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Doctors newspaper, 01.10.2019
Avoiding Deaths
Every third sepsis death in Germany could be avoided. Success factors for successful prophylaxis and detection were named at a specialist event.
By Angela Misslbeck
Streptococcus pneumoniae: One of the most common pathogens for sepsis.
© Tatiana Shepeleva / stock.adobe.com
Around 70,000 people in Germany die each year from sepsis, according to the German Patient Safety APS. After all, 15,000 of these deaths are considered preventable. Three completely different but equally promising ways of reducing sepsis mortality were shown by a specialist event of the APS together with the Sepsis Foundation, the German Sepsis Aid, Sepsis Dialogue and the Greifswald Unimedicine.
"Sepsis is an emergency," says Privatdozent Dr. med. Matthias Gründling from the University Hospital Greifswald. However, diffuse symptoms make the detection of sepsis difficult. A systematic screening should change that – model one for successful prophylaxis.
Already a paper-based screening in the emergency department improves detection, explained Gündling. Also important is a quick blood culture diagnostics. According to Gründling, the University Hospital Greifswald accelerated the blood culture diagnostics by 28 hours. Rural clinics that have previously used remote microbiology would have an even greater time advantage of 24/7 local blood culture diagnostics, he said.
Sepsis sister collects quality data
"If I start the antibiotic therapy later, the mortality increases," warned the Greifswald medical doctor. At its clinic, the proportion of sepsis patients with newly established adequate antibiotic therapy increased from around 24 percent in the first few years in 2006 and 2007 to more than 70 percent in the years 2014 to 2018.
The University Hospital Greifswald has also been working for a further reduction in sepsis mortality for ten years, among other things with special training for doctors and nurses for the prophylaxis and detection of sepsis, reports Gründling. Vulnerable patients who have had their spleens removed receive a splenectomy card. In addition, the University Hospital finances a sepsis nurse who collects quality data and also reports successes to the departments, so that the motivation increases.
Earlier recognition of sepsis is also supported by the UK Sepsis Trust campaign in England – Method Two. Dr. However, Ron Daniels, head of the Global Sepsis Alliance, is calling for more attention to sepsis outside the hospital. The UK Sepsis Trust has launched a comprehensive campaign to educate the laity and anchored billboards with the message: "Just Ask: Could it Be Sepsis" on the public streets.
The National Health Service has also responded. According to Daniels, a telephone triage, community services, a sepsis screening tool and a Red Flag system were introduced. As a result, screening rates rose to 87 percent by 2018. According to Daniels, 80 percent of sepsis patients are now receiving antibiotics. The predicted mortality had dropped to 20 percent.
The US State Department of Health has declared sepsis a matter of state concern and intervened regulatively in the management of sepsis. When collecting data in 2005 and 2006, there was a tremendous variance of 10 to 50 percent sepsis mortality among the various clinics in the state.
Which hospital achieves which values?
The Department of Health found that some clinics use protocols similar to our guidelines. It urged that these protocols be installed and trained in all clinics. At the same time it began to publish sepsis data, so that it can be seen which hospital reached which levels. "We hope that's enough motivation to change those things," says Chief Medical Officer Professor Marcus Friedrich.
The New York State Sepsis Report – the third method to detect sepsis more quickly – includes data on three-hour sepsis management, antibiotic use, six-hour management and mortality for each hospital , According to Friedrich, the 30-day mortality has dropped from 30 to 22 percent. "We save almost 5,000 people a year," says Friedrich. The report's data will test the success of public health policies, but also drive medical research. "We think that we will get further indications of improvements from the data," says Friedrich. He points out that children and pregnant women may need different guidance. This is currently being researched.
The data are freely available on the internet. https://healthdata.ny.gov/
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