1. Sepsis Prevention in ICU Patients
Jessica Wilborn

2. Data Reports 750,000 cases per year Sepsis is expected to increase by
1.5% per year and there will be a significant increase among the elderly
Severe sepsis is the leading cause of morbidity and mortality worldwide
The annual health costs is $24 billion
Sepsis patients have a 75% longer hospital stay compared to patients with other conditions
Patients hospitalized for septicemia are eight times more likely to die during the hospital stay
Research indicates 36% improved odds of inpatient survival rate among Emergency Departments that see higher numbers of sepsis patients (depends on hospital location and teaching status)

3. Sepsis
A life threatening condition where the body attacks its own tissues and organs in response to infection
Severe sepsis is progression to cellular dysfunction, organ damage, hypoperfusion,
Sepsis (infection SIRS criteria)
Severe sepsis (infection +SIRS criteria +organ dysfunction)
Sepsis can occur in any setting and with any patient

4. Systemic Inflammatory Response Syndrome (SIRS)
SIRS typically precedes sepsis
Characterized as:
Temperature >38 or <36
Heart rate more than 90bpm
Respiratory rate greater than 20 breaths/min
WBC count greater than 12,000 cell/mm3 or greater than 10% immature bands
Hyperglycemia
Altered mental status

5. Signs & Symptoms of Sepsis
Fever
Chills
Tachycardia
Tachypnea
Abnormal lab values
Low blood pressure SBP <90mmHg
MAP < 70 mmHg
Dehydration
Altered mental status
Reduced urine output

6. Sepsis & the elderly
Older patients may present with atypical symptoms or may be absent
Atypical symptoms include delirium, falls, loss of appetite, weakness, malaise, and fever can be absent or subdued
Often these patients experience a delay in treatment
Poor nutrition and low immune system significantly increase the risk of sepsis
Existing comorbidities metastatic neoplasms (43%), chronic liver disease (37%), and chronic renal disease (36%) significantly increase risk of sepsis related mortality
Frequently gram negative bacilli is detected. However, gram positive bacilli becoming common due to broad spectrum antibiotic use
Higher mortality among the elderly (40-50%) compared to individuals <65

7. Factors to predict prognosis in critically ill patients
Pre-infectious status
Gender
Age
Nosocomial events
Comorbidities
Severity of Illness

8. Vulnerable Populations
Young children
Older people
Long-term invasive devices
Immunocompromised

9. Nurse role in prevention
According to the Nursing Times, “Nurses have a important role in detecting patients with a deteriorating condition and initiating life-saving treatments” (McClelland, H.,and Moxon, A., 2014, p.17)
Recognize the symptoms and risk factors for sepsis pertaining to the patient
Referral to physician and interdisciplinary team
Initiate Surviving Sepsis Campaign Care Bundle
Within 3 hours: measure lactate, obtain blood cultures, administer broad spectrum antibiotics, administer 30 ml/kg crystalloid for hypotension or lactate ≥ 4mmol/L
Within 6 hours: apply vasopressors for hypotension, MAP ≥65 mmHg, CVP 8- 12mmHg, ScvO2 of ≥70%, remeasure lactate levels

10. Prevention Methods
Identify risk factors increasing susceptibility: infections, open wounds, long term invasive devices, invasive procedures, chemotherapy and anti-cancer treatments, pneumonia, and skin or soft tissue inflammation
Screening significantly increases prevention and decreases sepsis related mortality
Inservice training-poster, pocket guide, or badge reference of sepsis protocol and incorporated in new employee orientation and recertification
Implementing infection control practices
Communication of nurse to interdisciplinary team
Routine clinical assessments-vital signs and perfusion status
SSC Bundle Care- improves delivery of adequate care across all clinical settings

11. References
Aitkin, L., Schorr, C., Kleinpell, R. Implications of the new international sepsis guidelines for nursing care. American Journal of Critical Care. 22, 3, , May ISSN:
Destarac, A.L., Ely, W.E. (2012). Sepsis in Older Patients: An Emerging Concern in Critical Care. Advances in Sepsis, 22(1), 15-22
CDC (2014). Data Reports. Retrieved from
Gaieski, D. F., Edwards, J. M., Kallan, M. J., Mikkelsen, M. E., Goyal, M., & Carr, B. G. (2014). The relationship between hospital volume and mortality in severe sepsis. American Journal of Respiratory and Critical Care Medicine, 190(6), Retrieved from
Gille-Johnson, P., Hansson, K. E., & Gårdlund, B. (2013). Severe sepsis and systemic inflammatory response syndrome in emergency department patients with suspected severe infection. Scandinavian Journal Of Infectious Diseases, 45(3), doi: /
Lopez-Bushneil, K., Demaray, W. S., & Jaco, C. (2014). Reducing Sepsis Mortality. MEDSURG Nursing, 23(1), 9-14.
McClelland, H., Moxon, A., (2014). Early identification and treatment of sepsis. Nursing Times. 110(4), 14-17
Miller,Russell R., I.,II, Dong, L., Nelson, N. C., Brown, S. M., Kuttler, K. G., Probst, D. R., Clemmer, T. P. (2013). Multicenter implementation of a severe sepsis and septic shock treatment bundle. American Journal of Respiratory and Critical Care Medicine, 188(1), Retrieved from