Investigators from the Missouri Department of Health and Senior Services conducted a case-control study to examine the risk factors for MRSA infection during a 2002-2003 outbreak in a Missouri women's correctional facility. The study, which largely focused on personal hygiene factors, found that MRSA infection was significantly associated with low composite hygiene scores among the prisoners, after controlling for socio-demographic and other risk factors. The composite hygiene score was created on the basis of three individual hygiene practices: the frequency of hand washing per day, showers per week, and number of personal items shared with other inmates. Of the 55 confirmed MRSA cases, thirty were still available for interview at the time of investigation and 80 inmates were randomly selected as controls. Transmission among inmates appeared to be responsible for the outbreak as pulsed-field gel electrophoresis demonstrated that MRSA isolates were indistinguishable.

Based on these results, the authors conclude that a prison environment can easily become contaminated by MRSA, especially due to the inmates' improper care of infected skin lesions, poor personal hygiene, and close contact within a confined space. The study was limited by the recall bias of participants and the findings may not be applicable to other populations as all subjects were adult women. However, the authors assert that targeted education about MRSA infection, especially the importance of proper personal hygiene, should be an integral part of efforts to eliminate and prevent MRSA infections in prison settings, where inherent restrictions complicate the implementation of certain control measures.

In this study, published in The Lancet, investigators reviewed published research examining the prevalence and transmission dynamics of MRSA infection in two high-risk groups: prisoners and military enlistees. Significant risk factors included prison occupation, gender, comorbidities, prior skin infection, and previous antibiotic use. Although several studies suggest that crowded living and work environments, demanding physical activity, and poor hygiene are important risk factors, the authors found few studies that directly tested the epidemiological association with these suggested risk factors. Given the inherent barriers to infection control measures in these populations, the authors are concerned by the overall lack of research in these areas. Additionally, most of the identified studies were retrospective in design, with only one study utilizing prospective surveillance for MRSA colonization. Thus, the authors propose that future research seek to quantify the prevalence of MRSA infection among the entire population in prisons and military settings, rather than only those individuals affected by outbreaks. A more thorough examination of MRSA acquisition and transmission patterns in these settings might elucidate improved preventive strategies in other crowded and closed settings.

In a study of 100 randomly selected male inmates within the Rhode Island Department of Corrections Jail (RIDOC) - the central facility serving the entire state of Rhode Island - researchers found that there was high acceptance of rapid HIV testing (95/100). Participants in the study completed a questionnaire regarding risk-behavior, incarceration history, HIV-testing history, and attitudes towards testing. Each prisoner then received individualized HIV risk reduction counseling and the option of rapid HIV testing via the OraQuick Rapid HIV test (a blood-based test that returns results in 20-30 minutes). Almost all participants agreed that jail is a good place to perform HIV screening (96/100) and most supported partner notification by the state (83/100).

The findings of this study are significant, the authors suggest, because rapid testing, unlike the more traditional screening methods, allows for the immediate delivery of results and post-test prevention counseling. In this study, all participants received rapid test results and individualized risk reduction counseling prior to release. Despite the improved delivery of final negative results, the obstacle of providing confirmatory results for those subjects with rapid test preliminary positives remains. The one preliminary positive participant in the study was released from the facility prior to receiving his confirmatory test result. In assessing the limitations of the study, the investigators note the small size of the study and the relative comfort of RIDOC inmates with HIV testing in the corrections setting. Nonetheless, the authors highlight the feasibility and overall high acceptance of rapid HIV testing and suggest that further studies are needed to incorporate rapid testing into jail HIV-screening programs.