Journal of Critical Care
Volume 23, Issue 4 , Pages 452-453, December 2008

It is time to label sepsis as a public health problem

School of Population Health and School of Primary, Aboriginal and Rural Health Care, Discipline of Emergency Medicine University of Western Australia, Crawley 6009, Western Australia

Received 3 July 2008; accepted 6 August 2008.

Article Outline

 

Vinicor [1] suggested that a disease or condition can be classified as a public health problem when it exhibits the characteristics of high disease burden, uneven distribution, evidence that prevention strategies can reduce burden and that these strategies are not yet in placed. This article demonstrates how sepsis fulfills these criteria.

Sepsis is a common condition, and the incidence is projected to increase by as much as 1.5% per year. In addition, sepsis carries a high mortality and case fatality rate [2]. Worse still, those patients who survive the acute course have significant morbidity that may result in reduced health-related quality of life [3]. Furthermore, patients with sepsis draw heavily on expensive intensive care resources and often have prolonged hospital stays, which further add to costs.

Sepsis exhibits uneven distribution and outcomes across age, sex, and race groups. The incidence is disproportionately increased in the elderly, and age is an independent predictor of mortality [4]. Males and nonwhite races are at greater risk of sepsis [5], [6], and African Americans were reported to have higher case fatality rates.

Evidence shows that the burden of sepsis can be lessened. Measures such as institution-wide protocols and antenatal screening guidelines have been shown to be successful in preventing catheter-related infections and group B Streptococcus sepsis in neonates, respectively [7]. In addition, the methods used to identify those critically ill patients who are likely to die have become more established, which allows greater opportunities for early intervention and ultimately better outcomes.

Although some public health measures have already taken place, a more concerted approach akin to the modern public health practice themes suggested by Beaglehole et al [8] is needed to address this condition. Themes of leadership, along with collaborative actions across all disciplines and partnership with the population served could be feasible. A strategy should begin with data collection and extended to the setting up of surveillance systems. Data collection has been established in many countries by research-orientated organization, for example, ANZICS in Australia and New Zealand, ICNARC in United Kingdom, and PROGRESS in United States. This provides an excellent opportunity for global surveillance, which will assist in detecting changes in trends and in setting priorities.

Another public health strategy is to increase awareness of the condition among the general public, health care providers, and policy makers. Although the scientific community is striving to understand and discover better ways to detect and treat sepsis, the general public and the health care provider should be educated as to the latest developments in the prevention and treatment of sepsis, which could ultimately save lives. Increasing the policy makers' awareness will also assist in standardizing practice by identifying obstacles and testing the strategies that are needed to overcome such obstacles.

Encouraging efforts has been underway. In 2001, the Surviving Sepsis Campaign committee began the “Barcelona Declaration,” which calls for critical care providers, governments, health agencies, and lay people to join the fight against sepsis. Perhaps, someday, sepsis will be one of the top priority conditions listed in national initiatives to increase the health of the population, such as National Health Priority Areas in Australia, Saving Lives: Our Healthier Nation in the United Kingdom or Healthy People 2010 in the United States.

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References 

  1. Vinicor F. Is diabetes a public-health disorder?. Diabetes Care. 1994;17(Suppl 1):22–27
  2. Angus DDC, Linde-Zwirble WWT, Lidicker JJ, Clermont GG, Carcillo JJ, Pinsky MMR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–1310
  3. Heyland DK, Hopman W, Coo H, Tranmer J, McColl MA. Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life. [see comment] Crit Care Med. 2000;28(11):3599–3605
  4. Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. [see comment] Crit Care Med. 2006;34(1):15–21
  5. Merkitch KW, Schauberger CW, Fruechte BA. Preventing early-onset group B streptococcal sepsis: efforts to measure and improve compliance with guidelines. WMJ. 2006;105(8):67–70
  6. Esper AM, Moss M, Lewis CA, Nisbet R, Mannino DM, Martin GS. The role of infection and comorbidity: factors that influence disparities in sepsis. Crit Care Med. 2006;34(10):2576–2582
  7. Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. [see comment] Crit Care Med. 2004;32(10):2014–2020
  8. Beaglehole R, Bonita R, Horton R, Adams O, McKee M. Public health in the new era: improving health through collective action. Lancet. 2004;363(9426):2084–2086

PII: S0883-9441(08)00177-9

doi:10.1016/j.jcrc.2008.08.001

Journal of Critical Care
Volume 23, Issue 4 , Pages 452-453, December 2008

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