The norms and idiosyncrasies of prison life establish the correctional population as high risk for the development of contact and fomite driven infectious disease; MRSA in particular given the confluence of poverty, lack of healthcare access, substance abuse and medical comorbidities. This research has identified key risk factors associated with MRSA colonization within newly arrested men in Baltimore and noted a significant difference in risk profile between persons with and without a history of prior arrest. As expected, the prevalence of MRSA was significantly greater in this setting than what has been reported among the general population (15.8% vs. 0.84%). As the first large surveillance project of Staphylococcus aureus (S. aureus) and MRSA colonization and infection among newly arrested men, this study demonstrates the critical importance of the introduction of infection prevention strategies beginning at the point of entry into the correctional system. Further, the research has evaluated the use of rapid methods for detection of MRSA outside of healthcare environments. Despite previous analysis demonstrating adequate sensitivity and specificity of the BD GeneOhm MRSA™ assay in endemic settings, our study in a high prevalence community setting found the assay to be less sensitive and less specific than selective culture media. In our environment the use of the BD GeneOhm MRSA™ assay in clinical settings requires confirmation, yet the practical application for surveillance and isolation decision analysis is plausible.

This data has broad implications for correctional settings. Infection control professionals and other correctional health personnel must consider S. aureus and MRSA an ongoing threat to the health and well-being of the correctional population and correctional staff. Risk reduction strategies targeting the prevention of future outbreaks are required in both the jail and prison settings. Evaluation of low cost prevention strategies within the correctional environment is an urgently needed area of future research.