Camp nurses are in a unique position while caring for their charges. They work directly with the campers and counsellors 24 hours a day throughout their camp stay. For some children, their time at camp is their first ever time away from home and their parents, so if they become ill or are injured, the camp nurse is even more important. At the same time, many counsellors are teen-agers themselves and if they become ill, they are also the camp nurse’s responsibility.

Camp life, with the shared living quarters and new experiences and activities, can lead to illness and injuries. Camp nurses must work on keeping their charges as healthy as possible while dealing with illness and injuries that occur. Because of this close interaction, camp nurses are well placed to not only help spot and act on infections, but to help educate the campers and camp staff of the importance of infection prevention and sepsis awareness.

Sometimes incorrectly called blood poisoning, sepsis is the body’s often deadly response to infection.  Sepsis kills and disables millions and requires early suspicion and treatment for survival. Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction, and/or amputations.

Sepsis affects more than 30 million people worldwide each year, including more than 4 million babies and children. In the U.S., more than 75,000 infants and children develop severe sepsis and nearly 7,000 die.1

This is more deaths than children who die from pediatric cancers. Many more children are left with life-altering problems, such as amputations, organ dysfunction, post-traumatic stress disorder, and cognitive issues, to name a few. A study in 2013 showed that more than 1 in 3 children (34%) who survive severe sepsis are left with a change in cognitive skills that are still present 28 days following their discharge from the hospital.2

 How camp nurses can play a role in sepsis awareness and prevention

Although sepsis is the major cause of death within hospitals, up to 87% of sepsis cases originate in the community before patients are admitted.3 Sepsis in children attending camp can be triggered by any number of infections, from infected cuts and scrapes sustained on the playground, to contagious infections, such as pneumonia, influenza, and meningitis. Many of these infections can be prevented or treated effectively if caught in the earliest stages, thus reducing the risk of sepsis.

According to a report published in 2012, half of children in the US who have severe sepsis also have an underlying disease, like cancer or heart disease.4 Knowing this, professionals who work with students who are compromised in any way can be aware of this increased risk. That being said, although half of children who are affected have an existing illness, half have no predisposing factors for developing sepsis, yet they still get it – so awareness overall is paramount.

Preventing infections

Vaccinations

Many camps have strict requirements about vaccinations, particularly for the counsellors and staff. However, there are children who are unvaccinated for a variety of reasons, including allergies to the vaccines or conditions that make vaccines dangerous for them. Preventable illnesses can lead to complications, including sepsis. For example, haemophilus influenzae type B (HIB), largely prevented by the HIB vaccine, causes nearly 400,000 deaths per year in the US; 15% of children who contract invasive HIB disease and bacteremia are over the age of 5 years and may attend camp.4

Meningitis affects children of all ages, but teens are at particular risk of contracting Neisseria meningitides, which may be prevented through a routine vaccine. In the US, vaccination against meningitis is recommended for adolescents.

Of course, school-age children are also at risk of contracting the common childhood illnesses, such as pertussis and varicella. After a historic low in the number of pertussis cases reported in the US, 1,010 in 1976, numbers of cases started consistently rising in the early 1990s and have gotten as high as 48,277 in 2012.5 And a vaccine for chicken pox became available in the US in 1995. According to the CDC, varicella deaths declined by 87% during 2008 to 2011.6 “In children and adolescents less than 20 years of age, varicella deaths declined by 99% during 2008 to 2011 as compared with 1990 to 1994.”

Skin infections

Children attending camp may be exposed to elements that they may not experience as part of their usual living situations. For example, many children who rarely leave the city may never have been exposed to poison ivy or poison oak. Touching these plants can leave uncomfortable rashes on the skin. While these rashes don’t cause sepsis, they are terribly itchy and uncomfortable, and can result in broken skin – which can develop a bacterial infection. They also may be bitten by bugs much more than they are at home. Scratching these bug bites can break open the skin, allowing for an infection.

Sleep-away camps also give children the opportunity to try activities they may not have tried before, with outdoor activities such as roasting marshmallows on a bonfire, kayaking, jumping in waterfalls, or rock climbing. Or there may be new indoor activities, like wood working, cooking, or crafting. All these activities could result in injury to the skin: burns, scrapes, cuts, or even blisters from walking in new shoes or hiking boots. However minor, all skin injuries are an opening for germs to enter the body and cause an infection, particularly in a camp environment that may not be as clean as at home. So extra care is needed to keep injuries as clean and uncontaminated as possible.

Educating camp staff

Handwashing

Washing your hands is the best defense against contracting infections, but too many people – children and adults – are not washing their hands as effectively or frequently as they should. Reminding staff about the importance of hand washing, as well as encouraging administration to make available waterless hand cleansers throughout the cabins and other buildings would likely increase compliance.

Campers should also be reminded about the importance of handwashing and soap and water should be readily available for them to do so. This simple step can help reduce the incidence of infection caused by bacterial infections, such MRSA, and viral infections, such as influenza. The summer months in North America aren’t usually associated with flu season, which tends to cover much of the school year, but the flu can be contracted year round.

Recognizing signs of infections

Every person who works with children knows the types of injuries and illnesses that can occur. When camp counsellors and other staff members are knowledgeable about basic signs and symptoms of infections, they can be the ones to draw attention to the situation.

 Raising sepsis awareness in camps

Here are some ideas that may help raise sepsis awareness in camps:

Counsellor and staff information sessions.

Counsellors and other camp staff are not nurses and are not expected to be, but arming them with sepsis knowledge could save lives. The Sepsis 911 Information Kit, a program aimed towards the public, provides camp staff with a prepared presentation and a consistent message about what sepsis is, how it may be prevented, and how it is treated. The program was written with the general public in mind and has supporting materials for the presenters.

Sepsis and Children is a video describing how a boy developed sepsis and his progress from a previously healthy child to a young man with limb loss.

Life After Sepsis

Medical advances have allowed for people surviving illnesses that previously resulted in certain death. However, sometimes the survivors are left with long-lasting and life-changing physical and medical challenges. As more children survive severe sepsis and septic shock, camp nurses may see more children who have had sepsis. These children may be struggling with any number of issues, ranging from lasting effects of major surgery, amputations, dialysis, chronic pain/and or fatigue, hair loss, even PTSD. They may be unable to perform in activities at the same level as they did before their illness.

To see an extensive list of conditions, ranging from chronic illnesses like diabetes to emergency situations like appendicitis, and their links to sepsis, please visit Sepsis and… at Sepsis.org.

 

 

1 https://www.healthychildren.org/English/health-issues/conditions/infections/Pages/Sepsis-in-Infants-Children.aspx

2 https://www.ncbi.nlm.nih.gov/pubmed/24108117

3 https://jamanetwork.com/journals/jama/article-abstract/2654187?redirect=true

4 https://www.hindawi.com/journals/ccrp/2012/437139/

5 https://www.cdc.gov/pertussis/surv-reporting/cases-by-year.html