Sepsis: How Laboratory Can Help Mackenzie Roesti, RN, MSN, CCRN

What is Sepsis? Sepsis is a complex illness involving both infection and inflammation. Normally, the body’s response to an infection is targeted to the site of the infection. With sepsis, the body’s response, instead of being localized to the site of infection, causes symptoms to occur throughout the body Sepsis Continuum: SIRS- Systemic Inflammatory Response Syndrome Sepsis – Infection PLUS systemic inflammation (SIRS) in response to infection. Severe Sepsis – Sepsis complicated by organ dysfunction, hypo-perfusion or hypotension (e.g. altered mental status, oliguria, lactic acidosis) Septic Shock –Severe sepsis complicated by persistent arterial hypotension unexplained by other causes, despite adequate fluid resuscitation.

Sepsis: A Disease Defining Continuum 2 SIRS criteria plus (+) confirmed or suspected infection Severe Sepsis Sepsis plus (+) 1 NEW onset organ dysfunction/failure Septic Shock Severe Sepsis plus (+) Hypotension despite fluid resuscitation of 30mL/kg, &/or Serum lactate levels  36mg/dL (4 mmol/L), and perfusion abnormality

Sepsis Pathophysiology

Acute Organ Dysfunction in Sepsis

Sepsis Statistics There are approximately 1.5 million cases of sepsis every year in the United States with a mortality rate up to 50%. More than 1.5 million people get sepsis each year in the U.S About 250,000 Americans die from sepsis each year One in three patients who die in a hospital have sepsis Early goal-directed therapy completed within the first six hours of sepsis recognition significantly decreases in-hospital mortality Emphasize within the past 12 hours! If you are performing a breathing treatment at 0000, you are looking at vitals from 0000 (now) to 12pm the previous shift

Laboratory Warning Signs of Sepsis What labs help in the identification of severe sepsis/septic shock? Blood cultures (2 sets) Lactate (gold standard per CMS guidelines) Procalcitonin   What bundle elements related to lab/micro are needed?  Severe sepsis = Lactate > 18 To be repeated within 3hrs Septic shock = Lactate > 36 What is the appropriate time frame for these labs?  STAT Within 1 hour of TOP (time of presentation)

Role of Laboratory Techs Timely draws Within 1 hour of TOP Repeat lactate drawn within 3 hours of initial result Accuracy 8-10mL/blood culture bottle (advocate for 2 sets!) Correct order of draw Sanitizing skin with CHG to prevent contamination Prompt notification of RNs if cultures are positive

Mentoring RNs Lab techs help mentor RNs on proper collection techniques Two different sites 1st: Blue (Aerobic) 2nd: Purple (Anaerobic) 3rd: Gray (Lactate) On ice Invert all gently 8-10 times