Australia's response to AIDS in Prison

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 management.

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 Crown.

Common law responsibilities

Before discussing 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 responsibilities.

Under common law, every employer has the duty to provide the following:

competent staff;
a sufficient number of workers to do the work safely;
a reasonably safe place to work;
appropriate plant and equipment; and
a 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:

Prevention
Rehabilitation
Compensation

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 legislation

The purpose of the legislation is to ensure the health, safety and welfare of all persons at work.

These Acts protect the health, safety and welfare at work of:

all persons - including self-employed, visitors and prisoners in the workplace;
all workplaces (including prisons); and
all employees - including public servants ('binds the Crown').

Clearly, the 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.

Prevention HIV/AIDS prevention programs should be directed towards the following areas:

Development 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.
Establish 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.
Behaviour of individuals: Management must aim to develop an organisational climate that raises the awareness of staff and inmates and promotes safe behaviour.
Education 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.

Rehabilitation

WorkCover legislation

Example: 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:

establish a rehabilitation program in the workplace;
appoint a rehabilitation coordinator;
increase occupational health and safety standards within the workplace; and
provide 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 prison system.

Compensation

Workers 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.

Compensation 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.

Workers 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

Procedures/management policies

A communicable 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.

Communicable diseases In 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 infectious.
Blood soaked clothing is to be treated as infectious.

Hepatitis B 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 include:

Handling of items of clothing/bedding and areas that have been exposed to blood, semen, faeces, urine, pus or vomit.
Injuries inflicted on staff members, e.g. biting, body blows, needle sticks, splashing with blood, body fluids.
Accidents and injuries (e.g. in workshops).
Response to crises requiring mouth-to-mouth resuscitation.
Handling violent prisoners.
Reception of prisoners - handling prisoners' property.
Transport of prisoners - escort and removals.
Kitchen areas.
All searching, including cell/general/body.
Cleaning of body fluids.

OH&S 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.

IMPORTANT: These areas should be clearly marked so that all staff are aware of their location and content.

Equipment

a mop and bucket;
bleach solution;
mirrors (for searching);
sharps containers;
contaminated waste bags;
disposable protection suits, kits, etc.;
disposable gloves;
face masks and/or protective glasses (to protect eyes and mouth);
saline solution (to flush the eyes);
masks (for resuscitation).

Other equipment freely available to all staff:

antiseptic handwash;
airstrip (waterproof) dressings;
bleach sachets (powder bleach);
AIDS pouches (NSW), Infection Control Pouches (Victoria).

Infection control procedures

IMPORTANT: Staff must always follow infection control procedures

Before 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.
Cover all exposed wounds with Airstrip waterproof dressings.
Never put your hands where you cannot see (use a mirror).
Wear disposable gloves if you are likely to come into contact or where there is a potential for contact with blood or body fluids.
Wear eye and mouth protection in the likely event of blood splashes.
Intact skin which has been splashed with blood or body fluids should be bathed or showered as soon as possible.
Use sharps containers for the safe removal and disposal of syringes, knives, razor blades, tattoo guns, etc.
Use 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.
Use contaminated waste bags for the safe removal and disposal of any articles soiled by blood or body fluids.
Use an airway mask with one-way valve while giving mouth-to-mouth resuscitation e.g. laerdal mask.
Avail yourself of the Hepatitis vaccination and have a follow-up blood test so as to be aware of your Hepatitis B antibody status.
Wash your hands regularly.

General procedures-institutional staff

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:

Responsibility:

It is the responsibility of the Department to provide the necessary financial resources to permit the full implementation of these policies/procedures.
It is the responsibility of management to provide TRAINING to all staff.
It 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 aid cabinets.
The Superintendent must prominently display these procedures and ensure that they are known and understood.
It 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.
It 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.

Procedures to be followed in the event of needle stick injuries or exposure to blood or body fluids

Administer First Aid, encourage bleeding and clean the wound with bleach or hot soapy water. Cover the wound with a sterile dressing.
Seek 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. Zidovudine (AZT).
Trauma support should be made available to staff as a matter of course.
In 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 the eyes.)
Submit 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 Services Division.
NOTE: Local reporting procedures should be followed.

Procedures to be followed in the event of exposure to saliva

Immediate response following exposure to saliva from such sources as spitting incidents or during mouth to mouth resuscitation.

Irrigate affected area liberally with water repeatedly.
A mouth wash may be used (Chlorhexdine or Hydrogen Peroxide) have been recommended.
Eye wash may be used to irrigate eye. This may be especially important if clean running water is not available.

In cases of real concern where an officer is considered to be at risk or where exposure to a known hepatitis B carrier is confirmed:

The 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 known.

Handling of prisoners' property-reception and transport

Officers concerned with the handling of prisoners' property must follow infection control procedures.

In particular,

wear the gloves supplied;
dispose of gloves as contaminated garbage on completion of the task;
wash hands immediately after disposing of the gloves.

Body searching/cell searching/general searching

Officers involved in searching must follow infection control guidelines:

wear the gloves supplied;
Take extreme care when searching - use pens, mirrors, rulers, etc. where you cannot see;
On completion of the task, dispose of gloves as contaminated garbage.
Wash hands using hot soapy water immediately after removing and disposing of gloves.

Officers are 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 searching.

Splashing of body fluids

Where splashing 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.

Retaining sharp contaminated objects

On occasions 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.

Kitchens

A high standard of personal hygiene is to be maintained in food handling areas. Kitchens are to be maintained in a clean and hygienic state.

Trauma support service

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:

needle stick injuries
blood and/or body fluid spills
mouth-to-mouth resuscitation of prisoners
assaults
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.

Specific guidelines

Handing or cleaning areas contaminated by body fluids or excreta Officers must avoid bare-handed contact with contaminated articles.

Cleaning:

Wear gloves
Pour disinfectant or bleach onto the waste products, leave for 30 minutes, then clean with disposable paper towelling/Chux (use gloves).
On 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.
Dispose of the garbage, paper towelling/Chux and gloves as contaminated waste.
Wash your hands immediately after discarding gloves and garbage.

Response to 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.

Disposal of AIDS and hepatitis B contaminated garbage

Contaminated garbage

Any 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 contaminated waste.

N.B. Yellow plastic infectious waste bags should be located in wings, workshops and office areas. These bags should not be used for any other purpose.

Disposal of Waste

For 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.

Liquid waste should be disposed of, wherever possible, into the sewerage via a toilet rather than hand-basin, kitchen sink or laundry tub.

Laundering of 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.

This management policy can only be put into action once an officer comes forward to identify his/her condition and seek assistance.

Policy

Upon confirmation that an officer is HIVab+, the Department guarantees employment as long as the officer's health and circumstances permit.
The Department is committed to providing all necessary counselling and employee assistance programs.
HIVab+ staff will be allowed all necessary time off work to meet medical needs.
The Department will work in conjunction with outside agencies to ensure the best assistance is available to staff.

Procedures

In New South Wales the following procedures are available to HIVab+ staff members should they choose to seek assistance from the Department:

The officer will be referred to the Staff Counsellor who will coordinate case management.
The officer will be referred to the Medical Examination Centre, Department of Health, for assessment.
The 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.
The officer's case will be reviewed as required by the Medical Examination Centre.
Once the Medical Examination Centre advises the Department that an officer is unfit to continue, medical retirement will be processed as expeditiously as possible.

Contact Services

· Australian Capital Territory
Mr Ernie Mason, Belconnen Remand Centre, PO Box 3096, Belconnen ACT 2617
phone (06) 251 4933 ; fax (06) 251 1615

· New South Wales
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

· South Australia
Occupational Health and Safety Manager, Mr Chris Headland, 77 Waymouth Street, Adelaide SA 5000
phone (08) 226 9160 ; fax (08) 410 0066

· Victorian 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

· Western Australia
Occupational Health and Safety Officer, 441 Murray Street, Perth WA 6000
phone (09) 426 7500 ; fax (09) 426 7651

· Northern Territory
Occupational Health and Safety Officer, GPO Box 3196, Darwin NT 0801
phone (089) 89 5116 ; fax (089) 89 5050

· Tasmania.
Occupational Health and Safety Officer, Mr Roger Sly, PO Box 24, Lindisfarne TAS. 7015
phone (002) 43 8022 ; fax (002) 43 8997

· Queensland
Occupational Health and Safety Officer, GPO Box 1054, Brisbane QLD 4001
phone (07) 227 4111 ; fax (07) 227 6668

Recommendations

Prison administrators are responsible for providing the necessary financial and manpower resources to ensure that OH&S policies, procedures and prevention programs are fully implemented.
The 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.
The OH&S precautions in prison should be of the highest quality.
Prison 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 prison system.
Continued 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 personal safety.
Quality pre and post-test counselling should be provided to those who have had work related exposure to all communicable diseases
Procedures for the timely provision of available treatments for work related exposure to HIV/AIDS and all other communicable diseases should urgently be developed.
The rights of HIV antibody positive staff should be acknowledged and every assistance provided in terms of psychological/welfare services and management support.
The employment of HIV antibody positive staff must be guaranteed as long as the individual's health and circumstances permit.
The 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 legislation.
Prison staff infected by HIV in the course of their duties, should receive compensation with minimum bureaucratic and legal impediments.
HIV antibody positive prisoners should be integrated within the normal prison system and should retain the right to work and recreation programs.

References

· Planning Occupational Health and Safety 1988, 2nd edn, CCH Australia, North Ryde, NSW.

· Workplace Health and Safety Manual, (Consulting editor Anne Wyatt), CCH Australia for CCH International, North Ryde, NSW.

Acknowledgments

Special thanks are due to the following for their invaluable contribution to this paper:

· Department of Corrective Services

o Shirley Dawe, Manager OH&S

o John Doyle, POVB Representative

o Greg Delprado, POVB Representative

o Judi Fortuin, AIDS Unit and Coordination, National AIDS in Prisons Information Clearing House

o David Edwards, AIDS Unit and Coordination, National AIDS in Prisons Information Clearing House

o Eileen Adamson, Corrective Services Academy

o Louisa Scagliotti, Manager, Prison AIDS Projects

o Ken Keller, Superintendent, Operations

· Prison Medical Service:

o Dr Franc McLeod, Director

o Dr Pooba Govender, Deputy Director

· Sydney Hospital, Occupational Health and Safety Service

o Professor J.M. Dwyer, Prince of Wales Hospital

Appendix A

AIDS Pouches

All officers will be provided with a specially designed pouch containing the items listed below:

adhesive pads;
waterproof dressings;
durable, disposable gloves;
container of disinfectant (bleach);
container of mouthwash;
swabs;
resusci face shield.

8. AIDS pouches must be worn at all times while on duty.

9. 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.)

Originally published:
Issues in HIV/AIDS in the Australian prison system / Judi Fortuin (ed.)
ISBN 0 642 18311 2
Canberra : Australian Institute of Criminology, 1992. pp. 65-82

Issues in HIV/AIDS in the Australian prison system

Occupational health and safety in prisons