By Dr. Steven Q. Simpson
Sepsis is a public health crisis in the United States and around the world. There is no doubt about it. Each year, an estimated 270,000 people in the U.S. die from sepsis and another 100,000 are discharged from hospital to hospice care. It is the third leading cause of death in the country. By the time you finish reading this piece, another three people will have died of sepsis in this country alone.
Approximately 1.4 million additional people in the U.S. actually survive sepsis each year, but returning to their previous way of life can be difficult, sometimes even impossible. Up to half of survivors are left with life-changing long-term physical, cognitive, and/or psychological effects. These lasting effects force many to quit their jobs or school and can have a negative impact on personal relationships. Some face depression, anxiety, and other mental health issues. Thousands more are no longer able to cope with day to day activities on their own alone and must move into assisted care facilities.
Have You Ever Heard of Sepsis?
Sepsis is a medical emergency. It is the body’s overwhelming, out of control, and life-threatening response to infection. Sepsis and septic shock can lead to tissue damage, organ failure, and death. Any infection, from an infected bug bite to pneumonia, can trigger sepsis. Although sepsis strikes certain groups of people with greater frequency, such as the very old, the very young, and those with weakened immune systems, it also happens to in people who are fit and healthy. This includes pregnant or post-partum women, children playing at school, and athletes practicing with their teams.
Thanks to awareness campaigns over the past several years, more people in the U.S. than ever before have heard the word sepsis. But the 2019 Sepsis Awareness Survey, an annual survey conducted by Sepsis Alliance, found that over 1/3 of adults in the U.S. still have not heard of sepsis, and many who recognize the word are unable to recognize its most common symptoms. This should be surprising given that just about everyone knows of someone who has had sepsis. If you know somebody who was severely ill and hospitalized from an infection such as pneumonia, the flu, or even a urinary tract infection, you know someone who had sepsis. If you knew someone who died from an infection, you knew someone who had sepsis. In reality, however, it’s not surprising that so few people actually know what sepsis is because doctors and nurses often don’t say the word. Instead, they refer to the illness or death as a “complication of [fill-in-the-blank infection]”. If healthcare professionals don’t use the word, the public can’t learn about it, or advocate for their own healthcare or the care of a loved one.
Sepsis Compared to Other Medical Emergencies
These days we face so many serious health issues: heart disease, strokes, cancer, and opioid overdoses to name a few. Strokes take about 140,000 lives in the U.S. each year, half of the number of sepsis deaths. Yet 57% of Americans can tell you about stroke symptoms while only 14% of Americans can describe the symptoms of sepsis, as evidenced by the national survey undertaken on behalf of Sepsis Alliance.
Opioid overdoses take about 47,000 lives per year in the U.S., breast cancer about 41,000 lives, and prostate cancer 41,000 lives. This means that sepsis takes more lives in one year than opioid overdoses, breast cancer, and prostate cancer combined. Still, according to the 2019 survey, most people believe that opioid overdose deaths far surpass deaths related to sepsis. Interestingly, more people are aware of Ebola, an infectious disease that rarely affects people in the U.S., than they are of sepsis.
Clearly, the number of people who know what sepsis is and what it does to the body is not proportional to the the toll it takes on human life, especially in comparison with the number who know about other serious medical conditions, even ones that rarely affect us in North America.
Sepsis Is Expensive
Aside from the lives affected by sepsis, the condition also has a high financial cost to patients and their families, the community at large, insurance companies, and the government. The cost of an average hospital stay for sepsis is about $18,600 – double that for all other conditions. Overall, treating sepsis patients consumes more than $27 billion per year – the highest cost compared to any other condition or disease.
Sepsis is also the number one cause for hospital readmissions. An estimated one-third of sepsis survivors are re-hospitalized within three months of their initial discharge, at a cost of about $2 billion per year.
Rising costs related to sepsis don’t stop after hospital discharge because survivors often must be transferred to a rehabilitation facility as they work on regaining lost function/s, such as their ability to walk. Likewise, for the many survivors who experience long-term effects, such as amputations, chronic pain, post-traumatic stress disorder, and more, direct medical costs continue to rise for medications, treatments, therapies, and specialized equipment. More money is lost if the survivor cannot return to work at all or if caregivers must also take time off work to care for the sepsis survivor.
We Can Change the Statistics and Save Lives
As many as 80% of sepsis deaths can be prevented. Although we don’t know why some people develop sepsis and others don’t, we do know that rapid identification and treatment can significantly decrease the mortality rate. And like strokes and heart attacks, sepsis diagnosis and treatment within the first hour – the golden hour – could mean the difference between life and death.
In 2018, Sepsis Alliance launched a national initiative called Sepsis: It’s About TIME™ to promote sepsis awareness and the need for urgency in seeking treatment when sepsis is suspected. TIME as a memory aid stands for:
- Temperature: Body temperature is higher or lower than normal
- Infection: May have signs and symptoms of an infection
- Mental decline: Confused, sleepy, difficult to rouse
- Extremely ill: “I feel like I may die,” severe pain or discomfort.
People are encouraged to contact their healthcare provider, go to the nearest emergency room, or call 911 if they have a combination of two or more of these signs and symptoms and say, “I’m concerned about sepsis.” And be persistent. If the doctor says, “no”, ask why not. You deserve to know what the doctor is thinking.
Infection Prevention Reduces Risk of Sepsis
One important way to prevent sepsis is by preventing infections. We know that not all infections are preventable, but we can substantially reduce the risk of infection with accepted infection-prevention strategies. These include regular vaccinations, proper food handling, and personal hygiene, and timely identification and treatment of infections, no matter how seemingly insignificant they may be. Antibiotics are life savers, but overuse and improper use has resulted in mutations of bacteria so that some are resistant to antibiotics. Therefore, public education about proper antibiotic use is also vital.
Helping Healthcare Providers Improve Care
Sepsis awareness is increasing, but more still needs to be done. To address this issue, an increasing number of educational opportunities are available to healthcare professionals and others who work close to or with patients over the continuum of care. Maintenance or food service personnel who see the same patient every day may notice that the patient is more confused or out of sorts than usual. A home healthcare aide may notice that her patient has a fever and redness around a wound. A physical therapist may spot a developing sore under a patient’s prosthetic. Everyone has a role to play in sepsis identification and they should communicate any changes in status with the healthcare professionals in a patient’s life to ensure that possible infections are prevented or quickly treated.
Sepsis Alliance provides different levels of educational materials for various groups. Tools include basic brochures, videos, and toolkits for the general public, as well as Faces of Sepsis, a place for survivors and those who lost loved ones to sepsis to share their stories. There is also educational information for healthcare providers. All information is downloadable and free of charge.
The Sepsis Coordinator Network provides tools and resources geared towards healthcare professionals who are working to improve sepsis care in their facility or organization. Members do not have to be coordinators to join. The Sepsis Coordinator Network provides regular webinars and other materials to help providers learn more about sepsis, its presentation, and the importance of rapid treatment. Access is free and available from anywhere, at any time of day. In addition, the Sepsis Coordinator Network has forums where nurses and other professionals can discuss sepsis issues, allowing for free peer-to-peer exchange of information.
The Sepsis Institute, to be launched later this year, will include training modules and webinars for providers across the continuum of care, including primary care practitioners, emergency medical services personnel, nurses, and emergency room physicians. Content on The Sepsis Institute is funded in part with Federal funds from the Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response ASPR), Biomedical Advanced Research and Development Authority (BARDA), Division of Research Innovation and Ventures (DRIVe).
Millions of people have been killed or maimed by sepsis, and many live with its long-lasting effects. Despite its devastating human cost, sepsis is still unknown to many. It flies under the radar, often masked by other conditions. It’s time to shine a light on sepsis, to take it out of the shadows. It’s time to call sepsis what it is: a public health crisis.
Dr. Steven Q. Simpson is the Chief Medical Officer of Sepsis Alliance and Professor of Medicine and Acting Director of the Division of Pulmonary and Critical Care Medicine at the University of Kansas