PATIENT SAFETY
Sepsis: a hidden healthcare problem
Dr RON DANIELS argues that the NHS needs to focus on delivering a higher standard of care for patients with sepsis. He also highlights the need for more education and a greater awareness of the syndrome and its early symptoms, among health workers and at Trust level.
Sepsis is a syndrome which most health workers have heard of, but which few can describe accurately. It is characterised by an overwhelming inflammatory response secondary to an infection, most commonly arising in the lungs, abdomen or soft tissues, which unchecked will lead to organ dysfunction and death. The term represents a spectrum of disease, from ‘uncomplicated’ sepsis wherein a systemic inflammatory response is triggered by a new infection, through the development of one or more organ dysfunctions as a result of the inflammatory response (termed severe sepsis) through to the greatest severity disease present when multi-organ failure, and/or the subset of severe sepsis characterised by septic shock, ensue. It has only been 21 years since
consensus was reached as to what defines sepsis.1,2
Thus, as a disease entity
amenable to clinical research and improvement, it is relatively new, and the lack of awareness is understandable. It is not yet clearly understood whether all cases of sepsis will proceed to severe sepsis if unchecked, and there is some evidence that septic shock is triggered by differing pathways. But it is logical (and based on significant evidence) that early recognition and intervention will improve outcomes. Addressing this is of vital importance – patients with severe sepsis have an associated mortality of between 20% and 30% and represent the population at greatest risk of unchecked deterioration in our hospitals. Sepsis is a major killer in the UK. The incidence of severe sepsis (sepsis-induced
MARCH 2012
organ dysfunction) in the EU has been estimated at 90.4 cases per 100,000 population, as opposed to 58 per 100,000 for breast cancer,3
and some estimates are
far higher.4,5 Data from the Intensive Care demonstrated that
National Audit and Research Centre (ICNARC) in 20056
over 8,300 intensive care patients died from severe sepsis in a six month period, though not all ICUs contributed data and only Level 3 patients were included (many patients are not treated in Level 3 facilities.)7
The 37,000 annual deaths we
estimate to occur means that sepsis is likely to claim more lives than lung cancer, and more lives than breast, bowel and prostate cancers combined. The mean current risk of death for patients admitted to ITU with severe sepsis, according to
ICNARC data, is around 32%. Shockingly, we appear to accept chaotic performance in delivery of care to these patients who are among our most seriously ill. The NHS is failing patients with
sepsis, a situation it shares with the majority of developed health systems. International standards published in 2004 (revised in 2008, and about to undergo a further revision) by the Surviving Sepsis Campaign8,9
were distilled into two care
bundles in collaboration with the Institute for Healthcare Improvement. These bundles, and the guidelines they represent, were adopted by over 20
‘Sepsis is likely to claim more lives than lung cancer, and more lives than breast, bowel and prostate cancers combined.’
Dr Ron Daniels. THE CLINICAL SERVICES JOURNAL 45
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