The Medical Emergency You Must Know About
For patients suffering from sepsis, it's a race against time
Do you know what sepsis is? If not, it’s time you did — as the infection has emerged officially as a major health issue across the nation, and the Centers for Disease Control and Prevention this week issued new warnings and protocols to fight its deadly impact.
Sepsis often develops quickly and can initially look like other conditions. The CDC calls it “a complication caused by the body’s overwhelming and life-threatening response to infection.” It can lead to tissue damage, organ failure, and death.
Septicemia is now the costliest condition for hospitals to treat.
With deaths occurring in 13 percent of those who contract it, septicemia was ranked 20th in medical costs in 1999, 6th in 2009, and is now the most costly condition for hospitals to treat. Sepsis patients represented $23.7 billion in hospital costs in 2013, according to the Agency for Healthcare Research and Quality, a government entity.
The new CDC directives focus on fast action in preventing, recognizing, and treating sepsis — and in redefining it as a medical emergency. Over 80 percent of people diagnosed typically develop the infection outside of the hospital, so emergency rooms are a key place for identification. And more than 90 percent of adults and 70 percent of children who have developed sepsis had a health condition that may have put them at risk.
Any infection can lead to sepsis — though people age 65 years or older and infants less than a year old are particularly susceptible. Anyone with a weakened immune system or chronic medical condition like diabetes or heart disease should be aware of the warning signs.
- Fever or feeling very cold
- Extreme pain or discomfort
- Clammy or sweaty skin
- Confusion or disorientation
- Shortness of breath
- High heart rate
Thirty-five percent of sepsis occurs in patients with lung infections (such as pneumonia); 25 percent with urinary tract infections (UTI); 11 percent with gut infections; and 11 percent with skin infections.
The germs causing infection typically aren’t identified — but when they are, the most common offenders are staph, E. coli, and strep.
In addition to urging fast action, the CDC indicates all health care providers and facilities should put greater effort into preventing infections and train their employees in sepsis detection.
“I really like that they are placing an emphasis on early recognition of sepsis, as this is the most important part of the process,” said Dr. Christopher Carrubba, a physician consultant with Healthgrades in Aurora, Colorado. Carrubba works with hospitals and health care systems to implement best practices and improve sepsis outcomes.
“Emergency physicians need to be able to promptly recognize symptoms that are concerning, initiate an appropriate workup, and initiate treatment with fluids and antibiotics,” Carrubba told LifeZette.
He believes patients should know the steps as well — and directs patients to insist on attention if they have any chronic disease or condition that weakens the immune system. “Patients with conditions like chronic obstructive pulmonary disease (COPD), chronic heart failure, or weakened immune systems should warrant ICU [intensive care unit] consideration,” said Carrubba.
“No one has explained how sepsis has climbed the charts in the last 15 years and suddenly become the No. 1 in-patient diagnosis,” said one consultant.
Carrubba also believes health care facilities should track and train patients at risk of failure with home antibiotic therapy. “Doing a better job with outpatient infection management would prevent many cases of sepsis.”
Healthgrades is the only hospital ratings source that uses sepsis performance as a quality indicator.
Sepsis is also gaining the focus of new emerging technologies. Uniphy Health, of Newark, New Jersey, which specializes in mobile solutions for clinical settings, recently deployed a new platform for sepsis recognition at Jersey City Medical Center-RWJBarnabas Health, a 325-bed urban tertiary care center in Jersey City, New Jersey.
While the new CDC directives focus on better training of personnel, Uniphy Health’s Sentinel solution for sepsis continually scans patients’ electronic health records (EHR) and draws on predictive analytics to assess which patients are septic and/or at risk for septic shock. The system monitors more than 70 clinical features in real time, including body temperature, heart rate, respiratory rate, white blood cell count, medication lists, blood culture reports, diagnostic imaging, and clinicians’ progress notes.
The platform sends alerts to key physicians and nurses on the patient’s care team.
In spite of positive changes, the cause for the dramatic rise in sepsis hasn't been discovered.
"While these technologies sound promising, you've got to get to the root cause of the problem, and they aren't doing that," Al Lewis, of Boston, Massachusetts, said. Lewis is president of the Disease Management Purchasing Consortium International Inc., a consultant to health plans and self-insured employers.
"No one has explained how sepsis has climbed the charts in the last 15 years and suddenly become the No. 1 in-patient diagnosis," he said. "There are some good points in the new directives — but if they haven't figured out why the increase occurred, it's not proactive enough."
Pat Barone, MCC, is a professional credentialed coach and author of the Own Every Bite! bodycentric re-education program for mindful and intuitive eating.