37,000 lives each year are at risk from a serious condition called sepsis and this figure counts for the UK population alone. However, sepsis has never been in the forefront of public awareness. Until more recently, sepsis has been under reported in the media and there is a lack of attention in relation to the threat of sepsis, some would say alarmingly so given how many people suffer from it each year. In comparison to for example cancer, more people tragically die every year from sepsis which is more than breast, lung and bowel cancer combined. Crucially however, sepsis can largely be treated if caught in time.
The difficulty with sepsis is that it can develop from many different bugs in the body and it is the body’s reaction to this that causes harm. Every day we are exposed to bacteria, which usually does not cause us to become ill. Many people can have ‘mild’ sepsis which can make them feel ill but doesn’t require treatment in hospital. Mild sepsis can result from chest infections, urine infections, skin injuries, cuts, bites and other minor illnesses. However, if the body responds abnormally to a bacteria or infection this causes the body to release chemicals to fight the infection which causes inflammation within cells in the body. If left untreated the infection can cause septic shock as the inflammation causes tiny blood clots to form, blocking oxygen from vital organs and leading to organ failure and a life-threatening drop in blood pressure.
Having severe sepsis also carries long term morbidities and affects people’s lives. It can cause slower cognitive function, physical disabilities and this has an effect on the ability of someone to work and look after their family. The cost of sepsis is not just the 2 billion pounds it costs the NHS on a yearly basis, but the devastating effect sepsis can have on people’s lives.
The problem is that sepsis symptoms are similar to that of severe flu, gastroenteritis or a chest infection. This makes diagnosis difficult as symptoms can often be put down to “really bad flu”. Having a rash that won’t go away when pressed under a glass is an easily recognisable and well known symptom, but the more hidden symptoms of sepsis make it a difficult condition to catch early on. Treating sepsis requires the whole healthcare system across departments to respond efficiently and robustly. Patients with progressive sepsis are a time critical emergency that should not be underestimated. Critically, if sepsis is diagnosed it can be treated successfully with intravenous fluids and antibiotics and this is usually in an intensive care unit.
The earlier sepsis is diagnosed, the easier it is to treat. Problems occur when a patient is seen by a doctor, but dismissed with a case of flu, or a stomach upset and the infection is left to take hold. Common signs and symptoms of sepsis include fever, increased heart rate, increased breathing rate, and confusion. There may be symptoms related to a wound infection, or a rash (more common with Septicaemia). As severe sepsis is when the organs are affected this can cause insufficient blood flow, which may be apparent from signs such as low blood pressure, high blood lactate or low urine output.
Sadly, the story of Rory Staunton highlights the dangers of how sepsis can go overlooked. Rory was a young 12 year old boy when he was sent home with an upset stomach and dehydration from NYU Langone Medical Center in the USA, only to shockingly die three days later in the intensive care unit from septic shock. Sepsis was missed because his symptoms and the clear signs in Rory’s blood tests, were not acted on promptly by the doctors attending. Rory was sent home while the infection took hold until it was too late. This is a deeply tragic reminder of the suffering that sepsis can cause and potentially one that could have been avoided if the signs had been acted upon sooner. Rory’s case highlights the impact of misdiagnosis of sepsis. Rory showed signs and symptoms of sepsis in the Emergency Department. A blood test taken before he was discharged showed clear evidence of a raging septic infection taking hold in his body, but these results were not acted on by the hospital.
Rory’s family have been campaigning and are still working hard to get guidelines and protocols in place to outline best practice for identifying and treating sepsis. These are known in the United States as “Rory’s Regulations” and have already been adopted in New York state.
The UK Sepsis Trust are doing all they can to raise the profile of sepsis to increase awareness amongst the public and health professionals and to improve the standard of treatment in hospitals in the UK. For more information on the work they do and a sepsis “Symptom Checker” card which lists 6 symptoms to look out for, their website link is provided below.
The UK Health Secretary Jeremy Hunt announced in early 2015 that the NHS would put in place further measures to tackle sepsis, involving the NHS, government and national health bodies, but more is needed to raise the profile and increase the training in hospitals to treat sepsis patients successfully.
Raising awareness of sepsis is a crucial part of the struggle in a time critical fight against its potentially dreadful and life threatening effects.
More information about awareness and sepsis can be found on the website: www.sepsistrust.org
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