For Javier Aponte, an accident with a kitchen knife became a middle-of-the-night admission to the critical care unit, because he became septic.
Javier Aponte smiles as he recovers in the Critical Care Unit at Cooley Dickinson Hospital. A CDH improvement team has reduced the death rate from sepsis to 5 percentage points below the national rate. The team's efforts help patients like Javier Aponte, who battled a serious bloodstream infection.
Sepsis occurs when a severe infection gets into a person’s bloodstream.
The quick recognition of Aponte’s sepsis, also called septicemia, resulted from an aggressive Cooley Dickinson Hospital (CDH) improvement team that worked to catch sepsis earlier and reduce incidence of its worst complication: death.
Nationally, 16 percent of patients hospitalized with septicemia died from it in 2009, according to the federal Agency for Healthcare Research and Quality.
At CDH, the 2009 death rate was better than that, 13 percent. But that wasn’t low enough for CDH, where staff aspire to eliminate infections and the complications and deaths that result from them. Through the efforts of the improvement team, the sepsis mortality rate at CDH was cut by a quarter and went below 10 percent in 2011.
“We’re not finished yet,” said Richard N. Levrault, Jr., DO, who led Aponte’s care team.
Aponte’s story began in July, when he cut the nerves and tendons of his right pinky finger in an accident with a kitchen knife. He had surgery to repair the damage and thought he was on the road to recovery. But, despite intensive medical management, the finger kept getting infected.
Aponte’s doctors kept prescribing antibiotics, but his infection progressed to involve the bone and was largely resistant to oral antibiotics. A few months ago, the pinky “swelled as big as my thumb,” he said. He was hospitalized for a night after surgery to drain and clean it and was fine after that.
So he thought.
At 1:30 a.m. on Jan.16, Aponte said, “I woke up with a fever and muscle aches. My bones were hurting and my skin and eyes were red. After being admitted to the critical care unit, they put a central line in my neck to pump antibiotics in and to manage IV fluids.”
Aponte and his girlfriend, Lizmarie Serrano, said it wasn’t only the expertise at treating sepsis that stands out for them about his stay at CDH.
“They are taking really good care of me,” Aponte, age 21, said.
Serrano added, “The best part is they always inform us of what’s actually going on. They got his input.”
To Aponte’s surprise, the pinky finger he’d originally cut was not the only culprit. He said his fourth finger looked and felt fine. But infectious disease physician William Swiggard, MD, suspected – and an MRI confirmed – that the bone in that finger was infected. That required another surgery.
The accident happened soon after Aponte graduated from Northampton High School. The recurring infections and months of recovery delayed his search for work as an HVAC technician. He’s eager to get that started. But not before expressing gratitude for his care at CDH: “I’m glad I came here.”
Taming Sepsis Takes a Team
To catch sepsis before it becomes deadly, it takes observant nurses and doctors throughout the hospital who know what to look for, how to act fast, and just what to do.
People who have infections can rapidly get worse. And if sepsis takes over, organ systems can fail and patients can die, explained Richard N. Levrault, Jr., DO, Critical Care Unit medical director and physician champion for the sepsis mortality reduction rate team at Cooley Dickinson.
Levrault and the project’s nurse champions, Lynne Schmittlein, RN, and Cynthia Baecher, RN, reported success in reducing the death rate from sepsis at Cooley Dickinson. The CDH rate was better than the national rate to begin with, but is now 5 percentage points below the national rate.
“Just as there is the concept of a ‘golden hour’ in trauma cases and getting a heart attack patient into a catheterization lab within 90 minutes, there are actions to take for someone in septic shock that make a difference in the outcome,” Levrault explained.
The team improved sepsis care at CDH through better screening methods and establishing protocols for treating and monitoring patients with infection.
Levrault said families can have a role in early identification of sepsis, too, by letting hospital staff know right away if their loved one with an infection suddenly shows signs of confusion or fever or reports an increase in pain.
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