in Rural Alaska Ian Plumb MBBS MSc Epidemic Intelligence Service Officer Arctic Investigations Program 6th Annual Water and Sanitation Innovations for the Arctic February 5 th 2015 National Center for Emerging and Zoonotic Infectious Diseases ID: 694279
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An Intervention to Reduce Boilsin Rural Alaska
Ian Plumb, MBBS, MSc
Epidemic Intelligence Service OfficerArctic Investigations Program6th Annual Water and Sanitation Innovations for the ArcticFebruary 5th 2015
National Center for Emerging and Zoonotic Infectious Diseases
Division of Preparedness and Emerging InfectionsSlide2
Request for AssistanceUpdated community with results from Knowledge, Attitudes and Practices SurveyCommunity 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 consultationSlide3
Strategy for a Successful InterventionReduce mean incidence of boils by interrupting transmission of Staph aureusAddress multiple sources of transmission simultaneouslyBoilsAsymptomatic Individuals
Steam BathsHousehold ContaminationEnsure the strategy is expandableFeasible and scaleableAcceptable and locally ownedSlide4
Treatment of Boils
IndicationTreatment
Small Furuncle (deep infection of follicle)Warm CompressAntiseptic Crean
Mild Boil(collection of furuncles)Incision and DrainageModerate
or Severe Boil(systemic or refractory infection)Incision and Drainage AND AntibioticsRecurrent Boils
Consider decolonizationSlide5
DecolonizationMay reduce boils if combined with other measuresRandomized trial of 158 children including mupirocin and chlorhexidine lefd to fewer recurrent cases in treatment group
Intensive strategies successful in Denmark and GermanyBut in a cluster-randomized trial in a military facility, no benefit from decolonization alone May not possible to test or prioritize individuals with recurrent boilsSlide6
Barriers for Steam BathsSlide7
LaundrySlide8
Agitation Duration
Agitation Level
Drain &Rinse
Dryer DurationSlide9
Bile Salt Agar SwabSlide10
For 5cm2
Swatches
Potential Laundry Contamination
50% polyester 50% cottonSlide11
Inoculation with
Stapylococcus
aureus Slide12
Laundered SwatchesSlide13
Laundered SwatchesSlide14Slide15
Persistence of Staphylococcus After Wash, Rinse and Dry CyclesSlide16
Boils Intervention Package
Early ManagementSteam Baths
LaundrySlide17
Evaluation of an InterventionIs it relevant?Is it feasible?Is it acceptable?Is it scaleable?Slide18
Project Plan
Finalize Intervention
Baseline
Survey
Pilot Mats
Procure Supplies
Pilot Other Materials
Prepare
Videos
Clarify
Laundry
Post Intervention Surveys
‘Sweep up’ survey
Plan
Videos
Prepare
Supplies
Manage Distribution
Start InterventionSlide19
Acknowledgements
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: http://www.cdc.govThe 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
Residents of Participating Villages
YK Health Corporation Slide20
Potential InterventionsBarriers for steam bathsCleaning steam bathsKeeping separate scrubbersSterilizing laundryImproved handwashingEducational campaignDecolonize ‘super-spreaders’Slide21
Traditional SteambathsSlide22
Inside a Steambath
Inside height ~1.25 meters