The effectiveness of the Sepsis Code during the pandemic demonstrates the need to implement it in al

Alberto Martin

The Sepsis Code has demonstrated a positive impact on complications and morbidity and mortality in patients with severe sepsis admitted to the ICU.

One death every 2.8 seconds and almost 50 million people suffer from it every year. The figures for sepsis are staggering. It is a complication of infection that causes 11 million deaths a year. However, it remains largely unknown at the general level and hospital protocols for its early detection and management are not as widespread as would be desirable.

"It is a complex disease secondary to an infection that can lead to multi-organ dysfunction and death; a medical emergency that requires immediate attention and is associated with a serious health and economic burden, both for the patient and for health systems around the world," explain the Working Group on Infectious Diseases and Sepsis of the Spanish Society of Intensive Care Medicine, Critical Care and Coronary Units (SEMICYUC).

Today, 13 September, is World Sepsis Day, a date that reminds us of the importance of making progress in the study, control and treatment of this syndrome, a consequence of an exaggerated immune response to infection. Spanish intensivists have been working on this task for decades.

The implementation of the Sepsis Code in Intensive Care Units, and in the rest of the hospital areas, has provided an important infrastructure for the early detection of patients with this pathology, incorporating procedures, strategies and management protocols that reduce mortality and morbidity, regardless of the cause that triggers it.

In addition, as the Working Group explains, "it allows for higher quality, homogeneous care with the greatest possible capacity for resolution, based on the coordination of the professionals involved in sepsis care". Sepsis is our own body's response to an infection, but this response severely damages our own tissues and organs. Thus, "new" infectious diseases such as SARS CoV-2, which can themselves develop sepsis, force intensivists to redouble their efforts.

A significant number of patients admitted to ICUs for COVID-19 have died in the context of septic shock. The National Surveillance Study of Nosocomial Infection in Intensive Care Medicine Services (ENVIN) of the SEMICYUC warned this year that COVID-19 patients, in terms of device-associated infections, present a greater inflammatory response in the form of sepsis and/or septic shock during their ICU stay, compared to the 2019 data. The need and usefulness of implementing the Sepsis Code in all hospitals has become more evident than ever during COVID-19. "Having the Sepsis Code in hospitals has made it possible in times of pandemic to identify septic patients early in all care settings, through a coordinated multidisciplinary approach. It also ensures the immediate implementation of efficient measures that reduce sepsis mortality," explain the experts of the Working Group.

It should not be forgotten that in Spanish ICUs, since the implementation of SEMICYUC's Zero Projects in 2009, a very significant and sustainable decrease in healthcare-associated infections has been demonstrated, as well as a decrease in mortality and days of stay in the ICU. The more or less automated alert systems of the Sepsis Code help to identify potentially serious scenarios that, with other detection systems, might go undetected.

In addition, the incorporation of microbiological techniques in daily clinical practice for the rapid identification of micro-organisms and mechanisms of resistance helps to shorten diagnostic response times and to improve the appropriateness of antimicrobial treatment.

On the other hand, there are already programmes that incorporate algorithms based on artificial intelligence to stratify patients according to their risk of sepsis. They are today the maximum expression of discriminative technology for early detection of patients at risk, but, as the sepsis intensivists from SEMICYUC explain, it is a reality within the reach of very few hospitals.

What is possible is the implementation of the general protocols of the Sepsis Code and the Zero Projects. The latter, led and coordinated by SEMICYUC with the Ministry of Health, have enabled the national rates of bacteraemias related to central vascular catheters and pneumonias related to mechanical ventilation to be reduced by more than 50% of their initial reference rates. The more hospitals that implement them, the more guarantees we can continue to improve the fight against an infection that requires the coordinated effort of all.


Source: Redacción Notícias en Salud