​According to the Sepsis Definitions Task Force convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, the new definition of sepsis is "life-threatening organ dysfunction caused by a dysregulated host response to infection," according to a special communication in the February 23, 2016, issue of the Journal of the American Medical Association. For clinical purposes, organ dysfunction refers to an increase in Sequential Organ Failure Assessment (SOFA) score of at least two points—which represents a 10% mortality risk in general hospital patients with suspected infection. Septic shock is defined as "a subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to substantially increase mortality." Clinically, septic shock is identified by a need for vasopressors to maintain mean arterial pressure of at least 65 mm Hg and serum lactate level greater than 2 mmol/L despite adequate volume resuscitation—the combination of which represents a hospital mortality rate exceeding 40%. Healthcare providers can use a new bedside index called the quickSOFA (qSOFA) to rapidly identify adult patients in general hospital ward, emergency department, and out-of-hospital settings who are "more likely to have poor outcomes typical of sepsis," the authors write. Per the qSOFA, patients are at risk if they have at least two of the following criteria: respiratory rate of 22 breaths per minute or more, altered mentation, or systolic blood pressure of 100 mm Hg or less. If the patient meets qSOFA criteria, providers should investigate for organ dysfunction, begin or escalate appropriate therapy, and consider referring the patient for critical care or increase the frequency of patient monitoring. The new definitions do not specifically incorporate systemic inflammatory response syndrome (SIRS) criteria, which the authors contend were not sensitive and specific enough. In addition, the task force viewed severe sepsis as "superfluous" and thus eliminated the term. Other articles in the same issue address topics such as the development process and validation of the new definitions.

HRC Recommends: Sepsis can strike unexpectedly and progress quickly, and it contributes to one in every two to three hospital deaths (see the May 21, 2014, HRC Alerts). Still, sepsis is underrecognized among both the general public and healthcare providers. Risk managers should examine sepsis prevention, recognition, and treatment in their organization and consider the need for performance improvement initiatives. Components may include education for all clinicians on recognizing and treating sepsis; vigilance throughout the organization; champions and specialists in sepsis care; tools (e.g., bundles, protocols, screening tools); a swift, organized response when sepsis is suspected or diagnosed; quality improvement; feedback to clinicians; coordination within and across settings; and community outreach and patient education.