CDC's New Program Aims to Help Hospitals Combat Sepsis

About one third of individuals who die while hospitalized have sepsis during that hospitalization, yet more than 1400 hospitals in the United States report not having a sepsis program, according to the Centers for Disease Control and Prevention (CDC). Medscape spoke with CDC contributors Raymund Dantes, MD, MPH, and Hallie Prescott, MD, MSc, about the agency's new Hospital Sepsis Program Core Elements, created to help clinicians improve sepsis outcomes.

Why did the CDC develop the Hospital Sepsis Program Core Elements?

Dantes: The Hospital Sepsis Program Core Elements (or "Sepsis Core Elements") were created to help empower hospitals to create or enhance current sepsis programs in an effort to better protect patients. The Core Elements build upon prior large-scale efforts to improve sepsis outcomes, including clinical guidelines and regulatory initiatives. Many hospitals have developed sepsis programs to implement recommended practices. However, the composition, charge, and effectiveness of hospital sepsis programs vary. Since nearly 1 in 3 people who die in a hospital had sepsis during that hospitalization, CDC recognized an opportunity to share a toolkit that would help hospitals assess and implement best practices for sepsis programs that save lives.

The Sepsis Core Elements are inspired by the CDC's Core Elements of Hospital Antibiotic Stewardship Programs, which helped catalyze the development of antimicrobial stewardship programs in the US that improve and optimize antimicrobial prescribing. By 2021, nearly 95% of US hospitals had antibiotic stewardship programs that met all seven of the Core Elements of Hospital Antibiotic Stewardship Programs (Hospital Core Elements), a statistic that we hope to see from hospitals about future sepsis programs. Many of the core elements, such as "hospital leadership commitment" and "accountability," are shared, though the details of the Sepsis Core Elements are specific to this field.

How will the program help improve care for patients with sepsis?

Prescott: Sepsis is a complex condition, requiring management and coordination across hospital disciplines and departments. The Hospital Sepsis Program Core Elements provide a "manager's guide" to establishing and running an effective hospital sepsis program, with recommendations at all levels — for clinicians, hospitals, and health systems. They provide guidance on all hospital-based sepsis activities, including hospital leadership commitment to addressing sepsis; sepsis program leadership and composition; implementation of structures and processes to improve sepsis management throughout hospitalization; methods to track and report sepsis outcomes; and education of healthcare staff, patients, and family/caregivers about sepsis.

How will the Hospital Sepsis Program Core Elements be useful to hospitals around the country? How can they be adapted based on hospital size, populations and communities served, resources, etc.?

Prescott: The program provides a high-level overview and multiple examples for each core element. The examples are classified as priority or additional, which allows hospitals to focus on achieving higher-priority recommendations first. There is also an assessment tool, which hospitals can use to evaluate, guide, and reassess their efforts to optimize sepsis care. With multiple examples for each core element, hospitals can focus on implementing the core elements in ways that are feasible and appropriate for their context. All hospitals, regardless of size or population served, can tailor a program that can work for them.

How can the program help improve sepsis care at hospitals cross the country?

Prescott: Sepsis contributes to at least 1.7 million adult hospitalizations and more than one third of hospital deaths in the US. There is an urgent need to improve outcomes. A recent survey of over 5000 hospitals by CDC's National Healthcare Safety Network found that there are many challenges facing hospitals looking to address sepsis. These challenges include lack of a committee charged with improving sepsis care, insufficient dedicated time and/or resources needed to run the hospital sepsis program effectively, insufficient coordination across hospital disciplines and departments, and insufficient evaluation of the impact of existing hospital-based sepsis initiatives. The Hospital Sepsis Program Core Elements will help improve sepsis care by laying out the people, structures, and processes needed to optimize sepsis care. It will also help to facilitate hospital sepsis program self-evaluation and prioritization of next steps for optimizing sepsis care.

How does the program fit in with the CDC's ongoing efforts to combat sepsis?

Dantes: The Hospital Sepsis Program Core Elements complement and build upon existing clinical guidelines and regulatory initiatives to improve early sepsis recognition. Furthermore, the Sepsis Core Elements also provide guidance for hospitals to track their performance, improve sepsis care during recovery and post-discharge care, and provide education to healthcare professionals, patients, and family/caregivers. Another of the core elements is to improve patient and healthcare worker education. CDC provides free resources as part of its ongoing Get Ahead of Sepsis educational effort.

How will the agency measure success of the program?

Dantes: CDC will track uptake of the Hospital Sepsis Program Core Elements using the National Healthcare Safety Network Annual Survey beginning in 2024. This approach is similar to how CDC has tracked uptake of the Core Elements of Hospital Antibiotic Stewardship Programs, which is available on the CDC website.

How will the CDC help facilities successfully implement the program?

Dantes: CDC, through its Project Firstline national training collaborative, is launching a webinar series in conjunction with the American Medical Association. Infection prevention and control is a critical part of preventing infections that lead to sepsis. In a series of 1-hour virtual webinars, hospitals that have achieved success in their hospital sepsis programs will share practical advice for implementing one or more Sepsis Core Elements in a variety of settings. Free continuing education will tentatively be available. Registration for the webinars will open soon. More information can be found here.

Is there a requirement for hospitals to use the program?

Dantes: Many hospitals already have a sepsis committee or sepsis program of some kind. Our goal with the Sepsis Core Elements is to collect those structural and organizational best practices that can benefit hospitals of all different sizes, serving a variety of patient populations.

The Centers for Medicare & Medicaid Services has proposed adopting sepsis quality measures in its hospital value-based purchasing program. How else is the government working to help improve rates of sepsis?

Dantes: In addition to the Hospital Sepsis Program Core Elements, CDC continues to promote sepsis education among healthcare professionals, patients, and family/caregivers so that sepsis is recognized and treated as early as possible. CDC is also working to improve our understanding of the epidemiology of sepsis so that we can better target prevention measures.

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