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. They also deal with health issues and emergencies that occur during school hours. In this role, places school nurses in a good place to help spot and act on infections. They can also 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 life-threatening response to infection. Sepsis kills and disables millions and requires early suspicion and treatment for survival. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.
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 millions of children
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.
This is more deaths than children who die from pediatric cancers. Many more children live 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.
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. Any number of infections can trigger sepsis in school-aged children . This includes infected cuts and scrapes sustained on the playground, as well as infections, such as pneumonia, influenza, and meningitis. Many of these infections are preventable or treatable if caught in the earliest stages, thus reducing sepsis risk.
According to a study published in 2018, two-thirds of children in the US who have severe sepsis also have an underlying chronic disease. Knowing this, professionals who work with compromised students can be aware of this increased risk. Half of affected children have an existing illness. Half have no predisposing factors for developing sepsis, yet they still get it – so awareness overall is paramount.
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.
Meningitis affects children of all ages, but adolescents are at particular risk of contracting Neisseria meningitides. A routine vaccine may prevent the infection.
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. In 2019, there were 18,617 reported cases. 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. “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.”
School nurses educating staff and faculty
Washing your hands is the best defense against contracting infections. But too many people – children and adults – don’t wash their hands effectively or frequently. 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 hand washing. 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 is for the general public 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. Back-to-school activities could include infection prevention and sepsis awareness.
Life After Sepsis
Medical advances have allowed for people surviving illnesses that previously resulted in certain death. However, sometimes the survivors live 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. These range 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.
Suggested Citation: Sepsis Alliance. Sepsis and School Nurses. 2022. https://www.sepsis.org/sepsisand/school-nurses/
Updated July 12, 2022.