Transcript for CDC Telebriefing: New Vital Signs Report - How can we save patients from sepsis?

MICHELLE BONDS: Thank you, thank you all for joining us today to talk about a condition known as Sepsis, we are joined today by the Director of CDC, Dr. Tom Frieden, we are pleased to also have Dr Mitchell Levy, a sepsis expert, and founding member of the Surviving Sepsis Campaign, a global initiative to improve the care of patients with sepsis. First, I”d like to turn the call over to Dr. Frieden.

TOM FRIEDEN: Thanks very much. Thank you for joining us. CDC works 24/7 to protect the health, safety and security of Americans. This month”s Vital Signs report focuses on sepsis. Sepsis is caused by the body”s overwhelming and often life-threatening response to an infection. It can lead to organ failure and death. Bottom line here is that this report is putting a face on sepsis and documenting that it”s still a huge problem and it doesn”t have to be. Sepsis is an unrecognized killer. Sepsis is a medical emergency. An infection that is getting worse and is not treated can lead to sepsis and it”s scary. I know this first hand. 22 years ago when our older son was just 4 months old, I came home from work one day to find him near death. He was completely pale, I didn”t know if he was breathing or not, and it turned out he had bacteria in his blood. We were able to recognize it rapidly, treat it rapidly and he did fine and recovered completely. But he could have died from it. And far too many people do die from sepsis today.

Today, we want to inform patients and family members about the dangers of sepsis and call on health care providers to take opportunities to prevent, identify and rapidly treat patients with sepsis and to educate patients and families. The vital signs report has new information. We find, and this is surprising to many of the people who work in this field, that sepsis begins outside of the hospital for nearly 80 percent of patients. That”s new and different. We”ve been focusing on and making progress reducing sepsis in the hospital. In intensive care units, in volunteer care facilities and elsewhere. We also found that 7 out of 10 patients with sepsis had either recently interacted with healthcare providers or had a chronic disease that required frequent medical care. In other words, Health care providers are on the frontlines of both sepsis prevention and early recognition. Prevention really is possible. For example if a patient with diabetes goes to their regular doctor and is found to have increased blood sugar and a small wound on their foot, this is a prime opportunity to think about infections and reduce the risk of sepsis.
In addition to treating the infection, the clinician can inform the patient and family members, about how to care for the wound, how to recognize signs that the infection may be getting worse, and when to seek additional medical care. If this infection gets worse, this patient could be at risk for sepsis.  Taking the opportunity to both treat and inform this patients could save their life.  Helping patients know to ask, “Could this be sepsis” empowers patients and families, and could save lives. And I draw your attention to a graphic that outlines 6 of the key signs in sepsis, these are not widely known; Shivering or feeling cold pain or discomfort, clammy or sweaty skin, being confused or disorientated, shortness of breath and rapid heartbeat.

Sepsis most often occurs in people over the age of 65, or infants under the age of one. People with chronic diseases (such as diabetes) or weakened immune systems from things like tobacco use are at higher risk of sepsis. But even healthy people can develop sepsis from an infection especially if it”s not treated properly and promptly. We also found that sepsis is most often associated with four different types of infection: Infections of the lung, urinary tract, skin, and intestines or gut. We also found that several bacteria that were the most common germs that cause sepsis. We as a country can do much more to prevent patients from getting infections that lead to sepsis. Prevention can be done for example, by increasing vaccination rates for pneumococcal disease and for influenza because the flu is often followed by bacterial infections. We could also prevent infections by improving handwashing in healthcare facilities as well as in the community. Second, we can improve recognition of sepsis both in the community and in healthcare facilities and act fast if sepsis is suspected in the patient. One of the things that will help us do this is to inform patients and families about preventing infections that can lead to sepsis and recognizing the signs of sepsis early. The Sepsis Alliance released a survey today noting that about only half of Americans had heard of sepsis and 3 out of 4 Americans didn”t know the signs and symptoms of sepsis, those six signs that I mentioned earlier. We could protect more people by educating patients and families about signs and symptoms when they seek medical care.

Patients, parents and families can educate themselves about sepsis as well. Knowing how to recognize an infection, whether it”s getting worse, connecting with healthcare providers, improving management of chronic disease, vaccinating to prevent infections and handwashing to prevent infections from spreading. If you or your loved one is sick, don”t be afraid to ask your healthcare provider “Could this be Sepsis?” CDC takes a comprehensive approach to sepsis prevention, early recognition and management, we detect respond and prevent infectious diseases. Some of these are by vaccinations. Infections such as pneumococcus (which is what my son had) and Haemophilus influenza type B infections were once leading causes of sepsis in babies and young children but because of vaccinations we hardly see any of this a year. We continue to invest about 4 billion dollars a year in the vaccination program in this country to prevent those infections but we have much more to do.
We”ve also been able to reduce the rates of some infections that cause sepsis in healthcare facilities by half, but preventing more infections and stopping the spread of antibiotic resistant infections will protect even more patients from sepsis. In addition, we”re expanding CDC”s sepsis early recognition efforts. we”ll be launching a sepsis awareness campaign in the coming year this will be a multiyear multimillion dollar campaign we”ll host a series of continuing education opportunities for healthcare providers regarding sepsis starting this month. We continue to engage healthcare provider organizations, patients and family members regarding sepsis prevention and sepsis early recognition. And we are working to improve the national tracking of sepsis. The bottom line is that Sepsis is a medical emergency which occurs 8 out 10 times or starts 8 out of 10 times outside of the hospital. it”s still a huge problem and doesn”t have to be. The mortality rate from sepsis is between 15 and 30 percent and many of the people who survive sepsis will end up with a prolonged stay in the nursing home or other long-term care facility. This report gives us, really for the first time, an anatomy of sepsis – We now know where people get it, 8 out of 10 people get it outside of the hospital.  who gets it? 7 out of 10 recently got medical care or have a chronic disease. And “what did they get?”   Four key infections with several key bacteria. All of us can do more to prevent and recognize sepsis early. So that we protect more people from sepsis and inform and educate patients and their families to treat infections promptly, and act fast when sepsis does occur. I”d now like to ask Dr. Mitchell Levy, a clinical expert on sepsis to provide his thoughts. Dr. Levy?

MITCHELL LEVY: Thank you, Tom. And I think we agree clearly that sepsis is a critical public health issue. We have made tremendous progress in sepsis and the three most important things that we”ve learned is first we now understand the importance of early identification and treatment of sepsis, second we have seen improved survival through routine screening and treatment that is integrated into the workflow of hospitals and third, frontline healthcare providers really do make a difference. What”s clear is we need to expand these successes to other parts of the hospitals and other care locations. As you just mentioned, Tom, 80 percent of sepsis happens outside of the hospitals and CDC”s Vital Signs report calls on all frontline healthcare providers to understand what sepsis is and screen patients for sepsis. Frontline healthcare providers are our first line of defense against sepsis. We have found in the surviving sepsis campaign recently that educating and empowering nurses to do routine every shift screening can have a tremendous impact on sepsis mortality, transfer to the intensive care unit and make a real difference in the kind of care these folks get on the hospital floors. So sepsis is not just happening in critical care units it”s happening on hospital floors, clearly the emergency departments and outside the hospital as well.
So what can healthcare providers do? Well I think there are a few things – First, prevent infections in patients, Make sure that staff are following infection control requirements. Second, we need to educate patients and their families about sepsis so they can become partners with healthcare providers in the early identification of sepsis based on the signs and symptoms that you just talked about Tom. Third, thinking about sepsis, sepsis is fairly common I think just recently, you already mentioned the survey that was released that showed where the public is not aware enough about sepsis, so we need to do more to educate the public. Then next is acting fast, administering early antibiotics and finally reassessing antibiotic choices so that we can perform good antibiotic stewardship programs across the United States and hospitals. So I think we can make tremendous progress in improving sepsis early recognition and care but it is going to take a partnership between healthcare providers and the public working together to be vigilant, identifying sepsis early and treating sepsis appropriately and I also want to thank the CDC for highlighting this important public health issue. Tom, I”ll hand it back to you now.

TOM FRIEDEN: Thank you very much Dr. Levy. The bottom line here is Sepsis is a medical emergency, the recognition and treatment of sepsis is a race against time and we can protect more people from sepsis by informing patients and their families, treating infections promptly, and acting fast when sepsis does occur. Now I”ll turn it back for questions.

MICHELLE BONDS: Thank you Dr. Frieden. I believe we”re ready for questions. Please take the first question.

OPERATOR: Thank you, at this time it is * 1 to ask a question, please unmute your phone and record your name at the prompt once again it is *1 to ask a question. One moment please,
Our first question comes from Mike Stobbe with the Associated Press. Your line is now open.

MIKE STOBBE: Hi thank you for taking my call, I had a couple of questions if I could. Prior to this study, what was the best estimate of what proportion of cases first occurred outside the hospital? You said this one found it to be about 80 percent. What did we think it was before that? And then I have a follow-up.

TOM FRIEDEN: Thank you and let me turn that question over to Dr. Tony Fiore. I think basically there have been less rigorous analysis and less current analysis that these are not out of line with, but this is really the first time we have a definitive number. Dr. Fiore?

DR. TONY FIORE: That”s correct Dr. Frieden, Thanks. Previous analyses have shown that there is a considerable amount using a majority in this analysis of people who develop the initial symptoms outside the hospital and then present to the emergency room or provider after. I think what we did differently here is that we really delved deeply into types of interactions they had with healthcare in the previous month to get a sense of where there might be prevention steps, where there might be – that actually help prevent sepsis and so using the interventions we have now and the ones that we hope to have in the coming years we now know that there are places where people with sepsis do interact with healthcare and could be helped.

MIKE STOBBE: OK. Thanks. Could you also say, I guess I might have missed it or I”m asking you to repeat, what”s the incidence and what are the estimates of how many people get and die in the United States – how many people get and die from sepsis each year and what”s the trend? Has it been going down or holding steady. Dr. Levy talked about we have made a tremendous amount of progress I wasn”t sure what he was referring to. And also could you clarify what you are asking doctors to do if they think it”s sepsis? Do a blood draw and do a blood test? And that”s it, thank you.

TOM FRIEDEN: Some published reports estimate that there are between one and three million people a year in the US diagnosed with Sepsis each year. Between 15 and 30 percent of these patients will die. In terms of what we”re asking doctors to do, as you know there is no blood test for Sepsis and that”s one of the things that is challenging in terms of both its recognition and enumeration. What we do expect is that doctors will draw blood cultures if they think someone has Sepsis and then if clinically appropriate, start them on board spectrum antibiotics and then reassess 24 to 48 hours later to determine whether they need any antibiotics, those antibiotics, or more narrowly targeted antibiotics. We know that there are certain trends that are very positive. For example Haemophilus influenzae sepsis has been dramatically reduced. We know that for example Staph or MRSA in intensive care units has come down by half. But in term of the overall numbers it”s challenging because there is no standard definition of Sepsis or reporting of Sepsis and that”s one of the things that we will be working on to improve going forward. What we know is that however much there is, it”s too much and we can do a better job preventing it recognizing it early, treating it effectively, and preventing deaths.

DR. TONY FIORE: Thanks Dr. Frieden. That is correct. The general trend has been an increase in Sepsis cases over time. This is partly due to changing definitions of what Sepsis is and also recognition of people who previously been just identified as having a severe infection, now actually being recognized as having a form of Sepsis. Good news is that the mortality has generally been going down. This is probably the result of more aggressive active interventions that the healthcare societies and so on have done a great job of pulling together. There are the general trends.

DR. MITCHELL LEVY: I agree with what”s been said. I think it”s important to remember that Sepsis is the single most expensive condition treated in the United States. About 20.3 billion in 2011. The mortality rate although going down still remains quite high, it”s 15-25 percent or so. That”s a significant number, about 300,000 people in the US die of Sepsis every year. So, although the mortality rate seems to be going down based on appropriate treatment, we still have a long way to go.

MICHELLE BONDS: Next question please.

OPERATOR: Once again as a reminder it is *1 to ask a question. One moment for that to come through. Presently, we are not showing any further questions.

TOM FRIEDEN: Let me just reiterate Sepsis is a medical emergency and we can protect more people by informing patients and families, empowering them to ask “could this be Sepsis?”, treating infections promptly, preventing infections where possible, acting fast when Sepsis does occur. There”s more we can do to reduce deaths from Sepsis. Dr, Levy, anything you would like to add?

DR. MITCHELL LEVY: No, I would just echo what you said. I think the partnership between providers and the public remains a very important next step.

MICHELLE BONDS: Thank you for joining us today. For follow-up questions call the CDC press office at 404-639-3286 or send an email to media@cdc.gov. Thank you once again for joining us.  We”ll provide more updated information as we have it.  Thank you.

###
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES