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11 Most Common Mistakes Nurses and APPs Make When Preventing and Treating Sepsis

Sepsis just surpassed cancer to become the second-leading cause of death globally, according to a new study. Analyzing 109 million individual death records, its researchers observed that sepsis was responsible for roughly 20 percent of deaths globally. While data on the global burden of sepsis has been limited, this finding is double previous estimates.

What did the study find?

The research, published in The Lancet, found there were 48.9 million cases of sepsis in 2017, and 11 million of these patients died from the condition. That year, 56 million people died globally — 17.8 million from cardiovascular disease and 9.5 million from cancer.

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The data for the study included 195 countries and spanned 27 years, from 1990 to 2017. Sepsis incidence and mortality varied substantially across regions, with the highest rates in sub-Saharan Africa, Oceania, south Asia, east Asia and southeast Asia.

The good news? Sepsis incidence and mortality fell by 37 percent and 52.8 percent respectively between 1990 and 2017.

What does the study mean for clinicians?

Because sepsis is usually preventable and treatable, the researchers hope their findings will inform both policy and clinical improvements worldwide. While any organizational or infrastructural change from the research might be a ways away, providers can address sepsis prevalence and severity at their facilities with these simple steps:

How to prevent sepsis

Wash your hands.

This is the single most effective strategy, Steven Simpson, MD, chief medical officer of the Sepsis Alliance, tells Florence Health. Decontaminate your hands before any direct contact with a patient and before donning sterile gloves.

For more information, visit the Centers for Disease Control and Prevention hand hygiene guidelines for healthcare workers.

Wear protective clothing when appropriate.

Dr. Simpson notes that this is especially important when seeing patients with resistant, bacterial infections — but many nurses and APPs overlook this protocol. “Wearing your protective equipment is less to protect you than it is to protect the next patient,” he stresses.

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Remove infection-inducing medical devices as soon as possible.

Each shift, check whether you can safely remove any foley catheters, central lines, ventilators or other devices that increase a patient’s risk of infection.

“If you’re a nurse, you should ask the doctor every single day,” Dr. Simpson says. “People aren’t meant to have devices like this inside them. They collect bugs.”

Encourage patients to move.

Second in importance to perhaps only hand-washing, frequent movement will prevent accruing pulmonary secretions, collapsing alveoli and other conditions that increase sepsis risk.

Similarly simple actions can go a long way when diagnosing and treating sepsis, too:

How to diagnose sepsis

Always consider infection as a possible source of the patient’s problem.

“The biggest mistake that nurses and APPs on the floor make is to fail to think of infection,” Dr. Simpson explains. “There are lots of infections that you won’t necessarily think of as a cause because they don’t all present in such obvious ways.”

Organ dysfunction and presence of infection — the main components of sepsis — “are two things you should look at in any patient who’s not feeling well,” he adds.

Review the patient’s historical health data, not just from their current visit.

When reviewing charts, clinicians will often have thoughts like, “This patient’s blood pressure is low, but their pressure is always low.” Same goes for heart rate and other vitals. The problem with this, according to Dr. Simpson, is it’s an oversimplification that encourages clinicians to disregard a patient’s complete history.

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“Sometimes, it’s okay that a patient’s BP is running low, but you can’t think that until you’ve made absolutely darn sure,” Dr. Simpson says. “These signs should not be ignored, and the exact reason for them should be assessed and treated. Many times, it is sepsis.”

Interpret body temperature in the context of the patient’s condition.

Body temperature can be a red flag for sepsis, but only if you interpret it correctly. For example, a normal temp (98.8 degrees Fahrenheit) for someone with a kidney infection or an elderly person is worrisome as these patients tend to run low.

In addition, many docs, APPs and nurses don’t know that low body temperature can be a “significant” sign of sepsis, Dr. Simpson says, adding that individuals with this symptom usually “do worse with infection.”

Listen to what your patient is telling you.

“Patients know what feels bad and how it’s different from normal,” Dr. Simpson says. “They notice and will tell you what’s wrong every time, but you must listen carefully.”

He cautions that you should never assume patients are exaggerating, especially if they say they feel like they’re dying or a really intense pain. Of course, some folks have a low pain tolerance, but most of the time, there will be “something bad going on,” Dr. Simpson says. “It’s often inflammation at the source of infection.”

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Refresh your knowledge of the signs of common infections.

Especially important to commit to memory are the signs of pneumonia, urinary tract infections, including pyelonephritis, and peritonitis. Pneumonia and UTIs respectively are the top two causes of sepsis, Dr. Simpson says.

How to treat sepsis

Give the right amount of fluid to hypotensive, septic patients.

Current guidelines recommend 30 mL of IV fluid per kilogram of body weight. But many providers don’t follow this because they’re “afraid of heart failure and therefore under-resuscitate sepsis,” according to Dr. Simpson.

Give antibiotics as soon as possible.

Dr. Simpson says providers too often “take their sweet time” getting antibiotics for a patient, even though research consistently shows the longer the wait for antibiotics, the more likely the patient will die.

What’s more, Dr. Simpson led a study that found that many providers don’t realize if they’ve taken too long to give a patient antibiotics, contributing to septic shock. Why not? The condition usually doesn’t present for a day or so — long enough for the patient to move to a different unit and out of the care of the team that gave the initial treatment.

RELATED: You Could be Risking Your Patient’s Life by Not Cleaning Your Stethoscope

Delaying antibiotics is a “huge” but “correctable” mistake, Dr. Simpson says. “Sepsis is the fire, and the infection is gasoline. Until you fix the infection, you can’t fix the sepsis.”

These actions might seem too simple to have any real impact, but Dr. Simpson cautions fellow clinicians against falling into this trap: “It’s because they seem so simple, and that’s why people don’t do it.”

References:

Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study, The Lancet.

Causes of death, OurWorldInData.org.

Hand Hygiene in Healthcare Settings, Centers for Disease Control and Prevention.

Clinical Resources: Sepsis, Centers for Disease Control and Prevention.

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