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From: Sam7/29/2017 1:42:46 PM
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How to Avoid Sepsis, a Deadly Medical Emergency
More than 1 million Americans a year develop this condition, and 250,000 die from it, a new CDC reports says

By Kevin McCarthy
August 23, 2016

consumerreports.org

Dana Mirman didn’t pay much attention when she noticed what she assumed was a mosquito bite on her shoulder.

“After all, I live in Florida, people get bites,” says the 41-year-old communications professional.

Even when it began throbbing overnight she didn't worry much, assuming it was a simple allergic reaction. The next day she came down with flu-like symptoms, including vomiting and fever. “I still didn’t connect the two,” she says.

But later that evening her temperature spiked to 104 and her husband rushed her to the emergency room. The staff checked her blood pressure, and saw it was plummeting. They immediately started her on I.V. fluids and powerful antibiotics, she says—a response that likely saved her life.

Mirman was a victim of sepsis, an often deadly reaction to certain infections that can quickly race through your body, shutting down vital organs. While not well known, it's actually more common than heart attacks, and just as deadly.

More than a million people in the U.S. develop sepsis each year, and more than 250,000 deaths a year are linked to it, according to the Centers for Disease Control and Prevention. That’s higher than earlier estimates—an increase the CDC attributes mainly to better reporting on the infection, as well as the growing number of older people, who are especially susceptible to sepsis.

While many cases are linked to infections contracted in hospitals, doctor offices, nursing homes, and other healthcare facilities, a report out today from the CDC says that nearly half are community-acquired, meaning from infections people contract in their homes, schools, playgrounds, and elsewhere. Any infection can lead to sepsis, from a manicure gone wrong, food poisoning, or a simple urinary tract infection.

One reason sepsis is so dangerous is that patients and even doctors often don’t recognize the problem until it’s too late, says Anthony Fiore, M.D., of the CDC’s Division of Healthcare Quality Promotion and an author of the new report. “Rapid early treatment can save lives," he says. “It’s just like a heart attack or stroke,” in that the longer you wait, the deadlier it is.

Here’s what you need to know about sepsis, including how to recognize it and what to do if you suspect it.

How Sepsis Harms

Sepsis often starts with a local infection, most often in the lungs, digestive tract, urinary tract, or, as in Mirman’s case, on the skin. It usually stems from a bacterial infection, but fungal or viral infections can trigger sepsis, too.

Whenever the body develops an infection, the immune system normally kicks in, producing chemicals to fight the infection. But sometimes—either because the triggering bacteria is unusually powerful or because the person’s immune system is already weakened by other health problems—those chemicals are set loose in the bloodstream and course through the body.

Instead of just fighting the local infection, those chemicals unleashed by the immune system cause widespread inflammation and damage tissues in the liver, kidneys, heart, and other organs. Within hours, blood clots can begin to form, and damage to blood vessels causes blood pressure to drop, which in turn slows the delivery of vital nutrients to those organs already under attack. In the final stages, the heart weakens and organs begin to fail.

Who’s at Risk?
The new CDC reports helps identify who’s most at risk of sepsis. That includes people:

  • With chronic diseases. Seven out of 10 people in the CDC study who developed sepsis had diabetes, lung, kidney, or liver disease, or some other chronic condition. People with those conditions are at increased risk because they are susceptible to infection.
  • With conditions that weakened immune systems, such as AIDS or cancer.
  • Who are 65 or older or younger than a year old, probably because they too are more prone to infection.
  • Who have recently been in a hospital, nursing home, or other healthcare facility, in part because infection-causing bacteria are often common in those institutions.

How to Prevent Sepsis
While sepsis is often not recognized until it’s already progressed, Fiore said many cases could be prevented.

For one thing, the CDC report found that most sepsis patients have some underlying health problem that requires them to have frequent contact with doctors. Those visits, Fiore says, are an opportunity for healthcare providers to prevent infections that can turn septic (by, for example, ensuring that diabetics get thorough exams of their feet to check for wounds that could breed infections) and to educate people about warning signs for sepsis.

In addition, there are a number of steps people can take on their own to protect themselves from the underlying infections that can trigger sepsis. Here’s how:

  • Get vaccinated. Thirty-five percent of sepsis cases in the CDC study stemmed from pneumonia. Yet the CDC says that only 20 percent of high-risk adults under age 65 and 60 percent of those 65 and older have been vaccinated against that disease. And annual flu shots can also prevent respiratory infections that can sometimes turn septic. But only about a third of sepsis patients in the CDC study had a record of being vaccinated against the flu. “Thousands more deaths could be prevented with better coverage,” wrote the authors of the CDC report.
  • Treat urinary tract infections promptly. A quarter of sepsis cases resulted from urinary tract infections. So it’s important to see a healthcare provider if you have warning signs of those infections—usually a painful, burning feeling when you urinate and a strong urge to “go” often—and, when appropriate, be treated with antibiotics. UTIs are also common among hospital patients, especially those who have been catheterized, so it’s extra important to watch for those infections while in the hospital.
  • Clean skin wounds properly. About one in 10 sepsis cases follows a skin infection. So it’s essential to care for wounds and scrapes properly. That means washing with soap and water, cleaning out any dirt or debris, and covering wounds. And people with diabetes should make sure that they follow good foot care practices, since wounds there can often develop dangerous infections.
  • Avoid infections in hospitals. Since many infections that turn septic originate in hospitals and other healthcare facilities, it’s essential that you—and your healthcare providers—take steps to avoid those infections. That means, for example, insisting that everyone who comes into your hospital room—including doctors and nurses—wash their hands every time they touch you. Read more tips on how to avoid infections in hospitals.
Watch for Warning Signs
If you do develop an infection, it’s important to watch for signs of sepsis and, if you suspect it, act fast. Here’s what to do:
  • Know the symptoms. These include fever plus chills, shortness of breath, rapid breathing, increased heart rate, diarrhea, vomiting, rash, or pain, which many survivors describe as the worst they’ve ever felt. Disorientation or confusion can also be signs of sepsis.
  • Act fast. If you have any of those symptoms, “contact a healthcare provider and say, ‘I think I have an infection and it’s really gotten worse, and I think it’s possible I could have sepsis,” Fiore says. If it’s after hours, either contact the providers on-call service or, if you feel very sick, go to the emergency room. “It’s not something you sit on until morning,” he says.
  • Demand attention. Healthcare providers sometimes miss sepsis, or fail to react quickly enough, says Lisa McGiffert, the director of Consumer Reports Safe Patient Project. “Patients and their advocates need to be aggressive in pushing for quick action, and there is no excuse for a hospital or emergency room to respond to sepsis slowly once it is diagnosed,” McGiffert says. “Hospitals can do a lot to prevent death from sepsis by diagnosing it early and responding with urgency.”
  • Get the right treatment. If your doctor suspects sepsis, you should get treated with IV fluids and antibiotics right away. Initially, you will probably need a broad-spectrum antibiotic, which targets multiple bacteria. But your doctors should also order tests to identify the responsible bacteria and, if possible, switch you to an antibiotic that targets that specific bacteria.

In addition, Mirman—who started volunteering for the Sepsis Alliance, an organization that raises awareness about the condition, after her experience—emphasizes the importance of having support when dealing with sepsis. Sepsis can be extremely disorienting, and cause sleepiness, she says. “I was so exhausted, all I wanted to do was sleep” Mirman remembers. If it weren’t for her husband, she might never have made it to the emergency room. “I would not have picked up a phone and called 911.”

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