E. coli: preventing outbreaks at camp.

Every year I get the same call. "Hello, this is your health inspector. I want to arrange a visit to your camp."

I ask, "What day do you want to come?" This year, the conversation did not end there. The health inspector informed me that she strongly discourages the use of any uncooked meat on overnight camp-outs.

I thought, "What will they think of next? They are taking all of the challenge out of camping and ruining the overnight experience for these campers. I have cooked out on overnights since I was eight years old and no one ever got sick."

My first overnight was scheduled for the day before the inspection. More than anything I wanted more information. A few other camps in my area were getting this same message. I decided that we all need more information and some ideas for this edict I received.

What is E. coli?

Escherichia coli is the most common bacteria found in the human and animal gut. Much of the bacteria appears in human stool and animal manure. E. coli O157:H7 is only one strain of E. coli and is not usually found in foods. This strain was first reported in 1982 following foodborne outbreaks in Oregon and Michigan. The outbreaks were related to consumption of undercooked ground beef; E. coli O157:H7 has likely been a cause of illness for much longer than that.

The most common methods for contracting this bacteria are:

* eating raw foods, such as undercooked ground beef

* drinking raw milk and eating cheese made from raw milk

* drinking contaminated water

* from another person who has the bacteria.

The incubation period for E. coli O157:H7 is one to nine days, with most cases lasting between two and four days. Early symptoms are stomach cramps and watery diarrhea. The diarrhea may continue for more than a day and become bloody. This is due to the bacteria attacking the large intestine. The national Centers for Disease Control recommend that people who suddenly have bloody diarrhea be tested for E. coli.

According to the CDC, most people who have E. coli O157:H7 recover without antibiotics or other specific treatment in five to 10 days. There is no evidence that antibiotics improve the course of the disease, and researchers believe that some antibiotics may hasten kidney complications. Antidiarrheal agents, such as loperamide (Imodium) should be avoided.

Between 2 percent and 7 percent of E. coli O157:H7 infections lead to hemolytic uremic syndrome, which is life-threatening and is usually treated in an intensive care unit. The syndrome destroys red blood cells and causes the kidneys to fail. Blood transfusions and kidney dialysis are often required. Even with intensive care, the death rate for the syndrome is between 3 percent and 5 percent, and other life-threatening complications often arise.

How can we prevent an outbreak at camp?

You may wonder why camps should be concerned. In 1994, the Centers for Disease Control received three reports of E. coli outbreaks in summer camps. In one of these camps, 15 people became ill and three were hospitalized, including one with hemolytic uremic syndrome. Of the 15 who became ill, 13 reported eating undercooked ground beef on an overnight.

There are several steps camps can take to prevent an E. coli outbreak:

* Review cookout menus and substitute meat whenever possible. Overnights provide a great opportunity to try vegetarian recipes.

* Use precooked meats. Work with your food vendor to secure a source for precooked meats.

* Train kitchen and program staff to properly cook foods. The presence of E. coli O157:H7 is not routinely checked in beef production and processing; adequate cooking is the primary means of preventing illness.

If you do cook meat on the overnight, it must reach a core temperature of 160 degrees Fahrenheit for at least 15 seconds. The meat and juices can not be pink.

* Train kitchen and program staff to store food properly, remembering that the danger zone for food is between 45 degrees Fahrenheit and 140 degrees Fahrenheit. Minimize the time that food is subject to temperatures in this danger zone.

* Train kitchen and program staff to use, and require others to use, appropriate hand washing techniques before and after touching food.

On an overnight, set up hand washing facilities adjacent to the bathrooms. Ten, 15, or 50 feet away is enough of a walk to keep a child from using the hand washing facilities.

Use lots of warm soapy water and scrub hands for at least 10 seconds.

* Underscore the importance of giving direct supervision to food preparation, cooking, and hand washing when away from the dining hall.

Though I was not happy with the request from my health department to use only precooked meats, we have done so. The meat is taken out to the overnight prior to dinner and the campers reheat it for tacos, spaghetti, stew, or whatever happens to be on the menu that night.

One benefit of precooked meat is that you do not have to worry about how to dispose of the excess grease that comes with cooking meat at the campsite.

If you have questions or want to find someone who can provide training for your staff, contact your state Department of Health.

References

Centers for Disease Control (June, 1995). Escherichia Coli 0157:H7 Outbreak at a Summer Camp, Virginia 1994. Morbidity and Mortality Weekly Report, 44(22).

Mary D. McKinney is the camp director of Skagit Youth Camp, Seattle City Light. She also serves on the American Camping Association National Board of Directors and is the president of the ACA Evergreen Section.