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William was a handsome young child whose captivating smile could make anyone smile. His chest infection was misdiagnosed as viral. Thus, the antibiotic that could have prevented the development of pneumonia was not given to him in time. William eventually developed sepsis while sleeping, and his little chest cavity filled with a nasty fluid. The healthcare professionals tried their best, but William could not be saved. He was already in his new home, watching from above.

The phrase “sepsis” appeared in William’s autopsy report. Upon further investigation, it was shown that William’s life could have been saved if the earlier chest infection, subsequent pneumonia, and later sepsis had been detected appropriately. It is vital to raise awareness of sepsis symptoms among both the general public and healthcare professionals so that they may better identify the condition and respond appropriately.

UK Sepsis Trust Case Story

“The world must urgently step up efforts to improve data about sepsis so all countries can detect and treat this terrible condition in time.”

Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

What is Sepsis?

Sepsis occurs when the body responds to an infection in an unusually severe manner. It is sometimes also known as septicemia (blood poisoning).

When a person gets an infection, the immune system fights it by releasing proteins and other substances. Sepsis develops when this response becomes out of control, resulting in widespread inflammation.

Sepsis produces a significant drop in blood pressure in severe cases. It is referred to as “septic shock.”It can cause sudden organ failures, such as in your lungs, kidneys, and liver, and tissue damage. This can be life-threatening. Therefore, It is a fatal condition that requires prompt medical attention. 

Sepsis: A Silent Killer

As stated previously, sepsis is the body’s systemic inflammatory reaction to microbial infection, which can result in organ failure, shock, and death. It is referred to as a silent killer. Silent because it can be challenging for both professionals and the general public to detect, with symptoms often suggesting less severe illnesses such as influenza. 

What are the Stages of Sepsis?

There are three stages of sepsis:

Acute Sepsis

An infection gets into the blood flow and causes inflammation in the body.

Severe sepsis

The infection and inflammation are severe enough to start compromising organ function.

Septic shock

Septic Shock is a severe sepsis consequence resulting in a rapid blood pressure drop. This can result in various catastrophic problems, including organ dysfunction, tissue damage, stroke (brain attack), and even death.

What Statistical Data Is Showing About Sepsis?

Sepsis is a common cause of severe illness and death, with an estimated 123,000 cases in England each year and 37,000 deaths.

Sepsis is a significant cause of maternal, neonatal, and child mortality. Action required to combat sepsis will contribute to achieving Sustainable Development Goals (SDGs). According to WHO’s first global report on sepsis, it kills 11 million people each year, including many children. It disables millions more.

The report also finds that sepsis frequently results from infections acquired in healthcare settings. Around half (49%) of patients with sepsis in intensive care units acquired the infection in the hospital. An estimated 27% of people with sepsis in hospitals and 42% in intensive care units will die. 

What Signs And Symptoms To See?

Remember the acronym “It is About TIME ” when it comes to sepsis.”

TIME stands for Temperature, Infection, Mental decline, and Extremely ill.

The following signs and symptoms can be seen on suspicion of sepsis:

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What Causes Lead To Sepsis?

Infections might place you or a loved one at risk for developing sepsis. When pathogens enter the human body, they can produce an infection. If this infection is not stopped, it might lead to sepsis. Bacterial infections cause most cases of sepsis. Other viral infections, such as COVID-19 or fungal infections, can cause sepsis.

Who Is More Prone To Get Affected By It?

Anyone can develop sepsis from a minor injury or infection. However, some individuals are more prone, including individuals with weak immune systems, because of conditions like HIV or cancer or because they take drugs such as steroids. Children and older people are vulnerable to it, along with pregnant women. Furthermore, individuals with other conditions such as appendicitis, pneumonia, meningitis, cirrhosis, diabetes, or a urinary tract infection are also more susceptible to it.

How Can It Be Diagnosed?

Patients are diagnosed with sepsis when they develop a set of sepsis-related signs and symptoms. Sepsis is not diagnosed simply in the presence of an infection. If one experiences more than one of the symptoms of sepsis, especially if one has signs of infection or is in a higher-risk category, the doctor will most likely suspect sepsis.

Sepsis worsens to severe sepsis when there are indications of organ dysfunction in addition to the signs of sepsis, such as difficulty breathing (lung issues), low or no urine output(kidneys), abnormal liver tests (liver), and changes in mental status (brain). Most people with severe sepsis require an intensive care unit (ICU).

Septic shock is the most severe and is diagnosed when blood pressure drops alarmingly.

Sepsis can be especially hard to spot in babies and young children, unlike older children. It is difficult to detect in people with dementia, learning disabilities, and communication.

What Treatment Plan Should Be Adopted For Sepsis?

The paramedics will try to prevent the infection, maintain organ function, and control blood pressure. Extra oxygen and intravenous fluids can assist with this.

Antibiotics with a broad spectrum of activity may help early treat bacterial infections. Once the doctor determines the cause of sepsis, they can prescribe medication targeting the specific pathogen. Sometimes, doctors use vasopressors (drugs that constrict blood arteries) to lower high blood pressure. One could also get corticosteroids to combat inflammation or insulin to control blood sugar.

One may require further treatments, such as a breathing machine or renal dialysis, if the condition is severe. Alternatively, one may require surgery to drain or remove an infection.

Why Prevention Is Better Than Cure In the Case of Sepsis?

There are two main steps to preventing sepsis:

  1. Prevention of microbial transmission and infection
  2. Prevention of an infection evolving into sepsis

Prevention of Infection in the community involves using effective hygiene practices such as hand washing and safe food preparation, improving sanitation and water quality and availability, providing access to vaccines, particularly for those at high risk, and providing appropriate nutrition, including breastfeeding for newborns.
Prevention of infection in healthcare facilities mainly relies on functioning infection prevention and control (IPC) programs and teams, effective hygiene practices and precautions, including hand hygiene, and a clean, well-functioning environment and equipment.

Commissioning for Quality and Innovation (CQUIN)

The Sepsis Commissioning for Quality and Innovation (CQUIN) was introduced in 2015-16, focusing on incentivizing the screening for sepsis for prompt recognition and initiation of treatments for all patients (both adults and children) arriving at hospitals via medical emergency departments and has been extended from 2016-17 to those in inpatient departments.

Since combining the Sepsis and AMR CQUINs to support the Cross System Board’s goal of reducing the impact of serious infections, an improvement in the screening and treatment of sepsis, along with a reduction in antibiotic prescriptions, is witnessed.

Acute Deterioration

Acute deterioration involves recognizing the point at which the patient requires a different level of care and escalation to the appropriate person or location. Observations such as heart rate, respiration rate, temperature, and oxygen levels are monitored in hospitals to determine whether patients are improving or getting worse.

The Bottom Line

Every year on September 13, World Sepsis Day highlights the substantial cost sepsis has on world health and sheds light on local, national, and international efforts to combat sepsis. Sepsis is a fatal illness caused by a dysregulated host response to an infection, resulting in organ dysfunction and death. Each year, sepsis affects up to 50 million people, mostly children under age 5. There is a dire need to discuss the sepsis challenge and recognize acute deterioration to combat it.

References

https://www.who.int/news-room/fact-sheets/detail/sepsis

https://www.webmd.com/a-to-z-guides/sepsis-septicemia-blood-infection

https://sepsistrust.org/about/about-sepsis/patient-stories/william/

https://www.nhs.uk/conditions/sepsis/