Procedures for Handling Outbreaks at Camp

The rapid spread of gastrointestinal (vomiting and diarrhea), respiratory and other ailments can quickly change a pleasant camp visit into a difficult experience for staff and campers. The following information is provided to help identify an illness outbreak and limit its impact. Early intervention may prevent additional cases of illness.

Identification

  • Screen new camper/staff as they arrive at camp for any current or resent illness. Any symptomatic campers or staff members should be referred for medical evaluation.
  • Check the medical log entries daily for common ailments and/or increased frequency of cases of illness with similar symptoms (i.e., headache, vomiting, diarrhea, fever, eye infection, sore throat, etc.).

    If multiple campers and/or staff are ill, contact your local health department immediately (remember, reporting is required within 24 hours). Your children's camp may be experiencing a food, water, or person-to-person transmitted outbreak.

  • In the event of an outbreak, develop and maintain a log/linelist of ill campers and staff. This list should include the name, age, sex, camper or staff, unit/dorm/tent/cabin, onset date/time, symptoms, duration (hours), specimens collected, treatment/action (treatment provided, went home, etc), job duties (for staff). A sample log/list is included in this document.
  • Depending on the situation, the local public health department may recommend collecting stool or vomitus specimens from ill campers and staff for laboratory testing to try to determine the organism causing the illness.

Prevention and Control

  • Handwashing (staff and campers) must occur frequently and not just during outbreaks!
    • Adequate supplies of hand washing soap and disposable towels must be available at all times in food service and dining areas, bathrooms, and other areas where toileting or food service may occur.
    • Wash hands carefully with soap and warm, running water for 20 seconds after using the toilet. Additionally, all campers and staff should wash their hands frequently throughout the day and before eating or preparing food. Staff should monitor campers' handwashing. Camp staff should supervise and/or help young children wash their hands thoroughly and properly.
    • Hands should be washed with soap and warm water prior to performing ceremonial hand washing (e.g., Asher Yatzar or Netilat Yadayim).
    • Alcohol-based hand sanitizers should be used if soap and water is not available. Consider making alcohol-based hand sanitizers available throughout the camp.
      • Exercise caution and ensure proper supervision of young children using alcohol-based sanitizers.
      • When hands are visibly soiled, after toileting, and after cleaning vomitus or other potentially contaminated body fluids, alcohol-based sanitizers should not substitute for soap and water when possible.
  • Housekeeping - "Sick" areas (bathrooms, sleeping areas, etc.) and high touch surfaces require increased housekeeping emphasis.
    • Conduct regular cleaning and disinfection of bathroom facilities and high touch surfaces, toys, sports equipment, table tops, faucets, door handles, computer keyboards and the handles of communal washing cups. Disinfection can be accomplished with chlorine bleach (at a recommended concentration of 1 part household bleach to 50 parts water) to be used to disinfect hard, non-porous environmental surfaces.
    • Staff should be educated on and wear personal protective equipment (gloves and masks) and use disposable cleaning products when cleaning vomitus. In addition, staff should practice thorough handwashing, and be encouraged to change to clean clothing prior to resuming other activities.
    • Mattress covers soiled with vomitus or feces should be removed and promptly cleaned and disinfected or discarded.
    • Handle linens, sleeping bags, and clothing soiled with vomitus or feces as little as possible. These items should be laundered with detergent in hot water (at least 140°F) at the maximum cycle length and then machine dried on the highest heat setting. If there are no laundry facilities onsite capable of reaching 140°F, soiled items should be double bagged (using plastic bags) and taken offsite for proper washing and drying. If soiled items are sent home, instruct parents or caregivers of the proper washing and drying procedures.
  • Water Supply - Ensure proper treatment and only use approved sources.
  • Food Service
    • Always exclude ill food handlers from work and use gloves or utensils to handle prepared and ready to eat foods, including drink ice (not just during outbreaks).
    • Ensure that all food service staff (including campers who occasionally handle foods) wash their hands thoroughly before food handling and immediately after toilet visits.
    • Discontinue salad and sandwich bars, "family-style" service, buffets - use servers only.
    • Dining areas, including tables, should be wiped down after each use using a bleach solution of 1 part household bleach per 50 parts water. If a person vomits or has a fecal accident in 3 the dining hall, clean the affected area immediately. Food contact surfaces and dining tables near the accident should be sprayed using a bleach solution of 1 part household bleach per 10 parts water. Allow surfaces to air dry. Food that was in the area when the accident occurred should be thrown away.
    • Don't allow use of common or unclean eating utensils, drinking cups, etc..
    • Require cleaning staff/dishwashers to observe sanitary precautions.

Restrictions and Exclusions

  • Physically separate ill from well campers and staff.
    • At day camps, ill campers or staff members must be immediately isolated at the camp's infirmary or holding area and arrangements made to send them home.
    • At overnight camps, campers or staff members must be isolated from other campers in the infirmary or a location separate from uninfected campers and staff. Depending on the camp context and duration, camp directors may want to consider sending home campers and staff with illness or closing the camp.
  • Exclude ill persons from duties and/or activities until permission is granted by the health director to resume.
  • Restrictions from activities and isolation periods for ill individuals vary based on the type of iillness. Consult your local health department for the appropriate length of time period of isolation and activity restrictions for ill individuals to effectively prevent the spread of the illness throughout the camp.
  • Any camper and staff who are sent home should seek prompt medical attention.
  • New arrivals should not be housed with sick or recovering campers and staff.
  • Limit entry/exit from camp; postpone or restrict activities involving visitors, including other camps.

Reporting and Notification

  • Camps are required to notify their local health department within 24 hours of illnesses suspected of being water, food, or air-borne, or spread by contact. Local and state health departments are available to consult on prevention and control of any case or outbreak of illness in a camp.
  • Notify parents of the illness outbreaks. Please contact your local health department for assistance or template letters that can be used.