Nurses are front-line healthcare workers. They are often the first healthcare professionals who patients see when they visit a doctor’s office, clinic, or emergency department. Nurses are also out in the community, working with people where they live and work – and go to school. School nurses play a vital role in helping children stay as healthy as possible, as well as dealing with health issues and emergencies that occur during school hours. In this role, school nurses are well placed to not only help spot and act on infections, but to help educate the students and 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 school 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 school-aged children can be triggered by any number of infections, from infected cuts and scrapes sustained on the playground, to 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

Parents of healthy children may choose not to vaccinate against childhood illnesses. These 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 likely within the school system.4

Meningitis affects children of all ages, but adolescents 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.”

Educating staff and faculty

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 facility would likely increase compliance.

Students 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.

Recognizing signs of infections

Every person who works with children knows the types of injuries and illnesses that can occur. When teachers 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 schools

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

Staff information sessions.

Teachers 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 school nurses 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.

September is Sepsis Awareness Month, which  coincides with back-to-school. Infection prevention and sepsis awareness could be incorporated with back-to-school activities.

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, school nurses may see more children with complicated medical needs. 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 academically as they did before, or participate in activities, such as clubs and sports.

All these issues can present school nurses with challenges as they work with teachers, administrators, parents, and the children to develop care plans that will allow the children to continue with their education despite their recent health scare and current challenges.

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

 

Updated April 2, 2018.