An overview of sepsis, and how to identify it, in a hospital setting
Sepsis is one of the biggest killers in the UK, affecting tens of thousands of people. Once sepsis has set in, it can quickly develop into severe sepsis, causing organ failure and death.
Sometimes called septicaemia or blood poisoning, sepsis creates a distinct sequence of signs that, if followed, allows clinicians to detect and treat the condition before it becomes too late. As with many clinical risks, Doctors use a set of systems to reduce the impact of sepsis and increase survival rates.
Signs of sepsis
Checking for the signs, and interpreting them correctly, is critical in sepsis management and treatment. This is a rapidly developing area of medicine.
Blood tests should be carried out before an operation as a matter of routine, and signs such as fast heart-rate (tachycardia), low levels of oxygen in the blood (hypoxia), low urine output (anuria) and unusually fast breathing (tachypnoea) should all raise the alarm.
Much also depends on the condition of the patient and the reasons he or she is in hospital; rapid deterioration and excessive pain after a simple procedure, such as day-case surgery, may be a sign that something is wrong, and sepsis should be considered. Another example is unusual levels of pain and bruising in the area around a caesarean section wound.
Immune system response
One sign of sepsis is SIRS, or the Systematic Inflammatory Response Syndrome. This includes:
- Heart rate greater than 90 beats per minute
- Body temperature lower than 36°C or higher than 38°C
- Respiratory rate of greater than 20 breaths per minute
- A particularly high or low white blood cell count
If a diagnosis of infection is made and at least two of the above factors are met, a patient is defined as suffering from sepsis.
A patient suffering from both infection and organ failure is classed as having Severe Sepsis. Sudden, serious organ failure following a routine operation is unusual, and should be a sign that a patient may have sepsis.
One serious consequence of sepsis is kidney failure. This can be measured using the 'RIFLE' test:
- Risk – abnormal blood test results for six hours
- Injury – abnormal blood test result for 12 hours
- Failure – no urine passed for 12 hours
- Loss – acute kidney failure for four weeks
- End stage – no kidney function for three months
Many of these signs can occur rapidly, depending on the infection and the condition of the patient. Once organ failure has begun, the prognosis of a sepsis victim is precarious, making early detection even more crucial. However, different trusts have different approaches to sepsis. There is an increasing awareness of the threat posed by sepsis, and clinicians are developing a systemic approach in response.
Rather like a pilot undertakes a pre-flight checklist, clinicians are adopting a similar approach to care of patients with suspected sepsis.
A patient demonstrating the symptoms described above should be reviewed by an experienced clinician constantly monitored.
There are a number of other issues that need to be considered as the cause of the symptoms. Depending on the type of treatment the patient has been receiving and his or her medical history, these can include problems with the bowel such as perforation, lung infections or a variety of other issues. Scans such as ultrasounds or CT scans, as well as blood and urine tests, can be used to rule out other causes of symptoms.
Hospital staff must, clearly, remain vigilant.
Hospitals use early warning scores to assess the risk of patients. The National Early Warning Score gives a score of 1-4 as low risk, 5-6 as medium risk and 7 or above as high risk. A patient at medium risk should be reviewed immediately and monitored for any change in condition.
If left untreated, an infection can become life-threatening or fatal in a matter of days; in some cases, as with infections such as meningitis, the window to prevent serious harm can be a matter of hours. The systems set out above can play a pivotal role in reducing the risks of sepsis and saving lives.