Mistreatment.com Interviews UK Sepsis Trust

16 January 2014

Mistreatment.com Interviews UK Sepsis TrustMistreatment.com Interviews UK Sepsis Trust

Sepsis (often referred to as either blood poisoning or septicaemia) is a life-threatening illness caused by the body overreacting to an infection. It claims 37,000 lives a year (more than from any cancer or heart attacks) and Mistreatment.com has heard widely from members of the public of cases where some of the key symptoms are misdiagnosed; symptoms such as low blood pressure, delirium, shortness of breath and an inability to urinate.

Enquiries Mistreatment.com has dealt with often are regarding misdiagnosis and/or failure to deal promptly and effectively with sepsis once it arises for it is a medical emergency-the risk of not acting quickly enough is so dangerous it can lead to multiple organ failure, septic shock and even death.

Mistreatment.com spoke to UK Sepsis Trust Chief Executive Ron Daniels in an exclusive interview discussing clinical care in treating sepsis, why greater awareness is needed to deal with it and its specific causes. UK Sepsis Trust is a non-profit registered charity who wants to help the way our healthcare system deals with Sepsis. We are grateful to Ron in taking the time to speak with Mistreatment.com.

Ron, do you feel sepsis is increasing in ICU’s amongst hospitals in the NHS and as 2014 commences do you think greater awareness of sepsis risk and its management is required?

It does indeed appear that the incidence of sepsis is on the increase, this is reinforced by information provided through mediums such as the Center for Disease Control and Prevention in the US suggesting increases of cases of sepsis in the region of 8-13% on an annual basis; this is corroborated by data from the Office of National Statistics in the UK which reinforces the fact that there are presently more deaths from sepsis, based on our data, than from heart attack and stroke.

As we come into the New Year it is clear that sepsis is a key clinical area for urgent and emergency focused care, both on a grass roots level and outside it. The UK Sepsis Trust is working with NHS England and on a grass roots basis to help to bring about awareness of sepsis and also the need for an intelligent ‘suspicion’ when symptoms arise so that appropriate screening is undertaken and symptoms are promptly acted upon effectively at hospitals.

We recently worked with the Department Of Health, instructed NICE to develop a clinical guideline on sepsis outside the usual public consultation exercises, and we have also instructed the NHS as to how it fits within the National Outcomes Framework, primarily with regards to dealing with premature deaths and patients safety.

At a more grass roots level, hospitals are appointing sepsis nurses, so when symptoms are identified with correlating with the risk of sepsis, patients are evaluated and so the correct care is provided efficiently; this works in tandem with staff training, sepsis boxes and bags with equipment so that junior doctors, for instance, have the information needed to provide patients with immediate help. At the same time, Critical Care Outreach services fill the gap, whereby there can be appropriate screening for sepsis when a sick patient is identified.

Sanitation and hygiene conditions are extremely important in dealing with sepsis; do you feel this is as serious a cause of sepsis as excessive use of antibiotics in outpatient care, if not more?

Sanitation and hygiene conditions are certainly partly responsible, though most cases in the developed world are relatively unrelated to sanitation and hygiene, such as those arising from community acquired pneumonia. This can arise due to earlier poor treatment from a GP, for example, where infection has been misdiagnosed, or simply through bad luck or in elderly patients who are relatively immobile.

Sanitation and hygiene within the hospital premises and care homes is of paramount importance. Urinary Tract Infections (UTI) are an important cause of sepsis especially when a urinary catheter in place; to this end there is not much data of the long term effects of catheters and how safe they are. In a care home, for example, all these elements if poorly addressed will raise the risk of UTI, though in hospitals intravenous cannulae can account for 1% of cases where sepsis arises, whilst not a large cause in relative terms this still equates to approximately 1000 cases a year in the UK.

Overseas, sepsis is a major issue and access to reliable hygiene, sanitation and vaccination programmes is vital to limit the development of infection which might lead to sepsis. Continued mass uptake of appropriate vaccination programmes in the UK is also vital.

What is your opinion on the rising rates of severe and fatal sepsis during labour and delivery for pregnant women? Could you give some examples of how this problem could be alleviated?

While there has been an increase in the number of deaths attributed to sepsis in pregnancy such that sepsis is now the leading direct cause of maternal death, we must remember that the total numbers remain thankfully small. Improvements in outcomes and efforts to reduce the risk of other eventualities such as haemorrhage and venous thrombo-embolism have resulted in incidences of sepsis coming to the fore, and strategies are required by the healthcare system to mitigate its risk. For example, more reliable systems are needed to identify sepsis in its early stages, bespoke screening tools designed not for the general  adult population but which are specific to the nuances of pregnancy; to this end the UK Sepsis Trust is working with the Royal College of Obstetricians.

Another important element in this respect are that midwives generally deal with healthy women and those with stable long term illness rather than acute illnesses developing  where they become ill when undergoing delivery; whilst adept they are not as experienced in dealing with the physiology of acute illness. In this respect there is a need for more training in dealing with a woman when she appears very ill and where symptoms of sepsis may well be prevalent. Midwives need to be attuned to this kind of recognition and so working with Royal College of Midwives for training for sepsis is one way of doing this and be accomplished through competency training. Whilst in relative terms the numbers of sepsis occurring during labour and delivery for pregnant women is small and the average midwife sees fewer numbers of women a year who suggest septic like conditions, it is vital they know how to treat these symptoms when they arise.

At the same time it is important to ensure women at particular risk are made aware of the risks of sepsis and provided with appropriate patient population training in that respect, for example if they are on steroids or are diabetic or have had multiple pregnancies.

Ron is Chief Executive and one of the founders of the Trust; he developed his passion for improving systems for Sepsis during his Role as a Consultant in Critical Care and Anaesthesia, and his parallel role as CEO of the Global Sepsis Alliance. He is a recognised world expert in sepsis and lectures internationally.

Mistreatment.com has a number of specialist teams who can provide you with advice, guidance and support if you or a loved one has experienced serious infection related illness, sepsis related symptoms and birth related serious injury and infection. Mistreatment.com is able to provide information about your patient rights and options whether you feel you have been medically mistreated and want to make an official complaint or whether you would like to commence a medical negligence claim. If you or a loved one has experienced a suspected infection which led to sepsis, or certain risk factors such as being very young or old, diabetic, pregnant or on long-term steroids which were not identified, you can speak to Mistreatment.com for free to understand what your options may be.

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