There were three main objectives of this cross-sectional study of Maryland State correctional health care workers. The first was to evaluate compliance with work practices designed to minimize exposure to blood and body fluids; the second, to identify correlates of compliance with universal precautions (UPs); and the third was to determine the relationship, if any, between compliance and exposures. Of 216 responding health care workers, 34% reported overall compliance across all 15 items on a compliance scale. Rates for specific items were particularly low for use of certain types of personal protective equipment, such as protective eyewear (53.5%), face mask (47.2%) and protective clothing (33.9%). Compliance rates were highest for glove use (93.2%) waste disposal (89.8%), and sharps disposal (80.8%). Compliance rates were generally not associated with demographic factors, except for age; younger workers were more likely to be compliant with safe work practices than were older workers (P < 0.05). Compliance was positively associated with several work-related variables, including perceived safety climate (i.e., management's commitment to infection control and the overall safety program) and job satisfaction, and was found to be inversely associated with security-related work constraints, job/task factors, adverse working conditions, workplace discrimination, and perceived work stress. Bloodborne exposures were not uncommon; 13.8% of all respondents had at least one bloodborne exposure within the previous 6 months, and compliance was inversely related to blood and body fluid exposures. This study identified several potentially modifiable correlates of compliance, including factors unique to the correctional setting. Infection-control interventional strategies specifically tailored to these health care workers may therefore be most effective in reducing the risk of bloodborne exposures.

Our aim was to determine the incidence of tuberculin skin test (TST) conversion in the Maryland state correctional system. We conducted a historical longitudinal cohort study. A sample of 1,289 inmates, incarcerated in 16 of 23 prisons, who had a negative TST and a second test within 24 months was selected. The incidence of recent conversion was 6.3 per 100 person-years. Risk factors for conversion included high prison-population density (relative risk [RR] = 2.4; 95% confidence interval [CI], 1.5-3.8) and incarceration in a higher-security institution (RR = 2.4; 95% CI, 1.4-4.3). Incarceration in an institution with higher levels of isoniazid prophylaxis (> 65% of TST positives) reduced the risk of infection by 50% (RR = 0.5; 95% CI, 0.3-0.7). Crowding was strongly correlated with risk of conversion (r = 0.83; P < .001), while rates of isoniazid prophylaxis initiation were inversely correlated with risk of infection (r = -0.82; P < .001). In stepwise regression, higher prison-population density was the strongest predictor of increased infection. In a final model, inclusion of the rate of isoniazid prophylaxis initiation reduced the risk associated with crowding (RR = 1.4; P = .4). Annual screening programs for prisons can identify recent conversions that may not otherwise be detected.