Fighting Sepsis Requires Better Recognition of Signs and Symptoms

Preventing sepsis begins with preventing infection, says the chief medical officer of Sepsis Alliance.

In a typical year, more than 350,000 adult Americans die of sepsis—a number that could be lowered with better recognition of signs and symptoms of sepsis by everyone on a care team, says the chief medical officer of Sepsis Alliance, the nation’s first and leading sepsis organization.

“It should be everyone's responsibility,” says Cindy Hou, DO, MA, MBA, CIC, CPHQ, FACOI, FACP, FIDSA, Sepsis Alliance’s chief medical officer. Dr. Hou also is the infection control officer and medical director of research at New Jersey’s Jefferson Health.

“And the reason I say ‘everybody’ is just imagine that physical therapy comes to a person's home or to long-term care and they are doing careful assessments every single day. They may notice [signs of sepsis]. That’s why, in my opinion, everybody should be engaged,” she says.

A 2018 DePaul University study also found a lack of sepsis awareness among healthcare professionals, though it noted that “the nature and ambiguity of sepsis may contribute to the lack of understanding and lack of research.”

That knowledge gap regarding sepsis results in some startling data. According to Sepsis Alliance:

• More than 1.7 million people in the U.S. are diagnosed with sepsis each year.
• In the United States, sepsis takes a life every two minutes.
• Sepsis is the No. 1 cause of hospital readmissions, costing more than $3.5 billion each year.
• Nursing home residents are over 6 times more likely to present with sepsis in the emergency room than non-nursing home residents.
• More than one-quarter of U.S. adults have NEVER heard of sepsis and just 15% can name the common symptoms.

Elderly most prone to sepsis

Anyone can get sepsis, but those most prone include elderly people with chronic conditions such as diabetes, or kidney, heart, or lung disease, Hou says.

Indeed, more than 70% of sepsis patients are 60 years of age or older and adults age 65+ are 13 times more likely to be hospitalized with sepsis than adults younger than 65, says Sepsis Alliance.

And while sepsis is the leading cause of death in U.S. hospitals, according to Sepsis Alliance, that can be partially attributed to a patient’s condition before they ever entered the hospital, Hou says.

“Often what happens is that people present too late in the game, and the body’s response is very hard to turn off and so people may succumb to their underlying illness,” Hou says. “Most the time when people have sepsis, they really had an infection that was going on well before they came into the hospital.”

But sometimes, she says, sepsis isn’t recognized in time by clinicians.

“Sometimes there is what I call ‘academic disagreement’ about what constitutes a patient who has sepsis versus one who doesn't,” says. “What ends up happening is … lack of recognition of early signs and symptoms. Now sometimes, no matter what we do—they have the patient on the right treatment—sometimes they still succumb to their illness and that's where it hinges not on the treatment that was given but rather on the response of that patient’s body.”

In a home health setting, the subtle signs and symptoms of sepsis may go unnoticed by caregivers and family members, and the patient may be unable to articulate any discomfort, Hou says.

“An elderly person may have bladder pressure but perhaps they had a stroke or they can't express themselves,” Hou says.

Additionally, because the older population is more likely to have chronic conditions, the signs and symptoms of sepsis may not behave in a textbook manner and may present much later, when the danger of septic shock increases, Hou says.

Symptoms of sepsis

It's About TIME^TM  is Sepsis Alliance’s national initiative to raise awareness of sepsis and the urgent need to seek treatment when symptoms are recognized:

• T – Temperature: Higher or lower than normal
• I – Infection: May have signs and symptoms of an infection
• M – Mental decline: Confused, sleepy, difficult to rouse
• E – Extremely ill: Severe pain, discomfort, shortness of breath

“They may have a high temperature or a low temperature, they could be breathing fast, their heart could be fast, and it’s due to infection,” Hou says. “Most of the common causes of sepsis are related to conditions like a urinary tract infection, pneumonia, skin infections, or infections within the abdomen.”

Nurses are the “secret weapon” against sepsis because they’re generally with patients more often than physicians, Hou says.

“A nurse will be most likely to notice that something is off and, depending on their skill level, they may often be able to tell the ordering physician that this is what's going on,” Hou says.

Preventing sepsis

Lowering the numbers on sepsis centers on preventing it, as well as ensuring patients are treated correctly once it is diagnosed, Hou says.

Preventing sepsis begins and ends with infection control, she says.

“At the heart of it, sepsis is due to an overwhelming infection,” Hou says, “so the best way to prevent sepsis is to prevent an infection from occurring in the first place.”