For most of us, it’s scary to think about staying in the hospital. Certainly, no one goes to the hospital expecting to get sicker, but unfortunately it happens. And sepsis is a common cause of serious harm to hospitalized patients. Although over 40% of US adults have never heard of sepsis, it is the leading cause of death in US hospitals. What is sepsis? How do you get it? And why is sepsis so dangerous?
The what, how and why of sepsis.
What is sepsis?
Sepsis is a life-threatening medical condition caused by the body’s extreme response to an 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 NIH, more than 1.7 million people Americans develop sepsis each year. Moreover, almost 270,000 people die every year from sepsis in the US. Shockingly, about 1/3 of patients who die in the hospital have sepsis.
A 2020 report from the World Health Organization estimates that sepsis causes 20% of deaths worldwide. Unsurprisingly, the report states sepsis disproportionately affects those living in low- and middle-income countries.
However, the report also finds that children are disproportionately impacted. Importantly, the report states the limited availability of data from low- and middle-income countries means the true number of cases and deaths is unknown.
How does sepsis develop?
Many types of microbes 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 dangerous is it?
A 2020 report of an analysis of Medicare patients found that 10% of patients with non-severe forms of sepsis died while in the hospital or within a week of discharge. Moreover, 60% with non-severe forms of sepsis died within three years.
However, patients with septic shock fared significantly worse. In comparison, 40% of those with septic shock died while in the hospital or within a week of being discharged, and 75% died within three years.
Additionally, patients with other chronic health conditions, have a higher risk of sepsis and an increased risk of sepsis-related death.
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.
Who can get sepsis?
Although anyone can get sepsis, some patients have a higher risk. For example, infants, children, seniors are more at risk. Additionally, people with serious illnesses or injuries, such as AIDS, diabetes, cancer and liver disease are more prone.
Additionally, those who had an organ transplant and/or use medications to suppress the immune system have a higher risk.
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.
For instance, 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.
Another study, published in 2020, found that most patients with sepsis or septic shock experienced their onset outside of the hospital, but had recently received health care. Additionally, 42% of septic patients received antimicrobial drugs, chemotherapy, wound care, dialysis, or surgery in the 30 days before their sepsis occurred.
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. For example, early signs can appear similar to a urinary tract infection or the flu.
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.
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 receive treatment 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 target the aggressive immune response seen with sepsis.
In addition to using antibiotics to stop the infection, doctors may identify the source of the infection and implement “source control” measures.
Time is of the essence.
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.
Interestingly, a recent study found that identifying the source of the sepsis infection and implementing source control measures within 6 hours resulted in a 29% reduction in 90-day mortality rates.
Furthermore, studies show that rapid diagnosis and treatment could prevent as many as 80% of sepsis deaths.
What can you do to reduce your risk of sepsis and associated harm?
There are steps that patients and families can take to reduce their risk of exposure to germs that can lead to sepsis infections. Realize germs can be airborne or on objects, including on medical equipment.
Try to prevent infections by properly managing any chronic conditions and by getting all recommended vaccinations.
Choose the “right” hospital for surgery.
Not all hospitals provide the same level of monitoring to identify signs of sepsis after patients undergo surgery. Fortunately, you can look up your hospital, or hospitals in your area, on The Leapfrog Group’s website to see their score on post-surgical sepsis infections.
Practice good hygiene.
One of the most important actions for sepsis prevention is regular hand washing for at least 20 seconds. Not only should you frequently wash your own hands, you should make sure that anyone in a medical setting also washes their hands before they touch you or medical equipment that will touch your body.
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, make sure you keep all wounds clean and covered until they heal. And if you have a rash or infected area that is not getting better, or is getting worse, see your doctor! Better safe than sorry.
Avoid antibiotic overuse.
Lastly, antibiotic overuse contributes to these difficult infections, so practice safe antibiotic usage. For more information, read Are Antibiotics Helpful or Harmful? What You Need to Know.
Know the signs and symptoms of sepsis.
Watch out for the followings signs of sepsis:
- High heart rate or low blood pressure
- Fever, shivering, or feeling very cold
- Confusion or disorientation
- Shortness of breath
- Extreme pain or discomfort
- Clammy or sweaty skin
And act fast if you suspect sepsis.
Sepsis is a medical emergency and you should act accordingly. If you or your loved one has any of the above signs, and/or has an infection that’s not getting better or is getting worse, get medical care immediately. And make sure you ask your healthcare professional if the infection could lead to sepsis.
Learn more about infection prevention.
To learn more about reducing your risk of infections, including sepsis, read my blog posts:
- Germs in Hospitals and Doctor Offices – Watch Out!
- Protect Yourself from Superbugs.
- How To Protect Yourself from Hospital Infections.
- Handwashing in Healthcare Could Save Your Life!
- What’s Your Hospital’s Safety Record? Is Your Hospital Safe?
NOTE: I updated this post on 7-20-22.