Infection and sepsis rank among the leading causes of death worldwide, with resource-limited (developing) nations bearing the greatest burden across age groups
. The Surviving Sepsis Campaign
(SSC) has been working to improve care in developing nations, starting with an award-winning project in Rwanda that may serve as a model for future improvement initiatives. The results of this project
, as well as sepsis research priorities for the future
, as identified by the SSC Research Committee, were published in Critical Care Medicine
in August 2018.
Launched in 2017, the Sepsis in Resource-Limited Nations project held in Gitwe, Rwanda, in collaboration with the Gitwe Hospital and community, was designed around a concept of scan-teach-treat methodologies to facilitate early diagnosis and treatment of patients with sepsis. In acknowledgment of these efforts, the Society of Critical Care Medicine (SCCM) was recently honored with the prestigious Power of A Award, an association industry award from the American Society of Association Executives.
SCCM Past President J. Christopher Farmer, MD, FCCM, professor of medicine at Mayo Clinic; and Martin W Dünser, MD, PD, professor of anesthesiology at Johannes Kepler University Linz, began by collaborating with the Rwanda Ministry of Health and local researchers. Research assistants were trained to enter information into a discrete sepsis database. These data were then analyzed to learn more about the local patient population, including who develops sepsis and why.
The data scan revealed that the average age of a patient with sepsis in Rwanda was 8 years, meaning that the interventions implemented may help save the lives of children. Despite the average age of 8 years, the entire community was included in the study. The young average age of patients with sepsis is likely due to a demographic shift in Rwanda’s overall population over the past two decades.
Once data were collected and analyzed, the project leaders and faculty, in collaboration with local medical personnel, helped create materials and programs to educate healthcare providers on how to best identify and treat patients. This included education on early sepsis identification, which interventions might prevent escalation to organ failure, and when the best time is to initiate the interventions.
Finally, the project provided sepsis kits—basic supplies to facilitate early intervention in sepsis cases. The sepsis kits included fluids and directed antibiotics to treat known pathogens in the local region. Oxygen concentrators were provided to Gitwe Hospital’s emergency department to administer oxygen to both adult and pediatric patients. Vital sign measurements were also reinforced.
During the project, 7,326 people were screened for sepsis. Of these, more than 1,574 people qualified for intervention.
While a primary goal of the Sepsis in Resource-Limited Nations project was to reduce mortality due to sepsis, the larger aim was to empower local clinicians to recognize the signs and symptoms of sepsis and to act as quickly as possible. The researchers’ objective was to create focused training for the Gitwe medical community that would result in long-term awareness of actions and effective interventions.
Modest infrastructure, rural populations, few ambulances, and other barriers continue to make early interventions for sepsis in many developing countries challenging. However, this project was designed with sustainability in mind, and the entire team was strongly focused on empowering and training local healthcare providers. Making local resources accessible to the average hospital and building momentum for the future were the primary goals. The project was accomplished with less than $80,000 plus $5,000 of donated supplies, speaking to the superior level of engagement and tenacity on the part of the SSC volunteers and leadership and the dedication of the healthcare professionals in Rwanda.
The SSC also recently published research priorities for sepsis and septic shock
, providing a road map for potential future foci for the campaign. Of these, the top six clinical priorities were identified. They are:
- Can targeted, personalized, and precision medicine approaches determine which therapies will work for which patients at which times?
- What are ideal end points for volume resuscitation and how should volume resuscitation be titrated?
- Should rapid diagnostic tests be implemented in clinical practice?
- Should empiric antibiotic combination therapy be used in sepsis or septic shock?
- What are the predictors of sepsis long-term morbidity and mortality?
- What information identifies organ dysfunction?
Learn more about the Surviving Sepsis Campaign and related resources at survivingsepsis.org