RECOGNITION OF SEPSIS PROTOCOL - Adults & Children 2016 - NHFT
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ICPr013
RECOGNITION OF SEPSIS
PROTOCOL
Adults & Children
2016
1
Infection Prevention & Control
Jenny Boyce
November 2016
Review : February 2019RECOGNITION OF SEPSIS PROTOCOL
Table of Contents
Introduction................................................................................... 3
Purpose ......................................................................................... 3
Definitions ..................................................................................... 3
Sepsis. .............................................................................................. 3
Systemic Inflammatory Response Syndrome (SIRS) ......................... 3
Management of Sepsis ................................................................... 3
References ..................................................................................... 5
Appendix 1 - Sepsis Screening and Action Tool................................. 6
Appendix 2 – NICE Guidelines traffic light system ........................... 7
2
Infection Prevention & Control
Jenny Boyce
November 2016
Review : February 2019Introduction
Sepsis is a time-critical medical emergency, which can occur as part of the body’s response
to infection. The resulting inflammatory response adversely affects tissues and organs.
Unless treated quickly, sepsis can progress to severe sepsis, multi-organ failure, septic shock
and ultimately death. Septic shock has a 50% mortality rate.
The successful management of sepsis requires a high index of suspicion and early
recognition. Patients cared for in the home or ‘walk in’ centres must be identified and
treated initiated quickly without the use of higher level diagnostics available in the acute
hospital setting. Equally clinicians suspecting sepsis in a community hospital or minor
injuries unit will not have the same diagnostics available in an acute hospital and will have
to act quickly to reduce the risk to these patients. It is therefore essential to have access to a
clinical tool (Appendix 1 & 2) to support their clinical findings and clinical intuition when
suspecting patients at risk of sepsis.
Purpose
All clinical staff should be aware of potential patients ‘at risk’ of sepsis. Those staff engaging
in patient observations should use the National Early Warning Score (NEWS) and clinical
judgement to trigger use of the Sepsis Screening Tools (Appendix 1 & 2). This applies to all
patients all patient settings across Northamptonshire Healthcare Foundation Trust (NHFT)
Definitions
Sepsis.
Sepsis is defined as a systemic response to severe infection in the body; its sequence is
equal to generalised inflammatory shock response seen in the progressive stage of the
illness (Severe sepsis) (Woodrow, 2010). Due to the permeability of the tissues in sepsis,
septic shock can follow and lead to multiple organ failure. Sepsis is mainly caused by
bacterial infection, it can be caused by a viral, fungal or even parasitic source. As the
infection affects the body’s normal inflammatory response, physiological changes can be
seen that aid diagnosis. In around 20% of cases, the source of sepsis is unknown.
Systemic Inflammatory Response Syndrome (SIRS)
(SIRS) is a collection of signs that the body is reacting to a range of injuries or illnesses, and
is not specific to infection. It is clinically identical to sepsis and severe sepsis).
Management of Sepsis
It is important to recognise and identify the type of patients who may be at risk:
Extremes of age e.g. Premature babies, frail elderly
Diabetes
Immunocompromised e.g. chemotherapy patients, steroid treatment
3
Infection Prevention & Control
Jenny Boyce
November 2016
Review : February 2019 Indwelling medical devices e.g. catheters/central lines
Alcohol and drug abuse
Skin wounds e.g. burns
HIV/AIDS
Common causes of sepsis include
Pneumonia
Appendicitis
Urinary tract infection
Meningitis.
In an adult sepsis has to be considered a high possibility in the presence of two or more of
the following signs and symptoms indicating Systemic Inflammatory Response Syndrome
(SIRS) is present:
Temperature >38.3ºC or 20 breaths per minute
Heart rate >90 beats per minute
Acute confusion/reduced conscious level
Glucose >7.7mmol/l or < 4mmol/l (unless diabetic)
Signs that may indicate septic shock in an adult include:
Mottled cold peripheries
Central capillary refill >3secs
Systolic blood pressure 38.5°C
Inappropriate tachycardia (Discuss with paediatrician if unsure)
Altered mental state (including: sleepiness / irritability / lethargy / floppiness)
Reduced peripheral perfusion / prolonged capillary refill
A child presenting with two or more of the indicators and a suspected or proven infection
represents a clinical emergency, initiate immediate transfer to acute hospital setting.
(Appendix 2)
4
Infection Prevention & Control
Jenny Boyce
November 2016
Review : February 2019Sepsis management is a time critical medical emergency, and immediate acute hospital
transfer be initiated by calling 999. The patient should be monitored continuously and any
indication of septic shock needs to be communicated to the emergency service.
References
NHS England Patient Safety Alert “Resources to support the prompt recognition of sepsis
and the rapid initiation of treatment” - 2 September 2014 HS/PSA/R/2014/015
The UK Sepsis Trust - http://sepsistrust.org/
NICE 2016 Sepsis: recognition, diagnosis and early management
5
Infection Prevention & Control
Jenny Boyce
November 2016
Review : February 2019Appendix 1 - Sepsis Screening and Action Tool
To be applied to all non-pregnant adults and young people 12 years and over with fever (or recent fever)
symptoms
Are you worried your patient is sick? e.g.
Tick Low risk of sepsis. Consider other diagnoses.
High or low temperature Consider removing cannula/catheter.
Sudden deterioration Use clinical judgement and /or standard
Unusually drowsy, confused or delirious protocols
News >3
Give safety netting advice to carers: call 999 if
patient deteriorates rapidly, or arrange for medic
Are there signs/symptoms of infection?. to visit if condition fails to improve or gradually
Tick worsens.
Yes but source not obvious
Pneumonia/likely chest infection
Urinary tract infection
Abdominal pain or distension Is any ONE Amber Flag present? Tick
Cellulitis/septic arthritis/infected Relatives worried about mental state/behaviour
wound Acute deterioration in functional ability
Device related infection Immunosuppressed
Menigitis Trauma, surgery or procedure in last 6 weeks
Other (specify): Respiratory rate 21-24 OR dyspnoeic
Systolic BP 91-100mmHg
Heart rate 91-130 OR new dysrthymia
Tympanic temperature < 36o C
Clinical signs of wound, device or skin infection
Perform a full set of observations If under 17 & immunity impaired treat as RED
FLAG sepsis
Is ONE Red Flag present?. Tick
New deterioration in GCS/AVPU or acute confusion At risk of Sepsis.
Systolic BP 40mmHg below normal) Same day assessment by medic/nurse in
Heart rate >130 per minute charge
Respiratory rate >25 per minute Is urgent referral to hospital required?
Needs oxygen to keep SpO2 92% (88% in COPD) Agree documentation ongoing
Non blanching rash or mottled /ashen/cyanotic management plan (including observations
Not passing urine in 18 hours frequency, planned second review as
Urine output less than 0.5ml/kg/hr if catheterised agreed with medic/nurse in charge
Recent chemotherapy (within last 6 weeks) Monitor urine output
Consider life threatening sepsis mimics
e.g. Stroke
RED FLAG SEPSIS! Is a time critical condition, immediate action is required
If appropriate dial 999 arrange blue light transfer Consider IV fluids
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Infection Prevention & Control
Jenny Boyce
If available give O2 to keep saturations >94% (88-92% in COPD) Inform next of kin
Cannulate if skills & competencies allow
November 2016
Review : February
Ensure 2019
ambulance crew pre alert Red Card SepsisAppendix 2 – NICE Guidelines traffic light system
The NICE guidelines traffic lights system should be used to identify red flags for children. The following
have been taken from the NICE Feverish Illness Guideline (CG16
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Infection Prevention & Control
Jenny Boyce
November 2016
Review : February 2019You can also read
