Enhancing sepsis surveillance through infection prevention and control programs: A quality improvement initiative

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Background: Sepsis is a life-threatening condition and a major cause of morbidity and mortality. There is increasing global emphasis on reducing hospital-acquired sepsis (HAS). However, hospital infection prevention and control (IPAC) programs have not traditionally participated in sepsis surveillance. This study describes the integration of sepsis surveillance into an IPAC program to support the early identification of sepsis events. Methods: A quality improvement initiative using the Plan-Do-Study-Act model was conducted across several Canadian hospitals between April 2023 and January 2025. Multimodal interventions included education and sepsis surveillance to classify sepsis as either community-acquired or hospital-acquired. A retrospective cohort pilot study was conducted between November 9, 2024, and January 31, 2025, through the review of electronic health records to identify the origin of sepsis, characterize infection sources associated with mortality risk, and validate data reporting for future prevention strategies. Results: During the study period, 248 real-time sepsis diagnosis alerts were reviewed, of which 232 (93.5%) were community-acquired and 16 (6.5%) were hospital-acquired. Mortality was significantly higher among patients with HAS (37.5%) than among those with community-acquired sepsis (12.5%) (RR = 3.0, 95% CI [1.46, 6.15], p = 0.014). Among 290 infection sources, 22 (7.6%) were hospital-acquired, with urinary tract infection (UTI) being the most common (31.8%). Mortality was significantly lower among patients with UTI sources (8.8%) than among those with non-UTI sources (18.7%) (RR = 0.47, 95% CI [0.28, 0.80], p = 0.040). From November to January, HAS rates increased from 3.80 to 5.71 per 1,000 discharges, with 16 of 25 cases validated by IPAC surveillance. Conclusions: The findings of the current study demonstrate higher mortality among patients with hospital-acquired sepsis than among those with community-acquired sepsis. This sepsis surveillance system may serve as a valuable addition to hospital surveillance and quality improvement programs by providing insights into sepsis classification and infection sources.

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