Sepsis is one of the most common problems seen in the hospital setting. Healthcare workers must remain vigilant in detecting symptoms, managing sepsis, and treating the underlying cause.
Related: Nursing Management of Sepsis, 2nd Edition
What is sepsis?
According to the CDC, at least 1.7 million Americans develop sepsis every year. Sepsis is a life-threatening condition caused by some sort of infection in the body. Experts also refer to sepsis as “systemic inflammatory response syndrome” and “severe sepsis.” However, in 2016, researchers recommended a change in the way providers define the severity of sepsis.
Sepsis is characterized by inappropriate vasodilation and an exaggerated inflammatory response to an infection. This vasodilation and inflammation causes poor perfusion to vital organs, which leads to severe illness, organ failure, and in some cases, death.
While sepsis is a serious problem, it is also a treatable condition. Healthcare providers should be aware of the signs of sepsis, potential solutions, and risks of delayed treatment.
Early identification
The most important thing nurses can do in managing sepsis is early identification. Nurses are tasked with monitoring their patients for changes in condition and knowing when it is time to alert the provider or ask for an intervention.
The 2016 change in sepsis guidelines encouraged providers to determine the severity of sepsis by giving the patient a Sequential Organ Failure Score. This score is based on mean arterial pressure, bilirubin levels, Glasgow coma score, platelets, whether or not mechanical ventilatory support is needed, and ventilator settings.
A higher score indicates more severe sepsis with organ failure, while a lower score indicates more mild disease. SOFA scores higher than 11 are associated with an 80% mortality rate.
Most hospitals recognize that a patient who is positive for two or more conditions on the SOFA score is likely to have sepsis. These patients are at high risk of deterioration and death and should be treated or transferred to a higher level of care as soon as possible.
Nurses should have a particularly high suspicion of sepsis in patients who are neutropenic, suffer from liver cirrhosis, or have been in the hospital for a long period of time. The nurse can perform a quick SOFA test as well as look for any other markers of infection such as high body temperature, rising lactate levels, suspected infection, or hypotension.
Prevention
While most patients with sepsis come to the hospital already fighting some kind of infection, healthcare providers have a duty to prevent sepsis from developing in hospital patients.
A meta-analysis published in the Journal of Intensive Care Medicine found that the proportion of hospital-acquired sepsis among all hospital-treated sepsis cases was nearly 25%. Hospital-acquired sepsis was the most common in the intensive care unit. Here patients frequently need emergency bedside procedures, invasive monitoring, intravenous devices, and are immunocompromised.
Team approach to managing sepsis
Sepsis management requires a team approach. If a nurse suspects that a patient has developed sepsis, they should notify the provider and pharmacist immediately. Typical treatments for sepsis include:
- Search for a source of infection using blood, urine, and sputum samples
- Administer broad-spectrum antibiotics
- 30 mL/kg (adjusted body weight for BMI > 30) of intravenous (IV) crystalloid fluid be given within the first 3 hours of resuscitation (I-E)
- Invasive monitoring of arterial blood pressure via a radial arterial catheter
- Using a procalcitonin guide to choose a more specific antibiotic
- Practice good antibiotic stewardship
- Use norepinephrine as a first-line vasopressor to maintain a MAP of 65
- Stress-dose steroids
- Restore fluid balance after resuscitation
When healthcare professionals identify a source of infection is identified, treatment should follow immediately. This may include surgical removal of infected organs or medical devices, drainage of closed space infections such as abscesses, or perforation repair.
Nursing care of these patients is just as important as prescribed medications, surgeries, and other therapies. Nursing care of patients includes:
- Daily baths
- Frequent skin checks
- Routine oral care
- Physical therapies
- At least a 2h repositioning
- Sterility during dressing changes
- Frequent hand hygiene
- Disinfecting all high-touch surfaces in the patient room
- Proper personal protective equipment as appropriate
Morbidity, mortality, and recovery
At least 350,000 hospital patients die from sepsis each year. Most have been seen by a healthcare provider within a few days of hospital admittance. Many have an underlying health condition such as chronic lung disease or an already weakened immune system.
Fortunately, physicians, nurses, and other members of the healthcare team are getting better at identifying, treating, and managing sepsis. Research and experience confirm that early identification and aggressive treatment are essential for improving outcomes for patients with sepsis.
Patients who receive prompt and appropriate treatment can and often do recover from sepsis. However, these patients should receive good follow-up care. They should be screened for physical, emotional, mental, and cognitive dysfunction that is often present in post-intensive care syndrome.
Patients who have had extended or traumatic hospitalizations often need extensive physical, emotional, and behavioral therapies as they return to their homes, families, and jobs. Patients may need home health visits and should be referred to a mental health provider for check-ins. Early identification, administration of antibiotics, good nursing care, and adequate follow-up care are all essential in the care of a patient with sepsis.
