Reflection: Sepsis Assignment Paper

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Reflection: Sepsis Assignment Paper

Reflect on the following:
1. Visit the Surviving Sepsis website (in this week\'s content) and discuss the bundles and the campaign.
https://www.sccm.org/SurvivingSepsisCampaign/Home

2. Watch and reflect on the following video based on a true event:
https://youtu.be/SeaIY7kP2uI

My observations after visiting the surviving sepsis website and watching the UR Medicine video on YouTube demonstrate that sepsis is a preventable syndrome that requires the collective responsibility of visitors, healthcare providers, and a patient. Sepsis is a complex syndrome with a broad severity spectrum and the leading cause of death in ICUs.Reflection: Sepsis Assignment Paper.  It is made up of different clinical conditions that manifest as negative fall-outs of the body’s response to an underlying infection. In its severe form, sepsis can result in multiple or single organ failure or dysfunction and subsequent death. Due to its multifactorial and aggressive nature, sepsis kills rapidly; it affects millions of people globally and has a mortality rate of one in four.

Nurses play an integral role in preventing and managing sepsis since they are often the first in recognizing the signs and symptoms of infection. To optimize this role for early detection, nurses can ensure prompt screening and managing of patients. This implies that nurses must have the appropriate knowledge, skills, and resources on sepsis and septic shock, tools to conduct assessments and identify sepsis in the ED, ICU, outside the hospital setting, and the med-surge unit, sepsis diagnostic criteria, and the care bundles at the core of the SCC   guidelines.

Reflection

Bundles and the Campaign

The SSC (Surviving Sepsis Campaign) was launched in the year 2004 to improve diagnosis, the management, and survival of patients with sepsis. SCC is a collective initiative by the ESICM (European Society of Intensive Care Medicine) and the SCCM (Society of Critical Care Medicine) decrease sepsis-related morbidity and mortality globally (Society of Critical Care Medicine, n.d.). Sepsis bundles are supported by the best and most current evidence-based interventions that result in the best outcomes and the central concept that surrounds the management of patients with sepsis is that sepsis is a medical emergency. Therefore, patients with sepsis need urgent evaluation and management that includes an initial resuscitation with fluids while collecting laboratory findings and correcting hemodynamic status. Reflection: Sepsis Assignment Paper.

The recent SSC guidelines describe a 1-hour bundle that must be completed within one hour of diagnosing sepsis for prompt initiation of management and resuscitation. The interventions that must be performed by the ICU nurse include; collecting blood for blood culture and lactate levels, administering broad-spectrum antibiotics and fluids (crystalloids), for patients with life-threatening hypotension, the ICU nurse must initiate vasopressor therapy(Society of Critical Care Medicine, n.d.).

  • Measuring Lactate Levels

Serum lactate levels can help to detect existing or impending tissue hypoxia. The SSC guidelines recommend that with elevated lactate levels (> 2 mmol/L), an additional re-evaluation should occur within 2-4 hours as a marker for tissue hypoperfusion during resuscitation (Levy, Evans & Rhodes, 2018).

  • Collecting blood for culture Before Initiating Antibiotics

The nurse must obtain blood samples for culture before the initiation of the initial dose of broad-spectrum antibiotics since the cultures can be sterilized within minutes of administering the initial dose (Society of Critical Care Medicine, n.d.).This helps in optimizing pathogen identification for improved outcomes

  • Administering Broad Spectrum Antibiotics

The strong correlation that exists between the early initiation of antimicrobials and antimicrobial stewardship is still a significant aspect of the quality management of sepsis.

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Therefore, a clinician should begin empiric therapy with broad-spectrum antimicrobials that cover all pathogens immediately after diagnosing sepsis (Society of Critical Care Medicine, n.d.). Reflection: Sepsis Assignment Paper. However, after identifying a specific pathogen, therapy must either be narrowed using the most sensitive drug or discontinued if it is established that a patient has no infection.

  • IV Fluids

Prior initiation of IV fluids is integral for stabilizing septic shock or sepsis-induced tissue hypoperfusion. Therefore, resuscitation with fluids should start immediately and continue within the next 3 hours after realizing that a patient has hypotension, sepsis, or elevated lactate levels, after initiation (Society of Critical Care Medicine, n.d.). Fluid resuscitation should include at least 30 ml/kg of intravenous crystalloid fluids.

  • Vasopressor Therapy

If after the initial resuscitation with fluids fails to restore blood pressure,  then the clinician should start vasopressor therapy immediately in the initial hour to attain (MAP) of ≥ 65 mm Hg(Society of Critical Care Medicine, n.d.). This helps to restore adequate perfusion pressure to vital organs as part of the resuscitation bundle.

Infection Prevention Is everyone’s Business

The step-by-step account of narration by Lenora Bell, the founder of Cathie Mae Foundation whose one sister died from sepsis reveals the loss that can be incurred from failing to observe laid down guidelines on preventing HAIs. Ann Marie Pettis, the Infection prevention program director at UR Medicine Memorial hospital further emphasizes this knowledge by suggesting increased awareness and prevention as the responsibility of a visitor, patient, and healthcare staff as the best HAI defense method (UR Medicine, 2014). For instance,  if Diana, the nurse who was on duty at the nursing station took responsibility to educate Kelly on the appropriate use of gloves, to frequently clean up potentially contaminated surfaces, she could likely have broken the chain of transmission of pathogens and saved the patient’s life.

Since hands are the most susceptible to contamination and spreading pathogens in a hospital setup, visitors, healthcare providers, and patients should practice hand hygiene more often.  This includes using alcohol-based hand rubs (ABHRs) or handwashing (Bharara et al., 2020). Reflection: Sepsis Assignment Paper. The World Health Organization (WHO) explains this further by emphasizing the five moments of hand hygiene which stakeholders must observe as follows;

  • Before performing an aseptic/clean procedure
  • Before touching a patient
  • After touching a patient
  • After exposure to a risk/ body fluid
  • After touching a patient’s surrounding

References

Bharara, T., Gur, R., Duggal, S., & Chugh, V. (2020). Evaluation of hand hygiene compliance over the years, in an intensive care unit of a north Delhi hospital preparing for accreditation: A 3-year study. Journal of Family Medicine and Primary Care, 9(4), 1939.

Levy, M. M., Evans, L. E., & Rhodes, A. (2018). The surviving sepsis campaign bundle: 2018 update. Intensive care medicine, 44(6), 925-928.

Society of Critical Care Medicine (n.d.). About The Surviving Sepsis Campaign. Retrieved from https://www.sccm.org/SurvivingSepsisCampaign/Home

UR Medicine (14th May 2014). Infection Prevention is Everyone’s Business. Available at https://youtu.be/SeaIY7kP2uI

Reflection: Sepsis Assignment Paper