Issues in HIV/AIDS in the Australian prison system
Occupational health and safety in prisons
ISBN 0 642 18311 2
Canberra : Australian Institute of Criminology, 1992
Among the aims of
the National HIV/AIDS in Prisons Information Clearinghouse, is
the development of background papers and analyses on various
issues relating to HIV in prisons, such as:
- occupational health and safety;
- education and training;
- management of prisoners who have HIV antibodies;
- industrial issues;
- expansion of research efforts;
- policy trends.
One area of
employment that has received increased attention over recent
years is occupational health and safety (OH&S). This is
largely due to the unacceptably high incidences of industrial
injuries and diseases and recognition of the inadequacies of
traditional safety legislation.
Much has already
been done by way of new legislation and the promotion of the
concept of a safe environment by way of effective risk
I intend to
present this paper in three sections. The first will deal with
specific OH&S responsibilities. The second will detail the
procedures and management policies which need to be in place
for prison administrators to take control and manage this
problem. The third section will list specific recommendations.
legislative framework of OH&S
Prisons have not
always been bound by traditional legislation. However, there
was always a Common Law responsibility which has now been
augmented by specific OH&S legislation which binds the
Common law responsibilities
the scope of OH&S law and how we may place these
obligations into perspective for dealing with HIV/AIDS in
prison, it is appropriate to detail our common law
Under common law,
every employer has the duty to provide the following:
sufficient number of workers to do the work safely;
reasonably safe place to work;
plant and equipment; and
reasonably safe system of work.
Scope of OH&S law
All of the new
occupational health and safety legislation (NSW) and work care
(Vic.) focuses on:
The primary goal
of the legislation is the prevention of work-related illness
and/or injury. In the event of failure of prevention measures,
then the ill or injured worker is entitled to rehabilitation,
that is return to pre-injury status (whenever possible). At
the same time, the worker is eligible for monetary
compensation. This takes the form of salary and compensation
for the loss of function caused by the illness or injury.
The purpose of the OH&S
The purpose of
the legislation is to ensure the health, safety and welfare of
all persons at work.
protect the health, safety and welfare at work of:
persons - including self-employed, visitors and prisoners
in the workplace;
workplaces (including prisons); and
employees - including public servants ('binds the Crown').
scope and purpose of the legislation provides for the
protection of staff and inmates within the prison system.
In terms of
HIV/AIDS, the onus placed on prison administrators to comply
with the intent and scope of the legislation is daunting. The
responsibilities and duties of management are clearly defined
for employees. The status of prisoners, especially in terms of
rehabilitation and compensation, is not as clear.
The commitment to
OH&S in regard to HIV/AIDS management can be directly
attributable to the establishment of education/training
programs and the introduction of procedures, management
policies and preventative measures at the workplace.
Education/training programs are dealt with in another paper in
this series. It is the intention of this paper to examine
management responsibility and to document the procedures and
management policies that have been developed within the prison
system in New South Wales. The guidelines contained in this
paper are aimed at providing a framework for the development
of a uniform and consistent approach in the management of
OH&S/HIV issues in prisons.
HIV/AIDS prevention programs should be directed towards the
of management strategies and policies: Ensure that there
is a full understanding of the management procedures that
have been developed to control HIV/AIDS within prison. It
is important that all educational/training material has a
common theme and is uniformly presented.
a safe environment: Steps need to be taken to create an
environment which is free of hazards and provides first
aid, psychological and welfare services to staff and
inmates. Working conditions (living conditions) need to be
examined and maintained at an acceptable level. Issues
such as overcrowding should be addressed with vigour.
of individuals: Management must aim to develop an
organisational climate that raises the awareness of staff
and inmates and promotes safe behaviour.
and Training: OH&S policy is effective when
complimented by sound educational and training programs.
Employees should have access to information and
educational programs regarding infection control on
communicable diseases in the workplace. Where necessary
employees and inmates should be given instruction in
practical skills and equipment to maintain proper
infection control standards.
Amendments introduced in New South Wales in 1989 to the
WorkCover legislation were designed to help reduce the
increasing social and economic costs of workplace injury and
disease, by making it compulsory for all employers to:
a rehabilitation program in the workplace;
a rehabilitation coordinator;
occupational health and safety standards within the
employment protection to injured workers up to 52 weeks.
The very nature
of HIV/AIDS complicates the rehabilitation process. An
individual may retain good health and the capacity for active
employment for a number of years. However, within the prison
environment, the presence of HIVab+ staff and inmates creates
a myriad of management problems. Nevertheless, the legislative
requirement for workplace-based rehabilitation is valid and
desirable for prison staff.
Within the same
context, the rehabilitation process for inmates must be
similar. HIVab+ prisoners must retain the right to suitable
work/recreational programs and be integrated within the normal
compensation is a statutory obligation based upon a
contractual relationship between employer and employee, that
is the employment contract.
The aim of this
legislation is that an employee's income and employment
benefits should be maintained for the period that they are
unable to perform their usual work, so that they do not suffer
undue financial loss.
payable to staff who have become infected with HIV (due to a
work related incident) will cover all medical salary and leave
costs (that is income and employment benefits). In this
regard, the worker is limited to the benefits set down in the
Workers Compensation Act. However, for the employee to seek
redress for 'pain and suffering', he/she will need to consider
Common Law action. This is one area that Governments may need
to look at more closely. There is an urgent need to
investigate the legislative provisions for compensation to
cover such matters as economic loss, pain and suffering,
breakdown of relationships, stress and trauma, and so on for
staff who have become HIVab+ due to a work related incident.
compensation is not available to prisoners as there is no
formal contract of employment. Those who wish to seek redress
for injuries/illness, where it is alleged that prison
administration has been negligent, must do so via Common Law
action. In New South Wales, serving prisoners must seek leave
from the Supreme Court to initiate Common Law action. In order
to prove negligence, it must be demonstrated that the prison
authorities failed to take reasonable action to ensure the
safety of the individual.
Communicable Diseases in Prison
disease is a disease which may be transmitted directly or
indirectly from one individual to another. A disease due to an
infectious agent or toxic product produced by it. An
infectious disease is capable of being transmitted with or
without contact (Taber's Cyclopedic Medical Dictionary).
HIV has been
identified in all body fluids and secretions: the highest
concentration in blood, semen and vaginal fluids; and in
lesser quantities in excrement, tears and saliva. Within the
prison environment the primary method of transmission is via
sharing hypodermic needles and by unsafe sex practices.
order to reduce the risk of infection, the following
principles must be adhered to:
- All blood and blood contaminated objects must be regarded as
infected and infectious and treated accordingly.
- All contact with blood and body fluids MUST be reported to the
appropriate senior manager. (A uniform system of reporting
and communicating information must be developed with due
regard to confidentiality.)
- Ingestion of blood or blood products or splashing in the eyes MUST
be reported as above.
- Dressings and disposable blood soaked objects are disposed of as
- Blood soaked clothing is to be treated as infectious.
vaccination policy for staff-occupational health and safety All employees who come into direct contact with prisoners are
encouraged to apply to their Superintendent/Officer-in-Charge
for a course of Hepatitis B vaccinations.
Areas of concern
of items of clothing/bedding and areas that have been
exposed to blood, semen, faeces, urine, pus or vomit.
inflicted on staff members, e.g. biting, body blows,
needle sticks, splashing with blood, body fluids.
and injuries (e.g. in workshops).
to crises requiring mouth-to-mouth resuscitation.
of prisoners - handling prisoners' property.
of prisoners - escort and removals.
searching, including cell/general/body.
of body fluids.
equipment available to staff
Infection control equipment should be provided in wings and
work locations. This should be secured, and all staff should
have access to them.
These areas should be clearly marked so that all staff are
aware of their location and content.
mop and bucket;
protection suits, kits, etc.;
masks and/or protective glasses (to protect eyes and
solution (to flush the eyes);
equipment freely available to all staff:
sachets (powder bleach);
pouches (NSW), Infection Control Pouches (Victoria).
Infection control procedures
must always follow infection control procedures
commencing duty, wash hands with antiseptic handwash for
example, Hibicol. This solution is alcohol based and will
sting any cuts which may not be visible to the naked eye.
all exposed wounds with Airstrip waterproof dressings.
put your hands where you cannot see (use a mirror).
disposable gloves if you are likely to come into contact
or where there is a potential for contact with blood or
eye and mouth protection in the likely event of blood
skin which has been splashed with blood or body fluids
should be bathed or showered as soon as possible.
sharps containers for the safe removal and disposal of
syringes, knives, razor blades, tattoo guns, etc.
bleach and wear disposable gloves to clean up a bloodspill.
IMPORTANT NOTE: Bleach should not be used at a
crime scene until all investigations have been completed.
contaminated waste bags for the safe removal and disposal
of any articles soiled by blood or body fluids.
an airway mask with one-way valve while giving
mouth-to-mouth resuscitation e.g. laerdal mask.
yourself of the Hepatitis vaccination and have a follow-up
blood test so as to be aware of your Hepatitis B antibody
your hands regularly.
In New South
Wales in addition to compliance with the general procedures,
custodial officers and other institutional staff on duty in
institutions will be supplied with AIDS pouches (see Appendix
A) and are required to comply with these procedures which are
specific to the prison environment:
is the responsibility of the Department to provide the
necessary financial resources to permit the full
implementation of these policies/procedures.
is the responsibility of management to provide TRAINING to
is the responsibility of the Superintendent to initially
provide each officer with gloves, pouch, disinfectant and
swabs. It is also the duty of the Superintendent to ensure
that the institution has sufficient infection control
supplies, that is AIDS pouches and the contents of first
Superintendent must prominently display these procedures
and ensure that they are known and understood.
is the responsibility of the Deputy Superintendent,
supported by executive staff, to ensure that officers do
not commence duty without their AIDS pouches and to
monitor the contents thereof.
is the duty of each officer to ensure that he/she carries
and maintains the items in the AIDS pouch at all times and
ensures that open wounds are covered with occlusive
dressings while on duty.
be followed in the event of needle stick injuries or exposure
to blood or body fluids
First Aid, encourage bleeding and clean the wound with
bleach or hot soapy water. Cover the wound with a sterile
medical attention as soon as possible after the incident.
It is necessary for each jurisdiction to ensure that a
policy addressing the viability of prophylactic e.g.
support should be made available to staff as a matter of
the event of a blood splash to the eyes or mouth, irrigate
liberally with water and repeat process. (A mouth wash may
be used to rinse the mouth and saline solution to flush
written reports on all needle sticks or exposures to blood
or body fluids to Management. In New South Wales the
Superintendent will inform the Regional Commander as soon
as practicable. Copies of reports are to be forwarded to
the Regional Commander, the Manager, Prisons AIDS Project
and the Manager, Occupational Health and Safety, Personnel
NOTE: Local reporting procedures should be followed.
be followed in the event of exposure to saliva
response following exposure to saliva from such sources as
spitting incidents or during mouth to mouth resuscitation.
cases of real concern where an officer is considered to be
at risk or where exposure to a known hepatitis B carrier
affected area liberally with water repeatedly.
mouth wash may be used (Chlorhexdine or Hydrogen
Peroxide) have been recommended.
wash may be used to irrigate eye. This may be especially
important if clean running water is not available.
Medical Officer in attendance may prescribe the
hepatitis B immunoglobulin injection.
NOTE: This injection is only effective within the first
seven (7) days but preferably within three (3) days and
may be administered to an Officer if immunity is not
prisoners' property-reception and transport
concerned with the handling of prisoners' property must follow
infection control procedures.
the gloves supplied;
of gloves as contaminated garbage on completion of the
hands immediately after disposing of the gloves.
searching/cell searching/general searching
in searching must follow infection control guidelines:
the gloves supplied;
extreme care when searching - use pens, mirrors, rulers,
etc. where you cannot see;
completion of the task, dispose of gloves as contaminated
hands using hot soapy water immediately after removing and
disposing of gloves.
advised to take care to avoid bare-handed contact with blood
or body fluids and cuts or sticks from sharp objects. Officers
should not run their hands through bedding, under or over
surfaces that cannot be clearly seen. A ruler or similar item
should be used to search blind spots. Officers are to take
care to avoid needle sticks concealed in clothing when
of body fluids is likely to occur, protective glasses are to
be used, where practicable. This is not necessary when the
staff member is already wearing spectacles.
sharp contaminated objects
where sharp objects such as needles, tattoo guns, knives,
weapons, etc. may have to be retained as evidence for court
proceedings and these objects may be contaminated by blood or
body fluids, the object is to be placed in a puncture proof
transparent container. If no container available is big
enough, a coffee jar or other container that is either see
through or able to be labelled should be used.
A high standard
of personal hygiene is to be maintained in food handling
areas. Kitchens are to be maintained in a clean and hygienic
The presence of
the HIV virus can be a cause of a variety of trauma inducing
situations. A trauma support service is to be contacted if any
of the following incidents occur:
and/or body fluid spills
resuscitation of prisoners
In New South Wales the Superintendent/Officer of the Watch
must contact the consultants, Fischer McHale and
Associates, as soon as possible after the incident. It is
expected that the maximum time between the incident and
contact with the consultants will be 30 minutes. The
consultants are to be given a brief description of the
incident and the number of officers involved.
cleaning areas contaminated by body fluids or excreta Officers must avoid bare-handed contact with contaminated articles.
disinfectant or bleach onto the waste products, leave for
30 minutes, then clean with disposable paper towelling/Chux
furniture or items where bleach cannot be used, use
methylated spirits as above. This will kill HIV (the AIDS
virus) but not Hepatitis B virus, so the spill must then
be carefully cleaned with soapy water. Powdered bleach may
be used on carpets.
of the garbage, paper towelling/Chux and gloves as
your hands immediately after discarding gloves and
crises requiring mouth-to-mouth resuscitation Where practicable, a 'Laerdal mask' is to be used. These are
available in first-aid cabinets. However, in the absence of
this artificial airway, use the face shield provided in the
AIDS pouch. This also provides protection from the inhalation
of vomitus or gastric flatus expelled during resuscitation.
AIDS and hepatitis B contaminated garbage
disposable item (including gloves) contaminated in any way
with blood or body secretions must be treated as infectious.
Items are to be placed in a plastic waste bag, sealed in a
clearly labelled yellow plastic infectious waste bag and
incinerated or disposed of in the usual method for
Yellow plastic infectious waste bags should be located in
wings, workshops and office areas. These bags should not be
used for any other purpose.
waste disposal purposes, all disposable items and contaminated
items, excluding 'sharps', must be handled as infectious.
These items are to be placed in a plastic waste bag, and then
sealed in a clearly labelled yellow plastic infectious waste
bag. Sharps must be sealed in a hard plastic container, then
disposed of appropriately.
waste should be disposed of, wherever possible, into the
sewerage via a toilet rather than hand-basin, kitchen sink or
clothing splashed by blood or body fluids
Wash blood soaked clothing separately and include disinfectant
in the wash.
(NOTE: A normal
hot water wash with laundry detergent will destroy the HIV and
hepatitis B viruses. Milton or any other household bleach will
be effective in destroying the HIV and hepatitis B viruses.)
Items for the
laundry should be clearly marked as contaminated so that
laundry staff can take precautions.
Management policy-HIVab+ staff
All state and
territory departments should be responsible and committed to
the management of HIVab+ staff.
The Department of
Corrective Services recognises that the rights and privacy of
the individual are paramount.
policy can only be put into action once an officer comes
forward to identify his/her condition and seek assistance.
confirmation that an officer is HIVab+, the Department
guarantees employment as long as the officer's health and
Department is committed to providing all necessary
counselling and employee assistance programs.
staff will be allowed all necessary time off work to meet
Department will work in conjunction with outside agencies
to ensure the best assistance is available to staff.
In New South
Wales the following procedures are available to HIVab+ staff
members should they choose to seek assistance from the
officer will be referred to the Staff Counsellor who will
coordinate case management.
officer will be referred to the Medical Examination Centre,
Department of Health, for assessment.
Department, following consultation with the officer, may
offer other employment opportunities within the
Department, that is in cases where institutional stress or
personal circumstances are deemed to be detrimental to the
health of the officer.
officer's case will be reviewed as required by the Medical
the Medical Examination Centre advises the Department that
an officer is unfit to continue, medical retirement will
be processed as expeditiously as possible.
Mr Ernie Mason, Belconnen Remand Centre, PO Box 3096,
Belconnen ACT 2617
phone (06) 251 4933 ; fax (06) 251 1615
Mr Peter Byrnes, Occupational Health and Safety Manager, Roden
Cutler House, 24 Campbell Street, Sydney NSW 2000
phone (02) 289 1791 ; fax (02) 289 1399
Occupational Health and Safety Manager, Mr Chris Headland, 77
Waymouth Street, Adelaide SA 5000
phone (08) 226 9160 ; fax (08) 410 0066
Office of Corrections
Occupational Health and Safety Manager, Mr Alfred Tuet, Level
2, 20-22 Albert Road, Sth Melbourne VIC. 3205
phone (03) 698 6664 ; fax (03) 698 6617
Occupational Health and Safety Officer, 441 Murray Street,
Perth WA 6000
phone (09) 426 7500 ; fax (09) 426 7651
Occupational Health and Safety Officer, GPO Box 3196, Darwin
phone (089) 89 5116 ; fax (089) 89 5050
Occupational Health and Safety Officer, Mr Roger Sly, PO Box
24, Lindisfarne TAS. 7015
phone (002) 43 8022 ; fax (002) 43 8997
Occupational Health and Safety Officer, GPO Box 1054, Brisbane
phone (07) 227 4111 ; fax (07) 227 6668
administrators are responsible for providing the necessary
financial and manpower resources to ensure that OH&S
policies, procedures and prevention programs are fully
policies and procedures outlined within this document must
form part of everyday working life. Each person must
accept responsibility for their own safety and the safety
of others. The implementation of the infection control and
general procedures identified in this document are to be
mandatory throughout the Department.
OH&S precautions in prison should be of the highest
administrators must acknowledge and support the continued
education and training of both staff and inmates in regard
to HIV/AIDS and other communicable diseases within the
emphasis must be placed on prevention programs by the
development of specific management policies and
strategies; by taking the necessary steps to establish a
safe environment within prisons; and by influencing the
behaviour of individuals by improving working/living
conditions and by the promotion of risk management and
pre and post-test counselling should be provided to those
who have had work related exposure to all communicable
for the timely provision of available treatments for work
related exposure to HIV/AIDS and all other communicable
diseases should urgently be developed.
rights of HIV antibody positive staff should be
acknowledged and every assistance provided in terms of
psychological/welfare services and management support.
employment of HIV antibody positive staff must be
guaranteed as long as the individual's health and
compensation rights of staff and inmates need to be
investigated and clarified in terms of HIV/AIDS infection.
Urgent provision must be made for prison staff who become
infected whilst carrying out their duties and adequate
compensation incorporated into workers compensation
staff infected by HIV in the course of their duties,
should receive compensation with minimum bureaucratic and
antibody positive prisoners should be integrated within
the normal prison system and should retain the right to
work and recreation programs.
Occupational Health and Safety 1988, 2nd edn, CCH Australia, North Ryde, NSW.
Health and Safety Manual,
(Consulting editor Anne Wyatt), CCH Australia for CCH
International, North Ryde, NSW.
are due to the following for their invaluable contribution to
of Corrective Services
Dawe, Manager OH&S
Doyle, POVB Representative
Delprado, POVB Representative
Fortuin, AIDS Unit and Coordination, National AIDS in Prisons
Information Clearing House
Edwards, AIDS Unit and Coordination, National AIDS in Prisons
Information Clearing House
Adamson, Corrective Services Academy
Scagliotti, Manager, Prison AIDS Projects
Keller, Superintendent, Operations
Franc McLeod, Director
Pooba Govender, Deputy Director
Hospital, Occupational Health and Safety Service
J.M. Dwyer, Prince of Wales Hospital
officers will be provided with a specially designed pouch
containing the items listed below:
of disinfectant (bleach);
AIDS pouches must be worn at all times while on duty.
Bleach solution will have a 12 month shelf life for
sealed units (or must be changed every two days for
self-prepared or unsealed units.)
Issues in HIV/AIDS in the Australian prison system / Judi
ISBN 0 642 18311 2
Canberra : Australian Institute of Criminology, 1992. pp.