Researchers at the University of Pittsburgh’s School of Medicine analysed data from around 50,000 patients from 149 hospitals in New York – one of only two states in America – which has a mandatory protocol in response to sepsis, in place. The results of the study found that for every hour antisepsis protocol was not implemented, mortality rose by almost 4%.

“Our data shows that hospitals really need to do this at the outset, especially at the emergency department when they suspect sepsis,” lead author Christopher Seymour said. “It can be lifesaving.”

The study’s findings

In New York, the protocol is known as the ‘three-hour bundle’ because it is meant to be completed within three hours. In the protocol, doctors are required to first obtain a blood culture and then measure the serum lactate level, the indicator of septic shock and finally administer broad-spectrum antibiotics by IV. In Malaysia, healthcare professionals are also required to follow a similar set of guidelines for treatment of sepsis that were internationally agreed upon in 2016.

Another study conducted by researchers at the University of Utah’s School of Medicine examined the data of 945 patients who had been admitted into intensive care units between July 2013 and December 2015.

The study found that patients of sepsis were less likely to receive antibiotics immediately, especially when the emergency department was overcrowded. It was noticed that each one-hour delay in administering antibiotics increased a patient’s risk of dying from sepsis by 10%.

“Our findings suggest adequate staff and diagnostic resources are critical to effective sepsis care,” lead author Ithan Peltan said.

“Hospitals should also consider sepsis care reorganisation to bypass competing demands on clinicians and diagnostic resources.”

Drawbacks of the study

Seymour’s study has drawn some criticism however. Dr. Mervyn Singer, a professor of intensive care medicine at University College London, questioned the protocol’s instant reaction of administering antibiotics during a time of increasingly worrying antibiotic resistance. He believes doctors need precise data about when such treatments are needed instead.

Singer also noticed that while 23.6% of patients died from treatments that incomplete within three hours, a similar number of 22.6% of patients completed treatment within three hours but still died.

“I think a three-hour window is reasonable for treating most cases of sepsis, and some may benefit from more aggressive antibiotic treatment,” he said.

“But the idea that every hour makes a difference forces doctors to think they’re racing against time. And I’d argue that that three-hour window for some patients makes no difference whatsoever.”

The NHS also faces similar issues

The sepsis protocol only began in New York in 2012 following the death of 12-year-old Rory Staunton. He contracted a sepsis from an infected scrape on his arm and was poorly cared for by hospital staff. Following explosion of the story that began with an article in the New York Times, the state adopted ‘Rory’s Regulation’s’.

The NHS is also facing an issue of low adherence to sepsis care guidelines. In the UK, NHS guidelines state that patients who show signs of sepsis have to be assessed and treated within 60 minutes of their arrival at hospital.

However, a recent audit has revealed that only 44% out of 13,000 patients received antibiotics within an hour of reaching the emergency department. Moreover, just 45% patients were given a blood test and 43% provided intravenous fluids within the first hour of arrival.

Dr Taj Hassan, President of the Royal College of Emergency Medicine, UK, said, “Sepsis continues to be a leading cause of death in patients admitted to hospital as an emergency.”

“It is vital therefore that staff in the emergency department are able to rapidly assess, recognise, risk stratify and treat such patients with proven evidence-based therapy.” MIMS

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