HJBR Jan/Feb 2024

SEPSIS Q&A 28 JAN / FEB 2024 I  HEALTHCARE JOURNAL OF BATON ROUGE   infections are what we call “self-limited,” meaning that they will go away either on their own or with a normal immune response. In most cases, these infections are mild and caused by viruses, like the common cold. In other cases, a patient may have what we call “nonspecific”symptoms, meaning a variety of things can cause them, including infection, and bacteria may be present but not causing these symptoms; this situation often happens in patients with urinary complaints. Unfortunately, it can be difficult to know what is happening with each patient. In most cases of mild infections, the best strategy is to monitor the patient without antibiotics and only treat them when necessary, but this is a delicate balancing act because of the risk of an infection evolving into sepsis. This is another reason that we have worked so hard to figure out ways to measure the immune response — we may be able to help find those patients who are at higher risk of bad consequences of infections like sepsis and limit antibiotic therapy to them. The short answer to the question is that there are two major solutions to antimicrobial resistance: 1) research and development on new antibiotics that avoid resistance and 2) limiting the use of all antibiotics to only cases when it is necessary. There are other things that we do as well to battle antibiotic resistance. Those are better infection control measures to prevent the spread of infections — washing hands is probably the most important — and, when we do use antibiotics, using the most directed antibiotic we can for that specific bacteria and for the minimum amount of time required to treat the infection. Are antibiotic-resistant infections leading to an increase in sepsis cases? O’Neal While antibiotic-resistant infectious make treating sepsis more difficult, they are not, necessarily, resulting in more cases of sepsis. As things evolve, we see a higher percentage of infections caused by resistant organisms, but not necessarily more infections or cases of sepsis. We think that most of the increase in sepsis cases that we have seen over the last couple of decades is due to increased awareness more than anything, which is a good thing. Now we need to improve our ability to make an accurate diagnosis and improve the efficiency and effectiveness of treatment. What percentage of sepsis cases are hospital-acquired? Thomas The majority of sepsis cases present from the community to the emergency department. In fact, that number is likely over 85%. However, some infections are acquired during a hospital stay, and an abnormal host response can develop. These hospital-acquired cases can be even more difficult to spot and manage. How can hospital-acquired sepsis cases be lowered? Thomas The first step in reduction of hospital-acquired sepsis cases is the development of a robust quality and patient safety program. In taking the next step, OLOL also created a high-performance improvement division that focuses on the factors in the hospital that can lead to hospital-acquired sepsis cases. Finally, Our Lady of the Lake is unique in the region in the addition of research discoveries to this program. As a result, hospital infections are monitored with designed plans to eliminate any modifiable risk factors in the hospital environment. Once IntelliSep was developed, the quest began to address ways to utilize the technology in helping both emergency patients and inpatients. This approach has resulted in accolades in patient safety like the Leapfrog A score for OLOL consistently. According to CDC, Louisiana has led the nation in sepsis deaths for years, hovering around 20%, which represents approximately 1100 deaths annually. Why do you think Louisiana citizens suffer higher rates of sepsis compared to Mississippi citizens, with a sepsis death rate of 10%? Thomas National statistics on sepsis are a real challenge as they require the diagnosis in the hospital to be accurate. Also, most are based on hospital statistics, which require access to care. As hospital access becomes limited in rural areas, the statistics related to cause of death can become less reliable. Quite frankly, the question is less about comparison of the states, but realization that both sit in the bottom tier in terms of overall outcomes. As a healthcare system committed to quality in both states, the decision to pursue a novel early diagnostic, improve process and structure of sepsis care, and make sepsis a major focus of our system quality was designed to address communities in both states. How has the new sepsis testing been implemented at OLOL? Are all hospital patients tested? How frequently, and what results are being observed? Laperouse All patients in the emergency department are screened in triage for time- sensitive illnesses such as heart attack, stroke, major trauma, and, of course, sepsis. With certain abnormal vital signs and the possibility of an infection, the IntelliSep test is ordered right then in triage. Shortly after triage, blood work is drawn and sent to the lab. Once on the machine, the test takes less than 10 minutes to result. The results are broken down into three ranges: Band 1, unlikely sepsis, and Bands 2 and 3, likely sepsis. About half of the patients tested in the Our Lady of the Lake Emergency department have been Band 1. The rest are pretty evenly split between Band 2 and Band 3. For those that do not trigger an order from