Sepsis is actually the number one healthcare cost in the United States and can be very deadly and difficult to treat. In this episode, Dr. Bjorn Mercer talks to APU’s Dr. Stacey Malinowski, who has spent more than 20 years as a nurse, about sepsis awareness, prevention, recognition and treatment. Learn how sepsis, which is when the body has an overwhelming systemic response to an infection can be identified early. Learn how the pneumonic “TIME” can help people recognize the signs of sepsis so it can be treated immediately.
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Read the Transcript:
Dr. Bjorn Mercer: Hello. My name is Dr. Bjorn Mercer, and today we’re talking with Dr. Stacey Malinowski, Associate Dean in the School of Health Sciences. And today we’re talking about sepsis awareness. Welcome, Stacy.
Dr. Stacey Malinowski: Hi Bjorn. Thank you for having me.
Dr. Bjorn Mercer: Excellent. Important topic, so let’s just jump into it. So what is sepsis and why should we be talking about it today?
Dr. Stacey Malinowski: That’s a great question. So, most people don’t know what it is. So sepsis is actually your body’s response to an infection, but it’s like your body’s response to an infection on steroids, okay? It is this overwhelming systemic response, it infects all of your body systems and it’s actually the number one healthcare cost in the United States, like $65 billion a year. And it has a very high mortality rate, like four out of every 10 people who develop sepsis, unfortunately, die from it but it’s something that nobody knows about.
Dr. Bjorn Mercer: And, from our conversation you said it’s preventable. And so how can people reduce their chances of developing sepsis from an infection?
Dr. Stacey Malinowski: So, what happens is you start off with your infection. This could be any kind of infection, it could be bacterial, a parasite, it could be a virus, and your body can’t fight it effectively. So, the main strategy is to do those simple things you would do to prevent any type of infection. So, we’re talking very basic good hand hygiene, kill those bacterias, getting vaccinated to prevent viral infections.
If you do have an infection and see the doctor and they give you antibiotics, I cannot stress the importance enough of finishing the whole course of antibiotics because if you don’t, that infection can come back worse and it can lead to sepsis.
If you go to the doctor and they tell you have a viral infection, please do not ask them for antibiotics because it won’t work and it’s not going to help. So, good hand hygiene, getting vaccinated, seeking medical attention when you do have an infection that needs medical assistance, those are just some of the things we can do to prevent sepsis from occurring.
Dr. Bjorn Mercer: And that’s excellent. And this is a layman question: Are you more likely to get sepsis in the hospital or at home as you’re fighting something? Or does it not matter?
Dr. Stacey Malinowski: I guess it really doesn’t matter. There are certain people who are more likely to get it. For example, if you have a weakened immune system, if you’re elderly, if you are a child or an infant, if you are immunocompromised because you’re on chemotherapy because you have cancer. You could get it at home from an infection, you could get it if you’re in the hospital from an infection.
I will say, as an ICU nurse, most of the time patients are coming in with it and it seems to be one of the most common diagnoses. A lot of the times, it’s from a urinary tract infection that people didn’t treat and it gets worse to the point of sepsis where their organs starts shutting down. It’s very scary.
Dr. Bjorn Mercer: And, I’ve recently discovered, I need to know this because I’m not medical, that urinary tract infections can be, I guess a little more sneaky in older folks, if that makes sense. I’m not using any of the right terms.
Dr. Stacey Malinowski: No, you’re absolutely right. And what we usually see is it’s one of the main causes of confusion in the elderly. And we don’t notice urinary tract infections in the elderly until they become confused. We don’t know it’s a UTI at that point, they get confused, they come to the hospital, they’re early sepsis that came from a urinary tract infection. But there’s lots of reasons, bodily changes in older age, dehydration, incontinence issues in older age. So, yeah, we do tend to see UTIs more in the older population.
Dr. Bjorn Mercer: Yeah, and I can see how with, and I should say maybe quite older, maybe 80+, I mean any age is plus or minus whatever. But if you have an elderly parent or an elderly friend to make sure to observe them to make sure that if you do see something, to talk to them and maybe get them to the doctor because of this potential risk.
Dr. Stacey Malinowski: Right, exactly. So that brings up a good point. How do you know when it’s time to see the doctor if you have an infection of any sort? So, I like pneumatics and I have one for this one too. So the pneumonic for when you should see the doctor, it’s actually TIME. So T-I-M-E. So with sepsis, the T stands for temperature. So if somebody’s got a really high temperature or if they actually have a temperature that’s much lower than usual, that’s one sign you could be headed for trouble.
The I is for infection. So in many cases people may know they have an infection but it’s really, really mild. They have a cold, which actually now has turned into pneumonia. They had a cut that they didn’t think too much about on their leg, it looked a little red, but it’s gotten into their bloodstream.
M is for mental decline. So this is where your confusion come in. So this could be they’re straight up confused, they might just be very drowsy, sleepy, hard to wake them up.
And the E is for extremely ill. They just seem far more ill than they should be for having that scratch on their leg or for having that urinary tract infection. They might have shortness of breath or they might have really severe pain or just something that doesn’t make sense for what seemingly is going on.
Dr. Bjorn Mercer: And that’s great. I always love little things to help. So TIME. And I think this is proven that, unfortunately, males are less likely to get help than females I think at any age. And so if you do see any of that or if you do have an infection, especially like you said, where you have an infection that gets to your bloodstream, then that’s a serious issue.
Dr. Stacey Malinowski: It is. So you’ll hear, especially older people, talk about blood poisoning. You’ll hear that term, and some people they’ll confuse sepsis with blood poisoning. And I guess it is a type, but it could be more than the blood, the urinary tract, the skin, it could come from any source. But once it gets into your bloodstream, it’s very hard to treat, very, very hard to treat. And, unfortunately, we’re seeing more bacteria that are resistant to antibiotics. So, we have to throw a lot of different things at these bugs to try to fight them, especially while we’re trying to figure out exactly where it came from.
Dr. Bjorn Mercer: Yeah, and that goes back to when you said if you have different types of infections or if you have a viral infection, I believe, that just goes away. There’s nothing you can do about it.
Dr. Stacey Malinowski: Yes.
Dr. Bjorn Mercer: You have to be sick, you just have to let it run its course, versus I think a lot of people will think, “Oh, antibiotics will fix everything.” But, in reality, because antibiotics do fix so much, like you said, the bugs now are being more antibiotic resistant? Is that the correct term?
Dr. Stacey Malinowski: Yeah, they’re morphing, just as COVID, right? We have all these different strains emerging. These bacteria, these viruses, they get very smart and survival of the fittest, they learn how to mutate and change. And, so, the antibiotics that we originally created to fight that bacteria, they don’t work anymore. And now we’ve got to find a different one because, they change their cellular structure.
Dr. Bjorn Mercer: Yeah, and I think that’s one thing maybe that people realize because of COVID is that viruses and diseases change. I think that’s kind of obvious, but then we forget it because we think science can fix everything. But oftentimes, or should say almost all the time, science is catching up because we have to recognize something before we can try to fix it. And by recognize it means that it’s already in someone.
Dr. Stacey Malinowski: And I do think it’s kind of scary because I’ve been a nurse for over 20 years and it feels like, at least, slowly have seen these different bacteria change and we’ve seen these drug-resistant organisms start to emerge. But it feels like it’s been rather slow and we’ve identified the problem, been able to play catch up and work on it, but then we see with COVID, how rapidly it just kept changing and morphing. And like we see with the flu virus every year too, it’s always changing, there’s so many different strains, we never know how to effectively treat all of them or the most virulent at that time because you just don’t know. It feels to me like things are shifting much more rapidly than they have in the past.
Dr. Bjorn Mercer: Yeah, and I think one of the overconfidence of being a contemporary human is that we think that, “Hey, we’re alive, we’re not going to die because of a virus or a disease” when so many previous generations of humans had to constantly battle survival. And we should never assume that we will always win with medical or science when we just really need to always be careful and be as healthy as possible.
Dr. Stacey Malinowski: Yeah. And you just don’t know. And so that just goes with the washing the hands, getting your vaccines, staying in shape, having a healthy immune system by eating well, getting exercise, all those basic principles, all those things we know we should be doing on a regular basis really, I mean, that’s our best defense against anything really.
Dr. Bjorn Mercer: Oh for sure. And so this leads us to the last question: Are certain people more likely to develop sepsis than others?
Dr. Stacey Malinowski: So, we always have groups of individuals that are more prone to more severe infections. Think anybody who’s immunocompromised, that be your patients on chemotherapy, the young, the elderly, it could be diabetic patients, patients that have a lot of other health problems. So, the key being, you need to try and stay as healthy as you possibly can. So, back to the hand washing, the diet, the exercise, preventing getting the infection in the first place. But if you have an infection or suspect you do and it’s not getting any better, you really should follow up with a medical provider.
Dr. Bjorn Mercer: And that’s excellent. And, I think like we’ve talked many times in our podcast, is trying to be as healthy as possible. If you struggle getting exercise in your routine, find it. There’s ways you can find time to exercise several times a week.
And as far as diet goes, diet shouldn’t be, “I’m on a diet,” but having a healthy habit of eating where you’re eating a good balance of vegetables, a good balance of lean fats, a good balance of carbs. And just to ensure that whatever you’re doing and whatever you’re putting in your body is nutritionally rich in the sense that they are good whole foods and they’re valuable foods for your body.
Dr. Stacey Malinowski: Yeah, absolutely. You can’t overstate the importance of that diet rich in fruits and vegetables, the antioxidants, all of the vitamins, the things that are going to support that healthy immune system.
Dr. Bjorn Mercer: Exactly. So absolutely wonderful conversation today, any final words about sepsis awareness?
Dr. Stacey Malinowski: Just remember TIME. Remember temperature, too high, too low, if you know you have some sort of infection. That M for mental confusion, somebody’s too drowsy. And then E, extremely ill, somebody just seems far more sick than they should be for what they have going on.
Dr. Bjorn Mercer: Excellent. So always remember TIME. And today, we are speaking with Dr. Stacey Malinowski about sepsis awareness. Thank you Stacey for an absolutely wonderful conversation. And my name is Dr. Bjorn Mercer, and thank you for listening.