As COVID raged, another deadly threat was on the rise

As COVID-19 began to spread in California, hospitals were inundated with sick patients. Medical personnel struggled to deal with the onslaught.

Amid the new coronavirus threat, an old one was also on the quiet rise: More people have suffered from severe sepsis in California hospitals in recent years – including a worrying increase in patients who contracted sepsis inside the hospital itself, according to state data.

Sepsis occurs when the body tries to fight off an infection and ends up putting itself at risk. Chemicals and proteins released by the body to fight an infection can damage healthy cells as well as infected cells and cause inflammation, leaky blood vessels and blood clots, according to the National Institutes of Health.

It is a perilous condition that can end up damaging tissues and triggering organ failure. Across the country, sepsis kills more people each year than breast cancer, HIV/AIDS and opioid overdoses combined, said Dr. Kedar Mate, president and CEO of the Institute for Healthcare. Improvement.

“Sepsis is one of the leading causes of death in hospitals. It’s been true for a long time – and it’s become even more true during the pandemic,” Mate said.

Most cases of sepsis start outside of hospitals, but people are also at risk of getting sepsis when they are hospitalized for other illnesses or medical procedures. And that danger has only increased during the pandemic, according to state data: In California, the number of “nosocomial” cases of severe sepsis increased by more than 46% between 2019 and 2021.

Experts say the pandemic has exacerbated a lingering threat to patients, blaming both the dangers of the coronavirus itself and the strains hospitals have faced during the pandemic. The rise in sepsis in California came as hospital-acquired infections rose across the country — a problem that has worsened during spikes in COVID hospitalizations, researchers have found.

“This setback can and should be temporary,” said Lindsey Lastinger, a health scientist with the CDC’s Division of Health Care Quality Promotion.

Doctors describe sepsis as hard to detect and easy to treat in its early stages, but more difficult to treat by the time it becomes obvious. It can manifest in different ways and detecting it is complicated by the fact that its symptoms – which can include confusion, shortness of breath, clammy skin and fever – are not unique to sepsis.

There is no ‘gold standard test to say whether you have sepsis or not,’ said Dr Santhi Kumar, acting chief of pulmonology, intensive care and sleep medicine at Keck Medicine of USC. “It’s a constellation of symptoms.”

Christopher Lin, 28, endured excruciating pain and a burning fever of 102.9 degrees Fahrenheit at home before heading to Kaiser Permanente Los Angeles Medical Center. It was October 2020 and the hospital looked “surreal”, Lin said, with a tent set up outside and closely spaced chairs in the waiting room.

Her fever raised concerns about COVID-19, but Lin tested negative. At one point, in the emergency department, her blood pressure suddenly dropped, Lin said, and “it felt like my soul had left my body.”

Lin, who suffered from sepsis related to a bacterial infection, does not know where he was first infected. Days before going to hospital, he had undergone a quick emergency room procedure to drain a painful abscess on his chest and had the gauze changed by a nurse the next day, he said. These outpatient procedures are not included in state data on “nosocomial” sepsis.

A person with sepsis may have a high or low temperature, fast or slow heart rate, high or low breathing rate.

It can result from bacteria, fungal infections, viruses or even parasites – “and the challenge is that when someone walks into the emergency department with a fever, we don’t know which of those four things they have. “, said Dr. Karin Molander. , emergency physician and former chairman of the board of directors of Sepsis Alliance. Treatment may vary depending on the cause of the infection that caused the sepsis, but antibiotics are common as many cases are linked to bacterial infections.

The pandemic has piled on the risks: A coronavirus infection can itself lead to sepsis, and the virus has also brought more elderly and medically vulnerable people to hospitals who are at higher risk of contracting this dangerous condition, have said experts. Nearly 40% of severe sepsis patients who died in California hospitals in 2021 were diagnosed with COVID-19, state data shows. Some COVID-19 patients have been hospitalized for weeks, increasing their risk of other complications that can lead to sepsis.

“The longer you stay in the hospital, the more things happen to you,” said Dr. Maita Kuvhenguhwa, infectious disease attending physician at MLK Community Healthcare. “You’re immobilized, so you’re at risk of developing pressure sores” – not just on your back, but potentially on your face under an oxygen machine – “and the wound can get infected.”

“The lines, the tubes, being here a long time – all of this puts them at risk of infection,” Kuvhenguhwa said.

Experts said the pandemic may also have diverted attention from other types of infection control, as staff were stretched and hospital routines disrupted. California, which is nationally unusual in mandating minimum nurse staffing ratios, has allowed some hospitals to relax those requirements amid the pandemic.

Nurses who juggle more patients might not check and clean patients’ mouths as often to help prevent bacterial infections, Kumar said. Mate said hospitalized patients might not have their catheters changed as often due to staffing shortages, which can increase the risk of urinary tract infections.

Hospitals may have brought in traveling nurses to help fill in the gaps, but “if they don’t know the same systems, it will be harder for them to follow the same processes” to deter infections, Catherine Cohen said. , policy researcher at RAND.

Armando Nahum, one of the founding members of Patients for Patient Safety US, said pandemic restrictions on hospital visitors may also have compounded the problem, preventing family members from being able to spot that a relative was acting up. in an unusual way and cause concern.

Molander echoed that point, saying it’s important for patients to have someone who knows them well and who might be able to alert doctors: “My mom has dementia, but she’s normally very talkative.

Sepsis is a long-standing battle for hospitals: One-third of people who die in US hospitals had sepsis while hospitalized, according to a study cited by the CDC. But Mate argued that deaths from sepsis can be significantly reduced “with the right actions we know how to take”.

In Pennsylvania and New Jersey, Jefferson Health began rolling out a new effort to fight sepsis in the fall of 2021 — just before the first wave of Omicron started hitting hospitals.

Its system includes predictive modeling that uses information from electronic medical records to alert clinicians that a person might be suffering from sepsis. He also implemented a “standardized workflow” for patients with sepsis so that crucial steps like prescribing antibiotics happen as quickly as possible, hospital officials said.

The aim was to reduce the mental burden on doctors and nurses being pulled in many directions, said Dr Patricia Henwood, its clinical director. “Clinicians across the country are under strain, and we don’t necessarily need better clinicians — we need better systems,” she said.

Jefferson Health credits the new system with helping to reduce the number of deaths from severe sepsis by 15% in one year.

In New York State, the outcry over the death of 12-year-old Rory Staunton has led to new requirements for hospitals to adopt protocols to quickly identify and treat sepsis and report the data to the state. . State officials said the effort saved more than 16,000 lives between 2015 and 2019, and researchers found a greater reduction in sepsis deaths in New York City than in states without such requirements.

If your child gets sick, he said, “you shouldn’t have to wonder if the hospital on the right has sepsis protocols and the one on the left doesn’t,” said Ciaran Staunton, who co-founded the organization End Sepsis after the death of his son. His group welcomed the news when federal agencies were recently tasked with developing “hospital-grade measures” for sepsis.

Such a move might encounter opposition. Robert Imhoff, president and CEO of Hospital Quality Institute – a subsidiary of California Hospital Assn. — contended that there was no need to expand the type of requirements in place in New York.

“I don’t think hospitals should be mandated to provide safe, quality care,” Imhoff said.

State data shows that severe sepsis — including cases from both outside and inside hospitals — has increased in California over the past decade, but Molander said the Long-term increase could be linked to changes in reporting requirements which led to more cases being followed up. California has yet to release new data on severe sepsis acquired in hospitals last year and is not expected to do so until this fall.

For Lin, surviving sepsis left him determined to make sure the word out about sepsis – and not just in English. At the hospital, he had struggled to explain what was happening to his mother, who speaks Cantonese. After recovering, Lin worked with local officials to have Sepsis Alliance documents translated into Mandarin.

“I can’t imagine if it was my parents in the hospital,” he said, “living what I was going through.”