Children’s camps are typically set up for the summer months and are places of residence and recreation for 1 or more weeks for each of the children. Since this is a seasonal venture, usually during the summer, the people who become employees may either be students or individuals with limited experience working in temporary jobs. The equipment, whether for food service, recreational swimming facilities, on-site water and on-site sewage, playground or athletics, etc. may become dilapidated and in poor shape because of lack of maintenance and use.

The potential for disease varies with the microorganisms that the individuals bring to the camp environment, including influenza, as well as other diseases and the environmental health hazards that are present. This is exacerbated by people coming from different areas bringing their own set of viruses and bacteria and intermingling with others who do not have the same resistance to the organisms.

Problems found in overnight camping situations include:

  • 1. Inadequate or poor supervision of the children who are attending the camp.
  • 2. On-site potable water systems which are contaminated microbiologically and/or chemically.
  • 3. The use of unapproved or contaminated water supplies during at least part of a day.
  • 4. Water treatment systems, which require disinfection and removal of contaminants, not working properly.
  • 5. Inadequate disinfection of water.
  • 6. Presence of cross-connections and other plumbing and water distribution system concerns.
  • 7. Inadequate quantities of water to be used for drinking water purposes and for other purposes.
  • 8. Overflowing on-site sewage systems.
  • 9. Improper transportation of campers on truck beds.
  • 10. Improper supervision of swimming or other water areas.
  • 11. Improper storage of solid or hazardous waste.
  • 12. Improper storage of flammable liquids.
  • 13. Improper storage, preparation, serving, and disposal of food.
  • 14. Overcrowded and dilapidated sleeping areas for the children and staff.
  • 15. Inadequate insect and rodent control.
  • 16. The presence of noxious weeds, such as ragweed, poison ivy, poison oak, and poison sumac, which may contaminate campers and/or staff.
  • 17. Inadequate medical facilities and poorly trained personnel.

An example of another type of problem is the presence of toxigenic fungi and mycotoxins in damp temporary housing and also in the outdoor recreational environment. Since fungi may be found anywhere, especially where there is dampness, they are a potential source of disease, which may be spread by food or inhalation.

There were 299 bat incidents in 109 children’s camps in the state of New York from 1998 to 2002. A total of 1429 campers and staff were involved and 46.1% of these individuals received treatment for rabies. (See endnote 59.) It is also essential to be alert to problems with snakes and other wildlife as well as plants that can cause poisoning, as mentioned above.

Children and staff are exposed to disease and injury when they go on field trips away from the camp to animal farms, hiking in strange areas, climbing hills or mountains, caving, etc. There are large numbers of human-animal contacts each year in petting zoos, fairs, educational exhibits, etc. These contacts can lead to the transmission of various diseases from animals to these young people. (See endnote 57.)

More than 3.5 million children aged 14 and under sustain sports and recreation-related injuries every year from all activities including camps, and 21% of all traumatic brain injuries among children occur during sports and recreation. (See endnotes 50, 56.) Some 30% of all injuries are due to tripping, slipping, or falling.

However, children and/or staff illnesses are even more significant because they typically occur at a rate twice that of injuries.

Best Practices to Prevent and Mitigate Disease and Injury in Children’s Summer Camps

  • (See endnotes 44, 45, 46, 47, 60, 61)
  • • Prepare and submit a plan for the maintenance and operation of the summer camp to the local and state health department in keeping with the requirements of the given health authorities. The plan should be submitted at least 60 days prior to the anticipated opening of the facility in order for proper inspections to be performed, problem areas corrected, and appropriate certification or licensing to be granted.
  • • Prepare the plan to be a complete and intensive review of all aspects of camp life including: reporting of disease and/or injury to the appropriate authorities; the potential for abuse and neglect of the children; protecting children and adults from the sun; the qualifications and experience of all members of the staff including the camp director, water safety director, medical director, counselors, etc.; requirements for safe use of potentially dangerous items such as firearms, archery, playground and athletic equipment, boating equipment, etc.; building construction and sleeping space; fire safety; emergency procedures for weather or other types of emergency situations; transportation; horseback riding; and all environmental issues including food, laundry, solid waste, hazardous wastes, insects, rodents, water quality, plumbing, sewage, chemical and physical hazards, etc.
  • • Be prepared for outbreaks of disease such as influenza which may be found in the community, and follow all of the recommendations for prevention, mitigation, and control of the disease as noted by the appropriate authorities including the CDC. (See endnote 58.)
  • • Children and/or staff who become ill should be immediately segregated from the rest of the camp community and treated appropriately by medical personnel. They should not be integrated back into the camp community until the potential for transmission has passed.
  • • Special emphasis should be placed on the care and cleanliness of feet and the wearing of appropriate footwear within the camp and also on special trips. Flip-flops or sandals must be banned from all activity periods.
  • • Appropriate protective equipment as approved by the American Camp Association must be used for sports and other activities. Counselors must make sure that the equipment is used and properly put on.
  • • There should be training for children and staff and constant reminders concerning techniques of good personal hygiene including hand washing and protecting others against coughing and sneezing.
  • • Evaluations of the health record logs must be completed regularly to determine the causes of injuries and illnesses if possible and how to prevent these from occurring again.
  • • Knife safety must be taught and enforced since 15% of injuries at camps involve the use of knives.
  • • Blows to the head and concussions are of special concern because of the long-lasting potential problems involved. When these injuries occur, the individual should be immediately taken to appropriate medical authorities, examined, and the protocol for head injuries should be followed implicitly.
  • • Reduce the impact of fatigue on individuals by removing them from the activity if needed and re-evaluating how best to offer the activity or when to eliminate it. The temperature and humidity of the area as well as the time involved in conducting the activity should be also analyzed and necessary changes made. Allowances should be made for illness, size and age of the children, previous injury, and other conditions prevailing.
  • • Evaluate existing free time to determine if individuals are getting adequate periods of rest and are properly hydrated during the course of the day, especially when the weather conditions are extreme.
  • • All specialty counselors must be certified in their specialties and extremely knowledgeable about appropriate health and safety practices.
  • • Health authorities should make a minimum of two complete inspections of the camp including all facilities from medical care to all environmental issues. This would include the infirmary with its storage of medicine, appropriate isolation if needed, storage of medical logs, and submission to appropriate authorities of outbreaks of disease or severe injuries reports. This would also include inspection and evaluation of sleeping spaces, bathing, hand washing and toilet facilities, solid waste disposal, hazardous waste storage and disposal plans, potential insect and rodent problems, on-site water systems, on-site sewage disposal systems, food facilities, and all recreational swimming areas.
  • • Before using the water in the camp, flush the well, chlorinate the water and allow the water to be chlorinated for an appropriate period of time, usually 24 hours, and then run water through all taps until the water runs clear and there is no significant odor of chlorine. Hook up the chlorination equipment and make sure that it is operational. Flush all water lines within the camp until there is a free chlorine residual of at least 2.0 ppm at each of the taps in the distribution system. Shut off all taps and allow the water to remain in the water lines for at least 24 hours. Check the entire system for leaks and losses of pressure which should be a minimum of 20 pounds per square inch. Flush the entire system again and then determine if the water is clear, colorless, and has a free residual chlorine concentration of 0.2 ppm at the taps. (See endnote 48.)
  • • Wash and decontaminate all walls, floors, ceilings, beds, and bathroom facilities and air out all of the cabins prior to use by the campers. Check underneath the cabins to make sure that wildlife has not set up harborage. Determine if all stairs, railings, etc. have deteriorated and if they have, make sure that they are replaced immediately.
  • • Completely wash and decontaminate all kitchen equipment, floors, walls, ceilings, windows, dishes, utensils, pots and pans and allow to air dry. Check to see that all equipment is functioning properly and that there is adequate exhaust from areas where natural gas is used as fuel. Particularly check refrigerators and freezers to make sure that they reach appropriate temperatures. Check dishwashers to make sure that they reach proper temperatures. Check the hot water heaters.
  • • Prepare wholesome meals under proper sanitary conditions always using appropriate temperature and time sequences and excellent sources of food. (See Chapter 7, “Food Security and Protection.”)
  • • Have professional sewage haulers clean out all septic tanks and grease pits before starting any water flow in the camp. Test the on-site sewage systems by allowing the water flow used in testing the wells to enter the septic tank systems and see if there is any sign of overflow onto the ground. Also conduct a complete on-site sewage system evaluation. Check previous years’ reports and look for signs of overflow where the distribution system is located.
  • • Look for insect and rodent harborage and remove it after appropriate insect and rodent control programs. Exterminate the excess rodent population as well as mosquitoes and other insects within the areas where the children will be exposed. Remove all harborage.
  • • Make sure that all solid waste areas are constantly kept clean and the material is removed rapidly from the site.
  • • Store hazardous materials safely in a well-ventilated area which is locked. Remove all hazardous waste rapidly from the site to a secure hazardous waste disposal area.
  • • When campers or staff have arrived at the camp, determine if they are ill or have recently been ill. In either case send them to the infirmary to be evaluated by medical personnel.

If there are multiple individuals ill, immediately contact the local health department to report the event and to request additional help if necessary.

  • • All staff and campers must be given instructions in proper hand washing techniques and when to utilize them, as soon as they arrive at the campsite. This should be strictly enforced. Alcohol-based sanitizers for hands should only be used if soap and hot and cold running water is not readily available. However, after using the bathroom, tending to someone who was ill, or if an individual is ill, and always before eating, it is absolutely essential to wash hands thoroughly with soap and water for at least 20 seconds before rinsing. Segregate all sick people from the rest of the camp community and use appropriate isolation techniques including a proper gown, gloves, and mask if necessary.
  • • Exclude all sick food handlers from work until cleared by the medical team.
  • • In the event of an outbreak of potential food or waterborne disease, discontinue all salad and sandwich bars, buffets, or family-style food serving at tables. Wash all tables, chairs, equipment, utensils, and all parts of the dining area with the appropriate detergent and water and then use 1 ounce of bleach to 50 ounces of water as a disinfectant on all surfaces. Allow to air dry.
  • • Remove sick animals, especially those with diarrhea, immediately and thoroughly clean and disinfect the area. This includes the removal and destruction of sawdust, straw, and any other type of material that may be in the area where the animals have been present.
  • • All children and adults coming in contact with animals must immediately wash their hands with soap and water extensively and thoroughly under supervision to make sure there is no transfer of enteric diseases from animals to humans. There must be strict supervision of the children to make sure that they do not put their hands in their mouths or touch their face before hand washing. Strict hand washing procedures also apply if the individuals go into any facility that was used by animals.
  • • Educate all children and adults about the potential and actual spread of disease occurring when coming in contact with animals or their habitat.
  • • Emergency drills should be conducted periodically and without warning based on written plans for how to deal with fires, floods, outbreak of contagious diseases, or other emergencies. All staff members need to be trained and to immediately go to their stations to carry out their responsibilities when the alarm is sounded. Communication systems must be such that all individuals can be reached immediately to inform them of the hazardous or potentially hazardous situations occurring. Additional emergency health care must be readily available and easily contacted.
  • • All medications for campers or staff must be in locked cabinets and supervised by the camp nurse.
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