Sepsis: Blood Poisoning

Risk factors for infection can be anything that suppresses the ability of the host to resist the infectious pathogen, including the following: drugs, such as steroids and chemotherapy; disorders that affect the innate and adaptive immune responses, such as cancer, leukopenia, and HIV/AIDS; and a breakdown of the first line of defense, such a trauma, broken skin, or surgical wounds. Patients are at risk for developing sepsis and septic shock if they are very old or very young and have and inability to fight off the infection. Some other risk factors for the

Is sepsis complicated by organ dysfunction, is diagnosed in more than 750,000 patients per year and has mortality rates as high as 28%-50%.

Sepsis is the number one cause of death in intensive care units in the U.S. More than 750,000 cases of sepsis occur each year and about one third of those patients die from it (McKinney, 2014; Ulloa, 2011). Sepsis is a serious condition that is a result of an inflammatory response to infection that can damage organs if left untreated. Severe sepsis occurs when the infection leads to organ dysfunction. Septic shock is when multiple organ failure occurs due to infection and is worse than sepsis and severe sepsis.

Sepsis is defined by the Surviving Sepsis Campaign (SSC) as “the presence (probable or documented) of infection together with systemic manifestations of infection” (Dellinger et al.,

Systemic and can quickly become life-threatening with organ failure, including reduced blood pressure and heart failure 1 2

Under the Core measures, Sepsis is one of the problem-focused trigger for systemic infection and if untreated which can lead to death. In United States, it is the 11th leading cause of death and consumes the large amount of costs about $20.3 billion in 2011 (Jones et al.,2016). According to Centers for Disease Control and Prevention (CDC), more than 1.5 million people diagnosed with sepsis, and at least 250,000 patients die from that yearly (CDC, 2017). The evidence-based research revealed with results of certain pre existing conditions, pathophysiological studies, preventive measures and sepsis bundle for treating and preventing sepsis to save the life of the patients.

According to information published by the Mayo Clinic, sepsis has three stages: sepsis, severe sepsis and septic shock. The mortality rate for septic shock is nearly 50 per cent, and an episode of severe sepsis increases the risk of future infections. Severe sepsis causes blood flow to the vital organs, such as the brain, heart and kidneys, to become impaired. Sepsis can also cause blood clots to form in organs and extremities such as arms, legs, fingers and toes, which can lead to organ failure and tissue death (gangrene).

The progress of my project to develop a nurse driven sepsis screening tool and an algorithm for implementation on the intensive care unit (ICU) for early identification and prompt treatment of septic patients has progressed remarkably well. I have been productive in gathering current guidelines for sepsis with the aid of my preceptor who is a critical care nurse practitioner on the ICU. With his help, I have been able to assemble key pieces of research to create a sepsis screening tool, and a treatment algorithm with sepsis resuscitation bundles. Extensive research has been conducted to integrate evidence-based practice in my project. I have also spent time with the unit educator, critical care intensivists, and my colleagues in brainstorming and collecting ideas about my project.

The set of diagnostic procedures and the necessary treatment within this bundle is based on the EBP suggested guidelines. By following the recommended guidelines, I can assure the improvement of quality of care by providing my patient with the best current practice. According to the randomized study over a 12-month period conducted in the Emergency Departments (ED) in New Wales, Australia the introduction of sepsis guidelines in ED improved the early assessment and management of septic patients including reduction in time to antibiotic administration by 230 minutes and the improved urgent triage time by 49.1 % (Romero, Fry, & Roche, 2017).

Francis, M., Rich, T., Williamson, T., & Peterson, D. (2010). Effect of an emergency department

et al., 2008). Sepsis is a frequent cause of admission to intensive care units (ICUs) and it

A methodical search was undertaken of the databases – PubMed, CINAHL and ScienceDirect to ascertain the most appropriate evidence. Search terms used were “Sepsis Prevention”, “Sepsis Management” “Sepsis Early Recognition” and “Sepsis Detection” and merged using Boolean Logic (Glasper and Rees,

The exact definitions, stratification, and approach to diagnosis of the sepsis spectrum has been a persistent, yet seemingly productive, endeavor for many years1,5,16. Multiple consortiums have addressed the approach to diagnosing sepsis. In 1992, a consortium, comprised of the American College of Chest Physicians and the Society of Critical Care Medicine, instituted the Systemic Inflammatory Response Syndrome (SIRS) criteria which established the fundamental screening tool for identifying individuals with an inflammatory immune response (Table 1)5. A patient exhibiting two or more of the SIRS criteria combined with the presence or suspicion of infection was the fundamental criteria for sepsis diagnosis5. Although this approach is of merit, it is too broad. Patients recovering from surgery or suffering from various non-infectious processes would meet the criteria for sepsis under SIRS17,18. An exhaustive list of exogenous and endogenous processes may generate a SIRS-inclusive response in the absence of infection18. A criteria with greater specificity was greatly needed.

Sepsis, a potentially life-threatening complication of an infection, occurs when chemicals are released into the bloodstream to fight infection. These chemicals trigger inflammatory responses throughout the body (Mayo Clinic Staff, 2016). Sepsis can be triggered by any type of infection: bacterial, viral, or fungal. Contrary to popular belief, sepsis is responsible for a great number of deaths in the United States alone. Sepsis kills more than 258,000 Americans per year, is the number one cause of death in hospitals, and kills more Americans than prostate cancer, breast cancer, and acquired immunodeficiency syndrome (AIDS) combined. (Rory Staunton Foundation for Sepsis Prevention, n.d.) As cited in nursing journal, “Sepsis: Diagnostic and Therapeutic Challenges,” ‘One of the

Before kidney failure occurs, it department to five stages.7 In the first stage there is no change in