Centers for Disease Control and Prevention Sepsis Initiatives

SUMMARY

  • The U.S. Centers for Disease Control and Prevention (CDC) has proposed the “Adult Sepsis Event Toolkit” – 2018 (ASE Toolkit), and the “Hospital Sepsis Program Core Elements” – 2023 (Sepsis Program Core Elements).

  • The Program Elements were developed to help hospitals develop programs to monitor and optimize sepsis management and outcomes.

  • The goals of this ASE toolkit was to provide health systems a more objective measure to track sepsis incidence and outcomes based on the Sepsis-3 definitions.

REVIEW

CASE TOOLKIT (2018)

  • The CDC ASE Toolkit is for identifying sepsis in hospitalized patients.

  • The ASE Toolkit removes SIRS criteria from the definition of sepsis.

    • SIRS criteria are common and nonspecific.

    • SIRS criteria risks both over-detection and under-detection of sepsis.

    • SIRS has also been excluded from the Sepsis-3 Consensus Conference definition of sepsis.

  • THE ASE Toolkit excludes the use of ICD-10 codes to identify patients with infection.

    • ICD-10 codes are often inaccurate in the identification of sepsis.

    • Reported sepsis cases increase when ties to ICD-10 codes with financial implications.

  • ASE defines suspected infection as:

    • A blood culture ordered (regardless of result) AND

    • Antibiotic administration:

      • Within 2 days of blood culture

      • A duration of at least 4 days

  • ASE Organ Dysfunction is present with:

    • Initiation of vasopressors

    • Initiation of mechanical ventilation

    • New changes in serum creatinine, total bilirubin or platelet count.

    • Organ dysfunction definition does not consider:

      • Mental status

      • Vasopressor dose

      • Urine output

      • Blood gas results and fraction of inspired oxygen

  • Limitations of ASE Toolkit:

    • Excludes patients without blood cultures

    • Excludes hypotensive patients not requiring vasopressors

    • Excludes patients receiving non-invasive respiratory support.

SEPSIS PROGRAM CORE ELEMENTS (2023

  • Developed to assist hospitals in the development of multiprofessional programs designed to monitor and optimize the management and outcome of sepsis.

  • Complements existing sepsis guidelines and best practices.

  • Includes:

    •  Evidence based clinical management

    •  Education (clinicians, patients, families, caregivers)

    •  Tracking and reporting treatment & outcomes.

  • Emphasizes hospital leadership

  • Addresses all hospital based sepsis activities (not just improving the patient selection process):

    •  Education

    •  Track sepsis management

    •  Reporting of outcomes

  • Not just focused on the first 6 or 24 hours of sepsis management.

CONCLUSIONS

  • The Centers for Medicare and Medicaid have had a dramatic impact on focusing attention to sepsis with  the Severe Sepsis/Septic Shock Management Bundle (SEP-1), which is now being implemented for a pay for performance measure.

  • Considerable controversy with SEP-1 has resulted in the CDC developing 2 documents over the past several years to implement an improved risk adjusted sepsis outcome measure and hospital guide for optimal program development.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.