DR. PRIYA KUBENDIRANPROF. DR.K.S. CHENTHIL

IMCU

HISTORY OF SEPSIS

HIPPOCRATES (460-370 BC)

Greek word sipsi = make rotten

IBN SINA (979-1037 BC) - the coincidence of blood putrefaction (septicaemia) and fever

HERRMAN BOERHAVE (1668-1738), a doctor in Leyden, thought that toxic substances in the air were the cause for sepsis.

IGNAZ SEMMELWEIS (1818-1865)

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“It is not by chance that a single obstetrician has 16 fatal cases in a single month - I can only dispel the sadness which falls upon me by gazing into that happy future when the infection will be banished”

1840’s:Lying-in Hospital Vienna

Divided into two clinics- alternating admissions every 24 hours:

1. Doctors and medical students-did autopsies between deliveries

2. Second Clinic: Midwives-came in off the street to deliver-wore gloves outside

Maternal Mortality due to Postpartum "putrefaction" Lying-in Hospital, Vienna, Austria, 1841-1850

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Semmelweis’ Hand Hygiene Intervention

Hand antisepsis reduces the frequency of postpartum sepsis

(Hosp Epidemiol Infect Control, 2nd Edition, 1999)

First clinic

2nd clinic

The Intervention:Hand scrub with chlorinated lime solution: removed the putrefying smell from the hands of students and doctors

Hand hygiene basin Vienna, 1847

What was Semmelweiss’s reward in 1848 for this major contribution? - Fired by the hospital board for enforcing handwashing requirement for doctors

LOUIS PASTEUR (1822-1895)

Bacteria / microbes caused

putrefactionKilled by heating – sterilisation

JOSEPH LISTER (1827-1912)

Post amputation mortality – 50%Skin & instrument disinfection

with carbolic acid – antiseptic method

HUGO SCHOTTMULLER (1867-1936)

Modern definition of sepsis(1914): "Sepsis is present if a focus has developed from which pathogenic bacteria, constantly or periodically, invade the blood stream in such a way that this causes subjective and objective symptoms.”

“Therapy should not be directed against bacteria in the blood but against the released bacterial toxins”

ROGER C. BONE (1941-1997)

Helped develop the multi-disciplinary subspecialty of modern Critical Care Medicine

Promoted evidence-based approach to sepsis

"Sepsis is defined as an invasion of microorganisms and/or their toxins into the bloodstream, along with the organism's reaction against this invasion.“ (1989)

EPIDEMIOLOGYSepsis > 200,000 deaths/year in the USIncidence is > 700,000/ annumMortality for septic shock – 30% die within

first month & 50% dying within 6 months of diagnosis

Rising incidence of severe sepsis :1.Aging of the population2.Longevity of patients with chronic diseases3.Increase in people with AIDS4.Widespread use of antimicrobials,

immunosuppressives, indwelling catheters, mechanical ventilation

1344 admissions in ICU

Regional data

SURVIVING SEPSIS CAMPAIGNIn 2002, spearheaded by the ESICM (European Society of Intensive Care

Medicine), ISF (International Sepsis Forum) and SCCM (Society of Critical Care Medicine)

Aim : improving the diagnosis, survival, and management of patients with sepsis by addressing the challenges associated with it.

TERMINOLOGY

Infection, documented or suspected & some of the following variables:

1.General2.Inflammatory3.Hemodynamic4.Organ dysfunction5.Tissue perfusion

REFERENCES :•Harrison’s 17th edn•Infectious diseases - Dale•Internet -German sepsis society-Critical care 2007-Surviving sepsis campaign 2008-Medscape