ICE/DRO DETENTION STANDARD

ENVIRONMENTAL HEALTH AND SAFETY

# PURPOSE AND SCOPE. This Detention Standard protects detainees, staff, volunteers, and contractors from injury and illness by maintaining high facility standards of cleanliness and sanitation, safe work practices, and control of hazardous substances and equipment.

It applies to the following types of facilities housing DRO detainees:

-   Service Processing Centers (SPCs);

-   Contract Detention Facilities (CDFs); and

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-   State or local government facilities used by DRO through
    Intergovernmental Service Agreements (IGSAs) to hold detainees for
    more than 72 hours.

***Procedures in italics are specifically required for SPCs and
CDFs***.  IGSAs must conform to these procedures or adopt, adapt or
establish alternatives, provided they meet or exceed the intent
represented by these procedures.

Some terms used in this document are defined in the separate
**Definitions** Standard.

# EXPECTED OUTCOMES. The expected outcomes of this Detention Standard are:

1.  Facility cleanliness and sanitation will be maintained at the
    highest level.

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1.  Compliance with all applicable safety and sanitation laws will be
    ensured by documented internal and external inspections and
    corrective action when indicated.

2.  Compliance with all applicable fire safety codes and fire safety
    performance requirements for the facility furnishings will be
    ensured.

3.  Flammable, poisonous, toxic, and caustic materials will be
    controlled and used in a safe manner.

4.  Compliance with fire prevention regulations, inspection
    requirements, and practices, including periodic fire drills, will
    ensure the safety of detainees, staff, and visitors.

5.  Staff will be knowledgeable about procedures and responsibilities
    during emergency situations, including those that require
    evacuation, in accordance with a written plan and at least annual
    training.

6.  The facility will have a plan for immediate release of detainees
    from locked areas and provisions for a back-up system

7.  A sufficient number of properly positioned emergency exits that are
    clear from obstruction will be distinctly and permanently marked.

8.  Preventive maintenance and regular inspections will be performed to
    ensure timely emergency repairs or replacement to prevent dangerous
    and life-threatening situations.

9.  Potential disease transfer will be minimized by the proper
    sanitization of barbering equipment and supplies.

10. Pests and vermin will be controlled and eliminated.

11. Safe potable water will be available throughout the facility.

12. Emergency lighting and life-sustaining equipment will be maintained
    and periodically tested.

13. Disposal of garbage and hazardous waste will be in compliance with
    applicable government regulations.

14. The applicable content and information in this standard will be
    communicated in a language or manner which the detainee can
    understand.

# DIRECTIVES AFFECTED. This Detention Standard replaces Environmental Health and Safety dated 9/20/2000.

# REFERENCES

-   American Correctional Association 4th Edition, Standards for Adult
    Detention Facilities: 4-ALDF-1A-01, 1A-02, 1A-03, 1A-07, 1A-14,
    1A-15, 1A-16, 1A-17, 1A-18, 1A-19, 1A-20,1C-01, 1C-02, 1C-03, 1C-04,
    1C-05, IC-07, 1C-08, 1C-09, 1C-10, 1C-11, 1C-12, 1C-13, 1C-14,
    1C-15, 4B-07, 4C-18.

-   Occupational Safety and Health Administration (OSHA) Regulations

-   NFPA Standards

-   US Public Health Service Report on Carcinogens

# EXPECTED PRACTICES -- [GENERAL ENVIRONMENTAL HEALTH AND SAFETY]{.underline}

## General Environmental Health

> Environmental health conditions shall be maintained at a level that
> meets recognized standards of hygiene, including those from the:

-   American Correctional Association,

-   Occupational Safety and Health Administration,

-   Environmental Protection Agency,

-   Food and Drug Administration,

-   National Fire Protection Association\'s Life Safety Code, and

-   National Center for Disease Control and Prevention.

> The Health Services Department or IGSA equivalent shall assist in the
> identification and correction of conditions that could adversely
> impact the health of detainees, employees, and visitors. The
> sanitarian consultant is responsible for developing and implementing
> policies, procedures, and guidelines for the environmental health
> program that are intended to evaluate and eliminate or control as
> necessary, sources of injuries and modes of transmission of agents or
> vectors of communicable diseases.
>
> The consultant shall:

-   Conduct special investigations and comprehensive surveys of
    environmental health conditions, and

-   Provide advisory, consultative, inspection, and training services
    regarding environmental health conditions.

> The medical facility's Health Services Administrator is responsible
> for:

-   Implementing a program that assists in maintaining a high level of
    environmental sanitation, and

-   Providing recommendations to the facility administrator concerning
    environmental health conditions, in consultation with the sanitarian
    consultant.

## Staff and Detainee Safety

> The facility administrator shall ensure that adequate provisions are
> made for staff and detainee safety in accordance with these Detention
> Standards and applicable law. The Detention Standard on **Staff
> Training** further addresses employee training related issues. The
> Detention Standard on **Volunteer Work Program** addresses detainee
> training issues for workers. Detainees will receive safety instruction
> where necessary for living area-related assignments such as working
> with cleaning products to clean general use areas.
>
> Detainee living area safety will be emphasized to staff and detainees
> to include providing, as noted in the standards, a housekeeping plan.
> Bed rails are not common in detention settings except for medical
> housing units because of the potential safety risk they pose. When
> there are safety concerns with a detainee sleeping in a top bunk that
> is not along a wall and has no bed rail, accommodations will be made
> to ensure safety. In locations where ladders are not available,
> accommodations for detainees, such as the use of bottom bunks or the
> addition of a ladder or step, will be made on a case by case basis.
> Detainees who have medical or physical problems that sleeping on a top
> bunk will aggravate will be referred to the medical unit for
> consideration of a lower bunk permit.

## General Housekeeping

> The facility administrator shall ensure that staff and detainees
> maintain a high standard of facility sanitation and general
> cleanliness. When possible, the use of non-toxic cleaning supplies is
> recommended.

1.  All horizontal surfaces shall be damp-dusted daily with an approved
    germicidal solution used according to the manufacturer's directions.

2.  Windows, window frames, and windowsills shall be cleaned on a
    regular schedule, but do not require daily cleaning.

3.  Furniture and fixtures shall be cleaned daily.

4.  Floors shall be mopped daily and when soiled using the double-bucket
    mopping technique, and with a hospital disinfectant-detergent
    solution mixed according to the manufacturers directions.

5.  A clean mop head shall be used each time the floors are mopped.

6.  Waste containers shall be non-porous and lined with plastic bags and
    the liner shall be changed daily.

7.  The container itself shall be washed at least weekly, or as needed
    when it becomes soiled.

8.  Cubicle curtains shall be laundered monthly or during terminal
    cleaning following treatment of an infectious patient.

## Pests and Vermin

> The facility administrator shall contract with licensed pest-control
> professionals to perform monthly inspections to identify and eradicate
> rodents, insects, and vermin. The contract shall include a preventive
> spraying program for indigenous insects and a provision for callback
> services as necessary.

## Certification of Facility Water Supply

> At least annually, a state laboratory shall test samples of drinking
> and wastewater to ensure compliance with applicable standards. A copy
> of the testing and safety certification shall be maintained on-site.

## Emergency Electrical Power Generator

> At least every two weeks, emergency power generators shall be tested
> for one hour, and the oil, water, hoses and belts of these generators
> shall be inspected for mechanical readiness to perform in an emergency
> situation .
>
> Power generators are inspected weekly and load tested quarterly at a
> minimum, or in accordance with manufacturer's recommendations and
> instruction manual. Among other things, the technicians shall check
> starting battery voltage, generator voltage and amperage output.
>
> Other emergency equipment and systems shall be tested quarterly, and
> needed follow-up repairs or replacement shall be accomplished as soon
> as feasible.

## Garbage and Refuse

-   Garbage and refuse includes all trash, rubbish, and other
    putrescible and non-putrescible solid waste, except the solid and
    liquid waste discharged into the sanitary sewer system of the
    facility.

-   Garbage and refuse shall be collected and removed as often as
    necessary to maintain sanitary conditions and to avoid creating
    health hazards.

-   Facilities shall comply with all federal, state and local
    environmental regulations and requirements governing methods for
    handling and disposing of refuse.

# -- [HAZARDOUS MATERIALS]{.underline}

Every facility shall establish a system for storing, issuing, using, and
maintaining inventories of and accountability for hazardous materials.
The facility program will be supervised by a person who has been trained
in accordance with OSHA standards. The effectiveness of any such system
depends not only on written policies, procedures, and precautions but
also on adequate supervision and responsible behavior of staff and
detainees, including following instructions precisely, taking prescribed
precautions and using safety equipment properly.

A list of common flammable, toxic, and caustic substances is included at
the end of this Detention Standard as Table A.

## Personal Responsibility

> Every individual who uses a hazardous substance must:

-   be trained in accordance with OSHA standards;

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-   be knowledgeable about and follow all prescribed precautions;

-   wear personal protective equipment when indicated; and

-   promptly report hazards or spills to the designated authority.

## Protective Equipment 

-   Protective eye and face equipment is required where there is a
    reasonable probability of injury that can be prevented by such
    equipment. Areas of the facility where such injuries can occur shall
    be conspicuously marked with eye hazard warning signs.

-   Eyewash stations that meet the standards of the OSHA shall be
    installed in designated areas throughout the facility, and all
    employees and detainees in those areas shall be instructed in their
    use.

## Inventories

> Every area shall maintain a current inventory of the hazardous
> substances (flammable, toxic, or caustic) used and stored there.
> Inventory records shall be maintained separately for each substance.
> Entries for each shall be logged on a separate card (or equivalent)
> filed alphabetically by substance. The entries shall contain relevant
> data, including purchase dates and quantities, use dates and
> quantities, and quantities on hand.

## Material Safety Data Sheets Files

> Every department or other area of the facility using hazardous
> substances shall maintain a file of Material Safety Data Sheets
> (MSDSs) that includes a list of the locations where hazardous
> substances are stored, along with a diagram and legend of
>
> these locations. Designated staff from each department or area shall
> provide a copy of each file to the Maintenance Supervisor.

-   MSDSs are produced by manufacturers and provide vital information on
    individual hazardous substances, including instructions on safe
    handling, storage, disposal, prohibited interactions, etc.

-   Staff and detainees shall have ready and continuous access to the
    MSDSs for the substances with which they are working. Staff and
    detainees that do not read English will not be authorized to work
    with these materials.

-   Because changes in MSDSs occur often and without notice, staff must:

    -   review the latest issuance from the manufacturers of the
        relevant substances;

    -   update the MSDS files as necessary; and

    -   forward any changes to the Maintenance Supervisor, so that the
        copy is kept current.

## Master Index

> The Maintenance Supervisor shall compile:

-   a master index of all hazardous substances in the facility and their
    locations;

-   a master file of MSDSs; and

-   a comprehensive, up-to-date list of emergency phone numbers (fire
    department, poison control center, etc.).

> The Maintenance Supervisor maintains this information in the safety
> office (or equivalent) and ensures a copy is sent to the local fire
> department.

## General Guidelines Regarding Hazardous Substances

> **Issuance.** Flammable, caustic, and toxic substances (hazardous
> substances) shall be issued (that is, drawn from supply points to
> canisters or dispensed) only under the supervision of the designated
> officer.
>
> **Amounts.** Hazardous substances shall be issued in single-day
> increments (the amount needed for one day's work.)
>
> **Supervision.** Qualified staff shall closely monitor detainees
> working with hazardous substances.
>
> **Accountability.** Inventory records for a hazardous substance must
> be kept current before, during, and after each use.

## Flammable and Combustible Liquids

1.  Any liquid or aerosol labeled "Flammable" or "Combustible" must be
    stored and used as prescribed on the label required by the Federal
    Hazardous Substances Labeling Act.

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15. Lighting fixtures and electrical equipment installed in flammable
    liquid storage rooms must meet National Electrical Code requirements
    in hazardous locations.

16. Every hazardous material storage room shall:

-   Be of fire-resistant construction and properly secured;

-   Have self-closing fire doors at each opening;

-   Be constructed with either a four-inch sill or a four-inch depressed
    floor; and

-   Have a ventilation system (mechanical or gravity flow) within 12
    inches of the floor, which provides at least six air changes per
    hour.

17. Every storage cabinet shall:

-   Be constructed according to code and securely locked at all times;

-   Be clear of open passageways, stairways, and other emergency exit
    areas;

-   Be conspicuously labeled: "Flammable \-- Keep Fire Away"; and

-   Contain not more than 60 gallons of Class I or Class II liquids, or
    more than 120 gallons of Class III liquids.

18. Storage rooms and cabinets may be entered only under secure
    conditions and under the supervision of authorized staff.

19. Any portable container that is not the original shipping container
    must be designated as an approved safety can, which is listed or
    labeled by a nationally recognized testing laboratory. Each
    container shall bear a legible label that identifies its contents.

20. Excess liquids shall remain in original containers, tightly closed,
    in the storage room or cabinet.

21. The MSDS shall govern use of a particular flammable or combustible
    liquid.

22. Only authorized staff may dispense flammable and combustible
    liquids, using acceptable methods for drawing or transferring these
    liquids.

    Drawing from or transferring any of these liquids into containers
    indoors is prohibited except:

-   Through a closed piping system;

-   From a safety can;

-   By a device drawing through the top; or

-   By gravity, through an approved self-closing system.

    An approved grounding and bonding system must be used when liquids
    are dispensed from drums.

23. Without exception, cleaning liquids must have a flash point at or
    above 100° F (for example, Stoddard solvents, kerosene). Cleaning
    operations must be in an approved parts-cleaner or dip tank fitted
    with a fusible link lid with a 160° F melting-temperature link.

24. Staff shall follow MSDS directions:

-   When disposing of excess flammable or combustible liquids; or

-   After a chemical spill.

## Toxic and Caustic Substances

-   All toxic and caustic materials must be stored in secure areas, in
    their original containers, with the manufacturer's label intact on
    each container.

-   Authorized staff only shall draw/dispense these substances, in
    accordance with the applicable Material Safety Data Sheet(s).

-   Staff shall either return unused amounts to the original
    container(s) or, under certain circumstances, to another suitable,
    clearly labeled container n the storage area.

-   MSDS directions shall determine the disposal and spill procedures
    for toxic and caustic materials used in the facility.

## Poisonous Substances

> Poisonous substances or chemicals, such as methyl alcohol, sulfuric
> acid, muriatic acid, caustic soda or tannic acid, among others, pose a
> very high (Class I) caustic hazard due to their toxicity.
>
> **Methyl alcohol**, variously referred to as wood alcohol and
> methanol, is commonly found in industrial applications (for example,
> shellac thinner, paint solvent, duplicating fluid, solvents for
> leather cements and dyes, flushing fluid for hydraulic brake systems):

-   If ingested, methyl alcohol can cause permanent blindness or death.

-   Staff must directly supervise the use of any product containing
    methyl alcohol. Products containing methyl alcohol in a very diluted
    state, such as shoe dye, may be issued to detainees, but only in the
    smallest workable quantities.

-   Immediate medical attention is vital any time methyl alcohol
    poisoning is suspected.

## Other Toxic Substances

1.  Permanent **antifreeze** containing ethylene glycol shall be stored
    in a locked area and dispensed only by authorized staff.

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25. **Typewriter cleaner** containing carbon tetrachloride or
    tricholorochane shall be dispensed in small quantities and used
    under direct staff supervision.

26. **Cleaning fluids** containing carbon tetrachloride or tetrachloride
    or tricholoroethylene shall be strictly controlled.

27. **Glues** of every type may contain hazardous chemicals. When use of
    a nontoxic product is not possible, staff must closely supervise all
    stages of handling. The toxic glues must be stored in a locked
    location.

28. The use of **dyes and cements for leather** requires close
    supervision. Nonflammable types shall be used whenever possible.

29. **Ethyl alcohol, isopropyl alcohol, and other antiseptic products**
    shall be stored and used only in the medical department and only
    under close supervision. To the extent practical, such chemicals
    shall be diluted and issued in small quantities to prevent any
    injuries or lethal accumulation.

30. **Pesticides** not currently approved by the Environmental
    Protection Agency, such as DDT and 1080 (sodium fluoracetate), are
    prohibited. The Maintenance Supervisor is responsible for
    purchasing, storing (in a locked area), and dispensing all
    pesticides used in the facility.

31. The Maintenance Supervisor or other staff members responsible for
    **herbicides** must hold a current state license as a Certified
    Private Applicator. Persons applying herbicides must wear proper
    clothing and protective gear.

32. **Lyes** may be used only in dye solutions and only under the direct
    supervision of staff.

## Labeling of Chemicals, Solvents, and Other Hazardous Materials

> The facility administrator shall individually assign the following
> responsibilities associated with the labeling procedure:

-   Identifying the hazardous nature of materials adopted for use;

-   Requiring use of properly labeled containers for hazardous
    materials, including any and all miscellaneous containers into which
    employees might transfer the material;

-   Teaching staff the meaning of the classification code and the MSDS,
    including the safe handling procedures for each material, and
    impressing on staff the need to ensure containers are properly
    labeled; and

-   Placing correct labels on all smaller containers when only the
    larger shipping container bears the manufacturer-affixed label.

## Controlled Hazardous Materials 

> Certain substances require special treatment and careful planning and
> precautions before use. These controlled materials are classified
> according to the type of hazard and the nature of the restrictions
> imposed for their safe use, as specified in OSHA regulations.
>
> **Class I: Industrial Solvents.** Industrial solvents and chemicals
> used as paint thinners, degreasers, and cleaning agents may have toxic
> properties and low flash points, making them dangerous fire hazards.
>
> **Class II: Restricted Materials.** Beryllium, its alloys and
> compounds, and silver solder containing cadmium pose a danger to
> workers, for whom special precautions must be taken.
>
> **Class III: Recognized Carcinogens.** OSHA-listed carcinogens are
> governed by the OSHA regulations provided in 29 CFR 1910.1000.
>
> Although asbestos appears on the OSHA list, it is exempt from the
> regulation when:

-   no asbestos fibers will be released into the air during handling and
    use; and

-   the asbestos consists of firmly bound fibers contained in a product
    such as: a transit pipe, wallboard, or tile (except when being sawed
    or otherwise handled in a way that releases fibers into the air).

> **Class IV: Suspected Carcinogenic, Teratogenic, and Mutagenic
> Materials.** Chemical agents, substances, mixtures, and exposures are
> listed in the biennial *Report on Carcinogens* issued by the U.S.
> Public Health Service, in accordance with the Public Health Service
> Act. The Maintenance Supervisor shall ensure the facility has copies
> of the report and that there is compliance with the provisions of the
> latest edition.

# EXPECTED PRACTICES -- [FIRE PREVENTION AND CONTROL]{.underline}

## Fire Safety Codes

> Every facility shall comply with standards and regulations issued by:

-   OSHA;

-   the American Correctional Association \"mandatory\" Expected
    Practices;

    (Mandatory ACA Expected Practice 4-ALDF-1C-07 requires that the
    facility conform to applicable federal, state, and/or local fire
    safety codes, and that the authority having jurisdiction document
    compliance. A **fire alarm and automatic detection system are
    required** (or there is a plan for addressing these or other
    deficiencies within a reasonable time period), as approved by the
    authority having jurisdiction. If the authority approves any
    variance, exceptions, or equivalencies, they must not constitute a
    serious life-safety threat to the occupants of the facility.)

-   local and national fire safety codes, and

-   applicable standards of the American Society for Testing and
    Materials, American National Standards Institute, and Underwriters\'
    Laboratories or Factory Mutual Engineering Corporation.

> New construction, alterations, and renovations, shall comply with:

-   the latest revision or update of the International Council Codes.

-   the Uniform Building Code; or

-   the Standard Building Code, in accordance with 40 USC Title 619 and
    local law.

> If the local government does not mandate adherence to a particular
> code, construction must conform to the International Council Codes.
>
> In addition, the construction shall comply with the latest edition of
> the National Fire Protection Association\'s (NFPA) 101, Life Safety
> Code and National Fire Codes (NFCs). If the fire protection and life
> safety requirements of a local building code differ
>
> from NFPA 101 or the NFCs, the requirements of NFPA 101 and the NFCs
> shall take precedence and be recognized as equivalent to the local
> building code.

## Inspections

> A qualified departmental staff member shall conduct weekly fire and
> safety Inspections.
>
> Facility maintenance (safety) staff shall conduct monthly inspections.
>
> Written reports of the inspections shall be forwarded to the facility
> administrator for review and, if necessary, corrective action
> determinations. The Maintenance Supervisor shall maintain inspection
> reports and records of corrective action in the safety office. Fire
> safety deficiencies shall be promptly addressed.

## Fire Prevention, Control, and Evacuation Plan

> Every facility shall develop a fire prevention, control, and
> evacuation plan that includes the following:

1.  Control of ignition sources;

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33. Control of combustible and flammable fuel load sources;

34. Provisions for occupant protection from fire and smoke;

35. Inspection, testing, and maintenance of fire protection equipment,
    in accordance with NFPA codes, etc.;

36. Monthly fire inspections;

37. Installation of fire protection equipment throughout the facility,
    in accordance with NFPA codes;

38. Accessible, current floor plans (buildings and rooms); prominently
    posted evacuation maps/plans; exit signs and directional arrows for
    traffic flow; with a copy of each revision filed with the local fire
    department; and

39. Exit diagrams that shall be conspicuously posted throughout the
    facility.

## Fire Drills

> Fire drills shall be conducted and documented at least quarterly in
> all facility locations including administrative areas.

1.  Fire drills in housing units, medical clinics, and other areas
    occupied or staffed during non-working hours shall be timed so that
    employees on each shift participate in an annual drill.

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40. Detainees shall be evacuated during fire drills, except: in areas
    where security would be jeopardized; in medical areas where patient
    health could be jeopardized; or in individual cases when evacuation
    of patients is logistically not feasible. Staff shall simulate
    drills in areas where detainees are not evacuated.

41. Emergency-key drills shall be included in each fire drill, and
    timed. Emergency keys shall be drawn and used by the appropriate
    staff to unlock one set of emergency exit doors not in daily use.
    NFPA recommends a limit of four and one-half minutes for drawing
    keys and unlocking emergency doors. However, when conducting fire
    drills emphasis will be placed on safe and orderly evacuation rather
    than speed.

## Exit Diagram

> In addition to a general area diagram, the following information must
> be provided on signs:

-   Instructions in English, Spanish and the next most prevalent
    language at the facility;

-   \"You Are Here\" markers on exit maps; and

-   Emergency equipment locations.

> \"Areas of Safe Refuge\" shall be identified and explained on
> diagrams. Diagram posting will be in accordance with applicable fire
> safety regulations of the jurisdiction.

# EXPECTED PRACTICES -- [MEDICAL OPERATIONS]{.underline}

## Needles and Other Sharp Objects

> An established uniform procedure shall be established for the safe
> handling and disposal of used needles and other potentially sharp
> objects (sharps) to prevent both mechanical injury and the
> percutaneous transmission of infectious disease organisms, such as
> hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Sharps
> are defined as all disposable or discarded items derived from detainee
> care that could potentially transmit disease via direct subdermal
> inoculation. Items included are: hypodermic needles and syringes,
> scalpel blades, glass vials or ampules containing materials deemed to
> be infectious, burrs, glass cartridges, and lancets.
>
> Accidental injuries from sharp objects are common in health care
> programs; most are from needle sticks caused by staff attempting to
> recap hypodermic needles. A uniform procedure for used needles and
> other disposable sharps is necessary to reduce the number of such
> injuries by preventing the secondary handling of needles and other
> dangerous sharp objects used in the delivery of medical care.

## Standard Precautions (includes "Universal Precautions")

> Staff shall frequently wash their hands and routinely take precautions
> to prevent contact with blood or other body fluids.

a\. Gloves shall be worn: prior to touching blood and body fluids,
mucous membranes, or non‑intact skin of all patients; prior to handling
items or surfaces soiled with blood or body fluids; and prior to
performing venipuncture and other vascular access procedures.

Gloves shall be changed after contact with each detainee.

> b\. Masks and protective eye wear or face shields shall be worn during
> procedures that are likely to generate droplets of blood or other body
> fluids,
>
> c\. Gowns or aprons shall be worn during procedures that are likely to
> generate splashes of blood or other body fluids.

d.  Hands and other skin surfaces shall be washed immediately and
    thoroughly if contaminated with blood or other body fluids. Hands
    shall be washed immediately after gloves are removed.

> e\. All health-care workers shall take precautions to prevent injuries
> caused by needles, scalpels, and other sharp instruments or devices
> during procedures, when cleaning used instruments, during disposal of
> used needles, and when handling sharp instruments after procedures.
> Instruments and drugs will be maintained in a secure and sanitary
> condition,
>
> f\. To prevent needle stick injuries, needles shall not be recapped,
> purposely bent or broken by hand, removed from disposable syringes, or
> otherwise manipulated by hand. After use, disposable syringes and
> needles, scalpel blades, and other sharp items shall be placed in
> puncture-resistant containers for disposal.
>
> g\. Large-bore reusable needles shall be placed in a puncture
> resistant container for transport to the reprocessing area.
>
> h\. To minimize the need for emergency mouth-to-mouth resuscitation,
> mouthpieces, resuscitation bags or other ventilation devices shall be
> available for use in areas in which the need for resuscitation is
> predictable.
>
> I. Health-care workers who have exudative lesions or weeping
> dermatitis shall refrain from all direct patient care and from
> handling patient care equipment until the condition resolves.
>
> j\. Pregnant health-care workers shall strictly adhere to precautions
> to minimize the risk to the infant of perinatal transmission of HIV.

k.  Implementation of standard blood and body fluid precautions for all
    detainees eliminates the need for the use of isolation category of
    \"Blood and Body Fluid Precautions\" previously recommended by the
    Centers for Disease Control for individuals known or suspected to be
    infected with blood-borne pathogens. Isolation precautions shall be
    used as necessary if associated conditions, such as infectious
    diarrhea or tuberculosis, are diagnosed or suspected.

> Staff should encourage detainees to frequently wash their hands and
> routinely take precautions to prevent contact with blood or other body
> fluids.

## Accidental Needle Sticks

> Any employee or detainee who receives a needle stick or who is cut
> while handling potentially contaminated sharps shall be counseled
> regarding baseline testing for HBV and HIV and referred to their usual
> source of health care. If the injury also involves a person who is a
> known source of possible infection, that person shall also be tested
> for HBV and HIV. The incident shall be reported as an occupational
> injury and documented in accordance with applicable regulations for
> commissioned officers and civil service employees, respectively.
>
> The leading health service provider's exposure-control plan shall be
> followed in the event of a needle stick.

## Inventory

> Items that pose a security risk, such as sharp instruments, syringes,
> needles, and scissors, shall be inventoried and checked weekly by an
> individual designated by the medical facility's Health Service
> Administrator (HSA) or equivalent.

## Handling

> Without removing the needles or replacing the needle covers, staff
> shall place used (disposable) syringes in a plastic disposal box or
> container.

### Disposal Containers

> Use only commercially available, biohazardous-waste sharps containers
> approved by the National Institute of Safety and Health (for example,
> a \"Winfield Sharps Container.\").
>
> Do not use milk cartons or plastic milk jugs or other plastic
> containers of similar thickness.
>
> Use containers with a two-gallon capacity (approximate)
>
> Under no circumstances shall an item be removed from the sharps
> container.

### Location

> Sharps Containers shall be located on top of counters or, if on the
> wall, at least five feet above ground. Containers shall never sit on
> the floor.

### Disposal

> When the disposal box is one-half to two-thirds full, the lid shall be
> closed and locked, and tape shall be placed over the top of the lid to
> indicate that it is ready for disposal. The container shall be labeled
> with the words \"infectious waste\" or with the universal biohazard
> symbol, and placed in the proper area for removal and disposal.
>
> Sharps are considered infectious waste, and final disposal of the
> container and contents shall be through a commercial contractor that
> handles disposal of infectious waste in accordance with all local and
> federal regulations.
>
> The HSA shall make arrangements for disposal with an approved
> contractor and is responsible for validating that the contractor\'s
> disposal methods are in accordance with all infectious and hazardous
> waste disposal laws and regulations. Arrangements shall be made with
> local hospitals, if possible, for disposal with the hospitals\' own
> infectious waste.

## Environmental Health in Medical Operations

> While many of the following considerations, precautions, and specific
> procedures apply to situations that typically arise in medical
> operations, in many cases they have general application to all
> facility operations.

### General Housekeeping

> Environmental cleanliness will prevent, reduce and control nosocomial
> infections due to contaminated environmental surfaces. The HSA or
> designee is responsible for ensuring the cleanliness of the medical
> facility.
>
> Using an acceptable health agency standard as a model, the HSA shall
> establish:

-   The cleaning equipment; cleansers; disinfectants and detergents to
    be used,

-   The Methods of cleaning, and

-   The frequency of cleaning and inspections.

> The HSA or designee shall make a daily visual inspection of the
> medical facility noting the condition of floors, walls, windows,
> horizontal surfaces, and equipment.
>
> All surfaces touched by detainees or staff shall be cleaned using
> fresh solutions of appropriate disinfectant products, applied with
> clean cloths, mops, or wipes. Cleaned surfaces need not be monitored
> microbiologically since the results of such tests have been shown not
> to correlate with infection risk. Floors, walls, beds, tables, and
> other surfaces that usually come in contact with intact skin require
> low-level disinfection.
>
> Horizontal surfaces in detainee care areas are cleaned on a regular
> basis, when soiling or spills occur. Additionally, short-stay units
> are cleaned when a detainee is discharged. Cleaning of walls, blinds,
> or curtains is required only when visibly soiled.
>
> The Chief Nurse (or equivalent) is responsible for training all staff
> and detainees in using proper housekeeping procedures and proper
> handling of hazardous materials and chemicals.

#### General Cleaning

1.  All horizontal surfaces shall be damp‑dusted daily with an approved
    germicidal solution.

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42. Windows, window frames, and windowsills shall be cleaned on a
    regular schedule, but do not require daily cleaning.

43. Furniture and fixtures shall be cleaned daily.

44. Floors shall be mopped daily and when soiled using the double‑bucket
    mopping technique. The cleaning solution shall be a hospital
    disinfectant-detergent solution mixed according to the
    manufacturer's directions. A clean mop head shall be used each time
    the floors are mopped.

45. Waste containers shall be lined with plastic bags and the liner
    shall be changed daily. The container itself shall be washed at
    least weekly, or as needed when it becomes soiled.

46. Cubicle curtains shall be laundered monthly or during terminal
    cleaning following treatment of an infectious patient.

#### Isolation Cleaning

1.  An approved germicidal detergent solution shall be freshly prepared
    in accordance with the manufacturer\'s specifications for each
    cleaning.

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47. After cleaning the isolation room, mops and cleaning cloths shall be
    laundered before being reused.

48. Dirty water and used disinfecting solutions shall be discarded and
    the buckets and basins disinfected before being refilled. Items used
    in cleaning a contaminated isolation room shall never be taken into
    another area.

49. Linens shall be carefully removed from the bed and double bagged for
    transport.

50. All waste materials shall be double bagged and disposed of as
    contaminated waste.

#### Terminal Cleaning

1.  Every item in the room must be cleaned with an approved hospital
    germicidal solution.

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51. When applicable, linen shall be stripped from the bed, with care
    taken not to shake the linen. Linen shall be folded away from the
    person and folded inward into a bundle, then removed with minimal
    agitation.

52. When applicable, all reusable receptacles such as drainage bottles,
    urinals, bedpans, water pitchers shall be emptied and rinsed with
    germicidal solutions.

53. All equipment that is not to be discarded, such as IV poles,
    respirators and suction machines, shall be washed with an approved
    germicidal solution following manufacturer\'s guidelines for
    cleaning the specific piece of equipment.

54. When applicable, mattresses and pillows covered with durable plastic
    covers shall be thoroughly washed with the approved germicidal
    solution.

55. When applicable, beds shall be washed thoroughly using a small brush
    soaked in the germicidal solution to gain access to small holes and
    crevices, to areas between the springs, and to the casters.

56. All furniture shall be washed with a germicidal detergent solution.
    Use a small brush if necessary. Outside and underside as well as
    legs and casters must also be washed.

57. Wastebaskets shall be thoroughly washed with a germicidal solution
    after trash has been removed.

58. Telephones shall be thoroughly cleaned with a clean cloth soaked in
    the germicidal solution. The earpiece and mouthpiece shall be
    unscrewed, scrubbed, dried and replaced.

59. Walls and ceilings need not be washed entirely, but areas that are
    obviously soiled shall be washed with germicidal solution.

#### Choice of Disinfecting Materials

> Hospital-grade disinfectant‑detergent formulations registered by the
> Environmental Protection Agency may be used for environmental surface
> cleaning, but the physical removal of microorganisms by scrubbing is
> also as important as any antimicrobial effect of the cleaning agent
> used.
>
> Cost, safety, and acceptance by staff should be the criteria for
> selecting any such registered agent. The manufacturer\'s instructions
> for use shall be followed exactly.

### Blood and Body Fluid Clean-up

> Spills of blood and body fluids shall be cleaned up and the surface
> decontaminated in such a manner as to minimize the possibility of
> workers becoming exposed to infectious organisms, including HIV and
> HBV. A suitable cleanup kit shall be maintained for use in cases of
> spills of blood and body fluids. Cleanup kits may be obtained from
> commercial sources, or kits may be put together by ICE/DRO HSD staff
> or the designated health care provider.

#### Making a Clean-up Kit

> To prepare a clean-up kit for blood and body fluid spills, package the
> following materials in a 12\" x 15\" clear\" Ziploc\" bag:
>
> Gloves, rubber or vinyl, household type, (2 pair)
>
> Clean absorbent rags (4)
>
> Absorbent paper towels (15)
>
> Disposable bag marked \"Contaminated\" size 23\"x10\"x39\", minimum
> thickness 1.5 mils.
>
> Clear plastic bag 13\"x10\"x39\", minimum thickness 1.5 mils.

Bottle of \"hospital disinfectant\" (containing quaternary ammonium
chlorides in at least 0.8% dilution), or a bottle of household bleach
such as \"Clorox\" or \"Purex\" (5.25 % sodium hypochlorite).

#### Selection of Disinfectants

> Dilute solutions of sodium hypochlorite are reported extremely
> effective against both HIV and the Hepatitis B virus and therefore
> have been recommended for use in environmental decontamination
> procedures. Quaternary ammonium compounds are less effective against
> Hepatitis B. Chlorine in solution inactivates virus quickly and
> efficiently but must reach the virus particles to do so.
>
> Proteinaceous materials may interfere with the ability of the
> appropriate disinfectant solution to reach the virus particles. Since
> quaternary disinfecting compounds may act as a detergent as well as a
> disinfectant, their use may help in the cleaning and removal of
> proteinaceous materials from surfaces.
>
> A facility may use one of these compounds to help clean the surface,
> and then follow with the use of chlorine solution for final
> disinfection. Using one disinfectant compound rather than two would
> keep the procedure as simple as possible. By following routine medical
> cleaning procedures, most blood or fluids would be removed from the
> surface before application of the disinfectant, so the use of sodium
> hypochlorite solution shall be sufficient.

#### Selection of Gloves

> Household or industrial rubber gloves have been recommended for use
> rather than surgical rubber gloves. Surgical gloves are somewhat
> porous and are less resistant to mechanical damage and punctures
> during clean-up procedures.

#### Assignment of Cleaning Duties to Detainees in Medical Facilities

> Detainee workers may be assigned duties cleaning the medical facility.
> Detainees are permitted to clean floors, walls, and to remove trash,
> but are not permitted to clean medical equipment.

#### Instructions for Use of Clean-Up Kit

1.  Open the bag and remove the supplies.

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60. Depending on the type of disinfectant in the kit, take out bottle of
    \"hospital disinfectant\", or prepare a dilute solution of sodium
    hypochlorite. To prepare a 1:10 dilution of 5.25% sodium
    hypochlorite, mix 1 part of 5.25 % sodium hypochlorite (common
    household bleach) with 10 parts water.

61. Open the large clear plastic bag and the large bag marked
    \"Contaminated\". Place them next to each other.

62. Put on one pair of gloves.

63. Use paper towels to absorb as much of the fluid as possible; then
    place paper towels in the large clear plastic bag.

64. Pour the solution carefully onto the spill area. Dispose of the
    empty bottle in the large, clear plastic bag. Leave disinfectant in
    place for 15 minutes.

65. Use the rags to clean the area, and place rags in the large clear
    plastic bag.

66. Tie off the clear plastic bag and place it inside the large plastic
    bag marked \"Contaminated.\"

67. Remove gloves carefully and place them in the plastic bag marked
    \"Contaminated."

68. Put on the second pair of gloves and tie the \"Contaminated\" trash
    bag closed.

69. Dispose of the \"Contaminated\" trash bag properly in a
    contaminated-waste receptacle.

70. Dispose of the second pair of gloves in the contaminated-waste
    receptacle.

71. Wash your hands.

72. Prepare a new clean-up kit.

> NOTE: Do not place linen or non-disposable articles in the
> \"Contaminated\" trash bag.

### Hazardous and Infectious Waste Disposal 

> Infectious and hazardous waste generated at a medical facility shall
> be stored and disposed of safely and in accordance with all applicable
> federal and state regulations.
>
> For identified wastes that represent sufficient risk of causing
> infection or injury during handling and disposal, the following
> precautions shall be applied.

#### Definitions 

> Hazardous or infectious waste is defined as: microbiology laboratory
> waste; human blood and blood products; sharps (as defined in Section
> VIII, A above); laboratory and other chemicals; or certain drugs such
> as antineoplastic.
>
> Miscellaneous biomedical waste is defined as waste materials that are
> not specifically defined as infectious waste. Such waste includes
> bandages, dressings, casts, catheters, and disposable pads.
>
> Waste from detainees in isolation is not considered to be infectious
> waste unless it falls within the specific definition of infectious
> waste as stated above.

#### Collection and Storage

> Infectious waste must be separated from the general waste stream and
> clearly labeled as infectious:

-   Infectious waste shall be double-bagged and tied and labeled
    \"Infectious Waste.\"

-   The bags used must be impermeable, commercially supplied red bags
    intended specifically for biohazardous waste storage.

-   Miscellaneous biomedical waste shall be double-bagged and tied but
    need not be labeled as infectious.

#### Treatment and Disposal 

#### Blood products and designated body fluids shall be poured slowly and carefully down a toilet to prevent splash. Compacting of untreated infectious waste is prohibited. The waste disposal contractor must meet all state or and local requirements for transportation and disposal. {#blood-products-and-designated-body-fluids-shall-be-poured-slowly-and-carefully-down-a-toilet-to-prevent-splash.-compacting-of-untreated-infectious-waste-is-prohibited.-the-waste-disposal-contractor-must-meet-all-state-or-and-local-requirements-for-transportation-and-disposal. .unnumbered}

# -- [BARBER OPERATIONS]{.underline}

Sanitation in barber operations is of the utmost concern because of the
possible transfer of diseases through direct contact or by towels, combs
and clippers. Towels shall not be reused by other detainees until
sanitized. Instruments such as combs and clippers shall not be used
successively on detainees without proper cleaning and disinfecting.

1.  For sanitation reasons, it is preferable that barbering operations
    be located in a room that is not used for any other purpose. The
    floors, walls, and ceilings should be smooth, nonabsorbent and
    easily cleaned. There should be sufficient light, and the room shall
    be supplied with hot and cold running water.

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73. Each barbershop should have all equipment and facilities necessary
    for maintaining sanitary procedures for hair care, including covered
    metal containers for waste, disinfectants, dispensable headrest
    covers, laundered towels, and haircloths.

74. After each detainee visit, all hair care tools that came in contact
    with the detainee shall be cleaned and effectively disinfected.
    Ultraviolet lights are not appropriate for sterilization but may be
    used for maintaining tools that have already been properly
    sterilized.

75. Detailed hair care sanitation regulations shall be conspicuously
    posted in each barbershop for the use of all hair care personnel and
    detainees. Cotton pads, absorbent cotton and other single or
    dispensable toilet articles may not be reused, and shall be placed
    in a proper waste receptacle immediately after use. The common use
    of brushes, neck duster, shaving mugs and shaving brushes is
    prohibited.

76. Barbers or beauticians shall not provide service to any detainee
    when the skin of the detainee's face, neck, or scalp is inflamed, or
    when there is scaling, pus, or other skin eruptions, unless service
    of such detainee is performed in accordance with the specific
    authorization of the Chief Medical Officer. No person who is
    infested with head lice shall be served.

**Standard Approved:**

**James T. Hayes, Jr. /s/ 12/5/2008**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**James T. Hayes, Jr. Date**

**Director**

**Office of Detention and Removal Operations**

**TABLE A**

**Common Flammable, Toxic, and Caustic Substances**

> **[Class I Liquids]{.underline} [Toxic Substances]{.underline}**
>
> Gasoline Ammonia
>
> Benzene (Petroleum ether) Chlorine
>
> Acetine Antifreeze
>
> Hexane Duplicating fluid
>
> Lacquer Methyl alcohol
>
> Lacquer thinner Defoliants
>
> Denatured alcohol Herbicides
>
> Ethyl alcohol Pesticides
>
> Xylene (Xylol)
>
> Contact cement (flammable)
>
> Toudi (Toluene)
>
> Methyl ethyl ether
>
> Methyl ethyl ketone
>
> Naphtha Y, M, and P
>
> **[Class II Liquids]{.underline} [Caustic Substances]{.underline}**
>
> Diesel fuel Lye
>
> Motor fuel Muriatic acid
>
> Kerosene Caustic soda
>
> Cleaning solvents Sulfuric acid
>
> Mineral spirits Tannic acid
>
> Agitene
>
> **[Class III Liquids]{.underline}**
>
> Paint (oil base)
>
> Linseed oil
>
> Mineral oil
>
> Neat's-foot oil
>
> Sunray conditioner
>
> Guardian fluid