Combatting Sepsis through prevention

In Germany, 70,000 people die from septic syndrome every year – a condition which is brought about when the body is unable to effectively combat a systemic infection. On September 13, World Sepsis Day aims to raise awareness about the dangers of the disease and the importance of preventative measures for overall public health.

For every hour in which sepsis is not adequately treated, the chances of survival decreases by an average of 7.6 percent. The probability of surviving sepsis or septic shock after more than nine hours without anti-infective therapy is 25 percent. Antibiotic treatment within the first 60 minutes saves an average of four out of five patients, and according to the Robert Koch Institute, sepsis is the most frequent cause of death in Germany as a result of infection. [1] According to estimates by the World Health Organization (WHO), more than 30 million people suffer sepsis every year. Of that 30 million, six million will die. [2]

From an economic point of view, sepsis treatment costs $27 billion US dollars per year in the USA alone, making it the most cost-intensive inpatient disease in the country. [3] Data regarding the German population indicates that the expense per sepsis case in that country can exceed €27,000 euros.

“After cardiovascular diseases and cancer, sepsis is the third most frequent cause of death in Germany. Unfortunately, the disease is often underestimated and diagnosed too late.”

Dr. med. Andreas Glöckner, Medical Director

The figures show the devastating extent of this disease. Sepsis is often caused by pneumonia or an infection of the gastrointestinal tract.

When the pathogens enter the bloodstream from these sources, they spread rapidly and set in motion a series of initially helpful defensive responses in the body. This, however, becomes problematic when antibiotic-resistant bacteria are involved and it is no longer possible to treat the pathogens with the “conventional weapons” used to date. The advancement and increase of (multi-)resistant bacteria poses new challenges for the calculated and targeted antibiotic therapy of sepsis, making early treatment critical for a quick recovery.  

A further difficulty lies in the diagnosis, especially when valuable time passes before sepsis and the responsible pathogens can be clearly identified. An entire branch of research is working on making pathogen identification faster and safer.

Getting to the root of the problem

Effective preventative measures are even more important than reactionary treatment. First and foremost, thorough hand hygiene practice should be encouraged in all healthcare facilities. Approximately 80 percent of all sepsis cases infections are transmitted by the hands, and with each infection that is avoided, the risk of developing a life-threatening case of sepsis decreases.

Septic events occur relatively frequently, especially in health facilities such as hospitals. Intensive care units are the areas that see the highest number of sepsis cases. It is precisely here in the ICU that hand disinfection is often only implemented quantitatively, leaving the quality of disinfection unknown. Hand hygiene compliance rates of less than fifty percent are not uncommon. [4] The increasing workload in nursing is a significant obstacle to proper hand disinfection.

With regard to infrastructure, some factors can be identified in practice that have a negative influence on hand hygiene behaviour. Missing or poorly placed disinfectant dispensers that are not optimized for the workflow of hospital staff can contribute to insufficient hand hygiene compliance. This highlights the importance of properly placed disinfectant stations to drive proper hand hygiene compliance throughout healthcare facilities. Point-of-care mounting equipment allows for adaptive solutions that can make hand hygiene easier and more accessible. Innovations such as the use of high-visibility colours for greater attention, insights into the optimum installation locations, and intelligent dispenser systems that continuously record their usage data are all advancements aimed to increase compliance and decrease infections.

A study by Cure and Van Enk from 2015 impressively shows the positive influence of an optimized dispenser location on hand hygiene and thus on infection prevention. The scientists found that improved accessibility and visibility of a hand disinfectant dispenser goes hand in hand with an increased compliance rate. [5] In addition, there are numerous other scientifically researched measures that can improve the hygiene behaviour of doctors and nursing staff, such as consistent feedback, training and memory aids. [6,7]

The solutions are obvious; they just need to be put into practice.

“The aim must be to prevent nosocomial infections in order to remove the basis for a sepsis. Hand disinfection plays a key role in this.”

Dr. med. Andreas Glöckner, Medical Director

The WHO also advocates a preventive approach to avoid sepsis-associated deaths. True to the motto “Prevention of infection means prevention of sepsis”, it dedicated World Hand Hygiene Day 2018 to sepsis prevention in medical facilities. With its sepsis resolution a year earlier, the organization called on its more than 190 member states to implement these measures at the national level. For the WHO, the ultimate goal is the prevention of nosocomial infections. [8]

As we approach the 8^th anniversary of World Sepsis Day on September 13^th, efforts will continue to raise awareness about the dangers of sepsis. Events such as the Global Day of Action put on by the Global Sepsis Alliance continue to create a safer environment for all. Their goal is to reduce the number of sepsis deaths worldwide by one fifth by 2020 vs 2010 statistics. 

This target may appear difficult to achieve, but an overall improvement in hand hygiene performance can likely play an important role in achieving this goal.

Sources:

[1] Kumar, A., Roberts, D., Wood, K. E., et al. (2006). Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical care medicine, 34(6), 1589-1596.

[2] Fleischmann C., Scherag A., Adhikari NK., et al. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med 2016; 193(3): 259-72.

[3] Torio CM., Moore BJ.National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013: Statistical brief #204. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs: 2016: Rockville (MD)

[4] Eckmanns T, Rath A, Brauer H, Daschner F, Rüden H, Gastmeier P (2001) Compliance der Händedesinfektion auf Intensivstationen. Dtsch Med Wochenschr 126(25-26):745–74

[5] Cure, L., Van Enk, R.: Effect of hand sanitizer location on hand hygiene compliance. American Journal of Infection Control, 2015, Vol. 43: 917-921

[6] Do WiFi-based hand hygiene dispenser systems increase hand hygiene Compliance? American Journal of Infection Control (2018)World Health Organization, 70. World Health Assembly (Hrsg.): Improving the prevention, diagnosis and clinical management of sepsis. Report by the Secretariat. 2017.

[7] Diefenbacher, S., et al. A quasi-randomized controlled before–after study using performance feedback and goal setting as elements of hand hygiene promotion. Journal of Hospital Infection (2019)

[8] World Health Organization, 70. World Health Assembly (Hrsg.): Improving the prevention, diagnosis and clinical management of sepsis. Report by the Secretariat. 2017.