There is a lot we still don’t know about sepsis and severe infection, most particularly the lack of robust data on its incidence and outcomes. Whichever way you cut the existing data, however, sepsis is a huge problem. We have prepared below some responses to frequently asked questions to help you understand our mission, our values and our strategy for effecting change responsibly.

My agency doesn’t have a sepsis pathway or uses an outdated one – what should I do? Answer

With multiple agencies, including the World Health Organisation, recognising that the rapid identification and management of sepsis is a public health priority, every healthcare provider organisation should have a policy and/or pathway on sepsis.

If yours doesn’t have one, or uses an outdated version (e.g. the SIRS criteria), why not lead its implementation or development? Identify the right people to speak to – typically safety or governance leads, or clinical champions.

Organise a meeting, download the relevant tool for your clinical area from our tools page, and off you go.

If you come up against barriers, get in touch. We might be able to help.

If we keep pushing rapid treatment of sepsis, won’t we see an increase in antibiotic usage? Answer

The evidence suggests otherwise. Since NHS England introduced its CQuIN commissioning incentive to improve screening and antibiotic delivery for patients with sepsis across hospitals in April 2016, overall antibiotic consumption has remained steady and usage of very broad spectrum agents such as carbapenems has reduced by nearly 10%.

The good news is that antibiotics are being given earlier – mostly in Emergency Departments. We are getting better at managing sepsis!

How did Red Flag arise? Answer

Red Flag Sepsis was developed by the UK Sepsis Trust in 2015. It is a practical, operational tool that empowers frontline health professionals to act without the need to apply the complex formal international definition of sepsis.

Based on the National Early Warning Score (NEWS), together with other parameters known to represent high risk in patients with sepsis, Red Flag Sepsis has since been supported by The National Institute for Health and Care Excellence (NICE).

We recommend that any patient who looks unwell, or who is triggering on the NEWS-2 score (Royal College of Physicians 2018), be screened for sepsis. If there is clinical suspicion of infection, then the presence of one or more Red Flags should be evaluated. If a Red Flag is identified, the Sepsis Six pathway should be started immediately.

What about the sepsis-3 definition? Should we be using that? Answer

There are three good things about the sepsis-3 definition:

  1. The narrative: that sepsis is a life-threatening condition arising when the body’s dysregulated response to infection causes organ dysfunction. This has removed the old ambiguity about describing patients with some systemic signs, but who were relatively well, as having ‘sepsis’.
  2. The new ‘official’ definition of organ dysfunction, using a change in SOFA (Sepsis-associated Organ Failure Assessment Score).
  3. Dropping SIRS (the Systemic Inflammatory Response Syndrome) from the definition of SEPSIS – SIRS was over-sensitive and poorly specific.

So yes, use the narrative* and let’s not use SIRS to diagnose SEPSIS!

If you’re a researcher, a change in SOFA score is the most appropriate way to ensure you’re recruiting the right patients. But at the bedside, we need something simpler – we use Red Flag sepsis as an empowering surrogate.

I’ve heard of qSOFA. Why isn’t the UK Sepsis Trust recommending we use that? Answer

There is nothing wrong with qSOFA, the ‘bedside’ test proposed by the International Consensus Definitions Task Force. It is based on some evidence, albeit via a retrospective analysis of a large dataset, but is not prospectively validated.

It’s important to note that the Task Force did NOT propose qSOFA as either a treatment prompt or as a diagnostic tool – it was an identifier of patients in whom to look for sepsis.

Because we already use NEWS in the UK, and because it has since been shown to be as useful as qSOFA, we feel we should stick with what we know. We didn’t want our healthcare assistants, nurses, midwives and doctors to be asked to measure general risk using one scoring system, and then sepsis risk with another using different thresholds!

If your organisation uses electronic observations, it’s perfectly appropriate for qSOFA to be added as a second tool to identify risk. If you can’t automate it, though, both we and NICE suggest you stick with NEWS.

How did the Sepsis Six arise? What’s the evidence behind it? Answer

We developed the Sepsis Six in 2005 as a bedside tool to help (often junior) health professionals deliver the basics of care rapidly and reliably.

It was drawn from the international guidelines developed by the ‘Surviving Sepsis’ Campaign, but we recognised that a 16 page document containing 58 individual guidelines was unlikely to transform practice.

We set about developing the Sepsis Six as an operational solution. In 2011, we published evidence showing it to be associated with a 50% reduction in mortality – findings which others have since replicated.

Why does the Sepsis Six work? Because it’s simple. It’s memorable, it’s evidence-based and it empowers all staff to act. For these reasons, the Sepsis Six is now being used in 30 countries around the world.