Proactive steps include prevention in hospital patients and, failing that, treatment optimization.
Most cases of severe sepsis occur in patients who are already hospitalized for other reasons. A recent study found that, in a series of 166 patients with bloodstream infections admitted to an intensive care unit, 82.5% had nosocomial infections (Artero et al., 2012).
There is now a medical specialty, infection prevention, charged with reducing healthcare-acquired diseases, and infection preventionists are on staff in many medical institutions to organize and oversee infection control programs (Cook et al., 2011).
Control programs prescribe infection precautions and ensure that they are strictly followed. Preventionists set up handwashing campaigns. They advocate for the aggressive treatment of nosocomial infections and for the isolation of patients with drug-resistant infections. In some hospitals, preventionists are running trials of disease-resistant devices, such as antibiotic-coated vascular catheters (Kress & Hall, 2008).
Preventionists also work to modify medical habits. Examples of a typical preventionist’s agenda for their colleagues include:
- Encouraging reductions in the number of invasive procedures performed
- Encouraging reductions in the use and duration of indwelling catheters (vascular and urinary)
- Discouraging the unnecessary use of antimicrobial drugs
- Encouraging limitations on the length of time during which a broad-spectrum antibiotic is administered empirically (Kaki et al., 2011)
Patients with sepsis do better in medical centers experienced in managing the condition. Hospitals that have instituted an organized plan for recognizing and treating sepsis have shorter ICU stays and lower mortality rates for patients with sepsis. The Surviving Sepsis Campaign has assumed the task of helping hospitals improve their sepsis care. In addition to publishing evidence-based guidelines for managing sepsis, it also distributes instructions for setting up effective treatment facilities and for educating healthcare workers in the recommended procedures.
The Methodist Hospital in Houston, Texas (McKinley et al., 2011) is a role model for hospitals planning to apply the campaign’s sepsis management program. The Methodist Hospital has used the Surviving Sepsis Campaign’s guidelines to develop software that keeps records and that offers recommendations for the triage and the treatment of sepsis in their surgical ICU. The computerized system has been set up so that it is regularly re-examined and retuned, and the program continues to improve.
The Hospital’s software compiles comprehensive flow sheets and current patient summaries. It provides lists of care suggestions, including continually updated recommendations of time-sensitive interventions. It identifies points at which an experienced intensive care specialist should be consulted. It also offers a baseline against which doctors and nurses can check their clinical reasoning.
The hospital’s self-evaluations show that even those staff members who rotate in and out of the ICU can use the computerized system effectively. As a result of implementing the program and the software, the surgical ICU’s mortality rate for severe sepsis and septic shock dropped from 34% to 14% in three years (McKinley et al., 2011).
Test Your Knowledge:
Updated recommendations and guidelines for treating sepsis are published in journals and on the Internet by the:
- Surviving Sepsis Campaign.
- International Savings Program.
- International Red Cross.
Apply Your Knowledge:
What is your facility doing to promote and teach about the Surviving Sepsis Campaign? Who at your facility is in charge of infection control and clinical excellence? What can your role be?