How to Prevent Infection Progression to Sepsis

Clinical Issue Description 

Sepsis is a result of immune system overworking as it aims to fight off infections. The immune system releases a substantial number of chemicals in the blood, which leads to inflammation that can bring about damage to various body organs. Sepsis also leads to the development of blood clotting, which hinders an efficient flow of blood to the internal organs and limbs, depriving them of oxygen and nutrients. Life threating drop in blood pressure is caused by severe cases of sepsis. The main causative agents of sepsis are bacterial, viral and parasitic infections (Lin et al., 2018). Some of the most common bacteria that cause sepsis include Neisseria Meningitis, Salmonella spp, Escherichia coli, Staphylococcus aureus, Haemophilus influenza and Streptococcus pneumoniae (Doran et al., 2016). Sepsis can affect people of all ages. However, there are risk factors associated with the disorder. People suffering from AIDS, liver cirrhosis, cancers, chronic obstructive pulmonary disease and other immunodeficiency disorders are at a higher risk of suffering from the disease. Other social and demographical factors lead to sepsis such as poverty, tobacco use, dietary patterns and other lifestyle choices.

Sepsis is a major problem across global healthcare systems. In the USA, more than 970, 000 cases of sepsis are admitted yearly, and the figures have continued to increase over the years (Paoli et al., 2018). The rate of sepsis among hospitalized patients in the USA has continued to increase by 8.7% yearly for the past 20 years (Paoli et al., 2018). More than 50% of hospital-related deaths occur because of sepsis and with an increased sepsis severity; the mortality is expected to increase (Paolui et al., 2018). The length of stay for sepsis patients is estimated at 75% higher as compared to other diseases. In the USA hospitals, sepsis expenses rank highest with regards to admission rates, and in 2013, $24 billion was used in catering for sepsis-related expenses (Paoli e al., 2016). The $24 billion used in management of sepsis was higher as compared to osteoarthritis costs amounting to $17 billion and childbirth amounting to$13 billion (Paoli et al., 2016). This indicates that hospital expenses associated with sepsis are twice those of the other two conditions and the admission rates are expected to grow three times higher.

Sepsis is a life-threatening public health problem not only in the USA but globally. There is a need for implementing a quality improvement plan that shall assist in bringing down the high hospital mortality rates by half. These include observing hygienic practices such as proper surgical site preparation and hand washing to reduce the spreading of the infections. To ensure this is possible, there is need to use cross-functional teams that will work using collaborative efforts to ensure there is an efficient implementation of system-wide across the hospital departments. The treatment of sepsis should also begin early through pinpointing the causative microorganisms. Another major threat that has been identified as causing sepsis is the increasing antimicrobial resistance. This leaves infections untreated for a long time thus increasing the patient’s likelihood of developing sepsis. Hospital-wide programs and programs that can elevate antibiotic potency and education of healthcare practitioners can help in eliminating the mortalities caused by sepsis.

SWOT Analysis 

Strengths 

Sepsis has a huge economic burden on the country. The project aims at cutting down the sepsis-related disorders by almost half, and this is bound to reduce the $24 billion used towards sepsis management (Paoli et al., 2018). This will help the state, local and federal government in using the savings in funding other crucial sectors of the economy such as education and education. The project will also be beneficial to the hospitalized patients, as it will eliminate a need for additional financial costs they have to incur in managing the disorder. Sepsis management shall also reduce the high mortality rates resulting from the disorder, and this is bound to improve the psychologic wellbeing of patient’s families.

Weaknesses 

The major weakness facing the quality improvement project is having the right methodology to allow for much earlier detection of infections before they can become sepsis. The only means available is watching out for various symptoms associated with infections such as fever, confusion or disorientation, increased heart rate, diarrhea, rashes, vomiting, shortness of breath, rapid breathing, chills and pain. However, some of these signs and symptoms might not necessarily indicate that one has an infection.

Opportunities 

Sepsis is a serious medical condition and can lead to hospitalization if not well managed. At extreme cases, sepsis can lead to death. Currently, the rate of sepsis infections are very high, and through the project, it aims at reducing the number of sepsis cases and help in improving the overall quality of life for the patients. Patient with infections can also get assistance from the project, as it will ensure that they are screened to have a much earlier diagnosis and treatment of sepsis. The project will also aim at making the patients feel safe once they seek any medical services, as they will know they are in safe hands.

Threats 

The diagnosis and treatment of sepsis is not an easy undertaking for hospitals. The major impediment to the project is compliance from the patient. The patients cannot be forced to undergo any sepsis checkups, vaccinations or follow up visits. Similarly, the patients with sepsis suffer from other health disorders such as cardiovascular diseases, diabetes and obesity and this requires them to visit other primary care physicians. Patient non-compliance in form of follow-up visits is very vital towards sepsis management, and the unwillingness of the patient to adhere to physician request can hinder the ability to the project to, manage the disease.

Action Plan Outline 

The action plan towards mitigation of sepsis will involve two major steps; prevention of microbial infections and transmission and prevention of infection progression to sepsis condition.

Prevention of microbial infection and transmission 

The major causative agent for sepsis is microbial infections caused by bacterial, fungal, viral or parasitic. A substantial amount of these infections can be prevented through observing proper hygiene (Saito, Allegranzi, & Pittet, 2018). The washing of hands is a very simple task that all people can carry out on a daily basis. However, the effectiveness of handwashing requires that it is done properly and frequently as compared to what people do. One should ensure that the nails are also cleaned in the process and the hands dried using a clean and dry towel. Likewise, the safe preparation of food is key towards preventing sepsis. The project shall make sure that there is improved sanitation in not only hospitals but also at home including having quality water. Wischmeyer (2018) states that the project shall also push people to have healthy nutritional diet that can boost the immune system hence allowing the body to have an ability to fight off any infections.

The prevention of sepsis is not possible, but one can take a vital step towards preventing the occurrence of infection hence reducing the risk of developing sepsis. The most common sepsis cause is bacteria though other viral conditions such as viral pneumonia, viral meningitis, influenza and chickenpox can cause sepsis (Lin et al., 2018). An individual with a healthy immune system can survive viral attacks using over the counter drugs. However, an ineffective immune system can see one suffering from negative impacts of viral infection and hence, it is important to stay up-to-date on vaccination. The risks of sepsis can be reduced through vaccinations against pneumococcal vaccines (PCV 13) and (PPSV23) and influenza vaccine (Green et al., 2018); Samuel & Miller, 2019. These vaccines can also help in reducing sepsis risks in healthy individuals.

The project shall also ensure that patients are educated on the importance of adhering to the prescription schedule as provided for by the doctors. An individual who is required to take antibiotic must ensure that they are taken prescribed to prevent the development of resistance (Elias et al., 2017). If one does not fully complete the prescribed antibiotics course, the bacteria will not be completely killed, and this brings about recurrent infections, which can progress into sepsis.

The projects implementation timeline will be as shown below;

Clinical Issue Assessment 

Epidemiology 

The switching on of the body’s immune system and coagulation by the presence of infection, whether fungi, viruses or bacteria is what leads to a clinical syndrome referred to as sepsis. An individual who suffers forms severe sepsis will require a stay in the ICU due to tissue hypoperfusion or organ dysfunction. A low blood pressure despite having enough fluid replacement in the body in addition to organ failure leads to the development of sepsis shock. In 2001, there were more than 200,000 deaths resulting from sepsis representing an incidence level of 3.0 per 1000 people (Finfer & Machado, 2016). However, recent research suggests that these numbers have increased and this has seen sepsis leading to between 33-50% of all deaths occurring in hospitals (Finfer & Machado, 2016). However, a majority of the deaths occur in patients who present to themselves with sepsis to the hospital rather than acquiring it while hospitalized. However, finding the global epidemiology of the disease is not easy, as most of the deaths resulting from sepsis have been linked to the particular infection that initiated the disease. The most common causes of sepsis in adults include severe skin infection, urinary infection bowel perforation and pneumonia. Chronic illnesses such as high blood pressure, cancer, HIV kidney diseases and diabetes are also known to cause sepsis (Finfer & Machado, 2016). In newborns, immature immune systems resulting from low birth weight and premature babies can cause sepsis.

Symptoms and Signs 

The signs and symptoms of sepsis are at time nonspecific and subtle though the most common ones in young children include; jaundice, seizures, jitteriness, diarrhea, vomiting, abdominal swelling, pale color, apnea and poor breastfeeding (Randolp & McCulloh, 2014). However, the major sepsis symptoms across all ages include confirmed or probable infection, higher breathing rate, higher heartbeat rates and high fevers.

Sepsis Criteria 

The severity of sepsis is determined using two tools by physicians. One of the tools is the systemic inflammatory response syndrome (SIRS) (Berg & Gerlach, 2018). Berg & Gerlach (2018) state that one has to meet two or more of the following criteria;

Fever higher than 38 degree Celsius but lower than 36 degrees Celsius.

A heart rate of more than ninety beats per minute

Abnormal white blood cell count

Breathing rates higher than 20 breaths per minute.

The other tool sued in the assessment of sepsis is the sequential organs failure assessment (qSOFA). Rudd et al. (2018) states that one has to meet the following three criteria;

A low reading of the blood pressure

The higher breathing rate of more than 22 breaths per minute

Glasgow coma scale score reading less than 15

An abnormality in two or more of the criteria indicates there is a positive qSOFA

Stakeholders and Decision Makers 

There is a rapid change in the healthcare sectors an indication that the organizations must have in place strategies that allow for a quick adaptation if they are to meet their set goals and objectives. However, various projects aimed at improving organizational processes tend to fail due to the many stakeholders. Each stakeholder has an individual mental mode, and at times, they might conflict. The quality improvement project will involve four stakeholders from the healthcare sector; administrators, doctors, nurses and patients. The administrators tend to view any new changes depending on their impact on profitability and client satisfaction. The clinical staff view changes in terms of the impact on patient care while patients view changes in terms of what benefits they will get.

Without having a cross-functional team, the implementation of this project is bound to fail, as each of the stakeholders will focus on activities that tend to meet their viewpoints without considering the impacts on the other members. Each of the four stakeholders plays an important role in the success of an organization. The success of the quality improvement project is not just reliant on the cooperation but collaboration. In cooperation, the relationship is based on short-term goals. However, in collaboration the groups have to work together to accomplish a certain goal and the only way to make this possible is not to view each other as separate group but operate a cross-functional team (Morley & Cashell, 2017). In this case, the administration will arrange budgets that will help to implement accurate diagnostic tests, treatments, training and raise awareness of sepsis. However, to accomplish this, they will require working with the nurses and doctors, as they will have firsthand involvement in the entire project implementation. The doctors will carry out the diagnostic tests procedures and tests while nurses will focus on sepsis prevention strategies and help in the earlier detection of the disorder. The patients will expect to have better outcomes form the entire process and thus will be required to attend the various sepsis awareness programs and seek treatment on any infections.

Resources 

Budget 

Category	Item	Subtotal	Total Cost
Benefits	Administrators	$8,500
	Nurses	$5,500
	Doctors	$7,500	$21,500
Materials and supplies	Printing of flyers, posters etc.	$500	$500
Subscriptions and publications	Sepsis health publications	$250
	Sepsis related electronic newsletter services	$150	$400
Health education material	Sepsis logbooks	$500
	Sepsis DVD and literature	$300	$800
Equipment	bioMerieux solutions	$1000
	PCR-based sepsis quick test	$1500	$2,500
Incentives	Gift cards coupons	$2000	$2,500
Miscellaneous	Sepsis team meetings	$750	$750
			$28,950

Personnel 

The personnel who will be required in the implementation of the project will include a project manager who shall oversee the entire implementation of the project from start to finish. There is a need to have an accountant who shall ensure that the funds allocated to the project are used as required. The project shall also require the four key stakeholders, administrators, nurses, doctors and patients.

Time 

The project will begin on 1 December 2019 and end on 30 October 2020.This is an indication shall last for 11 months. During the 11 months, different project phases shall be implemented. From 1 December 2019 until 1 March 2020, it will project planning which will see the administrators and respective stakeholders playing on means to reduce sepsis in the general population. As from 2 March, 2020 up to 1 June 2020 the project implementation shall kick-off which include staff meetings, and training. As from June 2, 2020, until October 30 2020, sepsis prevention strategies shall be implemented. Beginning October 0 th 2020, sepsis reports shall be analyzed to ascertain the effectiveness of the project.

Implementation and Evaluation Strategies 

The project implementation strategies will include holding a staff meeting with the respective team members. The staff meetings shall involve discussing how the sepsis prevention and reduction program shall be implemented. The implementation process shall last from March 2, 2020, until October 30 2020. During this period, the staff shall be trained on how they will pass information to not only patients but also local community on sepsis detection and why it is vital to seek medical treatment in case one suffers from an infection. The project team shall also launch campaigns on the importance of vaccination and adhering to antibiotic prescription to eliminate the development of bacterial resistance. The project team shall also teach the patients and local community how to maintain hygiene through washing hands and safe preparation of food. The project team shall educate other health care practitioners on how to reduce hospital-acquired infections. The evaluation of the project’s success involved holding scheduled meetings with the project team members and identifying the various hindrances towards successful implementation of the program. The scheduled meetings used survey data gathered on the patient compliance rates vaccinations, follow-up visits and how many patients had sought infection-related services. This data was based on set targets, and I case these targets were not reached, it is an indication the project was not a success.

References

Berg, D., & Gerlach, H. (2018). Recent advances in understanding and managing sepsis.  F1000Research ,  7 .

Doran, K. S., Fulde, M., Gratz, N., Kim, B. J., Nau, R., Prasadarao, N., & Valentin-Weigand, P. (2016). Host-pathogen interactions in bacterial meningitis.  Acta Neuropathologica ,  131 (2), 185-209.

Elias, C., Moja, L., Mertz, D., Loeb, M., Forte, G., & Magrini, N. (2017). Guideline recommendations and antimicrobial resistance: the need for a change.  BMJ Open ,  7 (7), e016264.

Finfer, S., & Machado, F. R. (2016). The global epidemiology of sepsis. Does it matter that we know so little? American Journal of Respiratory and Critical Care Medicine, 193 (3), 228-23.

Green, C., Moore, C. A., Mahajan, A., & Bajaj, K. (2018). A simple approach to pneumococcal vaccination in adults.  Journal of Global Infectious Diseases ,  10 (3), 159.

Lin, G. L., McGinley, J. P., Drysdale, S. B., & Pollard, A. J. (2018). Epidemiology and immune pathogenesis of viral sepsis.  Frontiers in Immunology ,  9 .

Morley, L., & Cashell, A. (2017). Collaboration in health care.  Journal of Medical Imaging and Radiation Sciences ,  48 (2), 207-216.

Randolph, A. G., & McCulloh, R. J. (2014). Pediatric sepsis: important considerations for diagnosing and managing severe infections in infants, children, and adolescents.  Virulence ,  5 (1), 179-189.

Rudd, K. E., Seymour, C. W., Aluisio, A. R., Augustin, M. E., Bagenda, D. S., Beane, A., ... & De Silva, A. P. (2018). Association of the quick sequential (sepsis-related) organ failure assessment (qSOFA) score with excess hospital mortality in adults with suspected infection in low-and middle-income countries.  Jama ,  319 (21), 2202-2211.

Saito, H., Allegranzi, B., & Pittet, D. (2018). 2018 WHO hand hygiene campaign: preventing sepsis in health care and the path to universal health coverage.  The Lancet Infectious Diseases ,  18 (5), 490-492.

Samuel, R., & Miller, J. (2019). Is the influenza vaccine effective in decreasing infection, hospitalization, pneumonia, and mortality in healthy adults?  The Journal of the Oklahoma State Medical Association ,  112 (3), 86.

Paoli, C. J., Reynolds, M. A., Sinha, M., Gitlin, M., & Crouser, E. (2018). Epidemiology and costs of sepsis in the United States—an analysis based on the timing of diagnosis and severity Level.  Critical Care Medicine ,  46 (12), 1889.

Wischmeyer, P. E. (2018). Nutrition Therapy in Sepsis.  Critical Care Clinics ,  34 (1), 107-125.