The what, how and why of sepsis.
What is sepsis?
Sepsis is a serious medical condition caused by an overwhelming immune response to infection. In short, sepsis is blood poisoning by bacteria. Sepsis can lead to tissue damage, organ failure, amputations and death. Septic shock, the most severe version of the condition, occurs when a body-wide infection leads to dangerously low blood pressure.
How common is sepsis?
Unfortunately, sepsis is common, and deadly. According to the US Centers for Disease Control & Prevention, more than 1.5 million people in the US develop sepsis each year. About 250,000 people die every year from sepsis. Shockingly, about 1/3 of patients who die in the hospital have sepsis.
How does sepsis develop?
Many types of microbes can cause sepsis, including bacteria, fungi, and viruses. However, bacteria are the most common cause. Additionally, antibiotic-resistant infections can lead to sepsis. In many cases, doctors cannot identify the source of infection.
When a person has an infection, their body releases immune chemicals into the blood to combat the infection. When this response is overactive, the chemicals can cause widespread inflammation, leading to blood clots and leaky blood vessels. The restricted blood flow deprives organs of nutrients and oxygen and leads to organ damage.
No matter the cause, sepsis is a tricky one – it occurs unpredictably and can progress rapidly.
Why is sepsis so dangerous?
In severe cases, one or more organs fail. In the worst cases, the patient’s blood pressure drops, the heart weakens, and the patient spirals toward septic shock. Once this happens, multiple organs—lungs, kidneys, liver—may quickly fail, and the patient can die.
How do patients develop sepsis?
Sepsis can develop from an infection in one part of the body, such as the lungs, urinary tract, skin, or abdomen (including the appendix). Additionally, invasive medical procedures, such as inserting a tube into a vein, can introduce bacteria into the bloodstream and lead to sepsis.
Where do patients contract sepsis?
Although people can develop sepsis at any point in their healthcare journey, research shows the majority of sepsis cases originate in the community, not in the hospital. A review of sepsis cases at the University of Kansas Medical Center found that 60% of sepsis patients came through the emergency department, 15% were transferred in from other places and 25% developed while the patient was in the hospital.
What are the symptoms of sepsis?
Common symptoms of sepsis are fever, chills, rapid breathing and heart rate, rash, confusion, and disorientation. Since many of these symptoms are also common in other conditions, sepsis can be hard to diagnose, especially in its early stages.
How is sepsis diagnosed?
In addition to checking for the symptoms mentioned above, a doctor may test the blood for a white blood cell count and/or for the presence of bacteria or other infectious agents. Doctors may also use a chest X-ray or a CT scan to locate an infection.
Who can get sepsis?
Anyone can get sepsis, although some people are at higher risk than others. Those at highest risk are infants, children, the elderly, and people who have serious injuries or medical problems (e.g. diabetes, AIDS, cancer, or liver disease). Additionally, those who had an organ transplant and/or use medications to suppress the immune system have a higher risk.
Are there long-term effects of sepsis?
Many people who survive severe sepsis recover completely. But some people, especially those with pre-existing chronic diseases, may have permanent organ damage. Additionally, there is some evidence that severe sepsis puts people at an increased risk for future infections. Studies show that people with a history of sepsis have a higher risk of various medical conditions and death, even several years after the episode.
How do doctors treat sepsis?
After a sepsis diagnosis, most patients are treated in intensive care units (ICUs). Doctors try to stop the infection, protect the vital organs, and prevent a drop in blood pressure, usually with antibiotic medications and IV fluids. The sickest patients might need a breathing tube, kidney dialysis, or surgery to remove an infection. Unfortunately, experts have been unable to develop a medicine to specifically targets the aggressive immune response seen with sepsis.
Time is the enemy. As every hour passes without treatment, the prognosis worsens significantly. In fact, research shows that death rates increase by as much as 8% for every hour that treatment is delayed. Furthermore, studies show that rapid diagnosis and treatment could prevent as many as 80% of sepsis deaths.
What’s the government doing to help patients with sepsis?
The Centers for Medicare and Medicaid Services (CMS) wants all sepsis patients to receive timely, consistent, and high-quality care. To improve every hospital’s identification and treatment of sepsis, CMS adopted the Severe Sepsis and Septic Shock Early Management Bundle in 2015. This measure requires hospitals to follow multiple, time-sensitive steps.
The data is out – many hospitals are not doing a good job controlling sepsis.
For the first time ever, CMS just released data on hospitals’ control of sepsis. The CMS data includes statistics on performance at 3,005 hospitals for the first nine months of 2017. The site provides information for each hospital on the percentage of patients who received appropriate care for severe sepsis and septic shock.
Unfortunately, there is much room for improvement. The national average compliance rate for the CMS’ sepsis treatment measure was 49%.
However, it’s important to note that the data provided might not tell the whole story. Experts say that low compliance rates don’t necessarily indicate poor sepsis treatment. The measure evaluates the process, not patient outcomes. Additionally, hospitals can be marked as non-compliant over small issues like missing a treatment deadline by a few minutes. Or, a doctor can perform a treatment on-time, but delay in recording it, leading to perceived non-compliance.
Program improvements help patients.
There is some debate about whether the CMS measure can improve sepsis mortality rates, but research indicates that the guidelines can help. A 2016 study found patients suffered higher mortality rates when their lactate levels weren’t measured in the three-hour time window outlined by the CMS measure. Additionally, a sepsis program at the Dartmouth-Hitchcock Medical Center reduced their sepsis mortality rate by 75%. Their program includes clinician education and a lowered standard for starting treatments. And they created a standard treatment protocol that requires actions within three hours of identifying a potential sepsis patient: workers must take a blood sample to measure lactate, culture the blood to identify infections, start the patient on a broad-spectrum antibiotic and keep the patient sufficiently hydrated.
How well is YOUR hospital controlling sepsis?
You can look on Medicare’s Hospital Compare website to learn how well your hospital scored on the sepsis control measures. On the site, enter your zip code and/or the hospital’s name. When your hospital’s page appears, click the “Timely & effective care” tab and then click the “Sepsis care” drop-down menu. You can then see your hospital’s score and compare it to both state and national averages. The higher the score, the better. A high score shows that a hospital follows sepsis treatment guidelines and that, when patients develop sepsis, they are generally treated properly. A low score indicates poor sepsis care.
As mentioned above, these scores may be misleading due to reporting issues, clinical nuances and differences in clinical judgement. But one expert states that a low compliance rate for the CMS measure may point to issues with a hospital’s treatment protocols.
Although the rating system isn’t perfect, these scores are a great way to get a sense of a hospital’s performance. And knowledge is never a bad thing.
What can you do to reduce your risk of infections, including sepsis?
There are steps that patients and families can take to reduce their risk of exposure to germs that are airborne or on medical equipment.
One of the most important actions is regular washing of your hands for at least 20 seconds. Be sure to wash your hands in these circumstances, as recommended by Johns Hopkins Medicine:
- Use the toilet
- Blow your nose, sneeze and/or cough
- Touch an animal, handle pet food/treats
- Change a diaper
- Help someone with toileting
- Handle trash
Before and after (and during as needed) you:
- Care for a sick person
- Clean a wound or cut
- Prepare food
Additionally, if you have a rash or infected area that is not getting better, or is getting worse, see your doctor! Better safe than sorry.
Lastly, antibiotic overuse contributes to these difficult infections, so practice safe antibiotic usage.
To learn more about reducing your risk of infections, read my blog posts:
- Reduce Your Risk of Exposure to Superbugs in Hospitals.
- How Can Patients Protect Themselves from Hospital Infections?
- Why is Hand Washing in Healthcare So Important? What You Need to Do to Stay Safe.
- Are Antibiotics Helpful or Harmful? What You Need to Know.