Fighting Sepsis

The Fight Against Sepsis Sepsis kills over 250,000 people a year in America according to the Sepsis Alliance, a nationwide advocacy group committed to fighting sepsis throughout the country. Sepsis is responsible for more deaths than any cause except for cancer and heart disease. Tragically, hospitals often fail to notice the warning signs of sepsis when a patient is spiraling downward. More than 1 million people contract a severe case of sepsis each year in the United States. Tragically, up to 50 percent of patients diagnosed with sepsis die from it. It is also one of the most expensive conditions for hospitals to treat, costing over $24 billion annually.¹ It’s a complex condition, and researchers are pursuing various avenues to reduce deaths. In June of this year the Food and Drug Administration gave market clearance to a new test that will more rapidly identify the bug triggering a patient’s septic infection, potentially allowing doctors to give more targeted antibiotics. The detector, from T2 Biosystems Inc., finds and identifies the extremely rare bacterial cells in blood samples, rather than having to culture bacteria in a lab dish, which can take days.² While such technologies can help, the biggest problem, say some sepsis experts, is that many doctors, nurses, and family members don’t recognize sepsis until it is too late, delaying treatment until a life-threatening cascade of inflammation and organ failure has begun. Hospitals have been working on the problem for years, and their initiatives – including faster diagnosis and treatment, and removing catheters before infections set in – have led to some dramatic improvements. Dr. James Weinstein was CEO of New Hampshire’s Dartmouth-Hitchcock Medical Center in 2014 when he launched a hospital-wide effort to bring down the death rate from sepsis. “Over half who were diagnosed never went home. That’s an awesome, scary thing,” said Weinstein.³ The hospital started patients on antibiotics and fluids immediately after a sepsis diagnosis – and death rates plummeted. They have remained steady at about 12 percent to 15 percent since, he said. In Pennsylvania, Geisinger Health System has streamlined the process of getting antibiotics to patients with sepsis. “That used to take an hour or more, but now a clinician’s ‘sepsis alert’ triggers an automatic page to a phlebotomist to draw blood for analysis and a call to the pharmacy to deliver antibiotics in less than 15 minutes,” said Dr. Benjamin Hohmuth, Chief Medical Informatics Officer for the healthcare system.⁴ Seeking to diagnose sepsis more rapidly, the chain of 11 hospitals also launched a system in June of this year to analyze more than 100 variables in patients’ electronic medical records to predict which patients are most vulnerable to sepsis. When it comes to identifying sepsis in a patient, “Diagnosis can be tricky,” said Dr. Karin Molander, a board member of the advocacy group the Sepsis Alliance. “Many of the symptoms, such as feeling lousy, are vague and could have many causes,” said Molander, a doctor with Mills Peninsula Emergency Medicine Associates in Burlingame, CA. “It’s the combination of symptoms that should make people think ‘sepsis.’ For instance, if someone is extremely confused or disoriented and their leg is bright red and warm to the touch, sepsis should immediately come to mind. If a paramedic calls in a sepsis alert to the hospital, studies show that the patient mortality rate drops from 27 percent to 13 percent” Molander said.⁵ The Sepsis Alliance recently launched an advertising campaign that uses “TIME” as an acronym to help people remember to immediately seek medical attention if they experience: temperature above or below normal, infection, mental decline including confusion or sleepiness, and extreme illness with severe pain or discomfort. Usually, a sepsis patient is immediately started on a broad-spectrum antibiotics. But those drugs can have dangerous and unpleasant side effects, including causing persistent C. difficile infections, which can cause chronic diarrhea and life-threatening inflammation of the colon. And the antibiotics can miss certain bugs.⁶ Another weapon in the fight against sepsis are validated IFUs. So, how can validated IFUs help in the fight against sepsis? As we noted in earlier blogs, “an IFU is a step-by-step reprocessing guide to ensure that a reusable device is properly decontaminated, cleaned of all biomaterial, sterilized and that any residual moisture is voided before the device is returned to surgery.” Failure to follow manufacturers’ validated cleaning IFUs can lead to instruments that are contaminated with microbial biomaterial being returned to the OR after reprocessing. According to a report from the Centers for Disease Control (CDC), "Microbial contamination of the surgical site is a necessary precursor of a surgical infection.”⁷ One of the more common sources of microbial contamination in a surgical case is a surgical instrument that is contaminated with dead, sterile bio burden following reprocessing. All of this is why it is crucial to patient safety that your hospital only use instruments whose cleaning IFUs have been validated. Without validation, reprocessing personnel have no way of knowing if they can actually void the instrument of all organic bio-burden, including blood and gram-negative bacteria. By following manufacturers’ validated cleaning IFUs on every reprocessing cycle, your patients’ risk of contracting sepsis from a contaminated instrument drops significantly. 1. Sepsis Alliance website https://www.sepsis.org 2. Stat News, July 3, 2018 3. Op. Cite. 4. Op. Cite. 5. Sepsis Alliance website https://www.sepsis.org 6. Sepsis Alliance website https://www.sepsis.org 7. “Guideline For The Prevention Of Surgical Site Infection” Center For Disease Control