Professor Saul Faust, of the University of Southampton and University Hospital Southampton NHS Foundation Trust, chaired the group that developed the new guideline for the National Institute for Health and Care Excellence (NICE).
The national evidence-based guideline is the first of its kind and says health professionals need to think about the possibility of sepsis in all patients who may have an infection.
Professor Faust said:
“Anyone can succumb to sepsis. It can come on as the result of a minor injury or infection that the body is trying to recover from and the immune system goes into overdrive.
Sepsis can be difficult to diagnose with certainty. We want clinicians to start asking ‘could this be sepsis?’ much earlier on so they can rule it out or get people the treatment they need. The thinking should be similar to considering that chest pain could be heart related. Just like most people with chest pain are not having a heart attack, the majority of people with an infection will not have sepsis. But if it isn’t considered then the diagnosis can be missed.”
According to the UK Sepsis Trust there are around 150,000 cases of sepsis in the UK each year, which causes around 44,000 deaths.
Sepsis is a life-threatening condition that occurs when the body’s response to infection injures its own tissues and organs. Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion.
There may also be symptoms related to a specific infection, such as a cough with pneumonia, or painful urination with a kidney infection. In the very young, old, and people with a weakened immune system, there may be no symptoms of a specific infection and the body temperature may be low or normal rather than high.
Severe sepsis is sepsis causing poor organ function or insufficient blood flow. Insufficient blood flow may be evident by low blood pressure, high blood lactate, or low urine output.
Septic shock is low blood pressure due to sepsis that does not improve after reasonable amounts of intravenous fluids are given.
The NICE guideline includes recommendations to help health professionals working in any NHS setting recognise sepsis as soon as possible. Signs and symptoms are presented in clear tables to help clinicians assess each person’s risk based on their age and where they are being treated.
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.
Professor Mark Baker, director of the NICE Centre for Guidelines said:
“Once identified, sepsis can be treated very quickly and people are more likely to make a full recovery. We know that when hospitals are well prepared, clinicians do better at responding to patients with sepsis. However recent reports have revealed that many hospitals have no formal protocols for recognising and responding to sepsis.
If there is any delay in spotting the signs we will fail patients by leaving them with debilitating problems, or in the worst cases people will die. This guideline will be the first to provide advice based on the best available evidence on how to quickly identify and treat people with sepsis.”
The UK Sepsis Trust worked with NICE to update its range of clinical toolkits in line with the NICE guideline.
Sepsis: recognition, diagnosis and early management
NICE guidelines NG51
Published date: July 2016
Image: Thierry Geoffroy, CC BY-SA 3.0