It is easy to become casual about food preparation and food safety. According to the Centers for Disease Control and Prevention (CDC) website, each year one in six Americans, roughly 48 million people, become sick and 3,000 die as a result of foodborne illness.

Food Contamination Risks

The risk of foodborne illness is inherent in dining operations and arises out of the improper handling, storage, and/or cooking of food. Outbreaks are not uncommon at camp. Sources of contamination vary and include cross-contamination with another food product, the hands of a food handler, or a work surface. Failing to wash vegetables thoroughly, improper cooking, and failure to quickly refrigerate leftover food may be other sources of contamination.

According to the CDC, the most common germs causing foodborne illness are:

1. Salmonella
2. E-coli 0157
3. Campylobacter
4. Listeria
5. Shigella
6. Yersinia

The basic tools to ensure the integrity of the food served at camp involve:

• A food safety plan — compliance with American Camp Association (ACA) standards in this regard is a good start, but probably not enough to manage evolving risks.
• Vigilance — don't assume the plan is being executed properly, that staff is following all of the food handling practices you have in your written plan. Take a walk through the kitchen periodically when the staff is busy preparing a meal to see how well your food safety plan is being executed.
• Training — develop awareness of the risk factors through education. Keep the issues in front of staff throughout the summer; don't assume they know. Create a culture of safety by focusing on prevention and engaging them in the process.

Remember the four basics of food safety:

1. Cleanliness — keep the kitchen clean and disinfected. Always wash hands after handling poultry and other meat. Clean utensils, pots, and pans before using them to prepare other foods during the cooking process.
2. Separate/segregate — maintain separate food preparation areas so the poultry and other meat never come in contact with each other or with other foods. Using disposable gloves is another way to reduce the risk of cross-contamination. Keep meat separate from other foods in refrigerators.
3. Proper cooking — always cook meat and poultry to the proper temperature. Use a meat thermometer to be sure. Don't rely on oven temperature gauges. Require staff cooking on trips and overnights to follow the same practices, including the use of a meat thermometer used by the cooks in the dining hall.
4. Promptly refrigerate — store foods correctly, especially potentially hazardous foods. Leaving food items out too long may increase the risk of bacterial growth and cause illness.

Dining hall operations and food preparation have become more complicated and safety more challenging as food allergies have proliferated and more campers require special diets, such as gluten-free options.

Communicating these requirements to the cook and other staff who need to know can also be challenging. The consequences of failing to communicate these needs clearly can be serious. Failure to address these risk factors may result in legal liability should a camper suffer an allergic reaction due to cross-contamination.

Reports of food-related illness at camp occur every summer. Most cases are minor. But it is possible to have a large and serious outbreak of foodborne illness at camp. Under these circumstances, the health department might consider closing camp to determine the origin of the illness. Are you prepared for this possibility? Does your camp's insurance provide loss of income and extra expense insurance coverage if your local health department orders your camp closed to break the cycle of a foodborne illness?

Compliance with sound food safety practices such as those advocated by ACA standards and food safety professionals is critical. Considering the potential harm, camp directors must insist upon safe food-handling practices in the kitchen. Educating staff and increasing their awareness of the risk factors and safety practices is vital. Good execution of the plan, a commitment to safety, and constant improvement is critical to long-term success. Excellent detailed resources on food safety are available at www.cdc.gov and at www.Foodsafety.gov. The ACA Core Competencies Toolkits also has valuable information and online training modules available on food safety. When was the last time you reviewed and updated your kitchen risk management and food safety plan?

Communicable Disease Risks at Camp

Communicable disease was in the news again in 2014. Remember H1N1 (Swine Flu) from the summer of 2009?

The Ebola crisis has created anxiety throughout the world. The response to the situation in West Africa was slow at first. The first cases in the U. S. brought the risk to our doorsteps. However, it remains to be seen whether Ebola can be contained and controlled, or becomes a world health crisis as some media reports have suggested.

The risk of becoming sick with the Ebola virus in the U. S. is remote, but the crisis and concern serves as a timely reminder. As you begin preparations for the summer of 2015, take some time to review and update your camps communicable disease risk management plan.

Healthy Camp Study

The ACA Healthy Camp Study revealed that campers are twice as likely to become sick at camp as they are to get injured. As a result of this study, ACA developed four training modules in 2010 to help target certain prevention strategies. One of these modules is No Outbreaks Here: Simple Strategies for Reducing the Spread of Communicable Diseases at Camp. The information is presented by Linda Erceg and D. D. Gass. This would be a good place to start your review.

Changing Risk

Risks evolve and change over time. For many years certain childhood diseases have been controlled, virtually eliminated through vaccination. Recently, however, outbreaks of some childhood diseases (measles, mumps, pertussis [whooping cough]) previously controlled are showing up in pockets around the U. S. as parents worried over potential adverse effects of inoculations are reluctant to vaccinate their children. Are you ready for an outbreak of these old childhood diseases at your camp? Would your health center staff recognize the symptoms?

ACA Resources

ACA has developed some terrific resources for camp directors on their website around communicable diseases and infestations. 

This landing page offers a Top Tips for Camps format followed by a list of links to additional resources. The tips for reducing communicable disease and infestations are as follows:

1. Partner with parents to reduce the introduction of communicable diseases in camp.
2. Establish "opening day" screening processes.
3. Establish and implement policies that prevent the spread of disease.
4. Establish policies to keep your staff healthy.
5. Regularly evaluate and update your health care practices and procedures.

Visit the ACA website for more details associated with these tips.

The other resource links and documents highlight communicable disease and infestation topics from bed bugs to West Nile virus. Some topics, such as Norovirus, and Middle East Respiratory Syndrome (MERS), link to the CDC for the latest information on these diseases. Other topic links, such as Hantavirus Pulmonary Syndrome (HPS) and MRSA infections, connect to fact sheets that ACA has created.

Ensuring health and wellness of campers and staff at camp is an increasingly complex job. Fortunately, there are great resources to assist directors in this task. Consider the treasure trove of information Linda Erceg provided in her presentation for the 2011 Healthy Camp Symposium entitled Communicable Disease Management in the Camp Setting. From the ACA Health & Wellness landing page find the Association of Camp Nurses link and click on the title of her presentation. If there ever was a road map for managing communicable disease risks at camp, this is it! 

Are You Covered?

Management of the communicable disease issue and your plan should also include a review of your insurance coverage. Does your camp's business interruption insurance coverage include protection against a suspension of operations resulting from a communicable disease outbreak? Insurers specializing in camp risks should provide protection in this situation. Consider the limits of insurance carried for communicable disease. Are the limits of the insurance adequate to cover your loss of income if you had to refund a portion of the tuition following a closure? Discuss this matter with your insurance advisors for more perspective.

How important is this? Remember the facts from the ACA Healthy Camp Study quoted earlier. Campers are twice as likely to become sick at camp as they are to be injured. Don't overlook this fact, and focus on this key area in your risk management planning. Don't delay. Next summer will be here before you know it. Take the time now to review and update your camp's food safety and communicable disease risk management plan. Good luck!

Training at Your Fingertips
More information on ACA's four-part online training series, including the training module No Outbreaks Here: Simple Strategies for Reducing the Spread of Communicable Diseases at Camp

Other modules included in the series include:
OUCH: Protective Equipment, What All Staff Should Know, by Dr. Edward Walton and Mary Marugg
Footloose: Minimizing Slips and Falls at Camp, by Dr. Edward Walton and Mary Marugg
Knife Safety: Reducing Sharp Object Injuries at Camp, by Dr. Edward Walton and Mary Marugg

References
American Camp Association (2010). The healthy camp study impact report.

Centers for Disease Control and Prevention (2011). CDC 2011 estimates: Findings. Retrieved from www.cdc.gov/foodborneburden/2011-foodborneestimates.html

Edward A. Schirick, CPCU, CIC, CRM, is area senior vice president of RPS Bollinger Sports & Leisure in Monticello, New York, where he specializes in arranging insurance coverage and of fering risk management advice for camps. Schirick is a chartered property casualty underwriter, a certified insurance counselor, and a certified risk manager. He can be reached at 877.794.3113 or Ed_Schirick@RPSins.com. Visit www.campinsurancepro.com.

Originally published in the 2015 January/February Camping Magazine.