Awareness Of Sepsis Research Articles

Preterm infantta katater ilişkili sepsisin neden olduğu kardiyak tamponad

Cardiac tamponade due to catheter related sepsis in premature neonate is a rare and life-threatening complication; but prompt diagnosis and intervention can reverse this situation. We report a nine-day-old preterm infant who presented with pericardial effusion and cardiac tamponade secondary to catheter related sepsis. This report highlights two important aspects: occurrence of pericardial effusion in a neonate with peripherally inserted central venous catheter (PICC), with no evidence of composition of hyperosmolar parenteral solution, and awareness of sepsis as a cause for this critical condition.

Sepsis information-seeking behaviors via Wikipedia between 2015 and 2018: A mixed methods retrospective observational study.

Raising public awareness of sepsis, a potentially life-threatening dysregulated host response to infection, to hasten its recognition has become a major focus of physicians, investigators, and both non-governmental and governmental agencies. While the internet is a common means by which to seek out healthcare information, little is understood about patterns and drivers of these behaviors. We sought to examine traffic to Wikipedia, a popular and publicly available online encyclopedia, to better understand how, when, and why users access information about sepsis. Utilizing pageview traffic data for all available language localizations of the sepsis and septic shock pages between July 1, 2015 and June 30, 2018, significantly outlying daily pageview totals were identified using a seasonal hybrid extreme studentized deviate approach. Consecutive outlying days were aggregated, and a qualitative analysis was undertaken of print and online news media coverage to identify potential correlates. Traffic patterns were further characterized using paired referrer to resource (i.e. clickstream) data, which were available for a temporal subset of the pageviews. Of the 20,557,055 pageviews across 65 linguistic localizations, 47 of the 1,096 total daily pageview counts were identified as upward outliers. After aggregating sequential outlying days, 25 epochs were examined. Qualitative analysis identified at least one major news media correlate for each, which were typically related to high-profile deaths from sepsis and, less commonly, awareness promotion efforts. Clickstream analysis suggests that most sepsis and septic shock Wikipedia pageviews originate from external referrals, namely search engines. Owing to its granular and publicly available traffic data, Wikipedia holds promise as a means by which to better understand global drivers of online sepsis information seeking. Further characterization of user engagement with this information may help to elucidate means by which to optimize the visibility, content, and delivery of awareness promotion efforts.

Factors influencing awareness of healthcare providers on maternal sepsis: a mixed-methods approach

BackgroundAn awareness campaign set to accompany the Global Maternal Sepsis Study (GLOSS) was launched in 2017. In order to better develop and evaluate the campaign, we sought to understand the factors that influence awareness of maternal sepsis by exploring healthcare providers’ knowledge, perception of enabling environments, and perception of severity of maternal sepsis.MethodsWe used a mixed-methods approach that included 13 semi-structured interviews to GLOSS regional and country coordinators and 1555 surveys of providers working in GLOSS participating facilities. Directed content analysis and grounded theory were used for qualitative analysis, based on a framework including four overarching themes around maternal health conditions, determinants of maternal health, barriers and facilitators to sepsis identification and management, plus 24 additional sub-topics that emerged during the interviews. Descriptive statistics for frequencies and percentages were used for the quantitative analysis; significance was tested using Pearson χ2. Logistic regressions were performed to adjust for selected variables.ResultsAnalysis of interviews described limited availability of resources, poor quality of care, insufficient training and lack of protocols as some of the barriers to maternal sepsis identification and management. Analysis from the quantitative survey showed that while 92% of respondents had heard of maternal sepsis only 15% were able to correctly define it and 43% to correctly identify initial management. Provider confidence, perceived availability of resources and of a supportive environment were low (33%, 38%, and 48% respectively). Overall, the predictor that most explained awareness was training. Respondents from the survey and interviewees identified sepsis among the main conditions affecting women at their facilities.ConclusionsAwareness on maternal sepsis, while acknowledged as important, remains low. Healthcare providers need resources and support to feel confident about the correct identification and management of sepsis, as a prerequisite for the improvement of awareness of maternal sepsis. Similarly, providers need to know about maternal sepsis and its severity to understand the importance of reducing sepsis-related mortality and morbidity. Awareness raising campaigns can help bring neglected maternal health conditions, such as sepsis, to the forefront of global and local agendas.

Delivery-associated sepsis: trends in prevalence and mortality

Sepsis is a leading cause of pregnancy-related mortality. Previous studies have reported an increased prevalence of sepsis during pregnancy. Despite national campaigns to increase sepsis awareness, there is a lack of pregnancy-specific guidelines. We aimed to provide updated national estimates of the prevalence and trends of sepsis, sepsis-related in-hospital mortality, and factors associated with in-hospital mortality among women with sepsis at delivery. We conducted a serial, cross-sectional analysis using data from the 2002-2015 National Inpatient Sample, the largest publicly available all-payer inpatient database in the United States. We used International Classification of Diseases, ninth edition, Clinical Modification diagnosis and procedure codes to identify the study sample of delivery-associated hospitalizations and to capture diagnoses of sepsis (defined as infection with associated end-organ dysfunction). The primary outcome was in-hospital mortality. Obstetric comorbidities and pregnancy-related outcomes were also analyzed. Logistic regression was used to explore factors associated with sepsis during pregnancy and, among those with sepsis, to identify predictors of in-hospital mortality. Joinpoint regression was used to estimate the temporal trends in both sepsis and in-hospital mortality. Of the more than 55 million delivery-associated hospitalizations, 13,129 women met criteria for sepsis, corresponding to a rate of 2.4 per 10,000 deliveries. This rate increased from 1.2 to 3.7 per 10,000 over the study period, representing an annual increase of 6.6% (95% confidence interval, 4.2-9.1). The highest crude rates of sepsis (per 10,000) were among deliveries paid for by Medicare (14.8), deliveries to women aged 40 years or older (8.0), and deliveries to non-Hispanic black women (4.6). Compared with women without sepsis, women with sepsis had a greater than 10-fold increased prevalence of most selected obstetric comorbidities. One in 11 women with sepsis died prior to discharge, compared with 1 death in every 15,411 deliveries without sepsis. The sepsis-related mortality rate decreased 21.8% each year from 2010 through 2015. Maternal age greater than 40 years and nonprivate insurance demonstrated the highest odds of sepsis-related in-hospital mortality. While rates of delivery-associated sepsis have increased, case fatality has decreased.

1007. Etiology of Sepsis; A Systematic Review of Emergency Department Sepsis

BackgroundSepsis is a systemic response to an infection involving one or multiple organ failures frequently caused by bacteremia. Over a million cases of sepsis are reported in the United States annually with an estimated 25% mortality. Early recognition, diagnosis, and treatment of sepsis in the Emergency Department (ED) improves patient outcomes. Increased awareness of sepsis has fostered novel opportunities to improve diagnostics. EDs are increasingly targeted as areas of primary care for suspected septic patients. Understanding the etiology of ED sepsis supports empiric approaches and opportunities for targeted diagnostics. However, a systematic analysis of etiology of ED sepsis, spanning multiple years, is lacking.MethodsA retrospective analysis conducted over 60 months at Hennepin County Medical Center, an inner-city level one trauma center with over 100,000 ED visits annually were examined. Positive blood cultures drawn in the ED were included in data analysis. Charts were reviewed for patient demographics and whether the culture was treated; infections that were not treated were considered contaminants, and relevant susceptibility patterns.ResultsA total of 8,013 blood cultures were drawn in the ED over an initial 12-month period. Of these, 8.4% (n = 674) were culture positive resulting in 731 microorganisms. Of these, 314 were treated as infections with the remaining considered contaminants. Overall contamination rate was 2.9%. Of clinically relevant positive blood cultures, 19.4% were Escherichia coli, 18.5% were Staphylococcus aureus, 27.1% were strep species (group A strep 5.4%, group B strep 4.8%, strep pneumonia 5.1%), 7.0% were Enterococcus faecalis, and 6.4% Klebsiella pneumonia. Among these species, they accounted for 78.4% of pertinent positive cultures. Gram-negative bacteremias accounted for 41% of infections compared with 59% for Gram-positive organisms.ConclusionA comprehensive understanding of the etiology of ED sepsis facilitates appropriate empiric antimicrobial prescribing for patients who present with sepsis in the ED. Data collected to date identifies five key bacterial species associated with over 78% of confirmed ED sepsis. Disclosures All authors: No reported disclosures.

No better outcome of using antibiotic broadly in hospitalized adult patients with leukocytosis in emergency department

Background: Leukocytosis is a common laboratory finding in emergency departments worldwide. Various infectious diseases are common causes of leukocytosis in hospitalized adult patients. Most emergency physicians have a high awareness of sepsis or severe infection, which requires empirical antibiotics. However, there are many other etiologies for leukocytosis. The outcome of prescribing broad-spectrum antibiotics in the emergency department for leukocytosis patients is not well-understood. Objectives: Our objectives were to determine whether prescribing antibiotics in the emergency department affect outcome for hospitalized adult patients with leukocytosis. Methods: A retrospective cohort study of hospitalized adult emergency department patients with leukocytosis was conducted in a tertiary hospital in Taiwan between June 2016 and June 2017. Patients with leukocytosis (white blood cell count >11,000 cells per μL) who were admitted via the emergency department at the Kaohsiung Veterans General Hospital, from June 2016 to June 2017 were enrolled. Patients aged ⩽18 years, pregnant women, those who received prophylactic antibiotics prior to operation, and those with a final diagnosis of hematologic malignancy were excluded from this study. The primary outcome measure was hospital stay, and the secondary outcome measure was mortality. All collected data were statistically analyzed. Results: A total of 8054 hospitalized adult patients with leukocytosis were included (the exclusion criteria included patients aged ⩽18 years, pregnant women, those who received prophylactic antibiotics prior to surgery, and those with a final diagnosis of hematologic malignancy); all patients were admitted via the emergency department. In all, 4486 patients received initial antibiotic treatment in the emergency department, whereas 3568 patients did not receive antibiotics in the emergency department and ward/intensive care unit within 3 days. There was no statistically significant difference in hospital days (p = 0.239) or mortality (p = 0.345) between those who received and did not receive antibiotics in the emergency department. Conclusion: Hospitalized adult patients with leukocytosis did not necessarily require antibiotics in the emergency department except when they had a differential diagnosis that requires antibiotic treatment.

Sepsis in adults: Recognition and treatment in clinical guidelines

Sepsis is a potentially fatal condition, causing approximately five deaths every hour in the UK. However, new research is being published and guidelines are continually being updated—making it vital for general practice nurses to stay up-to-date with the latest developments Sepsis is a life-threatening condition. It is responsible for the majority of deaths in intensive care units worldwide, however, its pathophysiology is still not well understood. Over the past 2 decades, sepsis has been defined several times; the most recent was the Third International Consensus Definition for Sepsis and Septic Shock in 2016. It is becoming a ‘hot topic’ in healthcare—different organisations, such as the UK Sepsis Trust, are working towards raising awareness of sepsis and the importance of early recognition in improving outcomes. This subsequently led to the publication of the National Institute for Health and Care Excellence clinical guidelines for sepsis in 2016, updated in 2017. This article will explore the history of the definition of sepsis; the most updated protocols for early recognition and treatment; and the Sepsis Six. It will conclude with a list of relevant online resources available, in order to aid clinicians in their daily practice.

Determinants of sepsis knowledge: a representative survey of the elderly population in Germany

BackgroundSepsis is a life-threatening medical emergency requiring early diagnosis and urgent treatment. Knowledge is crucial, especially in major risk groups such as the elderly. We therefore assessed sophisticated knowledge about sepsis in the German elderly population.MethodsA telephone survey was carried out with a representative sample of 701 Germans from 16 federal states and a separate cohort of 700 participants from Thuringia, all aged ≥ 60 years. Sepsis knowledge was assessed via a 10-item questionnaire. Sociodemographic data and health information sources were assessed to identify determinants of sepsis knowledge.ResultsOf the participants, 88.6% had heard the term “sepsis” before; however, 50% of these failed to define sepsis correctly. Even if the knowledge of symptoms was moderately good, most participants could not correctly identify causes of sepsis and underestimated its incidence. Only a minority was aware that immunization may prevent sepsis. Regressions revealed that being younger, better educated and living in rural areas predicted higher levels of sepsis knowledge. Pharmacists were a relevant source of sepsis information.ConclusionsDespite overall awareness of sepsis, the understanding of its risk factors, symptoms and prevention is low in the elderly, with important implications for emergency and intensive care. We suggest further educational measures to improve early sepsis recognition and prevention through vaccination.

Sepsis: Early Recognition and Optimized Treatment.

Sepsis is a life-threatening condition caused by infection and represents a substantial global health burden. Recent epidemiological studies showed that sepsis mortality rates have decreased, but that the incidence has continued to increase. Although a mortality benefit from early-goal directed therapy (EGDT) in patients with severe sepsis or septic shock was reported in 2001, three subsequent multicenter randomized studies showed no benefits of EGDT versus usual care. Nonetheless, the early administration of antibiotics and intravenous fluids is considered crucial for the treatment of sepsis. In 2016, new sepsis definitions (Sepsis-3) were issued, in which organ failure was emphasized and use of the terms “systemic inflammatory response syndrome” and “severe sepsis” was discouraged. However, early detection of sepsis with timely, appropriate interventions increases the likelihood of survival for patients with sepsis. Also, performance improvement programs have been associated with a significant increase in compliance with the sepsis bundles and a reduction in mortality. To improve sepsis management and reduce its burden, in 2017, the World Health Assembly and World Health Organization adopted a resolution that urged governments and healthcare workers to implement appropriate measures to address sepsis. Sepsis should be considered a medical emergency, and increasing the level of awareness of sepsis is essential.

Communicating antimicrobial resistance and stewardship in the national press: Lessons from sepsis awareness campaigns

1The Review on AMR was an expert panel commissioned by the UK Government in 2014 tasked with analysing the economic and social impacts of AMR and proposing solutions to these. 2NICE is a UK non-departmental public body that sponsored by but separate from the Department of Health that produces evidence-based guidance for health practitioners. 3NHS England is a non-departmental public body sponsored by the Department of Health that oversees planning and delivery of health services in England. 4Note that circulation of the News of the World ceased in July 2011; the Sun on Sunday was launched by the same newsgroup in 2012, but is unavailable on the Nexis database.

Sepsis awareness in dental practices

Sepsis awareness in dental practices

Signaling Sepsis Scenario Development & Validation

Patient-based scenario-driven usability tests are routinely created for health information technology and clinical decision support evaluations. Due to low clinician awareness of sepsis, a study was undertaken to understand clinician performance and preference of different display types for sepsis clinical decision support through multi-centered usability testing. Patient-based clinical scenarios were created to mimic the environment in which providers would interact with clinical decision support. The data provided in the scenarios were drawn from real patient cases from two sepsis databases, including: demographics, visit/operational details, medical history (comorbidities, assessments, vital signs, laboratory values, clinician documentation), and patient disposition/outcomes. The purpose of this work is to inform electronic health record alert optimization and clinical practice workflow to support the effective and timely delivery of high quality sepsis care. This paper discusses the methodology, selection, and validation of patient-based cases used as the clinical scenarios in usability testing.

Reducing the risk of sepsis

Sarah Haslam, a mouth care specialist nurse from Kent, explains what her trust is doing to raise awareness of sepsis in dentistry.

Combatting Sepsis: A Public Health Perspective.

Public health professionals and organizations have an opportunity to create a more comprehensive sepsis prevention strategy that spans the continuum of care and merges existing infection prevention strategies with chronic disease management and improved education on the signs and symptoms of worsening infection and sepsis. Recent public health efforts have improved our understanding of US national sepsis epidemiology and focused on increasing sepsis awareness. Additional opportunities and challenges include creating more integrated sepsis and infection prevention programs that encompass outpatient and inpatient care.

Sepsis programme successes are responsible for the increased detection of bacteraemia

Escherichia coli bacteraemia reduction targets are challenging but, in West Wales, this was the key infection surrogate measure set by the local health board in 2013, prior to the introduction of a Welsh Government target. The initial plateau of cases was not maintained and prompted this review. To review all blood cultures submitted between 2002 and 2016, both positive and negative. With access to a microbiology data warehouse in Wales, all blood culture results were collected, extracted to Excel tables and analysed using change point analysis. Just under 200,000 blood culture results were examined. This study found an increase in blood culture submissions, but the positivity rate remained constant throughout the period and the increased number of E.coli reflected the increased number of blood cultures taken. This demonstrated the success of sepsis awareness and the use of sepsis bundles for rapid diagnosis and management. Success in one area (sepsis management) conflicts with 'failure' in reducing E.coli bacteraemia. It is argued that targets need to be considered carefully in the light of all available information, which have currently set the National Health Service up to fail.

Decision Tree Model for Hematology/Oncology Patients with Severe and Nonsevere Sepsis

Background:Hematology/oncology (H/O) patients have been screened for sepsis since 2013 at a pediatric hospital. Using sepsis screening (Ss) tool, results, and addition of organ dysfunction screening (ODs), decision tree (DT) was designed (Fig. 1) for nurses to identify sepsis and intervene.Objectives:Positive Ss require multiple assessments by nurses and H/O physicians creating sepsis alert fatigue. By implementing DT, calls to H/O physicians for sepsis alerts could be reduced 24% without increasing misses of patients with sepsis.Methods:Patients with Ss < 4 considered negative; Ss > 4 positive. ODs < 2 considered negative, = 2 at risk, > 2 positive for sepsis. In 2016, Ss were performed on H/O patients upon admission, status change, or nurse concern. May 2017, DT was implemented on H/O. From 5/5/17 to 8/30/17 Ss and ODs were conducted every 12 hours or with status change (Fig. 2).Results:Design period: 1,457 Ss (n = 1,393); 200 Ss positive (n = 180); 8 Ss, ODs < 2 (n = 44); 152 Ss, ODs = 2 (n = 139); and 0 Ss, ODs > 2. Implementation period: 6,502 Ss (n = 512); 1,647 Ss positive (n = 292); 293 Ss, ODs < 2 (n = 72); 1,351 Ss, ODs = 2 (n = 265); and 30 Ss, ODs > 2 (n = 14). See Figure 3 for pediatric intensive care unit (PICU) transfers during design/implementation periods.Conclusions/Implications:During implementation, calls were reduced to H/O physicians by 17.5% (ODs < 2). Most patients were ODs = 2. Recommendations included calling physician only if nurse was concerned of patient’s status with OD = 2. DT with addition of ODs has increased awareness of sepsis and communication between transferring providers. We have not found an increase in sepsis misses requiring transfer to PICU.

Recognition and clinical management of sepsis in frail older people.

Sepsis is a common condition caused by the body's immune and coagulation systems being 'switched on' by the presence of infection, either through bacteria or viruses in the blood. If untreated, sepsis can be life-threatening and is a leading cause of death in hospital patients worldwide. However, awareness of sepsis is low. This article provides an overview of the important role played by nurses in acute hospital settings in the early identification and treatment of suspected sepsis in frail older patients, and in escalating the care and management of deteriorating patients. It also explores recommendations in the 2016 National Institute for Health and Care Excellence guideline on sepsis recognition, diagnosis and early management.

The global maternal sepsis study and awareness campaign (GLOSS): study protocol

BackgroundMaternal sepsis is the underlying cause of 11% of all maternal deaths and a significant contributor to many deaths attributed to other underlying conditions. The effective prevention, early identification and adequate management of maternal and neonatal infections and sepsis can contribute to reducing the burden of infection as an underlying and contributing cause of morbidity and mortality. The objectives of the Global Maternal Sepsis Study (GLOSS) include: the development and validation of identification criteria for possible severe maternal infection and maternal sepsis; assessment of the frequency of use of a core set of practices recommended for prevention, early identification and management of maternal sepsis; further understanding of mother-to-child transmission of bacterial infection; assessment of the level of awareness about maternal and neonatal sepsis among health care providers; and establishment of a network of health care facilities to implement quality improvement strategies for better identification and management of maternal and early neonatal sepsis.MethodsThis is a facility-based, prospective, one-week inception cohort study. This study will be implemented in health care facilities located in pre-specified geographical areas of participating countries across the WHO regions of Africa, Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific. During a seven-day period, all women admitted to or already hospitalised in participating facilities with suspected or confirmed infection during any stage of pregnancy through the 42nd day after abortion or childbirth will be included in the study. Included women will be followed during their stay in the facilities until hospital discharge, death or transfer to another health facility. The maximum intra-hospital follow-up period will be 42 days.DiscussionGLOSS will provide a set of actionable criteria for identification of women with possible severe maternal infection and maternal sepsis. This study will provide data on the frequency of maternal sepsis and uptake of effective diagnostic and therapeutic interventions in obstetrics in different hospitals and countries. We will also be able to explore links between interventions and maternal and perinatal outcomes and identify priority areas for action.

Global trends in the awareness of sepsis: insights from search engine data between 2012 and 2017

BackgroundSepsis is an established global health priority with high mortality that can be curtailed through early recognition and intervention; as such, efforts to raise awareness are potentially impactful and increasingly common. We sought to characterize trends in the awareness of sepsis by examining temporal, geographic, and other changes in search engine utilization for sepsis information-seeking online.MethodsUsing time series analyses and mixed descriptive methods, we retrospectively analyzed publicly available global usage data reported by Google Trends (Google, Palo Alto, CA, USA) concerning web searches for the topic of sepsis between 24 June 2012 and 24 June 2017. Google Trends reports aggregated and de-identified usage data for its search products, including interest over time, interest by region, and details concerning the popularity of related queries where applicable. Outlying epochs of search activity were identified using autoregressive integrated moving average modeling with transfer functions. We then identified awareness campaigns and news media coverage that correlated with epochs of significantly heightened search activity.ResultsA second-order autoregressive model with transfer functions was specified following preliminary outlier analysis. Nineteen significant outlying epochs above the modeled baseline were identified in the final analysis that correlated with 14 awareness and news media events. Our model demonstrated that the baseline level of search activity increased in a nonlinear fashion. A recurrent cyclic increase in search volume beginning in 2012 was observed that correlates with World Sepsis Day. Numerous other awareness and media events were correlated with outlying epochs. The average worldwide search volume for sepsis was less than that of influenza, myocardial infarction, and stroke.ConclusionsAnalyzing aggregate search engine utilization data has promise as a mechanism to measure the impact of awareness efforts. Heightened information-seeking about sepsis occurs in close proximity to awareness events and relevant news media coverage. Future work should focus on validating this approach in other contexts and comparing its results to traditional methods of awareness campaign evaluation.

The Impact of Early Identification and a Critical Care-Based Sepsis Response Team on Sepsis Outcomes.

The Impact of Early Identification and a Critical Care-Based Sepsis Response Team on Sepsis Outcomes.