Infection Control for New York Health Care Professional ‒ 2024 Update ________________________________
• Have a critical care transitional program during ICU stay to floor transitions, using a handoff process during transitions of care, offering verbal and written sepsis education, and referring patients to peer support programs, postcritical illness follow-up programs, and posthospital rehabilitation programs. • For adults with sepsis or septic shock and their families, the clinical team should provide the opportunity to participate in shared decision making in post-ICU and hospital discharge planning to ensure that discharge plans are acceptable and feasible. • For adults with sepsis or septic shock, the principles of palliative care, which may include palliative care consultation based on clinician judgement, should be integrated into the treatment plan, when appropriate, to address patient and family symptoms and suffering. • For adults with sepsis or septic shock and their families, screening should be done for economic and social support, including housing, nutritional, financial, and spiritual support, and making referrals where available to meet these needs. * Sequential (or Sepsis-related) Organ Failure Assessment (SOFA) criteria or the “quick” (q)SOFA criteria CDC 2023 Hospital Sepsis Program Core Elements Early recognition of sepsis is the responsibility of all healthcare providers, and according to the CDC, sepsis begins outside of the hospital for nearly 80% of patients [4]. All U.S. hospitals are eligible to enroll in NHSN, and enrolled hospitals were required to complete the 2022 NHSN Patient Safety Component Annual Hospital Survey by March 1, 2023. As of June 1, 2023, among 5,397 hospitals enrolled in the NHSN Patient Safety Component, 5,228 had completed the survey. Seven surveys were excluded because of incomplete responses, which resulted in the inclusion of 5,221 hospitals in the analysis, for a 97% completion rate [34]. Results of the survey are as follows. • Hospitals reported using various approaches to rapidly identify patients with sepsis. ‒ 65% electronic health record–generated alerts based on systemic inflammatory response syndrome criteria ‒ 47% manual screening ‒ 33% predictive models ‒ 10% of hospitals reported having no standardized process for assisting with rapid sepsis identifica- tion. ‒ Having no standardized process was more common in hospitals with 0–25 beds (15%) than in hospitals with >500 beds (1%).
• Hospitals frequently reported the existence of protocols to assist in the management of sepsis care, including: ‒ Sepsis protocols tailored to specific patient popula- tions were available in one-third (34%) of hospi- tals, ranging from 21% among hospitals with 0–25 beds to 57% among those with >500 beds. ‒ Overall, 10% of hospitals reported having no standardized protocol to assist in the management of sepsis care. ‒ Having no standardized protocol to assist in the management of sepsis care was more common in hospitals with 0–25 beds (17%) than in those with >500 beds (1%). Survey results concluded that effective sepsis care must coor- dinate multiple clinical disciplines across all hospital care locations. Evidence-based care guidelines, state guidelines such as New York State Department of Health Sepsis Regulations , and federal initiatives such as the Centers for Medicare & Med- icaid Services Severe Sepsis and Septic Shock: Management Bundle agree that early identification and immediate management are critical [34]. Data on the scope and delivery of sepsis care show incon- sistencies in the management of sepsis, with some hospitals having some tools and protocols but no coordinated system for early identification and treatment. To address these areas and improve patient care, the Hospital Sepsis Core Elements were developed by the CDC to provide a framework for a comprehensive, structured response with resources for the highest standard of patient care [11]. The Hospital Sepsis Program Core Elements were designed to complement the existing state programs and federal initiatives through guidelines in the following areas [11]: • Hospital Leadership Commitment: Dedicating the necessary human, financial, and information technol- ogy resources • Accountability: Appointing a leader or coleaders responsible for program goals and outcomes • Multiprofessional expertise: Engaging key partners throughout the hospital and healthcare system • Action: Implementing structures and processes to improve the identification, management, and recovery from sepsis • Tracking: Measuring sepsis epidemiology, management, and outcomes to assess the impact of sepsis initiatives and progress toward program goals • Reporting: Providing information on sepsis manage- ment and outcomes to relevant partners • Education: Providing sepsis education to healthcare professionals, patients, and family/caregivers
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