1. Recognising sepsis and taking action
Dr Michelle Webb Renal Consultant, Associate Medical Director Patient Safety, East Kent Hospitals University NHS Foundation Trust and Co-lead for Sepsis Kent Surrey Sussex Patient Safety Collaborative

2. Sepsis
Sepsis is a life threatening condition that arises when the body’s response to an infection injures its own tissues and organs.
It can occur as a consequence of any infection
Failure to recognise early and treat agressively can lead to shock, multiple organ failure and death.
Sepsis can be caused by a huge variety of different bugs, most cases being caused by common bacteria which we all come into contact with every day without them making us ill.
Sometimes, though, the body responds abnormally to these infections, and causes sepsis.

3. Who is most at risk? The very young and the very old Pregnant women
Immunosuppressed
Chemotherapy
Drug treatments for immune disorders eg rheumatoid arthritis
Transplant patients
Those with Chronic Diseases eg diabetes

4. The Facts Incidence UK >100,000 annually
35,000 + deaths per year in UK. More than breast and bowel cancer combined
Incidence increased by 8-13% over last decade
Third highest cause of mortality in hospital setting
Commonest reason for admission to ITU
On average 2 children die per day
Basic interventions reliably delivered to 80% of patients could save 11,000 lives and £150 million

7. Delayed Initiation of antimicrobial therapy increases mortality
Fig. 3
Delayed Initiation of antimicrobial therapy increases mortality
Delayed initiation of antimicrobial therapy increases mortality. Bars represent 95% CI. (From Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34(6):1589–96; with permission.)
Crit Care Med 2006;34(6):1589–96

8. Surviving Sepsis Campaign
Aim was to reduce deaths from sepsis by 25% by 2009
Introduced Sepsis Six ©
6 elements
High flow oxygen
Take blood cultures
IV antibiotics within 1 hour, “golden hour”
IV fluid resuscitation
Check lactate
Monitor urine output

9. Evidence that Sepsis Six reduced mortality
Fig. 4
Evidence that Sepsis Six reduced mortality
Sepsis protocol implementation reduces mortality risk. (Data from Refs. [10,23,81–92].)
Source: Critical Care Clinics 2008; 24:1-47

10. Impact of using Screening Tool - NCEPOD
28%
30%
31%
36%
35%
55%

11. Impact of Sepsis Six Tool - NCEPOD
With care bundle
Without care bundle
Delay in escalation 9%
26%
Delay in administration of administration of antimicrobials
18.5%
38%
Fluids delayed/ not received
13%
23%
Oxygen delayed / not received 5%
15%
Investigation of source of infection
10%
28%
Blood cultures not taken
60%
79.5%
Less than good documentation of sepsis
19%
33%
Blood gases not taken

12. Why do cases get missed? Infection and Sepsis are a continuum
Young people are good at masking signs
Early symptoms can be “a flu like illness” or diarrhoea and vomiting
Respiratory Rate is the most sensitive early indicator and the least likely to be recorded in the community setting

13. Relationship between Lactate and Mortality

14. Purpose of Today To start thinking about how we can:
Improve recognition and awareness of sepsis across health and social care
Work better together – common tools, common language
Improve Safety Netting

15. Our plan to reduce sepsis incidence and mortality