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TVA foots the bill for installing new system
No one disputes that the Memphis/Shelby County (TN) jail has more than its share of problems, including overcrowding, high staff turnover, screening procedures that until recently were full of gaping holes, and TB rates that have recently soared to as high as 250/100,000.
All of that makes one recent development at the jail especially welcome. In what county authorities say is a first for U.S. jails, ultraviolet germicidal irradiation has been installed in all six of the jail’s air-handling units — and for free, thanks to a grant from the Tennessee Valley Authority (TVA)n working together with the city utility company.
"You don’t normally think of a power company trying to stamp out TB, and we’re very grateful to them," says Francis Fountain, MD, medical adviser to the Shelby County TB control program.
The UV fixtures have been installed inside the jail’s ventilation system, and not as free-standing fixtures, adds Fountain. Their manufacturer claims they’ll kill 99.9% of airborne pathogens, TB included. The one place the lights haven’t been installed is inside the jail’s medical facility, where air is exhausted directly to the outside, Fountain adds.
The decision to install UV lights — as opposed to, say, purchasing a digital chest X-ray unit — was based partly on the need not to add any new steps to the intake process, says Vincent Glover, manager of the county health department’s infectious disease program. "They process someone through the intake facility once every seven minutes, and they contend that adding anything at all to the process that make it longer is simply not acceptable," Glover adds.
The jail is the fifth-largest in the country. With a daily census that stands at about 2,800 people, it’s operating at almost twice its capacity of 1,600 people. The Criminal Justice Center, the intake point for the system, is supposed to feed inmates into other county-run facilities after 10 days, Fountain explains. Inmates who are sentenced to more than a year are supposed to be shipped off to the prison system. In reality, the intake facility acts as a bottleneck, meaning the jail functions as a de facto prison system.
To make things worse, the county mental health facility has only 125 beds, says Glover. That means the jail also acts as a holding tank for mentally ill homeless residents of the city. At any given point in time, he estimates, there are upwards of 500 mentally ill inmates housed in the jail.
All these problems must be managed on a meager budget of $2.5 million in funds from the county, Glover adds. The result is high turnover among the jail staff, a fact Glover says is hardly surprising. "The jail administration doesn’t want to take TB home to their families," he notes. "As I see it, the biggest problem is the lack of funding made available to the jail."
Along with engineering the collaboration with TVA that brought in the UV fixtures, TB controllers have been hard at work overhauling screening procedures at the jail, says Glover. From skin-testing just 200 people a year, the jail is now up to testing 5,000 a year, with male inmates having to wait no more than 10 days
for a TB test, Glover says.
At the women’s jail, new screening policies are about to go into effect that will skin-test female inmates as soon as they hit the door. Along with mandatory TB testing, HIV and syphilis testing are being offered at the same time, and syphilis case-finding is up substantially as a result, says Glover.
"As I look back over the last two years, I can see considerable changes," Glover says. One of the most promising changes is the construction of a new intake facility, now under way. "That should reduce some of the chaos and the backlog," Glover notes. "Maybe eventually it will give us the chance to do screening on intake" at the men’s jail as well, he adds.