Sepsis is the body’s overwhelming and life-threatening response to infection. Sepsis can lead to tissue damage, organ failure and death. As director of critical care services at Swedish Covenant Hospital in Chicago, I’ve seen the importance of prevention and early detection of sepsis firsthand.
According to research from the Agency for Healthcare Research and Quality, there are 18 million cases of sepsis diagnosed worldwide each year, and their incidence is rising by 8 percent to 10 percent annually — statistics to take note of as we mark Patient Safety Awareness Week this week. These cases are often difficult to diagnose because the signs and symptoms of sepsis mirror those of other disorders. It is important for patients, families and health care providers to work together to identify the condition so that patients who are infected get treatment as soon as possible while avoiding unnecessary use of antibiotics in others. The result of this strategy would be an increase in survival.
Identifying sepsis can be a challenge, mostly because the body does not differentiate the initial inflammatory phases of sterile inflammation from that of bacterial inflammation. Because there is no confirmatory diagnostic test, the diagnosis of sepsis is based on clinical judgment of suspected infection.
Often, patients with sepsis may experience symptoms such as nausea, vomiting and abdominal pain. These signs and symptoms are also linked to other common illnesses, some of which are not even infectious and therefore do not require antibiotics. In these cases, patients can be misdiagnosed and treatment plans implemented for illnesses that are not present, delaying the identification and treatment of some patients with sepsis.
Patients and their families can play a critical role in helping medical providers more rapidly identify sepsis through proper education about its causes and symptoms. Historical factors are often the most important data to identify the likelihood of an infection. In the intensive care unit, patients and their families can assist in preventing the progression of infections by being vigilant to changes in the patient's condition that could be consistent with an infection, thus acting as an early warning system for the physicians. These changes, which often are subtle, may be more apparent to the patient and family than the physician; they can aid in the early detection and treatment of sepsis.
It is extremely important for health care providers to be well-versed in the signs and symptoms of sepsis in order to treat patients as early and effectively as possible. Although this is one of the biggest challenges that physicians face, they are the critical link in the prevention, recognition and treatment of sepsis.
Additional strategies that have demonstrated reductions in the incidence of these infections include meticulously following infection control requirements, along with ensuring that patients are receiving the recommended vaccines for illnesses that could lead to sepsis — such as the flu, and pneumococcal and meningococcal disease.
Once sepsis is identified, time is of the essence. Health care providers should order tests to determine the location and cause of the suspected infection. Appropriate antibiotics should be started immediately and documented. The progress of the patient should also be tracked, and antibiotic therapy should be adjusted accordingly.
Sepsis is a devastating, deadly condition, but it can be contained by following proper protocols and acting quickly. Because of the lack of early reliable diagnostic tests, it is important to be proactive in following infection control and educating health care providers and patients. By doing our best to prevent infections and identifying and treating them quickly when they occur, we can work together to reduce the risk of sepsis.
Eric Gluck, M.D., is director of critical care services at Swedish Covenant Hospital in Chicago.
The opinions expressed by the author do not necessarily reflect the policy of the American Hospital Association.