Deadly Staph Infection 'Superbug' Has a Dangerous Foothold in U.S. Jails

Dr. Jeff Duchin, the communicable diseases chief for Seattle/King County Department of Public Health holds his soap-lathered hands in an attention-grabbing newspaper cover photo. Above his dignified image is a highly magnified picture of fuzzy bacterium. The bacterium doesn't appear to be particularly frightening, but it is. This "superbug," known as methicillin resistant staphylococcus aureus (MRSA), has the power to disable, disfigure and kill the people who come into contact with it.

Like so many other regional and national newspaper and magazine stories about MRSA's creeping presence in the nation, this feature in the Nov. 26, 2007, issue of the Seattle Times was chock-full of useful, preventative information. Among the key, common sense suggestions were for readers to remember that MRSA isn't limited to the transfer of blood or bodily fluids. While not airborne in the way that tuberculosis is (although MRSA has been known to be transmitted by sneezing), the bacterium spreads with tremendous ease by way of skin-to-germ contact. The article advised people to remember to wash their hands regularly; to avoid unbleached public washing facilities; not to share towels, razors, or any kind of shared drug paraphernalia; and to have the "courage" to be willing to ask medical personnel if they've washed their hands before touching you.

The Centers for Disease Control and Prevention CDC has rightfully called MRSA (pronounced mer-sa) the "cockroach of bacteria." It spreads silently and stealthily, and moves quickly from one location to the next. Once it's around, it's also incredibly difficult to get rid of because this virulent mutation of staph is resistant to all but the most rare and expensive antibiotics. Sometimes, even the super drugs don't work against this superbug, resulting in some 19,000 deaths in 2005, amounting to more than one in five of the estimated 94,000 Americans walking around MRSA lurking on skin surfaces and in nasal cavities.

Media headlines have emphasized the existing or potential presence of MRSA in hospitals and schools: at least three students are known to have died from the bacteria. "[D]rug-resistant strains of the bacteria are finding new homes in the community -- particularly among kids," as a recent Time article, "Staph on the March," warned readers.

Given this level of justifiable media and public attention to the dangers of MRSA, it's remarkable to note how little attention is being paid to the kinds of facilities where the superbug thrives and spreads the fastest: poorly ventilated living and sleeping quarters; overcrowded rooms; shared mattresses, toilets and showers; and a preponderance of people who arrive with poor health, drug problems and severely compromised immune systems. Homeless shelters and emergency rooms serving indigent populations are among them, but there is no question that the biggest incubators of all are the nation's 5,000-plus prisons and jails.

"MRSA is running rampant through prisons and jails in the country," says Paul Wright, editor of Prison Legal News and co-editor of the newly published book Prison Profiteers: Who Makes Money from Mass Incarceration. "Prisons and jails have historically been the incubators of disease, and that trend continues today. A disproportionate number of people with infectious diseases, including MRSA, will cycle through jails and prisons each year."

The exact number of people entering the criminal justice system with either the regular or superbug version of staph is unknown, owing to a combination of factors. For one, not all people who harbor the bacterium present symptoms. For another, most jails and prisons do not regularly test for or report it.

It would be easy to dismiss the prevalence of MRSA in jails and prisons as something that happens to people who are so irresponsible that they don't take the time to clean themselves or their cells. But stereotypes like these don't hold true once prisoners are actually given the opportunity to explain or demonstrate what their living conditions are like. Yes, many men and women enter the criminal justice system out of unstable, impoverished environments that have already put them at risk because of behaviors attendant to high-risk lifestyles. Like most Americans, people who end up behind bars don't actually know much of anything about how MRSA is spread, what signs of infection to look for -- or even, for that matter, that the bacterium exists.

Even those prisoners who understand how MRSA is transmitted and who seek the proper precautions tend to find that they cannot. Prisoners with obvious signs of infection are rarely separated from the general population and are commonly told that they are simply dealing with pimples or spider bites when they complain about sores or boils on their body that do not seem to heal.

Such was the case when I traveled to the state women's prison in Grants, N.M., in 2005. The prison, run since the early 1980s by the Corrections Corporation of America, had a veritable epidemic on their hands, something that even some staff admitted to me under the condition that I not publish their names. Many women called me over to so that I could witness the jarring sight of large, oozing, open sores, usually on their upper legs. None of the women with whom I spoke were receiving medical treatment; all had been told that their sores were the result of insect bites or their own unwillingness to stay clean. The women complained, in hushed tones, that the prison had yet to put an emphasis on providing enough soap and sanitary conditions to stem the spread of the bacteria.

Prisoners across the nation echo these concerns. It is not unusual for me to hear (or notice) that low-quality soap is doled out in very limited amounts; prisoners routinely complain about not having enough to last them through the week. Even having access to soap isn't a guarantee of being able to wash one's hands to get rid of surface germs, because the tap water made available to prisoners is often lukewarm or cold. The same is true for the availability of bleach to clean showers, toilets, as well as antiseptic cleanser for shared gym equipment. Antibacterial hand cleansers are so rare in prisons and jails as to be notable when they are available.

In Washington state prisons, prominent signs have been placed to warn correctional employees and visitors alike of the dangers of MRSA infection in the facilities, yet prisoners must grow accustomed to lack of soap, hot water, and unclean showers and other shared areas. (Worse yet, the possession of unauthorized, "contraband" antibacterial gel or antiseptic hand wipes is actually a punishable offense!)

In most jails and prisons, topical salves, gauze and bandages are rarely provided to prisoners with boils or sores that could well indicate MRSA infections. Many jail and prison employees are overworked and delay and deny prisoner requests to be seen and treated for even the most obvious health problems. Medical co-pays of $5 to $10 are yet another common barrier, because many prisoners simply don't have the means to afford what might seem to be a nominal amount in the "free world." Add to all of this the endless recycling of prison mattresses and poorly cleaned bedding and clothing, and it's easy to see why jail and prison environments are ripe for the spread of MRSA.

States known to have particularly serious outbreaks of MRSA in detention facilities include Massachusetts, Michigan, Pennsylvania, Alabama, Mississippi, Ohio and California. (The latter lays claim to unbearably overcrowded jails and prisons in which two-person cells are sometimes packed with eight people and in which dayrooms or gyms have been converted into a crazy jumble of bunk bed "housing" areas.)

When I traveled in early 2007 to research the women's jail in Los Angeles County, I entered the Lynwood facility with full knowledge of the reoccurring problem of large-scale MRSA infections in what has become the nation's largest jail system. One of the primary reasons for the frequency of outbreaks of MRSA in the Los Angeles County jail system has unquestionably had to do with severe population overcrowding.

When New York Times reporter Brent Staples visited the Los Angeles County Jail system in 2004, he noted that staph infections were "raging through the cellblocks." Inmates crowded at the bars, Staples wrote, to show him their lesions, not unlike what I had witnessed in the women's prison in New Mexico. "[J]ails that cannot organize themselves well enough to provide clean sheets stand little chance of success against heavyweight infectious diseases that have become endemic behind bars today."

Widespread staph infections in Los Angeles County jails didn't just happen to coincide with Staples' visit. In 2003, the Los Angeles County Department of Health Services investigated an outbreak among inmates, citing at least 1,000 cases of either the "regular" kind of staph infection or MRSA when they began their research. The department documented hundreds of new cases each month after the original investigation was under way. Less than ten percent of the infected inmates were believed to have entered the jail system with the staph bacterium, which meant that nine out of ten acquired staph within the jail setting.

During my visit to the Lynwood facility, I walked into the area containing what are known as "in-transit" holding cells, where inmates are placed when they are en route to, or returning from, court hearings in various parts of the county. These women had already been booked into the jail and could have been promptly returned to their housing units, but staffing constraints mandated a "holding" period. I was especially alarmed to see that more than 20 women were constrained in one small cell. Although at least a half-dozen adjacent cells sat empty, these women had been crammed into a space that had probably designed to hold six to eight inmates, at most. There were no bars, only something that looked like a Plexiglas window with a small vent on the bottom half. Several women crammed around it, trying to get gulps of fresh air -- or the closest thing approximating it inside this jail. These utterly miserable-looking women had squeezed themselves into every nook and cranny of the cell, which held one toilet in the back and a single pay phone. There were no towels, linens, mattresses or antibacterial gel in this cell.

If even one of those women entered that cell harboring tuberculosis or MRSA, it would be more than likely that at least one other person would acquire an infection, something that almost never makes the news until a full-blown epidemic is under way or a major lawsuit threatens to cost a government agency a pretty penny.

The notable exception where media exposure is concerned has been the spread of MRSA to guards and healthcare workers. Among many other similar situations in local jails and state prisons, prison employees have sued over unchecked and unaddressed MRSA infections that spread to spouses, children and acquaintances. Lawsuits across the country have emphasized that the top-level brass have shown disregard for educating frontline prison staff about MRSA, including information about symptom identification or simple prevention strategies -- even in the midst of what were later disclosed to be outbreaks in the captive population.

There have been many outrageous cases along these lines, including that of prison employees hospitalized for long periods of time because of resulting disabilities. One of those cases included a nurse in the Calhoun County Jail in Michigan who acquired MRSA from two prisoners who both died within the space of 13 hours. One of those prisoners had sneezed on the nurse in March 2005, and she developed such severe complications from the ensuing infection that part of her foot was amputated. In West Palm Beach, Fla., an assistant public defender almost lost an arm to MRSA when he contracted the disease from a client in a severely overcrowded, unsanitary jail in which 200 prisoners contracted the superbug within just a three-month span in early 2004. More recently, the California Department of Corrections and Rehabilitation was fined $21,000 for failing to take appropriate measures to prevent employees at the massive Folsom State Prison from acquiring MRSA infections. Many guards were hospitalized before the prison administration admitted that they had an outbreak on their hands.

From 2005 to 2006, the nonpartisan Commission on Safety and Abuse in America's Prisons looked at a multitude of issues and crises facing the American prison system, including the prevalence of untreated infectious diseases. The resulting June 2006 report, "Confronting Confinement," strongly recommended that prison and jail systems should join public health providers in "the common project of delivering high-quality healthcare that protects prisoners and the public."

The commission went further to insist that every detention facility in the United States should "screen, test and treat for infectious diseases under the oversight of public health authorities ... and ensure continuity of care upon release."

There have been a few moves toward that end that deserve recognition, including the Broward County jail system in Florida, which developed a program in 2004 to identify and treat each infection in order to stave off a larger outbreak. Each housing unit has information about MRSA, including color photos of common symptoms related to the infection. Staff education is an integral part of this program, and cultures are taken immediately of any prisoner or jail employee suspected of harboring staph. If cost-saving is the ostensible reason behind the lack of intervention in most jails and prisons, Broward County's model highlights the opposite. Rather than deal with sky-high medical costs, the very real risk of serious illness or death, lawsuits, prison and community outbreaks, jail administrators and medical personnel have opted for a much more logical and humane approach.

The jail system spends just $28 for each staph culture taken and to treat any infection aggressively by means of medication and the separation of an infected person from the general jail population until the person has recovered.

As noteworthy as it is, the Broward County model is exceptionally rare in our prison-crazed nation, which already bears a crown of shame for the incarceration of more people per capita than any other country in the world. Mass incarceration is a foolish and primitive approach to "public safety," and the most common underlying factors in prisoners' lives: mental illness, poverty, drug addiction, histories of trauma, unemployment, unstable housing or homelessness, and other damaging variables. Unfortunately for all of us, the overpopulation of jails and prisons is widely predicted to worsen over the next several years, at great, multitudinous cost to our society.

People deprived of their liberty as punishment should not be sentenced to suffer needlessly. While genuine prison depopulation and meaningful criminal justice reform will take untold years or decades to accomplish, we have the opportunity to reconceptualize at least this one aspect of incarceration -- and, hopefully, to move forward from there. Namely, jails and prisons should be viewed as an opportune setting in which trained professionals could address high-risk behavior, intervention and the effective treatment of health and medical problems (most notably in the prevalence of drug addiction, mental illness and infectious disease).

Considering that at least 95 percent of American prisoners will eventually be released -- at over 650,000 people per year -- local governments and jail/prison administrations should be setting their sights on the value of educating prisoners so as to prevent dangerous epidemics from raging behind prison walls and beyond. Moreover, improving and sanitizing living conditions in jails and prisons should be seen an absolute imperative for the sake of public health and human dignity.

The way in which the MRSA superbug in prisons continues to be treated (or untreated, as is usually the case) is a direct and ugly consequence of the dehumanization of men, women and youth locked away from our collective consciousness. Indeed, a "don't ask, don't tell" approach toward the deadly MRSA infection among our captive populations is ignorant and baffling at best, callous and sadistic at worst.