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27 January, 2020 00:00 00 AM

Sepsis: Everything you need to know

MD. GOLAM KIBRIA
Sepsis: Everything you need to know

Sepsis is a life-threatening illness caused by body's response to an infection. This infection injures its own tissues and organs, potentially leading to death or significant morbidity.Sepsis happens when an infection is in skin, lungs, urinary tract or somewhere else triggers a chain reaction throughout body.

The global epidemiological burden of sepsis is difficult to ascertain. It is estimated to affect more than 30 million people worldwide every year, potentially leading to 6 million deaths (Fleischmann et al., 2016). The burden of sepsis is most likely highest in low and middle-income countries (WHO, 2018).

According to the Centers for DiseaseControl and Prevention (CDC), there are more than 1.5 million cases of sepsis each year. This type of infection kills more than 250,000 Americans a year.

It is estimated that 3 million newborns and 1.2 million children suffer from sepsis globally every year (Fleischmann-Struzek et al., 2018). Three out of every ten deaths due to neonatal sepsis are thought to be caused by resistant pathogens (Laxminarayan, et al. 2016).

One in ten deaths associated with pregnancy and childbirth is due to maternal sepsis with over 95% of deaths due to maternal sepsis occurring in low- and middle-income countries (Say et al., 2014). One million newborn deaths are associated with maternal infection, such as maternal sepsis, each year (WHO, 2018).

What are the causes of sepsis?

Bacterial infections are the most common cause of sepsis. When germs get into a person’s body, they can cause an infection. If that infection is not stopped, it can cause sepsis.The most frequently identified germs that cause infections that can develop into sepsis include Staphylococcus aureus (staph), Escherichia coli (E. coli), and some types of Streptococcus (CDC).

Any infection can trigger sepsis, but pneumonia, abdominal infection, kidney infection, and bloodstream infection are more likely to cause sepsis. Fungal infection-induced sepsis is also on the rise (Martin, 2012).

Who is at risk of sepsis?

Sepsis is possible in anyone with an infection that develops a complication, but some vulnerable populationssuch as elderly people, younger children, pregnant women, neonates, hospitalized patients and people who have weakened immune system, Chronic illness, including diabetes, kidney or liver disease, AIDS, and cancer, and  severe wound, including severe burns (CDC, 2019).

Vulnerability to sepsis is becoming more widespread. More opportunities for infections become complicated.More people having invasive procedures and organ transplants, and more are taking immunosuppressive drugs and chemotherapies are at risk. Rising in antibiotic resistance, which happens when an antibiotic loses its ability to resist or kill bacteria (WHO, 2018).

What are signs and symptoms of sepsis?

Sepsis can be the clinical manifestation of infections acquired either in the community setting or in health care facilities.People with sepsis can present various signs and symptoms at different times. Warning signs and symptoms include fever or low temperature and shivering, altered mental status, difficulty breathing/rapid breathing, increased heart rate, weak pulse/low blood pressure, low urine output, cyanotic or mottled skin, cold extremities, and extreme body pain or discomfort (CDC, 2018). Suspecting sepsis is a first major step towards early recognition and diagnosis.

Severe sepsis occurs when there’s organ failure. Symptoms of septic shock include the symptoms of severe sepsis, plus a very low blood pressure.

What are the serious effects of sepsis?

Septic shock has close to a 50 percent mortality rate (Mayo Clinic). Severe sepsis or septic shock can also cause complications. Small blood clots can form throughout your body. These clots block the flow of blood and oxygen to vital organs and other parts of your body. This increases the risk of organ failure and tissue death (gangrene).

How is sepsis diagnosed?

Sepsis spreads within a person’s body from the original source of infection to other organs through the bloodstream.If having symptoms of sepsis, some test is done to make a diagnosis and determine the severity of infection.One of the first tests is a blood test which is checked for complications, such as infection, clotting problems, abnormal liver or kidney function, decreased amount of oxygen, an imbalance in minerals called electrolytes that affect the amount of water in body as well as the acidity of blood.

Depending on symptoms and the results of blood test, other tests is done including a urine test (to check for bacteria in your urine), a wound secretion test (to check an open wound for an infection) and a mucus secretion test (to identify germs responsible for an infection).

If the source of an infection cannot be determined using the above tests, internal view of body using one of the X-rays to view the lungs, CT scans to view possible infections in the appendix, pancreas, or bowel area; ultrasounds to view infections in the gallbladder or ovaries, and MRI scans, which can identify soft tissue infections.

How is sepsis managed as nurse collaboratively?

If not recognized early and managed promptly, it can lead to septic shock, multiple organ failure and death. The source of the infection is identified and treated. Administer appropriate antibiotics via IV to fight infection. Antimicrobial resistance is a major factor determining clinical unresponsiveness to treatment and rapid evolution to sepsis and septic shock. Sepsis patients with resistant pathogens have been found to have a higher risk of hospital mortality (WHO, 2018).

Early fluid resuscitation and oxygen administrationto maintain blood flow and oxygen to organs is important in the sepsis management. In addition, vasopressors may be required to improve and maintain tissue perfusion. Repeated exams and diagnostics, including monitoring vital signs, will guide the appropriate management of sepsis over time (WHO, 2018).

Sepsis is treated with insulin to stabilize blood sugar, corticosteroids to reduce inflammation, and painkillers to provide comfort.

Other types of treatment, such as kidney dialysis or assisted breathing with a machine, might be necessary. Sometimes surgery is required to remove tissue damaging by the infection (CDC, 2019).

What are sepsis preventions?

The measures are particularly important for the very young, older people, and others who are vulnerable to complications of infection. According to CDC, there are the following preventive measures to reduce the risk of an infection leading to sepsis.

1. Talk to doctor or nurse about steps to prevent infections. Some steps include taking good care of chronic conditions and getting recommended vaccines.

2. Practice good hygiene, such as hand washing, and keeping cuts clean and covered until healed.

3. Know the symptoms (fever, chills, rapid heart rate and rapid breathing, rash, or confusion and disorientation) of sepsis.

4. Get medical care immediately if sepsis is suspected or have an infection that is not getting better or is getting worse.

5. Taking a prescribed course of appropriate antibiotics as recommended by a healthcare professional, even if started to feel better.

 

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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