Jim Poggi
By Jim Poggi
What is sepsis? What level of public awareness is there?
Sepsis is a word the medical community is becoming more familiar with every year. And, while statistics point out that 65% of Americans know the word, only 1% of Americans can identify the symptoms. This figure is well below the number of Americans who can identify risk factors associated with heart disease, cancer and stroke.
Yet, there are more than 270,000 deaths associated with sepsis in the U.S. annually. Sepsis is recognized as the number one cause of hospital re-admissions and the single biggest contributor to hospital spending at over $24 billion annually. Sepsis is encountered, diagnosed and treated across the continuum of care including primary care, hospital ER and post-acute care rehabilitation centers.
Key sepsis advocacy groups are driving awareness
Clearly there is work to do in education regarding sepsis to reduce morbidity and mortality as well as cost to the healthcare system. As a result, there is a large and increasing body of organizations involved in clinical and public awareness campaigns. Several organizations, including the CDC and major healthcare institutions such as the Mayo Clinic and others have created substantial amounts of clinician and public education materials regarding what sepsis is, how it can be prevented and signs and symptoms that can lead to the urgent need for medical attention. Some of these resources are footnoted at the end of this article.
In addition, the Sepsis Alliance (https://www.sepsis.org/) sponsors a variety of educational materials and in 2012 created “Sepsis Awareness Month”, which is held annually in September. The Global Sepsis Alliance (https://www.global-sepsis-alliance.org/) is a non-profit organization that sponsors World Sepsis Day annually on September 13. In addition, the Global Sepsis Alliance offers a rich variety of educational materials on sepsis.
The Surviving Sepsis Campaign is a collaboration of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine and has resources available that include recommended diagnostic and treatment protocols and a range of educational materials. (http://www.survivingsepsis.org/Pages/default.aspx). As part of their advocacy campaign, they also actively support Sepsis Awareness Month.
What is the clinical definition of sepsis?
Sepsis itself is not a disease and it is not contagious. While its onset is a complication of an infection, sepsis is the body’s overwhelming and life-threatening response to the infection. As the body fights the infection, it produces chemicals to fight the infection. When these chemicals produce this overwhelming inflammatory response, sepsis is the result.
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) (JAMA 2016; 315: 801-10) defines sepsis as the development of systemic inflammatory response syndrome (SIRS) in addition to a documented or presumed infection.
Which infections cause it?
Sepsis can be caused by a wide range of bacteria, viruses, and fungi. Bacteria are the most common cause, with respiratory, skin, urinary tract and GI infections all known to lead to sepsis.
What are the key symptoms of sepsis?
Abnormal temperature (either high or low), evidence of infection, elevated heart and/or respiratory rate, decreased urine output and a high (>12,000) or (<4,000) low white blood count. The patient often presents with mental confusion and may report that they feel ill enough to die.
How is it diagnosed? What is new?
Patients that present with the clinical signs and symptoms above are also evaluated utilizing several lab tests, including CBC, lactate and procalcitonin. Recently, monocyte distribution width has received clearance as an early sepsis indicator. While there is no single lab test that conclusively diagnoses sepsis by itself, the number of available tests is increasing, and their speed, sensitivity and specificity are improving our ability to effectively diagnose sepsis quickly and confidently.
How is sepsis treated?
According to a variety of expert clinical sources, the key to successful treatment is speed in diagnosing and identifying the condition as sepsis followed by aggressive treatment with antibiotics and supportive fluid replacement therapy. Timely diagnosis and watchful patient management are critical elements of saving lives and reducing the incidence of post-sepsis complications.
What is the role of prevention and immunization for sepsis?
We know prevention is critical for any infection, and sepsis is no exception. Proper hygiene is important. Immunization for pneumonia, influenza and meningitis are considered especially effective in limiting the spread of organisms known to be implicated in development of sepsis.
Who is more susceptible to sepsis?
Unfortunately, it’s the usual folks: children under 1 year of age, the elderly, people with chronic diseases including respiratory and heart disease and those with compromised immune systems.
Is sepsis seasonal?
Yes, it is. While sepsis is a major health concern year-round, incidence of sepsis peaks during the months when respiratory illnesses peak, due to the higher incidence of pneumonia and influenza cases at that time of year.
What is the patient impact?
Acutely, sepsis causes over 270,000 deaths in the US alone each year. Its complications can lead to loss of extremities due to reduced circulation. Post sepsis complications occur in approximately 30% of cases and include a variety of physical, mental and affective symptoms including muscle weakness, fatigue, mental confusion and difficulty sleeping.
How can you learn more and even get involved in sepsis awareness events?
All advocacy groups agree that increasing awareness in the healthcare community and the public is an important element to preventing deaths and post sepsis complications. With sepsis diagnosed for more than 1.7 million patients annually, every U.S. community is impacted by it. As medical surgical account managers and members of our community who serve the health care community, we and our suppliers are in a position to help lead discussions and awareness in our community. To make it even easier, many advocacy groups provide templates for education and even community-based activities. Some of the links below will help you learn more about the kind and variety of ways to become involved in this important health care issue. Get involved; make a difference.
CDC web site: https://www.cdc.gov/sepsis/index.html
Sepsis Alliance web site: https://www.sepsis.org/
Sepsis awareness month: September: https://www.sepsis.org/sepsisawarenessmonth/
World sepsis day: https://www.worldsepsisday.org/
World Sepsis Day toolkits: https://www.world-sepsis-day.org/toolkits/
Surviving sepsis campaign: http://www.survivingsepsis.org/Pages/default.aspx