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Avoiding Sepsis – Strategies to Follow During the COVID-19 Pandemic

Sepsis has been called an epidemic hiding in plain sight. In the U.S., sepsis is responsible for 1 in every 3 hospital-based deaths.  Any infection, including viral infections such as COVID-19, can cause sepsis. Sepsis, in turn, may lead to serious illness including tissue damage and multiple organ failure, and if left untreated, it may also lead to death. Patients who recover from serious bouts of sepsis often face long and difficult recoveries.

Approximately 1.7 million American adults develop sepsis each year, and 270,000 will die as a result of it. Recognizing and fighting sepsis in hospitalized patients is difficult, and right now it is further complicated by higher numbers of patients on ventilators (and, in some cases, even sharing ventilators). Many of the seriously ill hospitalized COVID-19 patients are also fighting sepsis.

Successful Sepsis Interventions During COVID-19
Sepsis prevention and treatment has historically been somewhat difficult because the identity and source of the pathogen(s) that caused the sepsis is frequently unknown. Sepsis-focused interventions are most likely to be successful when the identity and source of the sepsis are known. Fortunately, this will likely be the case in many hospitalized COVID-19 patients.

  • The best sepsis prevention strategies are the ones that begin in the community and include food safety, pneumonia, and flu vaccinations, and the reduction of exposures to possible sources of pathogens.  While many Americans are more vigilant about their health at the moment (taking steps such as handwashing, wearing a mask, and practicing social-distancing) COVID-19 continues to spread. Some people will still contract the virus, and a small percentage of them will require hospitalization. Right now, recommending community sepsis prevention education may feel like putting the cart before the horse, but it can still have an impact even while the pandemic is ongoing.
  • Provide regular, ongoing sepsis education to ensure that staff are readily able to recognize all signs and symptoms of sepsis, particularly those that manifest at the onset of sepsis. The risk of death or serious harm from sepsis increases the longer it remains untreated.
  • Follow the Centers for Disease Control (CDC) recommendations on the prevention and treatment of sepsis.
    • Prevent infections – we may be at the point in the pandemic where this recommendation feels beyond redundant, but healthcare providers need to remain vigilant about hand hygiene and continue to educate patients about the importance of flu and pneumonia vaccines.
    • Educate patients and families – stress the need to prevent infections, particularly in patients that may already be managing some of the chronic conditions that will make them more vulnerable to poor outcomes should they contract COVID-19.   Patients should also be educated to be vigilant for the signs of sepsis so that they can seek early intervention if necessary.
    • The CDC encourages providers to “think sepsis” and be mindful of the signs and symptoms of sepsis in order to intervene at the earliest signs of the condition.
    • Act quickly when sepsis is suspected, particularly in COVID-19 patients where it is more likely to occur. Tests to determine whether or not an infection is present and where it is should be done when infection is suspected and antibiotics started quickly should infection be present.
    • Reassess often. Antibiotic therapy should be reassessed at least every 24 to 48 hours to monitor efficacy and to affirm decisions on type, dose and duration.
  • Be mindful of antibiotic stewardship. Some healthcare providers are already raising the possibility of increased antibiotic resistance as a result of increased use of strong antibiotics in hospitalized COVID-19 patients. However, it is still critical to emphasize the importance of rapid antibiotic intervention at the earliest signs of sepsis and remind clinicians to reassess or stop antibiotic therapy when new clinical data suggests that is an appropriate course of action.

Remain Vigilant
While the CDC and the World Health Organization (WHO) have both issued guidance on general infection control and sepsis, there is still somewhat limited guidance on the management of critically ill sepsis patients with COVID-19. Educating staff about the signs and symptoms (Fever, Infection, Mental Decline/Confusion and Feeling Extremely Ill) is the first line of defense against sepsis whether it be community or hospital-acquired.

Use the links below to learn more about sepsis and how HealthStream can help your organization deliver better outcomes.

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