September is Sepsis Awareness Month, a national effort to raise awareness of a leading cause of deaths in U.S. hospitals.
Cindy M. Hou, DO, FIDSA, is an advocate for prevention and treatment of sepsis.
Dr. Hou, the Infection Control Officer at Jefferson Health – New Jersey, was part of the team recognized in 2016 as a “Sepsis Hero” by Sepsis Alliance, the leading sepsis patient advocacy organization in North America. Jefferson Health – New Jersey, then known as Kennedy Health, was recognized for its life-saving Sepsis Program.
Sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure and death. In other words, it’s your body’s overactive and toxic response to an infection. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. Sepsis without organ dysfunction can lead to organ dysfunction with severe sepsis and septic shock. The term “septic shock” is used to describe what’s happening when a person’s blood pressure is low and does not respond to fluids. Organ(s) could be compromised and the risk of death increases.
The immune system usually works to fight any germs (bacteria, viruses, fungi or parasites) to prevent infection. If an infection does occur, your immune system will try to fight it, although you may need help with medication such as antibiotics, antivirals, antifungals and antiparasitics. However, for reasons researchers don’t completely understand, sometimes the immune system stops fighting the “invaders” and begins to turn on itself.
“In sepsis, the body responds to infection,” Dr. Hou says. “And the causes could be bacterial or viral, including COVID, and for many other reasons. The key points are early recognition and treatment – and sepsis is still not very commonly recognized to the public.”
According to Dr. Hou, many hospitals employ protocols and checklists around recognizing sepsis, similar to what pilots run though prior to take off. “Especially this September, as it is Sepsis Awareness Month, there’s quite a bit going on a national level to continue to elevate the role of how critical it is to know about sepsis.”
Signs of Sepsis
Sepsis is most commonly associated with the following types of infections:
- Lung infections (like pneumonia)
- Urinary tract infections
- Skin infections
- Infections of the digestive system
Because sepsis can happen quickly, in or out of a hospital, it is important to be alert for early signs. Some signs include the following:
- Fevers or low temperatures
- High heart rate
- Shortness of breath, cough, abdominal pain, or burning with urination
- Confusion or disorientation
- Lightheadedness and/or low blood pressure
- Decreased urine output
The earlier sepsis is detected and treated, the better odds a person with the condition has for full recovery compared to when septic shock has occurred. People who have developed sepsis—and most especially those who have progressed into septic shock—are usually transferred to a hospital’s intensive care unit for supportive care and close monitoring. Septic shock may be managed with intravenous fluids, dynamic assessments of volume status, antibiotics (if the cause is bacterial sepsis), medications to maintain blood pressure and mechanical ventilation (if respiratory support is needed). In cases of bacterial sepsis, antibiotic treatment should start within an hour of diagnosis to reduce the risk of serious complications or death. Intravenous antibiotics are usually replaced by tablets after two to four days. Sometimes, source control to help combat sepsis is needed – one example is drainage of an infected fluid collection.
More than 1.7 million Americans are diagnosed with sepsis each year, resulting in an estimated 270,000 deaths annually. Sepsis can often be treated if diagnosed early. Jefferson Health – New Jersey’s acclaimed Sepsis Program – initially developed as a way to recognize sepsis in patients in its Emergency Departments – also includes detection and management of patients throughout the hospital system, including on general medical-surgical floors.
“I would say at a local level in New Jersey, at one point we had three separate sepsis committees, so we’re very committed to finding ways to tackle sepsis,” Dr. Hou says. “So anytime anybody asks me about sepsis, I continue to volunteer to help out others.”
Dr. Hou was named to the Sepsis Alliance’s Board of Directors in December, 2020, having previously served on the Advisory Board in 2019. She has been heavily involved in provider education and training initiatives, including serving as the moderator for the inaugural Sepsis Alliance Healthcare Acquired Infection (HAI) Mini-Summit in December 2020.
Besides serving as Jefferson Health – New Jersey’s Infection Control Officer, she is the Interim Chief Quality Officer and an infectious diseases specialist. Locally, she is a physician lead for the hospital’s Antimicrobial Stewardship Committee, Infection Control Committee, Infection Prevention Task Force, and Sepsis on the Floors Task Force.
Professional education and training in sepsis – while on the rise – would be considered by many to be less than adequate. The Centers for Disease Control and Prevention (CDC) launched a Get Ahead of Sepsis campaign and toolkit for patients, caregivers, and all healthcare professionals to be able to recognize sepsis and intervene quickly at first suspicion. Resources target not only nurses and healthcare professionals in all care settings and specialty areas but patients and caregivers as well.
If you prevent infection you essentially never get a case of sepsis. It’s so important for people – patients, doctors, providers, nurses, everyone – to recognize when someone could have an infection and what those symptoms are. – Dr. Cindy M. Hou
Sepsis can affect anyone at any age, but especially susceptible are infants (under 12 months), pregnant women, older adults, and people with chronic health conditions like diabetes and/or weakened immune systems.
“It’s similar to some of the risk factors we think about for people who have COVID,” Dr. Hou says. “For people who are morbidly obese, their body behaves almost as if they’re immunosuppressed. People with chronic conditions, like diabetes, kidney disease, heart disease or lung disease, such as asthma or emphysema, are at risk.”
According to Sepsis Alliance, sepsis is the number one cost of hospitalization in the U.S. Costs for acute sepsis hospitalization are $27 billion annually. This is only a portion of all sepsis-related costs, since there are substantial additional costs after discharge for many.
The average cost per hospital stay for sepsis is double the average cost per stay across all other conditions. And, sepsis is the primary cause of readmission to the hospital, costing more than $2 billion each year.
While many people can survive sepsis, up to 50% of survivors suffer from post-sepsis syndrome, a condition that includes physical and/or psychological effects. Until a cure for sepsis is found, early detection and treatment is essential for survival and limiting disability for survivors.
“Surviving sepsis can be very traumatic; it can be an emotional experience for the patient and their family,” Dr. Hou says. “People can experience depression, anxiety, even post traumatic disorder because they may not remember certain elements and are told by others that they were extremely sick. Some survivors may need a multidisciplinary approach to combat sequelae of sepsis.”
Sepsis prevention may be possible by preventing infections from occurring in the first place. It is always good to practice hand hygiene, and stay up to date with vaccinations. “Hand hygiene is one of the primary drivers to prevent infection,” Dr. Hou says. “And vaccinations are extremely, extremely important – and we know that they’re very effective.” In addition, being aware of sepsis and getting early treatment for infections by seeing your doctor is very important.