Sepsis causes 350,000 adult deaths annually in the US alone. Sepsis Alliance focuses on raising awareness, improving education, and advocating for life-saving policies. Senior Clinical Content Advisor Marijke Vroomen Durning discusses the risk factors and best prevention methods to help in avoiding sepsis
Sepsis is one of the most common causes of death around the world. According to the World Health Organization (WHO), published data indicate there were 48.9 million sepsis cases worldwide and 11 million related deaths in 2020. This amounts to 20% of deaths globally. The number could be higher because of disparities in data collection.
Anyone can get sepsis, but older people represent the highest number of cases and sepsis-related mortality. People over 65 comprise the fastest growing population worldwide, and these numbers will increase over the next few decades. In 2019, 9% of the world’s population was over 65 (one in 11 people). By 2050, it will be 16% of the population (one in six), and the number of people 80 years and older will likely triple. The rise will be more dramatic in Europe and North America, where one in four will be over 65.
Why are older people more susceptible to sepsis?
While many healthy older people manage well on their own, age often brings with it diminishing or compromised immune function, muscle wasting, chronic illnesses, polypharmacy, and diminishing ability for self-care, which can lead to malnutrition and frailty, living in institutions, and reliance upon invasive medical devices, among other issues.
Infections can also be more difficult to diagnose in older people, which frequently leads to a delay in treatment, leading to sepsis. The most commonly shared example of this is related to mental status. An older person with a urinary tract infection might not complain of the typical symptoms that a younger adult will experience, such as burning with urination, urgency, or frequency. However, they may demonstrate other signs of illness, such as altered mental status or fever. An older person with pneumonia may become weak or fall but not have a fever or a cough. The change in mental status, weakness, and falling could be chalked up to frailty rather than infection. These assumptions delay medical care. According to Dr Cindy Hou, Chief Medical Officer of Sepsis Alliance, “Older individuals may want to bring a family, friend, or advocate to doctors’ appointments to be an active listener.” This can help healthcare professionals better understand changes in the patient they see in front of them.
Preventing infections is key to avoiding sepsis
The COVID-19 pandemic demonstrated the importance of infection prevention protocols in the community. People saw what frequent and proper hand washing, mask-wearing, and distancing could do to prevent the spread of infection. This mindset needs to continue because contrary to the popular belief that sepsis is mainly a problem that affects hospitalized patients, up to 87% of sepsis cases begin in the community. Everyone has a role to play in reducing
the spread of microbes, paying particular attention to more vulnerable populations.
To this end, Sepsis Alliance, a sepsis advocacy group in the United States and a founding member of the Global Sepsis Alliance, recently started a campaign called Infection Prevention Is Sepsis Prevention!
“Because sepsis starts with an infection, if diligence is paid toward preventing an infection from occurring in the first place, then sepsis is prevented,” Dr Hou explained. This means:
Managing chronic conditions. Following treatment plans is essential. For example, people with diseases like diabetes or chronic obstructive pulmonary disease (COPD) are at higher risk of contracting infections. Managing illnesses and consulting primary care providers or specialists when necessary are vital.
Getting all recommended vaccines. Respiratory infections, particularly pneumonia, are a common cause of sepsis. Vaccines are available for several illnesses, such as pneumococcal pneumonia, COVID-19, and influenza. Vaccinations for other illnesses, like shingles, are also important. Shingles can cause open wounds that can become infected. Everyone should consult their primary care professional to determine which vaccines are needed and when.
Practice good hand hygiene. As with during the pandemic, everyone should continue to wash their hands thoroughly and frequently with soap and water, or hand sanitizer.
Wear a mask. Masks can provide protection from sick people in crowds, especially in doctors’ offices.
Keep cuts and wounds clean. Clean all open wounds and keep them covered and protected. Use antibiotic ointment if desired.
Practice food safety. People with weakened immune systems need to avoid certain foods due to their risk of acquiring infections. These include raw or undercooked meat and poultry, raw fish, sandwich meats, and unwashed fresh fruit and vegetables.
Advocate. Patients who have indwelling catheters and other invasive devices can ask their physician when the device will be removed and follow up. If the device remains, ask why it is still there or if it can be removed.
Ask for help. Accidents in the home, missing or taking incorrect medication dosages, neglecting hygiene, and other issues can cause injury. Difficulty preparing nutritious meals can result in malnutrition. These can all increase the risk of infection.
Seek help if you notice signs of infection. Although the symptoms of infection depend on the part of the body affected, they typically include fever, redness or change of color around an injury, pus or discharge from an open wound, and increased pain.
Sepsis cannot always be prevented
Sepsis cannot always be prevented despite the prompt diagnosis and treatment of infections. However, sepsis- related deaths could be significantly reduced if sepsis is recognized and treated in a timely fashion. It is estimated that up to 80% of sepsis deaths are preventable.
Sepsis Alliance developed the mnemonic TIME to help people recognize the basic signs of sepsis.
T: Temperature is higher or lower than normal
I: May have signs of an infection or have a reason to believe there may have been exposure. For example, cutting a finger while gardening, having dental work, or having a medical procedure that introduced equipment (like a urinary catheter) or breaks the skin.
M: Change in mental status. This could be new onset of confusion or sleepiness, or a sudden change in dementia level.
E: Extreme pain, shortness of breath
Like heart attacks and stroke, sepsis is a medical
emergency. For every hour treatment is delayed, the risk of death increases between 4% and 9%.
