Location-specific hazards. The location of a CI is a factor in what risk drivers may be present. Facilities on the west coast of the U.S. may be impacted by particulates from wildfire smoke or from inhalation of airborne Coccidioides, which causes coccidioidomycosis (Valley Fever). East coast facilities have their own issues, including Lyme disease and hurricanes. During Hurricane Ian in September, the Florida Department of Corrections evacuated 25 facilities in the path of the storm. In addition to potential sewage backup, mold is a concern after the water recedes, especially during prolonged interruptions of indoor thermal conditioning. Thermal stressors must also be considered in the context of location and indoor environmental quality. For example, occupants of CIs along the southern border face heat stress to a greater degree than facilities in the north, while northern facilities are more likely to face hypothermia risks. Location also influences the impacts of environmental contaminants on CIs. A CI may have been constructed on land that has legacy contaminants or near facilities whose operations may negatively impact the CI. For example, a recent paper in the journal Integrated Environmental Assessment and Management describes a CI in New Jersey constructed on marshland that was reportedly a site for city sanitation waste, stormwater drainage, and illegal landfill dumping. A human health risk assessment performed at the facility identified mercury and beryllium as contaminants of concern. CONSIDERATIONS FOR FACILITY HEALTH RISK ASSESSMENTS These hazards are just a few that may impact the indoor environment at CIs. The hazards that plague CIs depend on factors such as population, geography, and location. Inmates are not the only people affected by unkept buildings. The health and safety of employees, visitors, and vendors is also on the line. It is recommended that CIs undergo facility health risk assessments to evaluate and control any potential risk driver that may be present. These assessments can be tailored to unique conditions and populations. It is important to correlate potential human health risk drivers with current usage of CIs. While newer CIs have been designed according to the most current guidelines from the U.S. National Institute of Corrections, older CIs were built under older standards. Aged CIs, especially those that are overcrowded, may not be used as originally designed and intended. Facility health risk assessments of all CIs should be based on current conditions, but older facilities may require more scrutiny because of changes that occurred over the years, such as the repurposing of campus buildings. Standards from national facility accreditation organizations may also dictate the acceptability of facility conditions. Starting at the micro building level, it is important to identify and document the nature of the occupants, including demographics, incarceration status (that is, low versus medium risk), general health status (such as the presence of transmissible infections like MRSA), and background—for example, how inmates interact within cliques formed either before or during incarceration. The employed population of the CI must also be considered in the context of demographics and elevated risk. Information about individual vendors and visitors may be difficult to obtain, so a general understanding of their makeup may be more helpful. Understanding the nature of the occupants indicates how they interact with the facility. On the macro building level, documenting the types of buildings and areas within those buildings is crucial for identifying locations that could pose a higher risk based on the nature of the space and the occupants. For example, understanding the areas within the CI—such as sleeping accommodations, holding cells, guard towers, dining areas, meeting rooms, showers, day rooms, administration areas, and so on—is vital for understanding how individuals and populations move through the facility. This knowledge allows for the identification of high-risk areas, which is integral to the risk assessment. For example, facilities that have a detox area may house occupants who have a higher probability of entering the CI with a positive disease status. Campus-wide evaluations should consider the usage of different facilities. Many CIs have “special housing” or accommodations that are used infrequently, which can lead to stagnant water, a breeding ground for pathogenic bacteria such as Legionella. Some CIs might have special facilities for elderly inmates; according to the National Commission on Correctional Health Care, incarcerated individuals 65 and older are the fastest growing demographic in CIs. Because the elderly have a higher risk from exposure to a number of substances, and infections are common occurrences at end of life, CIs may retrofit a building on campus to hold this elderly population or provide palliative care. But using buildings for purposes they were not designed to meet may contribute to health impacts. The facility health risk assessment should ensure that the unique needs of this population are addressed. CONTROLS While some CIs have pre-existing controls such as HVAC systems, the primary historical architectural design purpose for most domestic CIs was not to minimize the impact of adverse health outcomes. Based on hazards identified during the COVID-19 pandemic, CIs need more effective administrative and engineering controls to effectively reduce risks for inmates, employees, vendors, and visitors. Evaluation of the administrative operations at CIs can be effective in reducing risk. Many administrative operations involve the interactions of inmates and employees with the facility and with each other, including cleaning and disinfection programs based on specific use conditions. The assessment should evaluate whether changes in occupant flow alter the risk of a human health outcome. For example, if there is a pod of inmates who have a higher incidence of a communicable disease such as COVID-19, then risk may be reduced by restricting older guards from entering the pod or interacting with guards who have worked in the pod. While some administrative changes may reduce work efficiencies, this consequence must be weighed against increased risks to human health.