The New War On Sepsis

The New War On Sepsis

Dawn Nagel, a nurse at St. Joseph Hospital in Orange, Calif., knew she was going to have a busy day, with more than a dozen patients showing signs of sepsis. They included a 61-year-old mechanic with diabetes. An elderly man recovering from pneumonia. A new mom whose white blood cell count had shot up after she gave birth.

Nagel is among a new breed of nurses devoted to caring for patients with sepsis, a life-threatening condition that occurs when the body’s attempt to fight an infection causes widespread inflammation. She has a clear mission: identify and treat those patients quickly to minimize their chance of death. Nagel administers antibiotics, draws blood for testing, gives fluids and closely monitors her charges — all on a very tight timetable.

“We are the last line of defense,” Nagel said. “We’re here to save lives. If we are not closely monitoring them, they might get sicker and go into organ failure before you know it.”

Sepsis is the leading cause of death in U.S. hospitals, according to Sepsis Alliance, a nationwide advocacy group based in San Diego. More than 1 million people get severe sepsis each year in the U.S, and up to 50 percent of them die from it. It is also one of the most expensive conditions for hospitals to treat, costing $24 billion annually.

Most hospitals in the U.S. have programs aimed at reducing sepsis, but few have designated sepsis nurses and coordinators like St. Joseph’s. That needs to change, said Tom Ahrens, who sits on the advisory board of Sepsis Alliance.

“From a clinical point of view, from a cost point of view, they make a huge impact,” said Ahrens, a research scientist at Barnes-Jewish Hospital in St. Louis.

Research shows aggressive treatment of sepsis can save lives

Image result for Research shows aggressive treatment of sepsis can save lives

Minutes matter when it comes to treating sepsis, the killer condition that most Americans probably have never heard of, and new research shows it’s time they learn.

Sepsis is the body’s out-of-control reaction to an infection. By the time patients realize they’re in trouble, their organs could be shutting down.

New York became the first state to require that hospitals follow aggressive steps when they suspect sepsis is brewing. Researchers examined patients treated there in the past two years and reported Sunday that faster care really is better.

Every additional hour it takes to give antibiotics and perform other key steps increases the odds of death by 4 percent, according to the study reported at an American Thoracic Society meeting and in the New England Journal of Medicine.

That’s not just news for doctors or for other states considering similar rules. Patients also have to reach the hospital in time.

“Know when to ask for help,” said Dr. Christopher Seymour, a critical care specialist at the University of Pittsburgh School of Medicine who led the study. “If they’re not aware of sepsis or know they need help, we can’t save lives.”

The U.S. Centers for Disease Control and Prevention last year began a major campaign to teach people that while sepsis starts with vague symptoms, it’s a medical emergency.

To make sure the doctor doesn’t overlook the possibility, “Ask, ‘Could this be sepsis?'” advised the CDC’s Dr. Lauren Epstein.


Once misleadingly called blood poisoning or a bloodstream infection, sepsis occurs when the body goes into overdrive while fighting an infection, injuring its own tissue. The cascade of inflammation and other damage can lead to shock, amputations, organ failure or death.

It strikes more than 1.5 million people in the United States a year and kills more than 250,000.

Even a minor infection can be the trigger. A recent CDC study found nearly 80 percent of sepsis cases began outside of the hospital, not in patients already hospitalized because they were super-sick or recovering from surgery.



In addition to symptoms of infection, worrisome signs can include shivering, a fever or feeling very cold; clammy or sweaty skin; confusion or disorientation; a rapid heartbeat or pulse; confusion or disorientation; shortness of breath; or simply extreme pain or discomfort.

If you think you have an infection that’s getting worse, seek care immediately, Epstein said.



Doctors have long known that rapidly treating sepsis is important. But there’s been debate over how fast. New York mandated in 2013 that hospitals follow “protocols,” or checklists, of certain steps within three hours, including performing a blood test for infection, checking blood levels of a sepsis marker called lactate, and beginning antibiotics.

Do the steps make a difference? Seymour’s team examined records of nearly 50,000 patients treated at New York hospitals over two years. About 8 in 10 hospitals met the three-hour deadline; some got them done in about an hour. Having those three main steps performed faster was better — a finding that families could use in asking what care a loved one is receiving for suspected sepsis.



Sepsis is most common among people 65 and older, babies, and people with chronic health problems.

But even healthy people can get sepsis, even from minor infections. New York’s rules, known as “Rory’s Regulations,” were enacted after the death of a healthy 12-year-old, Rory Staunton, whose sepsis stemmed from an infected scrape and was initially dismissed by one hospital as a virus.



Illinois last year enacted a similar sepsis mandate. Hospitals in other states, including Ohio and Wisconsin, have formed sepsis care collaborations. Nationally, hospitals are supposed to report to Medicare certain sepsis care steps. In New York, Rory’s parents set up a foundation to push for standard sepsis care in all states.

“Every family or loved one who goes into a hospital, no matter what state, needs to know it’s not the luck of the draw” whether they’ll receive evidence-based care, said Rory’s father, Ciaran Staunton.

Sepsis Tops Conditions Tracked for Readmission Rates, but Triggers No Penalties

Sepsis Tops Conditions Tracked for Readmission Rates, but Triggers No Penalties

Sepsis has a higher rate of readmission than heart failure, but the federal government does not penalize hospitals for excessive readmissions due to sepsis.

Superbug infection kills patient in Reno

A superbug infection resistant to all 27 available antibiotics killed a woman in Reno, Nevada, the Centers for Disease Control and Prevention reported Friday, in issuing a precaution to hospitals nationwide.

While this superbug case was rare, sepsis blood infections reportedly kill an estimated 258,000 Americans each year.

Medical experts have been warning for years of the dangers of overprescribing antibiotics because of the potential for antibiotic-resistant superbugs.

The female patient who died this September from the superbug infection was a Washoe County, Nevada resident in her 70s who arrived in the United States in early August 2016 after an extended visit to India, the CDC said.

On August 18, she was admitted to an acute care hospital with a primary diagnosis of an infection called systemic inflammatory response syndrome, which likely resulted from an infected right hip.

A week after she was admitted, the hospital notified the Washoe County Health District in Nevada that the patient had a bacterial infection of carbapenem-resistant Enterobacteriaceae, called CRE.


No one knows how many patients are dying from superbug infections in California hospitals–q48_nyJSgCl8xVrBEwT6GLi1L5uwbL-wFLD1CzsDaqKwJvA7Gvbnan0dOU4uApCaA6Nc4bjRnR-iXNQlJtbH0Z6T0mA&_hsmi=35220326

Sharley McMullen's death certificate says she died from respiratory failure and septic shock caused by her ulcer.

We, the community of physicians, had been watching these patients die and trundling them off to the morgue for years.— Dr. Barry Farr, former president, Society for Healthcare Epidemiology of America

Could It Be Sepsis? C.D.C. Wants More People to Ask

Between one million and three million Americans are given diagnoses of sepsis each year, and 15 percent to 30 percent of them will die, Dr. Frieden said. Sepsis most commonly affects people over 65, but children are also susceptible. According to one estimate, more than 42,000 children develop sepsis in the United States every year, and 4,400 die.

Sepsis develops when the body mounts an overwhelming attack against an infection that can cause inflammation in the entire body. When that happens, the body undergoes a cascade of changes, including blood clots and leaky blood vessels that impede blood flow to organs. Blood pressure drops, multiple organs can fail, the heart is affected, and death can result.

“Your body has an army to fight infections,” said Dr. Jim O’Brien, the chairman of Sepsis Alliance. “With sepsis, your body starts suffering from friendly fire.”

Sepsis appears to be rising. The rate of hospitalizations that listed sepsis as the primary illness more than doubled between 2000 and 2008, according to a 2011 C.D.C. study, which attributed the increase to factors like the aging of the population, a rise in antibiotic resistance and, to some extent, better diagnosis.

Sepsis is a contributing factor in up to half of all hospital deaths, but it’s often not listed as the cause of death because it often develops as a complication of another serious underlying disease like cancer. So although death certificates list sepsis as a cause in 146,000 to 159,000 deaths a year, a recent report estimated that it could play a role in as many as 381,000.

Yet advocacy organizations say many Americans have never heard of sepsis and don’t know the signs and symptoms.

‘Superbug’ scourge spreads as U.S. fails to track rising human toll

Fifteen years after the U.S. declared drug-resistant infections to be a grave threat, the crisis is only worsening, a Reuters investigation finds, as government agencies remain unwilling or unable to impose reporting requirements on a healthcare industry that often hides the problem.