Sepsis is a life-threatening condition and can be fatal if not detected early on. Identifying sepsis can be difficult as there are several possible symptoms to look out for. It becomes even harder to spot in babies, children, dementia sufferers, people with learning disabilities and those who generally struggle to communicate.
While it is treatable, sepsis kills around 52,000 people every year in the UK. It is essential that the entire pharmacy team can identify the early signs and what to do if they suspect someone has sepsis. Let’s take a look at the common causes, symptoms and available treatment options.
What Is Sepsis?
Sepsis is a condition in itself but it’s usually caused by a bacterial infection in the blood known as septicaemia. Putting it plainly, sepsis is the result of a massive immune response to an infection. The body tries to fight it and, in the process, damages its own tissue and organs. In some instances it can even lead to total organ failure. This is also referred to as “blood poisoning” which is a medical emergency that can be fatal or life-altering for many.
Causes Of Sepsis
When septicaemia occurs, bacteria release poisons and the inflammatory response to the poison is what we refer to as sepsis. While the condition is life-threatening, it ranges from mild to severe with a higher rate of recovery in mild cases. According to the Mayo Clinic, septic shock has close to a 50% mortality rate with higher risk of future infections in severe cases.
Severe sepsis (septic shock) can also cause other complications like small blood clots throughout the body. These clots can block the blood flow and oxygen to vital organs which increase the risk of organ failure and even gangrene (tissue death). Nearly any infection can cause sepsis but it is more prevalent with pneumonia and infection of the abdomen, kidneys and bloodstream.
What Are The Symptoms?
Unfortunately, symptoms are often vague as they can be similar to flu, gastroenteritis or chest infections. The good news is that antibiotics can help if it’s diagnosed early.
Although some people are at a higher risk of infection, anyone can get sepsis. Those most at risk include young children and seniors, immunocompromised people like those with HIV or chemotherapy as a cancer treatment. Other risk cases are patients in an intensive care unit (ICU) and those exposed to invasive devices like intravenous catheters or breathing tubes.
Newborns And Young Children
Neonatal sepsis refers to new-born babies getting a blood infection. It is classified according to when it was contracted – early onset is during birth and late-onset is after birth. This helps healthcare professionals identify the best course of treatment. As mentioned earlier, symptoms can be vague but some signs include the following:
- malaise
- trouble breastfeeding
- low body temperature
- fever
- a pale colour and poor skin circulation with cool extremities
- abdominal swelling
- vomiting and diarrhoea
- seizures
- jitteriness
- jaundice (yellowing of the skin and whites of the eyes)
Neonatal sepsis remains the leading cause of infant death but early diagnosis and the appropriate treatment can help the baby recover completely. Today, thanks to maternal universal screening and proper neonatal testing, the risks are significantly lower.
Diagnosing Seniors
While anyone can get sepsis from an infection, the elderly are at risk due to a weakened immune system. It is commonly found in those with a chronic illness including diabetes, kidney disease, cancer, high blood pressure and HIV.
The most common causes in seniors are pneumonia or a urinary tract infection. In some cases, infected skin can cause infection due to pressure sores or skin tearing. These may not be noticeable for some time but confusion or disorientation are common symptoms to look out for.
Diagnosis And Symptoms In Older Children And Adults
Always consider the patient’s medical history but the first step in diagnosing sepsis is observing the symptoms. Check if the patient has had a recent infection, a surgical or catheter procedure or if they are vulnerable to infection. When diagnosing older children or adults, they may suffer from one or all of these symptoms:
- acting confused, slurred speech or delirious
- blue, pale or mottled skin, lips or tongue
- a rash that doesn’t fade when rolling a glass over it (the same happens with meningitis)
- difficulty breathing or breathing very fast
- hasn’t urinated all day (12 hours for babies)
- swelling, redness or pain around cuts or wounds
- very high or low temperature
- excessive shivering or muscle pain
Sepsis Prevention Tips
There are four general approaches to reducing the risk of an infection which can lead to sepsis. This particularly applies to the very young, elderly people and those who are vulnerable to complications. It’s important to keep the following in mind when discussing preventative measures:
- Keep vaccinations up to date including flu and pneumonia
- Keep any cuts, scrapes and wounds clean and follow good hygiene practices
- Take antibiotics as prescribed to avoid antimicrobial resistance
- In case of infection, keep symptoms in mind and seek medical treatment as soon as they appear
Sepsis Recovery
Recovery is possible but it depends on whether it was mild or severe along with any pre-existing conditions. Many people recover completely but others will report long-term effects. According to the UK Sepsis Trust, “it can take up to 18 months before survivors start to feel like their normal self”.
Approximately 50% of survivors deal with PSS (post-sepsis syndrome) which includes several long-term effects including damaged organs, insomnia, nightmares, disabling muscle and joint pains, fatigue and poor concentration among others.
Pharmacy Quality Scheme (CPPE Sepsis Training)
The new Community Pharmacy Contractual Framework to support the NHS Long term plan has been agreed. It builds on the Quality Payments Scheme to move pharmacists and their teams towards a more clinically-focused service.
Sepsis training is needed for the Pharmacy Quality Scheme (Risk Management and Safety Bundle). Teams can apply what they learned to respond in a safe and appropriate way when they suspect someone has sepsis. It will help staff identify signs and symptoms and when to refer them to a pharmacist.
CPPE has a pharmacy professional training module on sepsis but to ensure the information is disseminated to the whole pharmacy team, VirtualOutcomes have also added a sepsis team training module. Please contact us for more information and join the conversation on Facebook, Twitter and LinkedIn.