Arlington, VA., Oct. 3, 2017 - Healthcare experts have long known the benefits of integrated sepsis care programs, yet less information has been published on potential unintended consequences of these programs. That's changed with a new study that suggests that electronic sepsis screenings and treatment protocols could, in fact, lead to increased use of certain broad-spectrum antibiotics and healthcare facility-onset (HCFO) C. difficile infection (CDI) rates, according to findings published in the October issue of the American Journal of Infection Control (AJIC) , the journal of the Association for Professionals in Infection Control and Epidemiology (APIC).
The research is the first to address the inadvertent impact of sepsis care programs on broad-spectrum antibiotic use among hospitals and nursing unit-levels -- and follows previous reports demonstrating the effectiveness of sepsis care programs, now a part of most hospitals.
Lead researcher Jashvant Poeran, MD, PhD, Assistant Professor of Population Health Science and Policy, Orthopaedics, and Medicine at the Icahn School of Medicine at Mount Sinai, alongside colleagues from The Mount Sinai Hospital, analyzed adult inpatients at a 1,171-bed tertiary care teaching hospital who were admitted to nursing units with both sepsis care bundle programs in place and the highest incidences of sepsis, antibiotic use, and HCFO CDI. Researchers collected data on the administration of broad-spectrum antibiotics per 1,000 patient days and HCFO CDI data per 10,000 patient days from June 2011 through July 2014.
Poeran and his team defined sepsis care bundle programs as sepsis screenings integrated into a hospital's electronic health record and EHR-triggered antibiotic administration. This protocol aims to standardize initial evaluation and subsequent sepsis management orders, including monitoring, laboratory tests, and fluid and antibiotic administration. The order set recommends broad-spectrum antibiotics available for use without preauthorization from a hospital's antibiotic stewardship team. These broad-spectrum antibiotics can increase the risk of CDI.
Among the findings:
"Integrated sepsis care streamlines how treatment is delivered. Yet as our research indicates, providers face the tough task of addressing how to deliver timely sepsis care, while mitigating potential unintended consequences such as an increase in healthcare facility-onset Clostridium difficile infection that may be linked to increased use of broad-spectrum antibiotics," said Dr. Poeran. "Hospitals' antibiotic stewardship teams can use these observations to align protocol with processes that ensure appropriate antibiotic administration."
"Routine integrated sepsis treatment remains an integral part of how providers deliver rapid care to counter a sepsis diagnosis," said Linda Greene, RN, MPS, CIC, FAPIC, 2017 APIC president. "But this is a double-edged sword: How do we prevent and treat sepsis while minimizing antibiotic resistance? We cannot diminish the importance of implementing swift treatment, but so, too, do we need more research to uncover solutions to the unintended consequences that ensue."
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Sepsis remains the leading cause of death in U.S. hospitals. Across the country, a person receives a sepsis diagnosis every 20 seconds, accounting for 1.6 million people in the U.S. per year. Some 258,000 people die from the disease. That's one sepsis-related death every two minutes.
Visit http://www.apic.org to learn more information about preventing infections in healthcare facilities.
American Journal of Infection Control