Dr. Ron Daniels
CEO and Founder
The UK Sepsis Trust
The UK Sepsis Trust estimates that sepsis may kill as many as six million people globally each year. We know that sepsis goes unrecognised by members of the public, and that they present to healthcare too late as a result. We also know that healthcare professionals could be better educated, so that sepsis diagnoses can be made more quickly, and treatment administered as fast as possible, because earlier identification and treatment could prevent many of the millions of unnecessary deaths every year.
What is sepsis?
Sepsis is a reaction to infection in which the body attacks its own organs and tissues. It can arise in response to any infection, but most typically a bacterial infection of the lungs, urinary tract, skin/soft tissues (arising from a bite, cut or sting or from cellulitis) or abdomen (such as a perforated bowel). If not spotted and treated quickly, sepsis can rapidly lead to organ failure and death.
Sepsis and UTIs
Once bacteria are present in the bladder, there's a significant risk of a Urinary Tract Infection (UTI) developing. Sepsis caused by a UTI is often termed 'urosepsis'. Considering that around 20-30% of episodes of sepsis are secondary to UTIs, people who have undergone the Mitrofanoff procedure should be vigilant for sepsis symptoms. Increasing the frequency of catheterisation and bladder washouts can help prevent UTIs. As always, if you think you have a UTI seek medical help.
The human and economic cost
Sepsis is an indiscriminate condition, claiming young and old lives alike and affecting the previously fit and healthy. Approximately six million deaths are caused by sepsis worldwide every year, but many of those could be saved by increased public awareness, education for healthcare professionals and other basic care provisions.
Data from a recent study commissioned by the UK Sepsis Trust and carried out by the independent York Health Economics Consortium (YHEC) has found that there are likely to be at least 260,000 cases of sepsis annually in the UK – over 100,000 more than initial projections suggested.
According to the report, the cost of sepsis is likely to be £15.6 billion every year for the UK economy, rather than the £2.5 billion previously estimated. However, government intervention to improve access to healthcare and reliability of basic care could make a huge impact, saving thousands of lives and reducing the cost to the NHS by around £300 million.
Improving care globally
Last year, the World Health Organisation adopted a resolution on sepsis which makes the condition a global priority for policy makers and healthcare authorities.
The Global Sepsis Alliance (GSA) Executive Committee helped to gather information from clinicians and families in over 70 countries, initiating a sepsis resolution which was unanimously recommended by the WHO’s Executive Board and adopted at the 70th World Health Assembly in Geneva.
The resolution means WHO Director-General Dr Margaret Chan will draw attention to the public health impact of sepsis, and it urges all 194 United Nations member states to develop action plans to help save lives and improve outcomes for survivors of sepsis in developed and developing countries.
The WHO has dedicated $4.6 million USD of its budget to implementing the resolution’s recommendations, which include the effective use of antimicrobials, the introduction of affordable vaccines, treating sepsis as an emergency, providing suitable services for survivors, communicating with patients and relatives using the term ‘sepsis’ to improve public awareness and engaging in advocacy efforts, including those centred around World Sepsis Day (13th September).
The adoption of this sepsis resolution is a crucial step in the right direction for countries all over the world who urgently require focus and resources to reclaim the millions of lives lost unnecessarily to sepsis each year.
Improving care in the UK
The new National Institute for Health and Care Excellence (NICE) sepsis guideline (nice.org.uk/guidance/ng51) – published in July 2016 and building on care recommendations developed by the UK Sepsis Trust – provides best practice guidance for healthcare professionals confronted with potential cases of sepsis.
The guideline advises that sepsis be considered in any patient with an infection and that the condition should be treated with the same urgency as a possible myocardial infarction. It describes the signs and symptoms that clinicians should check for, dividing these into high and moderate risk criteria and delineating where the person should be treated. It further advises which tests to use in diagnosing sepsis and monitoring response to therapy.
If someone is identified in the community as being high-risk, NICE says they should be admitted to hospital urgently by ambulance. Once in hospital they should be seen by a senior doctor or nurse straight away so that treatment may be commenced. The guideline also advocates responsible use of antibiotics. Antibiotics should only be given to the sickest people: those who meet the high-risk criteria set out in the guideline, or alternatively those with a particular combination of moderate risk criteria. The UK Sepsis Trust screening tools encapsulate both patient groups under the term ‘red flag sepsis’: those patients warranting urgent intervention.
It is important to listen to the patient and their relatives: health professionals will ignore phrases like “I’ve never seen him this ill” or “I feel like I’m going to die” at their peril.
NICE, the UK Sepsis Trust and the international Surviving Sepsis Campaign all recommend the delivery of a set of basic care elements for patients within the first hour – in the UK and in many other countries these are described by the Trust’s ‘Sepsis Six’ care bundle (a set of interventions which can be delivered by any junior healthcare professional working as part of a team). All it requires is a qualified prescriber and basic healthcare equipment. Executing these six steps in the first hour following a patient’s presentation with sepsis will double the patient’s chance of survival.
For 2016/17 and into the next financial year, NHS England has (via commissioners) put in place a national lever to drive improvement in hospitals, requiring that they screen for sepsis and deliver antimicrobials promptly. The Royal College of General Practitioners has developed a sepsis toolkit, NHS England has issued a Safety Alert, and Health Education England has developed a suite of resources. These all aim to increase the awareness of the condition and its treatment.
With increasing levels of public awareness, and following the Parliamentary and Health Service Ombudsman’s report of 2013, complaints around sepsis are on the rise. Guidelines have led on to a NICE Quality Standard, published in September 2017, which makes deviation from accepted protocol harder to defend.
It is crucial that healthcare professionals can show that reasonable steps were taken to identify sepsis, and to assess and investigate the symptoms. Organisations are expected to demonstrate that systems are in place to facilitate recognition and intervention.