A team of researchers is highlighting what it calls significant gaps in sepsis policies and training standards throughout Canada, which they say show the need for a co-ordinated national action plan to address sepsis.
Sepsis is the body’s extreme response to an infection and is a leading cause of death worldwide, according to the World Health Organization (WHO). In Ontario, sepsis deaths have recently made headlines, prompting discussions about hospital protocols.
In 2017, a resolution by the World Health Assembly (WHA) — the decision-making body of the WHO — called on member states to create standards and guidelines for the prevention, early diagnosis and management of sepsis.
Years later, some countries like the United Kingdom and Australia have developed national action plans. But researchers including Dr. Kali Barrett say Canada still has a ways to go to meet that call to action. Barrett is a Toronto-based critical care physician and an affiliate scientist with the Health Services and Policy Research Collaborative Centre at the University Health Network.
“We’re trying to get governments’ support and recognition that this is a public health emergency,” said Barrett.
Barrett, along with a number of other researchers, has completed a literature review, looking at what policies exist throughout the country. They found most provinces — including Ontario — do not have any sepsis-specific policies and guidelines, and that training and hospital accreditation standards are also lacking. The research is undergoing peer review and is forthcoming in the Canadian Journal of Anesthesia.
When asked last month by CBC Toronto why there is no uniform standard for assessing and treating sepsis, and if the province was considering creating a sepsis protocol, the Ministry of Health did not answer those questions. In a statement, it said it “expects every hospital to uphold the highest standard of patient care.”
CBC News contacted the Public Health Agency of Canada to request comment on Canada’s efforts to meet the WHA call to action. In an email, a spokesperson pointed to the Canadian Institutes of Health Research funding the research network Sepsis Canada. They also said the Public Health Agency of Canada has developed policies related to “infectious diseases broadly,” which contribute to the reduction of sepsis.
‘Alarming’ gaps in training standards
Barrett says a national action plan should involve co-ordinating efforts at different levels of government to better recognize and treat sepsis, as well as improve public education.
While health care is under provincial jurisdiction, she says there are things that can be done at the federal level to support a co-ordinated approach to sepsis prevention, recognition and treatment.
That includes implementing new accreditation standards for hospitals, as well as training standards. The review found that many health-care professionals, from some physician specialties to midwives and paramedics, do not list sepsis recognition and treatment as a specific learning objective.
Barrett calls the lack of training standards “alarming,” since any medical professional could encounter a patient with sepsis, and speedy treatment is critical to improve chances of survival.
Fatima Sheikh, a PhD candidate at McMaster University and co-author of the research, says a co-ordinated action plan should include both a focus on health-care training, as well as public awareness.
“I often make the parallel with conditions like stroke. Most people in the community, even if they can’t list all the signs and symptoms, if they see one of those signs and symptoms, they can identify, ‘OK, something’s going wrong. I need to call 911,'” said Sheikh.
“We need to improve public awareness so that they know that sepsis is a life-threatening condition.”
Sheikh, whose research focuses on health equity, notes that a majority of sepsis cases begin with an infection acquired outside of the hospital. She says research has also shown an association between factors like socioeconomic status, race and gender and an increased risk of sepsis, making a co-ordinated strategy all the more important.
Need for proactive policies
Last month, CBC Toronto reported on a case of a woman who died from septic shock days after childbirth. Her family believes the death could have been prevented if medical staff had recognized the signs of sepsis more quickly.
Barrett and Sheikh say tragedies are often a catalyst for policy changes and hope it won’t take more deaths for a national strategy on sepsis to be put in place.
“We need to get these policies in place proactively without having to wait for another tragedy and someone else to die and family members to start advocating on their behalf,” said Barrett.
