When COVID-19 began to sweep through California, hospitals were inundated with sick patients. Medical personnel were scrambling to manage the avalanche.
Amid the new coronavirus threat, an old threat was also quietly rising: In recent years, more people have suffered severe sepsis in California hospitals, including a worrying rise in patients who contracted it inside the hospital, they show. state data.
Sepsis occurs when the body tries to fight an infection and ends up endangering itself. According to the National Institutes of Health, the chemicals and proteins released by the body to fight an infection can damage both healthy and infected cells, leading to inflammation, leaky blood vessels, and blood clots.
This is a dangerous condition that can end up damaging tissues and trigger organ failure. Nationwide, sepsis kills more people each year than breast cancer, HIV/AIDS and opioid overdoses combined, according to Dr. Kedar Mate, president and CEO of the Institute for Healthcare Improvement.
“Sepsis is one of the leading causes of death in hospitals. It has been that way for a long time, and it has been even more so during the pandemic,” Mate said.
The bulk of sepsis cases begin outside of hospitals, but people are also at risk of contracting sepsis while hospitalized for other illnesses or medical procedures. And that danger increased during the pandemic, according to state data: In California, the number of “hospital-acquired” cases of severe sepsis rose more than 46% between 2019 and 2021.
Experts say the pandemic exacerbated a lingering threat to patients, blaming both the dangers of the coronavirus itself and the stresses hospitals have faced during the pandemic. The rise in sepsis in California came at the same time as hospital infections were increasing across the country, a problem that was exacerbated during the increase in hospitalizations for COVID-19, the researchers have found.
“This setback can and should be temporary,” said Lindsey Lastinger, a health scientist with the Centers for Disease Control and Prevention’s Division of Health Care Quality Promotion.
Doctors describe sepsis as difficult to detect and easy to treat in its early stages, but more difficult when it becomes apparent. It can manifest in a variety of ways, and its detection 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 for whether or not you have sepsis,” says Dr. Santhi Kumar, acting chief of pulmonology, critical care and sleep medicine at Keck Medicine of USC. “It’s a constellation of symptoms.”
Christopher Lin, 28, endured excruciating pain and a searing 100-degree fever at home before heading to Kaiser Permanente Los Angeles Medical Center. It was October 2020, and the hospital looked “surreal,” according to Lin, with a tent set up outside and few chairs in the waiting room.
His fever raised concerns that it was COVID-19, but Lin tested negative. At one point, in the ED, his blood pressure dropped sharply, Lin said, and “it felt like my soul had left my body.”
Lin, who suffered from sepsis related to a bacterial infection, isn’t sure where he first got infected. Days before going to the hospital, he had undergone a quick procedure in the ER to drain a painful abscess in his chest, and the next day a nurse changed the gauze pad, he said. These outpatient procedures are not included in the state data on hospital sepsis.
A person with sepsis may have a high or low temperature, a fast or slow heart rate, and a high or low breathing rate.
It can be caused by bacteria, fungi, viruses, or even parasites, “and the problem is that when someone comes into the ER with a fever, we don’t know which of those four things they have,” says Dr. Karin Molander, an emergency physician and former president of the Sepsis Alliance. Treatment can vary depending on the cause of the infection that caused the sepsis, but antibiotics are common because many cases are related to bacterial infections.
The pandemic increased 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 the dangerous condition, experts said. Nearly 40% of severe sepsis patients who died in California hospitals in 2021 were diagnosed with COVID-19, according to state data. Some COVID-19 patients were hospitalized for weeks, increasing their risk of other complications that can lead to sepsis.
“The more time you spend in the hospital, the more things happen to you,” said Dr. Maita Kuvhenguhwa, an infectious disease 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 device – “and the wound can become infected.”
“The lines, the tubes, being here a long time… all of it puts them at risk of infection,” Kuvhenguhwa explained.
The experts noted that the pandemic may have diverted attention from other types of infection control as well, as staff were under pressure and hospital routines were disrupted. California, which is unusual nationwide in imposing minimum nurse staffing ratios, allowed some hospitals to relax those requirements amid the pandemic.
According to Kumar, nurses caring for more patients may not be checking and cleaning their mouths as often to prevent bacterial infections. Mate noted that hospitalized patients may not have their catheters changed as often due to staff shortages, which can increase the risk of UTIs.
Hospitals may have hired roving nurses to fill the gap, but “if they don’t know the procedures, it will make it more difficult for them to follow the same processes” to prevent infection, said Catherine Cohen, a policy researcher at the Rand Corp.
Armando Nahum, one of the founding members of Patients for Patient Safety US, said the pandemic restrictions on hospital visits may also have exacerbated the problem, preventing that family members could detect that a relative was looking unusual and raise their concerns.
Molander echoed that point, saying it’s important for patients to have someone who knows them well and can alert doctors: “My mom has dementia, but she’s usually very talkative.”
Sepsis has long been a battle for hospitals: One-third of people who die in US hospitals had sepsis during their hospitalization, according to research cited by the CDC. But Mate argued that deaths from sepsis can be significantly reduced “with the appropriate measures that we know how to take.”
In Pennsylvania and New Jersey, Jefferson Health began rolling out a new effort to combat sepsis in the fall of 2021, just before the initial wave of Omicron began hitting hospitals.
His system includes predictive models that use information from electronic medical records to alert doctors that someone might be suffering from sepsis. It also establishes a “standardized workflow” for patients with sepsis so that crucial steps, such as prescribing antibiotics, occur as soon as possible, hospital officials explained.
The goal was to ease the mental burden on doctors and nurses working in many directions, according to Dr. Patricia Henwood, the hospital’s clinical director. “Doctors across the country are under a lot of pressure, and we don’t necessarily need better doctors, just better systems,” she said.
Jefferson Health credits the new system with reducing deaths from severe sepsis by 15% in one year.
In New York state, the uproar caused by the death of 12-year-old Rory Staunton forced 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 greater reductions in sepsis deaths in New York than in states without such requirements.
If her child gets sick, she 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 End Sepsis organization after her son’s death. Her group welcomed the news that federal agencies were recently ordered to develop “hospital quality measures” for sepsis.
This measure could meet with opposition. Robert Imhoff, president and CEO of the Hospital Quality Institute, affiliated with the California Hospital Association, argues that there is no need to expand New York’s existing requirements.
“I don’t think hospitals should be forced to provide safe, quality care,” Imhoff said.
State data shows that severe sepsis — including cases originating both outside and inside hospitals — has been on the rise in California over the past decade, but Molander said the long-term increase may be linked to changes in notification requirements that led to increased follow-up of cases. California has yet to publish new data on severe hospital-acquired sepsis last year, and is not expected to do so until this fall.
For Lin, surviving sepsis left him determined to make sure the word about sepsis gets out, and not just in English. At the hospital, he had a hard time explaining what was happening to his mother, who speaks Cantonese. After recovering, Lin worked with local authorities to have the Alliance Against Sepsis materials translated into Chinese.
“I can’t imagine if it was my parents who were in the hospital,” she said, “going through what I was going through.”
To read this note in English Click here
This article was first published in Los Angeles Times in Spanish.
