Infection PLUS two positive SIRS
SIRS
Temp > 100.4 F (38 C) OR < 96.8 F (36 C)
Heart rate > 90
Respiratory rate > 20
WBC > 12,000 OR < 4,000 OR > 10% bands
Could be OBS or inpatient.  Inpatient if:

  • Bacteremia, infection of medical device, meningitis, endocarditis, fungal infection
  • Febrile neutropenia (absolute neutrophil < 1.5)
  • Hemodynamically unstable – persistent HR > 100 OR BP < 90
  • Persistent, severe vomiting and dehydration
  • Isolation required (TB)
  • Adrenal insufficiency
  • Severe hypoglycemia
  • Acidosis or alkalosis (pH > 7.45 or < 7.35)

SIRS without infection is NOT sepsis and is usually OBS!
DO NOT document “infection with SIRS”!  This is sepsis.
SEVERE SEPSIS
Meets criteria for sepsis PLUS has one marker of organ dysfunction.
ORGAN DYSFUNCTION

  • SBP < 90 or MAP < 65
  • Lactate > 2
  • Altered mental status (GCS < 15)
  • INR > 1.5 OR PTT > 60
  • Platelets < 100,000
  • Creatinine > 2 (above baseline)
  • Urine output < 0.5 cc/kg/hr
  • Acute respiratory failure
  • Bilirubin > 2

       These patients will be inpatients.

CDI NOTES

  • MUST have source of infection to have sepsis
  • If patient meets criteria for sepsis and provider documents “infection with SIRS”, send query for sepsis.
  • If patient meets criteria for sepsis and provider does not document sepsis, send query.  However, if patient only meets for sepsis and not severe sepsis, and provider states “no sepsis” let it go.
  • If patient meets for severe sepsis and there is no documentation even of sepsis, send query to provider.  If answer is “no sepsis”, send case to physician advisor.
  • If provider documents sepsis when patient has severe sepsis, let it go.
  • If patient is on pressors, should be documented as septic shock.
  • Encourage providers to use .ICD10sepsis – guides provider to furnish:
    • Source of sepsis (should eventually be known)
    • Infectious organism (if known)
    • Present on admission?
    • Sepsis, severe sepsis, septic shock
    • Clinical indicators – SIRS, organ dysfunction
  • Query for patients with sepsis
    • State clinical indicators – SIRS, organ dysfunction, site of infection
    • Ask if these clinical indicators are consistent with sepsis, severe sepsis, septic shock, non-infectious SIRS or other
  • Query for patients without sepsis
    • State definition of sepsis and list clinical indicators that are absent (no infection, only one SIRS positive, no organ dysfunction)