Recovering from Sepsis
ContentsSeniors and sepsis Causes of sepsis Sepsis signs and symptoms Stages of sepsis Sepsis testing Sepsis treatments Sepsis care after hospital discharge Assessing care needs Care options for sepsis recovery Selecting a sepsis recovery care provider Effects on caregivers Financial considerations for sepsis recovery Legal considerations for sepsis recovery Sepsis FAQs
Recovering from Sepsis
Sepsis can be a life-threatening condition that sometimes occurs as the result of an infection. Sepsis is caused when the immune system attempts to fight an infection but instead triggers an inflammatory response throughout the body. This response may attack tissue or organ systems leading to organ failure and death.
Sepsis is a serious health concern in the U.S. with 1.5 million cases of sepsis diagnosed annually and 1 out of 3 hospital deaths attributed to sepsis. This guide covers sepsis complications, recovery care, treatment options, long-term effects, and more.
Sepsis spreads quickly throughout the body and may progress to septic shock, a stage of sepsis in which blood pressure falls very low and death may occur. It is important to seek treatment for sepsis as soon as possible. The quicker treatment for sepsis begins, the greater the chance of survival.
Seniors and sepsis
According to the Sepsis Alliance, seniors are more at risk for developing sepsis than any other group. Seniors account for 12% of the American population but
Seniors are also at a greater risk of sepsis because it may be harder to detect infections when they occur.
Symptoms of infections such as a UTI often present differently in seniors than they would in a younger person. Instead of early signs such as frequent urination or a burning sensation while urinating, the first sign of a UTI for seniors may be a change in mental state. Seniors with a UTI may be confused, disoriented, or just not acting like themselves.
Sudden confusion or a change in behavior in seniors should always be reported to a doctor as soon as possible so they may be assessed and possibly tested for any potential infections.
Causes of sepsis
Sepsis can be caused by
- Lung infections such as pneumonia
- Skin infections such as those around a wound or surgical site
- Stomach infections such as a perforated bowel
- Kidney infections such as a urinary tract infection (UTI)
- Bacterial infections from bacteria such as E.coli or staph
Anyone may develop sepsis from an infection but those who are more likely to develop sepsis are:
- Individuals with an impaired immune system
- Individuals with diabetes
- Individuals with cancer
- Individuals with other chronic illnesses
Sepsis signs and symptoms
There are many warning signs of sepsis. These symptoms may affect different body systems and may present differently in different people. Not everyone will have every symptom. Some general symptoms to be aware of include:
- High fever
- Edema (swelling)
- Loss of consciousness
- Heart rate greater than 90 beats per minute (bpm)
- Fast respirations (rate of breathing)
- Hypothermia (a body temperature that is lower than normal)
- High blood glucose (without having diabetes)
- Low blood pressure
- Decreased urinary output
Other signs may be detected by lab tests and include indicators such as:
- Low platelet count
- High lactate level in the blood
- Blood clotting irregularities
- High white blood cell count
- Low oxygen level in the blood
The signs of sepsis may be easy to miss or mistake for other conditions. If an individual has an intravenous (IV), a urinary catheter, a wound, or has recently had surgery and is experiencing any of the signs and symptoms of sepsis noted above, these signs and symptoms should be reported immediately.
Stages of sepsis
Sepsis is often thought of as a three-stage syndrome. Treating sepsis during the early stage decreases the risk of serious complications and death. The stages of sepsis are:
- Sepsis - A person diagnosed with sepsis must have an infection and at least 2 of the following symptoms:
- Body temperature above 101 F
- Body temperature below 96.8 F
- Heart rate greater than 90 BPM
- Respiratory rate greater than 20 breaths a minute
- Severe sepsis - Severe sepsis is diagnosed when the signs of sepsis are present and at least 1 symptom that may indicate organ failure is also present. These symptoms include:
- Difficulty breathing
- Decreased urine output
- Decreased platelet count
- Change in mental status
- Abnormal heart function
- Abdominal pain
- Septic shock - An individual with septic shock has the signs and symptoms of severe sepsis noted above as well as a very low blood pressure reading that does not improve with simple fluid replacement.
If sepsis is suspected, several tests may be done. The doctor may run blood tests, confirmatory tests to gather more information and tests for the presence of specific infections. The tests that are performed will depend on the individual and their symptoms but may include:
- Complete blood count (CBC) - A CBC may be done to determine the number of white blood cells in the blood. An unusually high number of white blood cells may indicate an infection while an unusually low level of white blood cells may indicate a high risk of developing an infection.
- Blood culture - Blood culture tests are used to determine the type of bacteria or fungus that is causing an infection.
- Lactate test - The organs may produce lactic acid when they are not receiving an adequate supply of oxygen. This may be a sign of serious infection.
- C-reactive protein (CRP) test - CRP is produced in the body when there is serious inflammation such as the inflammation caused by infection.
- Clotting tests - Sepsis may significantly affect the body’s ability to clot blood. An individual may not be clotting or may be producing many tiny clots. Blood tests to check levels of platelets may identify these clotting problems.
- Endotoxin tests - An endotoxin is produced when bacteria cells disintegrate. The presence of endotoxins in the blood indicates a serious infection. This is a confirmatory test. Antibiotics and other treatments will likely have begun before the results of this test are returned.
- Procalcitonin (PCT) tests - PCT is a protein in the blood that can
risewhen there is a bacterial infection in the body. As with an endotoxin test, a PCT test is a confirmatory test.
- SeptiCyte test - A SeptiCyte test is done to determine if sepsis-related genes have been activated.
- Urine tests - Urine testing may be done in cases of sepsis resulting from a UTI. These tests may include a urinalysis to measure levels of proteins, bacteria, and other substances in the urine and a urine culture to determine what type of bacteria or fungi has caused the UTI.
Testing may also be done to check for the specific infection that led to sepsis. This may include testing for:
Sepsis is a medical emergency. Studies show that the risk of death from sepsis increases by 7.6% for every hour that goes by without treatment. Treatment for sepsis usually includes administration of IV antibiotics and fluids.
Antibiotic treatment may involve a course of multiple antibiotics, both broad spectrum (able to fight several common bacteria) and specific to stop the spread of infection. These antibiotics are typically administered through an IV so they enter the bloodstream as quickly as possible.
Fluids are also administered through an IV to treat sepsis. Fluids are used to stop the blood pressure from dropping too low and to assist the organs in working through sepsis. This may prevent both progressions into septic shock and organ damage.
Additional treatments will depend on the specific infection that caused the sepsis and may include:
- Central venous catheter (central line) placement – A central line is a long tube inserted into a vein so that fluids and antibiotics may be administered with more ease than when using a standard IV
- Arterial line placement – An arterial line is inserted into an artery so that blood draws may be done quickly without the need for continuous needle sticks. An arterial line also allows blood pressure to be monitored
- Corticosteroid medications – Corticosteroid medications may be used to reduce inflammation and to inhibit the immune system. They are sometimes used to counteract sepsis in the body
- Vasopressor medications – Vasopressors are used to raise the blood pressure of patients who are experiencing septic shock and have dangerously low blood pressure
- Oxygen administration – Individuals with severe sepsis or in septic shock may have low oxygen levels. Oxygen is administered to help increase oxygen levels
- Mechanical ventilation – When a patient is no longer able to breathe on their own due to sepsis, they may be placed on mechanical ventilation. A ventilator will breathe for the patient until they are well enough to resume breathing on their own
- Kidney dialysis – Kidney dialysis does the work of the kidneys when they are unable to filter the blood properly. This may be done on a short-term acute basis or a long-term basis if kidney failure occurs
Sepsis care after hospital discharge
Recovery from sepsis is often a complex process. Sepsis may result in an increased likelihood of another serious infection. Approximately 1 of every 3 sepsis patients experiences another hospitalization within three months of initial discharge from a hospital. Sepsis may also result in significant complications such as:
- Memory loss or other cognitive changes
- Chronic pain
- Fatigue (prolonged unusual feelings of being tired or needing more rest)
- Increased physical weakness
- Skin itching and peeling
- Nail and hair breakage
- Loss of appetite
In addition to the above complications, many people recovering from sepsis experience weight loss and have difficulty caring for themselves.
They may no longer be able to walk as much as they used to and they may have difficulty with daily tasks. They may not be able to dress themselves, shower, or perform other self-care tasks the way they could prior to sepsis. These tasks are known as the activities of daily living (ADLs).
Individuals recovering from sepsis may also have difficulty performing tasks such as medication management, meal planning, or financial management. These tasks are referred to as instrumental activities of daily living (IADLs).
Post sepsis syndrome
Approximately 50% of sepsis survivors experience post sepsis syndrome (PSS). Individuals with PSS experience symptoms that go beyond the typical complications associated with sepsis. These sepsis recovery complications include both physical and psychological effects and may include:
- Panic attacks
- Lack of concentration
- Loss of self-esteem
- Decreased cognitive function
- Extreme fatigue
- Extreme muscle and joint pain
These symptoms may affect an individual's ability to perform ADLs and may have a significant impact on their overall quality of life. An individual whose sepsis was treated in an intensive care unit (ICU) has a greater risk of PSS. Seniors are more likely to develop PSS and have a marked decline in both mental status and physical ability level.
In addition to PSS, any ICU stay, including one for sepsis, may result in post-traumatic stress disorder (PTSD) in some patients. PTSD is a serious condition that may last for years after the hospital stay. Individuals with PTSD may experience symptoms such as nightmares, flashbacks, and phantom pains.
Rehabilitation after sepsis
After an individual has sepsis, they will need rehabilitation. It is important for the individual to move around as much as they are able to in order to help restore their previous level of function. This rehabilitation will start in the hospital. A physical therapist will work with the person in their room, assisting them to walk around their room and to perform as many ADLs as they are able to. A physical therapist will also teach the person exercises to help them get stronger.
After discharge, additional physical and occupational therapy may be required. These therapists may work with a patient in an outpatient facility, an inpatient facility, or in their home. This therapy will vary depending on the person’s previous functional level and on how severe their sepsis was. The therapy may address pain levels, ability to walk independently,
Assessing care needs
After sepsis, an individual may no longer be able to care for themselves the way they could in the past. They may have significant difficulties with ADLs and IADLs and require additional assistance to recover safely and completely.
There are several factors to consider when deciding what type of care provider a person needs during recovery from sepsis. Some important considerations include:
Any complications from sepsis?
An individual who experiences significant complications from sepsis will need a greater amount of assistance than someone whose sepsis resulted in no complications or in minor symptoms. A person who had severe sepsis or septic shock is more likely to experience complications than an individual whose sepsis is treated at an earlier stage.
What caused the sepsis?
If an individual has a pre-existing condition that results in a weakened immune system which increases their likelihood of developing sepsis, they are at risk of developing a serious infection or another case of sepsis in the future. In cases where the sepsis was caused by a condition such as pneumonia, the individual may have other long-term problems such as decreased lung function.
How is the pain level?
Pain management may be difficult for an individual to control on their own. Sepsis may result in severe and lasting pain. Therapy and medications may help reduce this pain, but in some individuals, chronic pain may develop following sepsis. Chronic pain may increase depression and other mental health symptoms associated with PSS.
Any decline in cognitive function?
Sepsis may result in a decreased cognitive abilities including memory. This may be especially pronounced in seniors and in individuals who already had a pre-existing condition such as dementia. A decrease in cognitive function may mean it is no longer safe for an individual to care for themselves in their own home.
Does the individual live alone?
Many people are not able to care for themselves with complete independence but are able to remain in their home if they live with a spouse, adult child, or another caregiver. With the assistance of a caregiver and home health services, an individual may be able to recover from sepsis at home.
Is the home safe?
Household layout issues such as poor lighting or narrow staircases may lead to falls. Individuals who have had sepsis may be at an increased risk of falling due to medication changes, increased pain level, or increased cognitive impairment.
Are there any other health conditions that need to be managed?
Sepsis may be difficult to recover from for individuals who have additional health conditions. They may feel overwhelmed with the number of medications and treatments needed. Some conditions such as diabetes or cancer increase the likelihood that an individual may develop another serious infection or case of sepsis.
Is the person able to perform IADLs such as cooking?
While recovering from sepsis, an individual may no longer be able to perform their IADLs. They may be too weak to stand and prepare meals. Since individuals recovering from sepsis often have a decreased appetite, they may also not have the motivation to prepare food for themselves. Proper nutrition is essential to a healthy recovery.
An individual recovering from sepsis and their family may want to look into other options such as meal delivery, meals prepared by home health care, or meals provided at senior centers.
Care options for sepsis recovery
Home health care
Home health care is a good choice for individuals who are able to return home safely but need extra assistance with medications, therapies, and ADLs.
For individuals who live with a caregiver, home health care may be able to help both the affected individual and their caregiver with the recovery process. Home health care team members may be able to teach caregivers how to perform tasks or provide safe assistance to the individual recovering from sepsis. This may help an individual stay safely in their own home for much longer than they would have been able to without the assistance of home health care.
A home health care agency allows an individual to receive any needed therapies and treatments at home. Professionals such as physical therapists and occupational therapists will visit the individual in their home and guide them through exercises to help improve function and retain as much independence as possible.
Nurses will provide any needed treatments such as pain management or wound care. Home health aides will help the individual with ADLs. Additional professionals such as dietitians, respiratory therapists, speech therapist, and social workers may also visit the individual’s home, depending on their specific needs and plan of care.
Different home health care agencies offer different services, some offer extended hours, meal preparation, transportation arrangements, and other services. If an individual requires any of these services, they should ensure that the agency they select offers these services. When an individual is recovering from sepsis, they and their family should meet with several home care agencies to assess which one best suits their needs.
Inpatient facilities for sepsis recovery
If it is not possible for an individual to stay in their home safely while recovering from sepsis, inpatient care may be the best choice.
Depending on the needs of the individual, they may want to consider a skilled nursing facility (SNF) or an assisted living facility (ALF). After sepsis, it may be necessary for an individual who is recovering to stay in an SNF. SNFs are designed to meet primarily short-term acute needs.
Recovery from sepsis in a skilled nursing facility
For a person recovering from sepsis, this may mean that their doctor wants them to be monitored in an SNF until they can perform certain physical tasks on their own, are weaned off a high level of oxygen, a wound has healed, or until their pain is under control.
At an SNF, an individual will have a healthcare team overseen by a doctor who will provide care and treatments. Physical and occupational therapists will work with the individual in their room or in therapy suites to help them increase their mobility and self-care abilities. These therapists may teach the individual how to use a walker or other assistive devices to safely complete their ADLs with as much independence as possible.
Nurses at the SNF will provide treatments and medications. Nursing assistants will help with ADLs and monitor vital signs. A dietitian will make sure the individual is eating enough and may provide nutritional beverages or snacks to supplement calories and help improve the person’s appetite.
When an individual is hospitalized due to sepsis, a doctor or social worker will inform the person and their family if discharge from hospital to an SNF is recommended. They will explain what the goals of an SNF stay are and why they do not feel it is safe for the individual to return home yet.
Most hospitals have a list of local SNFs and should be able to tell the individual and their families which ones have beds available. If possible, a family member or caregiver should visit a few SNFs to help them make an informed choice. If it is not possible to visit multiple facilities, researching these facilities on the internet may also assist in selecting the most appropriate SNF.
Recovery from sepsis in an assisted living facility
After an individual no longer needs the skilled level of care provided by an SNF, they may still not be able to live at home safely. An ALF provides more privacy and independence than an SNF while still providing an individual with 24-hour assistance.
Unlike an SNF, a move to an ALF is meant to be a long-term choice. In an ALF, staff will be able to assist with ADLs, medications, and some treatments. ALFs also provide meal services, activities, housekeeping, laundry, and transportation.
ALFs generally do not have physical or occupational therapists on staff. However, some ALFs work with home health agencies to provide these services if required by residents.
For example, if an individual is already living in an ALF before they are diagnosed with sepsis, they may be discharged back to the ALF with home health care services. The home health care team will work with the ALF during the individual’s recovery to provide therapy and other skilled services within the ALF. The home health care team will also be able to inform the ALF staff about any changes to the individual’s ability level and needs.
Some ALFs and SNFs are part of communities known as continuing care retirement communities (CCRCs). In a CCRC, many levels of care are offered on one campus or in one building. This arrangement allows individuals to stay in a familiar setting as their care needs change.
For example, in a CCRC, an ALF resident may experience an infection that leads to sepsis. After their hospital stay, they may be discharged to the SNF level of care within their CCRC. Once their SNF goals are met, they will return to the ALF level of care in the CCRC. The CCRC environment creates continuity of care and may give residents a sense of security.
Selecting a sepsis recovery care provider
Selecting the correct care provider is a very important choice. Once an individual and their family have determined whether home health care, an ALF, or SNF care is required, they will need to select the most appropriate provider of that care. Some important considerations to keep in mind include:
Has the provider treated patients
recovering from sepsis in the past?
It is important to make sure the provider that is selected is knowledgeable about sepsis. The provider should have a good track record of caring for patients who are recovering from sepsis and a low rate of hospital readmission.
What is the provider’s infection control policy?
Infection control is a top concern for many care providers. For the safety of their patients and staff, the provider should have plans in place for waste disposal, sanitation, equipment storage, and other infection-related concerns.
Are clients or residents encouraged to be as active as possible?
While recovering from any health condition or illness, individuals should be encouraged to be as independent and active as their doctor recommends. It is common for many people who have had a serious medical condition to want to do less due to fear or pain. This may lead to a decline in health and to an increased risk of another infection. A care provider should ensure an individual is getting the appropriate amount of movement and activity.
How do the staff interact with residents and clients?
If possible, an individual or a family member should visit with a provider and meet several staff members. They should watch how the staff interact with residents or clients. This will help the individual and their family determine if they will be comfortable with the care provider.
Taking the time to make an informed choice may make an individual and their family feel more comfortable with the care they are receiving and more confident it will lead to positive results. A safe recovery in a caring environment will have a significant impact on the success of an individual's recovery and on their quality of life.
Effects on caregivers
Sepsis may result in significant changes for caregivers as well as for the affected individual. An individual’s recovery from sepsis may be long and may result in increased care needs adding to the time a caregiver spends providing care.
In addition, the strain of caring for an individual who experiences a life-threatening medical emergency such as sepsis may be overwhelming for a caregiver and lead to feelings of depression, helplessness, anxiety, or resentment. Caregivers are encouraged to practice self-care to manage these feelings.
Some self-care tips for caregivers include:
- Maintain a daily exercise routine
- Get enough sleep
- Eat well-balanced meals
- Spend time outdoors
- Ensure one’s own medical needs are taken care of
- Take time out and breaks when needed
- Pay attention to one’s own emotions and seeking counseling if needed
- Ask for help
Caregivers may also find it helpful to join a support group online or in person to talk about their feelings and learn about best care practices for their family member.
Financial considerations for sepsis recovery
There are costs associated with the various types of long-term care that a person recovering from sepsis may require. Different home health care providers, ALFs, SNFs, and CCRCs accept different payment options. These payment options may depend on the level of care needed and on individual care factors such as stay in a private room.
More detailed information on the options for covering long-term care costs may be found here, however, some general guidelines for the different options include:
Home health care
As long as a home health care provider is Medicare-certified and the ordering doctor confirms there is a skilled need, Medicare will pay for 100% of the costs of home health care. Medicare will cover the costs for these services on a part-time and temporary basis (less than 8 hours a day for less than 21 days).
Services to assist with IADLs such as housekeeping, transportation, and meal preparation are not paid for by Medicare. Different agencies will accept different payment forms. Some common payment options include Medicaid, private pay, and long-term care insurance.
Skilled nursing facilities (SNF)
Medicare will cover 100% of the costs for up to 20 days as long as there has been a qualifying hospital stay. On days 21 through 100, Medicare will pay a portion of the costs and the individual will be responsible for a copay amount. After 100 days, Medicare will no longer cover the costs of care in an SNF and the individual will be responsible for the entire amount. Most SNFs accept payments such as long-term care insurance, Medicaid, and private pay.
Assisted living and continuing care communities
The cost assisted living facilities and continuing care communities aren't covered by Medicare. The care they provide is considered non-medical and other payment methods will need to be used. An ALF or CCRC may have staff who will be able to assist an individual and their families in determining which payment option best fits their needs and budget.
Legal considerations for sepsis recovery
Recovery from sepsis may be an overwhelming and stressful process. An individual may need to apply for Medicaid, choose a long-term provider, or make other financial and medical decisions. It may be helpful for an individual to set up a power of attorney at this time who can assist with these decisions. A power of attorney will be able to make financial and care decisions for the individual so that they can focus on their recovery.
After a medical emergency such as sepsis, an individual may also want to set up a living will if they do not have one already. Having a living will protect the individual and their wishes for medical care in the event of another medical emergency, even if they are unable to express those wishes themselves.
While planning for the financial requirements of long-term care, an individual and their family may also want to establish a funeral trust to start prepaying for funeral costs.
- What are some steps a person can take to help recover from sepsis?
Recovery from sepsis may be an emotionally and physically draining time. In addition to following the care plan received from the doctor or therapists, a person may want to take some of the following steps:
- Set small goals for each week and record them in a journal, this may help with tracking progress and recovery which may lead to greater motivation
- Read the journal as often as needed, this may provide reassurance that a person is making progress and getting better, even on days when they are feeling depressed or anxious
- Talk with friends and family about sepsis. It is normal to have many emotions after sepsis and talking them out may help a person sort through them
- Learn as much as possible about sepsis to better understand what happened
- Keep a list of questions to ask the doctor on the next checkup
- Ask the hospital if an ICU visit is able to be arranged if the person spent time in the ICU. Seeing the ICU may help an individual who had sepsis process the experience
- Can sepsis be prevented?
By taking steps to prevent infections, an individual may be able to greatly reduce their risk of contracting sepsis. Some best practice measures for preventing infection include:
- Washing hands thoroughly and practicing good hygiene
- Taking antibiotics as prescribed
- Always complete the full course of antibiotics
- Getting vaccinated for the flu and other infections
- Ensuring all caregivers and healthcare professionals coming in contact with the person washes their hands
- Practicing a healthy lifestyle that includes nutritious food, appropriate exercise, and enough rest
- Seeing a doctor if a cold or other illness is not improving with home treatments
- Is sepsis contagious?
No. Sepsis is not contagious. While the infection that caused the sepsis may be contagious, sepsis itself is not contagious. Sepsis is the body responding to an infection. It is an individual response of the affected person’s immune system.
While there are certain settings where sepsis may seem more common, that is not because sepsis is contagious. In those settings, sepsis is more likely to occur because infections are more likely to occur. Infections may lead to sepsis.
- Does septic shock always result in death?
No. Septic shock is the most serious stage of sepsis. The severe drop in blood pressure that occurs in septic shock may lead to organ failure and death. However, septic shock is not always fatal. Treatments such as antibiotics and fluids may help. Death from septic shock is less than 50 percent and the faster sepsis is treated, the greater the chances of a full recovery.
Try to solve the new Formula Cube! It works exactly like a Rubik's Cube but it is only $2, from China. Learn to solve it with the tutorial on rubiksplace.com or use the solver to calculate the solution in a few steps.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.