Sepsis is on the rise. There are three times as many cases of sepsis and almost twice as many Australians dying from it each year than previously thought, according to the first assessment of the worldwide burden of sepsis published in The Lancet.
Sepsis, commonly known as blood poisoning, is life threatening and on the rise. Yet there is low awareness of the condition in Australia.
It is one of the leading causes of hospital deaths worldwide yet, our firm is seeing cases of improper diagnosis or treatment of sepsis.
The escalation of sepsis among older people and its consequences, means aged care facilities need to pay more attention to prevention and diagnosis of the condition.
What is sepsis and what are the symptoms?
Sepsis is caused by the body’s response to an infection that can quickly become life-threatening.
The body normally releases chemicals into the bloodstream to fight infection. Sepsis occurs when the body’s response to these chemicals is out of balance.
Sepsis can affect all parts of the body. In severe cases, one or more organs fail. In the worst cases (known as septic shock), sepsis causes the blood pressure to decrease to dangerous levels and the heart to become weaker. Once this happens, multiple organs may fail quickly and, if not corrected, the person will die.
Common symptoms of sepsis are fever, chills, rapid breathing, rapid heart rate, rashes, drowsiness, confusion, disorientation, and not passing urine. Many of these symptoms are similar to symptoms of other conditions, like the flu.
How many Australians get sepsis and why is it increasing?
It is one of the leading causes of death in hospital patients worldwide. According to The George Institute for Global Health, sepsis kills more people than prostate and breast cancer. For every three people that come down with sepsis, one will die.
Each year around 18,000 people are treated in an Intensive Care Unit (ICU) in Australia and New Zealand for severe sepsis. Around 5,000 people die from the condition in Australian hospitals each year.
The results of the Global Burden of Disease study, released in early 2020, now gives a more accurate picture of the size of the problem by including sepsis occurring outside of the hospital, putting the number of Australian cases at 55,000 and deaths at 8,700.”
The death rate for sepsis is now as high or higher than it was in the pre-antibiotic era of the early 1900s, and in some years, it is in the top 20 causes of death.
Why is sepsis on the rise?
The incidence of sepsis is increasing because our population is aging. More people have chronic illnesses and are being treated with immunosuppressive drugs and chemotherapy. Bacteria are becoming more resistant to antibiotics.
Large increases of sepsis deaths in the 65-85 and over-85 age groups are occurring.
Medical experts are concerned and some say more can be done to reduce deaths caused by sepsis. Professor Peter Collignon, an infectious diseases expert at the Australian National University, says deaths from sepsis are likely to continue to get worse over time.
Low awareness of sepsis is a major issue
In 2016, a national awareness survey found 60% of Australians have not heard of sepsis, and only 14% could name one of its symptoms. Sepsis is a time-critical condition requiring rapid recognition and treatment with antibiotics. Early intervention is known and proven to save lives. With approximately 70% of cases originating outside of hospital, low public awareness of sepsis in Australia leads to delayed recognition and treatment, and a higher likelihood of death or disability for patients according to a 2017 report on the need for national action plan to stop sepsis.
Sepsis in older people
In an article in Emergency Medicine Australia – Burkett, Macdonald, Carpenter, Arendts, Hullick, Nagaraj And Osborn conclude that sepsis is overwhelmingly a disease of older people.
Patients over 65 years of age account for two-thirds of sepsis cases and older people account for the most rapid escalation of longitudinal incidence.
When presenting to an emergency department with sepsis, older people are more unwell, with higher levels of both potentially reversible organ dysfunction and mortality than younger people.
For survivors, sepsis is often a life-changing illness associated with high levels of morbidity, especially if severe enough to warrant admission to the ICU. Although sepsis mortality in Australia and New Zealand has fallen steadily since 2000, the odds of being discharged to a rehabilitation facility have increased three-fold in the same period. One third of survivors in two trials didn’t return to their previous level of functioning at six months.
For the elderly, the most common infections that trigger sepsis are pneumonia, urinary tract infections, and pressure sores from sitting in a wheelchair or lying in a bed. What makes it even more difficult in this age group is that the infections themselves are often easily missed. The signs of pneumonia in the elderly can also be very subtle. Due to decreased lung function, their cough may be minimal and shortness of breath hard to detect.
An issue in aged care and hospitals
The causes and impact of sepsis on older people is why sepsis needs more attention in aged care facilities.
Most often, sepsis occurs in people who are hospitalised or who have recently been hospitalised.
In both aged care facilities and hospitals, appropriate recognition and timely management of patients with severe infection and sepsis is a significant problem.
The National Institute for Health and Care Excellence (NICE) quality standard declares that patients exhibiting signs of sepsis must be seen by a senior doctor and need to be treated within one hour with antibiotics and intravenous fluids. If at high risk, they should be seen immediately.
This declaration follows a report by the National Confidential Enquiry into Patient Outcome and Death that stated “40 per cent of people admitted to [the ER] with sepsis did not have a timely review by a senior clinician.”
Our client stories on sepsis
There are many stories of aged care residents having falls and developing pressure wounds that are not properly treated to prevent ongoing infection and sepsis.
Her story was featured in the second part of Who Cares?, the ABC TV Four Corners expose into the aged care sector, that helped spark the Royal Commission into Aged Care.
June had falls in the aged care facility in which she was living, was unable to walk and eventually developed pressure sores. No-one told her family. The Aged Care Complaints Commission found that the home didn’t regularly liaise with the GP, had not sought a wound specialist review and had left wound care to be mainly completed by untrained carers.
Our health law team also successfully sought damages for improper sepsis treatment in hospital. The hospital’s failure to diagnose and then administer treatment quickly enough meant our client suffered extensive injuries and disabilities including hypoxic respiratory failure, kidney failure, partial amputation of several of her fingers and toes, loss of tissue on the sole of her foot, nerve damage, neuropathic pain, scarring, muscle wasting and psychiatric injury. Our client spent many months in hospital and then in rehabilitation recovering from her injuries.
If you believe that you or a loved one has developed an infection, treat it promptly. Even the smallest scrape warrants cleaning with soap and water and the application of an antibacterial ointment. Proper and frequent hand washing also decreases the risk of infections.
If you or a loved one has experienced improper treatment of sepsis, our expert health law and elder law lawyers can help advocate for you and seek justice. Please talk to us about the options available