Sepsis: Deadly without rapid intervention

Every year more than 1.5 million people develop sepsis in the United States, and at least 250,000 die as a result, according to the Centers for Disease Control and Prevention. While deadly, sepsis is treatable – but only if caregivers’ response is rapid.

Sepsis is the body’s extreme response to an infection – in the skin, lungs, urinary tract or somewhere else – which triggers a chain reaction throughout the body. It begins outside of the hospital for nearly 80 percent of patients. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

The signs and symptoms of sepsis can include:

• Confusion or disorientation
• Shortness of breath
• High heart rate
• Fever, or shivering, or feeling very cold.
• Extreme pain or discomfort
• Clammy or sweaty skin.

The most frequently identified germs that cause infections that develop into sepsis are Staphylococcus aureus (staph), Escherichia coli (E. coli) and some types of Streptococcus.

Although sepsis typically develops in the community, people with sepsis are treated in the hospital, says CDC. Research shows that rapid, effective sepsis treatment, which includes giving antibiotics, maintaining blood flow to organs, and treating the source of infection, can save lives. Doctors treat sepsis with antibiotics as soon as possible. Many patients receive oxygen and intravenous fluids to maintain blood flow and oxygen to organs. Other types of treatment, such as assisting breathing with a machine or kidney dialysis, may be necessary. Sometimes surgery is required to remove tissue damaged by the infection.

Post-sepsis syndrome
Half of sepsis survivors suffer physical and/or psychological long-term effects, according to the Sepsis Alliance, an advocacy organization founded in 2007. Those effects include:

• Insomnia, difficulty getting to sleep or staying asleep.
• Nightmares, vivid hallucinations and panic attacks.
• Disabling muscle and joint pains.
• Extreme fatigue.
• Poor concentration.
• Decreased mental (cognitive) functioning.
• Loss of self-esteem and self-belief.

PSS can affect people of any age, but a study from the University of Michigan Health System, published in 2010 in the medical journal JAMA, found that older severe sepsis survivors were at higher risk for long-term cognitive impairment and physical problems than others their age who were treated for other illnesses. Their problems ranged from not being able to walk, even though they could before they became ill, to not being able to do everyday activities, such as bathing, toileting, or preparing meals. Changes in mental status can range from no longer being able to perform complicated tasks to not being able to remember everyday things.

The study’s authors wrote, “Sixty percent of hospitalizations for severe sepsis were associated with worsened cognitive and physical function among surviving older adults. The odds of acquiring moderate to severe cognitive impairment were 3.3 times higher following an episode of sepsis than for other hospitalizations.”

For information on sepsis and on the CDC’s “Get Ahead of Sepsis” initiative, go to https://www.cdc.gov/sepsis/get-ahead-of-sepsis/

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Early recognition, early intervention
Ohio hospitals achieved a 13.4 percent statewide reduction in sepsis mortality, representing an estimated 1,486 lives saved over the first 18 months of an Ohio Hospital Association initiative, which began in June 2015.

The initiative rests on two key strategies: 1) early recognition, and 2) early, appropriate intervention with the incorporation of the Surviving Sepsis Campaign’s three-hour sepsis bundle (i.e., blood cultures, broad-spectrum antibiotic agents, and lactate measurement).

Participating hospitals reported the following activities:

• Coordinating with EMS/ambulance services to provide sepsis education and early appropriate intervention protocols.
• Incorporating national Sepsis Alliance templates for discharge instructions of sepsis patients.
• Reviewing rapid response team protocols and activation process to treat sepsis patients.
• Improving recognition and treatment before rapid response team is needed.
• Implementing Focused Assessments to determine condition of septic patient.
• Creating and distributing education materials (signs of sepsis) for the community and partners.
• Assigning a dedicated “sepsis coordinator” to work with clinical team on policies and protocols.
• Expanding education for staff orientation.
• Distributing a sepsis alert page throughout the hospital when a patient arrives or is identified as septic, creating a mandatory consult for a critical care physician and ensuring information is passed, including the time for the six-hour focused exam and the location of the patient.
• Developing marketing materials such as radio ads and billboards to educate the community on the signs of sepsis.

Source: Progress Report 2017: OHA Statewide : https://www.ohiohospitals.org/OHA/media/Images/News%20and%20Publications/Reports/OHA-Sepsis-2017-Progress-Report-FINAL.pdf

Treatment delays costly
The real opportunity for sepsis survival lies in identifying and treating sepsis before it becomes severe, according to the University of Kansas Health System. “In some cases, we identify the potential for sepsis early and prescribe antibiotics, but we don’t get them into the patient quickly enough,” reports the health system on its “Management of the Sepsis Patient” web page. “The answer can be as simple as issuing a STAT order or following up with the hospital’s inpatient pharmacy and the patient to ensure rapid delivery. When we see a patient with a severe injury – say a bleeding artery – we don’t delay. We take immediate action to stop the bleeding.

“Similarly, if a patient enters the emergency room with an infection, he is probably sick enough to warrant STAT antibiotics.”

Some key statistics from the University of Kansas:

• Every hour we delay treatment, we add 7 percent to the mortality rate.
• Elevated creatinine levels increase mortality dramatically.
• Mortality for severe sepsis without rapid response is 30-50 percent.
• If the patient develops shock, the mortality rate rises to 60-80 percent.
• Sepsis is not just a community hospital problem. Even in major academic medical centers, the mortality rate for sepsis is 50 percent if treatment for septic shock is delayed more than four hours.

Source: University of Kansas Health System: http://www.kansashealthsystem.com/for-professionals/publications-resources/newsletters/read-innovations-review/sepsis-may