Clinical

What is sepsis?

Sepsis is when the body’s response to infection injures its own tissues and organs. It is a life-threatening condition arising when the body’s abnormal, or ‘dysregulated’, immune response to an infection causes organs to start failing.

Sepsis can be triggered by any infection, but most commonly it occurs in response to bacterial infections of the lungs, urinary tract, abdominal organs or skin and soft tissues.

Caught early, outcomes are excellent. Left unchecked, the patient is likely to spiral to multi-organ failure, septic shock and death. It’s estimated that, every year, sepsis costs the NHS £2 billion and claims the lives of at least 44,000 people.

How can health care professionals help?

The solution to sepsis is teamwork. Few conditions have such an ability to affect any patient, presenting to any facet of healthcare. If we’re to save lives, everyone needs to know their role. Spotting sepsis requires vigilance, robust systems such as NEWS, and excellent pathways of communication and response.

How to spot sepsis

Sepsis is a serious condition that can initially look like flu, gastroenteritis or a chest infection. If left untreated, it can lead to shock, multi-organ failure and death.
Think sepsis if the patient:

  • Is triggering an early warning score
  • Looks ill (to a health professional or an unusually concerned relative)
  • Has any signs of infection

The National Early Warning Score (NEWS) has been shown to identify patients at risk of deterioration. In the context of infection, a NEWS >5 should always prompt a screen for sepsis, including an immediate check for any Red Flags.

It’s vital we listen to patients and their relatives. If a relative says ‘he’s never been this unwell before’, he hasn’t.

SEPSIS RED FLAGS

  • Responds only to voice or pain / unresponsive
  • Acute confusional state
  • Systolic B.P ≤ 90 mmHg (or drop > 40 from normal)
  • Heart rate > 130 per minute
  • Respiratory rate ≥ 25 per minute
  • Needs oxygen to keep SpO2 ≥ 92%
  • Non-blanching rash, mottled / ashen / cyanotic
  • Not passed urine in last 18 h / UO <0.5 ml / kg / hr
  • Lactate ≥ 2 mmol / l
  • Recent chemotherapy

The Sepsis Six

To manage sepsis, it’s become clear that a rapid response, managing the patient using the basics of care and escalating when the patient doesn’t respond, is more effective than any complex pathway.

The Sepsis Six was developed by founders of the UK Sepsis Trust in 2005 as an operational solution to a set of complex yet robust guidelines developed by the International Surviving Sepsis Campaign.

  1. GIVE 02 TO KEEPS SATS ABOVE 94%
  2. TAKE BLOOD CULTURES
  3. GIVE IV ANTIBIOTICS
  4. GIVE A FLUID CHALLENGE
  5. MEASURE LACTATE
  6. MEASURE URINE OUTPUT

Guidelines, definitions and practical solutions

The last five years have seen significant changes to the international definitions of sepsis, and to our understanding of what works (and what doesn’t) in managing the condition. Though definitions and guidelines will continue to change as our scientific knowledge improves, with the launch of the NICE Guideline NG51 (supported by UKST) in 2016 we can look forward to a period of clarity and stability.

NICE broadly supported the use of UKST’s operational solution, The Sepsis Six, to an ‘official’ definition which uses ‘Red Flags’, based upon observations we already take at the bedside, to trigger an intervention.

OUT OF HOURS (OOH)/ TELEPHONE TRIAGE

SCREENING AND ACTION TOOL FOR UNDER-5S Open

Use these tools for OOH and telephone triage for all children aged 0-4.

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SCREENING AND ACTION TOOL FOR CHILDREN AGED 5-11 Open

Use these tools for OOH and telephone triage for all children aged 5 to 11.

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SCREENING AND ACTION TOOL FOR ADULTS AND CHILDREN AND YOUNG PEOPLE 12 YEARS AND OVER Open

Use these tools for OOH and telephone triage for all patients aged 12 and over.

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SCREENING AND ACTION TOOL FOR USE IN PREGNANCY Open

Use these tools for OOH and telephone triage for all women who are pregnant, or who have given birth in the last 6 weeks.

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NARRATIVE TOOLKIT Open

Developed with Integrated Care 24 (IC24), this document describes how to identify warning signs remotely including a helpful workbook for staff, and sets out a blueprint for excellence in sepsis care.

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Thank you to Dr Maria Karretti, Associate Medical Director at IC24 who helped to produce these toolkits.

COMMUNITY SERVICES

SCREENING AND ACTION TOOL FOR COMMUNITY CARERS Open

This tool is designed for carers of adults in the community who are not formally trained as health professionals.

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SCREENING AND ACTION TOOL FOR COMMUNITY NURSES Open

This tool is for use by Community Nurses caring for adults.

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SCREENING AND ACTION TOOL FOR COMMUNITY MIDWIVES Open

This tool is for use by Community Midwives caring for patients during pregnancy or who are within 6 weeks after giving birth.

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GENERAL PRACTICE

SCREENING AND ACTION TOOL FOR UNDER-5S Open

Use these tools in general practice for all children aged 0-4.

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SCREENING AND ACTION TOOL FOR CHILDREN AGED 5-11 Open

Use these tools in general practice for all children aged 5 to 11.

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SCREENING AND ACTION TOOL FOR ADULTS AND CHILDREN AND YOUNG PEOPLE 12 YEARS AND OVER Open

Use these tools in general practice for all patients aged 12 and over.

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SCREENING AND ACTION TOOL FOR USE IN PREGNANCY Open

Use these tools in general practice for all women who are pregnant, or who have given birth in the last 6 weeks.

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NARRATIVE TOOLKIT Open

Developed with representatives of the RCGP, this document describes the origin of Red Flag Sepsis and the Sepsis Six, and sets out a blueprint for excellence in sepsis care.

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PREHOSPITAL CARE/ AMBULANCE SERVICES

SCREENING AND ACTION TOOL FOR UNDER-5S Open

Use this tool in the prehospital environment for all children aged 0-4.

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SCREENING AND ACTION TOOL FOR CHILDREN AGED 5-11 Open

Use this tool in the prehospital environment for all children aged 5 to 11.

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SCREENING AND ACTION TOOL FOR ADULTS AND CHILDREN AND YOUNG PEOPLE 12 YEARS AND OVER Open

Use this tool in the prehospital environment for all patients aged 12 and over.

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SCREENING AND ACTION TOOL FOR USE IN PREGNANCY Open

Use this tool in the prehospital environment for all women who are pregnant, or who have given birth in the last 6 weeks.

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NARRATIVE TOOLKIT Open

Developed with the College of Paramedics, this document describes the origin of Red Flag sepsis and the Sepsis Six, and sets out a blueprint for excellence in sepsis care.

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EMERGENCY MEDICINE AND ACUTE MEDICAL UNITS

SCREENING AND ACTION TOOL FOR UNDER-5S Open

Use this tool at access points to acute hospitals for all children aged 0-4.

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SCREENING AND ACTION TOOL FOR CHILDREN AGED 5-11 Open

Use this tool at access points to acute hospitals for all children aged 5 to 11.

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SCREENING AND ACTION TOOL FOR ADULTS AND CHILDREN AND YOUNG PEOPLE 12 YEARS AND OVER Open

Use this tool at access points to acute hospitals for all patients aged 12 and over.

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SCREENING AND ACTION TOOL FOR USE IN PREGNANCY Open

Use this tool at access points to acute hospitals for all women who are pregnant, or who have given birth in the last 6 weeks.

Download pdf
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NARRATIVE TOOLKIT Open

Developed in 2015 with the Royal College of Emergency Medicine, this document describes the origin of Red Flag sepsis and the Sepsis Six, and sets out a blueprint for excellence in sepsis care.

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ACUTE HOSPITAL INPATIENTS

SCREENING AND ACTION TOOL FOR UNDER-5S Open

Use this tool for all children aged 0-4 who are inpatients in an acute hospital.

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SCREENING AND ACTION TOOL FOR CHILDREN AGED 5-11 Open

Use this tool for all children aged 5-11 who are inpatients in an acute hospital.

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SCREENING AND ACTION TOOL FOR ADULTS AND CHILDREN AND YOUNG PEOPLE 12 YEARS AND OVER Open

Use this tool for all patients aged 12 and over who are inpatients in an acute hospital.

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Close
SCREENING AND ACTION TOOL FOR USE IN PREGNANCY Open

Use this tool for all women who are pregnant, or who have given birth in the last 6 weeks, who are inpatients in an acute hospital.

Download pdf
Close
NARRATIVE TOOLKIT Open

Developed in 2015 with the Royal College of Physicians, this document describes the origin of Red Flag sepsis and the Sepsis Six, and sets out a blueprint for excellence in sepsis care.

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LABORATORY SERVICES

BLOOD CULTURES TOOLKIT Open

Describes excellence in access to laboratory services, and in the transport, handling and reporting of microbiology results.

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DENTAL SERVICES

DECISION SUPPORT TOOL FOR PRIMARY DENTAL CARE FOR CHILDREN AND YOUNG PEOPLE AGED UNDER 5 Open

Use this tool for all children aged 0-4 who are assessed in a Primary Care setting by a Dental Practitioner.

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DECISION SUPPORT TOOL FOR PRIMARY DENTAL CARE FOR CHILDREN AND YOUNG PEOPLE AGED 5-11 Open

Use this tool for all children aged 5-11 who are assessed in a primary care setting by a dental practitioner.

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DECISION SUPPORT TOOL FOR PRIMARY DENTAL CARE FOR ADULTS AND CHILDREN AND YOUNG PEOPLE 12 YEARS AND OVER Open

Use this tool for all patients aged 12 and over who are assessed in a primary care setting by a dental practitioner.

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