Here's a great post Lucie Lecomte found on the agreeably prickly blog Controversies in Hospital Infection Prevention: Why are we dialing it up to eleven? Excerpt and then more links:
Fear and managing risk
Our greatest fears often revolve around areas where we lack experience, and very few healthcare workers in the US have ever cared for a patient with viral hemorrhagic fever. Importantly, not only does Ebola Fever not have any proven effective therapies, there is also no post-exposure prophylaxis. A simple lapse in infection control protocol cannot be undone with a pill or injection.
One way we attempt to manage fear is to overprotect: if one barrier works, two must be better. In general, redundancies mitigate risk, but this isn't absolute. As Dan pointed out in his post yesterday, we may inadvertently increase risk by complicating infection control protocols with gear that healthcare workers may find distracting, uncomfortable, and lack training to use.
The litigious nature of American society also impacts our strategies. And many healthcare workers, while willing to accept much greater health risks in their personal lives, demand zero occupational risk.
Non-epidemiologic decision making
In many hospitals today, healthcare epidemiology staff have become advisors to hospital administrators who ultimately make decisions regarding the logistics of infection prevention. And their decisions may not be purely based on science. They often have aversion to approaches that would appear to be out of the mainstream of what other hospitals are doing, even if that's wrong.
In addition, infection prevention is often used as a public relations tool. If you don't believe that, do a simple Google search and you will find scores of press releases from hospitals who have purchased germ-zapping robots. By the way, I believe that one of the best uses for a hydrogen peroxide vapor robot would be terminal disinfection of the Ebola patient room. Perhaps those hospitals who have invested in this technology should be the first to receive Ebola patients.
Paramilitarization of public health
In the run-up to the Iraq War, the Bush administration sought to engage the public health and medical communities in the war on terror. Much effort was devoted to preparations for bioterrorism. Who can forget the smallpox vaccine debacle? Preparedness was all the rage, and the Joint Commission couldn't resist jumping on that bandwagon.
Admittedly, some of the impacts of this were positive. For example, hospitals became more tightly linked to public health agencies and those agencies became much more engaged and proactive. But a new group of professionals emerged who are employed to make us prepared, and perhaps a little scared.
A physician colleague who works in the IT world tells me that the constant fear mongering by IT security specialists is in part a job security tactic.
Ok, anyone still surprised we've cranked it up to 11? I'm hoping that with any luck we'll be able to dial it down to 8 this week.