______________________________ Infection Control for New York Health Care Professionals ‒ 2024 Update
Data gathered by the National Healthcare Safety Network (NHSN) in 2022 showed the following sepsis data in 5,221 acute care facilities [34]: • Sepsis contributed to at least 350,000 deaths annually in the United States and at least at least 1.7 million adult hospitalizations. • 73% of hospitals reported having a sepsis program, ranging from 53% among hospitals with 0–25 beds to 95% among hospitals with >500 beds. • Only 55% of all hospitals provide sepsis program lead- ers with dedicated time to manage their sepsis program and conduct daily activities. • 1 out of 3 patients that died during hospitalization had sepsis. II. New York State Sepsis Improvement Initiative and Rory Staunton’s Law (as it applies to healthcare professionals) . A. Purpose: 1. To increase early recognition of suspected sepsis by all healthcare professionals by requiring such individuals to complete course work or training on sepsis. 2. Stress the importance of timely initiation of evidence-based protocols to improve sepsis out- comes. B. New York State regulations at 10 NYCRR §§ 405.2 and 405.4 require hospitals to among other things 1. Adopt evidence-based protocols to ensure early diagnosis and treatment of sepsis. 2. Ensure hospital staff are trained to implement such sepsis protocols. The Public Health and Health Planning Council and the Commissioner of Health amended sections 2800 and 2803 of the Public Health Law, Sections 405.2 and 405.4 of Title 10 (Health) of the Official Compilation of Codes, Rules and Regulations of the State of New York law [35]. Section 4 reads, in part, “Sepsis protocols must include components specific to the identification, care, and treatment of adults and of chil- dren, and must clearly identify where and when components will differ for adults and for children.” Rory’s Regulations is a law named in honor of a 12-year-old boy who died after an infection from a laceration he received at school led to sepsis. This law requires hospitals to take the following measures [35]. • Implement an evidence-based process, including suit- able training, resources, and equipment for healthcare providers, for quickly recognizing and treating sepsis in adults and children
• Collect sepsis data to improve the quality of care and provide these data to the state annually • Implement a Parent’s Bill of Rights to ensure parents and primary care providers receive vital information about children’s care The Rory Stanton Foundation, now called END SEPSIS, has raised awareness of sepsis and treatment, and Rory’s Regula- tions have saved an estimated 16,000 lives since 2015. III. Causes of Sepsis [35] A. Development of sepsis following infection 1. Bacterial infections commonly trigger sepsis, although other microbial infections (e.g. fungal or viral) can also trigger sepsis 2. Populations at increased risk of developing sepsis include: a. The very young (under 1 year), and individu- als 65 years of age and older; b. People with chronic conditions such as dia- betes, lung disease, kidney disease, or cancer; and c. People with impaired immune systems. 3. Sepsis most commonly results from infection in the lungs, urinary tract, skin, and/or gastroin- testinal tract VI. Early Recognition of Sepsis A. Manifestations of sepsis based on types of infections and host factors B. Some people may have subtle sepsis presentations. C. Signs and symptoms that may be associated with sepsis in persons with confirmed or suspected infection can include: 1. Altered mental state, shortness of breath, fever, clammy or sweaty skin, extreme pain or discom- fort, high heart rate. 2. Signs and symptoms in children and the elderly: a. Symptoms of sepsis in older adults may be subtle and include rapid heart rate; rapid respiratory rate; a high white blood cell count; and fever. b. Fever is the most common presenting symp- tom in children, although very young chil- dren may have a lower temperature. Other symptoms may include sudden changes in temperature, heart, and respiration, very warm or cool to the touch, listlessness, irritability, difficulty eating, and decreased urination [36]. 3. Severe forms of sepsis including septic shock.
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