Drs. Christopher Ellis, Karel Tyml and Michael Sharpe

London Sepsis Checklist

While sepsis rates are not easy to capture and compare, early recognition and treatment is an area of improvement for hospitals across the country including London Health Sciences Centre.

To help address this, a multidisciplinary team led by Dr. Christopher Fernandes, chair, Medical Advisory Committee and director, Quality of Medical Care, focused on four initiatives:

  • better recognition of sepsis;
  • enhancing Critical Care Outreach Team utilization;
  • improving antibiotic stewardship; and
  • improving palliative care recognition.

In response, the London Sepsis Checklist was developed and includes a sepsis screening tool and checklist for the emergency department and all inpatient floors, as well as antibiotic guidelines, a comprehensive website, and online learning modules for physicians and nursing staff.

Preliminary results show that a multidisciplinary approach using a variety of tools means faster recognition and treatment of sepsis, ensuring a safer health care experience for our patients.

ABOVE: Through their research, Drs. Christopher Ellis, Karel Tyml and Michael Sharpe have shown that vitamin C is a potentially safe and effective treatment for sepsis.

BELOW: Dr. Christopher Fernandes, chair of the medical advisory committee and director of quality of medical care, reviews the sepsis checklist completed for an emergency patient with registered nurse Michelle Douglas.

Dr. Christopher Fernandes with registered nurse Michelle Douglas

NEW RESEARCH helps patients survive sepsis

Treating sepsis, the leading cause of death in intensive care units (ICUs) around the world, is one of the most significant challenges in critical care medicine.

Often developing from infections associated with trauma, surgery, burns or cancer, sepsis occurs when the body’s immune system goes into overdrive, overwhelming normal processes in the blood.

In the most severe cases, small blood clots form in tiny vessels called capillaries throughout the body, blocking blood flow to vital organs leading to organ failure.

Babies, the elderly, and those with weakened immune systems are more likely to get sepsis, but even healthy people can become deathly ill from this syndrome.

Health experts predict that hospitals will continue to see an increase in the number of patients with sepsis due to increases in invasive medical procedures, the number of immuno-compromised patients being treated, and an increase in the number of elderly patients with more than one disease.

But new research underway at Lawson Health Research Institute (Lawson) is showing that vitamin C, used for decades to maintain good health, has been identified as a potentially safe and effective treatment for this life-threatening illness.

Lawson’s Drs. Karel Tyml and Christopher Ellis, along with Dr. Michael Sharpe, an intensivist at University Hospital, have found that a single injection of vitamin C not only prevents blocked capillaries during the onset of sepsis, but it can also reverse this effect by unplugging already plugged capillaries.

“Our research into sepsis has found that early as well as delayed injections of vitamin C significantly improve chances of survival,” explains Dr. Tyml. “And more importantly, a single injection of vitamin C is long-lasting and prevents capillary plugging for up to 24 hours.”

“In our animal models of sepsis, we have observed that plugging of capillaries results in lower oxygen levels in the tissue,” says Dr. Ellis. “The more capillaries that are plugged, the lower the oxygen levels.”

The potential benefit of this treatment is substantial. Vitamin C is inexpensive and previous studies have shown that it can be safely administered to patients.

“It has the potential to significantly improve the outcome of sepsis,” says Dr. Sharpe.

Drs. Tyml, Ellis and Sharpe are eager to find appropriate support to move this research from the bench to the bedside. “All of our work in the lab with vitamin C supports the hypothesis that it will be helpful in decreasing sepsis rates and death from sepsis in patients,” says Dr. Tyml. “Our next step is to begin pilot projects in humans to prove this.”