Infection Control for New York Health Care Professional ‒ 2024 Update ________________________________
D. If a person presents with suspected or confirmed infection, healthcare professionals should assess for signs of and risk factors for sepsis. Risk factors for sepsis include the following [37]: • Diabetes • Malignancy • Chronic kidney and liver disease • Use of corticosteroids • Immunosuppressed state • Burns • Major surgery • Trauma • Presence of indwelling catheters • Prolonged hospitalization • Hemodialysis • Extremes of age V. Principles of Sepsis Treatment [1] A. Prompt diagnosis and treatment are critical for opti- mal outcomes; there is increased morbidity/mortality with delayed recognition and response. B. Recommended diagnostic modalities include blood cultures and other testing to identify source and site of infection and organ dysfunction. C. Recommended treatment of sepsis includes adminis- tration of appropriate intravenous (IV) antimicrobial therapy, with source identification and de-escalation of antibiotics as soon as feasible. VI. Patient Education and Prevention [1] A. Preventing infection: Hand hygiene, wound care, and vaccination. B. Risk factors (high-risk patients). See above. C. Warning signs and symptoms of sepsis. See above. D. Seeking immediate care for worsening infection and signs and symptoms of sepsis. E. Giving relevant history and information to clinicians. The June 2019 revision on sepsis by the NYSDOH includes the following protocol for hospitals. The Sepsis Protocol [35]: Hospitals shall establish, monitor, review and update when appropriate a sepsis protocol based on current evidence. I. Objectives: Protocol/s established by hospitals shall, (a) assist in rapid identification of patients with severe sepsis and septic shock; (b) specify an approach to stratifying patients into sepsis, severe sepsis, and septic shock based on appropriate clinical and laboratory findings; (c) specify treatment approaches. II. Inclusion and Exclusion criteria : Protocols shall contain processes to rapidly identify individuals appropriate for treatment. Protocols can be tailored specific to popula-
tions like newborns and infants in NICU, pregnant women, etc. Protocols shall include explicit criteria defin- ing those patients who should be excluded from protocols, such as patients with certain clinical conditions or those who have elected palliative care. III. Basic frame: A basic framework for both adult and pediatric protocols must address the following: (1) the physiologic measurements that will be used to guide resuscitation interventions; (2) the time frame goals for interventions such as fluid administration; (3) need to obtain blood cultures and cultures from identified infec- tion sources prior to antibiotic administration; (4) the goal for timely administration of broad spectrum antibiotics; 5) criteria for on-going treatment or transfer to more intensive level of care. IV. Adult protocol - minimum requirements: Protocols for adult patients must include consideration of the following elements, based on evidence-based guidelines, and target timeframes for critical interventions: (1) measurement of a blood lactate level; (2) collection of blood cultures; (3) administration of broad-spectrum antibiotics; (4) fluid administration; (5) fluid status assessment; (6) vasopres- sors and remeasurement of lactate for eligible patients. V. Pediatric protocol - minimum requirements: Protocols for pediatric patients must include consideration of the following elements, based on evidence-based guidelines: (1) blood culture collection; (2) antibiotic administration; (3) fluid administration and therapeutic endpoints. Centers for Medicare & Medicaid Services [CMS] Severe Sepsis and Septic Shock: Management Bundle [SEP-1] CMS, a division of the U.S. Department of Health and Human Services (USDHHS), is the federal agency that provides health coverage to more than 160 million individuals through Medi- care, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace [38]. In 2015, CMS added bundled care and public reporting of the Early Management Bundle Severe Sepsis and Septic Shock: Management Bundle [SEP-1] quality measurement due to rising morbidity, mortal- ity, and Medicare costs. Since the 1990s, sepsis bundled care has been viewed as ben- eficial as a way to deliver effective, immediate care to stop the progression of sepsis (known as the sepsis cascade) to severe sepsis and finally septic shock with mortality rates of 40% to 80%. The bundle requires active participation from nurses, who must be knowledgeable about the sepsis cascade, treat- ment, and reporting to comply with the Sep-1 quality measure. Some evidence-based research studies have been conducted on the nurse’s role in Sep-1 care. It is critical for all healthcare professionals to review new research on sepsis to increase their knowledge and skills for best practice to improve the quality of care and eliminate the deadly cascade.
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