Journal of Critical Care (2012) 27, 410–413

Editorial

Stop sepsis—save lives: A call to join the global coalitionfor the World Sepsis Day

Sepsis causes more deaths worldwide per year thanprostate cancer, breast cancer, and HIV/AIDS combined.Hospitalization rates for sepsis have overtaken those formyocardial infarction in the United States, where sepsis hasbeen increasing by an annual rate of between 8% and 13%over the last decade [1]. Reasons are diverse and include theaging population, increasing use of high-risk interventions inall age groups, and the development of drug-resistant andmore virulent varieties of infections. In the developingworld, malnutrition, poverty, and lack of access to vaccines,and timely treatment all contribute to death.

Globally, 20 to 30 million patients are estimated to beafflicted every year, with over 6 million cases of neonatal andearly childhood sepsis and over 100000 cases of maternalsepsis [2]. Moreover, most deaths from maternal and earlychildhood sepsis occur in resource limited areas of the world.A patient with sepsis is 5 times more likely to die than a patientwho had a myocardial infarction. Worldwide, a person dies ofsepsis every few seconds. The humanitarian and economicburden of this increasing health care disaster is poorlyrecognized by the public and by policymakers. Deplorably,funding for sepsis research is considerably lower than fundingfor other less common and less deadly diseases. (Table 1).

A considerable percentage of sepsis cases could beprevented through the widespread adoption of practices ingood general hygiene and hand washing; cleaner obstetricdeliveries; and through improvements in sanitation, betternutrition (especially among children under 5 years of age),provision of clean water in resource poor areas [2]; andvaccination programs for at risk patient populations [7,8].

In addition, sepsis mortality can be reduced considerablythrough the adoption of early recognition systems andstandardized emergency treatment [9–11]. However, theseinterventions are currently delivered to less than 1 in 7 patientsin a timely fashion [12,13]. Sepsis is often diagnosed too late.Patients and health care professionals do not suspect sepsis,and the clinical symptoms and laboratory signs that arecurrently used for the diagnosis such as raised temperature orincreased pulse, breathing rate, or white blood cell count are

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not specific for sepsis. Recognition in neonates and children iseven more problematic because the signs and symptoms maybe nonspecific and subtle, but deterioration is usually rapid.

Other factors contributing to sepsis being underrecog-nized and poorly understood are confusion about itsdefinition among patients and health care providers, lack ofdocumentation of sepsis as a cause of death on deathcertificates, and inadequate diagnostic tools. An internationalsurvey suggests that 80% to 90% of people in North Americaand Europe are not familiar with the term sepsis and of thosewho are, most are not aware that sepsis is a leading cause ofdeath [14].

To address these gaps in insight and to decrease theburden of sepsis worldwide, the Global Sepsis Alliance(GSA) and its founding members—the World Federation ofSocieties of Intensive and Critical Care Medicine(WFSICCM), the World Federation of Pediatric Intensiveand Critical Care Societies (WFPICCS), the World Feder-ation of Critical Care Nurses (WFCCN), the InternationalSepsis Forum (ISF) and the Sepsis Alliance (SA)—announced the launch of their new global initiative at thisyear's ISICEM (International Symposium on Intensive Careand Emergency Medicine) meeting in Brussels. As a result,the first World Sepsis Day (WSD) will be held on September13, 2012, under the slogan “Stop sepsis—save lives.”

World Sepsis Day aims to improve public awareness ofthe enormity of the problem and the time-critical nature ofsepsis. It strives to unite health care providers, patients andfamilies, policymakers, and all other stakeholders behindfive long-term targets to be achieved by 2020. These targetsare set out in the World Sepsis Declaration (www.world-sepsis-day.org) as follows:

1. Reducing sepsis incidence through prevention by at least20%. 2. Improving survival for children and adults in allcountries. 3. Raising public and professional awarenessand understanding of sepsis. 4. Ensuring improved accessto adequate rehabilitation services. 5. Creating andmaintaining sepsis incidence and outcomes databases.

Table 1 Research funding in relation to disease incidence

Incidence per100000 a

Million USD spent forstate-funded research2011 (US) b,c

Sepsis [1] 377 91Stroke d [3] 112-223 317Top 3 cancers(prostate, femalebreast, lung andbronchus) [4]

331.8 2277

Myocardialinfarction [5]

208 438

HIV e [6] 22.8 2900a All figures for United States, 2008.b Data source: http://www.kff.org/hivaids/7029.cfm.c Data source: http://report.nih.gov/categorical_spending.aspx.d Europe, 2000 to 2008.e United States, 2006.

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1. Prevention: By 2020, the incidence of sepsis will havedecreased by at least 20% by promoting practices ofgood general hygiene and hand washing, cleandeliveries, improvements in sanitation, nutrition, anddelivery of clean water and through vaccinationprograms for at-risk patient populations in resourcepoor areas.

2. Survival: By 2020, sustainable delivery systems willbe in place to ensure that effective sepsis controlprograms are available in all countries. All countrieswill be monitoring time taken for patients with sepsisto receive the most important basic interventions,antimicrobials, and intravenous fluids in accordancewith international consensus guidelines. We intend thatsurvival rates from sepsis for children (includingneonates) and adults will have improved by a further10% from their levels at 2012.

3. Awareness: By 2020, sepsis will have become ahousehold word and synonymous with the need foremergent intervention. Lay people will much betterunderstand what the early warning signs of sepsis are.Families' expectations of delivery of care will haverisen such that delays in therapy are routinelyquestioned. We are also working to alert policymakerson the impact of sepsis; to improve overall prevention,recognition, and treatment standards; and to form alobby for those affected by the illness. By 2020, allmember countries will have established learning needsfor sepsis among health professionals and ensured theinclusion of training on sepsis as a medical emergencyin all relevant undergraduate and postgraduate curric-ula. Recognition of sepsis by health professionals as acommon complication of high-risk medical interven-tions will have significantly improved, thereby reduc-ing the numbers of patients who become exposed tothe risk.

4. Rehabilitation: By 2020, all member countries willhave set standards and established resources for theprovision of follow-up care after discharge fromhospitals of patients who had sepsis.

5. Sepsis registries: By 2020, the measurement of theglobal burden of sepsis and the impact of sepsiscontrol and management interventions will haveimproved significantly, and all member countrieswill have established voluntary or mandated sepsisregistries, which are consistent with and complemen-tary to the data requirements of the internationalcommunity, helping to establish sepsis as a commonhealth problem.

The member societies of the World Federations and otherprofessional bodies that support the WSD originate from 69countries and represent more than 600000 physicians,nurses, and allied health care workers. The WSD coalitionwill build on the expertise of its member sepsis advocacygroups and professional organizations, which have beendedicated to the fight against sepsis in different continents formany years, to create a united and powerful body to helpdrive robust improvements. To date, more than 70international and national societies from all continents havejoined this coalition.

1. How can you participate?

1.1. Join the movement

Our aim is to get more than 1000 hospitals to endorsethe ideals and goals of the World Sepsis Declaration bySeptember 13, 2012. We urge you to commit yourorganization to these goals and, in so doing, join thebody of enlightened organizations from around the globededicated to reducing the health, economic, and humanburden of sepsis.

Stopping the progression of sepsis by addressing thetargets set out in the World Sepsis Declaration alsorequires close interdisciplinary collaboration of all stake-holders involving but not limited to public health,community medicine, hygiene, microbiology, infectiousdisease, emergency medicine, critical care medicine, andrehabilitation. Therefore, we urge all interested parties tocreate broad multidisciplinary coalitions at the local,regional, national, and global levels that will allow theglobal health community to effectively respond to thechallenges in the prevention, diagnosis, and therapy ofsepsis and its sequelae.

1.2. Support the World Sepsis Day

For your support of WSD, we can provide you with anumber of educational and promotional materials such as

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posters, flyers, pocket cards, and power point presentationsthat you may download from our Web site (www.world-sepsis-day.org). There you and your institution may also signthe World Sepsis Declaration and register to become anofficial supporter of this movement. On and aroundSeptember 13, we would encourage you to meet with yourhospital management to discuss programs to support thegoals of WSD; organize interdisciplinary regional symposiaon sepsis, charity events, open day meetings for the public atyour health care institution; meet the press and hold seminarsto educate your health care workers; etc. We will keep youinformed about all the planned activities and will register andpost your event on our Web site.

1.3. Donate

Establishment of the Global Sepsis Alliance andconceiving of and planning the activities for WSD haveonly been made possible through the provision of generousgrants from private donors, foundations and professionalsocieties, and the pro bono work of many individuals. Weare particularly grateful to The Significance Foundation; theMerinoff family; the Feinstein Institute; the North ShoreUniversity Hospitals; the GSA Founding organizations; theGerman Sepsis Society and the Jena (Germany)–basedCenter for Sepsis Control and Care which hosts the WSDHead Office. Given the enormity of the task facing us anddespite having built a credible, altruistic, and far-reachingcoalition, the available resources remain insufficient.Therefore, our fund-raising activities in support of ourWSD activities and targets are ongoing, and we are open tosupport from all sources. The Guiding Principles for theinteraction of the Global Sepsis Alliance with commercialentities and the mutual benefits for WSD sponsors can bedownloaded from the WSD Web site (www.world-sepsis-day.org).

The Global Sepsis Alliance, the body that will host the fundsfor WSD on behalf of the coalition for the WSD, is a charityregistered in England and Wales. The GSA and the WSDgoverning bodies as well as their officers have committedthemselves to act in accordance to the NGOGuidance and Anti-Corruption Principles of Transparency International.

2. Conclusion

Bringing the growing burden of sepsis in the developedand developing world to the attention of health policymakersat the national, regional, and global level and raising thechances of early prevention and recognition of sepsis is animportant step in the long fight against reducing mortalityrates for the disease. Other fields in medicine such ascardiology, cancer, and HIV, which have driven successfulimprovements, have demonstrated that such achievementsrequire concerted political and public awareness campaigns.

In case of cancer, “…it needed icons, mascots, images,slogans—the strategies of advertising as much as the tools ofscience. For any illness to rise to political prominence, itneeded marketing..... A disease needed to be transformedpolitically before it could be transformed scientifically.”(S. Mukherjee [15]). However, the realization of the targetsof the WSD can only be driven from the top of theprofessional healthcare sector and by policymakers them-selves, and requires the dedication of health care pro-fessionals on all levels of care from physicians to communityhealth care workers.

Konrad Reinhart MD (Prof.)Niranjan “Tex" Kissoon MD, FRCP(C),

FAAP, FCCM, FACPE (Prof.)Ron Daniels MB, Ch.B, FRCA, FFICM (Dr.)

Edgar J. Jimenez MD, FCCM (Prof.)Center for Sepsis Control and Care

Erlanger Allee 10107747 Jena, Germany

E-mail address: office@world-sepsis-day.org

References

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[2] Kissoon N, Carcillo JA, Espinosa V, et al. World Federation ofPediatric Intensive Care and Critical Care Societies: Global SepsisInitiative. Pediatr Crit Care Med 2011;12:494-503.

[3] Feigin VL, Lawes CM, Bennett DA, et al. Worldwide stroke incidenceand early case fatality reported in 56 population-based studies: asystematic review. Lancet Neurol 2009;8:355-69.

[4] U.S. Cancer Statistics Working Group. United States Cancer Statistics:1999–2008 Incidence and Mortality Web-based Report. Atlanta: U.S.Department of Health and Human Services, Centers for DiseaseControl and Prevention and National Cancer Institute; 2012. Availableat: http://apps.nccd.cdc.gov/uscs/toptencancers.aspx.

[5] Yeh RW, Sidney S, Chandra M, et al. Population trends in theincidence and outcomes of acute myocardial infarction. N Engl J Med2010;362:2155-65.

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[7] Mangia CM, Kissoon N, Branchini OA, et al. Bacterial sepsis inBrazilian children: a trend analysis from 1992 to 2006. PLoS One2011;6:e14817.

[8] Public Health Agency of Canada. Canadian National Report onImmunization. CCDR 2006;32S3:1-44 Available at http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/06pdf/32s3_e.pdf.

[9] Ferrer R, Artigas A, Levy MM, et al. Improvement in process of careand outcome after a multicenter severe sepsis educational program inSpain. JAMA 2008;299:2294-303.

[10] Levy MM, Dellinger RP, Townsend SR, et al. The Surviving SepsisCampaign: results of an international guideline-based performanceimprovement program targeting severe sepsis. Crit Care Med 2010;38:367-74.

[11] Barochia AV, Cui X, Vitberg D, et al. Bundled care for septic shock:an analysis of clinical trials. Crit Care Med 2010;38:668-78.

[12] Kumar A, Roberts D, Wood KE, et al. Duration of hypotensionbefore initiation of effective antimicrobial therapy is the critical

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determinant of survival in human septic shock. Crit Care Med2006;34:1589-96.

[13] Phua J, Koh Y, Du B, et al. Management of severe sepsis in patientsadmitted to Asian intensive care units: prospective cohort study. BMJ2011;342:d3245.

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