from which MRSA was cultured from July 24 through December 31, 2001/inmates in Georgia Correctional facility 6. 16case/19 controls 7. Medical staff implemented measures to improve skin disease screening, personal hygiene, wound care, and antimicrobial therapy 8. Case–control study 9. Level IIIb 10. Control group versus intervention group 11. Rate of reduction in incidents of MRSA infection in correctional facility in Georgia 12. On multivariable analysis, working as a dormitory orderly and a stay of longer than 36 days were the strongest predictors for MRSA skin infection. The rate of MRSA skin infections declined significantly between both the preintervention and peri‐intervention periods and the postintervention period (P < .01 for both comparisons). 13. MRSA skin disease can become a problem in a correctional facility. Interventions which focus on skin disease screening, antimicrobial treatment, and hygiene may decrease MRSA. 14. Study provides specific causes of infection (MRSA and the interventions which can be carried out to control these incidents. 15. The population is limited and there is only one correctional facility being studied – results have limited applicability. B. 1. Personal Hygiene and Methicillin-resistant Staphylococcus aureus Infection 2. George Turabelidze, Mei Lin, Barbara Wolkoff, Douglas Dodson, Stephen Gladbach, and Bao-Ping Zhu 3. 2007 4. USA 5. Population: Inmate at prison X with culture-confirmed MRSA infection of skin or soft tissue diagnosed between January 1, 2002, and May 30, 2003. Controls randomly chosen at the same prison --inmates who never experienced illness compatible with MRSA infection during the study period, and whose physical examination at the time of the investigation showed no evidence of MRSA infection 6. 137 7.Nurse examined risk factors for MRSA infection, with a focus on personal hygiene factors 8. Case-control study 9. Level IIIb 10. Control versus intervention group 11. Rate of reduction in infection from MRSA 12. Case-patients were more likely than controls to report abnormal skin conditions in their medical history, but the difference was marginally significant. Patients and controls did not differ in antimicrobial drug use (topical or systemic) in the 3 months before prison admission. Patients were more likely than controls to share personal products especially nail clippers and shampoo with other inmates. Patients were also less likely than controls to wash personal items or bed linens themselves instead of using the prison laundry. Additionally, patients tended to wash their hands and take showers less often. 13. Results underscore the importance of the targeted education efforts to control MRSA outbreaks. Such measures may be important in reducing the spread of MRSA in prison settings 14.This study portrays relevant results which exemplify the use of ethical research applications 15.There could be recall bias about risk factors, especially for inmates who were interviewed long after symptom onset. Also, all study participants were incarcerated adult women. This affects the generalizability of the results C. 1. MRSA Prevention and Control in County Correctional Facilities in Southwestern Ohio 2. Jeffrey A. Webb, John S. Czachor 3. 2009 4. USA 5. Inmates in the County Correctional Facilities Southwestern Ohio 6. 234 7. Environmental control, MRSA screening, standard precautions, treatment, personal hygiene, education 8. Descriptive retrospective summary study 9. Level IIIb 10. Infection protection practices comparing rural and urban county jails. 11. Prevention and control preparedness activities of county jails in the Greater Dayton area of Ohio 12. In the rural and urban county jails protocols and control measures were in place for environmental control, MRSA screening, standard precautions, treatment, personal hygiene, and education. There was no significant difference between rural and urban county jails in their handling of MRSA issues. 13. There is significant compliance with MRSA prevention and control protocols among county jails in the Greater Dayton area. 14. The study does not compare interventions but summarizes the efficacy of health practices in the prison setting 15. Results are only applicable to the Southwestern Ohio prison system covered, applicability of results to the general population is limited. D. 1. Highly Effective Regimen for Decolonization of Methicillin-Resistant Staphylococcus aureus Carriers 2. M. Buehlmann; R. Frei; L. Fenner; M. Dangel; U. Fluckiger; A. F. Widmer. 3. 2004 4. Switzerland 5. Hospitalized patients with MRSA colonization or infection 6. 94 7. Standardized decolonization treatment using mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with chlorhexidine soap for 5 days 8. Prospective cohort study 9. Level IIb 10. Standard decolonization treatment versus no treatment 11. Establish efficacy of a standardized regimen for decolonization of methicillin-resistant Staphylococcus aureus (MRSA) carriers 12. Most frequent locations of MRSA colonization were the nose, the throat, perianal area, rectum, and the inguinal area. Decolonization was seen in 87% of patients. Decolonization was successful in 54 of the patients in the intent-to-treat analysis and in 51 of 52 patients in the on-treatment analysis. 13. Standardized regimen for MRSA decolonization was highly effective in patients who completed the full decolonization treatment course. 14. It fully discussed the use of decolonization in the MRSA carriers. The root cause of these infections was highlighted. 15. This study did not specifically apply to prison facilities, it included the larger community setting, where the prison system is a small part of. E. 1. The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers 2. Sally F. Bloomfield, Allison E. Aiello, Barry Cookson, Carol O'Boyle, Elaine L. Larson 3. 2007 4. UK 5. Studies related to the impact of hand hygiene in reducing transmission of ID in the home and community 6. 98 studies 7. Handwashing and alcohol-based sanitizers 8. Systematic review 9. Level IIIa 10. Intervention studies and risk modeling approaches 11. Reduced risk of infection 12. Hand hygiene can reduce infection, most particularly gastrointestinal infections but also respiratory tract and skin infections. Decontamination of hands can be carried out either by handwashing with soap or by use of waterless hand sanitizers, which reduce contamination on hands by removal or by killing the organisms in situ. 13. Hand hygiene must be promoted and accompanied by hygiene education. 14. This study establishes various studies to help support the conclusion of this study 15. This study does not specifically apply to the prison setting. Reference Bloomfield, S., Aiello, A., Cookson, B., O’Boyle, C., & Larson, E. (2007). The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers. American Journal of Infection Control, volume 35(10), pp. S27-S64. Buehlmann, M., Frei, R., Fenner, L., Dangel, M., Fluckiger, U., & Widmer, A. (2008). Highly Effective Regimen for Decolonization of Methicillin-Resistant Staphylococcus aureus Carriers. Infect Control Hosp Epidemiol, volume 29: pp. 510–516. Rohde, R. (2006). Prevention, Treatment, and Containment of Methicillin-Resistant Staphylococcus Aureus Infections in County Jails. Faculty Publications-Clinical Laboratory Science Program. Paper 9. Retrieved 20 September 2011 from http://ecommons.txstate.edu/cgi/viewcontent.cgi?article=1009&context=clsfacp&sei-redir=1#search=%22hand%20washing%20sanitizer%20prisons%22 Roodsari, R., Makekzad, F., & Ebrahimzadeh, A (2007). Skin diseases in male prisoners. Indian J Dermatol Venereol Leprol, volume 73: pp. 55-56. Turabelidze, G., Lin, M., Wolkoff, B., Dodson, D., Gladbach, S., Zhu, B. (2007). Personal Hygiene and Methicillin-resistant Staphylococcus aureus Infection. ShouXi.net. Retrieved 22 September 2011 from http://journal.9med.net/qikan/article.php?id=223742 Webb, J. & Czachor, J. (2009). MRSA Prevention and Control in County Correctional Facilities in Southwestern Ohio. J Correct Health Care, volume 15(4), pp. 268-279. Wootton, S., Arnold, K., Hill, H., McAllister, S., Ray, M., Kellum, M., LaMarre, M., & Lane, E. (2004). Intervention to Reduce the Incidence of Methicillin‐Resistant Staphylococcus aureus Skin Infections in a Correctional Facility in Georgia. Infection Control and Hospital Epidemiology, volume 25(5), pp. pp. 402-407. Read More