Last years crisis.

[Alex Egan, LPN, EMT-B]

The saying goes you are never more prepared then you are for last years crisis. So let's all learn from each other. What was last years big deal and how did you deal with it?

We had quite an uptick in impetigo last year. We responded by increasing skin checks, and moving the scrub/bactroban treatments down into the boys camp to improve compliance. We continued our normal skin issue documentation, but added a list that went to the head staff each am that informed them of all active cases, all new cases, and all campers we would need to see for noon meds. (Our doctor does TID Keflex, this is about out only noon med). We increased sanitation in our trouble areas, by coordinating with the maintenance department.

All told it took us about two weeks to get things under control, things fell into place once we realized we were not having our standard levels of infections, once we identified that they were clustered, we implemented the above interventions. We are now quite prepared for an impetigo outbreak, which I'm sure will not be our major issue this year

Please share, commiserate, and tell us all what your camps big deal was and any insight you can give on how to help others deal with the same.

[blue bag nurse]

How often do you do the skin checks?

[Alex Egan, LPN, EMT-B]

We check once a month by the nurse. Group leaders should do them weekly. We added in an extra one in an attempt to find out exactly how many cases we actually had rather than how many decided to report or sick call

[CampNurse1]

Hey, Big Al, here I am on my last long weekend before camp, relaxing. And I am relaxing by thinking about camp, lol!

Here is a good link regarding impetigo: Impetigo: MedlinePlus Medical Encyclopedia

I am really lucky! I have a Certified Infection Control nurse on my staff. I even sleep with her on occasion. You kinda have to when you are married. She also gives me access to her amazing network. For those of you less lucky, there are many online resources. Stick with ones you can defend yourself with if things go wrong, such as National Institutes of Health, or CDC.

Being special needs, our staff does skin check nightly during shower time. They then document by circling the suspected area on a body drawing. The nurse checks these sheets on cabin rounds (after evening activity). The staff is motivated because they cannot go off duty until the nurse "clears" the cabin. Obviously, if there is anything on the Personal Care Sheet, the nurse will check it out. This is probably overkill for most camps.

A good skin policy is essential. In general, open wounds will not be admitted to camp here. Certainly not any weepy blisters. Our parents and caregivers get a letter from me about our admission policy, namely, "Do not bring a sick or injured camper to camp!" A "turn around (non-admittance)" at the check-in table is heartbreaking for the camper and inconvenient for the family. I try to avoid it at all costs. Stick to your guns if you think a camper is not well enough to come to camp. My soft heart led me astray a few times in my early years. I regretted it each time.

I worked at a camp once with a pretty loosy-goosy check-in policy. On the first day, six campers came straight from the airport to the infirmary. This was during the 2009 H1N1 outbreak. Their parents were mostly in Europe so going home was not an option. They paid high dollar to this private for profit camp. The only one allowed to call parents was the Camp Director. As the summer wore on, some of staff figured out they could nurse their hangovers better if they could drop their pesky campers at the health center. What a mess! I avoid rich kid camps, but that's another thread.

One of the tough things about camp nursing is that you often have to tell the Camp Director something he doesn't want to hear. "Impetigo linen has to be washed daily, or after each use." "We've got to start a hand hygiene program." "ALL camp laundry must be washed in hot water." "All fomites must be disinfected daily." "Why are your servers not wearing gloves?" "All bleach solution must be replaced daily." "Clean the commodes last." You get the idea. Be kind, diplomatic, and patient. Back up your statements with evidence.

Infection Prevention met with apathy and even resistance my first year at camp. As time went by, administration saw wellness work! Our illness rates last summer were just about zero. In past years, it was common to see 15-20 sick campers and staff at a time. I am told one of the cabins used to be used as a quarantine area. If you are to the point of using quarantine, you are waaaay behind. Proactive is better than reactive. I am now seeing Infection Prevention in the orientation schedule! If I could get the staff to stop swapping spit on the weekends, I would be golden, lol! Those darn kids!

Wellness is the heart of nursing, and Infection Prevention is the heart of wellness.