Beware of Sepsis

From the Medical Laboratory Observer​​.

Sepsis is a life-threatening condition triggered by a systemic infection, caused by bacteria, virus or parasite that ultimately affects the function of vital organs. Sepsis is a progressive shutdown of the body’s organs and systems caused by systemic inflammation following infection that enters the blood or soft tissue. Those who don’t die often experience life-altering consequences like loss of limbs or organ dysfunction.

Symptoms of sepsis include chills or fever; extreme pain or discomfort; clammy or sweaty skin; confusion or disorientation; shortness of breath; and a high heart rate. Also nausea, vomiting, diarrhea or sore throat, all infection signs.

Given its prevalence and consequences, sepsis is a huge driver of medical costs, accounting for an estimated $17 billion annually in national healthcare expenses.

INFO : Beware of sepsis caused by infection

ACTION : A possible cure for Sepsis

​Inpatients Are Often at Great Risk of Sepsis

Infections that progress to sepsis in the hospital may increase risk of death. Researchers found the death rate of patients with sepsis was 10 percent compared to 1 percent among patients without sepsis. In fact, the same study found 50 percent of all in-hospital deaths were related to sepsis.

Recent research published in the Canadian Medical Association Journal proposes sepsis should be recognized as a distinct cause of death in hospitals around the world. Researchers argue that changing the focus on sepsis would potentially improve nutrition and hygiene and lead to the initiation of timely treatment.

In the U.S., as many as 50 percent of patients had sepsis at the time of their death. Interestingly, most of these patients were admitted to the hospital with a diagnosis of sepsis and did not acquire the condition while hospitalized. The cost of treating sepsis is high, topping $24 billion in 2014, with nearly 25 percent of all hospital charges attributed to the treatment of sepsis.

Sepsis is a condition that does not discriminate, as it affects all age groups, socioeconomic groups and men and women alike. There are groups who are more vulnerable than others, such as newborns and the elderly. Those who suffer with chronic diseases or have a weakened immune system are also at greater risk.

Successful results rely on early detection and rapid treatment. Through recognition that sepsis is a discrete cause of death, better clinical practice guidelines stressing recognition in the community and the ER may reduce the overall number of deaths. It strikes over a million Americans every year, according to the CDC, and over 250,000 of them will die. It kills more Americans than AIDS, breast cancer and prostate cancer COMBINED. Anyone can get sepsis; it makes no distinction based on race, creed or age.

The first step is to seek treatment quickly when there are any symptoms. People shouldn’t wait until their doctor can see them, but go to the emergency room right away. In nearly 80 percent of cases, sepsis had started when the patient was at home.

Sepsis occurs most often in people over 65 but infants under the age of 1 are also susceptible, as are people with chronic diseases like diabetes or weakened immune systems such as from tobacco use, for example. And healthy people can develop sepsis from an infection that’s not treated properly as well. Sepsis is most often associated with lung, urinary tract, skin and gut or intestinal infections. Many sepsis patients had visited a doctor or been in a health care setting before developing the infection.

Experts agree that the key to fighting sepsis is ensuring quick diagnosis and treatment within the “golden hour” when it can be most effective. Pilot initiatives in some hospital systems have shown great strides in decreasing sepsis mortality through effective implementation of what is basically a “checklist”: a standardized protocol to facilitate quick and accurate diagnosis and fast and effective treatment as soon as any sign of sepsis arises. But no state has required these simple protocols be implemented at all hospitals.

New York is the first state in the nation to require all hospitals to adopt evidence-based protocols for the early diagnosis and treatment of sepsis. Specifically, hospitals will be required to adopt protocols that provide for:

• The screening and early recognition of patients with sepsis, severe sepsis and septic shock;
• A process to identify and document individuals appropriate for treatment through severe sepsis protocols; and
• Guidelines for treatment including for early delivery of antibiotics.

Protocols must be evidence-based and based on generally accepted standards of care and include components specific to the identification, care and treatment of adults and of children and make clear when different approaches are required for adults and children.

​​​Apr. 18, 2014

Editor: Although the publication date of an article may not be current the information is still valid.

Nurse Nightmare: Sepsis

By Joshua Lewis from Healthcare

What is Sepsis?

Sepsis is a very serious condition that generally occurs in people with weak immune system. Millions of people around the globe suffer from sepsis and their life may get badly affected if they fail to recover. Statistics show that about 1 in 4 patients suffering from this disease eventually die. The patient would only survive this condition if the condition is not severe. If it is in an early stage and less serious, chances are bright that one would be able to recover and get back to a normal healthy life once again.

Sepsis is basically a complication of infection, which can be fatal. It takes place when the body is infected and the chemicals released into the blood to combat it lead to inflammation over the whole body. In the worst case scenario, this condition may lead to septic shock, the most critical type of sepsis, in which blood clots form due to inflammation. These clots block oxygen flow from various organs. As a result, organs fail to work and there is a serious drop in blood pressure which can be life threatening.

Symptoms

There are various symptoms of sepsis. These are broadly divided into 3 stages namely:

Sepsis
Severe sepsis
Septic shock

Sepsis often takes place when patients are hospitalized and recovering from a procedure. General symptoms of this condition include:

• Infection
• Fever over 101.3 f
• Heart rate higher than 90 beats per minute
• Breathing rate higher than 20 breaths per minute

In case of severe sepsis, some of the signs the patients may undergo are:

• Abdominal pain
• Decrease in platelet count
• Notably decreased urine output
• Sudden change in mental status
• Problems in breathing

Septic shock is the worst of all types of sepsis. The symptoms include:

• Rapid heart rate.
• Agitation
• Cool arms and legs.
• Confusion
• High or very low temperature
• Light-headedness.
• Little or no urine.
• Restlessness
• Lethargy

If a person experiences any of these signs he or she must get medical aid instantly.

Causes of Sepsis

Infections: Various kinds of infections may lead to Sepsis. These may include bacterial, fungal, or viral infections. There are different types of bacteria that may show resistance against the effects of antibiotics that once killed them. They are often the main source of the infections that lead to sepsis. It may also happen due to pneumonia, kidney infection, abdominal infection or infection in the blood.

Aging population: According to studies, it has been revealed that the life expectancy in America is quite high. That is why; there is a rising rate of people who are at the highest risk.
Weak immune systems: Weakened immune system is another cause of this condition. Many Americans have weak immune systems due to a number of conditions such as transplant drugs, HIV and more.

Sepsis in United States Hospitals

According to statistics, the number of people with sepsis is increasing in the U.S. a variety of reasons contribute to more cases of this condition. These may include:

• Rise in drug-resistant bacteria
• Aging populations
• Growing number of people weak immune systems (due to diseases such as cancer or HIV).

Statistics show than over 750,000 patients are diagnosed with severe sepsis every year in the U.S and as many as 25 Americans die every hour from sepsis, which makes this condition worse than other deadly diseases such as cancer. In most cases, sepsis affects patients in the pre-hospital settings.

The Impact of Sepsis on Patients

Patients of Sepsis may undergo different experiences, depending on their individual case. Those who have a septic infection may develop physical or mental impairments as they grow older. Aged people who suffered from severe sepsis but survived are likely to develop cognitive issues.

Patients with this condition need also need help in order to carry out various activities in their life. Studies show that older Americans who suffer from this condition undergo various problems associated with both body and brain. These problems are not simple rather complicated in most of the cases. They not only affect the patients but also their family member since the patient becomes dependent on them to a considerable extent. Many times as the family is unable to manage all these issues, the patients are moved to nursing homes for better care.

Prevention of Sepsis

If you want to remain safe from the negative impacts that are caused by sepsis, prevention is a must. In fact, it is the only way to avoid all the disabilities that are associated with this condition. Prevention not only helps the patients and their families from the burden of care, but it will also allow them to reduce the cost it involves.

In order to reduce the risk of sepsis in children, recommended immunization must be followed. Infections that may impact the patient in hospitals, which may lead to this deadly condition, can be reduced by following proper hygiene and hand washing standards.

In many parts of the world, impure water and unsanitary facilities lead to severe digestive infections that lead to sepsis. Promotion of hygiene can thus play a great role in prevention of the disease. Clean deliveries, better sanitation and nutrition, availability of clean water are some of the measures that can be taken in order to prevent this problem.

Creating awareness among people regarding the causes and seriousness as well as prevention of sepsis is another simple yet effective way to control it. If only people are aware they can adhere to hygiene practices, be more careful in their lifestyle and adopt ways to prevent this condition and minimize its occurrence.

It is also essential to provide Vaccinations against pneumococcus bacteria, meningococcus and haemophilus bacteria to patients who don’t have spleen as they have a higher risk of sepsis. In addition, these people should also be provided with prophylactic treatment with antibiotics prior to surgery.

Another step in preventing the number of deaths caused by this condition is to control bacterial resistance to antibiotics. The increased use of antibiotics in healthcare settings has led to a tremendous rise in antibiotic-resistant bacteria. Proper steps must be taken in regard. It includes the targeted and cautious use of antibiotics that are often prescribed by mistake for viral infections.

 Future Research in Sepsis

Even though the outcomes of sepsis have improved the rate of mortality is still alarming. There is no treatment which is specifically meant to treat this condition. The only way to manage the symptoms is to recognize the signs at an early stage so that appropriate measures can be taken. These may include source control measures as required, administration of right antibiotics and vasoactive drugs as required.

Even though many efforts have been made to comprehend the basic pathogenesis of sepsis, the intricacies relationship of pathogen, host as well as environment that has an impact on the prevalence of the disease, this condition has seem to have not much effect despite better treatments and approaches.

The present clinical research models look much dubious to make new therapies that will bring about new changes or clinical results.

Oct 4, 2015

Editor: Although the publication date of an article may not be current the information is still valid.

> See Patient Safety Toolkit

Rory’s Story

By Orlaith Staunton for MomsRising.org

When my son Rory died I met with a grief counselor. One of the first questions he asked me was, “Where do you feel the pain?” “I feel it everywhere,” I answered.  “It’s right here on the tips of my fingers. It’s in my toes, it’s in my head, it’s in my heart. I feel it in my stomach, I stiffen…it’s everywhere.” That was in April 2012, my son had just died from sepsis. Rory scraped his arm while playing basketball on Wednesday and even though we brought him to his pediatrician and a leading New York City medical facility, he was dead on Sunday evening, April 1st, at 6.30pm.

Rory died from sepsis, something we as a family had never heard of before. In the aftermath of his death we searched for answers. Rory had complained on Wednesday that he had scraped his elbow playing basketball; after midnight I heard him throwing up in the bathroom and when I brought him back to bed he complained of a pain in his leg. I rubbed his leg and eased him back to sleep but in the morning he was running a fever and we called his pediatrician who agreed to see him. Although she recorded a 102 fever, 140 pulse, severe leg pain, blotchy skin and 36 breaths a minute, she insisted that he had a stomach bug; she said he would be fine and not to worry but to go with him to the ER for rehydration. At the hospital the ED doctors concurred with the diagnosis and sent him home with a prescription for Zofran, an anti-nausea drug.

The following day, Friday, when Rory’s symptoms didn’t improve we returned to the hospital and he died there on Sunday from septic shock.

Sepsis is the body’s life-threatening reaction to an infection. It strikes over a million Americans every year, according to the CDC, and over 250,000 of them will die. It kills more Americans than AIDS, breast cancer, Ebola and prostate cancer COMBINED. Anyone can get sepsis; it makes no distinction based on race, creed or age.

Sepsis is common and deadly and it kills with astonishing speed: For every hour delay in giving antibiotics after low blood pressure has set in, the survival rate decreases by 7.6 percent. But sepsis is preventable and treatable. In fact, early identification followed by antibiotic and IV fluids is all that is required. Mortality rates for sepsis are catastrophically high because the general public, and particularly parents, are not taught about sepsis or educated about the signs. Parents should know the indicators and the importance of seeking immediate medical attention, just as we know to be on the alert for signs of meningitis. The agonizing truth is that, had my husband and I known about sepsis and how to identify it, our son would still be alive. Sepsis is very easy to detect, but only if you’re looking for it.

After Rory died, we knew as a family that we needed to do something about spreading awareness and education on sepsis. We set up the Rory Staunton Foundation in Rory’s memory. At our urging, New York State introduced Rory’s Regulations in 2013, which require all hospitals to adopt a set of sepsis protocols for faster diagnosis and treatment of sepsis. The Governor estimates these regulations will save over 5,000 New Yorkers every year. Included in these regulations is a Parents Bill of Rights to ensure better communication between hospital staff, parents and patients in Emergency Rooms throughout the state. Our goal is to have these regulations enacted in every state by 2020.

On a national level we organized the first every U.S. Senate Hearing on Sepsis in September 2013; we are pressuring the CDC to acknowledge sepsis as the killer that it is and we have garnered national recognition of sepsis by sharing on our stories with broadcast and print journalists nationwide. Last week in Washington D.C. we held the Rory Staunton Foundation Second Annual Forum on Sepsis where we established a National Family Council on Sepsis, a coalition of those affected by sepsis that is both a support network and a unified voice for action on sepsis.

Every hour of every day I miss my son desperately. He was, in words of his 6th grade teacher, “the most profound 12 year old I have ever met.” Rory wanted to be a pilot and Sully Sullenberger was his hero. He had a very strong social conscience and was elected to student council at this school where he led a campaign, Spread the Word to End the Word, to curtail the casual, derogatory use of the term “retarded.” In our neighborhood he and his friends formed their own country, Kidadelphia and adapted the United States motto for their slogan: “In God and Fun We Trust.” Rory was president.  He worshiped and adored his little sister Kathleen.

As a parent, I urge all of you reading to learn the signs of sepsis, share the information far and wide, be vigilant with your precious children and not to be afraid to challenge the ‘experts’ in advocating for their care.

September 30, 2015  

Editor: Although the publication date of an article may not be current the information is still valid.

> See Patient Safety Toolkit