Sepsis is a life-threatening disease that arises when the body's response to infection injures its own tissue and organs. It affects nearly 750,000 Americans each year, and every case of sepsis adds significant cost and days to hospital length of stay.
In this segment, Sheri Hahn, MSN, ARNP, FNP-C, discusses this potentially life-threatening infection, and the steps you can take to protect yourself.
Selected Podcast
Sepsis: What You Need to Know About this Emergent Condition
Featured Speaker:
Sheri Hahn, ARNP
Sheri Hahn, ARNP is a nurse practitioner with Florida Hospital Memorial Medical Center. Transcription:
Sepsis: What You Need to Know About this Emergent Condition
Melanie Cole (Host): According to the CDC, sepsis is the body’s overwhelming and life-threatening response to infection, which can lead to tissue damage, organ failure, and even death. My guest today, is Sheri Hahn. She’s a Certified Family Nurse Practitioner at Florida Hospital. Welcome to the show, Sheri. What is sepsis?
Sheri Hahn (Guest): Like you said, Melanie, it’s a complication that’s caused when the body has an overwhelming and potentially life-threatening response to infection. Most people can fight off an infection, but some people can’t. In a worst-case scenario, it can lead to tissue damage, organ failure, and sometimes, even death.
Melanie: Are there certain people with an infection that are more likely to get sepsis – people with immunocompromised systems, or elderly? Who’s most likely to get it?
Sheri: Oh, absolutely. Everyone is at risk, but individuals who are at greatest risk for developing sepsis are neonates and infants – those children under the age of one – elderly patients, of course, over the age of 65. Frequently, we see elderly patients that suffer from simple urinary tract infections that turn into sepsis – that quickly advances to sepsis. Immunocompromised patients, or more specifically, patients with diabetes, and that’s because these patients tend to have poor wound healing or neuropathies, which means they have decreased sensations in their extremities. They’re often unaware that they have suffered an injury that can lead to an infection. Patients with renal failure, particularly those patients that are on dialysis or patients that have indwelling urinary catheters -- again, any time you introduce a foreign object into your body such as a catheter, it becomes a portal or an opportunity for that infection. Our patients that are in nursing homes or long-term care facilities, recent or prolonged exposure to antibiotics, recent surgery or hospitalizations, IV drug abusers, smokers, alcoholics, obese patients, and people who are malnourished all are at increased risk. So, you can see that covers just about anybody.
Melanie: Because it’s such a quick moving situation, what are some of the signs and symptoms that somebody should be aware of that would concern them enough to call 9-1-1 and say it’s possibly sepsis?
Sheri: Well, symptoms are very wide-spread and can vary significantly from patient-to-patient, but some of those symptoms are subtle, such as confusion and agitation. They can be painful urination or a decrease in your urinary output, diarrhea, increased heart rate, increased respiratory rate, any alteration in your body temperature, such as a fever that is classified as anything over 101.5, or hypothermia when your temperature is below 95, when you have cool or clammy skin – your extremities feel cool or clammy to the touch -- when your blood pressure is altered – when it’s either extremely high or extremely low -- when you notice a warm or hot, reddened area on your skin or a red streak coming from an area particularly in an area of a wound. Those are all good reasons to seek out your primary care provider or the Emergency Room.
Melanie: Let’s talk about that for a second. If somebody thinks that they’ve got an infection that is possibly becoming sepsis, do they call 9-1-1? Do they drive themselves? And if they call 9-1-1, is it that important that they say this could be sepsis so that EMS knows what to look for?
Sheri: Anytime a person is concerned enough that they’re questioning in their mind should they call 9-1-1, I always suggest that they do. If that’s something that they’ve even questioning, then it’s better to be safe than sorry. Often times it’s something that we see in the primary care office that we can evaluate an order the proper labs or imaging tests and get our patients going down the right path before it requires hospitalization, but that’s a big part of what we do. We have to make sure that patients are maintaining that chronic disease management, seeing their primary care provider, making sure that they are being cared for properly. It doesn’t always require going to the Emergency Room or being hospitalized, but prevention is the key and hoping that we don’t get to that point.
Melanie: And how do you assess or diagnose that it is sepsis, and then what are the resulting treatments? Is there a way to stop this from progressing?
Sheri: Yep. First, it’s going to be a big fact-seeking mission. We’re going to do a history. We’re going to look at clinical findings. We’re going to order pertinent labs and imaging based on where we think that infection may be – is it respiratory? Do we need to do chest X-rays? Is it urinary? Do we need to order a urinalysis and urine culture? Just where do we think the source of the infection is? Urinary – urosepsis is a big one that we see, and often times in the elderly population, the first sign of that is very subtle. It’s just confusion. They may not act themselves. They may be having frequent falls. We check their urine, and lo and behold they’ve got some signs of infection in their urine dip, and we send it off for culture. We start them on an antibiotic, and the culture comes back and tells us exactly what the organism is, and make sure that the antibiotic that we have selected is appropriate for treating that organism. If it’s caught early on and we get them started on the appropriate antibiotic and get them treated, then yes, we can keep them out of the hospital. That is, obviously, our ultimate goal.
Melanie: Are there different antibiotics, Sheri, that would work for sepsis once you’ve identified what type of organism that this is?
Sheri: Absolutely, there’s all different kinds of antibiotics depending on the organism -- there’s gram positive, gram negative, there’s broad spectrum. That’s all part of identifying exactly what the organism is. Another big thing – we’re always encouraging our patients that if an antibiotic is prescribed by your primary care provider, it’s imperative that you take that antibiotic until the course of treatment is complete, even if you feel better a few days into treatment – encouraging those super-bugs that’s all over the media and that you’re hearing about these days.
Melanie: So, sepsis can be stopped, if caught early?
Sheri: Yes, it can. And the goal is to prevent an infection from becoming septic – or becoming sepsis. You want to take – somebody can have an ordinary infection, a wound infection, that can progress to sepsis or an ordinary urinary tract infection that can progress to urosepsis or pneumonia that can progress to an overwhelming sepsis. The goal is to, obviously, see those patients, treat them, and give them the proper modalities to prevent them from becoming septic, and keeping them out of the hospital.
Melanie: Is there a way to prevent sepsis?
Sheri: Well, yeah, prevention is always key. You want to follow good hygiene. Simple things like good handwashing, and cover your mouth when you sneeze and cough, getting recommended vaccines – that’s a big one. That’s something that you need to make sure you’re having those conversations with your primary care provider, and again, good chronic disease management -- making sure you’re following up with your primary care provider, making sure that your hypertension, your diabetes, your renal disease, are all well-controlled. Or, make sure you don’t progress to having any of those chronic diseases. Smoking cessation, that’s a big one. People who smoke are at a huge risk for developing sepsis before someone who doesn’t smoke. People who drink excessively are at a greater risk. All of these things are things that your primary care provider wants to educate you on, and help you with, and give you the modalities to work on prevention and not do.
Melanie: Thank you, so much, Sheri, for being with us today. It’s such important information for listeners to hear. You’re listening to Health Chats by Florida Hospital. For more information, you can go to HCPPhysicians.org, that’s HCPPhysicians.org. This is Melanie Cole. Thanks, so much for listening.
Sepsis: What You Need to Know About this Emergent Condition
Melanie Cole (Host): According to the CDC, sepsis is the body’s overwhelming and life-threatening response to infection, which can lead to tissue damage, organ failure, and even death. My guest today, is Sheri Hahn. She’s a Certified Family Nurse Practitioner at Florida Hospital. Welcome to the show, Sheri. What is sepsis?
Sheri Hahn (Guest): Like you said, Melanie, it’s a complication that’s caused when the body has an overwhelming and potentially life-threatening response to infection. Most people can fight off an infection, but some people can’t. In a worst-case scenario, it can lead to tissue damage, organ failure, and sometimes, even death.
Melanie: Are there certain people with an infection that are more likely to get sepsis – people with immunocompromised systems, or elderly? Who’s most likely to get it?
Sheri: Oh, absolutely. Everyone is at risk, but individuals who are at greatest risk for developing sepsis are neonates and infants – those children under the age of one – elderly patients, of course, over the age of 65. Frequently, we see elderly patients that suffer from simple urinary tract infections that turn into sepsis – that quickly advances to sepsis. Immunocompromised patients, or more specifically, patients with diabetes, and that’s because these patients tend to have poor wound healing or neuropathies, which means they have decreased sensations in their extremities. They’re often unaware that they have suffered an injury that can lead to an infection. Patients with renal failure, particularly those patients that are on dialysis or patients that have indwelling urinary catheters -- again, any time you introduce a foreign object into your body such as a catheter, it becomes a portal or an opportunity for that infection. Our patients that are in nursing homes or long-term care facilities, recent or prolonged exposure to antibiotics, recent surgery or hospitalizations, IV drug abusers, smokers, alcoholics, obese patients, and people who are malnourished all are at increased risk. So, you can see that covers just about anybody.
Melanie: Because it’s such a quick moving situation, what are some of the signs and symptoms that somebody should be aware of that would concern them enough to call 9-1-1 and say it’s possibly sepsis?
Sheri: Well, symptoms are very wide-spread and can vary significantly from patient-to-patient, but some of those symptoms are subtle, such as confusion and agitation. They can be painful urination or a decrease in your urinary output, diarrhea, increased heart rate, increased respiratory rate, any alteration in your body temperature, such as a fever that is classified as anything over 101.5, or hypothermia when your temperature is below 95, when you have cool or clammy skin – your extremities feel cool or clammy to the touch -- when your blood pressure is altered – when it’s either extremely high or extremely low -- when you notice a warm or hot, reddened area on your skin or a red streak coming from an area particularly in an area of a wound. Those are all good reasons to seek out your primary care provider or the Emergency Room.
Melanie: Let’s talk about that for a second. If somebody thinks that they’ve got an infection that is possibly becoming sepsis, do they call 9-1-1? Do they drive themselves? And if they call 9-1-1, is it that important that they say this could be sepsis so that EMS knows what to look for?
Sheri: Anytime a person is concerned enough that they’re questioning in their mind should they call 9-1-1, I always suggest that they do. If that’s something that they’ve even questioning, then it’s better to be safe than sorry. Often times it’s something that we see in the primary care office that we can evaluate an order the proper labs or imaging tests and get our patients going down the right path before it requires hospitalization, but that’s a big part of what we do. We have to make sure that patients are maintaining that chronic disease management, seeing their primary care provider, making sure that they are being cared for properly. It doesn’t always require going to the Emergency Room or being hospitalized, but prevention is the key and hoping that we don’t get to that point.
Melanie: And how do you assess or diagnose that it is sepsis, and then what are the resulting treatments? Is there a way to stop this from progressing?
Sheri: Yep. First, it’s going to be a big fact-seeking mission. We’re going to do a history. We’re going to look at clinical findings. We’re going to order pertinent labs and imaging based on where we think that infection may be – is it respiratory? Do we need to do chest X-rays? Is it urinary? Do we need to order a urinalysis and urine culture? Just where do we think the source of the infection is? Urinary – urosepsis is a big one that we see, and often times in the elderly population, the first sign of that is very subtle. It’s just confusion. They may not act themselves. They may be having frequent falls. We check their urine, and lo and behold they’ve got some signs of infection in their urine dip, and we send it off for culture. We start them on an antibiotic, and the culture comes back and tells us exactly what the organism is, and make sure that the antibiotic that we have selected is appropriate for treating that organism. If it’s caught early on and we get them started on the appropriate antibiotic and get them treated, then yes, we can keep them out of the hospital. That is, obviously, our ultimate goal.
Melanie: Are there different antibiotics, Sheri, that would work for sepsis once you’ve identified what type of organism that this is?
Sheri: Absolutely, there’s all different kinds of antibiotics depending on the organism -- there’s gram positive, gram negative, there’s broad spectrum. That’s all part of identifying exactly what the organism is. Another big thing – we’re always encouraging our patients that if an antibiotic is prescribed by your primary care provider, it’s imperative that you take that antibiotic until the course of treatment is complete, even if you feel better a few days into treatment – encouraging those super-bugs that’s all over the media and that you’re hearing about these days.
Melanie: So, sepsis can be stopped, if caught early?
Sheri: Yes, it can. And the goal is to prevent an infection from becoming septic – or becoming sepsis. You want to take – somebody can have an ordinary infection, a wound infection, that can progress to sepsis or an ordinary urinary tract infection that can progress to urosepsis or pneumonia that can progress to an overwhelming sepsis. The goal is to, obviously, see those patients, treat them, and give them the proper modalities to prevent them from becoming septic, and keeping them out of the hospital.
Melanie: Is there a way to prevent sepsis?
Sheri: Well, yeah, prevention is always key. You want to follow good hygiene. Simple things like good handwashing, and cover your mouth when you sneeze and cough, getting recommended vaccines – that’s a big one. That’s something that you need to make sure you’re having those conversations with your primary care provider, and again, good chronic disease management -- making sure you’re following up with your primary care provider, making sure that your hypertension, your diabetes, your renal disease, are all well-controlled. Or, make sure you don’t progress to having any of those chronic diseases. Smoking cessation, that’s a big one. People who smoke are at a huge risk for developing sepsis before someone who doesn’t smoke. People who drink excessively are at a greater risk. All of these things are things that your primary care provider wants to educate you on, and help you with, and give you the modalities to work on prevention and not do.
Melanie: Thank you, so much, Sheri, for being with us today. It’s such important information for listeners to hear. You’re listening to Health Chats by Florida Hospital. For more information, you can go to HCPPhysicians.org, that’s HCPPhysicians.org. This is Melanie Cole. Thanks, so much for listening.