Infection Control in the Bush: The Curious Case of Community Acquired MRSA in Southwest Alaska

Background: "Boils" have plagued the residents of "bush" Alaska since recorded history. Every decade for the past 30 years epidemiologic studies have found associations between boils and the environment, cultural practices, and living conditions. Community members and providers often accept the plague of boils as well as its microbiological source (community-acquired MRSA)as fate and fact. A review of past studies and an attempt to implement control measures reveals infection control and disease prevention measures in the setting of such antecedents and acceptance to be fraught. Methods: A review of the literature on "boils" and CA-MRSA in Southwest Alaska was undertaken as part of a quality improvement evaluation for the Infection Control Program in a small critical access hospital in Southwest ("bush") Alaska. Active surveillance culturing for CA-MRSA was undertaken on in an inpatient setting as a measure of prevalence in the winter of 2010. Results: 13% of a small sample of patients admitted to an inpatient setting screened positive for CA-MRSA. Key clinical, medical and laboratory processes were poorly implemented and not amenable to improvement over the course of the evaluation. Quality improvement, organizational, and cultural issues hinder disease management interventions and represent a challenge for infection control and disease management. Conclusions: The social epidemiology of "boils" and the practice environment for CA-MRSA prevention are greatly affected by structure, culture, and organizations. Innovative models of infection control need to be developed for effective disease prevention and management.