The rate of infections that turn septic among patients at the Cape Breton health complex based in Sydney, N.S., has risen for the past four years.
The rate is now just over double the national average. Health officials are working inside the facilities to bring those numbers down, while an organization that supports vulnerable patients is trying a new way to keep them out of the hospital in the first place.
Janet Bickerton, a nurse and the health co-ordinator for the Ally Centre of Cape Breton, said people who use injection drugs are more susceptible to sepsis than most because wounds from needle use often get infected.
"That is the big concern with wounds of that nature," she said.
"Once it becomes abscessed and, if it's not treated, then … those bacteria etcetera can circulate in the blood and then you've got sepsis, and then you're in a really bad situation. It's really a life-or-death situation at that point."
The Ally Centre runs a clinic in downtown Sydney. Many of its patients use drugs.
"We had six people last year who spent three weeks and more in the intensive care unit because of sepsis and one fatality from sepsis last year, so that's quite high," Bickerton said.
Sepsis occurs when an infection gets out of control.
According to the Canadian Institute for Health Information, the rate of sepsis acquired in the Cape Breton health complex is 10.5 patients per 1,000 admissions.
The national rate is 4.8. The Nova Scotia average is 5.8.
The Cape Breton health complex includes community hospitals in New Waterford, Glace Bay, North Sydney and the regional hospital in Sydney, which is the main health centre for the region.
Patients with a serious wound who visit the Ally Centre don't always get the help they need at the hospital, Bickerton said.
In part, that's because they can feel judged for their drug use by health-care professionals and then avoid the hospital until it's too late.
For those who do go to the hospital, serious infections are often treated with intravenous antibiotics administered on an outpatient basis.
People go for one treatment, then they go home and have to return to the hospital daily, until the course is done.
Bickerton said some patients aren't always able to get the full treatment they need to prevent an infection from becoming septic because of their drug use and chaotic lives
"Normally what has to happen is they have to go back for let's say seven to 10 days, often to ambulatory care and have their IV treatments," she said.
"So, that works for some people. It doesn't really work for this population. They often don't have a phone. They don't have transportation.
"They could be homeless and how do they get there and when they get there, again we're in the same situation in an environment that's very uncomfortable for them and they're a flight risk."
Pilot project launches this month
This month, the Ally Centre is launching a pilot project with Nova Scotia Health and the Victorian Order of Nurses to provide home care for those at the centre's clinic.
It's unique because some patients are homeless or their housing is precarious and may be unsafe for home-care workers, said Bickerton.
The VON will set up at the clinic and the Ally Centre will act as a home for their patients.
Nova Scotia Health will not say how many actual deaths occurred in Cape Breton regional hospitals due to sepsis.
However, it said in an email that those deaths have declined by 15 per cent in each of the last two years.
At the same time, the hospitals' standardized mortality ratio — a measure of the rate of unexpected deaths — has stabilized.
It is still higher than the national average, but is no longer the highest in the country.
Officials say the top three causes of unexpected deaths at Cape Breton hospitals are heart failure, chronic pulmonary obstructive disease and sepsis.
Brett MacDougall, Nova Scotia Health's vice-president of operations for the eastern zone, said the high rate of in-hospital sepsis is a concern.
But he said a number of changes have been made, and more are on the way.
The hospitals have made improvements during surgeries and are making staff aware of the need for early detection of infections.
Nurses are removing catheters earlier to reduce infections and a clinical care group is reviewing protocols around central venous devices.
The province is also hiring a full-time sepsis co-ordinator this month to help focus staff on the problem, MacDougall said.
Dr. Don Brien, an orthopedic surgeon at the regional hospital in Sydney and the eastern zone medical executive director, said staff are working differently and with a common purpose.
The rate may be rising because of an increase in the diagnosis of sepsis, but fewer people are dying, he said.
"There's this real heightened awareness now at every level from when they come into the emergency department to when they go to the floor, when they go to the operating room or the ICU, so we have all these protocols in place to help identify sepsis," Brien said.
"We feel like we are doing something right because despite the increase in the diagnosis of sepsis, we're not seeing an increase in the mortality rate of sepsis."
Don't avoid hospital, says sepsis expert
Dr. Alison Fox-Robichaud — a critical care specialist, professor of medicine at McMaster University in Hamilton and scientific director for the research network Sepsis Canada — said sepsis is common at all hospitals.
No matter what the mortality and sepsis numbers are, people should not hesitate to go to the hospital for proper medical care, she said.
"What I would say to people is to be aware of when you're developing infections," she said.
"If you think you're unwell, get to the hospital early. I would also encourage people to ask, if they're unwell in hospital, to ask their health-care provider, 'Could it be sepsis?' because early recognition and early treatment is important."
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