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LEROY O. BACA. SHE:R1F'T

January 21, 2005

The Honorable Board of Supervisors
County of Los Angeles
383 Kenneth Hahn Hall of Administration
500 West Temple Street
Los Angeles, California 90012
Dear Supervisors:
RESPONSE TO ISSUES RELATED TO MRSA
The following information is provided in response to Supervisor Antonovich's request
made during the January 11, 2005, Board of Supervisors meeting regarding a news
media report that the cases of Methicillin Resistant Staphylococcus Aureus (MRSA) has
increased significantly in the jails.
Certain Los Angeles area media outlets have attempted to portray recent MRSA
statistics as a sharp increase in the number of cases within the Los Angeles County jail
system; however, our data shows the number of new MRSA cases per month has
reached a plateau and has remained constant, around 200 cases, for all of 2004. To
be more specific, our data shows a monthly average of 208 cases. As such, we can
positively report that there have been no recent significant increases in the number of
cases within the jails.
One media source stated that the number of cases has "quadrupled" since 2002. While
this statement may appear true from a raw numbers standpoint, the media report failed
to include explanatory information that we provided to them regarding this apparent
increase. August 2002 was the point in time when the Sheriffs Department, working in
conjunction with the Los Angeles County Department of Health Services, became truly
cognizant of the MRSA issue confronting us. Prior to that time, MRSA infections had,
in some cases, been mistakenly diagnosed as spider bites. This was, and occasionally
continues to be, a common mis-diagnosis throughout the State as well as the Nation.

:7l :Jraddion

0/ c'5eruice

Board of Supervisors

-2-

January 21, 2005

As a result of our realization, we formed a multi-discipline MRSA Task Force, which
continues to meet on a bi-monthly basis. This task force, which includes Dr. Elizabeth
Bancroft, M.D., and other representatives from the Department of Health Services, has
helped lead to the development of MRSA treatment regimens and protocols.
Additionally, policies and practices related to inmate hygiene, exchange of clothing and
bedding, facility cleanliness, along with inmate and staff education, were developed and
enacted. The steps taken by the Sheriffs Department and the Department of Health
Services to aggressively treat MRSA show that MRSA is not a problem beyond our
control. Rather, MRSA proves to be a problem that has been, and continues to be,
controlled through a cooperative effort of subject experts.
Our baseline numbers have increased since 2002 because our efforts to identify, treat
and mitigate MRSA infections have significantly increased. We are more aggressively
looking for skin lesions and irritations, cUlturing more wounds, and identifying and
reporting more cases than we did two and one-half years ago. Additionally, we have a
better trained staff and screening process at our Inmate Reception Center, which assist
in identifying MRSA cases that come into the jails from the community.
Again, it is important to remember that our monthly cases have remained constant,
near the 200 mark, for the past several months. Our latest data shows that 24 percent
of the new cases each month are from inmates who are already infected before
entering our jails. It is also important to note that we have the "community" strain of
MRSA within our jails, and will likely have MRSA to deal with as long as inmates
continue to bring it in with them. Recognizing the fact that we have the "community"
strain, the Sheriffs Department takes efforts to ensure that MRSA does not leave the
jails and return to the community. As such, we ensure that recently released inmates
are given the opportunity to follow-up with public health services upon leaving our
facility.
The Los Angeles County Sheriffs Department is not the cause of the MRSA problem.
There is a misconception that MRSA started in the Los Angeles County jails. This is
simply not the case. In the correctional environment, MRSA exists in nearly every
major jail system throughout the United States and, indeed, the world. My staff has
personally interacted with corrections staff from across the Nation regarding their
experiences and difficulties battling this infection. The community strain that impacts
correctional systems also impacts athletic teams, school systems, the military,
homeless populations, and other arenas wherein there is close personal contact and
the sharing of personal items. There are some reports that MRSA has even crossed
species, with purported cases from county animal shelters.
In order to combat this problem, your Board has recommended that the Sheriffs
Department work with the Department of Health Services in order to reqUire that all
inmates be forced to shower. The Sheriffs Department requires that all inmates

Board of Supervisors

-3-

January 21 , 2005

booked into our jail system be taken through the shower area. Additionally, access to
showers is given to inmates on a daily basis. All inmates in a dorm setting are allowed
access to the showers continually throughout the day. Inmates housed in cells, or
those that pose a safety or security concern, are allowed daily scheduled access to the
showers. The only exceptions to this policy are inmates who are away for court,
medical reasons, visiting, or who simply refuse to take a shower. Although all inmates
are allowed and encouraged to shower daily, each inmate has the ultimate
responsibility to actually do so.
At no time does the Sheriffs Department use physical force to require an inmate to take
a shower. Although an appropriate public health officer may issue an order allowing the
use of force in order to require showers, this is a humanitarian, logistical, and civil
liability issue that the Sheriffs Department is not willing to undertake. Utilizing force in
order to ensure all inmates shower will have a detrimental effect, resulting in
unnecessary injuries to both staff and inmates alike. We will continue to allow inmates
every opportunity to shower, but will not compel mandatory showers through
reasonable force without a valid court order.
Your Board has also requested an update on the recently approved hiring of a
Physician Epidemiologist and support staff to help address MRSA issues within our
jails. My staff is currently meeting with a highly desirable candidate whom we hope to
quickly place into the hiring process. The acquisition of support staff would commence
immediately thereafter.
Attachment A shows excerpts from material recently published by Pfizer U.S.
Pharmaceuticals entitled, "The Rising Burden of MRSA." This first chart proVides a
brief history of the evolution of staph aureus resistance. Methicillin was developed as
early as 1960 to combat Penicillin-resistant staph aureus. The chart also shows a
''widespread and continuous emergence of Methicillin resistance (MRSA)" from the
1960's to present.
Attachment B shows 2003 statistics of MRSA rates from the various regions of the
United States. For example, for the Pacific region, 39.5 percent of patients reporting
infections were resistant to Methicillin.
Attachment C shows that MRSA is prevalent across the globe. Clearly, MRSA is a
worldwide issue.
Attachment D shows an update of our detailed report covering 20 issues addressed by
the Department of Health Services for combating MRSA. Among the corrective actions
still in effect are the introduction of a hand sanitizing lotion for personnel, the creation of
an informational Videotape presentation that outlines the MRSA issue, the availability of
daily showers for all inmates, as well as separate housing being made available at both
Men's Central Jail and North County Correctional Facility for those inmates who have

Board of Supervisors

-4-

January 21,2005

been identified as being infected with MRSA. The attached table summarizes the
current status of the 20 recommendations, which includes a complete accounting of our
corrective actions that have been taken to date.
Attachment E shows a recent MRSA audit conducted by my staff. These audits are
conducted on a quarterly basis and cover five areas of concern, including personal
hygiene, environmental cleaning, bedding/clothing exchange, education, and laundry.
Our audit shows that all facilities are compliant with the recommendations set forth by
the Department of Health Services.
As always, the Sheriff's Department continues to work toward increasing the awareness
of MRSA throughout the jails for both staff and inmates. The Sheriff's Department has
and will continue to make considerable progress regarding this problem and actively
work with the Department of Health Services, and other agencies, in an attempt to
combat MRSA through education, medication, medical protocols, and continued
monitoring of the problem. If you have any additional questions or concerns, please
call me or Chief John L. Scott of Custody Operations Division at (213) 893-5001.
Sincerely,

~-&coLEROY D. BACA
SHERIFF

AITACHMENT A

ATTACHMENT 8

>:j
>-

~

z
....,
()

Adapted from Christiansen KJ. et al. Antimicrob Agents Chemother. 2004;48:2049-2055. EARSS. Annual Report 2002. Bilthoven,
The Netherlands: EARSS; 2003. Mendes C. et al. Braz J Infect Dis. 2003;7:44-61. NNIS. Am J Infect Dis. 2003;31:481-498.

M.R.S.A. RECOMMENDATIONS BY DEPARTMENT OF HEALTH SERVICES
CURRENT STATUS OF COMPLIANCE - JANUARY, 2005
FACILITIES

~

RECOMMENDATION #2

RECOMMENDATION #1
SURVEILLANCE - Medical InLake Screening

SURVEILLANCE - Daily Logs of Skin Infection

MSB

Refer 10 IRe.

IRC

MC]

Recommendation still in effect - A specific
question, directly related to skin cuts I boils / sores
I wounds has been added to the medical screening
process for all inmates at lRC.
Refer to IRe.

Recommendation still in effect· A daily log
docwnenling all skin infectinns, which lists
inmate's name, booking number, and housing
location is maintained in the facility clinic.
Refet to MSB.

Refer to MSB.

TICF

Refer to IRe.

Refer to MSB.

CRDF

Refer to IRe.

Refer to MSB.

NCCF

Refer 10 IRe.

Refer 10 MSB.

PDC-EAST

Refer to IRe.

Refer 10 MSB.

PDC·NORTH

Refer to IRC.

Refer

10

MSB.

MlRALOMA

Federal deLainees housed al this facility. Federnl
detention sLandards followed.

Refer

10

MSB.

()

~

o

Page -1

M.R.S.A. RECOMMENDATIONS BY DEPARTMENT OF HEALTH SERVICES
CURRENT STATUS OF COMPLIANCE - JANUARY, 2005
FACILITIES

RECOMMENDATION #4

RECOMMENDATION #3
SURVEILLANCE - Culwre all Skin Infections

SURVErLLANCE - Evaluate All Cell Mates

MSB

Recommendation still in effect - All skin
infections are cultured upon initial clinic
examination.

Rccorruncndation still in effect - Evaluation of
cellm3tes having contael with infected MRSA
patient is still in place.

eRC

Skin infections are cultured upon initial intake and
screening, as necessary.

Refer to MSB.

MCJ

Refer 10 MSB.

Refer to MSB.

TICF

Refer

MSB.

Refer to MSB.

eRDF

Refer to MSB.

Refer 10 MSB.

NCCF

Refer to MSB.

Refer [0 MSB.

PDC-EAST

Refer (0 MSB.

Refer

PDC·NORTH

Refer to MSB.

Refer to MSB.

MIRA LaMA

Federal detainees housed althis facility. Federal
detention standards followed.

Refer to MSB.

(0

(0

MS£l.

Page -2

M.R.S.A. RECOMMENDATIONS BY DEPARTMENT OF HEALTH SERVICES
CURRENT STATUS OF COMPLIANCE -JANUARY, 2005
FACILITIES

RECOMMENDATION #5

RECOMMENDATION #6
QUALITY ASSURANCE Random Chan
Review
Reconunendation still in effecl- Although DIIS
recommended a random review, we review all
medical records of MRSA patients to ensure

IRC

SURVEILLANCE - ill Medical Charts of MRSA
Infecled Inmatcs
Reconunendation still in effecI- All medical
charts arc Ul mlS; a consistent diagnosLS of
specific MRSA infections are being conducled by
medical personnel.
Rcfer 10 MSB.

MCJ

Refer 10 MSB.

Refer to MSB.

rrCF

Refer 10 MSB.

Refer to MSB.

CRDF

Refer In MSB.

Refer tn MSB.

NCCF

Refer to MSB.

Rcfer 10 MSB.

PDC-EAST

Refer 10 MSB.

Refer to MSB.

PDC-NORTH

Refer 10 MSB.

Refer to MSB.

MIRALOMA

Federal deminees housed al this facility. Federal
detention smndards followed.

Federal deminees housed at tltis facility_ Federal
delention smndards followed.

MSB

appropriate treatment.

Refer to MSB.

-Page -3

M.R.S.A. RECOMMENDATIONS BY DEPARTMENT OF HEALTH SERVICES
CURRENT STATUS OF COMPLIANCE - JANUARY, 2005
FACILITIES

_

MSB

RECOMMENDATION #8

RECOMMENDATION #7
WOUND CARE AND TREATMENT - Dressing
Ch.. -.
Rcconunendarion still in effect - Dressing change
completed daily, and as needed, for any admitted
inmates.

WOUND CARE AND TREATMENT - Bandage
~.~

.....

~_.

&

............ -

......

Reconul1endation still in effecl- Bandage disposal

protocols are in place.

IRe

Recommendation still in effect - Dressing change
completed by medical personnel if irunates arrive
with wound

Refer to MSB.

MCJ

Rcconunendation still in effect - Dressing changes
completed by medical personnel daily.

Refer to MSB.

lTCF

Refer to MCl.

Refer to MSB.

eRDF

Refer to MCl.

Refer to MSB.

lNCCF

Refer to MCJ.

Refer to MSB.

PDC·EAST

Refer to MCl.

Refer to MSB.

IPDC-NORTH

Refer to MCJ.

Refer to MSB.

IMIRALOMA

Federal detainees housed at this facility. Federal
detention standards followed.

Federal detainees housed at this facility. Federal
detention st3.llda.rds followed.

Page -

M.R.S.A. RECOMMENDATIONS BY DEPARTMENT OF HEALTH SERVICES
CURRENT STATUS OF COMPLIANCE - JANUARY, 2005
FACILITIES

RECOMMENDATION #10

RECOMMENDATION #9

IRC

Recommendation still in effect- LASD Doctors
have been briefed by DHS and LASD Chief
Physician regarding correct antibiotic treattnent
nrotocol. Comolianee is reviewcd through Q/A.
Refer to MSB.

PREVENI'ION OF MRSA TRANSMISSION..
Educate inmates about PrcvcnrionIT: ._ ..
Recommendation still in effect - Informational I
educational video shown to all newly incoming
inmates at IRe, and shown at housing facilities.
Fliers and casters have been distributed.
Refer '0 MSB.

MCJ

Refer

MSB.

Refer to MSB.

rrCF

Refer to MSB.

Refer to MSB.

CRDF

Refer to MSB.

Refer to MSB.

NCCF

Refer to MSB.

Refer

'0

MSB.

PDC-EAST

Refer to MSB.

Refer

[0

MSB.

PDC-NORTH

Refer to MSB.

Refer to MSB.

MIRALOMA

Federal detainees housed at this facility. Federal
de'ention standards followed.

all housing areas.

WOUND CARE AND TREATMENT - Ensure

Prooer Treatment Protocol
MSB

'0

_-_._

Recommendation still in effect - Video shown in

Page -5

M.R.S.A. RECOMMENDATIONS BY DEPARTMENT OF HEALTH SERVICES
CURRENT STATUS OF COMPLIANCE - JANUARY, 2005
FACILITIES

RECOMMENDATION #11
PREVENTION OF MRSA TRANSMISSION • ...... v ........

MSB

mc

~

•

...........

RECOMMENDATION #12
PREVENTION OF MRSA TRANSMISSION -

........................ ..-..........

Recommendation still in effect - Inmates showered
on a daily basis.

Recommendation still m effecl- Custody Division
Policy requires cells/area to be cleaned after
MRSA is suspected.

Reconunendarlon still in effect - All incoming

Rcfer to MSB.

irunates allowed to shower upon cony and
processing. Soap is provided.

MCl

RccoITUl1endation still in effect - Showers available
16-20 hours daily. Soap is available; persolUlel
have been briefed on the importance of providing

Refer to MSB.

TfCF

soap to inmates.
Refer to MCl.

Refer to MSB.

CRDF

Refer 10 MO.

Refer 10 MSB.

NCCF

Refer to MCl.

Refer to MSB.

PDC-EAST

Refer to MO.

Refer to MSB.

PDC-NORTH

Refer 10 MO.

Refer to MSB.

MJRA LOMA

Refer to MCl.

Refer to MSB.

Page -6

M.R.S.A. RECOMMENDATIONS BY DEPARTMENT OF HEALTH SERVICES
CURRENT STATUS OF COMPLIANCE - JANUARY, 2005
FACILITIES

_

..........

RECOMMENDATION #14

RECOMMENDATION #13

PRINENTION OF MRSA TRANSMISSION ..,,. .......... l;....

PREVENTION OF MRSA TRANSMlSSION-.

...........................

MSB

Reeommeodation still in effect-Inmates
diagnosed with MRSA are showered and
linen/clothing is exchanged.

Refer to POC-NORTII.

IRC

Refer to MSB.

Refer to POC-NORTH.

MCJ

Refer to MSB.

Refer to POC-NORTH.

ITCF

Refer to MSB.

Refer to POC-NORTH.

CROF

Refer to MSB.

Refer to POC-NORTH.

NCCF

Refer to MSB.

Refer to POC-NORTH.

POC-EAST

Refer to MSB.

Refer to POC-NORTH.

POC-NORTH

Refer to MSB.

MlRALOMA

Refer to MSB.

Recommendation still in effect - POC-North
Facility still manages aU laundry operations for the
Oepartment. Laundry is washed and dried at
temperatures sufficient to kill MRSA. Exploring
the possibility of adding an additional shift.
Refer to POC-NORTII.

Page -7

--

M.R.S.A. RECOMMENDATIONS BY DEPARTMENT OF HEALTH SERVICES
CURRENT STATUS OF COMPLIANCE -JANUARY, 2005
FACILITIES

RECOMMENDATION #15
PREVENTION Or- MRSA TRANSMISSION ................. J

~

.vw....... u .• ;I'j,

RECOMMENDAnON #16
PREVENTION or- MRSA TRANSMISSION .............""...............n..

'I' .................. - ......

MS13

Refer to POG-NORTH.

Recommendation still in effect - Clolhing and
linen exchanged every other day and upon request
by medical personnel.

IRG

Refer to POG-NORTH.

Recommendation still in effect - All incoming
inmates are issued clean clothing.

MC!

Refer to POG·NORTH.

Refer to TTGr-.

TICr-

Refer to POC-NORTIi.

Recommendation still in effect - Linen I Uniforms
I Underwear exchanged twice weekly.

CRDF

Refer to POC-NORTH.

Refer to ITCF.

NCCr-

Refer to POC-NORTH.

Refer to ITCF.

POC-EAST

Refer to POC-NORTH.

Refer to ITCF.

POC·NORTH

Reeommeodation still in effect- Laundry dried

Refer to ITGF.

Lhoroughly before fe-issue to housing facilities;
still in compliance.
MIRALOMA

Rcfer to POC-NORTH.

Recommendation still in effect - Unifonns - three
per week; underwear - 5 sets per week; Linen I set
per week. Federal standards in place at this
facility.

Page -8

M.R.S.A. RECOMMENDAnONS BY DEPARTMENT OF HEALTH SERVICES
CURRENT STATUS OF COMPLIANCE - JANUARY, 2005
FACILITIES

RECOMMENDAnON #17
PREVENTION OF MRSA TRANSMISSION Limit Transfers of Infected I
Recommcndation still in effect - Medical
wristband identification procedure in place to
I ....... ~...'"

MSB

RECOMMENDATION #18
PREVENTION OF MRSA TRANSMISSION Medical Summary and Treaanent PI,
Recommendation still in effect- IHIS provides
.~

medical swmnaries for aU inmates.

prevent lhe random movement of acutclchronic
IRC

type inmatcs.
Refer to MSB.

Refer to MSB.

MCJ

Refer to MSB.

Refer to MSB.

TICI'

Refer to MSB.

Refer to MSB.

CRDF

Refer to MSB.

Refer to MSB.

NCCF

Refer to MSB.

Refer to MSB.

PDC·EAST

Refer to MSB.

Refer to MSB.

PDC-NORTH

Refer to MSB.

Refer to MSB.

MIRALOMA

Federal dctainees hnused at this facility. Federal
detention standards followed

Federal detainees houscd at this facility. Fcderal
detention standards followed.

Page-9

M.R.S.A. RECOMMENDATIONS BY DEPARTMENT OF HEALTH SERVICES
CURRENT STATUS OF COMPLIANCE - JANUARY, 2005
FACILITIES
MSB

RECOMMENDATION #19

RECOMMENDATION #20

PREVENTION OF MRSA TRANSMISSION -

PREVENTION OF MRSA TRANSMISSION -

................

10.1 .................................. I .........

............ 1 •

.................. u

......... ., ....... ~ ....... ...................

&

.v.~

..v ..

Recommendation still in effect - Training videos
and bulletins for staff are cWTcntly being utilized.
MRSA prevention techniques are still discussed at

IRC

Recommendation partiaJly completed - System
capabilities have now been installed, practice and
protocols for medical personnel are being
reviewed and implemented.
Refer to MSB.

facility briefings.
Refer to MSB.

MCl

Refer to MSB.

Refer to MSB.

TICF

Refer to MSB.

Refer to MSB.

CRDF

Refer to MSB.

Refer to MSB.

NCCF

Refer to MSB.

Refer tn MSB.

PDG-EAST

Refer to MSB.

Refer to MSB.

PDC-NORl1l

Refer to MSB.

Refer to MSB.

MlRALOMA

Refer (0 MSB.

Refer to MSB.

Page -10

161551N25A· SH-AO (11190)

COUNTY OF LOS ANGELES

SHERIFF'S DEPARTMENT
Dale:
OFFICE CORRESPONDENCE

FROM:

I HAEL L. BOR MAN, LIEUTENANT
CUSTODY SUPPORT SERVICES

TO:

January 10, 2005

FILE:
PROJECT: 205005

CHARLES M. JACKSON, CHIEF
CORRECTIONAL SERVICES DIVISION
JOHN L. scon, CHIEF
CUSTODY OPERATIONS DIVISI9N

SUBJECT:

METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS AUDIT

Custody Support Services conducted a Methicillin Resistant Staphylococcus
Aureus (MRSA) quarterly review and audit. The audits were conducted at all
custody facilities. Each audit was unannounced and consisted of visual
inspections and interviews of personnel and inmates. The purpose of this review
was to ensure that the corrective actions set forth in Division Policy and monthly
MRSA meetings was being adhered to. The following items were audited:
Item I • Personal Hygiene:
Status:
Fully in Compliance.

Synopsis:
The facilities were audited to ensure that inmates received showers and
soap on a daily basis. Custody Support Services personnel made contact
with staff, inmate workers, and general population inmates while
conducting these audits.
Audit:
Showers and soap are av.ailable to inmates on a continuing basis at all
facilities. Auditors noted that soap was available and ensured that
showering of inmates were noted on the Title 15 - Uniform Daily Activity
Log.

ATTACHMENT E

MRSAAUDIT

·2·

JANUARY 10,2005

Item II - Environmental Cleaning:
Status:
Fully in compliance.

Synopsis:
The facilities were audited to ensure that the housing areas were property
cleaned after inmates with MRSA are identified. The housing areas were
checked for proper cleaning, mattresses were checked for proper disinfecting,
and torn mattresses infected with MRSA were audited to ensure they were being
property discarded.
Audit:
All facilities were in compliance with environmental cleaning of the facility.
Housing areas and mattresses are disinfected, and torn mattresses that are
used by inmates with MRSA are discarded properly.
Item III • Freguency of Bedding I Clothing Exchange:
Status:
Fully in Compliance.

Synopsis:
The facilities were audited to ensure that inmates receive the appropriate
amount of bedding and linen. Additionally, auditors ensured that inmates
diagnosed with MRSA were showered and issued new clothing.
Audit:
All facilities were in full compliance with bedding I clothing exchange. All inmates
diagnosed with MRSA are showered and given new clothing.
Item IV • Education and Protection:
Status:
Fully in compliance.

MRSAAUDIT

-3 -

JANUARY 10, 2005

Synopsis:
The facilities were audited to insure that staff were educated on MRSA and the
various means of protecting themselves. Auditors checked to ensure training
videos were seen by inmates, training bulletins were reviewed by staff, and
various other in-service training was conducted at briefings.
Audit:
All facilities show the training and MRSA videos to staff and inmates. Bulletins
and information on MRSA is made available and all other aspects of staff
education and protection were being properly followed and documented;
compliance with these issues are confirmed in monthly MRSA meetings.
Item V • Laundry Services:
Status:
Fully in compliance.

Synopsis:
Pitchess Detention Center - North is responsible for overseeing the Laundry
Operations. The laundry area was audited to ensure that clothing was being
washed and dried at temperatures that would destroy MRSA bacteria.
Audit:
All inmate laundry is washed and dried at temperatures that will destroy the
MRSA bacteria.
This audit details the current status of the MRSA policy. If you have any questions or
need additional information, please contact Deputy Shawn Kehoe at Custody Support
Services, (213) 473-6517.
MLB:SRK:srk