The time for safe, efficient and effective sepsis management is now
European healthcare leaders from a variety of disciplines met at BD European Headquarters in Eysins, Switzerland on 6 September 2019 for BD DAYS – Sepsis. The day's agenda was filled with interactive panel discussions, insightful presentations and inspirational case studies to accelerate the implementation of positive actions to better manage sepsis and help save lives.
It all started with a sore throat. On 8 April 2013, Dave Carson felt achy and thought it was the flu. His doctor told him to take paracetamol and come see him the next day. But the same evening, he became violently ill and thought he was going to die. He was rushed to the emergency department and quickly admitted into an intensive care unit (ICU) with septic shock and multiple organ failure². They put him into an induced coma that lasted three weeks. His family was told that he had a minimum chance of survival.
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Mr Dave Carson
Sepsis Survivor, United Kingdom
In 2014, Adam Linder's team carried out a survey on sepsis awareness in Sweden³. While 53% of Germans have heard the term sepsis, only 20% of Swedes have³. This led them to set up Sepsisfonden the following year⁴. This organisation’s main goals are to fundraise for sepsis-related research initiatives and educate the general public, decision makers and healthcare professionals on sepsis⁵. According to Ron Daniels and Konrad Reinhart, personal stories are the key to success⁴. So, Sepsisfonden has raised awareness with videos on social media, brochures, a card listing sepsis symptoms and a team of ambassadors who give lectures on sepsis throughout Sweden⁴. They organised a seminar with the Swedish government. Along with the U.K. Sepsis Trust and the German Sepsis Society, Sepsisfonden is an active member of the Global Sepsis Alliance⁶. Thanks to Sepsisfonden’s efforts, sepsis awareness in Sweden has increased from 21% in 2015 to 43% in 2019⁴.
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Assoc Prof Adam Linder
Senior Consultant, Lund University Hospital, Sweden
Identifying drivers and barriers
Ms Garín opened the discussion by asking the three members of the panel to share their thoughts on drivers and barriers. From a microbiological perspective, Dr Weinbren pointed out the biological variability of blood cultures and the unpredictability of results. Delays are another barrier and according to some studies, it is uncertain whether rapid test results have an impact on clinical outcomes in patients with suspected sepsis.
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Moderator Ms Fiona Garín
Senior Director, BD Strategic Marketing Europe
Assoc Prof Eduardo Palencia Herrejón
Coordinator, Code Sepsis, Infanta Leonor Hospital, Madrid, Spain
Dr Mike Weinbren
Consultant Medical Microbiologist, King’s Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, United Kingdom
Assoc Prof Adam Linder
Senior Consultant, Lund University Hospital, Sweden
Prof Gherardi began by saying that the incidence and mortality of blood stream infections (BSIs), including sepsis, are increasing, often because of inappropriate antibiotics prescribed within the first 24 hours. Misuse of antibiotics may lead to antimicrobial resistance⁷. Blood culture is the gold standard for detecting BSIs⁷. Ensuring best practice during the preanalytical phase could lead to improved BSI diagnoses and better antibiotic management according to Prof Gherardi.
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Assoc Prof Giovanni Gherardi
Clinical Pathology, University Campus Bio-Medico; Deputy Director, School of Specialisation in Clinical Microbiology and Virology, Faculty of Medicine, Rome, Italy
Sepsis is time dependent⁸. The longer we wait to administer antibiotics, the higher the risk of mortality⁸. But overuse of antibiotics increases antibiotic resistance⁹. It is important to find a balance between early antibiotic treatment and overconsumption⁹. Dr Ferrer added that to avoid exacerbating resistance, we need to administer treatment rapidly, then de-escalate rapidly. He is a member of the Surviving Sepsis Campaign (SSC)’s executive committee¹⁰. The SSC “encourages clinicians to act as quickly as possible to obtain blood cultures, administer broad spectrum antibiotics, start appropriate fluid resuscitation, measure lactate, and begin vasopressors if clinically indicated” within one hour of sepsis identification¹¹.
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Dr Ricard Ferrer
Head of the Intensive Care Department, Vall d’Hebron Hospital, Barcelona, Spain; Chairman, European Society of Intensive Care Medicine (ESICM) Systemic Inflammation and Sepsis section; President, Spanish Society of Intensive Care
Dr Dickmann started by defining risk control as “our wish to have static, measurable, stable, predictable risks¹².” However, there are often surprises. So, to remedy this, she designed an original approach to detect the public health risk earlier, respond to it faster, have “smoother coordination” and then learn from the past to leave a “smarter legacy” leading to better risk governance in the future¹²,¹³.
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Dr Petra Dickmann
Senior Academic Clinical Fellow, University Hospital and Center for Sepsis Control and Care, Jena, Germany
Lobbying regionally¹⁴
Mr Gómez opened the panel discussion by mentioning the European Parliament’s latest resolution on antimicrobial resistance (AMR) included a section on sepsis. Prof Reinhart would like the European Union (E.U.) to ask member states to adopt the World Health Organisation (WHO) resolution on sepsis¹⁵. He has had discussions with the European Commissioner for Health and Food Safety and the President of the European Commission to collaborate on different policy initiatives. Health First Europe has been actively lobbying the European Parliament to make sure sepsis is on the E.U. agenda for the next five years. Ms Raso explained that health is a national competency and the E.U. has limited competence in this sector. However, the E.U. has the ability to promote a European-wide epidemiological study, run a pilot programme on a specific public health issue and they can also support member states in setting up national programmes. Health First Europe hosted a round table debate at the European Parliament called #STOPSEPSISEU on 20 September 2019. The aim is to drive engagement among policy makers and healthcare leaders.
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Moderator Mr José Luis Gómez
Vice President, BD Public Policy Europe
Prof Dr med Konrad Reinhart
Chair, Global Sepsis Alliance, Jena, Germany
Ms Melina Raso
Executive Director, Health First Europe, Brussels, Belgium
Dr Ron Daniels
CEO, Global Sepsis Alliance; Founder and CEO, UK Sepsis Trust, Birmingham, United Kingdom
Dr Giulio Toccafondi
Patient Safety and Quality Manager, Centre for Clinical Risk Management, Florence, Italy
Dr Ricard Ferrer
Head of the Intensive Care Department, Vall d’Hebron Hospital, Barcelona, Spain; Chairman, European Society of Intensive Care Medicine (ESICM) Systemic Inflammation and Sepsis section; President, Spanish Society of Intensive Care
I think the laboratory is given a massive role to play, but it's not reaching anywhere near its full potential at the moment. — Dr Mike Weinbren - Consultant Medical Microbiologist
King's Mill Hospital, Sutton-in-Ashfield, United Kingdom
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We can't look at sepsis as a singular, or as a silo. We have to look at everything that involves patient care, and what may deteriorate from there. — Ms Margarida Pacheco - Matron
Emergency Department, King’s College Hospital NHS Foundation Trust, United Kingdom
I always feel as if I’m representing sepsis survivors everywhere. — Mr Dave Carson - Sepsis Survivor
United Kingdom
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Sepsis kills a lot of people worldwide, so it is important that we all fight it together. — Pr Giovanni Gherardi - Clinical Pathology
University Campus Bio-Medico, Rome, Italy
Sepsis is a moving target. It's something that is very dynamic. What we need are flexible and responsive health systems. — Dr Petra Dickmann - Senior Academic Clinical Fellow
University Hospital and Centre for Sepsis Control and Care, Jena, Germany
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