1. 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
Good morning.
National Center for Emerging and Zoonotic Infectious Diseases
Division of Preparedness and Emerging Infections

2. Request for Assistance
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

3. Strategy for a Successful Intervention
Reduce mean incidence of boils by interrupting transmission of Staph aureus
Address multiple sources of transmission simultaneously
Boils
Asymptomatic Individuals
Steam Baths
Household Contamination
Ensure the strategy is expandable
Feasible and scaleable
Acceptable and locally owned

4. 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

5. 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

6. Barriers for Steam Baths

7. Laundry

8. Agitation Duration
Agitation Level
Dryer Duration
Drain &
Rinse

9. Bile Salt Agar Swab

10. Potential Laundry Contamination
For 5cm2 Swatches
50% polyester 50% cotton

11. Inoculation with Stapylococcus aureus

12. Laundered Swatches

13. Laundered Swatches

15. Persistence of Staphylococcus After Wash, Rinse and Dry Cycles

16. Boils Intervention Package
Early Management
Steam Baths
Laundry

17. Evaluation of an Intervention
Is it relevant?
Is it feasible?
Is it acceptable?
Is it scaleable?

18. Project Plan Finalize Intervention Baseline Survey Pilot Mats
Procure Supplies
Pilot Other Materials
Prepare
Videos
Clarify Laundry
Post Intervention Surveys
‘Sweep up’ survey
Plan
Prepare Supplies
Manage Distribution
Start Intervention

19. 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
Telephone: CDC-INFO ( )/TTY:
Web:
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

20. Potential Interventions
Barriers for steam baths
Cleaning steam baths
Keeping separate scrubbers
Sterilizing laundry
Improved handwashing
Educational campaign
Decolonize ‘super-spreaders’

21. Traditional Steambaths
In this photo you can see two steam baths next to one another.
Located HERE
CLICK

22. Inside a Steambath Inside height ~1.25 meters
This photo is the inside of the pictured steam house. They are relatively squat at about one and a quarter meters in height and you crawl into the steam on all four
You can see the heat source here
Click