COMMISSIONER'S DIRECTIVE

MANAGEMENT OF INFECTIOUS DISEASES

Policy Bulletin 181

Guidelines 821-2 - Bleach Distribution

POLICY OBJECTIVE

1. To contribute to public health and a safe and healthy environment through a comprehensive infectious diseases program.

AUTHORITY

2. Corrections and Conditional Release Act, sections 69, 70, 85-88.

CROSS-REFERENCES

3. Commissioner's Directive 800 - Health Services;
Commissioner's Directive 803 - Consent to Health Services Assessment, Treatment and Release of Information;
Protocol 821-1 - Managing Exposure to Blood and/or Body Fluids;
Guidelines 821-2 - Bleach Distribution.

DEFINITIONS

4. Infectious diseases are those which can be transmitted from one person to another and include:

1. those contracted through exposure to blood or body fluids of an infected person;
2. sexually transmitted diseases; and
3. those contracted through exposure to airborne droplets (e.g. tuberculosis and influenza A).

5. Harm reduction is a policy, a program or a measure aimed at reducing the negative health, social and economic consequences of harmful behaviours such as injection drug use and unsafe sex. Harm reduction items such as condoms and bleach reduce the risk of transmission of disease and the harms consequent to infection.

6. Standard precautions are a set of precautions to be employed at all times when a person is in contact with potentially infectious materials such as blood and body fluids.

7. Surveillance is the process of collecting, analyzing, and sharing information about diseases occurring in a population so that the appropriate prevention, education and treatment requirements can be identified.

PRINCIPLES

8. CSC shall be guided by public health principles in managing infectious diseases in the penitentiary environment.

9. A full range of infectious diseases program elements, including but not limited to screening/testing, immunization, education and training, harm reduction measures, care and treatment, surveillance activities, and partnerships, shall be implemented based on best evidence and public health expertise.

10. The gender and cultural requirements of individuals and groups shall be respected and reflected in all activities aimed at addressing infectious diseases in the inmate population.

11. Approved harm reduction items shall be readily and discreetly accessible to inmates in CSC operational units so that no inmate is required to make a request to a staff member for any item.

12. Staff and inmates have a personal responsibility to take precautions to avoid contracting and transmitting infectious diseases and to participate in training and education provided to them.

13. Inmates living with infectious diseases shall be provided with humane treatment and support, in an environment free of discrimination.

14. An inmate's infection status shall remain confidential and shall not be released without his or her consent except as explicitly permitted by CD 803 - Consent to Health Services Assessment, Treatment and Release of Information and by Protocol 821-1 - Managing Exposure to Blood and/or Body Fluids.

15. Wherever possible and appropriate, opportunities for community service agencies and peer involvement in the delivery of education and counselling to inmates on infectious diseases shall be pursued. The Peer Education and Counselling (PEC) Program must be put in place at all penitentiaries with the exception of mental health units and reception units.

RESPONSIBILITIES

16. The Director General, Health Services is responsible for the development and delivery of a national infectious diseases program.

17. The Regional Deputy Commissioner is responsible for ensuring the overall regional implementation of the infectious diseases program.

18. The Institutional Head is responsible for ensuring:

1. that training and education is provided to staff and inmates on a regular basis which includes:
   1. the principles of standard precautions to prevent and control diseases,
   2. their personal responsibility to protect themselves and others at all times, and
   3. the principles of harm reduction;
2. that training and education provided to inmates also include:
   1. available services and treatments, and
   2. the Peer Education and Counselling Program;
3. that inmates and staff involved in the handling and clean-up of blood and body fluids are trained in the use of and provided with protective clothing and equipment;
4. that approved harm reduction items are available as provided in this policy; and
5. that procedures are in place for the follow-up of any inmate or staff member exposed to the blood or body fluids of any other person as per Protocol 821-1 on Managing Exposure to Blood and/or Body Fluids (attached to this Directive).

19. The Chief, Health Services is responsible for ensuring:

1. that pre-test and post-test counselling is offered to all inmates at admission and throughout their incarceration;
2. the provision of quality clinical care and treatment to inmates living with infectious diseases, including continuity of care when transferred to another institution and pre-release planning for their return to the community;
3. the accuracy and currency of statistical reporting on infectious disease, including rates of testing and immunizations; and
4. quality control of the harm reduction measures at the institution, sterilizing procedures, and management/transportation of biohazardous waste.

ORIENTATION FOR NEW ADMISSIONS

20. CSC's Reception Awareness Program will provide standard content for the initial introduction of newly admitted inmates to services available to them to address infectious diseases and substance abuse issues.

HARM REDUCTION

21. The Institutional Head shall ensure that non-lubricated, non-spermicidal condoms, water-based lubricants, dental dams and bleach are discreetly available to inmates at a minimum of three locations, as well as in all private family visiting units.

22. Bleach and instructions on disinfecting with bleach shall be made available in accordance with Guidelines 821-2 on Bleach Distribution.

SCREENING/TESTING

23. An assessment of risk behaviours and screening for infectious diseases by means of a questionnaire and a physical examination shall be done for all inmates at admission and reviewed regularly during incarceration.

24. All inmates presenting themselves for testing shall be offered pre-test and post-test counselling by a health services professional.

25. Tuberculosis shall be managed in accordance with the Tuberculosis Prevention and Control Guidelines for Federal Correctional Institutions.

26. Screening for sexually transmitted diseases (STD) shall be carried out in accordance with the Canadian STD Guidelines.

IMMUNIZATION

27. Each inmate shall be offered immunization as recommended in Health Canada's Canadian Immunization Guide.

POST-EXPOSURE PROPHYLAXIS

28. In order to ensure consistent and prompt response in the event of exposure to the blood or body fluids of another person, Protocol 821-1 on Managing Exposure to Blood and/or Body Fluids shall be followed in all cases.

MANAGEMENT OF INMATES LIVING WITH INFECTIOUS DISEASES

29. Inmates living with infectious diseases shall normally be housed with the general inmate population unless they require a level of care which cannot be provided outside a health care setting.

30. Clinical isolation shall only be considered when following protocols of infection control.

31. Inmates living with infectious disease shall:

1. be offered the same opportunities as other inmates to participate in educational, job, vocational or other programs, except where limitations to a specific assignment are clinically indicated; and
2. have access to the full range of available institutional counselling and support services and, to the greatest extent possible, to local community counselling and support services.

PRE-RELEASE PLANNING FOR INMATES LIVING WITH INFECTIOUS DISEASES

32. Inmates who require ongoing medical care for the treatment of an infectious disease shall be:

1. referred to the full range of community treatment resources prior to their release;
2. given a summary of their related health care information for the benefit of their health care providers in the community;
3. provided with information on groups which offer education and support services in the community in which they will be residing; and
4. encouraged to establish contacts with education or support groups in the community.

SURVEILLANCE

33. CSC's Health Services shall ensure that data on infectious diseases in the inmate population are routinely collected, reported and disseminated, while protecting the confidentiality of health information relating to individual inmates.

34. Cases of infectious diseases shall be reported and managed in accordance with provincial or territorial regulations.

PARTNERSHIPS

35. CSC's Health Services shall ensure that partnerships are established nationally, regionally and locally with other federal departments, provincial and municipal governments, service agencies and stakeholder groups, in order to ensure the sharing of information, best practices, and expertise.

Acting Commissioner,

Original signed by :
Don Head

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