Sepsis Awareness Month

The Centers for Disease Control and Prevention (CDC) report that at least 1.5 million people annually get sepsis in the U.S. Of these 1.5 million people, 250,000 will die.

As medical professionals, we’ve all taken care of patients with sepsis. We know that sepsis causes our patients to become very sick, very quickly. The CDC defines sepsis as, “…the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have —in your skin, lungs, urinary tract, or somewhere else—triggers a chain reaction throughout your body.”

Basically, sepsis can occur without notice – which is why we must take it seriously and be diligent about prevent detention and prevention.

Sepsis Prevention

Sepsis prevention can start with illness prevention.

• Getting recommended vaccines can help. Vaccines prevent viral infections from occurring. They “trick” your body into believing it has been infected with the illness. This causes the body to become immune to getting the specific virus.
• Taking care of wounds helps prevent infection. Getting a scrape, cutting your finger, or sustaining a blister from a too-tight shoe all cause breaks in the skin. When you have a break in the skin, bacteria can enter. As we know, this can cause infection – which can cause sepsis. When you have an open wound, care for it properly by cleaning it, covering it (or getting stitches if indicated), applying ointment if needed, and observing for signs of infection (redness, discharge from the wound, pain, and warmth of the wound).
• Handwashing is of the utmost importance. When hands are visibly dirty, soap and water must be used. Handwashing should also be performed after using the bathroom, before handling food, after blowing the nose and coughing, after touching pets, and routinely when outside the home.

When a bacterial infection is diagnosed, and an antibiotic is prescribed, care should be taken to take the antibiotic exactly as prescribed. For example, if the antibiotic should be taken every eight hours, it should be taken as indicated. This also means that if it is prescribed for 10 days, it should be taken for the full 10 days. Although symptoms likely will improve, the bacteria are likely still present, which is why the entire course of bacteria should be taken to ensure that sepsis does not occur.

Best Practice

Despite prevention, sepsis will still occur. Therefore, we have “best practice” guidelines.

The Surviving Sepsis Campaign (SSC) has outlines specific guidelines for the treatment of sepsis. Their guidelines are extensive and are based on evidence-based practice. Their first recommendation states, “Sepsis and septic shock are medical emergencies, and we recommend that treatment and resuscitation begin immediately.” This means that medical staff should be able to recognize sepsis – and should have screening tools in place – so that should sepsis develop, treatment can be initiation right away.

There are recommendations for fluid resuscitation, hemodynamic monitoring, sepsis screening, obtaining blood cultures to determine the source of sepsis as well as the appropriate antimicrobial treatment, when to start empiric therapy – and this is a very limited list. To review the SSC’s International Guidelines for Management of Sepsis and Septic Shock, click here.

One-Hour Sepsis Bundle

The SSC’s guidelines are exhaustive and encompass sepsis treatment in general. Much of it does discuss what should ideally happen right away when sepsis is suspected. It does, however, recommend treatment that continually occurs.

But what should happen right away? Minutes matter, especially for the critically ill.

The SSC Hour-1 Bundle has five treatment guidelines that ensure resuscitation for the septic patient:

1. Measure a lactate level (should be redrawn if the level is elevated – >2mmol/L)
2. Draw blood cultures prior to starting intravenous antibiotics
3. Administer broad-spectrum antibiotics
4. Begin transfusion of 30ml/kg crystalloid for hypotension or lactate >4mmol/L
5. Start intravenous vasopressors if hypotensive after fluid resuscitation to maintain a mean arterial pressure greater than or equal to 65 mmHg

The Bottom Line…

Sepsis is a serious medical condition. 1 in 3 deaths in the hospital occur because of sepsis. As medical professionals, we must be diligent in detecting sepsis so that proper treatment can be initiated early.

Resources
Centers for Disease Control and Prevention. (2018, July 20). Sepsis – data & reports. Retrieved from https://www.cdc.gov/sepsis/datareports/index.html

Centers for Disease Control and Prevention. (2018, July 22). What is sepsis? Retrieved from https://www.cdc.gov/sepsis/what-is-sepsis.html

Critical Care Medicine. (2017, March). Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2016. Retrieved from https://journals.lww.com/ccmjournal/Fulltext/2017/03000/Surviving_Sepsis_Campaign___International.15.aspx

Sepsis Alliance. (2017, December 14). Sepsis and prevention. Retrieved from https://www.sepsis.org/sepsis-and/prevention/

Surviving Sepsis Campaign. SSC Hour-1 Bundle. Retrieved from http://www.survivingsepsis.org/Bundles/Pages/default.aspx