Sepsis: A Hidden Threat Every Nurse Must Recognize to Save Lives

Overview of Sepsis

September is Sepsis Awareness Month, a great time to renew your focus on sepsis readiness and care. Sepsis is a life-threatening syndrome of physiologic, pathologic and biochemical abnormalities induced by infection, and a major public health concern.

In 2018, it was reported that in the U.S., the hospital cost of sepsis was about $16,324 for sepsis without organ dysfunction, $24,638 for severe sepsis and $38,298 for septic shock. About one-third of all sepsis survivors, and more than 40% of older sepsis survivors, have another hospitalization within three months of the initial sepsis, most commonly due to a repeat episode of sepsis or another infection. The average cost for a hospital readmission at 30 days after the initial sepsis hospitalization is $16,852. This amounts to more than $3.5 billion in annual costs. Fortunately, there is increasing attention focused on the economic and personal costs following sepsis. In a systematic review of data across multiple countries from 2002-2024, the median total healthcare cost among sepsis survivors in year one after discharge was $28,719, and the median total healthcare cost in year two after discharge was $22,460. Each year, according to the Centers for Disease Control and Prevention (CDC), at least 1.7 million adults in the U.S. develop sepsis, and at least 350,000 die as a result. The infection, which is most commonly bacterial, can also be fungal, parasitic or viral (COVID-19 or influenza). Respiratory, gastrointestinal tract, urinary tract and skin infections are the most common sources of infections that can lead to sepsis.

As many as 87% of sepsis cases originate in the community and not in the hospital. Even though most sepsis cases start in the community, hospitalized patients are at high risk for hospital-associated infections (HAIs) and for developing sepsis related to invasive devices and lines such as ventilators, intravenous catheters, central lines, etc. The healthcare cost is much greater for patients when sepsis is not present on admission (POA). Mean patient costs were considerable at $21,568 and, when stratified, POA was $18,023 and a staggering $51,022 for non-POA. Many patients who are admitted to the hospital are on one or more antibiotics. This also puts them at risk for Clostridioides difficile (C. diff), which can lead to sepsis.

The "Sepsis Chain of Survival" concept was introduced in 2025. It is based on the "Chain of Survival" concept developed for cardiac arrest that emphasizes continuous and interconnected, not strictly linear, time-critical interventions to improve patient survival. Key components include the importance of early recognition, prompt emergency medical services activation, timely antimicrobial administration, and appropriate fluid resuscitation, optimized critical care management, effective source control and infection management, and comprehensive post-sepsis care. Each intervention is critical to improved sepsis care and outcomes.

Sepsis Definitions

The first consensus definition of sepsis was published in 1992, after being developed in 1991 during the American College of Chest Physicians (ACCP)/Society of Critical Care Medicine (SCCM) Consensus Conference. Sepsis definitions have evolved over time to the most recent Sepsis 3 definition presented at the SCCM Critical Care Congress in 2016, where sepsis was defined as "life-threatening organ dysfunction caused by a dysregulated host response to infection."

In 2005, the International Pediatric Sepsis Consensus Conference (IPSCC) published definitions and criteria for sepsis, severe sepsis and septic shock in children. In 2024, the SCCM Pediatric Sepsis Definitions Taskforce updated definitions and criteria, resulting in the Phoenix criteria that define sepsis as an infection with life-threatening organ dysfunction.

Today, the adult and pediatric definitions are aligned with life-threatening organ dysfunction caused by an infection. However, because of the physiological differences between adults and children, the sepsis definitions vary with pediatrics using age-specific vital signs and a focus on fewer organ systems. Shock is defined without requiring low blood pressure.

Sepsis Management Guidelines

The Surviving Sepsis Campaign began in 2002. The Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) fund, create and publish the Surviving Sepsis Campaign (SSC) guidelines. In February, the updated "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026" and "Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026" were released. Executive summary articles review the history, methodology, content and major changes since the previous guidelines.

The updated adult guidelines contain 129 statements, including 46 new recommendations that focus on prehospital care, antibiotic timing and optimization, and cautious fluid management with active fluid removal and postdischarge care transitions. These guidelines are formally endorsed by 24 professional organizations worldwide.

The 2026 guidelines for children are an update from 2020 and integrate the definition of pediatric sepsis based on the Phoenix criteria. These guidelines apply to all patients from greater than or equal to 37 weeks of gestation at birth to 18 years with probable or confirmed sepsis or suspected or confirmed septic shock. The 2026 guidelines include 61 statements covering recognition and management of infection (18 statements), hemodynamics and resuscitation (18 statements), ventilation (three statements), adjunctive, metabolic and immunologic therapies (19 statements) and long-term follow-up (three statements). They are formally endorsed by 14 professional organizations worldwide.

Patient Population at Risk for Sepsis

Sepsis is an equal-opportunity clinical syndrome that can happen to anyone. However, the following risk factors put people at higher risk of developing sepsis:

• Ages 65 and older, and younger than 1 year old
• Recent birth, miscarriage or abortion
• Chronic conditions such as diabetes, lung disease, cancer, kidney disease or chronic obstructive pulmonary disease (COPD)
• Weakened immune system due to chemotherapy treatment, HIV or a recent organ transplant, or a genetic disorder, such as Down syndrome or sickle cell disease, that affects the immune system
• Splenectomy
• Recent surgery or a serious illness
• Surviving sepsis; once someone has had sepsis, they're more likely to get it again.

Early Recognition of Sepsis

Early recognition of sepsis is critical, whether it's in the hospital, outpatient care facility or the community. An 8% increase in mortality for patients with septic shock occurs with every hour of delay in antibiotic administration. Sepsis is often challenging to recognize in its early stages, which is the optimal time to begin treatment. It is said that sepsis is difficult to recognize early on when it is easy to treat and easy to recognize later on when it is difficult to treat. Based on research data, the Sepsis Alliance estimates that as many as 80% of sepsis deaths could be prevented with rapid evaluation and treatment. Delays in sepsis recognition and treatment increase morbidity and mortality.

Antimicrobial Stewardship

The Society for Healthcare Epidemiology of America (SHEA) has partnered with the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS) and the Society of Infectious Diseases Pharmacists (SIDP) to convene regularly to advance antimicrobial stewardship. Antimicrobial stewardship refers to coordinated interventions to improve appropriate use of antimicrobials in all healthcare settings (acute care, outpatient care and long-term care). This stewardship is achieved through optimizing antimicrobial regimen, dose, duration of therapy and route of administration. The objectives of antimicrobial stewardship are to (1) achieve the best clinical outcomes related to antimicrobial use, while (2) minimizing the emergence of antibiotic-resistant organisms, C. diff infection and other adverse events, and (3) reducing excessive costs attributable to suboptimal antimicrobial use. The guidance focuses on strong recommendations for antimicrobial therapy, which means the guideline applies not only to antibiotics but also to antifungals and antivirals.

Antibiotic administration is a key component of managing sepsis, and it's critical to start antibiotics targeted for the suspected or known pathogen as soon as possible, optimally within one hour of the recognition of sepsis. Appropriate antibiotic use is critical to optimize clinical outcomes for patients with sepsis, minimize risk of C. diff infection and prevent antimicrobial resistance. Nurses can play a key role in reviewing antibiotics daily. Consider asking yourself, "Are there any new, related lab results that may influence an antibiotic change or discontinuation? Is the administration of antimicrobials appropriate for this patient?"

Resources for Antimicrobial Stewardship

• CDC Core Elements of Antibiotic Stewardship

Maternal Sepsis

According to the most recent report from the Centers for Disease Control and Prevention, sepsis is the leading cause of pregnancy-related mortality. Most of these deaths are estimated to be preventable with early identification and treatment. Sepsis affects an estimated 5.7 per 10,000 pregnancies. The distinctive and complicated maternal immune system puts people throughout pregnancy at risk for infection and sepsis.

The World Health Organization (WHO) says maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, postabortion or the postpartum period.Maternal sepsis is frequently preventable. Normal physiologic changes during pregnancy such as a high heart rate, high respiratory rate, decreased blood pressure and increased white blood cell count are similar to signs of sepsis. These normal changes contribute to delays in recognition, prompt appropriate treatment and escalation to a higher level of care that leads to high rates of maternal sepsis.

The American College of Obstetricians and Gynecologists (ACOG) released a Consensus Statement through the Alliance for Innovation on Maternal Health (AIM) in 2023, which focuses on sepsis in an obstetric care consensus bundle.

The California Maternal Quality Care Collaborative (CMQCC) published "Improving Diagnosis and Treatment of Obstetric Sepsis, V2.0 Toolkit" in September 2025. The toolkit introduces a new two-step screening and confirmation process to more accurately diagnose and manage obstetric sepsis.

Significant racial disparities occur in maternal sepsis similar to those in other sepsis populations. Black, Asian/Pacific Islander and American Indian/Alaska Native obstetric patients have a diagnosis of sepsis at significantly higher rates than white patients.

Maternal Sepsis Resources

• California Maternal Quality Care Collaborative (CMQCC): Improving Diagnosis and Treatment of Maternal Sepsis Toolkit
• ACOG Sepsis in Obstetric Care Safety Bundle
• AIM Urgent Early Warning Signs
• Advocacy Language for Patients
• Sepsis Alliance: Pregnancy & Childbirth

Pediatric Sepsis

There are more than 18,000 pediatric sepsis cases and more than 1,800 deaths annually in the U.S. In-hospital mortality was 10%.

Pediatric Sepsis Resources

• Preventing Infections Helps Prevent Sepsis
• Video: Bug Helps You Learn to Stay Sepsis Safe
• Infection Prevention Is Sepsis Prevention in Young Children
• Infection Prevention Is Sepsis Prevention in Teens

Life After Sepsis

Up to 50% of sepsis survivors have long-term physical and/or psychological issues, a condition known as post-sepsis syndrome. These effects include:

• Insomnia, which is difficulty getting to sleep or staying asleep
• Nightmares, vivid hallucinations and panic attacks
• Disabling muscle and joint pain
• Extreme fatigue
• Poor concentration
• Decreased mental (cognitive) functioning
• Loss of self-esteem and self-belief

Resources for Life After Sepsis

• Sepsis Alliance Connect: a virtual support community
• Life After Sepsis video

Steps nurses can take to help improve sepsis care:

• Practice and share information about infection prevention.
• Increase sepsis awareness in your communities.
• Educate patients, families and the community about sepsis, symptoms and, importantly, why it's a medical emergency.
• Always consider a diagnosis of sepsis! Rule it out when you're assessing patients.
  • When patients are triaged and seen in the emergency department, urgent care or even their primary care physician's office, clinicians should work to rule out sepsis, just as they would acute myocardial infarction or stroke.
• Recognize the unique physiological changes of obstetric patients, and screen for sepsis using the two-step process. Step 1: Initial screen for serious infection, and Step 2: Bedside Sepsis Evaluation
• Always consider antibiotic use through the lens of antibiotic stewardship as a key strategy to improve sepsis care and decrease antibiotic resistance.
• Apply an equity lens:
  • Racial disparities - The sepsis mortality of hospitalized patients is reported to be higher for diverse racial and ethnic patients compared with white patients. A recent retrospective study of patients with a diagnosis of septic shock found that Black patients had 1.57 times the odds of 90-day mortality compared with non-Hispanic white patients. Potential contributing factors that need further investigation include potential disparities in sepsis recognition leading to delayed treatment that may result in poor clinical outcomes.
• Clarify misconceptions about sepsis such as:
  • Misconception 1: If you don't have a fever, you don't have an infection or sepsis.
    Fact: Older adults frequently don't have a fever with infection and sepsis due to the aging process; therefore, temperature is not a good indicator of whether a patient has infection or sepsis.
  • Misconception 2: Sepsis is blood poisoning and contagious.
    Fact: Sepsis is not blood poisoning and is not contagious. The infection may be contagious but not sepsis, which is the body's response to infection.
  • Misconception 3: Only people with chronic conditions develop sepsis.
    Fact: Anybody can develop sepsis.
• Show a Sepsis Alliance Faces of Sepsis video at a unit meeting.
• Earn the American Association of Critical-Care Nurses (AACN) Sepsis Micro-Credential.

Learn more through the following resources:

• AACN Clinical Resources for Sepsis
• Sepsis Alliance Institute - Education and Resources for Healthcare Professionals and Individuals Working in Healthcare
• Resources you can share with patients and caregivers
• Sepsis Alliance
• CDC Hospital Sepsis Program Core Elements

Concepts to Remember About Sepsis

• Sepsis is the body's overwhelming reaction to infection.
• Infection prevention is sepsis prevention.TM
• Sepsis is a medical emergency.
• Early treatment of patients with sepsis is critically important to improve clinical outcomes.
• Infection and sepsis can sometimes happen during pregnancy, childbirth, postabortion or a postpartum period and should be screened and managed differently than for the general adult population.
• Children are not small adults and must be evaluated and treated appropriately.
• Provide education and resources to patients with sepsis and their caregivers throughout the hospital stay and at discharge.
• Get involved in your workplace and community to increase sepsis readiness and awareness.

What is your hospital's initiative to prevent and manage sepsis?