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Eleven of the 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.

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

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% and 52.8% between 1990 and 2017, respectively.

What Does the Study Mean for Providers?

Because sepsis is usually preventable and treatable, the researchers hope their findings will inform 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

Steven Simpson, MD, chief medical officer of the Sepsis Alliance, says this is the single most effective strategy. 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 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.

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 daily,” 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.

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 many infections that you won’t necessarily think of as a cause because they don’t all present in such obvious ways.”

Organ dysfunction and the 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 their current visit.

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

“Sometimes, it’s okay that a patient’s BP is running low, but you can’t think that until you’ve made absolutely sure,” Dr. Simpson says. “These signs should not be ignored, and their exact reason 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°F) 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 exaggerate, especially if they say they feel like they’re dying or have a really intense pain. Of course, some folks have a low pain tolerance, but most of the time, “something bad will happen,” Dr. Simpson says. “It’s often inflammation at the source of infection.”

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. Dr. Simpson says pneumonia and UTIs are the top two causes of sepsis.

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.

Moreover, 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.

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.”

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