World Sepsis Day blog

Alan Bell, NNUH Sepsis Practitioner

What is sepsis and what happens to the body when someone has sepsis?

Sepsis is a medical emergency and should be considered in any person who might have an infection and who is deteriorating. Sepsis, also known as blood poisoning, is the immune system’s overreaction to an

infection or injury. Normally our immune system fights infection – but sometimes, for reasons we don’t yet understand, it attacks our body’s own organs and tissues. If not treated immediately, sepsis can result in organ failure and death. With early diagnosis, it can be treated with antibiotics.

What are the symptoms and why is it so important to treat early?

Sepsis can initially look like flu, gastroenteritis or a chest infection. There is no one sign, and symptoms present differently between adults and children.

In adults

Seek medical help urgently if you or another adult develop any of these signs:

• Slurred speech or confusion
• Extreme shivering or muscle pain
• Passing no urine (in a day)
• Severe breathlessness
• It feels like you’re going to die
• Skin mottled or discoloured

In children

If your child is unwell with either a fever or very low temperature (or has had a fever in the last 24 hours), call 999 and just ask: could it be sepsis?

A child may have sepsis if they:

• Are breathing very fast
• Has a ‘fit’ or convulsion
• Looks mottled, bluish, or pale
• Has a rash that does not fade when you press it
• Is very lethargic or difficult to wake
• Feels abnormally cold to touch

A child under 5 may have sepsis if they:

• Are not feeding
• vomiting repeatedly
• Has not passed urine for 12 hours

How is sepsis diagnosed and what is the treatment?

There is no one test to diagnose Sepsis; it is a combination of factors, the clinician’s intuition, the patient’s condition and a thorough examination of the patient. A wide variety of clinical investigations can be used to assist the clinician in making a diagnosis, tests such as taking blood cultures for analysis in the lab, chest x-ray and a urine sample may be taken. In simple terms, if you suspect your patient might have an infection and they are deteriorating then you should suspect Sepsis and consider commencing treatment. Unless there is a clinical reason for the patient not to be treated, the Sepsis 6 should be commenced and the patient treated with IV antibiotics as soon as possible.

What is being done at NNUH to identify and treat all patients with sepsis quickly?

In 2019 as a result of the work carried out by the Royal College of Physicians the Trust implemented NEWS2 (National Early Warning Score). NEWS2 is a simple and effective way for Trust staff to identify those patients who may be deteriorating and potentially unwell with Sepsis.

All patients who attend ED are screened within 15 minutes of their arrival; those patients who are identified as being septic will receive immediate attention and treatment. On the wards, staff who believe they have a septic patient can request a Red Emergency Sepsis Bag using the 2222 system; this bag contains all the equipment and antibiotics to commence lifesaving treatment.

What work is ongoing to improve sepsis care at the Trust?

There are a number initiatives being used to improve the care of patients with suspected or confirmed Sepsis within the Trust; the two areas I am directly involved in are the auditing of patients who have been identified as being septic and the education and training of staff.

The education of staff is essential in ensuring that our patient’s continue to receive the highest standard of care. In early 2020 staff received the following education and training:

• All newly employed HCAs now receive a Sepsis presentation as part of their induction
• Deteriorating Ward Patient drop-in sessions and e-learning package: This is aimed at ward staff and will work in a similar way to the BLS drop in sessions. It will be a one hour interactive session and staff will complete a number of scenarios examining the deteriorating patient, including sepsis following the A –E algorithm. An interactive deteriorating patient e-learning package is also being developed.
• Trust Sepsis Cascade Trainers Course. This is a new course that will enable ward staff to deliver sepsis training to their colleagues. All band 4 HCAs, AHP and nurses can apply to attend this one day course.

Alan Bell, NNUH Sepsis Practitioner