Preventing the spread of SARS-CoV-2, the virus that causes COVID-19, is a global priority. From the start of the pandemic, U.S. officials have recognized that protecting our nation's most at-risk populations is especially critical for saving lives and reducing the financial, economic, and human costs of the current crisis. Incarcerated individuals are among our nation's most vulnerable demographic groups—which means that protecting inmates from COVID-19 is a leading public health priority.

Unfortunately, it's been estimated that 1 in 5 incarcerated individuals in the United States have had COVID-19. To combat this statistic, the U.S. Centers for Disease Control and Prevention (CDC) have released their interim guidance on the management of COVID-19 in correctional and detention facilities. The CDC's guidance is a living document that offers data-driven recommendations for keeping inmates, staff, and visitors safer. Chief among these recommendations are updated policies surrounding the use of personal protective equipment (PPE). Not only are these policies important for slowing the spread of COVID-19, but they're also important for preserving critical PPE supplies.

Is your facility in compliance with the CDC's latest guidelines on COVID-19 PPE for correctional facilities? Do you know when correctional staff and inmates should wear PPE and what type is recommended? Keep reading for the most important policies and practices you need to know.

PPE Policy Changes for Facilities, Inmates, Staff Members, and Visitors of Correctional and Detention Centers

For Facilities

It's never been more important for correctional facilities to have sufficient stocks of cleaning supplies, medical supplies (given the extent of the facility's healthcare capabilities), PPE, and hygiene supplies. Facilities also need an appropriate restocking plan and schedule, and careful efforts should be made to optimize the supply of each PPE category, including surgical masks, N95 respirators, eye protection, gloves, and gowns or coveralls.

Important supplies to maintain adequate stock and inventory of include tissues, liquid or foam hand soap, paper towels, hand dryers, and EPA-registered disinfectants. When soap and water aren't readily available, alcohol-based sanitizers containing at least 60% alcohol will need to be used on premises—although in certain situations and areas, alcohol-based sanitizers might not be permissible due to security restrictions.

Supply management isn't the only operational preparedness policy correctional facilities should take. Other considerations need to be made:

  • Cloth face masks should be worn by all personnel unless PPE is required.
  • Donning and doffing stations should be set up directly outside areas and spaces where PPE is needed. If PPE is being reused, then strategies for safer re-use should be clearly communicated and maintained. One example: staff wearing reusable PPE should move from areas of low to high exposure in order to prevent cross-contamination. Preventing cross-contamination is also possible through the use of disposable PPE such as the disposable protective garments offered by International Enviroguard.
  • For facilities with limited onsite healthcare services, close collaboration with state, local, tribal, and/or territorial health departments is essential. This helps ensure that best-practice procedures are followed for medical isolation, quarantine, and necessary medical evaluation, care, and transfer.
  • The CDC offers specific guidelines on what to do in the event of supply shortages. For example, in the event of gown shortages, gowns or coveralls should be reserved for any individuals who are participating in aerosol-generating procedures, activities that pose the risk of splashes and sprays, and high-contact activities that increase the risk of pathogens transferring to clothing. In the event of N95 respirator shortages, surgical masks can be an acceptable alternative.
  • In at least three scenarios, correctional facilities should consider testing individuals for COVID-19: when individuals show signs or symptoms of COVID-19, when asymptomatic individuals have a recent known or suspected exposure to SARS-CoV-2, and when asymptomatic individuals do not have a known or suspected exposure to SARS-CoV-2 but early identification might be necessary (e.g., if the correctional facility is in an area with moderate to significant levels of community transmission). PPE (including N95 respirator, eye protection, glove, and gown or coverall) is a must for staff members who test individuals for COVID-19.

Lastly, facilities must be prepared to provide medical evaluation and treatment for any incarcerated individuals as soon as they show any symptoms of COVID-19, including difficulty breathing, fever, chills, muscle pain, sore throat, and new loss of taste or smell.

For Correctional Staff

Staff training is imperative to ensure proper use and preservation of PPE, especially in the face of possible shortages. You should ensure that all staff members understand how to don, doff, store, and/or dispose of their PPE, as well as how to perform hand hygiene before and after handling their PPE. Ideally, staff members should have a working understanding of what COVID-19, how it's spread, and what its potential signs, symptoms, and consequences are.

  • Staff members having direct contact with asymptomatic inmates who have been quarantined as close contacts of someone with COVID-19 should wear surgical masks, eye protection, and gloves.
  • Staff members performing temperature checks on any group of people—including inmates, visitors, and fellow staff members—should be wearing surgical masks, eye protection, and gloves. They must also perform hand hygiene by washing their hands with soap and water for at least 20 seconds or (if soap and water isn't available) using a hand sanitizer with at least 60 percent alcohol, prior to donning their PPE.
  • Staff members who have direct contact with inmates who have confirmed or suspected cases of COVID-19 should were N95 respirators, eye protection, gloves, and gowns or coveralls. This includes staff members who are transporting or providing medical care for inmates with confirmed/suspected COVID-19.
  • In situations when infectious aerosols might be generated (e.g., during cardiopulmonary resuscitation (CPR)), N95 respirators, eye protection, gloves, and gowns or coveralls should be worn.
  • Any staff member handling laundry or used food service items from someone with COVID-19, or their close contacts, should wear gloves and gowns or coveralls in addition to a cloth mask.
  • When transferring an individual with known or suspected COVID-19, correctional staff members should follow the same precautions as those used for close contacts of someone with COVID-19. At a minimum, correction facility transport vehicles should have their windows down and set the fan to high, non-recirculating mode.

In some cases, disposable gowns or coveralls limits the ability of staff to access duty belts and gear. In these cases, staff should ensure they thoroughly disinfect their gear after close contact with anyone who has confirmed or suspected COVID-19. Additionally, clothing should be changed and laundered as soon as possible.

Lastly, staff members should be reminded that it's important to stay home when feeling sick, and if symptoms develop while on duty, staff members should leave the facility as soon as possible and following CDC guidelines for COVID-19 positive individuals (e.g., self-isolating, contacting a healthcare provider for testing, etc.).

For Inmates

Cloth masks aren't technically considered PPE. But cloth masks are appropriate for source control among incarcerated individuals who don't meet criteria for N95 respirators and surgical masks. They play a big role in protecting inmates from COVID-19 or spreading it.

The CDC defines source control as the use of masks as simple barriers that prevent respiratory droplets from traveling into the air when the mask-wearer coughs, sneezes, talks, or breathes. By encouraging the use of cloth masks in congregate settings, correctional facilities can reduce overall risk of exposure to SARS-CoV-2. The CDC notes that masks should not be worn by inmates who have trouble breathing or are unable to remove the mask without help. Widespread use of cloth masks is also one of the most critical ways that correctional facilities can preserve PPE.

  • According to the CDC, cloth masks should be worn by inmates who have confirmed or suspected cases of COVID-19, or who are asymptomatic and under quarantine after coming in close contact with another person who has COVID-19. Cloth masks shouldn't be worn under conditions that require surgical masks.
  • For inmates who are handling laundry or food service items from someone with COVID-19, or someone who is a close contact of someone with COVID-19, gloves and gowns or coveralls should be worn in addition to cloth masks. Gloves and coveralls should also be worn by inmates who are cleaning areas where someone with COVID-19 spends their time.
  • Inmates with suspected cases of COVID-19 should be individually isolated.
  • Inmates who are close contacts of people with confirmed or suspected COVID-19 should be quarantined individually whenever possible.
  • Inmates with confirmed cases of COVID-19 should be medically isolated as a cohort into a specific isolation area. Cohorts of COVID-19 positive inmates should wear masks whenever anyone else enters their isolation area. This area should be a well-ventilated room with a solid door and walls. Ideally, one large area should be used for medical isolation, as this can help conserve PPE and reduce the risk of cross-contamination.

Preserving the integrity and effectiveness of PPE is important for protecting supplies. So, all inmates who meet the requirements to wear PPE need to be trained in how to don, doff, and dispose of their equipment. Inmates should also be encouraged to report any symptoms to staff and be educated about the purpose of social distancing, proper hand hygiene, quarantining, not sharing utensils and dishware, and medical isolation.

For Visitors

Visitors are required to undergo verbal screening and temperature checks prior to entry. Verbal screening questions should include the following:

  • Today or in the past 24 hours, have you had any of the following symptoms?
    • Fever, felt feverish, or had chills?
    • Cough?
    • Difficulty breathing?
    • In the past 14 days, have you had close contact with a person known to be infected with the novel coronavirus (COVID-19)?

In addition to being formally screened, visitors must also wear face masks, such as cloth coverings or surgical masks, that cover their mouth and nose. Correctional staff members will need to be sure to use a clean pair of gloves while temperature checking each individual visitor.

Conclusion

Prison inmates are among the most vulnerable populations in America for infectious diseases, including COVID-19. Incarcerated individuals typically live in close quarters to each other. Many have chronic health conditions which increase their risk of contracting and becoming severely ill with COVID-19. Unsurprisingly, stricter PPE practices are some of the most important things correctional facilities can do right now when it comes to protecting inmates from COVID-19 and preventing the spread of this global disease.

At a minimum, cloth face coverings should be worn by inmates, staff, and visitors alike. To prevent the risk of PPE shortages and to conserve supplies, PPE such as N95 respirators, surgical masks, eye protection, gloves, and gowns should only be used in specific situations. Fortunately, the CDC has outlined these guidelines in detail.

Along with intelligent PPE practices, reinforced hygiene, intensified cleaning and disinfecting, symptom screening, social distancing, testing of symptomatic and asymptomatic individuals, and ongoing communication can help correctional facilities do their part to protect individuals and put an end to the pandemic.