Reducing the burden of sepsis

Sepsis is a time-critical medical emergency that arises when the body’s response to an infection damages its own tissues and organs. It can lead to shock, failure of multiple organs and death if not recognised early and treated promptly. While sepsis can affect anyone, the most vulnerable patient groups are young children, patients with chronic health conditions and the elderly.

The recent Global Burden of Disease Study found that sepsis kills an estimated 11 million patients every year. In Australia, the study found that previous estimates were exceeded by three times as many sepsis cases and almost twice as many deaths. The current estimate gives a more accurate picture of the size of the problem by including sepsis occurring outside of the hospital, putting the number of Australian cases at 55,000 and deaths at 8700 annually. The true impact of sepsis on the population extends well beyond deaths and direct healthcare costs: patients with sepsis often suffer from prolonged, sometimes life-long sequelae affecting quality of life and productivity, and related impact on their families.

In May 2017, the World Health Organization recognised sepsis as a global health priority, adopting a resolution to improve the prevention, diagnosis and management of sepsis around the world. The World Health Assembly (WHA) resolution calls on all United Nations member states to take specific actions to reduce the burden of sepsis, including implementing national action plans.

The Australian Sepsis Network (ASN), hosted by The George Institute for Global Health, is a collaboration of individuals and organisations working to reduce the burden of sepsis in Australia across all age groups. The mission of the ASN is to facilitate a coordinated national approach to tackling sepsis in Australia.

In response to the WHA resolution, the ASN convened a National Sepsis Summit in 2017 that produced the Stopping Sepsis National Action Plan, with four overarching goals:

• Establish a nationally coordinated sepsis advocacy body.
• Invest in prevention and awareness campaigns.
• Establish and implement a national sepsis clinical care standard.
• Invest in support services for sepsis survivors and their families.
   

At present, healthcare services widely accept benchmarks defining best practice in diseases such as major trauma, myocardial infarction or stroke. In contrast, there is wide variability of care in meeting international best practice to improve the recognition and timely treatment of sepsis. As an inherently time-critical disease, effective recognition and intervention has a huge potential to save lives and result in improved cost-effectiveness of healthcare delivery.

Core components of so-called ‘sepsis bundles’ include taking blood cultures and lactate, providing intravenous antibiotics and administering a fluid bolus. Increasing the reliability of delivering sepsis bundles requires work along distinct processes. These include:

i) public awareness and education to facilitate the recognition “could this be sepsis?”;

ii) systematic screening programs in healthcare facilities;

iii) implementation of sepsis treatment bundles in hospitals;

iv) benchmarking for best practice at state, national and international levels; and

v) developing support systems for affected patients and families beyond discharge.

Subject matter experts are engaged by the ASN to provide advice on clinical practice, policy, research, education and consumer lived experiences to achieve targeted and effective interventions that aim to reduce the burden of sepsis. Improved coordination across clinicians, healthcare and academic institutions, public health and policymakers will be key to improve outcomes for children and adults with sepsis in Australia. The National Action Plan from ASN has set the strategy for this endeavour.

*Dr Brett Abbenbroek (RN, BSc, MPH, PhD) is the Australian Sepsis Network Program Manager within the Critical Care Division at The George Institute for Global Health, Sydney.
**Associate Professor Luregn Schlapbach is Co-Chair of the Paediatric Statewide Sepsis Clinical Advisory Group in Queensland, and Chair of the ANZICS Paediatric Study Group. He works in the Paediatric Intensive Care Unit at Queensland Children’s Hospital.

Image credit: ©stock.adobe.com/au/maxsim