When people suffer from sepsis, the body’s immune system goes into overdrive, setting off a series of reactions including widespread inflammation, swelling and blood clotting. This can lead to a significant decrease in blood pressure, which can in turn reduce the blood supply to vital organs, starving them of oxygen. If not treated quickly, sepsis can lead to multiple organ failure and death.
The early treatment of sepsis is not complicated or expensive, involving IV antibiotics along with IV fluids and supplemental oxygen where appropriate.
Sepsis can affect people of any age; it is most common in the elderly and the very young. For some people – such as older people with advanced frailty or dementia – sepsis is a common and sometimes unpreventable cause of death.
The chances of neonatal sepsis occurring are increased by premature birth, rupture of the mother’s membranes more than 24 hours before delivery, by the mother having Group B Streptococcus (GBS) infection whilst pregnant, having a previous baby with GBS, and maternal fever.
There is a lack of reliable estimates of incidence and prevalence of sepsis, due to a lack of consistency of definitions used to describe sepsis and due to differences in coding practice between professionals and organisations, although various studies have taken place to define this. The following estimates are based on nationally available data:
- In 2017/18 186,000 hospital admissions were for people with a primary diagnosis of sepsis (Source: HES).
In 2015, 23,135 people died from sepsis, where sepsis was an underlying or contributory cause of death (Source: ONS).
Since 2012, a lot of new material and information has been published about sepsis therefore the public and healthcare professionals are more aware; this has led to an increase in the number of people identified and diagnosed with sepsis.
NEWS provides a mechanism to assess physiological parameters in acutely ill patients, including those with suspected sepsis, and helps to identify deterioration.
The UK Sepsis Trust developed the ‘Sepsis Six’ – a set of six tasks including oxygen, cultures, antibiotics, fluids, lactate measurement and urine output monitoring- to be instituted within one hour by non-specialist practitioners at the frontline. The Sepsis Six Care Bundle as a whole has been shown to reduce the relative risk of death by 46.6 per cent when delivered to patients with severe sepsis within one hour.
Safety netting is where a patient with an infection has been clinically assessed and thought not to have sepsis but the patient/carer is given information on what to look out for that should prompt them to seek further clinical assessment.
GP software providers have been asked to include sepsis safety netting resources that GPs can pass on to patients/carers, especially the parents of children with infections.
Sepsis is treated with antibiotics. However, antibiotic resistance (a term called antimicrobial resistance or AMR) now poses a significant threat to the delivery of healthcare. It is therefore imperative to ensure that principles of good antimicrobial stewardship and appropriate use of antibiotics are built into all activities, communication, training and actions relating to the treatment of sepsis.
NICE guidance on sepsis was published in 2016. It provides an evidence-based approach to recognising and initiating treatment for suspected sepsis. However, some frontline staff found it complex and difficult to translate the guidance into practice and this was reflected in a survey by the National Patient Safety Collaborative Sepsis Cluster.
To address this issue, NHS England (on behalf of the Cross-System Sepsis Board), brought together experts to develop practical implementation advice on the NICE sepsis guidance. NICE supports the implementation advice guidance as a pragmatic approach that recognises clinical judgement as a critical component of the assessment for sepsis.
NHS England brought together a group of experts from across the health and care landscape including the Royal Colleges, patients and expert clinicians to advise on actions needed to drive improvement in the identification and treatment of sepsis.
The over-arching purpose is to improve the prevention, early diagnosis and prompt treatment of sepsis in order to reduce the mortality and morbidity that it causes.
There is currently no single Paediatric Early Warning Score (PEWS). A National PEWS board for England has been established, led by Royal Colleague of Paediatric and Child Health and supported by NHS England and NHS Improvement to define a single PEWS.