Document 409930
Sepsis: Prevent it. Spot it. Treat it – beat it. World Sepsis Day Newsletter 05 /2014 World Sepsis Day: One day, year-long effort +++ Strategic Goals and what you can do! +++ A perspective on ARISE +++ Take Position: pay-for-performance +++ Community-acquired sepsis +++ World Health Day +++ Sponsor news page no. 1 | 8 That was World Sepsis Day, 2014 – a one day, year-long effort. More than 220 events. Every continent – over 40 countries. From educational events to quality improvement. Interested in a printed version of our A0 size overview poster of World Sepsis Day 2014 ? Mail us by 11th November at office @ world-sepsis-day.org Don’t forget to state your postal delivery address and name! POLAND World Sepsis Day: 13 September 2014 The Global Sepsis Alliance and its founding members have joined forces with other healthcare organizations to initiate the World Sepsis Day movement. The campaign has been made possible thanks to the expertise of our founding organizations and the professionals behind them, as well as the support of outstanding experts from around the world. With our campaign we are educating medical professionals, informing policymakers, and creating awareness among the general public. Our aim is to reduce the incidence of sepsis 20% by 2020. What you can do: Healthcare Professionals: Only what is counted counts! Please take care that sepsis is coded according to the WHO Coding system. WHO Establish sepsis and relevant treatment within the WHO Sepsis Survivors or family, relatives and friends who lost someone due to sepsis: Speak up about sepsis. It‘s crucial – your first hand experience helps to raise awareness. Global Burden of Disease Report Recognizing the global burden of sepsis in the Global Burden of Disease Report Please become a supporter of World Sepsis Day and sign the World Sepsis Declaration: www.world-sepsis-day.org Countess of Chester Hospital Pediatric sepsis IKT event Aberdeen NHS - Grampian Pink Picnic Cheltenham NHS - Gloucestershire Hospitals Patient story video Lecture Display package Chester Countess Of Chester Hospital Information display Gateshead Parker Domnick Hunter Awareness day Glasgow MD Anderson Cancer Center Michael E. DeBakey Sepsis Awareness Veterans Affairs Medical Campaign Center (MEDVAMC) Informative events Educational event The Medical Center of Lewisville Lexington T2 Biosystems Pink Picnic Midland MidMichigan Medical Center Lectures and public campaign MidMichigan Medical Center Jonathan R. Vasiliou Foundation HUNGARY Conquest Hospital Fiona Elizabeth Agnew Trust (FEAT) & Scottish Patient Safety Programme Presentations & networking session Kaunas Lithuanian University of Health Sciences Lectures & blood donation Kaunas Cwm Taf University Health Board Information display & Dewi Sant Hospital & medical training Vilnius University Lithuanian University of Health Sciences Students conference Pontypridd Vilnius Vilnius University Conference, lectures & Pink Picnic Vilnius Vilnius University Medical Faculty Medical training & discussion Vilnius Vilnius University Lithuanian University of Health Sciences Marathon team & blood donation Reading Royal Berkshire Hospital Salford Salford Royal NHS Foundation Trust Simulation training Stornoway NHS - Eileanan Siar Learning session Tonypandy Ysbyty Cwm Rhondda Hospital Information display West West Hertfordshire Hospitals Hertfordshire Display, quiz & video York Information displays Lecture Major conference London UK Sepsis Trust Cycle for Sepsis London UK Sepsis Trust Inaugural Ball Sepsis Master Class York Teaching Hospitals NHS Foundation Trust IRELAND ITALY Royal Glamorgan Hospital Pontypridd King’s College Hospital UK Sepsis Trust Sepsis Parliament NETHERLANDS West Hertfordshire Hospitals CROATIA Symposium Lunteren Panel discussion Berlin Vivantes Klinikum am Urban Lecture Greifswald Universitätsmedizin Greifswald Lecture Heidelberg Universitätsklinikum Heidelberg Symposium Jena Universitätsklinikum Jena Awareness event & Pink Picnic Olpe Krankenhaus Olpe Lecture Rüsselsheim GPR Klinikum Lecture & breakfast Students conference Kaunas Conference Vilnius Blood donation Kaunas Pink Picnic Vilnius Education meeting Erzurum Education meeting Gaziantep Education meeting Izmir Education meeting Malatya Education meeting Samsun Education meeting Van Awareness event Ankara Milan Éupolis Lombardia Conference Lunteren Zagreb Our Lady of Lourdes Hospital Modena Nuovo Ospedale Civile S. Agostino-Estense Patient information National Patient Safety Program The Netherlands Somers Point Shore Medical Center Educational event Tuscany Florida Hospital North Pinellas Pink Picnic Italian Society of Intensive Care Symposium Tarpon Springs Croatian Society of Nurses in Anesthesiology, Reanimatology, Intensive Care and Transfusion Rome Gemelli Teaching Hospital Sepsis Masterclass Washington, D.C. Rory Staunton Foundation National Sepsis Forum Washington, D.C. BD Diagnostics Global Sepsis Alliance Lecture Helios Kliniken Symposium Heidelberg Medical training Vilnius Istanbul Education meeting Edirne Drogheda Zombie gauntlet Universitätsklinikum Jena TURKEY Lectures Zagreb Sepsis Heroes event Panel discussion Berlin Marathon Vilnius Education meeting Bursa Sepsis Alliance Symposium Symposium Sepsis-Stiftung and others Education meeting Adana Johnathan R. Vasiliou Foundation Master classes, video, presentations, displays Information display & quiz for staff Helios Kliniken Berlin Education meeting Ankara New York Our Lady of Lourdes Hospital Universitätsklinikum RWTH Aachen Bad Berleburg Launch of national program Istanbul New York Shore Medical Center LITHUANIA Sepsis Parliament Information display Royal Glamorgan Hospital Royal Berkshire Hospital Reading Conference Information display & quality management Sepsis Week & information display King’s College Hospital UK Sepsis Trust Cycle for Sepsis Becton Dickinson UK Sepsis Trust Conquest Hospital Llantrisant York Teaching Hospitals Conference Minehead Community Hospital Hull and East Yorkshire Hospitals Trust London Ysbyty Cwm Rhondda Hospital SepsEast & University of Szeged London Hastings UNITED STATES OF AMERICA Houston UK Sepsis Trust Inaugural Ball Minehead Hull McMaster University Houston Parker Domnick Hunter Pink Picnic Lectures Aachen Gy r Presentations Glasgow McMaster University McMaster University &Hamilton Health Sciences Summerside Prince County Hospital Salford Royal Polish Housewife Polish Sepsis Group GERMANY SepsEast Conference Budapest UNITED KINGDOM Hamilton Hamilton Lewisville A truly global effort to fight sepsis. On every continent. In over 40 countries. United Nations: General Assembly Recognition of World Sepsis Day as World Day World Sepsis Day operates at a truly global level. Different countries and regions act according to their local healthcare systems and economic means. We are proud to look back at such a successful World Sepsis Day 2014. CANADA Outlook: World Sepsis Day strategic targets The recognition of sepsis by global health authorities is one key in reducing sepsis incidence 20% by 2020. Pink Picnic Poznan Poznan Wisla Aberdeen 1st stage of national education meetings on awareness Kayseri Kayseri Erciyes University Symposium Ankara Turkish Medical and Surgical Intensive Care Society Lectures Stornoway Launch of national program for sepsis education Turkish Society of Intensive Care & Ministry of Health Ankara, Istanbul Turkish Society of Adana, Bursa, Intensive Care & Edirne, Erzurum, Ministry of Health Gaziantep, Izmir (2), Kayseri, Konya, Malatya, Samsun, Van Awareness event Glasgow Patient information Modena Éupolis Lombardia Drogheda Salford Chester Pontypridd & Tonypandy Cheltenham Llantrisant London Minehead Hastings Florida Hospital North Pinellas Kaunas Gateshead York Cottingham Vilnius Olpe Aachen Munich Gyor Education meeting Kayseri Education meeting Konya Kruševac Greifswald Lunteren Poznan Berlin Bad Berleburg Jena Wisła Rüsselsheim Heidelberg Augsburg Paris Summerside, PEI SERBIA General Hospital Kruševac Lectures Budapest Szeged Midland, MI Hamilton, ON Lexington, MA Zagreb Milano Modena Italian Society of Intensive Care Gemelli Teaching Hospital KOREA Kruševac Tuscany Barcelona New York, NY T2 Biosystems MD Anderson Cancer Center Ankara Palma Korean Society of Critical Care Medicine Erzurum Kayseri Izmir Elche Malatya Konya Symposium Seoul Seoul Istanbul Bursa València Washington, D.C. MEDVAMC Awareness Campaign Samsun Edirne Rome Somers Point, NJ The Medical Center of Lewisville Van Symposium Seoul Tokyo Yokohama Gaziantep Adana Nagoya Lewisville, TX Houston, TX FRANCE Institut Pasteur PEMEX Conference Hospital Juárez de México Symposium Mexican Group for the Study of Intensive Care Medicine (GMEMI) Academic event and Pink Picnic Mexico City Hospital "Dr. Manuel Gea González" Symposium Mexico City Hospital Central Sur de Alta Especialidad PEMEX Symposium, conference and public event Symposium Mexico City Round table discussion Elche Barcelona Paris Tarpon Springs, FL MEXICO Mexico City Mexico City SPAIN Sociedad Catalana de Pediatría Presentation & discussions Barcelona Vall d' Hebron University Hospital Quality Management Initiatives Elche Hospital General Universitario de Elche Round table discussion Palma de Mallorca Hospital Son Llàtzer Patient information València Hospital de Sagunto Presentations & open forum discussion Institut Pasteur San Juan Belize City Hospital Son Llàtzer Kathmandu JAPAN Sepsis Rally Kathmandu Kathmandu Lucknow Jaipur Nepal Critical Care Development Foundation Karachi Doha Sepsis Rally Rajkot Aurangabad WSD Thailand 2014 Bangkok GMEMI academic event Hospital “Dr. Manuel Gea González” GMEMI Pink Picnic Cali NIGERIA QATAR PAKISTAN INDIA San Juan Kano Doha Karachi Aurangabad ISCCM Maharashtra Hospital Pediátrico Universitario Dr. Antonio Ortíz Kano State WSD Celebration Chapter Hamad General Hospital Pakistan Society of Critical Care Medicine Advance Sepsis Management Course Symposium Bhavnagar The Criticare Symposium Symposium Gurgaon Max Super Speciality Hospital Sepsis Week San Juan Cali Sincelejo VENEZUELA Clinica Universitaria Rafael Uribe Uribe Universidad Libre - Universidad del Valle UCIPED Corporacion. III Simposio Nacional de Sepsis Belize City Colombian Association Infectology Caribbean Region Symposium Belize City Belize Medical and Dental Association and Belize Society of Critical Care Medicine Symposium Karl Heusner Memorial Hospital Awareness day Symposium & Pink Picnic Pink Picnic Kano Hamad General Hospital Symposium Karachi Palmas Barcelona Workshop Jaipur Fortis Hospital Education Lucknow ISCCM Lucknow Education & Conference New Delhi Action Balaji Hospital Education New Delhi Society of Critical Care Medicine Delhi NCR Symposium Rajkot Bharat Serums Discussion Salvador College of physicians of Anzoátegui State Brasília Conference & discussion Discussion Rajkot Society of Critical Care Medicine Conference Barcelona Karl Heusner Memorial Hospital CBC Radio campaign & Sepsis Forum Public awareness events Yokohama Sepsis Easy Sepsis Easy Round table discussion & public campaign Jakarta INDONESIA PHILIPPINES Jakarta Manila Philippines Department of Health Surprise Pink Picnic Indonesian Society of Intensive Care Medicine Manila Section of Pediatric Critical Care Medicine of the University of Sto. Tomas Hospital Video presentation Socializing Sepsis Campaign Vitória Symposium Belize City Public awareness events Department of Emergency & Critical Care Medicine, Nagoya University Graduate School of Medicine Bangkok Belo Horizonte Symposium Cali Seminar & discussion Japanese Society of Intensive Care Medicine and Japanese Association for Acute Medicine Nagoya Radio Campaign Nagoya THAILAND PUERTO RICO Sepsis Week & Pink Picnic Quito BELIZE COLOMBIA Japanese Society of Intensive Care Medicine and Japanese Association for Acute Medicine Yokohama Manila Barcelona Hospital Juárez de México Tokyo Bhavnagar Kano Sincelejo NEPAL New Delhi Gurgaon Socializing Sepsis Campaign Symposium Sincelejo Rio de Janeiro Pink Picnic Manila Hospital Unimed Vitória São Paulo LAMIB Wauchope Porto Alegre The Criticare ISCCM Lucknow Newcastle Pelotas Sydney Buenos Aires CHILE ECUADOR Temuco Quito Federación Panamericana e Ibérica de Sociedades de Medicina Crítica y Terapia Intensiva Pediatric Intensive Care Unit at Hospital de los Valles Symposium Congress Symposium Quito Congress Temuco BRAZIL Brasília Belo Horizonte Niterói Hospital Santa Luzia Lectures Hospital Madre Teresa Lectures Complexo Hospitalar de Niterói Lectures Palmas Hospital Geral de Palmas Lectures Pelotas Hospital Escola da Ufpel Sepsis Week Pelotas Hospital São Francisco de Paula Actions & lectures Porto Alegre Hospital São Lucas da PUC Actions Rio de Janeiro Hospital Clínicas de Padre Miguel Lectures Rio de Janeiro Hospital Municipal Souza Aguiar Sepsis Week Rio de Janeiro Hospital Universitário Pedro Ernesto Sepsis Week Salvador São Paulo Liga Acadêmica de Medicina Intensiva da Bahia Hospital AC Camargo Hospital Clínicas de Padre Miguel Hospital Universitário Pedro Ernesto Hospital Municipal Souza Aguiar Hobart ISCCM Maharashtra Hospital Santa Luzia Hospital Escola da Ufpel Hospital São Francisco de Paula Hospital AC Camargo Clínicas de Padre Instituto Americano de Sepse AUSTRALIA Irmandade Santa Casa Sepsis Forum Hospital Mboi Mirim Hospital Santa Marcelina Itaquera Actions & lectures São Paulo Hospital São Paulo Actions Sanatorio Anchorena and Fundación Favaloro São Paulo Instituto Americano de Sepse Sepsis Forum Symposium São Paulo Irmandade Santa Casa de São Paulo Actions & lectures Vitória Hospital Meridional Lectures Vitória Hospital Unimed Vitória Lectures Symposium Buenos Aires Complexo Hospitalar de Niterói Lectures São Paulo São Paulo Buenos Aires ARGENTINA Melbourne Temuco Lectures Hospital Madre Teresa Hospital Geral de Palmas Hospital São Lucas da PUC Hospital Hospital São Clínicas Paulode Padre Hospital Mboi Mirim Hospital Santa Marcelina Itaquera THANK YOU TO OUR SPONSORS Hobart Royal Hobart Hospital Melbourne Royal North Shore Hospital Wauchope District Memorial The Northern Hospital Calvary Mater Newcastle Sepsis education The Northern Hospital Sepsis education Newcastle Calvary Mater Newcastle Road Show & quiz St Leonards Royal North Shore Hospital Lecture Victoria ARISE Wauchope Wauchope District Memorial Hospital Education board, quiz & sepsis education Erin Kay Flatley Memorial Foundation | Roche | Adrenomed | Pfizer Pharma GmbH Copyright: World Sepsis Day 2014 | Powered by Lindgruen-Gmbh next page ▾ World Sepsis Day Newsletter 05 /2014 page no. 2 | 8 World Sepsis Day 2014 – a short overview: After 2012 and 2013, which focused on establishing the movement, 2014 centred on realizing the goals as they are laid out in the World Sepsis Declaration. Achieved milestones World Sepsis Day 2014: The WHO began by promoting World Sepsis Day with the following actions: _ Sending a note of support for WSD to their mailing list of over 20 000 contacts _ Sending a note of support for WSD to over 17 000 healthcare facilities that are part of the WHO‘s global campaign on hand hygiene _ Posting information on the Patient Safety home page with the link to the WSD website (http://www.who.int/ patientsafety/en/) They have furthermore informed us that they look forward to further collaboration with GSA. This is especially timely because of its relevance to Ebola. United Nations General Assembly: _ First contacts have been established Communication: _ Spanish Website _ Newsletter enhanced professionally to three languages _ Fundraising event & donation online international _ SoMe outreach _ Network/supporter activities _ World Sepsis Day Movie, in 6 languages (Japanese is nearly complete) _ Network communication and activation through mailings (e.g., posters, press releases and more) Collaboration: _ Evidence4action / MamaYe _ WAAAR (World Alliance Against Antibiotic Resistance) _ Life after Sepsis Survey _ Australian Sepsis Network New Ambassadors: _ Dr. Tom Frieden, Director CDC, USA _ Prof. Johanna Wanka, Federal Minister of Education and Research, Germany _ Prof. Dorel Sandesc, Vice Federal Minister of Health, Romania We would like to welcome: _ Prof. Jean Carlet, FR (Steering Committee & Expert) _ Prof. Jean-Marc Cavaillon, FR (Expert) _ Prof. Jean-Francois Dhainaut, FR (Expert) _ Dr. Janet Diaz, USA (Steering Committee & Expert) _ Prof. Simon Finfer, AU (Steering Committee) _ Prof. Majid Mokhtari, IR (Steering Committee & Expert) _ Prof. Zsolt Molnár, HU (Steering Committee) _ Prof. Necmettin Ünal, TR (Expert) We would like to thank Michael O‘Leary for his great work in 2012 and 2013. Michael O‘Leary was a highly valued member not only in the World Sepsis Day Steering Committee but also in ANZICS. Both engagements are now taken on by Simon Finfer. The input of all Steering Committee Members is highly valued – their regional and national engagement helped to establish World Sepsis Day. Supporters of World Sepsis Declaration The goal in 2014 was to establish sustainable strategic collaborations. In 2013 the goal has been to increase the supporter base, especially in the cluster of hospitals. Dec. 2012 Sep. 2013 Sep. 2014 Hospitals & Healthcare Services: 1,237 2,600 3,053 Non-Profit Organizations: 143 220 295 Total Non-Profit & Hospitals: 1,380 2,820 3,348 Healthcare Professionals 1,529 1,478 2,071 Private Individuals <50 537 929 Total 2,959 4,835 6,348 Events Over 148 Events reported to World Sepsis Day Headquarters in over 30 countries by 30th September. These are significantly more events actively reported than in 2013! There were approximately as many as 50% unreported events in 2012 and 2013, with information gathered informally at talks and in conference settings by personal contacts. Given this, the full event outreach could be, in a conservative estimate, around 220-300 events. next page ▾ World Sepsis Day Newsletter 05 /2014 page no. 3 | 8 Outreach 1-30th September 2014 Frankfurter Allgemeine Zeitung / Deutschland: http:// www.faz.net/aktuell/wissen/seuchen-und-systemeebola-dengue-sepsis-13180968.html Media Reach: • Reports indicate approximatley 250 newspapers (not PR portals) and 22 500 news items published online and/or print features around the world in English, Spanish, Mandarin Chinese, Arabic, German, French, Portuguese, and other major languages of Europe, Asia and Africa. •Reports indicate up to 3000 radio features •Reports indicate up to 150 TV features Deutsche Welle / Online (Ger & Eng): http://www.dw.de/ sepsis-unerkannt-oft-lebensgefährlich/a-17917596 International Press Releases: Headline Search Online: Grand Total: 51,109 Top Release Watch Links: 63,304,200 (Reach: top online sites that have posted your news release, as measured by the number of visitors that frequent that site per day.) Some Highlighted Features: Times of India / India: http://timesofindia.indiatimes.com/ city/aurangabad/Lack-of-awareness-giving-rise-tosepsis-deaths-Experts/articleshow/42853618.cms NY Times / USA: http://www.nytimes.com/2014/09/19/ nyregion/an-effort-to-raise-awareness-of-sepsis-led-byfamilies-touched-by-it.html CBS News / USA: http://www.cbsnews.com/news/sepsisdeath-of-rory-staunton-prompts-his-parents-to-raiseawareness/ Telegraph / UK: http://www.telegraph.co.uk/health/1104 7019/Sepsis-is-on-the-rise-warns-medical-expert.html Press features have appeared in nearly all countries with events. Social Media Outreach 1-16th September 2014 Facebook: 2,619,940 Page Impressions // Likes: 3,819 Twitter: 138,300 Page Impressions // Followers: 1,976 // Are you interested in the full report? Click here to see more event images, examples of press features and social media activities. WSD14_Summary The recognition of sepsis by the WHO is key in reducing sepsis incidence 20% by 2020. To achieve this, we will concentrate our activities toward recognition of sepsis as a global burden and to get World Sepsis Day mandated as World Day by the United Nations. What you can do to support this: HÜRRIYET BURSA / Turkey Hirado / Hungary: http://www.hirado.hu/videok/ ?video=240076 Le parisienne / France: http://www.leparisien.fr/ informations/une-journee-contre-les-infections13-09-2014-4130747.php Brazil: around 1,600 insertions Serbia: TV Features Die Welt / Deutschland: http://www.welt.de/gesundheit/ article132218866/Die-gefaehrliche-Blutvergiftung-kannjeden-treffen.html Healthcare Professionals: Only what is counted counts! Please take care that sepsis is coded according to the WHO ICD coding system. Sepsis survivors or family, relatives and friends who lost someone due to sepsis: Speak up about sepsis. It's crucial – your first-hand experience helps to raise awareness. Please inform your contacts to become supporters of World Sepsis Day and sign the World Sepsis Declaration: www.world-sepsis-day.org next page ▾ World Sepsis Day Newsletter 05 /2014 page no. 4 | 8 Perspective: Sepsis Mandates: Improving Inpatient Care While Advancing Quality Improvement Cooke CR, Iwashyna TJ. Sepsis Mandates: Improving Inpatient Care While Advancing Quality Improvement. JAMA 2014; 313(14): 1397-8 In this viewpoint article, Colin Cooke and Jack Iwashyna discuss potential for large-scale change within a healthcare system with regard to its management of patients with sepsis through the use of financial performance incentives. Using the U.S example of the Centers for Medicare and Medicaid Services (CMS), they argue that considered, phased implementation of pay-per-performance initiatives for sepsis might ‘advance the science and practice of quality improvement to face the common reality of diagnostic ambiguity or inadequacy.’ Once coding and data capture are addressed, a starting point for any pay-per-performance initiative must surely be to improve the proportion of eligible patients (for example, those triggering an Early Warning Score) who are screened for sepsis. In systems where clinical measurement is not heavily resourced, it may be necessary that, rather than assessing whole-bundle compliance, surrogates such as time to antibiotics or to review by Sepsis Team be used. NHS England will shortly be issuing national commissioning levers for sepsis along these lines. The challenge for any healthcare organization aiming to incentivize better performance in sepsis care is to ensure that measures reflect the need for graded implementation, and that potential for unintended harm, including through the over-zealous use of antimicrobials in cases of diagnostic Well-designed, national performance incentives for sepsis uncertainty, be addressed. The are likely to save lives and improve However, this cannot be a ‘one size fits authors recognize that metrics should quality of life for survivors by reducing all’ approach: the complexity of the focus not only on outcome measures, time to delivery of the basics of care. metrics used will be governed by but on counselling efforts to address They could also be used to build national resources available for measurement poor recognition, staging successful registries for sepsis in order that we and systems available to capture data. implementation, ensuring mandates might better understand the human are responsive to new evidence, and targeting learning and fiscal burden of disease, and in order that resources rather than judging. may be appropriated. The recommendations within this article are key to better care. We would agree that ‘National programs for sepsis are needed’, and welcome the concept that financial incentives Ron Daniels to performance improvement would be helpful. However, CEO Global Sepsis Alliance this cannot be a ‘one size fits all’ approach: the complexity of the metrics used will be governed by resources available for measurement and systems available to capture data. The under-recognition of sepsis is a global issue which must be addressed. Under ICD-10 coding rules, the causative infection must be coded as primary diagnosis with severe sepsis secondary. Any national programme must begin with a willingness to capture both primary and secondary codes to identify sepsis incidence, a strategy already adopted by the CDC. Within the UK, the Health and Social Care Information Centre is considering this same approach, and the Global Sepsis Alliance is lobbying the WHO to support such change. next page ▾ World Sepsis Day Newsletter 05 /2014 page no. 5 | 8 Perspective: The Australasian Resuscitation in Sepsis Evaluation: The ARISE study The impetus for the ARISE study, began in 2006 following discussion between researchers in Australia, The United States and the United Kingdom. Early Goal-Directed Therapy for patients with severe sepsis was being recommended as the only approach to the early resuscitation of patients with severe sepsis and septic shock, in spite of the evidence supporting this therapy coming largely from a relatively small trial conducted in only one centre. While there was consensus that identifying patients with sepsis as early as possible and commencing their specific therapy (with antibiotics and source control) in an expedient fashion was clearly important, there was considerable controversy regarding the utility of some of the components of Early Goal-Directed Therapy (for example, the potential for giving excessive fluids, the side effects of blood transfusion and dobutamine). There was also considerable doubt regarding the external validity, that is, whether the results of the trial could be replicated outside of the unique centre where the original research was conducted. care, in any of the trial outcomes. What do these results mean for clinicians, both in the developed world, with well-resourced healthcare systems and for those working in resource-poor settings? The trial results confirm that clinicians caring for patients with severe sepsis can focus on providing early antibiotics, early source control, judicious fluids titrated according to the clinical judgement of the treating clinicians and good supportive care for their individual patient, without requiring them to follow the specifics of the Early Goal-Directed Therapy protocol for all patients. Out of these discussions the ARISE study was conceived to test whether patients with early septic shock would have a lower mortality rate at 90 days receiving Early Goal-Directed Therapy compared to usual care in a variety of healthcare settings, across a variety of countries. The study was conducted in 51 centres, largely across Australia and New Zealand, but also Hong Kong, Finland and the Republic of Ireland. Not only were large academic hospitals included, but metropolitan and rural centres were also included to ensure that the results of the study would apply in a wide variety of healthcare settings. The ARISE study has been a remarkable success on a number of levels. There has been a tremendous level of co-operation between Emergency Departments and Intensive Care units involved in the study to enable the development and implementation of the study protocol and to successfully complete the study. There has also been an unprecedented level of international collaboration between the three teams running parallel trials in Australasia (The ARISE study), the United Kingdom (the ProMISe study), and the United States (The ProCESS) study. This close collaboration means that the results of all three trials can be combined in a database to allow more research to be done in the process of finding new ways to reduce the mortality of severe sepsis. After commencing recruitment in October of 2008, the final trial participant was recruited in April of 2014, and the results of the trial have recently been released at the European Society of Intensive Care Scientific Meeting in Barcelona and via the New England Journal of Medicine. The primary result of the trial showed no difference in mortality between the trial participants randomised to receive Early Goal-Directed Therapy and those who were randomised to receive usual care. There was no difference found in the time the trial participants in each group spent in the ICU or in hospital. In fact, there were no major differences between the patients who received Early GoalDirected Therapy and those who received just good usual One of the other successes of the trial has been the increased interaction with stakeholders via social media. The ARISE study has a Facebook page and a Twitter account (@TheARISEstudy). These new modes of communication were designed to facilitate dialogue with study sites and local investigators during the recruitment period of the trial, allowing local sites easy access to the study investigators to answers questions regarding the study protocol or local implementation strategies. More recently these media have facilitated an ongoing engagement between the research team and clinicians and those interested in discussing the next page ▾ World Sepsis Day Newsletter 05 /2014 page no. 6 | 8 results of the study on blogs and via podcasts, …click here to join. By reaching out via social media networks, the research team is attempting to hasten the translation of this valuable evidence into clinical practice so that the care of patients with severe sepsis can continue to improve. After all, this is really the point of performing studies, such as the ARISE study, to improve the care of patients with sepsis. Prof. Sandra Peake Anthony Delaney Patient arrives in the emergency department Time to randomization from arrival in the emergency department in minutes Early Goal-Directed Therapy (EGDT): Placement of a central venous catheter to monitor pressure and ScvO2 and to administer intravenous fluids, vasopressors, dobutamine, or packed red-cell transfusions. Team approach with a set of 6-hour resuscitation instructions. Protocol-based standard therapy (ST): Adequate peripheral venous access and administration of fluids and vasoactive agents to reach goals for systolic blood pressure and shock index and to addres fluid status and hypoperfusion. Usual care (UC): Decisions about the location of care delivery, investigations, monitoring, and all treatments were made by the treating clinical team. Duration of stay in ICU and hospital in days Deaths by 90 days ProCESS study (31 centers in the US)1 ,k ED 5,1 197 n=439 EGDT n=446 ST 185 n=456 UC 181 5,1 4,7 31,9% 11,1 30,8% 12,3 33,7% 11,3 ARISE study (51 centers, mostly in Australia or New Zealand)2 , k ED n=796 UC n=792 EGDT 4,7 178 4,9 186 Kumar et al. (24 centers in Canada and the US)3 Survivors in percent 100% 80% 40% 20% 0 1 2 3 4 56 9 12 Time in hours till start of therapy 24 14,1 18,8% 18,6% Early recognition and treatment save lives. 60% Adult patients with antibiotic therapy 15,1 36 1_ The ProCESS Investigators: A randomized Trial of Protocol-Based Care for Early Septic Shock. N Engl J Med: March 18, 2014 // 2_ The ARISE Investigators and the ANZICS Clinical Trials Group: Goal-Directed Resuscitation for Patients with Early Septic Shock. N Engl J Med: October 1, 2014. // 3_ Kumar A, Roberts D, Wood KE, et al.: Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med, 34: 1589-1596, 2006. next page ▾ World Sepsis Day Newsletter 05 /2014 7 page no. 7 | 8 Perspective: Community-acquired sepsis - an underestimated challenge Recent studies prove that sepsis is not only an underestimated problem in hospital settings, but also in outpatient and emergency care. Since studies like ProCESS and ARISE underlined the importance of early recognition and treatment of sepsis in the Emergency Department (ED), we know about the key role of the ED in the successful management of sepsis. However, there is data that suggests that Emergency Departments and other outpatient facilities are not sufficiently trained in the early diagnosis and management of sepsis. Older epidemiological studies found an incidence of 140 sepsis cases in the ED setting per a population of 100,000 (Strehlow et al. 2006) and may underestimate the real burden of sepsis in the ED. Recently, Henriksen et al. (Henriksen et al. 2014) found that in a cohort of 8,358 medical ED-patients in the years 2010 and 2011 in Sweden, about 20% presented with any form of sepsis. Based on those estimates, they concluded an annual incidence rate of 731 sepsis patients admitted to EDs per 100,000 inhabitants. The main focus of sepsis was pneumonia (63%), followed by urinary tract infections (24%) and abdominal infections (11%). This is in accordance with another epidemiological study from the US (Seymour et al. 2012): They found that from 2000-2009 the incidence of severe sepsis in the ED more than doubled and in 2009 they observed an incidence of 3,3 severe sepsis cases per 100 ED patients, exceeding the incidence of acute myocardial infarction (2,3 patients/ Changes in the rates of hospitalizations with severe sepsis among emergency medical services* In summary, sepsis is a major challenge for healthcare systems all around the world – and particularly members of the ED team hold a key position in early recognition and therapy of sepsis. Therefore, they need to be trained in an appropriate way to be able to provide optimal patient care. That is why adequate teaching on early sepsis recognition and evidence-based sepsis management has to become part of the medical school training and professional education for healthcare providers in both inpatient and outpatient facilities all over the world. Until now, sepsis is not sufficiently covered by the curricula of nurses, paramedics and medical students compared to other conditions like stroke, acute myocardial infarction or trauma – this needs to change. It is the aim of the GSA and the World Sepsis Day movement together with the national and international supporters to raise awareness for this hidden healthcare disaster. Given the magnitude and the multifactorial causes of the problem, joint actions of all stakeholders are urgently needed which should ideally be developed and focused in national action plans currently in demand in some countries like Germany and the US. Germany: Nationwide action plan to fight sepsis USA: First national sepsis forum For further information, visit: www.world-sepsis-day.org Konrad Reinhart Chairman Global Sepsis Alliance 400 Adjusted rate per 10 000 EMS 100 ED patients) and stroke (2,2/100 ED patients). This data clearly proves that sepsis is not a problem which is limited to the hospital setting. Severe Sepsis Carolin Fleischmann, MD 300 Acute myocardial infarction 200 Severe Sepsis Literature Henriksen DP, Laursen CB, Jensen TG, Hallas J, Pedersen C, Lassen AT. 2014. Incidence Rate of Community-Acquired Sepsis Among Hospitalized Acute Medical Patients – A Population-Based Survey. Crit Care Med. Acute myocardial infarction *Seymour CW, Rea TD, Kahn JM, Walkey AJ, Yealy DM, Angus DC. 2012. Severe sepsis in pre-hospital emergency care: analysis of incidence, care, and outcome. Am J Respir Crit Care Med, 186 (12):1264-1271. Stroke Strehlow MC, Emond SD, Shapiro NI, Pelletier AJ, Camargo CA, Jr. 2006. National study of emergency department visits for sepsis, 1992 to 2001. Ann Emerg Med, 48 (3):326-331, 331 e321-323. Stroke 100 2001 2003 2005 2007 2009 next page ▾ World Sepsis Day Newsletter 05 /2014 page no. 8 | 8 Thanks to our sponsors & all those driving forces behind World Sepsis Day To organize and provide website maintenance, campaign material and this newsletter is both time- and resourceconsuming. Without the donation of our sponsors and private philanthropic donors this would not be possible. We rely on donations. If you like what you see and value the work we are doing, please donate here. We would like to thank: Center for Sepsis Control and Care: For donating the greatly-needed resources of a part-time assistant and communication budget. B | Braun: For being a one-year Bronze and currently a three-year Silver Sponsor to 2015 ThermoFisher Scientific: For ongoing support and Silver Sponsoring in 2014 Becton Dickinson and Company For Bronze status in 2014 and supporting World Sepsis Day with numerous events in 2014. CSL Behring: For being a Sponsor to 2013 and especially for Silver Sponsoring in 2014 And Adrenomed, Alere Technologies, Klinik Bavaria, InflaRx for your valued donations. We would like to thank especially all those private individuals who donated such as: • Erin Kay Flatley Memorial Foundation– thank you Carl Flatley for your ongoing support! • ThermoFisher Scientific: Employee Tombola to raise funds for World Sepsis Day and to all those great private donors. Thank you! Important upcoming events & dates: 3-5 December 2014 International Sepsis Forum, Paris: Sepsis 2014 Meeting December 2014: Material for World Sepsis Day 2015 available in the World-Sepsis-Day.org toolkits 17-20 March 2015 ISICEM Brussels: GSA Joined Sepsis Session and World Sepsis Day Supporter Meeting 1 April 2015 England: Start of government-funded national pay-per-performance initiative for sepsis quality improvement. 9 -11 April 2015 Emirates Critical Care Conference, Dubai Joint Session with GSA and WSD Supporter Meeting 8 - 9 May 2015 International Intensive Care Symposium, Istanbul Joint Session with GSA and WSD Supporter Meeting 29 August - 2 September 2015 WFSICCM, Seoul: GSA Joined Sepsis Session and World Sepsis Day Supporter Meeting We invite you to download the newsletter and use these key messages for your own bulletins, website, Facebook, and/or Twitter accounts or to disseminate it to your colleagues /other organizations or friends in your area. Date: 5 November 2014 Responsible: Konrad Reinhart, Ron Daniels, Flavia Machado, Niranjan Tex Kissoon, Regina Hanke Feedback is always appreciated! Contact: Center for Sepsis Control and Care, Erlanger Allee 101, 07747 Jena, Germany Mail: [email protected] Please share this newsletter and inform us about your activities. Stay connected Twitter: twitter.com/WorldSepsisDay #sepsis: information related to sepsis #wsd15: events around World Sepsis Day 2015 #5moments: handhygiene #pic: pink picnic Facebook: facebook.com/WorldSepsisDay Our sponsors Erin Kay Flatley Memorial Foundation | Adrenomed | Alere Technologies | Klinik Bavaria | InflaRx | last page ▾
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