For 15 days in February, Michael Berger lay in a medically induced coma, on a ventilator, verging on kidney failure as doctors at Kennedy University Hospital-Cherry Hill fought to keep him from succumbing to severe sepsis.
In medical terms, Berger was circling the drain.
"It was a life-threatening situation," says Aaron Crookshank, medical director of the intensive-care unit and Berger's physician. "I felt he had a 50/50 chance when he originally presented with this constellation of problems."
Just a few days before being hospitalized, Berger was a healthy 46-year-old. And then he got a paper cut on his finger.
The roughly 3/16 of an inch split in his skin was all the flesh-eating bacteria needed to enter his bloodstream and start scaling his right arm. The invasion triggered a "disregulated host" response, the definition of sepsis.
Berger landed in a good place.
Since 2012, Kennedy Health has waged an all-out war on sepsis. In the last four years, the hospital system has reduced its sepsis mortality rate from 27 percent to 9.2 percent, making the three-hospital system among the best in the Garden State and beyond, said Thomas Haymann of the advocacy group the Sepsis Alliance. The improvement translates into saving more than 180 lives in the last four years, hospital officials said.
New Jersey's sepsis mortality rate, which was 28.7 percent in 2015, has been slowly trending downward since 2011, when it reached 32.6 percent. In 2014 the New Jersey Hospital Association launched a statewide Sepsis Learning and Action Collaborative. In one year, the program has been credited with saving 400 lives.
A similar statewide program initiated by the Hospital and Healthsystem Association of Pennsylvania has reduced severe sepsis mortality from 17.7 percent in 2009 to 11 percent in 2014.
"We have gotten really good at this," said Marianne Kraemer, Kennedy Health's chief nursing officer, who chairs the sepsis committee along with Henry Schuitema, head of emergency medicine.
Kennedy received the Sepsis Alliance's Sepsis Hero Award earlier this month in New York City.
"What really intrigued us about Kennedy was that they are a three acute-care hospital system that has really taken [sepsis awareness] very seriously and has implemented change throughout their entire system," said Haymann, the Alliance's executive director. "They are really walking the talk, which is what we look for."
Asked why New Jersey's rate is above the national average, Haymann said statewide initiatives, patient co-morbidities, and even how cases are identified all affect sepsis rates.
"The way that sepsis cases are tracked is not uniform," he says. "So it's hard to compare apples to apples."
Due in some part to heightened awareness, the number of cases nationwide has risen to about 1.6 million a year. And while the mortality rate for sepsis and septic shock has fallen to 15 percent to 20 percent nationally, 258,000 people still die from the condition annually, according to the Sepsis Alliance. That's more than die from prostate cancer, breast cancer, and AIDS combined.
Kennedy's administrators decided in 2012 to make reducing sepsis mortality a priority. The campaign started in its emergency departments and intensive care units. But information on how to recognize and treat septic patients was still scarce.
"In those first few years we didn't quite know what to pull, what data to look at, or what protocols to get started," Kraemer said.
So everyone who came into a Kennedy emergency department with a fever, low blood pressure, or change in mental status went straight to the ICU. Today doctors diagnosis sepsis when any two of these conditions are present: respiratory rate greater than 22, systolic blood pressure (top number) of less than 100 (120 is normal), change in mental status.
As new national protocols were introduced, the staff turned its attention to getting faster urine and blood cultures and administering the right antibiotics.
"The clock is ticking because every minute you don't get this done the patient is getting sicker," Kraemer said.
Each year the ED staff got better at identifying sepsis, sending fewer patients to the ICU. So in 2014 the Sepsis on the Floors Task Force was created to figure out why patients became septic while hospitalized.
Chaired by Cindy Hou, the task force found that using fewer devices - catheters, IVs, central lines - "significantly reduced" infection rates and lowered in-house sepsis cases. The task force also convinced Kennedy's medical executive board to pass a policy allowing nurses who suspect their patient may be septic to order blood cultures without a doctor.
Education has been a key to the Kennedy's sepsis campaign. Everyone - from department chairs to nursing assistants - must attend a mandatory two-hour sepsis class.
"When we have gotten everybody, then we come back and we do it all over again," Kraemer said.
Long before the Sepsis Alliance award was announced Kennedy was fielding calls from hospitals in Maryland, Ohio and Alaska that had heard of Kennedy's success and wanted to know how to duplicate it.
"I believe the one key thing is perseverance with the team that is putting your program together, to stay with it," Kraemer said. "There were times in the beginning two years that we didn't know what we were looking for. It wasn't making sense but we stayed with it."
Seven months after teetering between life and death Berger is fully recovered.
"If it wasn't for these doctors and nurses ..." he said, leaving the rest of the sentence unspoken.
"I can't thank them enough."