How can health stakeholders and EU policymakers work to improve the management of sepsis in all health care settings? How to raise awareness on the burden of SEPSIS?
The 3rd roundtable debate of the European Network for Safer Healthcare was organised by Health First Europe in the European Parliament on 25 September 2019. Kindly hosted by MEP Simona Bonafè (S&D, Italy), the meeting brought together health stakeholders, national representatives and the European Commission to exchange best practices on how to better tackle the burden of sepsis and to discuss joint efforts that need to be in place to improve sepsis prevention, diagnosis and early treatment.
Sepsis is a major public health emergency due to its high mortality and economic cost. As emphasised by MEP Bonafè, “Sepsis is a global health crisis and a major challenge for patient safety. Sepsis is a global killer, accounting for 7 to 9 million lives lost every year (equivalent to 1 death every 3.5 seconds). In Europe alone, it is conservatively estimated that more than 3.4 million individuals develop sepsis each year, of whom 678,000 die”. Those who survive may face lifelong physical or psychological consequences, including disabilities. Moreover, sepsis is the pathology with the highest hospitalization costs. In Europe, the costs of severe sepsis amount to typically 23.000-42.000 € per sepsis period per patient. Indirect and long-term costs are much higher, accounting for social costs. However, many studies and organisations suggest that the number of deaths due to sepsis as well as the cost for the health care system are largely underestimated. Sepsis is intrinsically interlinked with antimicrobial resistance (AMR) and healthcare-associated infections (HAIs). Infections which do not respond to first-line antimicrobial therapy due to AMR, may progress to sepsis rapidly. Delays in diagnosis of sepsis and lack of antibiotic stewardship programs are key drivers of the misuse of broad-spectrum antibiotics as a ‘last ditch’ attempt to improve outcomes. Therefore, it is time for MEPs to “work with the Commission and the Council to support the development of consistent national sepsis action plan across Europe”, as stated by MEP Bonafè.
The WHO Sepsis Resolution gives a template for a structured approach to sepsis prevention and management. Unfortunately, and as clearly pointed out by MEP Bonafè, “only very few European countries have followed the call of the WHO Resolution on Sepsis to develop national Action Plans for improving the prevention, early recognition, and management of sepsis in both adults and children”. In order to fill this gap and tackle the burden of sepsis, the World Health Organization will be working as from next year on developing clinical management guidelines for sepsis, as presented by Dr Mercedes Bonet from the WHO’s Department of Reproductive Health and Research. Those guidelines will cover every health care settings, going from the first contact with the patient to the intensive care unit.
Tackling sepsis requires a broad and multi-level approach. Awareness on sepsis is a way to save lives: changing how sepsis is measured, diagnosed and treated is everybody’s responsibility, from citizens to patients, and health care workforce.
- Awareness on sepsis is a way to save lives. As highlighted by Marvin Zick of the Global Sepsis Alliance “Not everybody in the world has to know about sepsis, but everybody has to know somebody who does”.
- Sepsis protocol for the detection should be placed anywhere (meaning in all health care settings) and anytime: every doctor evaluating a patient with an infectious disease should evaluate if this patient presents an organ failure.
- With a probability of 40% to die, sepsis needs to be recognised and treated rapidly. As commonly agreed, there is an urgent need to work for a better detection and diagnosis of sepsis. However, many health care settings lack the requisite resources and diagnostic capacity to implement current sepsis management,test patients at risk,provide in real-time results to the clinicians to reduce mortality and to permit a continuous adjustment of the treatment based on the obtained results and reduce the empirical therapy.
It is critical to work together at a local, national, European and global level. This roundtable needs to be perceived as a kick-off meeting for broader actions combining the expertise and relevance of each participant to tackle the burden of sepsis. In this respect, the European Union has an important role to play in the fight against sepsis, by means of
- Promoting European epidemiological studies to delineate the real burden of sepsis in Europe under the guidance of the European Commission and the European Center for Disease Prevention and Control (ECDC). In this framework, the interoperability of existing national or regional patient-level datasets should be facilitated to better understand the epidemiology of sepsis and the link with antibiotic resistance.
- Designing a comprehensive Pan-European Infection Management Program under the European One Health Action Plan on AMR launched by the European Commission, that includes:
- Research on prevention of infection risks including an increased capability of early recognition of resistant bacteria and of compromised host response.
- A common sepsis code for emergency care which requires hospitalization for antimicrobial therapy, and which suggests a suspect of organ dysfunction: a criteria of sepsis.
- Development and harmonization of existing international guidelines on the identification, diagnosis, and treatment of sepsis to ensure efficient and consistent cross-border implementation.
- The launch of a European Observatory for sepsis to carry out comprehensive analysis of sepsis impact on public health and costs, as well as to identify best practices in prevention, identification and management of sepsis fostering future European guidelines.
- Raising awareness of sepsis across Europe by launching a European Sepsis Awareness Week