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Spotting sepsis early saves lives

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Children are particularly at risk of developing se Children are particularly at risk of developing sepsis and their symptoms are easily missed

Many conditions can be prevented or can reduce the risk of long-term harm if caught early. One of these conditions is sepsis. Yet, most healthcare professionals believe that sepsis is a condition most common in secondary care. However, if the symptoms of sepsis are spotted early by primary care healthcare professionals, sepsis can be treated by an antibiotic with no further risk to the individual.

It is estimated that every year in the UK around 100,000 people are admitted to hospital with sepsis, and that around 37,000 of those will die.1 Around 1000 cases occur in children under five years old.1

It is the most common reason for admission to intensive care units in England and a more common reason for hospital admission than heart attacks.1

The All Party Parliamentary Group on Sepsis says in its 2015/16 annual review that ‘due to the swift decline experienced by sufferers, early diagnosis and management is essential and can save thousands of lives while also reducing NHS costs and demand on facilities.’1

Health secretary Jeremy Hunt announced measures in January 2015 to encourage public and clinical awareness of sepsis. The aim was to make tackling sepsis as important as tackling Clostridium difficile and MRSA, rates of which have nearly halved since 2010.

The measures introduced by Mr Hunt included the launch of an electronic tool from this autumn to prompt GPs to check for the signs and symptoms of sepsis in reference to NICE guidelines; new NICE clinical guidelines on diagnosing and treating adults with sepsis – to be released in 2016; and a public awareness campaign by Public Health England on the signs and symptoms of sepsis.

Health Education England is also due to ensure that healthcare workers and trainees will receive training and education on sepsis.

The UK Sepsis Trust recently launched a toolkit aimed specifically at reducing children’s deaths. It also launched a screening tool for healthcare professionals.

Speaking at the launch, Mr Hunt said: ‘It is vital that we tackle this devastating condition which destroys the lives of hundreds of families each year. We’re already making good progress to improve diagnosis – but of course we want to go further. So I welcome this toolkit, which will help NHS staff spot the early signs of sepsis and act quickly with the right treatments, preventing children from needlessly losing their lives to this silent killer’.

World Sepsis Day on 13 September aimed to raise the awareness of the number of unnecessary deaths from sepsis.

What is sepsis?
Sepsis is a condition caused by the body’s immune response to a bacterial or fungal infection, which, if not dealt with quickly, can lead to organ damage, multi-organ failure, septic shock and death. It more commonly develops from infections that occur in the lungs, bowel, skin, soft tissues, and urinary tract, although it can also come from meningitis or other infections of the brain, liver infections or from indwelling devices such as catheters.

Primary care prevention
Sepsis is not just a secondary care condition and primary care professionals should be trained and educated to recognise the symptoms as early as possible. In 2006, a study demonstrated that each hour’s delay in administrating antibiotics to patients with septic shock was associated with a 7.6% greater risk of death.2

Cheryl Gillan MP, the chair of the All-Party Parliamentary Group on sepsis says that the emphasis must be placed on ensuring as many healthcare professionals are trained to recognise the signs of sepsis in the multidiscplinary team.

‘I think for me the nurse is often the first point of contact for sepsis patients and they provide that interface and monitoring of patients. I think for GP practices they need to be aware of what the signs are. I understand from healthcare professionals they need to be able to differentiate sepsis from flu, and earlier presentations to healthcare allows the earlier delivery of the basics of care, which reduces mortality. This is why it is important that healthcare professionals... in a GP practice... should suspect sepsis.’

Practice and community nurses can look out for the following symptoms: being confused or not responding, having difficulty breathing or rapid breathing, weakness, producing less urine than usual, low blood pressure, blotchy skin, racing heart beat, fever, chills and low body temperature.3

Patients most at risk are young children or the elderly, those who have conditions affecting the immune system, pregnant women, those who have just had surgery or those with a long-term condition. However, sepsis can affect anyone and should be considered when faced with a patient presenting with the symptoms above.

Mr Hunt’s campaign on reducing sepsis deaths was kick-started by the death of three-year-old Sam Morish in December 2010. Sam died from sepsis after a string of healthcare professionals failed to recognise Sam’s symptoms in time to administer effective treatment. Sam’s story highlights that early recognition is key in targeting sepsis.

Nicola Lythell, a sepsis specialist nurse at Great Western Hospitals NHS Foundation Trust, says that the Trust is committed to driving down sepsis deaths and currently 80% of its sepsis patients survive, in comparison to the national average of 65%.

‘My role in the Trust is to identify cases of sepsis as quickly as possible and to ensure that all staff are familiar with the Sepsis Six, a set of internationally recognised steps that should happen as soon as a patient shows signs of sepsis.

‘Sepsis can take hold incredibly quickly and, if it’s not treated rapidly, it can prove fatal.’

Ms Lythell regularly works with primary care professionals to ensure that they are able to recognise the symptoms of sepsis and are able to react quickly if they suspect sepsis by ensuring that all healthcare staff are aware of the Sepsis Six bundle.

Ms Lythell also believes that nurses in nursing homes should receive training on sepsis as those over the age of 65 are at a higher risk of developing it, particularly if they have pre-existing health conditions.

The focus on sepsis is part of the Great Western Hospitals NHS Foundation Trust’s 500 Lives campaign, which aims to save 500 lives in the next five years, through providing safe, high-quality care and treatment.

Box 1: Sepsis Six care bundle
Management of sepsis after admission to hospital is popularly known as the ‘Sepsis Six’ bundle. This involves six elements, three treatments and three tests, which should be initiated by the medical team within an hour of diagnosis.

Treatments:

  • Giving antibiotics.
  • Giving fluids intravenously.
  • Giving oxygen if levels are low.

Tests:

  • Taking blood cultures to identify the type of bacteria causing sepsis.
  • Taking a blood sample to assess the severity of sepsis.
  • Monitoring your urine output to assess severity and kidney function.

Reference: http://www.nhs.uk

Conflicting messages?

However, some healthcare professionals may feel that the messages around early intervention in sepsis prevention and the separate campaign on reducing antimicrobial resistance contradict each other by minimising antibiotic prescribing.

Ms Gillan says: ‘We need to ensure that the sepsis message and that for tackling antimicrobial resistance is not confused, because the messaging around sepsis and antimicrobial resistance is entirely complementary. Some think that this emphasis on not giving antibiotics is where we are going but in this particular aspect part of healthcare, antibiotics are a very effective and central intervention,’ she says.

Research identifies and corroborates the idea that sepsis is largely preventable if spotted early and this is where primary care nurses can play a role. Being up to date with sepsis signs and symptoms can help nurses contribute to lowering the annual number of sepsis deaths and cutting the cost of this condition to the NHS. IN

Resources
1. http://sepsistrust.org/clinical-toolkit/

References
1. The All Party Parliamentary Group on Sepsis. Annual review. 2015/16

2. Kumar A, Roberts D, Wood KE et al. Duration of hypotension prior to initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine 2006; 34: 1589–96

3. Gemma Ellis. Spotting sepsis as early as possible can save lives. Independent Nurse. February 2014.

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