After 40 years as a nurse, there are certain words that immediately get my attention. “Sepsis” is one of them.
Maybe that’s because I began my career in critical care, where I saw how quickly a patient’s condition could change. Someone could appear to have a fairly routine infection and then, sometimes in a matter of hours, become critically ill.
But you don’t have to be a critical care nurse to recognize that something is wrong.
Families frequently notice the change first. Mom suddenly seems confused. Dad is breathing differently. Someone who was expected to improve after starting treatment is getting weaker instead. The family may not know the medical reason, but they know this is not normal.
September is Sepsis Awareness Month. And on September 17th, we recognize World Patient Safety Day.Together, they offer an important reminder: patients and families are not merely observers in healthcare. What they notice—and whether someone listens—can make a lifesaving difference.
So, this month’s issue of The Flametalks about sepsis: what it is, why it can be missed and what every one of us should know.
— Betty Long, RN, MHA, President/CEO, Guardian Nurses Health Advocates
What Is Sepsis?
Sepsis is the body’s extreme response to an infection. It occurs when the body’s response triggers a chain reaction that can damage its own tissues and organs. Without prompt treatment, sepsis can lead to organ failure and death.
According to the Centers for Disease Control and Prevention, approximately 1.7 million adults in the United States develop sepsis each year. At least 350,000 die during hospitalization or are discharged to hospice. Most cases begin before the patient arrives at the hospital. Not surprisingly, sepsis has been identified as the most costly condition treated in U.S. hospitals when measured by total inpatient hospital costs–more than $60 Billion every year!
Almost any infection can lead to sepsis, but the infections that trigger it most commonly begin in the lungs, urinary tract, skin or gastrointestinal tract. Pneumonia, a urinary tract infection or an infected wound can become far more serious than it initially appears.
Although bacterial infections cause most cases, viral infections—including influenza—and fungal infections can also lead to sepsis. Already taking an antibiotic does not guarantee that an infection is under control or rule out sepsis if the person is getting worse.
Anyone can develop sepsis, or septicemia, but the risk is higher for adults 65 and older, children younger than one, folks with weakened immune systems or chronic medical conditions, pregnant women or those recently postpartum, and those who recently had surgery, were hospitalized or were seriously ill.
Why Sepsis Can Be Missed
There is no single symptom that announces, “This is sepsis.” Its symptoms can resemble the flu, dehydration, medication side effects or the original infection. A person may have a fever—or may instead feel unusually cold. They may seem exhausted, confused or simply “not themselves.”
That last observation is especially important with older adults. Sudden confusion or a significant change in behavior should not automatically be dismissed as part of aging. Neither should severe weakness in someone who was functioning normally a day or two earlier. Possible warning signs of sepsis include:
- Confusion or disorientation
- Shortness of breath
- A rapid heart rate or weak pulse
- Fever, shivering or feeling very cold
- Clammy or sweaty skin
- Extreme pain or discomfort
A person with sepsis may have one or several of these symptoms. The important question is not whether every box is checked. It is whether someone with an infection is becoming seriously ill or deteriorating.
Trust the Change You See
Patients and families sometimes hesitate to raise concerns because they don’t want to overreact or be perceived as difficult.
Please……be difficult.
Or, more accurately, be persistent. There is a difference.
If someone is getting noticeably worse, “Let’s wait and see” may not be the safest plan. Tell the healthcare professional exactly what has changed:
- “She was alert yesterday, and today she is confused.”
- “His breathing is much faster than it was earlier.”
- “He’s being treated for an infection, but he’s worse.”
- “This is a significant change from her normal condition.”
- “Could this be sepsis?”
You are not trying to diagnose the patient. You are providing important information and asking the healthcare team to consider a serious possibility.
If someone with an infection is rapidly worsening or showing possible signs of sepsis, you need to seek immediate medical care. Sepsis cannot be diagnosed or treated at home. Don’t wait for the next available office appointment—or until morning—to see whether things improve.
Before You Leave
If you or someone you love is diagnosed with an infection, don’t leave the physician’s office, urgent care center or hospital with nothing more than “Call us if it gets worse.”
Ask what “worse” means.
What improvement should you expect, and when? Which symptoms require an immediate call? When should you go directly to the emergency department? Who should you contact after hours? When should follow-up occur?
Write the answers down. When people are sick, frightened or exhausted, even the clearest instructions can disappear somewhere between the examining room and the parking lot. Trust me on this.
Preventing infection also reduces the risk of sepsis. Stay current with recommended vaccinations, manage chronic conditions, practice good hand hygiene, and keep cuts and wounds clean and covered until they heal.