Dernière mise à jour : 10 mai 2019
Qu'est-ce qu'une septicémie?
Une septicémie (aussi appelée sepsie) est une cascade complexe et potentiellement mortelle des réponses physiologiques à l’infection, définie comme « ... un dysfonctionnement organique possiblement mortel causé par une réaction dysrégulée de l’hôte à l’infection.» Au Canada, en 2011, un décès sur 18 était associé à une septicémie. Il est important de noter que le diagnostic précoce et le traitement de la septicémie réduisent le nombre d'évènements indésirables et la mortalité, en plus de réduire les couts associés à la sepsie pour le système de santé canadien.
La septicémie affecte de façon disproportionnelle les personnes vivant en milieu rural ou éloigné au Canada. En voici quelques raisons.
- Les personnes vivant en milieu rural ou éloigné ont un risque plus élevé de contracter des infections menant potentiellement à la septicémie.
- L'accès aux soins nécessaires pour prévenir, diagnostiquer et traiter la septicémie ne sont actuellement pas adéquats.
(La suite du texte est en anglais.)
Opportunities for Improvement
CADTH’s Environmental Scan identified potential areas for improvement of sepsis-related care in rural and remote areas, including (but not limited to):
- more education for health care providers about sepsis
- more public education to raise awareness about sepsis
- improved access to preventive interventions, diagnostic tests, antimicrobials, and other treatment equipment
- implementation of specific clinical care guidance and associated policies/protocols for sepsis diagnosis and treatment.
Barriers to Detection and Treatment
Barriers to the timely detection and treatment of sepsis in rural and remote areas include (but are not limited to):
Lack of Guidance
With the exception of the Health Canada guidelines for primary care nurses (currently being revised), the Canadian guidance tools identified were for in-hospital use, rather than for use in pre-hospital or remote settings.
Staff Training and Experience
Staff at health centres in remote areas may lack the training and experience needed to recognize sepsis. In addition, the limited health care staff available make it difficult for patients to access care, with delays meaning they may present at a more advanced stage of illness.
Patient Transportation
Geographic barriers to accessing services, as well as additional patient transport delays (e.g., due to bad weather preventing flights in or out of the community), were identified as barriers to the timely treatment of sepsis.
Access to Diagnostic Tests
Examples of diagnostic tests that were available for some survey respondents but not for others included: protocols for referral of patients to other health care settings; access to laboratory services for blood, wound, or respiratory culture, or measurement of sepsis-related markers; access to point-of-care tests for sepsis-related markers; urinalysis; imaging; and specialist consultation via telemedicine.
Limited Medications and Supplies
A recent study of injuries treated at nursing stations in northern Ontario found that, although most (74%) administered IV fluids, only a few (less than 10%) provided oxygen or antibiotics, and none administered vasopressors to stabilize blood pressure.
To note, vasopressors are administered under the direction of a physician, but support from physicians via telemedicine could provide this direction before a patient is transported.
To note, vasopressors are administered under the direction of a physician, but support from physicians via telemedicine could provide this direction before a patient is transported.
Storage and Access Challenges
There are often limited choices of antibiotics available; some antibiotics are used frequently and supplies run out; there is limited storage in medicine rooms and local pharmacies; and restocking of medications can be slow. As a result, appropriate broad-spectrum antimicrobials may not be readily available.
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Dernière mise à jour : 10 mai 2019