The basics of universal precautions: teaching staff to avoid infection.

Universal precautions refers to infection control measures that all health care workers and child care providers follow with the goal of protecting themselves and the children in their care from disease-producing microorganisms. The concept requires workers to treat all blood and various other bodily fluids as if infected with HIV, hepatitis B virus, and other bloodborne pathogens.

The camp experience includes many activities where children explore nature and interact with others, so both minor and major injuries can be expected. In very rare circumstances, contact with blood or other body fluids can be a means of infection transmission. Thus, universal precautions should be considered an important component of staff and volunteer training and education. All people who work in a camp setting must understand the proper precautions to take to prevent the spread of infection.

The Basic Principles

Following are the basic principles of universal precautions.

Contact with blood must be avoided

If a camper scrapes a knee or cuts himself, camp staff should be sure that no other child touches the blood. In the administration of first aid, there must be a barrier between the person helping the child and the blood. Examples of barriers include towels, a t-shirt, a bandana, bandages, or whatever is accessible. Surgical gloves may not be readily accessible in the outdoors, but should be provided throughout the camp where cleansing may be needed and at every activity area.

All body fluids (except sweat) should be considered potentials for infection

Blood is the major risk for transmission for the serious bloodborne infections like HIV and hepatitis B. Contact with urine and stool should be avoided, because other pathogens (such as CMV or diarrhea causative agents) can be spread via these fluids. Saliva and spit and nasal drainage are major ways respiratory viruses are spread. Tears are not a major source for infection, and sweat is not considered a risk.

Universal Precautions Applies to Everyone

The term "universal precautions" emphasizes that infection control measures apply to everyone, staff and campers. Many persons can harbor infectious agents and be asymptomatic and unaware. Confidentiality mandates that camp staff may not be aware of an individual camper's diagnosis. Universal precautions assures that all persons are treated equally. Further, the actions of the staff can be powerful teaching tools to teach children that infection prevention measures are easy and expected.

Specific examples of prevention measures are the following.

* Injury involving bleeding: Do not touch the blood; use a barrier to stop the bleeding and cover the injury. Use gloves at the medical facility if significant first aid is indicated (make sure to inquire about latex allergy first).

* Wet bed or loss of stool or vomit: Do not touch urine, stool, or vomit. Clean up child and area as appropriate. If the environment needs cleaning, wear gloves and use a cleaning solution. Put soiled clothes and sheets where others will not touch them.

* Use of restroom: Staff should wash hands with soap for 30 seconds after use of restroom or helping a child use the restroom.

Camps are responsible for training employees and instructing volunteers about universal precautions and for supplying proper equipment. Such equipment should include: gloves in every cabin and activity area, antibacterial soap at all sinks, and a mouth shield with a one-way valve for each lifeguard. It is recommended that all camp staff receive the hepatitis B vaccination (a series of three injections given over six months).

Knowledge, preparation, and attention to proper equipment can help to ensure a safe environment for campers and staff. Applying basic universal precautions will minimize risks of infection transmission and contribute to the wonderful experience of camp for everyone.

Glossary of Related Terms

Bloodborne pathogens: pathogenic microorganisms that are present in human blood and cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus and HIV.

Contaminated: the presence or reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.

Contaminated sharps: a contaminated object that can penetrate the skin including needles, scalpels, or broken glass.

Decontamination: using physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item until it is no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

Engineered controls: controls (e.g., sharps disposal containers, self and sheathing needles) that isolate or remove the bloodborne pathogen risk from the workplace.

Exposure incident: specific eye, mouth, or other mucous membrane, non-intact skin or arenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties.

Occupational exposure: reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties.

Other potentially infectious materials: The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, any body fluid that is visibly contaminated with blood, and all. body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human; and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

Parenteral: piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions.

Universal precautions: an approach to infection control whereby all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, or other bloodborne pathogens.

Work practice controls: controls that reduce the likelihood of exposure by altering the manner in which a task is performed.

Definitions from the text of OSHA's Bloodborne Pathogen Standard 1910.1030. For more information on the standard, visit OSHA's Web site: www.osha.gov.

Recommended Reading

The following books, available from the ACA Bookstore, provide more information on health and wellness at camp:

* Creating a Healthy Camp Community: A Nurse's Role by Kris Miller Lishner and Margaret Auld Bruya.

* Teacher's Drug Reference: A Guide to Medical Conditions and Drugs Commonly Used to Treat School-Age Children by Alan P. Agins, Ph.D.

* Emergency Medical Treatment: A Handbook of What to Do in an Emergency to Keep a Child (or Adult) Alive Until Help Arrives by Stephen Vogel, M.D., and David Manhoff

Kerry Brown is a child life specialist and an assistant camp directors at Camp John Marc in Meridian, Texas.

Janet Squires, M.D., is the director of the HIV program at Children's Medical Center of Dallas. She is also the camp doctor for Camp Tecumseh (a weekend camp for families impacted by HIV or AIDS) held at Camp John Marc.