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THE HIDDEN KILLER
@sepsisuk
Georgina McNamaraExecutive Lead Nurse For Education
The UK Sepsis Trust
Senior Clinical Educator HoEFT
UK T The UK Sepsis Trust
• Constituted by the Charities Commission Memorandum of Articles
• Registered as UKST in 2012, then Ltd by Guarantee in 2015.
• Originally 12 Trustees
• Chairman, 2 Trustees, Executive Board of 8
• Strategic work plans are Political, Awareness and Education.
• Ongoing outcomes- 2 million more people aware of sepsis from our work
• Approximate cost of £90 to save a life
• HEE, APPG, NHSE,NCEPOD, Cross System Board Report, NICE guidelines in draft for consultation
• Changes to terminology, all to fit with Red Flag Sepsis
• No Partners
• Ongoing themes are as above with more toolkits
Iceberg?
NCEPOD 2015
• GP difficulties carrying antimicrobials intravenously without equipment to take blood cultures
• 1/3 of GP’s reviewed none of the 4 basic vital signs temperature, pulse, blood pressure and respiratory rate had been recorded
• When patients were sent in to hospital no referral letter available in 43% of cases
• ED full set of vital signs in 40% of cases.
• Compliance sub optimal 27-47% (2011) marginal improvements now
• Majority of patients still not receiving antimicrobials within an hour of diagnosis (30% increase in mortality, if hypotensive)
• 68% Microbiology rounds in ICU
• <10% in ward environments
• Network Centres for Angioplasty and HSU-narrow windows of opportunity
Iwashyna et al: Long-term cognitive impairment & functional disability among survivors of severe sepsis.
JAMA, 2010.
16.8
3.8
6.2
7.1
0 5 10 15 20
Moderate-severe
Mild
Before sepsis After sepsis
Cognitive impairment
Basics limit severity
Recognition 2014-16
@SepsisUK
Funk and Kumar
Critical Care Clinics 2011 (in press)
‘For each hour’s delay in
administering antibiotics,
mortality increases by
7.6%’
Septic shock
First hour antibiotics in 27%...
0
10
20
30
40
50
60
70
Apr-09 Jun-09 Aug-09 Oct-09
Sepsis 6 Resusc Both Mortality
Compliance,GHH (%)
Mortality
Cohort size (%)
Mortality % ‘RRR’ %
(‘NNT’)
Total 567 (100) 34.7 -
Sepsis Six 347 (61.2) 44.0
Sepsis Six 220 (38.8) 20.0 46.6
(4.16)
Timeline development
Onset of Severe Sepsis
Seen by first doctor
Blood Culture taken
Antibiotics given
Seen by Senior Doctor
Seen by Critical Care
Specialist
Arrive Critical Care
12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00
Sepsis Timeline at NUH 2005/06
Timeline development
Onset of Severe Sepsis
Seen by first doctor
Blood Culture taken
Antibiotics given
Radiology
Seen by Senior Doctor
Seen by Critical Care
Specialist
Arrive Critical Care
CVP line placed
12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00
Sepsis Timeline at NUH 2009/10
Timeline development
Onset of Severe Sepsis
Seen by first doctor
Blood Culture taken
Seen by Senior Doctor
Antibiotics given
Radiology
Seen by Critical Care
Specialist
Arrive Critical Care
CVP line placed
12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00
Sepsis Timeline at NUH 2012/13
Fixing things.
@SepsisUK
‘Sepsis is a condition
whose time has
come’
‘The same muscle and effort should be put
into sepsis as for meningitis, MRSA and C
Diff’
‘Now is the time not for words but for practical
actions on the ground’
Recommendations……..
• All hospitals should have a formal protocol
• To facilitate the transition from primary to secondary, care….standard methods…obs/risks/relevant history
• Source control/early identification reinforced in guidelines and tools
• All Trusts should be 100% compliant with Care Bundles
• Antimicrobial policies should be in place, including regular reviews
• Senior microbiology input 24/7
