The Centers for Disease Control and Prevention (CDC) has issued core elements for hospital sepsis programs, calling for a multidisciplinary team to prevent, detect, and treat these life-threatening systemic breakdowns.
“Sepsis is the body’s extreme response to an infection,” the CDC states.1 “It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Most cases of sepsis start before a patient goes to the hospital. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.”
Sepsis, an inflammatory immune reaction, has been somewhat under the radar during the focus on the pandemic, but a staggering 1.7 million Americans develop it every year. About 350,000 of these patients will die in the hospital or be discharged to hospice care.
It generally is considered a community-acquired condition, but 20% to 30% of sepsis is acquired in the hospital. This portion is clearly in the infection preventionist’s bailiwick, since anything they do to prevent infections also can head off this profound systemic response to one.
“The severity of infections is due to an activation cascade that will lead to an auto amplifying cytokine production: the cytokine storm,” researchers report.2
“We need healthcare epidemiology, infection prevention, and antibiotic stewardship to be at the table,” says Arjun Srinivasan, MD, deputy director in the CDC Division of Healthcare Quality Promotion. “Most of these cases are coming in from the community, so the identification and management is not something that healthcare epidemiology and infection control is involved with in most instances.”
However, in addition to the sepsis cases that begin as hospital-associated infections (HAIs), admitted patients have multiple invasive devices and lines that warrant infection prevention oversight or policies for strict management and assessment. “By definition, patients with sepsis are critically ill, so they have a high risk of HAIs,” he says. “Almost all of them are going to be on devices — ventilators, central lines, catheters. They will be on antibiotics that put them at risk of Clostridioides difficile. It is a really important need to make sure that the care that these patients receive is as safe as it possibly can be.”
The timing of antibiotic delivery is critically important for sepsis treatment. “Have structures and processes [in place] to facilitate prompt delivery of antimicrobials, which we know is a key aspect associated with better outcomes from sepsis,” Hallie Prescott, MD, sepsis expert, said at a recent CDC webinar. “Some specific examples of things that hospitals can do to facilitate prompt delivery of antibiotics after they are ordered is to stock common antimicrobials in high-use locations, such as the emergency department or intensive care unit. Have [a policy in place] to immediately process antimicrobial orders for patients with sepsis.”
The CDC’s core elements for a hospital sepsis program are as follows:
• Hospital leadership commitment: Dedicating the necessary human, financial, and information technology resources;
• Accountability: Appointing a leader or co-leaders responsible for program goals and outcomes;
• Multi-professional expertise: Engaging key partners throughout the hospital and healthcare system;
• Action: Implementing structures and processes to improve the identification of management of, and recovery from, sepsis;
• Tracking: Measuring sepsis epidemiology, management, and outcomes to assess the effect of sepsis initiatives and progress toward program goals;
• Reporting: Providing information on sepsis management and outcomes to relevant partners;
• Education: Providing sepsis education to healthcare professionals, patients, and family/caregivers.
REFERENCES
- Centers for Disease Control and Prevention. Hospital Sepsis Program Core Elements. Last reviewed Sept. 15, 2023. https://www.cdc.gov/sepsis/core-elements.html
- Chousterman BG, Swirski FK, Weber GF. Cytokine storm and sepsis disease pathogenesis. Semin Immunopathol 2017;39:517-528.
The Centers for Disease Control and Prevention has issued core elements for hospital sepsis programs, calling for a multidisciplinary team to prevent, detect, and treat these life-threatening systemic breakdowns.
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