SEPSISA GUIDE FOR PATIENTS AND FAMILIESBY ANN E. LAPOLLA

Sepsis is a medical emergency. According to the Global Sepsis Alliance, sepsis is the lead-ing cause of death worldwide and it is esti-mated to kill tens of millions of people each year. Recent surveys have shown that world-wide 50 to 60% of people were unfamiliar with the term “sepsis”. This guide is a small step in the journey to help patients and families un-derstand, prevent, and recognize sepsis.

INTRODUCTION TO SEPSIS1

WHAT IS SEPSIS?

Sepsis is a medical emergency that may occur as a re-sult of a severe infection or injury. In 2010 a group of experts from around the world met in New York at the Merinoff Symposium to work together to combat sep-sis. Together they developed a universal definition of sepsis:

“Sepsis is a life threatening condition that arises when the body's response to an infection injures its own tis-sues and organs. Sepsis leads to shock, multiple or-gan failure and death especially if not recognized early and treated promptly. Sepsis remains the primary cause of death from infection despite advances in modern medicine, including vaccines, antibiotics and acute care. Millions of people die of sepsis every year worldwide.”

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Sepsis may be diagnosed if a person has a suspected or known infection and develops any of the following:

1.changes in mental status (new confusion, unable to stay awake)

2.fever (temperature > 38.3°C)

3.low body temperature (hypothermia; temperature < 36°C)

4.heart rate > 90 beats per minute (age and medica-tion dependent)

5.fast breathing (respiratory rate > 20 for adults)

6.swelling (edema) of the arms or legs

7.cold or discolored skin (mottling)

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Severe sepsis occurs when a person has sepsis and develops low blood pressure or organ dysfunction. Ex-amples of organ dysfunction include:

• not making urine or only small amounts of urine

• yellowing of the skin (jaundice)

• bleeding

• coma

• heart failure

• unable to breathe

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HOW DOES SEPSIS HAPPEN

Pathophysiology of sepsis: How does sepsis happen?

When the body suffers an infection or injury, sepsis may occur. Examples of infection sites in the body in-clude the urinary tract, lungs, abdomen, skin or soft tis-sue, and blood. Examples of injuries that may lead to sepsis include burns, wounds, or trauma. Sepsis is not caused by the infection itself, but rather results from the body’s attempt to protect itself from the infection or injury. Although most sepsis is the result of a bacterial infection, sepsis may also result from infection by vi-ruses, fungi, and parasites.

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Bacteria and other infectious agents have substances in their outer membranes that alert the body to release chemicals to fight the infection. These chemicals can begin to attack the body itself and damage the lining of the blood vessels causing leaking from the smallest vessels (capillaries). They can also cause the vessels in the body to dilate leading to low blood pressure (hy-potension) and septic shock. Other chemicals may cause the blood to clot more easily and lead to block-ages in fragile vessels. Organs, such as the kidney, liver, and brain may begin to fail as a result of in-creased leaking, low blood pressure, and clotting.

The following pages present information on common infections that may lead to sepsis. Learn about urinary tract infections, pneumonia, and skin infections and how they may lead to sepsis

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A urinary tract infection (cystitis) is an infection of the bladder. If a uri-nary tract infection is not treated, the infection may spread to the kid-neys (polynephritis) or into the blood stream. The body will try to fight the infection by releasing chemicals and cells, such as macro-phages to fight the bacteria. If the chemicals and infection fighting cells begin to damage blood ves-sels and organs, sepsis and severe sepsis occur. If the blood pressure becomes low, septic shock occurs. Septic shock can lead to organ (kid-ney, heart, or brain) damage and death.

It is important to learn the signs and symptoms of a urinary tract infec-tion and to seek treatment as soon as possible.

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Signs and symptoms of a urinary tract infection may include:• painful urination• burning while urinating• having to urinate frequently• having to urinate urgently• bedwetting or new incontinence• dribbling• urine that smells foul• cloudy urine• blood in urine• fever and chills• low temperature• stomach pain• back pain• vomiting

The first sign of a urinary tract infec-tion in older adults may be confu-sion. People with diabetes may no-ticed that their blood sugars are high with a urinary tract infection.

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Urinary tract infections can be prevented by:• always wash your hands

when you use the toilet• drink plenty of fluids to re-

main hydrated• practice good hygiene• women and girls: always

wipe front to back• change diapers or briefs

when they become soiled • clean the skin with every dia-

per or brief change• eat nutritious foods• stay active

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Pneumonia is an infection in your lung that may make it difficult for you to breathe. Pneu-monia may be caused by:• bacteria• fungi• viruses• chemical exposure• aspiration (food or fluids go into the lungs

instead of the stomach)

When the small air sacs (alveoli) in your lungs become exposed to bacteria and other sub-stances, they may fill up with fluid and pus. Fluid makes it difficult to breathe because there is less surface area in the alveoli to ex-change oxygen for carbon dioxide. When the body does not receive enough oxygen it can-not function properly. Cells may die causing damage to the brain, kidneys, heart, and other organs.

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Signs and symptoms of pneumonia may vary according to the type of infection you have. If you have pneu-monia you may have:• fever (higher than normal tempera-

ture)• hypothermia (lower than normal

temperature, especially if you are older)

• chills or sweating• cough• shortness of breath• chest pain that changes with

breathing• weakness, fatigue, muscle pain• cyanosis (blue color to fingers/

toes/skin/lips)• high heart or breathing rate• confusionRemember: Difficulty breathing, chest pain, confusion, and cyanosis are medical emergencies. Seek im-mediate medical attention.

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You can help prevent pneumonia in yourself or family members by:• washing your hands frequently, es-

pecially after contact with people who are ill

• not smoking• avoiding second hand smoke• not allowing anyone to smoke

around your baby• if you smoke, washing your hands

and changing your clothing before holding your baby

• asking your health care provider which vaccinations you or your family members should receive

• getting your flu shot if approved by your health care provider

• covering your cough• wearing a mask if you are ill • drinking fluids• eating healthy foods• staying active

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MRSA (methicillin-resistant Staphylo-coccus aureus) is a type of staph bacteria that is resistant to certain antibiotics used to treat infections. MRSA can cause infections of the skin, urinary tract, and lungs.

There are 2 types of MRSA bacteria: hospital associated MRSA and com-munity associated MRSA. Signs and symptoms of infection will vary depending on the type of MRSA.

People at risk for community associ-ated MRSA include athletes, chil-dren, and people living in group or dormitory settings such as military personnel, correctional facilities, and schools.

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Heath care-associated MRSA infections may become life-threatening very quickly so be sure to seek immediate medical attention if you have recently been in the hospital or other health care facility.

Community-acquired MRSA infections may have the follow-ing signs and symptoms:• a sore that resembles a spi-

der bite• a pimple or red bump with

pus or drainage• redness, pain, swelling,

warm to touch• fever (may be a medical

emergency)Do not attempt to treat an MRSA infection yourself, al-ways seek medical attention.

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You can help prevent MRSA infec-tions by:• Washing your hands with soap

and water or an alcohol-based hand rub. Washing your hands often and frequently after contact with others.

• If you have a cut or open wound, keeping it clean and covered with a clean dry bandage until it is healed.

• Not touching cuts, wounds, or bandages on others. If you come into contact with another person’s wound or bandage, immediately wash your hands.

• Not sharing personal its such as washcloths, towels, razors, cloth-ing, and athletic equipment.

• Keeping your living, working, and athletic training environment clean.Wipe down gym equip-ment such as weights, mats, and machines before and after use.

WHO IS AT RISK FOR SEPSIS?

Everyone is at risk for sepsis but there are groups of people that are at greater risk. People at greater risk for sepsis include:

• Newborns

• Older adults

• Hospitalized patients

• Dialysis patients

• Patients with impaired immune systems, such as can-cer patients

• People who abuse alcohol or drugs

• People with diabetes

• People with medical devices, such as IV catheters, urinary catheters, tracheostomies, and drains

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WHEN CAN SEPSIS HAPPEN?

Sepsis may occur following illness, infection, surgery, hospitalization, or any other medical event. A simple cut on your finger may become infected and lead to sepsis. The most important thing you can do for your-self or your family member is to be aware of the signs and symptoms of sepsis and to call for help if you sus-pect sepsis.

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WHERE DOES SEPSIS HAPPEN?

Sepsis may occur anywhere, at home, school, or in a medical facility, such as a hospital or long term care facility. Washing your hands with an alcohol-based gel or soap and water is an effective way to prevent the spread of germs. Be sure that all health care providers have washed their hands before touching you. Do not be afraid to ask them to wash their hands.

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There are several actions that you and your family can take to prevent sepsis. Washing your hands is one of them. Others include learning how to recognize sepsis and calling for help as soon as you suspect sepsis.

SEPSIS: PREVENT, RECOGNIZE, ACT

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HANDWASHING

The most important action that you and your family can take to prevent sepsis is to wash your hands. Wash your hands often but especially after using the toilet and before eating. Carry hand sanitizers with you to gel your hands frequently to prevent illness. If your hands are especially dirty or if you have been ex-posed to spores in stool, you must wash your hands with soap and water. Always feel free to ask if your doctor, nurse or other health care professional has washed their hands before touching you.

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Type to enter text

World Health Organization Hand Washing Guide.

RECOGNIZE SEPSIS

The most important tools in your home are your senses: sight, hearing, smell, and touch. If you sus-pect that you or your family member has sepsis do the following:

LOOK at the skin (blue, pale, mottled), wound (red-ness, streaking, discharge), surgical incision, or medi-cal device (IV line, dialysis catheter, drain tube)

LISTEN to breathing (fast, slow, irregular, working hard) and talking (new confusion, difficulty speaking)

SMELL for new odors, such as urine (may mean new incontinence), rotten or sweet smell (may indicate in-fection), acetone (may indicate a sugar problem)

TOUCH their skin (cold, hot, sweaty)

Other tools you should have in your home include a thermometer for checking temperature, a watch with a second hand for measuring pulse (heart rate) and breathing (respiratory) rate, and a blood pressure ma-chine or cuff.

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Valuable tools to have in your home

GATHER INFORMATION

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If you suspect sepsis gather information about yourself or your family member. Obtaining informa-tion is a simple process. Do not be intimidated. It is not your job to diagnose sepsis. You are simply gathering information to help medical staff care for you or your family member.

REMEMBER: CALL “911” or emer-gency services immediately, if you are concerned about a life-threatening condition.

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Below is a simple process for gathering information:• take the temperature, write it down• use a watch with a second hand, watch breath-

ing for 1 minute while counting the number of breaths (you may also place a hand on your or the person’s chest to count), write it down

• find the pulse (you may use wrist or neck in an adult); use your watch with a second hand and count the heart heats for 15 seconds, write it down

• use home blood pressure machine to take blood pressure, write it down

• look• listen• smell• touch

As you gather information such as tem-perature, heart rate, respiratory rate, and blood pressure be sure to write it down so that it is available when you call the doc-tor or go to the hospital. When you write it down be sure that you write the time that you got the information. You may write your information down on a paper or card or use one of the checklists in this book such as SBAR or UNSAFE. Be sure that you bring the information you have gath-ered with you to the hospital so that you can show it to the triage nurse and emer-gency room physician.

SEPSIS:  PATIENT  AND  FAMILY  CHECKLIST

Unstable • Unsteady  on  feet• Falling

No  response • Not  talking• Not  responding• Not  following  with  eyes

Skin • Dry• Eyes  sunken  or  dark• Cooler  than  normal/cold• Pale• Mottled/Blue/Purple

Alertness • Sleepier  than  normal• Doesn’t  recognize  family/friends• New  confusion

Fluids  and  Food

• Not  drinking• Not  eating• Little  or  no  urine• New  incontinence

Extremities:  arms  and  legs

• Cold• Mottled/Blue/Purple• New  swelling

If  any  of  the  above  are  new  or  a  change  in  you  or  your  family  member,  please  seek  immediate  medical  attention.

CALL FOR HELP

Sepsis is subtle and can become life-threatening very quickly. There are treatments that can be done at the hospital in the first hour of sepsis that can markedly im-prove the patient’s chances of survival. Call for help as soon as you suspect that you or your family member may have sepsis.

Do not be afraid to call emergency medical services. Do not feel that you are imposing or wasting the staff’s time at the emergency room. Every 1.75 seconds someone in the world dies from sepsis.

If you suspect sepsis, CALL FOR HELP.

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COMMUNICATE CONCERNS EFFECTIVELYWhen you call for help or go to the emergency room it

is important to communicate your concerns effectively

so that staff respond appropriately. Sepsis is a medi-

cal emergency. Some hospitals have a “Code Sepsis”

similar to a “Code Blue” that may be called to obtain a

rapid response to a patient with suspected sepsis.

Some hospitals do not have a protocol to respond rap-

idly to a patient with suspected sepsis. In either case,

it is important for you to be an advocate for yourself or

your family member. Remember that to communicate

effectively you must:

• remain CALM

• speak CLEARLY

• be CONCISE

• state your CONCERN

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The triage desk in an emergency department is often very busy. It is important not to become frightened or overwhelmed. You may find a tool such as SBAR to be helpful in communicating your information and con-cerns to the triage nurse. “SBAR” is a tool used in the military and healthcare to convey critical informa-tion in a rapid and organized manner. The “S” stands for situation (why did you or your family member come to the emergency room today?), “My father is 80 years old and has a fever of 101°F”. The “B” stands for background (state recent illness, surgery, or injury), such as “My father was recently discharged from the

hospital with pneumonia”. The “A” stands for assess-ment, such as “I think my father has pneumonia”. The “R” in SBAR stands for recommendation, but think of it as “Request” or “Response”, such as “I want my fa-ther to be screened for sepsis”.

SBARA COMMUNICATION TOOL FOR PATIENTS AND FAMILIES

S SITUATION WHAT IS HAPPENING TO YOU OR YOUR

FAMILY MEMBER?

“I HAVE A FEVER OF 101°F TODAY”“MY FATHER DOESN’T RECOGNIZE

US”“MY MOTHER HAS BEEN

INCONTINENT SINCE YESTERDAY”

B BACKGROUND HOW LONG HAS YOUR CONCERN

BEEN GOING ON? STATE RECENT

ILLNESSES, SURGERIES,

INJURIES

“MY CHILD HAS NOT BEEN DRINKING FOR 2 DAYS”

“I HAVE NOT BEEN ABLE TO URINATE FOR 2 DAYS”“MY FATHER HAS BEEN

COUGHING FOR 3 DAYS”

A ASSESSMENT STATE WHAT YOU THINK IS

HAPPENING. USE WORDS SUCH AS SEPTIC, SEVERE

SEPSIS, CRITICALLY ILL

“I BELIEVE THAT MY MOTHER IS SEPTIC. SHE HAS A TEMPERATURE OF 101°F, HER RESPIRATORY RATE IS 28, AND SHE HAS A COUGH.”

R REQUEST STATE WHAT YOU WANT TO HAPPEN

“I WANT MY FATHER SCREENED FOR SEPSIS”

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Practice using SBAR at home in order to be prepared in case of medical emergency. It will save time when relaying information to healthcare providers. It will also allow you to communicate critical information about you or your family member in a rapid and organized way. You may want to practice using the scripts below:

“My name is _______________. My mother’s name is _________________. She is 86 years old and has been very confused today. I have noticed that she has been incontinent since yesterday and her urine has a strong smell. Her hands and feet are cold and blue. I think she may have a urinary tract infection. I want her screened for sepsis.”

“My name is ____________. I am _____ years old and have a fever of _______ F. I have been coughing and am short of breath. I think I have pneumonia. I want to be screened for sepsis.”

The most important thing that you can do for yourself and your family is to learn the signs and symptoms of sepsis.

SIGNS AND SYMPTOMS OF SEPSIS

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WHAT IS A SIGN?The medical definition of the word “sign” is an objec-tive finding that can be seen, heard, smelled, or felt. Examples of medical “signs” include:

• coarse or crackly breath sounds

• the color of discharge from a wound

• the smell of a bacterial infection

• cold hands and feet

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WHAT IS A SYMPTOM?

The medical definition of the word “symptom” is some-thing that is experienced by the patient. Examples of symptoms include:

• pain: “I have abdominal pain.”

• nausea: “I feel nauseous.”

• chills: “I feel very cold.” “I have the chills.”

• dizzy: “I am very dizzy.”

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SIGNS OF SEPSIS

• fever (higher than normal temperature)

• hypothermia (lower than normal temperature)

• changes in skin color and temperature: cold, blue, warm, flushed

• more sleepy than normal, acting differently, confused

• not eating or drinking normally

• urinating less frequently or not at all

• difficulty breathing

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If you or your family member are ill and experience signs of sepsis, seek medical attention.

SYMPTOMS OF SEPSIS:

Remember a symptom is something that a person feels or says. Young children who are ill, are able to communicate that they are “hot”, “cold”, “tired”, or in “pain”. Infants may cry more and change the pitch of their cry. Look and listen for clues from family mem-bers who are ill. Be alert when someone who is ill says things such as “I’m having pain”, “I don’t feel good”, “I have never felt this way before”, “I am so sick”, “I am so cold”, or “I can’t breathe”. Seek medical attention as soon as you suspect sepsis.

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If you or family member are ill and having symptoms of sepsis, seek medical attention.

WHAT TO DO IF YOU SEE SIGNS AND SYMPTOMS OF SEPSIS

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CALL FOR HELP IF YOU SEE SIGNS AND SYMPTOMS OF SEPSISSepsis can turn into a life-threatening illness very quickly. If you see signs and symptoms of sepsis in yourself or your family member, call for help. If you or your family member is experiencing a medical emer-gency such as chest pain, difficulty breathing, or changes in mental status, call emergency services.

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Going to the hospital can be overwhelming and frightening. It is important to communi-cate your concerns effectively. Stay calm. Stay focused. Speak clearly.

SEPSIS: THE HOSPITAL

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THE EMERGENCY ROOMMany emergency rooms are very busy and chaotic places. Information is obtained very quickly at triage to treat life-threatening emergencies first. Sepsis is a medical emergency. In 2012 it became the number one reason why patients were admitted to the hospital in the United States. More people are now admitted to the hospital for sepsis than heart attacks and strokes.

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A nurse demonstrating therapeu-tic touch and caring while triag-ing a patient in the emergency room

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Today, everything moves very quickly. You have prob-able felt rushed in a variety of situations, such as order-ing food, paying for items at a store, and at emer-gency triage. Taking time to slow down and breathe ac-tually saves time and results in more effective commu-nication between patients, families, and caregivers. Re-member, you have the right to be heard by members of your health care team.

If you or your family member feel rushed, ask the hos-pital staff to slow down. Remember to be prepared and collect information before you go to the hospital Use a checklist, communication tool like SBAR, or a script to effectively communicate information. Finally if you believe that you or your family member may have sepsis always state, “I (or my family member) want to be screened for sepsis”.

THE GOLDEN HOUR OF SEPSIS

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Patient receiving high flow oxy-gen in the emergency room.

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THE SEPSIS SIX

The sepsis six are six things that can be done by mem-bers of the healthcare team during the first hour of treatment that may dramatically reduce the risk of dy-ing from sepsis. The sepsis six are:

• high flow oxygen

• draw blood to measure hemoglobin and lactate (a measure of whether or not the cells have enough oxy-gen for normal metabolism)

• draw blood cultures

• start IV fluids

• administer antibiotics

• measure urine output accurately

Tubes used to collect blood for checking electro-lytes, lactate, blood cell counts, blood type, and how fast the blood clots.

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Blood culture bottles for checking for bacteria in the blood. The bottles con-tain a broth to support the growth of both aerobic (need oxygen) and an-aerobic (do not need oxy-gen) bacteria.

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Starting IV fluids dur-ing the first hour of sepsis treatment is essential to surviving sepsis. Even if the pa-tient has swelling, there is not enough fluid in the blood ves-sels due to the leak-ing capillaries. Re-search continues on how much fluid is needed so that other organs in the body, such as the kidneys are not harmed by too much fluid.

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Starting antibiotic therapy during the first hour of treatment significantly in-creases the patient’s chances of survival. The medical team will start with broad-spectrum antibi-otics to treat the patient. After the blood culture re-sults are available (usually 3 days), the medical team will be able to prescribe antibiotics specific to the bacteria causing the infec-tion.

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Measuring urine output accurately is key to moni-toring how the patient’s kidneys are functioning and to access how well the patient is being hy-drated. It is usually neces-sary to place a urinary catheter in the patient’s bladder to measure the urine. The medical team will assess urine output every hour with the goal to keep urine output greater than 50 milliliters (about 2 ounces) per hour. Urine output goal varies based upon the pa-tient’s age and weight. Ask the medical team what the hourly goal is for your family member.

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THE INTENSIVE CARE UNIT

If you or your family member have been diagnosed with severe sepsis or septic shock, you will be trans-ferred to the intensive care unit (ICU). The health care team is composed of nurses, physicians, advanced practitioners, and therapists who have additional edu-cation, training, and skills to care for critically ill pa-tients. The ICU staff are available to support you and your family during this time. Pastoral care and li-censed clinical social workers provide spiritual and emotional support as well as valuable resources.

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THE INTERMEDIATE CARE UNIT

If you or your family member is admitted to the hospi-tal with sepsis you may be transferred to an intermedi-ate care unit, also known as a “telemetry” or “step-down” unit. The staff on this unit are highly trained and skilled to care for patients who may not require ICU care. You may be discharged to home from this unit or you may be transferred to a medical-surgical unit or re-habilitation facility.

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THE MEDICAL/SURGICAL UNITThe medical-surgical unit is where you or your family member may be transferred from either the intensive care unit or the intermediate care unit. The staff on this unit will help you prepare for your discharge home. The staff on this unit are very skilled in patient educa-tion and care. Feel free to ask them for help and sup-port.

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RAPID RESPONSE TEAMS

A rapid response team is composed of a team of skilled health care providers, including physicians, critical care nurses, and respiratory therapists. Rapid response teams were developed to provide emer-gency assistance to nurses caring for patients outside of critical care areas. Members of the rapid response team follow patients who have recently discharged from ICU and provide education and support to nurs-ing staff. If you believe that you or your family member is having new signs and symptoms of sepsis or any other emergency, ask your nurse to call the hospital’s rapid response team.

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PATIENT SAFETY INITIATIVES: “CONDITION HELP” AND “SPEAK-UP”

“Condition Help” and “Speak-Up” are patient safety ini-tiatives that encourage patients or family members to call directly for help. Many hospitals have special phones or numbers that patients and families can call when they are concerned about their care. Designated phone operators and nurses respond to the concerns and send a skilled nurse to the patient’s bedside to evaluate the patient for an emergency condition. Ask your hospital about their “Condition Help” and “Speak-Up” patient safety programs.

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“Speak Up” is a patient safety pro-gram that encourages patients and family members to be active and knowledgable about their care. Re-member:

S = Speak Up if you have questions or concerns.

P = Pay attention to your medica-tions and care in the hospital.

E = Educate yourself about your medical condition, medications, and treatments.

A = Ask questions. Ask for help.

K = Know your medications and medication allergies. Know your medical history.

U = Use resources offered by the hospital, such as patient education materials and patient advocates.

P = Participate in and plan your care.

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The Story of Josie King

Josie King was an eighteen month old girl admitted to the hospital for first and second degree burns after climbing into a hot bath. Two days before she was to be discharged Josie died as a result of medical errors and a hospital staff that would not listen to her par-ents’ concerns. To ensure that this does not happen to another child, Jo-sie’s parents formed the Josie King Foundation. The Kings are committed to patient safety and work to educate and unite health care providers and consumers about patient safety. The Jo-sie King Foundation supports patient safety programs such as “Condition Help”.

Recovering from sepsis depends on your age, how quickly you were treated for sepsis, and pre-existing medical conditions.

DISCHARGE FROM THE HOSPITAL THE HOSPITAL

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FOLLOW YOUR HEALTHCARE PROVIDER’S INSTRUCTIONS

Before you or your family member are discharged from the hospital, members of your health care team should spend time to educate you and your family about your home care instructions. These instructions should provide information about:

• when to schedule a follow-up appointment with your health care provider

• how to care for yourself or family member at home, such as wound care, breathing treatments, and medi-cations

• warning signs and when to call for medical assis-tance

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CALL FOR MEDICAL ASSISTANCE

When you return to your home, do not be afraid to call your health care provider with any questions or con-cerns. Examples of when you should call your pro-vider include: questions about medications, side ef-fects from medications, new or increased pain, fever or low temperature, or you are not getting better over time.

People who have had sepsis may be more likely to get it again. Watch for signs and symptoms of sepsis and seek immediate medical attention. If you feel that it is a medical emergency such as difficulty breathing, chest pain, or new confusion call emergency services.

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Although sepsis can strike anyone, there are groups of people that are more likely to experi-ence it. This chapter examines populations that have a higher risk of sepsis.

SPECIAL POPULATIONS

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THE ELDERLYElderly patients are more susceptible to infections and sepsis due to:

• pre-existing medical conditions such as heart and lung disease, kidney disease, diabetes, or fragile skin

• less activity and may spend more time sitting in chairs or lying in bed leading to pressure ulcers and skin infections

• not eating and drinking enough leading to dehydra-tion and low protein (albumin) levels in the body that decrease the body’s ability to fight infection

• may have incontinence of urine and stool leading to skin and bladder infections

• aging of the immune system

• signs and symptoms of sepsis are different in the eld-erly:

• low temperature instead of fever

• confusion may be the first sign of sepsis

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If you or your senior family member has signs or symp-toms of sepsis, seek medical assistance right away. Older people may have decreased abilities to fight in-fection and may develop life-threatening illness quickly.

Ways to protect you or your older family member from sepsis:• wash your hands• talk to your health care provider about appropriate

vaccines for your age group• stay away from people who are ill• drink plenty of fluids and nutritious foods• if you are ill and not getting better, seek medical at-

tention early

Ways to make a difference:• educate your friends and family about sepsis• volunteer to speak about sepsis at local assisted liv-

ing facilities, nursing homes, or senior centers

NEWBORNS AND YOUNG INFANTSNewborns and young infants may be susceptible to sepsis because their immune systems (infection-fighting abilities) are not fully developed. These very young babies may have different signs and symptoms of sepsis. It is common for parents or caregivers to say that the baby “doesn’t look right” or “isn’t acting normally”.

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Newborns and very young infants who are developing sepsis may have the following signs and symptoms:

• fever (above 100.4°F or 38°C rectally)

• low or unstable temperatures

• difficulty feeding or lack of interest in feeding

• vomiting

• irritability or unable to be consoled

• lethargy (sleeping more than usual, will not interact)

• loss of muscle tone or appears floppy

• fast breathing or difficulty breathing (working hard)

• apnea (baby stops breathing for > 10 seconds)

• change in heart rate (very fast or slow)

• changes in skin color (pale, blue, jaundiced-yellow)

• rash

• few or no wet diapers

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MInutes old, this newborn is inter-acting with his dad.

If your newborn or infant is exhibiting signs or symp-toms of sepsis, call your pediatrician or family health care provider immediately. If your infant is having diffi-culty breathing, lethargy (excessive sleepiness), fever, low temperatures or any other emergency condition, call emergency services right away.

Steps you can take to protect your newborn and young infant:

• insist that no one touches your baby without washing their hands

• no smoking around your baby

• do not let people who are ill touch your baby

• protect your newborn from crowds and public events

• talk to your health care provider about recom-mended vaccinations for your baby and family mem-bers

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CHILDRENChildren are susceptible to developing sepsis be-cause of communication problems and low suspicion of sepsis by health care providers. Young children may have difficulty communicating how sick they are and teenagers may communicate very little or not at all. Children may become septic following an injury to their skin or soft tissue, respiratory infections, or ab-dominal infections.

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Children who are developing sepsis may exhibit the fol-lowing signs and symptoms:

• fever

• irritability

• vomiting

• lethargy (sleeping more that usual, more tired that usual)

• difficulty breathing

• confusion

• a rash

• cool skin or changes in skin color

• fast heart rate

• ill or toxic (very ill) appearance

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If your child is ill or has suffered an injury watch him or her closely for signs and symptoms of sepsis. Call for medical assistance right away if your child has a high heart rate, difficulty breathing, new confusion or any other potentially life-threatening condition.

Things that you can do to prevent sepsis in children and teens:

• volunteer to educate students in your child’s class, scout troop, or athletic program about sepsis

• teach children and teens effective hand washing skills

• insist on being present with your teen if he goes to the clinic or emergency room so that you can advo-cate for him

• if you are not comfortable with your child’s care “Speak-Up” until you are heard

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DIABETICS

People with diabetes are more susceptible to sepsis because:

• hyperglycemia (high blood sugar) may impair the body’s abilities to fight infection (immune system)

• diabetes may cause damage to the blood vessels re-sulting in decreased blood flow to the body’s tissues and increased risk for infection

• diabetic neuropathy (causes decreased sensation in skin) may increase risk for infection due to inability to feel cuts and sores

• serious and sometimes fatal skin and urinary tract in-fections occur more frequently

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Individuals with diabetes may develop the following additional signs and symptoms of sepsis:

• severe hyperglycemia (unable to control blood sug-ars)

• severe dehydration• increased or decreased urination• no urine• severe abdominal pain, nausea, and vomiting• sweet, fruity smell to breath

Ways to prevent sepsis if you or your family members have diabetes:

• keep your blood sugar below 200 or in the range your health care provider has recommended.

• check your skin daily for cuts and injuries.• check your feet daily. Have a podiatrist check your

feet every two to three months.• do not wait. Call for medical assistance early if you

are ill.• if you have a life-threatening condition, call emer-

gency services right away.

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If you have diabetes, plan ahead to prevent sepsis:• When you become ill, you may require changes in your diabetes medications to

control your blood sugars. Talk to your healthcare provider about a plan for when you are ill.

• Talk to your friends and family about the signs and symptoms of sepsis so that they can help you get medical care early if you become ill.

• Write down your current medications and allergies. Keep it in a place where emergency personnel can find it and give it to your family to bring to the hospi-tal.

PATIENTS WITH MEDICAL DEVICES

What is a medical device? Examples of medical de-vices include PICC lines, tunneled central venous catheters, urinary catheters, tracheostomy tubes, and drains. Why are patients with medical devices more susceptible to infection and sepsis? Any device that interferes with the integrity of the skin or enters an area of the body, such as the bladder or lungs increases a person’s risk of infection. A simple way to think of this is to imagine that the device creates an entryway for bacteria to march down the device and into the blood stream, lungs, or bladder.

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PEOPLE ON DIALYSIS: PERITONEAL AND HEMODIALYSIS

People on dialysis have greater risks for developing serious infections and sepsis because they have:

• weakened immune systems (infection-fighting sys-tems) due to kidney disease

• additional health problems such as diabetes, heart disease, and lung disease

• more hospital admissions and surgeries

• more needle sticks and catheter accesses leading to more chances for bacteria to enter the bloodstream

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People on peritoneal dialysis are at risk for infection and developing sepsis. Peri-toneal dialysis is an option for people with end stage kidney disease. It is a type of dialysis that requires surgical placement of a catheter into the abdomi-nal cavity. Peritoneal dialysis uses the ab-dominal membrane as an artificial kid-ney. Dialysis fluid fills the abdominal cav-ity and “dwells” for a period of time. While the dialysis fluid is in the abdomi-nal cavity, toxins and wastes travel from the blood across the abdominal mem-brane in to the fluid. After a period of time the fluid is drained into a drain bag.

The most common infection experienced by people on peritoneal dialysis is called peritonitis, an infection of the membrane in the abdominal cavity. Peritonitis may be caused by an infection in or around the catheter or an infection in the bowels.

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Peritonitis can quickly lead to sepsis. Signs and symptoms of peritonitis in-clude:• abdominal pain• cloudy fluid in drain bag• fever• nausea • diarrhea• low blood pressure• new constipationCall your health care provider if you have any signs or symptoms of peritonitis.

Prevention of catheter infection includes:• strict hand washing when performing

peritoneal dialysis• using a mask when uncapping the

catheter • keeping a clean environment • not allowing pets in the room where di-

alysis takes place as they may play with tubing causing a serious infection

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People receiving hemodialysis with central venous catheters are at higher risk for infection than people who have fistulas or grafts. Skin bac-teria can infect the blood stream causing sepsis by marching down the catheter. Other infections may happen as the result of a film con-taining bacteria that coats the in-side of the catheter. The “Fistula First” initiative is a program to en-courage patients to have fistulas placed instead of using catheters to prevent serious infections.

Signs and symptoms of an infection at a dialysis catheter site include:• fever• chills• redness or pus where the catheter

enters the skin• confusion• low blood pressure

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Ways to prevent infection and sep-sis with dialysis catheters include:• strict hand washing • wear a mask whenever the cathe-

ter end is open or the dressing is off

• keep the dressing over the cathe-ter clean, dry, and intact

• use a device to stabilize the catheter so that it does not move and create a larger hole for bacte-ria to travel down

• check the catheter and site every-day for redness and other signs of infection

• use your dialysis catheter only for dialysis - it is your lifeline

• NEVER let anyone use your dialy-sis catheter for routine lab draws or medications

• call your healthcare provider for help early if you suspect that you have an infection

PEOPLE WITH IMPAIRED IMMUNE SYSTEMSPeople with impaired immune systems because of can-cer, HIV/AIDS, medications, or other medical condi-tions are more susceptible to infections and sepsis. When the immune system (infection fighting system) is suppressed (not working well), pathogens (bacteria, fungi, or viruses) may take over causing life-threatening illness.

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Signs and symptoms of sepsis in-clude:• changes in mental status (confu-

sion, sleepiness)• fast breathing• fast heart rate• fever or low temperature• changes in skin color (pale, blue,

mottled)• changes in skin temperature (cold

or hot)

Ways to prevent sepsis if you have an impaired immune system:• strict hand washing • wear a mask when the catheter

end is exposed• screen visitors and do not allow ill

people to visit you• practice good oral hygiene and

keep the mucus membranes in your mouth moist

• check your skin daily for new inju-ries

• eat nutritious foods

Spreading the word about sepsis is simple. Join an organization such as the Sepsis Alli-ance or Global Sepsis Alliance to learn more about sepsis and how you can make a differ-ence. Volunteer to educate about sepsis at schools and senior centers. Talk to your friends and family about sepsis.

HOW TO SPREAD THE WORD ABOUT SEPSIS

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The following is a list of resources about sepsis that I found very helpful and patient-friendly:

www.sepsisalliance.org

www.globalsepsisalliance.org

www.sepsistrust.org

www.survivingsepsis.org

www.internationalsepsisforum.com

www.worldsepsisday.org

www.feinsteinintitute.org

http://cme.stanford.edu/septris/game/SeptrisAbout_1.html (Sepsis game for clinicians developed by Stan-ford)

http://www.newgrounds.com/portal/view/382253 (Sep-sis game for kids)

RESOURCES

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