standard surgical mask would protect them from inhalation of aerosolized tuberculosis droplets, and 23 percent thought that correctional health care workers were not at risk for infection with multidrug-resistant tuberculosis. The researchers found that training on tuberculosis risk was inconsistent. Some prison facilities provided extensive training, whereas others provided almost no training. A third of all respondents said that they had received no workplace training at all on tuberculosis in the previous year. Eleven percent of the workers reported that they had not been offered tuberculin skin testing in the previous 12 months, which is in conflict with stated institutional policy. Almost a fifth of respondents reported that they had a positive skin test history, and roughly half of this group said that they had received some type of follow-up care.

A report on the Cook County Jail in Chicago underscores the logistical challenges of implementing tuberculosis control measures to protect jail inmates and staff in a large facility (McAuley, 2000). This jail admits more than 100,000 people a year and houses about 10,000 per day on average, more than the facility was designed to handle. All those detained have a medical evaluation that includes a tuberculin skin test (read within 48 to 72 hours) and a chest radiograph (read within 18 hours). Persons with suspected tuberculosis identified during or after the evaluation are sent to the jail’s emergency room, which has negative-flow isolation rooms. Those who have a suspicious radiograph but are released before it is read are to be seen by a communicable disease investigator and brought to the tuberculosis clinic of the county health department. (An analysis of the experience with this system’s screening strategy is reported later in this chapter.)

An article by Jones and colleagues (1999) about their experience at the Memphis city jail is also illuminating. From January 1995 through December 1998, the Memphis city jail admitted and discharged more than 173,000 individuals, an average of 159 a day. The median length of stay was 1 day, and four-fifths of those admitted had been incarcerated in the jail previously. Single cells held between 18 and 36 inmates, and mingling of inmates was extensive.

Other Surveys

In 1997, the American Federation of State, County, and Municipal Employees (AFSCME) developed separate but similar surveys to collect information about employer compliance with tuberculosis control recommendations affecting health care workers, law enforcement personnel, and social services workers (August, 1999).2 They received responses for


The survey went to approximately 100 district councils (which distributed them to local unions) and large unaffiliated local unions. Of the 170 responses, some came from employers, but most (145) came from workers. Reporting on skin test conversions and cases of tuberculosis was incomplete, but cases of disease were reported in all sectors.

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