Beating Sepsis in South America by Machado

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Beating sepsis in Latin America is a challenge. There are 5 major issues. First, we badly know our enemy. There are few papers coming from our continent and most of them are low quality epidemiological studies, with only a couple about quality improvement initiatives. In Brazil, some recent studies showed a critical scenario. In a random selection of 229 Brazilian ICUs the mortality rate was 55.7%. Another important issue is the availability of resources. In this study, based on a score of 8 items considered necessary to care for septic patients, about 30% of the institutions from the poorest region of Brazil were considered as having low availability, which means having five or less of these items. There is also an important inequality in ICU access. The number of ICUs bed in the public system is 7.6 per 100,000 habitants while there are 25.5 beds per 100,000 habitants covered by the private system. The quality in process of care also varies between these two types of systems. In the Latin America Sepsis Institute database, now with almost 30,000 patients coming from institutions that have implemented sepsis protocols based on the SSC bundles, a reduction in mortality occurred only in those from the private system. This difference is even more impressive among those patients with sepsis in the emergence department. Another major issue is the low awareness both among the healthcare team and lay people. A recent survey conducted in 134 cities including more than 2000 Brazilians showed that less than 7% of them have ever heard the word sepsis. Raising awareness is the key point as this will also help to get support from the government. Governmental healthcare policies in the sepsis field are needed and they are the most impacting strategy in our settings.

Health & Medicine

If you know your enemy and
you know yourself you need
not fear the results of a
hundred of battles.
Sun Tzu

First major problem: absence of data
Sepsis OR severe sepsis OR septic shock
AND
Name of the country
AND
Epidemiology OR mortality OR burden OR quality
improvement OR clinical trial
Limited to 10 years
287
N = 1
27
N = 0
98
N = 4
829
N = 3349
N = 0
0
N = 0
94
N = 6
20
N = 0
0
N = 0
0
N = 0

First major problem: absence of data
SPREAD - Sepsis PREvalence Assessment Database

Third major problem: ICU access
The true map of access
3.0
19.9
3.5
17.4
1.7
8.1
3.6
45.8
2.9
35.4
2.0
27.6
5.2
26.7
8.5
32.0
3.0
27.2
3.7
33.8
4.4
25.3
5.5
37.7
6.4
22.9
5.6
18.4
7.7
32.4
3.7
27.8
9.8
16.8
12.3
18.9
7.5
21.6
7.8
47.9
5.5
25.9
12.4
60.8 7.5
15.26,.5
37.7
10.0
21.8
6.8
17.7
10.6
24.7
Per 100.000 habs
Cadastro Nacional dos Estabelecimentos de Saúde (CNES) – 2013,
Agência Nacional de Saúde Suplementar (ANS) e Instituto Brasileiro de Geografia e Estatística (IBGE).

Third major problem: ICU access
The true map of access
Cadastro Nacional dos Estabelecimentos de Saúde (CNES) – 2013,
Agência Nacional de Saúde Suplementar (ANS) e Instituto Brasileiro de Geografia e Estatística (IBGE).
7.6 public ICU beds for
100,000 habitants
Middle-West
7.4
Northeast
5.0
North
3.2
South
9.4
Southest
10.4
25.5 private ICU beds for
100,000 habitants
Middle-West
38.5
Northeast
28.4
North
28.8
South
22.2
Southest
24.2

Mortality throughout the intervention according to the type of hospital
Latin America Sepsis Institute database
Intervention: multifaceted sepsis protocol implementation
Period: 2005-2014
N = 21,203 patients
Fourth major problem: inadequate process of care

Latin America Sepsis Institute database
Intervention: multifaceted sepsis protocol implementation
Period: 2005-2014
Only ER patients
N = 10,694 patients
Our worst scenario: public emergency services
Mortality throughout the intervention in patients from the emergency
department according to the type of hospital

Have you ever hear the world sepsis?
Body response to an infection 40%
Blood poisoning 27%
I don’t know 22%
AND

Percentage of positive answers to the question: “Have you ever
heard the world sepsis?”
49,0
44,0
29,0
6,6
0
10
20
30
40
50
60
Alenanha Estados Unidos Canadá Brasil
Respostaspositivas%
Brazil
2.126 people
134 cities
June 2014
Fifth major problem: awareness

We should not only raise
awareness but rather raise
passion
What is our number one priority?

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