Download An Intervention to Reduce Boils in Rural Alaska

An Intervention to Reduce Boils
in Rural Alaska
Ian Plumb, MBBS, MSc
Epidemic Intelligence Service Officer
Arctic Investigations Program
6th Annual Water and Sanitation Innovations for the Arctic
February 5th 2015
National Center for Emerging and Zoonotic Infectious Diseases
Division of Preparedness and Emerging Infections
Request for Assistance
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Updated community with results from Knowledge,
Attitudes and Practices Survey
Community requested assistance from the Arctic
Investigations Program and the Yukon-Kuskokwim
Health Corporation
Plan to develop an intervention to reduce boils from
existing knowledge and through community
consultation
Strategy for a Successful Intervention
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Reduce mean incidence of boils by interrupting
transmission of Staph aureus
Address multiple sources of transmission
simultaneously
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Boils
Asymptomatic Individuals
Steam Baths
Household Contamination
Ensure the strategy is expandable
 Feasible and scaleable
 Acceptable and locally owned
Treatment of Boils
Indication
Treatment
Small Furuncle
(deep infection of follicle)
Warm Compress
Antiseptic Crean
Mild Boil
(collection of furuncles)
Incision and Drainage
Moderate or Severe Boil
(systemic or refractory infection)
Incision and Drainage AND
Antibiotics
Recurrent Boils
Consider decolonization
Decolonization

May reduce boils if combined
with other measures
 Randomized trial of 158 children
including mupirocin and
chlorhexidine lefd to fewer
recurrent cases in treatment group
 Intensive strategies successful in
Denmark and Germany
 But in a cluster-randomized trial in
a military facility, no benefit from
decolonization alone

May not possible to test or
prioritize individuals with
recurrent boils
Barriers for Steam Baths
Laundry
Agitation
Duration
Agitation
Level
Dryer
Duration
Drain &
Rinse
Bile Salt Agar Swab
Potential Laundry Contamination
For 5cm2 Swatches
50% polyester 50% cotton
Inoculation with Stapylococcus aureus
Laundered Swatches
Laundered Swatches
Colonies of staphylococcus aureus per ml
Persistence of Staphylococcus After Wash,
Rinse and Dry Cycles
1000000
Starting Concentration of Inoculum
100000
10000
1000
100
10
1
Swatch 1
Swatch 2
Swatch 3
Swatch 4
Danby Tub
Effluent
Water
Boils Intervention Package
Early Management
Steam Baths
Laundry
Evaluation of an Intervention
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Is it relevant?
Is it feasible?
Is it acceptable?
Is it scaleable?
Project Plan
Pilot Mats
Procure
Supplies
Pilot Other
Materials
Prepare
Supplies
Finalize
Intervention
Clarify
Laundry
Prepare
Videos
Plan
Videos
Baseline
Survey
Manage
Distribution
Start
Intervention
Post
Intervention
Surveys
‘Sweep up’
survey
Acknowledgements
•
Residents of Participating Villages
•
YK Health Corporation
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: http://www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of
the Centers for Disease Control and Prevention.
National Center for Emerging and Zoonotic Infectious Diseases
Division of Preparedness and Emerging Infections
Potential Interventions
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Barriers for steam baths
Cleaning steam baths
Keeping separate scrubbers
Sterilizing laundry
Improved handwashing
Educational campaign
Decolonize ‘super-spreaders’
Traditional Steambaths
Inside a Steambath

Inside height ~1.25 meters