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Surviving Sepsis

Surviving Sepsis

A fast response is key to beating this deadly complication.

Written by Melissa Bean Sterzick

Sepsis is an extreme condition that can occur when a person is fighting infection. Instead of just attacking the infection, the immune response becomes exaggerated and creates inflammation throughout the entire body.

David Rand, MD, Torrance Memorial Physician Network infectious disease specialist and co-director of infection control at Torrance Memorial, says sepsis is something to watch for carefully in seniors.

“Sepsis can happen throughout life. It is estimated that the 65-plus age group makes up 18% to 20% of the population in the U.S., but they make up 65% to 80% of sepsis patients,” he says. “The leading thought is that at age 65 to 70 our immune systems begin to decline. Seniors also have more chronic conditions that put them at risk.”

Dr. Rand says sepsis is not a subtle condition no matter what the age of the patient. Fever, chills and other symptoms of infection are present. These include cough, nausea, vomiting, shortness of breath, urinary symptoms and diarrhea. In addition, low temperature, changes in mental status and just appearing ill can all indicate the onset of sepsis.

“The easiest thing to think of is a respiratory rate of greater than 20, a heart rate of greater than 100, temperature of 101 or above or less than 96. Those are things people could see at home,” Dr. Rand says. “If those things are noticed, you’ve got to call your physician. With an infection, antibiotics are key.”

If signs of sepsis are evident, see your primary care physician for lab work and treatment. However, if the patient is extremely ill, Dr. Rand recommends the emergency room, where intravenous antibiotics can be administered quickly.

“The sooner we start antibiotics, the better the overall prognosis becomes. People think of sepsis as a blood infection, but that is not always the case. It’s a spectrum that moves from an infection, then can worsen into severe sepsis and then septic shock,” he says. “You’ve got to take it seriously and get them to the hospital quickly.”

Julie Che is the nursing director for critical care at Torrance Memorial. She says Torrance Memorial’s sepsis program has saved 442 lives since it was implemented in 2014.

The program has two parts. The first is an algorithm that gathers patient data including vital signs and blood work. It issues an alert if the patient is developing sepsis or experiencing sepsis. Alerts reach the bedside nurse, nursing lead and rapid response nurse. The second part of the program is a protocol that directs nurses—after they receive an alert—to draw blood cultures, draw labs and coordinate treatment with the designated physician.

“The algorithm really looks at the entire scope of what is going on with the patient,” Che says.

Dr. Rand says lifestyle factors do not necessarily protect patients from sepsis, but a healthy diet and regular exercise are recommended for supporting the immune system. The most important thing individuals can do to prevent sepsis is stay current with vaccinations.

“If you can prevent influenza, you’ve prevented many other complications. For the 65-plus population, the pneumonia vaccine is important, as well as a pertussis booster,” he says. “And it might seem basic, but it is so important to emphasize handwashing. It is our first line of defense in preventing infections.”

Taking care of wounds is also part of preventing sepsis. Dr. Rand says older skin is thinner, bruises more easily and heals more slowly. Wounds should be cared for properly, disinfected and treated by a doctor if they do not heal.

One of the main signs of developing sepsis is fever. Dr. Rand says there are patients who visit his office who know they have had a fever but never took their temperature. He says every home should have a working thermometer and put it to use.

The treatment for sepsis is antibiotics. However, identifying the source of the infection is key to administering the right antibiotic. According to Dr. Rand, people do not become immune to sepsis.

“Once you’ve had an infection, your body will make antibodies to the infecting organism, but immunity to one infection does not mean immunity to others. The bacteria change, and they are much smarter than we are. We’ve been trying to kill them for decades, and they have developed many mechanisms of resistance,” he says.

Che says the hospital implements new approaches to sepsis as soon as they are known. And they are currently waiting on the development of a refined algorithm that can be used in pediatrics and neonatal departments. “We’re very happy with the results we’ve had over the years,” she says.

Individuals can protect themselves from the worst outcomes of sepsis by being aware of their health and their symptoms. Family members are important support for observing signs of sepsis and making decisions about medical care.

“Pay attention to your body. Learn to identify when you’re really getting sick. The inflammatory response is different for everybody. If you’re already taking an antibiotic and you don’t get better in a day or two—or you get worse—then you have to seek medical attention pretty quickly,” says Dr. Rand. “You’ve got to speak up.” •

David Rand, MD, is an infectious disease specialist with Torrance Memorial Physician Network— Milefchik-Rand. He practices at 2841 Lomita Blvd., Ste. 125 in Torrance. He can be reached at 310-784-6954.