What's It Like to Be an Infection Prevention Nurse in a Correctional Facility?

Kissa M. Robinson, BSN, MHA, MBA

Disclosures

October 25, 2017

Are you ready for a career change? Our series of first-person accounts of what it's like to be a nurse in a nontraditional role might provide inspiration to those seeking a new path within nursing.

How I Became an Infection Prevention and Control Nurse

I was inspired to become a nurse, from a very young age, because of my love for helping people. When we visited my great-aunt in a nursing home, I found myself offering help not only to my aunt but to other patients as well. Along with babysitting, this fueled my passion to care for others. I received my bachelor's degree in nursing, followed by a master's in healthcare administration and then an MBA. However, none of this prepared me for my role as an infection preventionist. Thankfully, I met an infection preventionist who became my mentor, and then I discovered the Association for Professionals in Infection Control and Epidemiology (APIC), which offers courses in infection prevention and control.

I began my career as an infection prevention and control nurse in 2007 when my organization acquired the contract to provide healthcare services in the city jail. The city jail is a maximum security facility that houses men, with a medium-to-maximum security annex that houses men, women, and juveniles awaiting trial, those sentenced for misdemeanors, and convicted felons pending transfer to the Federal Bureau of Prisons. Working in a correctional facility was not a dream of mine; however, an infection control nurse was included in the contract staffing plan. The vice president of nursing thought I was the most qualified candidate for the position. I accepted the position without much thought and have not looked back.

My Day as a Prison Infection Prevention and Control Nurse

There is no such thing as a typical day in the correctional setting. My day starts as though I am at an airport, going through the security checkpoint. In my office, I determine which hat(s) I will wear that day. Most days, I wear the "public health/nurse educator/consultant" hat. In this role, I conduct environmental rounds; collaborate with providers about the treatment of sexually transmitted infections; communicate with departments of health and other prisons; educate staff on modes of disease transmission and biohazardous waste; recommend plans of action for isolation and the management of lice, scabies, or bed bugs; and create and maintain records for accreditation.

I love nursing for its diversity and the many ways to use my skills and acquire new ones. As an infection prevention and control nurse, I am able to educate, advocate, and collaborate. Weekly, I educate on infection prevention and control practices. Daily, I advocate for patients to receive the care and treatment they need. Constantly, I collaborate with providers, nurses, correctional staff, and various agencies to ensure that standards and outcome measures are met.

Figure. Kissa instructing healthcare providers on the need for influenza vaccination. Courtesy of Kissa Robinson.

The most common infections for which inmates are evaluated and treated are syphilis, chlamydia, gonorrhea, HIV, hepatitis B and C, methicillin-resistant Staphylococcus aureus, and tuberculosis. Each inmate receives health screening and testing on intake to determine the patient's baseline health status. This helps to identify any new problems or infections that develop during incarceration. Many inmates are already infected with one or more of the common infections before incarceration. Therefore, our goal is to assess the need for further evaluation and treatment upon incarceration and help them to maintain or regain optimal health.

Overall, my role is administrative, but occasionally I have to interact with an inmate to investigate positive test results or assess an inmate for tuberculosis or syphilis who was lost to follow-up with the Department of Health. When I am in investigative mode, I usually locate the inmate and then communicate with the officer to call and bring the patient to the medical unit. All visits are private, with an officer nearby in case of an emergency. If the patient is housed in the isolation cell, I visit the patient in isolation and make sure that I don the necessary personal protective equipment before entering the cell.

The Challenges of Infection Prevention and Control in a Prison

I love being a nurse because I love people. And although I love being an infection prevention and control nurse, it has its own set of challenges. A huge challenge is achieving compliance with infection control practices. I must ensure that not only the healthcare (medical) staff adhere to infection control policies and procedures but also the correctional (security) staff. The correctional staff are the most challenging because their focus is on security rather than understanding how infections are transmitted. For example, officers are hesitant to transport an inmate housed in the isolation cell because they fear being exposed to infection. Inmates will paint the walls of their cells with feces, and "medical" staff are expected to clean it. I have to continuously help staff understand, from a healthcare perspective, the importance of adhering to infection control practices and distinguish between medical and security responsibilities.

One of my duties is to conduct environmental rounds of the clinical areas, and this means periodically going to the housing units, the area where inmates are housed in their cells. Several years ago, while performing an environmental audit in one of the housing units, a fight broke out in the neighboring housing unit. The inmates housed on the unit where I was heard the commotion and rushed to the gate to watch. This prevented my colleague and I from leaving the unit. We had to wait until the officer was able to get the inmates back in the unit before opening the gate. While waiting, we could see the inmates resisting and heard threats of violence against female officers. In that moment, many thoughts went through my mind. I went into "safety mode" to think calmly of ways to protect myself. Thankfully, no one was hurt, and when the gate opened we hurriedly made our way back to the medical area.

Want to find out more about infection prevention and control nursing? Visit APIC's Professional Practice resources and the Nursing Infection Control Education Network.

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