Clinical update: Sepsis
Clinical update on new NICE guidline on sepsis
Sepsis, a clinical syndrome caused by the body's immune and coagulation systems being switched on by an infection, is believed to cause about 44,000 deaths a year. If not recognised early and treated promptly, sepsis can lead to shock, multiple organ failure and death. Major reports (UK Parliamentary and Health Service Ombudsman enquiry in 2013 and the UK National Confidential Enquiry into Patient Outcome and Death in 2015) have highlighted sepsis as being a leading cause of avoidable death that kills more people than breast, bowel and prostate cancer combined.
All healthcare professionals should treat suspected sepsis with the same urgency as a suspected heart attack, according to the National Institute for Health and Care Excellence (NICE). In the first national evidence-based guideline of its kind, NICE says health professionals need to think about the possibility of sepsis in all patients who may have an infection. People at high risk of severe illness from sepsis in primary care should be referred by ambulance to hospital. Once in hospital they should be seen by a senior doctor or nurse straightaway who can start treatment.
Altered mental state, raised respiratory and heart rate, low blood pressure, reduced urine output, a mottled or ashen appearance, non-blanching rash of skin, cyanosis of skin, lips and tongue and signs of potential infection, such as redness or swelling, can all be symptoms of sepsis. A patient may have a low or high temperature. Symptoms can be non-specific and easily missed. Healthcare professionals should refer to the NICE guidance when assessing each person’s risk based on their symptoms, age and where they are being treated.
Babies under the age of one and people over the age of 75 are at higher risk. People who are very frail, have impaired immune systems or immune function, treated for cancer with chemotherapy, take long-term steroids or immunosuppressant drugs are also at higher risk. Risk is increased in those who have had surgery or invasive procedures in the last six weeks, misuse intravenous drugs or have indwelling lines or catheters. Women who are pregnant or have given birth or had a termination or miscarriage in the last six weeks are at higher risk.
How you can help your patient
Think ‘could this be sepsis?’ if a patient presents with the signs or symptoms of an infection. Take into account that people with sepsis may have non-specific, non-localised presentations, for example feeling very unwell, and may not have a high temperature. Pay particular attention to concerns expressed by the person, family or carers for changes from usual behaviour. Treat sepsis as an immediate life-threatening condition that should be recognised and treated as an emergency.
Julian Newell, corporate matron at Sherwood Forest Hospital NHS Trust and a member of the committee developing the NICE guidance.
‘All nurses should know that early recognition is absolutely fundamental in the successful treatment of sepsis, which is a life threatening condition. Previous reports have shown us that many frontline staff fail to recognise the signs of sepsis, and it can have devastating consequences for the patient. The understanding of the condition has improved a lot over the last 15 years, and this new guidance is an important step as it brings together the international evidence. It has set out all the signs and symptoms into a traffic light system so that healthcare staff can see if a patient is at high risk of sepsis shock.
'Nurses in the community and primary care who see a patient at high risk should call 999 for an ambulance. The challenge for employers is to make sure that the sepsis pathway enables nurses to escalate patients quickly.’
Find out more
- Neutropenic sepsis: prevention, identification and treatment. Warnock C, Nursing Standard (April 2016) journals.rcni.com/doi/10.7748/ns.30.35.51.s48
- Improving the management and care of people with sepsis. Fitzpatrick D, McKenna M, Rooney K, Beckett D, Pringle N. Emergency Nurse (February 2014) journals.rcni.com/doi/pdfplus/10.7748/en2014.04.22.1.18.e1294
- A mother’s instinct. McNamara G. Nursing Standard (February 2016) journals.rcni.com/doi/abs/10.7748/ns.30.25.26.s25