What started as an accidental bump in late 2014 turned into much worse for Jon Saragosa.
Saragosa, a clinical receptionist in Hilo Medical Center’s imaging department, said he was wearing shorts at Ala Moana on Oahu when he bumped his leg against a concrete bench.
It was a bruise at first, but a couple days later, “pus started coming out of it.”
“It wasn’t just a bruise, it was a puncture wound,” he said.
Saragosa’s primary care doctor prescribed antibiotics for what they thought was a localized infection.
“So it seemed to scab up and go away,” Saragosa said, but a month later, “it kind of burst out of my leg.”
He had sores on his left leg and left foot.
Saragosa returned to his doctor, who sent him straight to the emergency room. He had to have surgery to remove the infection that had spread around his calf and lower leg.
The infection, which was later learned to be a combination of staph and strep, had caused necrotizing fasciitis and eventually led to sepsis.
Sepsis is “basically the body’s overwhelming response to an infection,” said Kim Suganuma, a registered nurse and quality management coordinator at HMC.
Chemicals released in the immune system get into the blood stream and cause a widespread inflammation throughout the body, she explained.
“So we normally have our immune system that usually will work for us but sometimes it goes into overdrive, so it’s basically an overwhelming systemic infection.”
Suganuma said sepsis is divided into three stages: sepsis, severe sepsis and septic shock.
“That’s why we try to catch it early,” she said.
It can have a bacterial, viral, parasitic or fungal cause, and can mimic a lot of flu-like symptoms like fever, chills, fast breathing and heart rate, shortness of breath, low energy levels and cold and clammy skin.
“So that’s why it can be a little bit tricky,” Suganuma said. “It’s kind of a group of symptoms. It kind of will mimic flu-like symptoms and it tricks people. They go, ‘well, you know, it’s probably the flu. I’ll stay home for a couple days. It’ll be alright.’ But, then it can progress very rapidly once it gets into your blood stream and it becomes systemic. It can move very rapidly, so you can progress from that sepsis, to severe sepsis to septic shock. And once a patient is in septic shock, the chances of survival is about 50%.”
According to Suganuma, anyone can get sepsis, but the risk is greater for people who are immunocompromised, like cancer or HIV patients, children, the elderly or those with chronic health issues, like diabetes.
Sometimes it can start from a cut or insect bite that becomes infected, from the flu that turns into pneumonia, urinary tract infections or skin infections.
“We see that a lot,” Suganuma said. “In the islands, we have a high rate of MRSA (methicilliin-resistant Staphylococcus aureus) because of our warm, moist, tropical environment. And we’ll see that in very healthy individuals who maybe went hiking … and cut themselves on a piece of lava and it becomes infected … ”
Suganuma said HMC averages around 60-65 sepsis activations a month, during which a team assembles to assess and address the situation.
In April 2018, HMC started a sepsis surveillance system in its electronic medical record, “and that really helped with early identification and early treatment, which is the key to sepsis survival.”
On a recent morning at HMC, as Suganuma talked, a voice came over the intercom calling for an sepsis team activation in the hospital’s emergency department.
When a patient comes in, she said providers look at whether the patient has a presumed or confirmed infection and inflammatory responses indicated by elevated vital signs.
As the information is entered into the electronic medical record, it will trigger a pop-up notification and the nurse will call a sepsis activation.
“And what it does at that point, it gets all the players at the bedside,” said Suganuma.
Recovery from sepsis depends on the severity of the sepsis and pre-existing conditions, she said.
“Some people will recover completely and some people will have life-long effects, whether that be kidney issues or amputations or disabling muscle or joint pain, depression, panic attacks …,” she said.
Saragosa said he spent about a week in the intensive care unit before moving to acute care for a month and a half and spent another month and a half in a skilled nursing facility.
Suganuma said HMC was asked to present information about its sepsis treatment at a national quality conference in July, “because Hawaii is leading all 50 states, not just Hilo Medical Center, but the entire state of Hawaii is leading sepsis care out of all 50 states. That’s pretty impressive for our state.”
Between 2016 and 2018, HMC saw a 30% increase in survivability of patients in septic shock, when the patients came into the emergency room and a sepsis activation was called. The protocol was implemented in 2015.
And with early recognition and early intervention Suganuma said HMC was able to reduce the length of a patient’s hospital stay.
While there’s no way to prevent sepsis, Suganuma said people should stay up-to-date on vaccines, practice good hygiene and take proper care of wounds, seek early treatment for any kind of infection and take antibiotics as directed.
“Seek immediate are if you develop signs of an infection,” she said. “Every minute counts when it comes to sepsis treatment. The sooner you get treatment, the better the outcome.”
Email Stephanie Salmons at ssalmons@hawaiitribune-herald.com.
