SARS-CoV-2 Infection Among Correctional Staff in the Federal Bureau of Prisons

Objectives. To examine SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) epidemiology and risk factors among Federal Bureau of Prisons (BOP) staff in the United States. Methods. We calculated the SARS-CoV-2 case rate among 37 640 BOP staff from March 12 to June 17, 2020, using payroll and COVID-19–specific data. We compared occupational factors among staff with and without known SARS-CoV-2 using multiple logistic regression, controlling for demographic characteristics. We calculated relative risk among staff in stand-alone institutions versus complexes (> 1 institution). Results. SARS-CoV-2 was reported by 665 staff across 59.8% of institutions, a case rate of 1766.6 per 100 000. Working in dorm-style housing and in detention centers were strong risk factors, whereas cell-based housing was protective; these effects were erased in complexes. Occupational category was not associated with SARS-CoV-2. Conclusions. SARS-CoV-2 infection was more likely among staff working in institutions where physical distancing and limiting exposure to a consistent set of staff and inmates are challenging. Public Health Implications. Mitigation strategies—including augmented staff testing, entry and exit testing among inmates, limiting staff interactions across complexes, and increasing physical distancing by reducing occupancy in dorm-style housing—may prevent SARS-CoV-2 infections among correctional staff. (Am J Public Health. Published online ahead of print April 15, 2021: e1–e4. https://doi.org/10.2105/AJPH.2021.306237 )

Targeted Outpatient Fluoroquinolone Intervention utilizing an Integrated Electronic Health Record in the Bureau of Prisons

Background: Fluoroquinolones are the perfect target for antimicrobial stewardship programs (ASPs) due to their broad-spectrum nature, poor safety profile, and frequent misuse. In April 2019, the Bureau of Prisons (BOP) created a national antimicrobial stewardship clinical pharmacist consultant program. One of the program’s main initiatives was to screen active fluoroquinolone prescriptions for appropriateness and work with providers to tailor therapy as needed. Since July 2019, pharmacist consultants have utilized a singular system-wide electronic health record (EHR) to conduct fluoroquinolone prospective audit and feedback targeting all BOP sites across the country. The objective was to assess the national impact of prospective audit and feedback on outpatient fluoroquinolone prescriptions utilizing pharmacist consultants and an integrated EHR. Method: Reviews were conducted in a federal correctional setting including 122 BOP sites with an average daily population of 167,308 inmates. The ASP consisted of 7 pharmacists, each assigned a region across the country. Consultant pharmacists were in charge of conducting daily fluoroquinolone reviews within 72 hours of the prescription being written, utilizing a singular system-wide EHR to gain remote access to newly prescribed prescriptions along with all other pertinent information (ie, clinical notes, patient profiles, laboratory, and radiology). Interventions were sent via e-mail. Total fluoroquinolone prescriptions per 1,000 inmates during the preintervention period (July 1, 2018, to September 30, 2018) were compared to the postintervention period (July 1, 2019, to September 30, 2019), after the development of the clinical consultant program. Data were also collected during the 3-month postintervention period to include total fluoroquinolone prescriptions reviewed, total recommendations sent, percentage of recommendations accepted, and intervention types. Results: In total, 833 fluoroquinolone prescriptions of 1, 264 total prescriptions written (66%)were reviewed over the 3-month postintervention period. In total,192 interventions were recommended (23%). Of the interventions recommended, 65 (34%) were accepted. The most common intervention was to stop therapy (41%), followed by changing antibiotic (37%), and shorten therapy duration (8%). Total outpatient fluoroquinolone prescriptions decreased by 1.5 prescriptions per 1,000 patients after the intervention. Conclusions: Pharmacist-driven prospective audit and feedback on a national scale utilizing a singular system-wide EHR resulted in an overall decrease in outpatient fluoroquinolone prescriptions over short period of time.Funding: NoneDisclosures: None

Pandemic Compassionate Release and the Case for Improving Judicial Discretion over Early Release Decisions

After decades of Bureau of Prisons’ maladministration of the sentence reduction authority authorized by 18 U.S.C. § 3582, Congress passed the First STEP Act of 2018 with the intention of expanding the use and transparency of compassionate release. Although the COVID-19 pandemic was not among the considerations when the First Step Act became law, it contains several important modifications that may protect thousands of federal prisoners from severe sickness and premature death while in custody. First, its procedural modification allowing federal prisoners to circumvent the often-artificial strictures of the Bureau of Prisons allows for a timely and proactive release decision from the sentencing court before a vulnerable individual is stricken with the deadly virus. Second, district courts are now permitted to grant release decisions to deserving individuals who were previously blocked from petitioning their sentencing court by the Bureau of Prisons. Importantly, courts are empowered to find grounds for release beyond those specifically enumerated in the now-outdated Sentencing Commission policy statement that formerly restricted compassionate release decisions. After observing the potential of the new compassionate release process as modified by the First Step Act, Congress should avoid concurrent systems of release and judicial discretion over early release should be expanded by statute or via an updated Sentencing Commission policy statement.