Copyright 2019 - Clinical Commissioning Groups Association

Sepsis: the hidden killer you need to know - Sepsis Trust

CareSepsis is a reaction to infection in which the body attacks its own organs and tissues.

It can arise in response to any infection, but most typically a bacterial infection of the lungs, urinary tract, skin/soft tissues (arising from a bite, cut or sting or from cellulitis) or abdomen (such as a perforated bowel). If not spotted and treated quickly, sepsis can rapidly lead to organ failure and death.

The human and economic cost

Sepsis is an indiscriminate condition, claiming young and old lives alike and affecting the previously fit and healthy. Approximately six million deaths are caused by sepsis worldwide every year, but many of those could be saved by increased public awareness, education for healthcare professionals and other basic care provisions.

New data from a study commissioned by the UK Sepsis Trust and carried out by the independent York Health Economics Consortium (YHEC) has found that there are likely to be at least 260,000 cases of sepsis annually in the UK – over 100,000 more than initial projections suggested.

According to the report, the cost of sepsis is likely to be £15.6 billion every year for the UK economy, rather than the £2.5 billion previously estimated. However, government intervention to improve access to healthcare and reliability of basic care could make a huge impact, saving thousands of lives and reducing the economic burden by as much as £2.8 billion (largely through minimising indirect costs incurred by lost productivity).

Improving care in the UK

The new National Institute for Health and Care Excellence (NICE) sepsis guideline (nice.org.uk/guidance/ng51) – published this July and building on care recommendations developed by the UK Sepsis Trust – provides best practice guidance for healthcare professionals confronted with potential cases of sepsis.

The guideline advises that sepsis be considered in any patient with an infection and that the condition should be treated with the same urgency as a possible myocardial infarction. It describes the signs and symptoms that clinicians should check for, dividing these into high and moderate risk criteria and delineating where the person should be treated. It further advises which tests to use in diagnosing sepsis and monitoring response to therapy.

If someone is identified in the community as being high-risk, NICE says they should be admitted to hospital urgently by ambulance. Once in hospital they should be seen by a senior doctor or nurse straight away so that treatment may be commenced. The guideline also advocates responsible use of antibiotics. Antibiotics should only be given to the sickest people: those who meet the high-risk criteria set out in the guideline, or alternatively those with a particular combination of moderate risk criteria. The UK Sepsis Trust screening tools encapsulate both patient groups under the term ‘red flag sepsis’: those patients warranting urgent intervention.

If the patient has a suspected infection and their physiology suggests that there may be complications developing, the UK Sepsis Trust screening tools work well in conjunction with the NICE guidelines to identify patients with red flag sepsis. It is important to listen to the patient and their relatives: health professionals will ignore phrases like “I’ve never seen him this ill” or “I feel like I’m going to die” at their peril.
NICE, the UK Sepsis Trust and the international Surviving Sepsis Campaign all recommend the delivery of a set of basic care elements for patients within the first hour – in the UK and in many other countries these are described by the Trust’s ‘Sepsis Six’ care bundle.

The Sepsis Six is a set of interventions which can be delivered by any junior healthcare professional working as part of a team – all it requires is a qualified
prescriber and basic healthcare equipment. Executing these six steps in the first hour following a patient’s presentation with sepsis will double the patient’s chance of survival.

Most patients will begin to improve rapidly once the Sepsis Six is delivered in a timely fashion. For those who don’t, or who continue to deteriorate, early contact with seniors and with critical care is of paramount importance: patients with sepsis have a 30 per cent risk of death so nothing should be left to chance.

Start the clock ticking following presentation: it is not acceptable to start the clock ticking on first identifying red flag sepsis; rather it should be when having first identified the condition. For emergency departments and acute medical units, this might be at triage, but for inpatient facilities we should acknowledge that even in acute trusts, guidelines mandate observations only every 12 hours in otherwise stable patients.

For 2016/17 and into the next financial year, NHS England has (via commissioners) put in place a national lever to drive improvement in hospitals, requiring that they screen for sepsis and deliver antimicrobials promptly. The Royal College of General Practitioners has developed a sepsis toolkit, NHS England has issued a Safety Alert, and Health Education England has developed a suite of resources. These all aim to increase the awareness of the condition and its treatment.

With increasing levels of public awareness, and following the Parliamentary and Health Service Ombudsman’s report of 2013, complaints around sepsis are on the rise. Guidelines will give way to a NICE Quality Standard in 2017 which will make deviation from accepted protocol harder to defend.

It is crucial that healthcare professionals can show that reasonable steps were taken to identify sepsis, and to assess and investigate the symptoms. Organisations are expected to demonstrate that systems are in place to facilitate recognition and intervention.

Improving care globally

The World Health Organisation has adopted a resolution on sepsis which makes the condition a global priority for policy makers and healthcare authorities.

As part of the Global Sepsis Alliance (GSA) Executive Committee, Dr Ron Daniels BEM, CEO of UKST, helped to gather information from clinicians and families in over 70 countries, initiating a sepsis resolution which was unanimously recommended by the WHO’s Executive Board and adopted at the 70th World Health Assembly in Geneva.

The resolution means WHO Director-General Dr Margaret Chan will draw attention to the public health impact of sepsis, and it urges all 194 United Nations member states to develop action plans to help save lives and improve outcomes for survivors of sepsis in developed and developing countries.

The WHO has dedicated $4.6 million USD of its budget to implementing the resolution’s recommendations, which include the effective use of antimicrobials, the introduction of affordable vaccines, treating sepsis as an emergency, providing suitable services for survivors, communicating with patients and relatives using the term ‘sepsis’ to improve public awareness and engaging in advocacy efforts, including those centred around World Sepsis Day (13th September).

Dr Ron Daniels commented: “The adoption of this sepsis resolution is a crucial step in the right direction for countries all over the world who urgently require focus and resources to reclaim the millions of lives lost unnecessarily to sepsis each year.”

Sepsis Trust 

For more information please contact

UK Sepsis Trust, 2nd Floor,
36 Bennetts Hill
Birmingham, B2 5SN
0800 389 6255
sepsistrust.org

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