Outcomes of Care: Sepsis

Sepsis Overview

Sepsis is a severe, potentially life-threatening illness caused by overwhelming infection. Most commonly these infections are caused by bacteria or their toxins, but may also be caused by fungi, parasites or viruses. Common sites of infection include the kidneys, lungs, skin, bowels, liver and gall bladder.  Sepsis can lead to widespread inflammation and blood clotting. Inflammation may result in redness, heat, swelling, pain, and organ dysfunction or failure. Blood clotting during sepsis causes reduced blood þow to limbs and vital organs, and can lead to organ failure or gangrene (damage to tissues).  Of the nine-hundred thousand people in the United States that contract Sepsis each year, twenty-percent of them die. Terrifyingly, your chances of dying in the hospital from Sepsis is about four times higher than the risk of dying from a heart attack or a stroke.

The most serious types of sepsis are severe sepsis and septic shock.

Sepsis Treatment Goals: The "Surviving Sepsis" Campaign

Despite the severity of the condition, there are distinct opportunities to improve the management of sepsis. Advancements can be made by identifying patients earlier in the process of their care through the use of internationally-acknowledged definitions, treating patients with the most appropriate medication and adopting uniform standards of care.

Addressing the need for the better treatment of sepsis, the Surviving Sepsis Campaign was launched in 2004 as a global campaign to reduce mortality rates in severe sepsis by 25% in 5 years. Originally sponsored by 11 international professional organizations, it is now supported by 14 organizations.

Intrinsic components of the Surviving Sepsis Campaign are several evidence-based recommendations which, taken together, will substantially reduce mortality due to severe sepsis and septic shock.

Within Cottage Health System, the pivotal guidelines identified by the Surviving Sepsis Campaign in the fight against sepsis have laid the groundwork for  the creation of the "Slay Sepsis Protocol".

Components of the "Slay Sepsis Protocol":

1. ED Sepsis Pathway: Early identification of patients likely to have sepsis, and sending appropriate lab and X-ray tests to make the diagnosis of sepsis and its likely source.
2. Initiating rapid  fluid resuscitation.
3. Rapid administration of  appropriate antibiotics after blood cultures drawn.
4. Calling the Sepsis Team to continue the 6 hour resuscitation efforts and further manage patients using evidence-based guidelines in the ICU.

Using these elements as a goal, and having a coordinated, multi-disciplinary approach to rapidly identify and aggressively treat septic patients can radically reduce mortality. Because of the Slay Sepsis Protocol, the chance of dying of severe sepsis or septic shock at Santa Barbara Cottage Hospital is half of what it was 5 years ago.

Severe Sepsis
Severe sepsis occurs when sepsis leads to low blood pressure or dysfunction of one or more organs. The published national mortality rate from severe sepsis is approximately 20%. Severe sepsis can lead to septic shock, multiple organ dysfunction syndrome (formerly known as multiple organ failure), and death.

This measure is the number of patients who expired before discharge from the hospital after a stay in the adult intensive care unit (ICU) while being treated for severe sepsis. Patients who did not wish to have aggressive resuscitation measures are excluded.

Severe Sepsis Mortality Rate (Excluding DNR)
	Santa Barbara Cottage Hospital	National Average (2004) *
2007-2008	9.7%	20%
2008	5%
2009	12%
2010	3%

Septic Shock

Septic shock is the most severe form of sepsis, and develops when an infection totally overwhelms the body. This leads to severely decreased blood pressure, inadequate delivery of oxygen and blood to the organs, and if unchecked, multiple organ dysfunction syndrome and death. Its most common victims are children, immuno-compromised individuals and the elderly, but it can occur even in previously healthy persons of any age. The published national mortality rate from septic shock is approximately 45%.

This measure is the number of patients who expired before discharge from the hospital after a stay in the adult intensive care unit (ICU) while being treated for septic shock. Patients who did not wish to have aggressive resuscitation measures are excluded.

Septic Shock Mortality Rate
	Santa Barbara Cottage Hospital	National Average (2004) *
2005 - 2007	24%	45%
2008	27%
2009	28%
2010	18%

  * Since 2004, national rates have not been available.