Treat life-threatening sepsis within the hour, says NICE - News & Features

10 March 2017
Treat life-threatening sepsis within the hour, says NICE

In a new draft quality standard, NICE says people showing symptoms of sepsis must be checked vigilantly.

Once someone is classed as high-risk they should be seen by senior staff and receive the correct treatment within an hour.

Professor Gillian Leng, NICE deputy chief executive, said: “Severe symptoms can develop in sepsis very quickly. If high-risk patients are not identified and treated promptly, people can be left with debilitating problems. In the worst cases, they may die.

“This quality standard highlights priorities in the continued fight to improve sepsis care. We know from recent case reviews that there are inconsistencies in how people’s symptoms are assessed in different settings. More can be done to provide rapid treatment.”

The quality standard highlight areas from NICE’s 2016 sepsis guideline that will help health professionals improve care for those who are at risk of becoming seriously ill.

What is sepsis?

It originates from another medical condition such as an infection in the lungs, urinary tract, skin, abdomen (such as appendicitis) or other part of the body. Invasive medical procedures such as insertion of a vascular catheter can introduce bacteria into the bloodstream and hasten the condition.

Many different types of microbes can cause sepsis, including bacteria, fungi and viruses, but bacteria are the most common culprits. Severe cases often stem from a body-wide infection that spreads through the bloodstream, but sepsis can also arise from a localised infection.

Bacteria such as group B streptococcus (GBS), Escherichia coli, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, and Salmonella are common culprits in sepsis in newborns and infants younger than 3 months old.

Sepsis causes the body's usual response to infection to go into overdrive. Bacteria from the infection and the toxins they produce can alter a person's body temperature, heart rate, and blood pressure, and prevent the body's organs from working properly.

Who's at risk?

Anyone can get sepsis, but those with compromised immune systems, children, infants and the elderly are most vulnerable. Conditions that are particularly prone to infection:

  • GI tract – Liver disease, gallbladder disease, colon disease, abscess, intestinal obstruction, and GI instrumentation
  • GU tract – Pyelonephritis, intra- or perinephric abscess, renal calculi, urinary tract obstruction, acute prostatitis or abscess, renal insufficiency, and GU instrumentation
  • Pelvis – Peritonitis and pelvic abscess
  • Lower respiratory tract – Community-acquired pneumonia (with asplenia), empyema, and lung abscess
  • Vascular system – Infected IV line or prosthetic device
  • Heart and cardiac vasculature – Acute bacterial endocarditis and myocardial or perivalvular ring abscess

Urgent action

One way to help prevent some types of sepsis is through vaccination. Immunizations routinely given to infants today include vaccinations against certain strains of pneumococcus and Haemophilus influenzae type b that can cause sepsis or occult bacteremia, an infection of the blood.

Dr Ron Daniels BEM, Chief Executive of the UK Sepsis Trust, comments: “An emphasis on timely treatment and diagnosis is crucial if we are to improve outcomes for people with sepsis, and this quality standard could be a hugely impactful reinforcement of the recent guideline recommendation that sepsis is treated with same urgency as heart attacks.” 
NICE says that high-risk sepsis patients should get antibiotics and IV fluid treatment within the hour. If it will take more than an hour to get someone to hospital, GPs or ambulance staff can also administer antibiotics.