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A Doctor’s Perspective – Uncovering Why Some Doctors Don’t Understand Sepsis

Categories: Healthcare-associated infections, Sepsis

Steven Q. Simpson, MD

Steven Q. Simpson, MD

Guest Author: Steven Q. Simpson, MD
University of Kansas and Sepsis Alliance

I am one of the newest members of the board of directors of Sepsis Alliance.  If you haven’t heard of Sepsis Alliance, it is a non-profit organization whose aim is to heighten awareness of severe sepsis as an emergency among the general public and among health care providers (www.sepsisalliance.org).  I joined this movement, because the need is strident.  Severe sepsis is the secret killer.  Even though its historical mortality rate is as high as 50%, it is under recognized as a cause of death.  For example, we know that cancer is a leading cause of death in the US, and we spend billions of dollars on cancer research to find preventions and cures.  Yet, what is the single largest cause of death among cancer patients?  It is listed as infection, at 48% of cancer deaths, but it is not the infection, per se, that kills.  It is the severe sepsis engendered by the infection.  And most of those deaths are logged as cancer deaths.

A large part of my own career has centered on teaching physicians, both young and old, how to recognize when they are looking at severe sepsis and how to respond quickly and aggressively.  We have substantial data from numerous trials, observational studies, and quality improvement studies that interventions can be relatively simple, consisting of antibiotics and fluids.  But only when the condition is recognized early and the treatments are given rapidly.   When there are delays, severe sepsis can rapidly become septic shock, with substantially higher risk of death.  You might think that this would be an easy sell for physicians who, after all, are there to save lives.  But you would be wrong in many cases.

A Mother’s Account: “If We Had Known About Sepsis, We Would Have Looked for Sepsis”

Categories: Healthcare-associated infections, Sepsis

Rory Staunton

Rory Staunton

Guest Author: Orlaith Staunton
Co-Founder of The Rory Staunton Foundation

Our son Rory Staunton, 12 years old, died on Sunday, April 01, 2012 from undiagnosed sepsis.

A few days earlier Rory fell playing basketball and scraped his arm. Rory began to feel ill just past midnight a day and a half after the fall. His dad and I brought him to our pediatrician. Rory was vomiting, feverish, with a pain in his leg, mottled skin, and low blood pressure. The pediatrician did not share his vital signs with us but assured us there was nothing to worry about – gave him a diagnosis of gastric flu and said he needed to be rehydrated. She sent him to a major New York hospital for rehydration. At the hospital, they concurred with the mistaken diagnosis. They gave him IV fluids, took blood tests, said to give him Tylenol and sent Rory home. Later black marks began appearing all over his body and we rushed our son back to the hospital where he died in ICU on Sunday evening. The cause of death was severe septic shock brought on by infection, hospital records say. The blood test taken at the ER remained unread; it showed massive numbers of immature white blood cells in his system-a known sepsis indicator.

Why So Many Foleys?

Categories: CAUTI, Clostridium difficile, Healthcare-associated infections

Wendy Kaler, CLS, MPH,CIC

Wendy Kaler, CLS, MPH,CIC

Guest Author: Wendy Kaler, MPH, CIC
Dignity Health Clinical Lead for CAUTI Prevention

At Dignity Health, our goal is to reduce the rate of hospital-acquired infections (HAI) by 40 percent and readmissions by 20 percent before 2015, and we are well on our way. We have introduced specific evidence-based practices and bedside intervention activities to evaluate full adoption of safe preventive practices and assure coordination of care at the bedside with clinicians, including physicians. When I am provided the opportunity to share my experiences with Dignity Health’s “No Harm Campaign” to prevent catheter-associated urinary tract infection (CAUTI), I am often asked “why is it so difficult to get Foleys discontinued?”

Weighing the Benefits and Risks of Using a Foley

During training, physicians and nurses are made aware of the advantages of indwelling urinary catheters indwelling urinary catheters, but oftentimes the instructors do not focus on the associated risks of these devices. With competing priorities and time constraints, health care providers do not prioritize indwelling urinary catheters as a device that should be assessed daily for need, especially in the critical care units. Historically, the intensive care unit (ICU) staff believed that all critical care unit patients need a Foley. Lack of good alternatives available to provide bladder management and output measurement have contributed to this practice. Bedside nurses are ultimately managing the Foley and the advantages for them are understandable, including reducing the amount of time they must spend managing the bladders of their patients and keeping their patients skin dry. However, bedside nurses need to be aware that the risks to the patient are greater than the advantage to themselves. For example, if a patient develops a UTI and is treated with antibiotics, they are at an increased risk to develop multi-drug resistant organisms or C. difficile infection.

Moving the Needle to Safe Dentistry

Categories: Healthcare-associated infections, Injection Safety

John O’Keefe, BDentSc, MDentSc, MBA

John O’Keefe, BDentSc, MDentSc, MBA

Guest Author – John O’Keefe, BDentSc, MDentSc, MBA
Board Chairman,
Organization for Safety, Asepsis and Prevention (OSAP)

Because safe injection and sharps management practices are central to dentistry, the One & Only Campaign resonates strongly in the dental care sector. That is why the Organization for Safety Asepsis & Prevention (OSAP), the dental sector’s premier organization dedicated to infection prevention and control, is joining the Campaign as a Member. We whole-heartedly support the Campaign and pledge to spread its messages to our members. We are also eager to share information on how we in the dental care sector promote safe injection practices with the healthcare community at large.

It was through my own personal experience in 1984 that I really learned about the importance of safe injection practices and how they relate to creating the safest dental visit possible. I had joined a practice where I was replacing another dentist who had left to set up his own practice elsewhere. I quickly learned that for months this dentist had been taking partially-used local anesthetic carpules from the old practice and re-using them in his new office. I was shocked by this behavior, especially when “one needle, only one time” thinking was already so ingrained in dentistry with regard to local anesthetic practices.

Mind the “Learning Gap!”

Categories: Healthcare-associated infections, Injection Safety

Kim James, MS/FNP-BC RN, Nurse Practitioner, Director of Occupational Health Services, Brookdale University Hospital & Medical Center

Kim James, MS/FNP-BC RN

Guest Author: Kim James, MS, FNP-BC
Director, Occupational Health,
Brookdale University Medical Center

When teaching about Safe Injection/Safe Needle Practices, I always like to determine the students’ knowledge base regarding these principles. I’m often surprised to find that what I take for granted as a “given” is anything but!

This is one reason why, at my “In-Services”, I always ask for a show of hands and ask: “True or False? Changing the needle (between patients) makes a syringe safe to reuse?”  (If you’re familiar with the One & Only Campaign’s “Dangerous Misperceptions” flyer, the answer is “false”.)

I posed this question at in-services recently conducted at my hospital for Resident Physicians.  I hoped all residents would shout “That’s wrong!!!”  Very few responded that this statement was False.  Imagine my surprise when, at another in-service attended by 23 Dental Residents, only one hand shot up with the comment, “That is FALSE!”

Upon asking the Resident why this was a false statement, he said he was not sure.  This triggered a spirited discussion about the importance of changing both the needle as well as the syringe. I suspect some of those Residents questioned it and didn’t speak up, but this is just too important to leave to chance.

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