Cindy Hou, DO, joins Jubril Oyeyemi, MD, to discuss how primary care clinicians can prevent, recognize, and manage sepsis.
In honor of September being Sepsis Awareness Month, host Jubril Oyeyemi, MD, chief medical officer of the Camden Coalition of Health Care Providers and founder of the Cherry Hill Free Clinic, sits down with Cindy Hou, DO, chief medical officer of Sepsis Alliance and an infectious disease physician dually board-certified in internal medicine and infectious diseases.
Sepsis is often framed as an emergency department or ICU problem, but Hou walks through the opportunities primary care clinicians have across the entire sepsis journey, from preventing the infections that precede it to supporting patients after they return home from a sepsis hospitalization.
Hou frames the primary care clinician as the first line of defense against sepsis, since most patients call their own doctor before they ever consider the emergency department. That first call is the moment to ask questions, examine the patient, and identify an infection before it can cascade, since most sepsis cases begin as community-acquired infections that primary care clinicians are positioned to catch early. Hou also points to the value of a longitudinal relationship: a primary care clinician who has known a patient for years is more likely to notice that something is subtly off than an emergency department team meeting that patient for the first time.
0:00 – Introducing sepsis and Sepsis Alliance
3:28 – Why sepsis is a primary care issue
6:16 – "Infection prevention is sepsis prevention"
10:30 – Who is most vulnerable to sepsis
12:08 – Recognizing sepsis without hospital-grade tools
15:22 – The TIME mnemonic
17:56 – Red flags for an ED referral
20:12 – Telehealth and phone triage
24:08 – Balancing sepsis vigilance with antibiotic stewardship
31:24 – Following up with sepsis survivors
34:23 – Language access and equity
This logic underlies the phrase Hou helped develop and trademark at Sepsis Alliance, "infection prevention is sepsis prevention." Since every case of sepsis begins with an infection, she argues that vaccination, wound care, hand hygiene, and food safety counseling are sepsis prevention tools in their own right, even when sepsis itself is never mentioned.
Hou also cautions against a narrow view of who is at risk. Patients over 65, those with chronic kidney or liver disease, diabetes, cancer, or autoimmune disease on immunosuppressants face elevated risk, but she stresses that healthy patients can and do develop sepsis, so vigilance should not be reserved for the obviously vulnerable.
Without the labs and imaging available in acute care, Hou says primary care clinicians have to rely more heavily on history, exam, and pattern recognition. A patient who is usually mobile and conversational but suddenly seems lethargic or "off," combined with signs of infection, abnormal vital signs, or subtle findings like dry mucous membranes or reduced urine output, should raise concern for early organ dysfunction. To make these signs easier to teach and remember, Sepsis Alliance developed the TIME mnemonic: temperature abnormalities, signs of infection, mental decline, and appearing extremely ill.
Hou also outlines findings that should lower the threshold for an emergency department referral, using cellulitis as an example. Crepitus suggests a deeper space infection, cellulitis crossing a prosthetic joint raises concern for prosthetic joint infection, and high fevers that persist despite oral antibiotics may signal a need for IV therapy.
Oyeyemi adds a layer specific to his own uninsured patient population at the Cherry Hill Free Clinic: fear of medical debt can make patients reluctant to go to the emergency department even when clinically indicated, which raises the stakes for getting the phone and portal triage right.
Hou notes that MyChart messages and phone calls both carry a risk of losing important detail in translation, and that certain reported symptoms, such as ongoing chills, should prompt an immediate escalation rather than a written reply.
Asked how to balance vigilance for sepsis against the risk of overprescribing antibiotics, Hou describes several stewardship principles clinicians can apply even without acute care resources: checking a patient's prior culture results, adjusting for renal function and obesity, avoiding agents likely to trigger C difficile, and using rapid flu and COVID-19 testing to rule out a viral etiology before reaching for antibiotics. She and Oyeyemi also work through a recurrent urinary tract infection case, with Hou recommending imaging or urology referral to rule out structural disease, counseling on hydration, and considering vaginal estrogen in appropriate patients, alongside a reliable urinalysis and culture before each new antibiotic course.
Hou was also a coauthor on a recent multisociety position paper on hospital-based sepsis strategies, and while that paper is written for inpatient teams, she suggests primary care clinicians benefit from understanding it, since they may be receiving these patients back from the hospital or counseling them ahead of a future admission.¹
Hou describes the week following a sepsis hospitalization as a critical window for follow-up, even when patients would rather not see another clinician so soon. She watches for brain fog, extraordinary fatigue, and signs that an infection has not fully resolved, and emphasizes expectations counseling, since survivors face an elevated risk of a repeat episode and often need support with basic activities during recovery.
Language access is a related priority for Hou, who stresses that literacy and medical fluency, not just spoken language, can delay recognition of sepsis. She recommends plain language paired with the actual clinical terms, teach-back to confirm understanding, and interpreter access from the moment a patient registers, noting that a patient who has spoken English their whole life can still be lost by clinical jargon.²
Hou closes with a call to action for primary care clinicians: prevent the infection, recognize the signs and symptoms of sepsis, and counsel patients that infection prevention is sepsis prevention.
