CLINICAL RISK REDUCTION Sepsis
Dr Ron Daniels of the UK Sepsis Trust highlights the importance of improved diagnosis and management in this oſt-missed condition
S
EPSIS 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/soſt 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. Every year in the UK 150,000 people are affected by sepsis; 44,000 die as a result and 26,500 (a quarter of all survivors) suffer permanent, life-changing injury. It’s an indiscriminate condition, claiming young and old alike
and affecting the previously fit and healthy. It is more common than myocardial infarction and kills more people than bowel, breast and prostate cancer and road accidents combined. Misdiagnosis and delayed treatment (followed by rapid deterioration) are at the centre of most poor outcomes or fatalities. Earlier identification and treatment across the UK would save 14,000 lives and result in 400,000 fewer days in hospital for patients every year, which alone would save the NHS over £314 million per annum. A report published last year by the National Confidential
Enquiry into Patient Outcome and Death (access at
tinyurl.com/ owh24qs) revealed that in over a third (36 per cent) of cases there were delays in identifying sepsis. Te report also found that many hospitals had no formal protocols in place to recognise sepsis.
Diagnosis Te 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. Te 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.
16 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. Te 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. Te UK Sepsis Trust screening tools (
sepsistrust.org/clinical-toolkit/) encapsulate both patient groups under the term ‘red flag sepsis’: those patients warranting urgent intervention.
Management 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
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