Infection Prevention and Control

By Elizabeth Franklin-Best, Esq., and Christopher Zoukis, JD, MBA

Program Statement	6190.05
Subject	Infection Prevention and Control
Current edition	May 7, 2026
Change notices	None
Supersedes	Program Statement 6190.04, Infectious Disease Management (6/3/2014) — rescinded
Governing regulation	28 C.F.R. part 549, subpart A (§§ 549.10–549.15)
Governing statute	18 U.S.C. § 4014 (Correction Officers Health and Safety Act of 1998, Pub. L. 105-370)
Other binding standards	OSHA 29 C.F.R. § 1910.1030 (Bloodborne Pathogens); 29 C.F.R. § 1910.134 (Respiratory Protection)
Related BP forms	BP-A0659, Medical Summary of Federal Prisoner/Alien in Transit
Official PDF	https://www.bop.gov/policy/progstat/6190_005.pdf

Checked against the BOP policy set · 2026-09-07 · How we verify

This policy governs how the Bureau of Prisons tests for, isolates and reports infectious disease — and, most importantly for anyone actually living under it, when a person in federal custody can be tested without consent and what happens if they refuse. It sits alongside our page on medical and dental care in federal prison, which covers how to get seen for an illness in the first place; this page covers what the Bureau can require of you.

Program Statement 6190.05 took effect on May 7, 2026 and replaced a policy that had stood since 2014. Almost nothing written about BOP infectious-disease policy elsewhere on the internet reflects it yet.

The rule itself: infection control

The binding text is 28 C.F.R. § 549.12, reproduced inside the Program Statement. It is short, and it is the part a reader actually came for, because it is the part that says what the Bureau may do over an objection.

§ 549.12 Testing.

(a) Human Immunodeficiency Virus (HIV) —

(1) Clinically indicated. The Bureau tests inmates who have sentences of six months or more if health services staff determine, taking into consideration the risk as defined by the Centers for Disease Control guidelines, that the inmate is at risk for HIV infection. If the inmate refuses testing, staff may initiate an incident report for refusing to obey an order.

(2) Exposure incidents. The Bureau tests an inmate, regardless of the length of sentence or pretrial status, when there is a well-founded reason to believe that the inmate may have transmitted the HIV infection, whether intentionally or unintentionally, to Bureau employees or other non-inmates who are lawfully present in a Bureau institution. Exposure incident testing does not require the inmate’s consent.

(3) Surveillance Testing. The Bureau conducts HIV testing for surveillance purposes as needed. If the inmate refuses testing, staff may initiate an incident report for refusing to obey an order.

(4) Inmate request. An inmate may request to be tested. The Bureau limits such testing to no more than one per 12-month period unless the Bureau determines that additional testing is warranted.

(5) Counseling. Inmates being tested for HIV will receive pre- and post-test counseling, regardless of the test results.

(b) Tuberculosis (TB).

(1) The Bureau screens each inmate for TB within two calendar days of initial incarceration.

(2) The Bureau conducts screening for each inmate annually as medically indicated.

(3) The Bureau will screen an inmate for TB when health services staff determine that the inmate may be at risk for infection.

(4) An inmate who refuses TB screening may be subject to an incident report for refusing to obey an order. If an inmate refuses skin testing, and there is no contraindication to tuberculin skin testing, then, institution medical staff will test the inmate involuntarily.

(5) The Bureau conducts TB contact investigations following any incident in which inmates or staff may have been exposed to tuberculosis. Inmates will be tested according to paragraph (b)(4) of this section.

(c) Diagnostics. The Bureau tests an inmate for an infectious or communicable disease when the test is necessary to verify transmission following exposure to bloodborne pathogens or to infectious body fluid. An inmate who refuses diagnostic testing is subject to an incident report for refusing to obey an order.

Reproduced from Program Statement 6190.05 at pp. 12–16, and cross-checked word for word against the regulation as published at ecfr.gov.

Why we quoted the regulation and not the surrounding pages. Program Statement 6190.05 prints the regulation and the Bureau’s own staff instructions in the same document, distinguished only by typeface — the header of every page reads “Federal Regulations from 28 CFR: this type. Implementing instructions: this type.” That distinction vanishes the moment the PDF is converted to text, which is how a great deal of confidently wrong writing about BOP policy gets made. The block above is the regulation, verified independently against eCFR. Everything below that is labeled as instruction is instruction.

The three categories the Program Statement adds

Around that regulation, the Bureau’s own policy sorts testing into three categories that the regulation does not name:

Voluntary testing – occurs when an inmate sends a request for testing to Health Services.

Mandatory testing – occurs when an inmate is deemed at risk for an infectious disease and the test is clinically indicated and/or surveillance testing is required to monitor trends and prevent an outbreak. Inmates must participate in mandatory testing. If they refuse, staff should initiate incident report codes 227 (refusing to participate in a required physical test or required examination unrelated to testing for drug abuse) and 307 (refusing to obey an order of any staff).

Involuntary testing – occurs either when an inmate is known to be at risk for an infectious disease after an exposure or is the known source of an exposure incident, and the test is clinically indicated. Inmate written consent is not required for involuntary testing.

Program Statement 6190.05 at pp. 11–12.

Two things about that passage are worth stating precisely, because they are the difference between understanding this policy and misreading it.

First, the code numbers are policy, not regulation. The regulation says only that a refusal may draw “an incident report for refusing to obey an order.” The specific pairing of code 227 with code 307 appears nowhere in § 549.12; it is the Bureau’s instruction to its own staff, and it recurs at least five times in the Program Statement. It is nonetheless what will actually happen, so knowing the numbers is useful — see inmate discipline program for what those codes carry.

Second, involuntary testing is backed by force, and the policy says so. Where an inmate identified as the source in an exposure incident continues to refuse, the Program Statement directs that “involuntary testing will be conducted to ensure the safety of staff and the inmate in accordance with the Program Statement Use of Force, Application of Restraints, and Firearms. The use of force for involuntary testing must be authorized by the Warden or their designee” (PS 6190.05 at pp. 12–13). That is not a hypothetical clause. See use of force and restraints.

Every deadline in the policy, in one table

These are the time limits and numeric thresholds a person in custody or a family member is most likely to need. Each is pin-cited, and each is labeled regulation (binding) or instruction (the Bureau’s own policy, which it can revise on its own).

Requirement	The limit	Source
TB screening on arrival	within two calendar days of initial incarceration	§ 549.12(b)(1) — regulation; PS at p. 13
TB testing initiated	within two calendar days of initial Bureau incarceration	instruction; PS at p. 14
Repeat TB testing after a previous negative test	required if out of Bureau custody for more than 14 calendar days	instruction; PS at p. 14
Holdover / in-transit exception	a stay of less than four calendar days requires only a TB symptom screen	instruction; PS at p. 14
Chest radiograph after a new positive TB test (no symptoms)	completed within 14 calendar days of the positive test	instruction; PS at p. 14
New chest radiograph after time out of custody	required within 14 calendar days of arrival where the person was out of continuous Bureau custody 30 calendar days or more	instruction; PS at p. 15
Follow-up chest radiograph after a positive annual test	within 14 calendar days	instruction; PS at p. 15
TB clearance before transfer — symptom window	no complaints or symptoms associated with suspected active TB within the past 30 calendar days	instruction; PS at p. 17
TB clearance before transfer — negative test	a negative TB test within the previous 12 months; a negative skin test “must be documented in millimeters”	instruction; PS at p. 17
Inmate-requested HIV test	no more than one per 12-month period unless the Bureau determines additional testing is warranted	§ 549.12(a)(4) — regulation; PS at p. 13
HIV testing, clinically indicated	applies to inmates with sentences of six months or more who are determined to be at risk	§ 549.12(a)(1) — regulation; PS at p. 12
Hepatitis B vaccination for inmate workers in high-risk details	must be offered within 10 calendar days of assignment	instruction; PS at p. 23
Vehicle used to transport suspected or confirmed active TB	aired out at least one hour before entering without a respirator	instruction; PS at p. 19
Suspected foodborne outbreak	reported within one working day to the Regional Food Service Office and Central Office branches	instruction; PS at p. 11

Compiled from Program Statement 6190.05 at the pages cited, with every regulation line cross-checked against 28 C.F.R. § 549.12.

The HIV rules, and the one statutory protection nobody mentions

The six-month threshold in § 549.12(a)(1) is not a Bureau invention. It comes from 18 U.S.C. § 4014(a), which directs that the Attorney General “shall cause each individual convicted of a Federal offense who is sentenced to incarceration for a period of 6 months or more to be tested for the presence of the human immunodeficiency virus, as appropriate, after the commencement of that incarceration, if such individual is determined to be at risk.”

The same statute carries a protection that is genuinely important and almost never discussed:

(d) The results of a test under this section are inadmissible against the person tested in any Federal or State civil or criminal case or proceeding.

18 U.S.C. § 4014(d).

That is a rule of evidence set by Congress, not a Bureau policy, and it is worth knowing if you are being told that a test result can be used against you.

Opt-out testing. The Program Statement instructs that “[t]he Bureau also uniformly uses opt-out testing. In opt-out testing, all inmates are informed upon admission, either orally or in writing, that HIV testing will be performed unless they refuse testing” (PS 6190.05 at p. 12). Opt-out means the test happens by default. Refusing is possible and, under (a)(1) and (a)(3), staff “may” write an incident report — the regulation uses may, not will.

Exposure-incident testing is different, and the difference is consent. Under § 549.12(a)(2), where there is a well-founded reason to believe an inmate transmitted HIV to a staff member or another non-inmate lawfully present, testing “does not require the inmate’s consent,” and it applies regardless of sentence length or pretrial status. The Program Statement adds that a person identified as a source will be “informed of the need for testing and provided education and counseling about it prior to testing being performed” (PS 6190.05 at p. 12).

Counseling is mandatory both ways. § 549.12(a)(5) requires pre- and post-test counseling “regardless of the test results.” The Program Statement adds that written informed consent for testing is not required, that all inmates testing positive “will be counseled by a physician and referred immediately to Psychology Services for evaluation and follow-up needs,” and that pregnant inmates who test positive will be counseled about perinatal transmission and given information on treatment options to prevent it (PS 6190.05 at p. 13).

Medical isolation, quarantine, and the room that has to exist

The policy draws a line most people blur. Medical isolation separates people who are infected. Quarantine separates people who are well but may have been exposed. Decisions to start or stop either “are made by the CD or designee in accordance with CDC guidance,” and while a person is in medical isolation or quarantine, “a daily clinical assessment must be completed and documented in the medical record by a healthcare provider” (PS 6190.05 at p. 9).

That daily-assessment line is the single most useful sentence in the policy for anyone whose relative has been moved into isolation. It creates a daily record. If a family is told nothing for a week, the policy says a documented clinical assessment should exist for each of those days.

Airborne Infection Isolation Rooms (AIIRs) are the specialized negative-pressure rooms required for tuberculosis. Not every prison has one, and the policy is blunt about the consequence: “Only those institutions equipped with a functional and professionally validated AIIR have the option to medically isolate and treat inmates with suspected or diagnosed tuberculosis (TB) or other airborne diseases… Facilities that do not have a validated AIIR must arrange to medically isolate inmates at another institution with a validated AIIR or the local hospital” (PS 6190.05 at p. 9).

The Bureau imposes concrete engineering checks on those rooms. Negative pressure must be monitored and logged before occupancy, daily when occupied, and monthly when not occupied; the rooms must be validated at least annually by a professional with air-balancing expertise, including measuring negative pressure, calculating air exchanges per hour, confirming emergency power, and ensuring the room is “either vented at least 25 feet away from air intakes, windows and walkways, or … equipped with High Efficiency Particulate Air (HEPA) filtration prior to venting” (PS 6190.05 at p. 10).

Medical isolation is not the Special Housing Unit, and it should not be run like it. If your relative is being held in what is described as medical isolation but is functionally disciplinary segregation, that is a distinction worth pressing — compare special housing units.

Your job, your housing, and your programs

Testing positive is not, by itself, a disciplinary matter. 28 C.F.R. § 549.13 says so directly:

(c) If an inmate tests positive for an infectious disease, that test alone does not constitute sole grounds for disciplinary action. Disciplinary action may be considered when coupled with a secondary action that could lead to transmission of an infectious agent. Inmates testing positive for infectious disease are subject to the same disciplinary policy that applies to all inmates (see 28 CFR part 541, subpart B). Except as provided for in our disciplinary policy, no special or separate housing units may be established for HIV-positive inmates.

Reproduced from Program Statement 6190.05 at p. 20; verified against 28 C.F.R. § 549.13.

The Program Statement’s implementing text draws the practical distinction: “Infectious diseases not transmitted by casual contact include HBV, HCV, and HIV. Inmates with these diseases are allowed to work in Food Service or other work assignments, but still require an evaluation for clearance.” By contrast, inmates with diseases transmitted through casual contact “will be prohibited from work assignments in any area, until fully evaluated by a health care provider,” and inmates with foodborne illnesses are prohibited from work assignments until evaluated and cleared (PS 6190.05 at p. 20).

Medical hold blocks transfer. Where a person is being worked up for suspected active TB, is on treatment for active or latent TB, has another communicable disease, or is known to have been exposed to one, “[t]he CD or designee must place an inmate on medical hold to prevent transfer” (PS 6190.05 at pp. 17–18). This is a common and confusing experience: a transfer is approved, then does not happen, and nobody explains why. A medical hold is one of the ordinary reasons. See the federal inmate transfer process.

It can also stop a court date. If a person with suspected active TB or another communicable disease is scheduled to appear in court or at an ICE or Parole Commission hearing, the warden must ensure the hearing authority is notified that the person “is undergoing surveillance or treatment for a communicable disease and must not attend in-person proceedings until cleared by the CD or designee” (PS 6190.05 at p. 18). Counsel who cannot get a client produced should ask whether a medical hold is the reason.

Who is allowed to know

28 C.F.R. § 549.14 ties disclosure to the Privacy Act of 1974 and to the Correction Officers Health and Safety Act of 1998, and the Program Statement then lists the categories of people who may be told: Bureau staff “who have a need to know in the performance of their duties, including but not limited to, health care personnel, social workers, unit management staff, and psychologists”; public health authorities where reporting is legally required; and non-Bureau staff such as U.S. Marshals or state or local law enforcement who were exposed while lawfully present (PS 6190.05 at p. 21).

Two limits are worth naming. Where an inmate is the source case in an exposure incident, test results may be provided for treatment purposes but “[d]ocumentation that may not be provided includes the source case’s personal identifiable information (e.g., name, date of birth, or register number)” (PS 6190.05 at p. 21). And in the other direction: “The identity of the inmate who was the potential source of the exposure will not be revealed to the exposed inmate(s) or staff and will not be recorded in the exposed inmate’s medical record” (PS 6190.05 at p. 17).

Note also that the Bureau’s position is that “[i]nmate authorization for release of information is not needed before making legally mandated communicable disease reports to public health authorities” (PS 6190.05 at p. 9). If you are in the Witness Security Program, an additional Central Office notification step applies before your name is released. For how health records generally are held and released, see medical records access.

What infection control policy means for you

If you are the person inside: refusing a TB test

You cannot refuse a TB skin test into oblivion. Under § 549.12(b)(4), if you refuse and there is no contraindication, “institution medical staff will test the inmate involuntarily,” and the Program Statement directs staff to write incident reports 227 and 307. You also cannot choose your own test: “An inmate may not request to substitute a chest radiograph for a TB test,” and an IGRA blood test or chest x-ray may be substituted only where the Clinical Director approves it for a documented medical contraindication, or where the warden, in consultation with the Office of General Counsel, approves a legal contraindication such as a religious exemption (PS 6190.05 at pp. 14–16).

If you have a real contraindication — a documented severe reaction to a previous skin test, for instance — say so early and make sure it is documented. The policy provides that where “a severe reaction to a TST (e.g., whole arm swelling or severe blistering) was documented in the medical record or is described by the inmate, then an IGRA must be used” (PS 6190.05 at p. 14). That is one of the few places the policy uses must.

You can request an HIV test, once in a 12-month period as of right. Send an Inmate Request to Staff to Health Services. And if you work in a high-risk detail — Health Services orderly, blood-spill clean-up team — you must be offered hepatitis B vaccination within 10 calendar days of assignment. If you were never offered it, that is a documented gap and a specific thing to raise.

If you are the family: three questions that get real answers

The three questions that get real answers are these. Is there a validated AIIR at that institution? If your relative has suspected TB and the facility does not have one, the policy says they must be moved to a facility or hospital that does. Is a daily clinical assessment being documented? The policy requires one for every day in medical isolation. Is there a medical hold? That is the usual quiet reason a transfer or a court appearance does not happen.

You will not be given clinical details directly. Health information is released under the rules described above and, generally, only with the person’s authorization. The realistic route is for your relative to authorize release, or for counsel to obtain records — see medical records access.

If you are counsel: infection control

This policy generates unusually good documentary hooks. Each institution must maintain, and have its Governing Body approve annually, four written items: the Health Services Unit IP&C procedures, the IP&C risk assessment and plan, the tuberculosis exposure control plan, and the bloodborne pathogen exposure control plan (PS 6190.05 at p. 2). IP&C meetings are held “at least quarterly and documented with meeting minutes.” AIIR negative-pressure monitoring is logged before occupancy, daily when occupied and monthly when unoccupied, and annual validation records are maintained by the Facilities department. Sharps injuries are tracked on an ongoing log.

Those records exist because policy says they must, they are institution-level rather than inmate-level, and their absence or their contents can be the whole case in a conditions matter. Note also the OSHA overlay: the bloodborne pathogen plan “must be consistent with 29 CFR 1910.1030,” a legally binding standard in its own right, independent of anything the Bureau does.

Applied Insight — Christopher Zoukis, JD, MBA, Managing Director: On an infectious-disease problem, the record we look for first is rarely the medical file. It is the institution’s own IP&C paperwork — the quarterly meeting minutes, the AIIR validation log, the sharps injury log, the annual exposure control plan. The Bureau requires that this material exist and be approved annually by the institution’s Governing Body. When an institution cannot produce it, that fact is often clearer and more consequential than any single clinical entry.

What changed with Program Statement 6190.05

Program Statement 6190.05 took effect May 7, 2026, rescinding Program Statement 6190.04, Infectious Disease Management (6/3/2014). The Bureau’s own Summary of Changes is unusually terse:

Program Statement Rescinded: 6190.04 Infectious Disease Management (6/3/2014)

Changes: Extensive changes have been made throughout this program statement to improve clarity and align with updates to Bureau of Prisons (Bureau) procedures.

Reproduced from Program Statement 6190.05 at p. 1.

That single line is the entire stated change log for a policy rewrite spanning twenty-five pages. It is worth saying plainly: the Bureau did not itemize what changed here, unlike most of its 2026 reissues. Comparing the two editions clause by clause is therefore the only way to know, and we do not represent that we have done so.

What we can state from the face of the current document is structural, and it is substantial. The policy was renamed — from Infectious Disease Management to Infection Prevention and Control, matching the modern healthcare term of art and the “IP&C” program vocabulary that runs through the new text. The current edition is built around a named institutional program with a designated IP&C nurse who implements it, an annual risk assessment, four separately approved written plans, quarterly documented meetings, and Central Office templates for the meeting minutes and reporting formats. It incorporates OSHA’s respiratory-protection and bloodborne-pathogen standards by citation throughout, adds a sharps safety program with an injury log and annual device review, adds a locally developed Respiratory Illness Pandemic plan reviewed annually, and adds explicit COVID-19 and influenza content to the inmate education requirement at Admission and Orientation.

As with every Program Statement, the underlying regulation did not move. The sections in 28 C.F.R. part 549, subpart A carry an effective date of December 29, 2016. The Bureau rewrote its instructions to staff in 2026; it did not rewrite what binds it. Everything on this page marked instruction can change again without notice-and-comment rulemaking.

Where people get stuck after refusing a TB test

“They wrote me a shot for refusing a TB test.” This is the most common dispute under this policy, and the policy anticipates it: codes 227 and 307, together. The route is the ordinary one — try informal resolution with your Unit Team, then a BP-9 to the warden, a BP-10 to the region, a BP-11 to Central Office, through the administrative remedy program. The argument that actually goes somewhere is not “I did not want the test.” It is a documented medical or legal contraindication: a recorded severe reaction to a prior skin test (in which case the policy says an IGRA “must be used”), or a religious exemption approved by the warden in consultation with the Office of General Counsel. Get the contraindication into the medical record before the refusal, not after. See inmate discipline proceedings for how the hearing itself works.

“My transfer was approved and then it wasn’t.” Check for a medical hold. The Clinical Director must impose one for suspected or treated TB, another communicable disease, or a known exposure. A hold is not permanent and is not disciplinary, and where transfer is necessary the institution consults the Central Office IP&C Section rather than simply refusing. An Inmate Request to Staff to Health Services asking whether a medical hold is in place, and on what basis, is the cleanest way to find out.

“There is no isolation room here.” Then under the policy your relative should not be isolated there for suspected TB. The instruction is explicit: facilities without a validated AIIR “must arrange to medically isolate inmates at another institution with a validated AIIR or the local hospital,” and while awaiting transport the person must wear a surgical mask and be kept in a single cell in a low-traffic area, away from general population. If someone is instead being held in ordinary segregation with suspected airborne TB, that is a departure from the Bureau’s own written procedure and should be raised in writing immediately, at the institution and then through the remedy path.

“I was never offered the hepatitis B vaccine.” If the work assignment is on the institution’s bloodborne exposure control plan as a high-risk detail — Health Services, blood-spill clean-up — the offer is due within 10 calendar days of assignment. A refusal has to be signed, and the policy states that “[i]nmates who refuse vaccination may request and obtain the vaccination later.” If neither an offer nor a signed refusal exists in the record, ask for it by name.

Related BOP policy on infection control

• Health Services Administration (Program Statement 6010.05) — the umbrella policy: how health care is organized, staffed and accredited, and who the Clinical Director and Health Services Administrator are.
• Patient Care (Program Statement 6031.06) — the Bureau’s core clinical policy; this one cross-references it for suitability for work details.
• Autopsies (Program Statement 6080.02) — reissued the same day as this policy, and the governing rule where a death follows an infectious illness.
• Special housing units and inmate discipline program — the two policies this one cross-references by name for housing and for the 227/307 codes.
• Use of force and restraints — the policy that governs involuntary testing when it comes to that.
• Medical records access and medical designations and care levels — for records and for whether a facility can manage a given condition.
• Intake screening and the intake process — where the two-day TB screening actually happens.

For the reader’s-eye view of getting medical attention day to day, see medical and dental care in federal prison. Where a chronic or serious infectious condition bears on early release, see compassionate release for medical conditions.

Frequently Asked Questions About Infection Prevention

Reviewed for legal accuracy by Elizabeth Franklin-Best, Esq., Principal Attorney·September 2026