Presentation by Georgina McNamara, Executive Lead Nurse for Education, Sepsis Trust at ECO 14 in Preston - "Sepsis - The Hidden Killer"

1. THE HIDDEN KILLER
@sepsisuk
Georgina McNamara
Executive Lead Nurse For Education
The UK Sepsis Trust
Senior Clinical Educator HoEFT

2. 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

7. Iceberg?

8. 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

10. 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

11. Basics limit severity

12. Recognition 2014-16
@SepsisUK

13. Funk and Kumar
Critical Care Clinics 2011 (in press)
‘For each hour’s delay in
administering antibiotics,
mortality increases by
7.6%’
Septic
shock

14. First hour antibiotics in 27%...

20. 0
10
20
30
40
50
60
70
Apr-09 Jun-09 Aug-09 Oct-09
Sepsis 6 Resusc Both Mortality
Compliance,GHH (%)

21. 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)

22. 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

23. 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

24. 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

25. Fixing things.
@SepsisUK

26. ‘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’

34. #3andAhalf
bit.ly/SepsisNovel

38. 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

42. george@sepsistrust.org
www.sepsistrust.org
www.world-sepsis-day.org