Why a sudden outbreak of infectious illness is ‘only the start’

Breathing hygiene is a crucial safety precaution that must be practiced regularly and properly My job is to investigate what caused a blip in the health of the staff and students in the schools…

Why a sudden outbreak of infectious illness is 'only the start'

Breathing hygiene is a crucial safety precaution that must be practiced regularly and properly

My job is to investigate what caused a blip in the health of the staff and students in the schools I serve, something often referred to as a brief occurrence.

We ask the teachers and students for information about a high-risk behaviour they may have or have displayed. I can tell if they are ill or are at risk of becoming ill, perhaps due to dietary or lifestyle choices, or due to infectious disease.

When I say my job is to investigate, I mean I will work to unearth the cause and determine whether there are others for whom this intervention would be useful.

Meaning it may be years before it is fully understood what is causing the very occasional episodes of contagious illness that we know are taken by over 100 million school children worldwide each year.

Anxiety can take the form of physical complaints. People may complain of exhaustion, muscle aches, fever, nausea, dizziness, headaches, abdominal discomfort, chest pains, chills, or discharge from the nose or ears, and will often not be able to repeat their experiences or explain the episodes.

Some of these may be described as mild flu symptoms, while others may be listed as the beginning of a much more serious illness requiring hospitalisation and medication.

I cannot tell if they are a true trigger of sickness, but have given them to my colleagues who can attempt to identify those serious illnesses.


I have been a school nurse for 18 years and get training of various kinds each year and every year we need to update our training. The most recent training took place in March 2018.

I find it important to know about every strain of bacteria that I am expected to look out for – although some are known and others are not. Other things I need to know include pH and hydration, concentrations of medication, types of antibiotics and antibiotics for particularly tough patients.

This is a very new year for healthcare workers in general, so there is a lot of training coming up that affects our knowledge and our willingness to use new techniques for dealing with viral infection.


I am the only full-time school nurse in my school district, which is located in San Diego County in the south-western United States. For the time being, we get some respite during the summer – but this can quickly be wiped out as winter weather begins.

We work closely with the local fire service, ambulance service and law enforcement, each of whom has their own handling of infectious disease and their own best practices for dealing with infection.

After the incident we decide whether we need to involve a physician, although almost every time this is the case it is to just offer medication.

There are no guidelines about how many antibiotics to offer, but this is not uncommon because a huge number of infections that we try to treat, require at least one antibiotic.

As well as providing timely care, we also have a role in promoting good hygiene, such as with hand washing and a genuine understanding of the risks associated with inhalation diseases and mumps.

Safety first

In the end, both my colleagues and I are counting on the fact that we make the right choices and then rest assured that our students and teachers are safe.

We carry out the protection of our pupils against infectious diseases and, as emergency doctors, will not hesitate to perform an emergency course of antibiotic treatment or to prescribe more.

As well as medics, nurses and first-responders, there are many other health professionals who are on site in schools across the US when outbreaks occur.

Working in a school during these outbreaks can often be very challenging, but it is often rewarding in the same way as running an accident and emergency clinic. It is my job to balance different layers of safety – first of course to educate and protect both the patient and the staff.

To deal with spontaneous outbreaks, it is often necessary to handle the emergency immediately – we do this either by transporting the patient to the ambulance or taking the patient to the local medical centre.

After the emergency we advise the staff on how to manage the problem in their individual classrooms and throughout the day.

In my experience the number of kids affected by the outbreak is usually between two and five people. Although I can’t know for sure, I believe that this is the same across most schools.

Although we don’t know the exact cause, if we do eventually find out, that will not be the only thing that we will have discovered. We can plan to extend the life of our hospitals as well as our infections and stop many people from going to hospital in the first place.

Paula Stiles is a school nurse in California. Follow her on Twitter @PHSN

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