What Is the Definition of Sepsis?

What is the definition of sepsis?

Sepsis is defined as the presence (probable or documented) of infection together with systemic manifestations of infection. Severe sepsis is defined as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion.

What is the impact of sepsis?

The overall mortality rate for patients admitted with severe sepsis is 35% (5 times higher that STEMI and stroke).

It is responsible for approximately 40,000 deaths annually in the UK and affects all age groups. e.g. it is the highest cause of direct obstetric related death. Neutropenic sepsis is the commonest form of sepsis at RSCH.

Early recognition and early treatment of severe sepsis are the key points of the RSCH and national Sepsis projects.

Why treat severe sepsis within the hour?

The diagnosis of severe sepsis is a MEDICAL EMERGENCY. Early signs need to be recognised and treated….within THE HOUR

The Number Needed to Treat (NTT) of the sepsis six resuscitation bundle to prevent one death, is 4.6 (NNT 42 for Aspirin in STEMI, NNT 45-90 for PCI in STEMI).

How do we identify sepsis in the Emergency Floor?

We use the Emergency Floor sepsis screening tool to identify sepsis.

Step 1: Screen patients using the EWS and clinical acumen. Some patients may have a normal EWS score but look unwell. Escalate early to a Senior Doctor.

Step 2: Apply the SIRS criteria AND clinical acumen. Up to 1 in 8 patients with severe sepsis were SIRS negative in a recent study. Severe sepsis is a time critical condition: every hour of delay in antibiotic administration causes an increase in mortality of 8%.

TIME IS LIFE IN SEVERE SEPSIS

Step 3: Identify the possible source of infection and treat accordingly. It is important to start the appropriate antibiotic.

How do we manage Sepsis in the Emergency Floor?

Sepsis is managed by early treatment and risk stratification, using “red flags” and SIRS criteria.

What antibiotics do we give for Severe Sepsis?

If a source of sepsis is identified then follow the systems in the MicroGuide app to guide specific therapy.

If no source is identified, then treat as SEVERE SEPSIS / SEPTIC SHOCK, unclear source.

Produced by

EF Sepsis Team, November 2015

v.0.5 12.11.15

References:

RCEM sepsis toolkit: http://www.rcem.ac.uk/

The UK Sepsis Trust: http://sepsistrust.org/

R.Judd. Annals of Pharmacotherapy.2014.Vol48 (10) 1260-75

Sepsis resources and this leaflet can be found on the Trust intranet, click on the SPACE icon or follow this link:

http://trustnet2.royalsurrey.nhs.uk/SBUs/SurgeryOncology/Pages/SPACE.aspx

Information Leaflet for the Emergency Floor Clinical Staff