1.1 Background
Sepsis is a life-threatening infection syndrome reaction, which is usually the common end of death for many infectious diseases around the world.. It involves organ dysfunction caused by a dysregulated host response to infection and may lead to death if left untreated. [1] Sepsis also represents a global health problem in terms of morbidity, mortality, social and economic costs. Although usually managed in Intensive Care Units, sepsis showed an increase prevalence among Internal Medicine wards in the last decade. This is substantially due to ageing of population and to multi-morbidity. [3] However, there is consensus that the incidence is increasing, driven by an ageing population with multiple comorbidities, increased use of immunosuppressive therapy and high-risk interventions. Mortality estimates for sepsis range from 27% to 36; however, the risk of death from sepsis has been falling over the recent decades despite the increasing incidence, perhaps due to improvement in care. [6]In the community, sepsis is usually a clinical exacerbation of a common and preventable infection. Sepsis also frequently results from infections acquired in health care settings, which are one of the most frequent adverse events during care delivery and affects hundreds of millions of patients worldwide every year. [1] Recent progress in sepsis research has been able to improve the knowledge about the basic pathophysiological process of sepsis. However, in daily ICU practice it remains difficult to identify and treat sepsis, its related conditions, adequately. There are still concerns about the lack of a consistent definition and understanding of sepsis in the global medical community. [7] Sepsis is the presence of a documented or strongly suspected infection, with a systemic inflammatory response, as indicated by the presence of some of the following features- body temperature greater than 38 ºC or less than 36 ºC, heart rate greater than 90 beats/min, respiratory rate greater than 20 breaths/min or hyperventilation with PaCO2 less than 32 mmHg, White blood cell count > 12,000/mm3, <4,000/mm3 , or with >10% immature neutrophils. Severe sepsis is sepsis complicated by acute circulatory failure characterized by persistent arterial hypotension, despite adequate volume resuscitation, and unexplained by other causes. [7]
In the case of COVID-19, the effects on the respiratory tract are known, and most people are hospitalized and develop pneumonia to varying degrees; however, virtually all other organ systems are affected. When available, the Global Sepsis Alliance can more clearly emphasize that COVID-19 does cause sepsis. Approximately 2-5% of COVID-19 patients show typical signs of multiple lesions of sepsis after approximately 8-10 days. COVID-19 died of sepsis and its complications, so it is important to understand and recognize the early signs of sepsis and start treatment immediately after the diagnosis is made. [13]
The Global Sepsis Alliance stated that COVID-19 can cause sepsis, which is the body's overwhelming life-threatening response to infection, which can lead to organ damage or death.[14]
Sepsis is a life-threatening syndromic response that my lead to death if left untreated. Sepsis often presents as the clinical deterioration of common and preventable infections. The increase in the incidence and severity of sepsis may be related to population aging, immunosuppression and multidrug resistant infections. On this connection, the majority of cases of sepsis (about 60-80%) have been observed in patients over 65 years old, with a 30-times increase in over 85 years old. At present, most of patients referring to Emergency Department (ED) share the above-mentioned features (Eg old age, chronic diseases) and quite a lot of sepsis patients are hospitalized from emergency room to non-intensive care unit.[3] Since diseases caused by infections are common in Sudan thus Sepsis cases will always be present. However, sepsis being a preventable case if diagnoses early and managed adequately. Thus House Officers and Medical Officers must have sufficient knowledge regarding the diagnosis, management and other important medical information regarding sepsis otherwise the cases will be missed on its early stages or not managed sufficiently or any form of low performance which will cause the septic patient to die a preventable death. Sepsis remains a major cause of morbidity and mortality worldwide, with increased burden in low- and middle- resource settings.
Sepsis and COVID-19 have many similarities, but the direct shift of sepsis management to COVID-19 management requires a little care.The pathophysiology of COVID-19 is currently not fully understood and seems to vary from person to person. Sepsis remains a major health burden worldwide and all protocols are poor. It is also important to note that further evaluation is needed in the context of COVID-19. In fact, with fast collaborative efforts towards COVID-19, perhaps sepsis management can ultimately see more benefits from COVID-19. [15]
Our research has assessed both the House officers and Medical officers’ knowledge upon diagnosing and properly managing sepsis cases in Ibrahim Malik Teaching hospital. Thus my findings are of substantial value because it reflects whether the House officers and Medical officers in Ibrahim Malik Teaching hospital are will prepared to deal with life threatening cases of Sepsis and potentially saving their patients’ lives. Also my findings are determining whether further trainings should be conducted regarding sepsis diagnosis and management thus not to let septic patients die a preventable death. It is shedding the light to Medical colleges and Hospital medical staff to give this topic more attention for the future and current House and Medical officers.
1.2. OBJECTIVES
General Objectives:
- To Asses House Officers and Medical Officers knowledge upon diagnosis and management of Sepsis in Ibrahim Malik Teaching Hospital in 2021.
Specific Objectives:
- To assess House/Medical officers’ knowledge upon diagnosis, management of Sepsis as well as well as SOFA (Sequential Organ Failure Assessment)
- To assess House/Medical officers’ basic knowledge about SIRS (Systemic inflammatory response syndrome)
- To assess the impact of previous clinical experience between House officers and Medical officers on their knowledge performance.