I've been doing a lot of thinking lately. This is perhaps because I'm between jobs and have some occasional downtime but it's more likely the result of not actually owning a computer these past two weeks, unless you count my phone. What I've been thinking about is why I ended up in hospital epidemiology in the first place. I mean, who, in their right mind, would choose to go into a profession that is under appreciated, under funded and lacks the proper scientific data to make rational clinical decisions. I could go on, and I'd be happy to if you meet me at the local pub...
What keeps sticking in my head is how little we've advanced since Semmelweis described the benefits of hand disinfection. For one, we're still doing quasi-experimental studies, although Semmelweis's design was at least controlled (midwives). It also seems that most of our contentious debates, including those around active detection and isolation, would be unnecessary if we'd followed his advice and had 100% hand hygiene. As for recent advances, the CLABSI checklist popularized by Peter Pronovost is probably the most important. Why was this advance made by someone who wasn't an ID physician or hospital epidemiologist? I think it's because as a profession we're stuck. Perhaps more clinical trials will advance things, but I have this suspicion we'll just end up proving what we already know - where will the advancement come from?
So, what does this have to do with the iPad? I just came across this article by Daniel Eran Dilger on how Steve Jobs utilizes creative destruction to change the world. The article is a little tech heavy and perhaps Apple biased, but I don't think that detracts from it's main points which I believe have relevance for a potential 'new' future for infection prevention. Dilger's main points are: (1) "Jobs understands death as a creative force better than most people. For society, culture, and technology to progress, old thinking has to die off to make way for fresh new ideas. People who don’t die are dragged kicking and screaming in the future..." and more importantly (2) "When something works, you don’t need to kill it. But in some cases you should."
So what does this mean for infection prevention and what should be "killed off"? I don't know. It's only been two weeks! However, I think we need to discuss what old ideas we are unnecessarily holding on to and we shouldn't back away from killing off things that work. Yes this is easier said than done and is perhaps a useless exercise. I'm just one guy, I don't even own a computer and I'm not even sure I know what a metaphor is.