Review of enteric outbreaks in prisons: effective infection control interventions

Objectives

To identify documented outbreaks, worldwide, of enteric illness in correctional facilities over the last 10 years to understand the epidemiology of the outbreaks and explicitly identify effective infection control measures.

Study design

Review of literature and outbreak investigation reports.

Methods

Computer-aided searches of literature databases and systematic searches of government websites were completed to identify relevant outbreak reports. Reference lists were hand-searched to validate the electronic search methodology. Reports identified through personal communications with public health officials were also included.

Results

Of the 72 outbreaks meeting the inclusion criteria, 76% and 21% were associated with bacterial agents and viral agents, respectively. The majority of outbreaks were associated with Salmonella (n = 20), Clostridium perfringens (n = 14), norovirus (n = 14), pathogenic Escherichia coli (n = 10) and Campylobacter spp. (n = 5). Transmission was primarily foodborne (67%). During an outbreak, the most common control measures included limiting movements of ill inmates and staff, and their exclusion from kitchen duty. The most common retrospectively reported preventative recommendations included monitoring food temperatures and effective infection control procedures.

Conclusions

It is essential to monitor food temperatures to prevent enteric outbreaks in prisons. Training in safe food handling should be offered to inmates who work in the kitchen. Enteric outbreaks are best controlled by effective infection control practices, while active surveillance and early diagnosis may prevent further spread of illness.