Cheryl Martin (Host): Sepsis can be a life-threatening condition. Coming up, a deep dive into the world of sepsis and its complications if contracted in the hospital. Our guest, Dr. Tiffany Javier, she's completing her third year of a residency in internal medicine as chief resident at Valley Hospital Medical Center. This is Health Talk with the Valley Health System presented by the Valley Health System. I'm Cheryl Martin. Dr. Javier, so glad to have you on to talk about this important health risk.

Tiffany Javier, DO: Hi, I'm so excited, Cheryl, to be talking about this today.

Host: So, first off, what is sepsis?

Tiffany Javier, DO: Sepsis has a definition that has definitely evolved through the years, but it is a life-threatening organ dysfunction caused by a dysregulated response to infection. Essentially, it's a heightened immune response triggered by infection that shows us the infection may have spread from its original source, and maybe our bodies are having a hard time fighting the infection on its own without medical treatment.

So, we see signs of this when patients have heightened temperature changes, heart rate, respiratory rate, even low blood pressure. Sepsis is ultimately a clinical diagnosis because we identify it through a combination of signs and symptoms rather than a single laboratory test.

Host: So, can sepsis be prevented?

Tiffany Javier, DO: Sepsis can be prevented two different ways. Primary prevention is when we want to directly prevent infection from occurring in the first place. For example, vaccinations can reduce the incidence of infections that ultimately lead to sepsis. Certain protocols in our hospital can actually prevent healthcare-associated infections from occurring in a patient who maybe didn't originally come to the hospital for an infection-related reason.

Even if we manage chronic conditions more readily, like diabetes, COPD, kidney disease, and cardiovascular disease, this can reduce the risk of sepsis in a patient who has any of these medical issues. But secondary prevention is really what we end up doing in the hospital, which is when we want to prevent a known infection from progressing to sepsis.

So, this requires some early recognition and rapid treatment once we know it is there. At Valley Hospital, we actually use sepsis screening protocols, code sepsis, to aid in early recognition. Also, it's recommended that we start antimicrobial therapy even as soon as within one hour if we think the sepsis is severe, or one to three hours if we feel it is sepsis without the late-stage complications.

Host: Talk more about how sepsis is contracted in a hospital setting.

Tiffany Javier, DO: So, hospital-acquired sepsis actually even accounts for about 12% of all sepsis cases, but it carries a higher mortality. So, sepsis can be contracted in the hospital almost in any body system. Pneumonia is probably the most common cause of hospital-acquired infection that ultimately leads to sepsis. Some cases are ventilator-associated, but also, aspiration, immobility, post-surgical status. These are definitely things that patients can experience that ultimately lead to pneumonia. Bloodstream infections can occur directly from the invasive things that we do in the hospital, including access lines like central lines, or the bacteria or fungi from an original source can actually translocate to the blood.

We commonly can see patients who had an ongoing infection without adequate treatment that ultimately have bacteria in their bloodstream that matches what is from the original source. Intraabdominal infections can occur after surgery or with the introduction of nasogastric tubes. UTIs are very commonly associated with catheters that we use on patients. Skin and soft tissue infections can also occur from surgical sites or even pressure ulcers that are obtained while a patient is in the hospital bed, not being frequently repositioned. Clearly, you can see how any body system can be affected by an infectious process during a hospital stay. And it progresses to sepsis if we don't recognize it early enough or efficiently treated.

Host: So, if you contract sepsis in the hospital, what should you do as a patient?

Tiffany Javier, DO: I feel the most important thing to do if you contract sepsis in the hospital is to immediately notify your team, because this is a medical emergency where every hour matters. If you develop any new symptoms while you're in the hospital, such as fever, chills, confusion, breathing faster than usual, having a faster heart rate than usual, or even just this general sense of feeling worse, it's important to alert your nursing staff and medical team immediately.

It's actually very common for patients and families to be the first to notice when there is signs of clinical deterioration. And so, that gives us the opportunity to administer treatment and initiate a workup as providers. We would want to start therapy immediately, including broad-spectrum antimicrobials, IV fluids, blood tests, and ultimately addressing the source.

Host: Because getting sepsis is life-threatening, isn't it?

Tiffany Javier, DO: Yes, absolutely.

Host: What are some of the other long-term effects that sepsis can have on a patient and how can they be managed?

Tiffany Javier, DO: Sepsis can lead to complications in nearly every organ system. Respiratory complications include hypoxemia, so a patient requiring supplemental oxygen or even acute respiratory distress syndrome. Cardiovascular complications include septic shock, with shock being defined as severe hypotension that requires vasopressor support, or even sepsis-induced cardiomyopathy, where we see the heart does not beat what is considered normally, whether that is dysfunction with the systolic side or the diastolic side.

Acute kidney injury can occur in sepsis, even to the point of requiring renal replacement therapy with dialysis. Neurologic complications can manifest as encephalopathy, such as delirium or obtundation. These are just complications that occur more likely in the acute phase that we see in the hospital, but only approximately half of sepsis survivors actually recover fully.

More often, there are these long-term complications that leave patients with persistent impairments, so things like cognitive impairment, functional disability, psychiatric complications, recurrent infection, and even rehospitalization.

Host: So, is there anything the patient can do to eliminate the long-term effects or prevent them, I should say?

Tiffany Javier, DO: I think as far as the patient's role in preventing complications kind of takes the backburner. I do believe at the point of sepsis when it is at the level of causing complications, it is the responsibility of your providers to recognize early when there are signs of deterioration and to initiate treatment as soon as possible. This is definitely something that is even a global issue, because there are certain initiatives that are trying to recognize sepsis earlier and treat it even faster.

Host: What are the takeaways you want us to walk away with as we discuss the complications of sepsis and just the importance of being knowledgeable about it?

Tiffany Javier, DO: I think the main takeaways when it comes to sepsis is that it needs to be recognized early and treated rapidly. And so, one needs to be educated on what are the signs of sepsis even at its earliest. I think making sure that you're aware of also your hospital protocols as a provider is very important in order to have the best outcome when it comes to sepsis.

Host: Dr. Tiffany Javier, thanks so much for coming on to educate us about sepsis and its complications extremely helpful. Thank you so much.

Tiffany Javier, DO: Thank you so much for having me, Cheryl.

Host: For more information, visit our website, valleyhealthsystemlv.com. And if you found this podcast helpful, please share it on your social media and check out our podcast library for other topics of interest to you. This is Health Talk with the Valley Health System, presented by the Valley Health System. Thanks for listening.

Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians.