Sepsis: Time to Act
By Emily May, Manager, Centre for Health Solutions
I recently had the honour of attending the UK Sepsis Trust’s (UKST) impactful ‘Sepsis: Time to Act’ annual event. The event brought together healthcare professionals (HCPs), passionate advocates and sepsis survivors and their support networks, to raise awareness and incite action to reduce the impact of sepsis. From the informative presentations to the shared personal stories, I was struck by the urgency and importance of addressing sepsis head-on. I’m therefore using this week’s blog to share my key takeaways from the event in order to help amplify UKST’s call to action and continue to raise awareness of, and share solutions to, the scale and impact of sepsis.
What is sepsis?
Sepsis is a life-threatening medical emergency that occurs when the body's immune system has an extreme response to an infection and begins to damage its own tissues and organs. The body’s reaction leads to widespread inflammation throughout the body which can impair blood flow, leading to organ dysfunction, and, in severe cases, multiple organ failure and sometimes death.
Sepsis can affect anyone, but people who are older, very young, pregnant or have other health problems are at higher risk. Common signs of sepsis include fever, fast heart rate, rapid breathing, confusion and body pain. It is usually caused by bacterial infections but may be the result of other infections such as viruses, parasites or fungi. Its treatment requires medical care, including the use of antimicrobials, intravenous fluids and other interventions.
Data published in 2020, identified some 49 million cases and 11 million sepsis-related deaths worldwide. Almost half (20 million) occurred in children under five years of age1. In the UK, each year, some 245,000 people are diagnosed with sepsis and 48,000 lose their lives. A recent YouGov survey, commissioned by UKST, illustrated the widespread impact of sepsis, with 45 per cent of the 2,087 UK respondents knowing someone affected or had sepsis themselves.2
What do the UK public know about sepsis?
Public awareness of sepsis in the UK has increased significantly in recent years. UKST’s YouGov survey revealed that 94 per cent of the respondents are aware of sepsis, with 91 per cent recognising it as a medical emergency. This is a marked increase from 76 per cent awareness in 2019 and 27 per cent in 2012. Notably, these figures surpass public awareness levels in other developed nations such as the United States (63 per cent), Australia (50 per cent) and Germany (61 per cent).3
However, the UKST event illustrated all too clearly that while the high level of public awareness in the UK is encouraging, awareness alone is not enough. Translating this awareness into action is crucial for saving lives and improving outcomes for the thousands of people affected each year. Indeed, despite increased awareness of sepsis as a medical emergency, the YouGov survey revealed limited understanding of its symptoms or that the symptoms differ between adults and children with only 31 per cent of respondents feeling confident in recognising if they or someone else might have sepsis.4 This highlights the need for greater education about the symptoms, including educating HCPs and the public.
What is the human impact of sepsis?
Even if people survive sepsis, they and their families often face long-term health challenges with around 40 per cent of survivors experiencing cognitive, psychological or physical aftereffects, and some 80,000 people annually suffering life-changing consequences. These symptoms are not always physical, with sepsis survivors reporting fatigue (80 per cent), anxiety (53 per cent), and difficulty concentrating (47 per cent). Furthermore, 37 per cent struggle with tasks they could previously perform, and 34 per cent suffer with PTSD (post-traumatic stress disorder).5
During the event, we heard from sepsis survivors of the many challenges faced when returning to ‘normal’ life and work. This included dealing with the hidden long term-symptoms while friends and colleagues might not be able to ‘see’ any physical changes. Participants at the event provided testimonies of the mental challenges experienced including second-guessing every runny nose or upset stomach as potentially the start of another sepsis infection. A debate was sparked on the chance of ‘lightening striking twice’ – are survivors more resilient and therefore likely to see a recurrence or are they in fact more susceptible Like so many aspects of sepsis, more research and data points are required to have an answer to the dilemma.
We heard from family members of people impacted by sepsis. Sepsis places a huge burden on the partner and family members of the patient, with problems navigating the challenges of caregiving and emotional distress as well as potentially dealing with long-term lifestyle adjustments and the unknown survival rates. The need for comprehensive support systems and patient advocacy, both during and after the patient’s treatment, was a consistent theme of families’ experiences. Attendees at the event showed their appreciation for occupational health professionals who provide tailored assessments, rehabilitation plans, and workplace adjustments, empowering sepsis survivors to regain independence and return to the ‘normal life’ craved after the traumatic experience.
There was intense discussion on the importance of clinicians listening to family members concerns about the patient, particularly at the very early stages of sepsis diagnosis. We heard how, since April 2024, ‘Martha’s Rule’ was being rolled out to at least 100 hospitals enabling patients and families to seek a second urgent review if the patient’s condition is believed to be rapidly worsening but they feel they are not getting the care they need.6 This ‘rule’ was a response to the heartbreaking case of 13-year-old Martha Mills who died from sepsis in 2021, following the failure to escalate her to intensive care, after her family’s concerns about her deteriorating condition were not responded to promptly. The attendees at the event welcomed this important patient safety initiative but acknowledged the importance of raising awareness of this ‘rule’ and empowering everyone to feel confident in calling for Martha’s rule to be applied.
What are the clinical challenges in recognising and treating sepsis?
During the event, we heard about the challenges in diagnosing and treating sepsis across the NHS. The non-specific symptoms often mimic other conditions, making early identification difficult. The varied patient presentations, ranging from mild (but often quick to decline) to life-threatening, further complicates diagnosis. This is particularly challenging in busy A&E departments where time constraints and pressure for rapid assessments can hinder the thorough investigations sometimes needed to confirm sepsis.
Moreover, identifying the source of infection to administer the most effective antibiotics can be problematical and time-consuming. Susceptibility testing, the standard test for identifying the most effective antimicrobial, requires 24 hours of incubation before the appropriate narrow-spectrum antimicrobial can be identified, necessitating the initial use of broad-spectrum antimicrobials. Studies are ongoing into rapid diagnostic tests as optimising antibiotic use is essential to increase chances of successful treatment, minimise adverse antibiotic effects and curb the rise of AMR.7,8 Septic shock, a severe complication of sepsis, further increases the complexity of care, requiring intensive resources and organ support. Survivors often experience long-term physical, cognitive, and psychological effects necessitating specialist ongoing care and rehabilitation.
How to help improve sepsis outcomes?
To help improve sepsis outcomes, the UKST is calling for the government to:
- Measure and publish performance data on the sepsis care pathway. Reliable data are needed to understand the quality of NHS sepsis care, identify opportunities for improvement and provide targeted support where needed.
- Empower frontline decision-making with better integration of rapid diagnostics. There is no single test to diagnose sepsis, but diagnostics help doctors make important decisions about the types of treatment to use. Diagnostic tests are typically done in centralised laboratories, which means clinicians have to wait for the results. Time is of the essence when treating sepsis, so health professionals need access to fast and reliable tests to reduce preventable deaths.
- Raise awareness of the signs and symptoms of sepsis and signpost rehabilitation services to reduce pressures on the NHS. Empowering the public to ‘Just ask “Could it be sepsis?” can help save lives, and ensuring survivors have access to ongoing care and support will help keep them well and out of hospital.9
Conclusion
The UKST's "Sepsis: Time to Act" event served as a powerful reminder of the devastating impact of sepsis and the urgent need for collective action. While the UKST has made commendable progress in raising public awareness, it is crucial to translate this awareness into concrete steps that improve patient outcomes. By focusing on data-driven insights, empowering frontline healthcare professionals with rapid diagnostics, and providing comprehensive support for survivors, we can strive towards a future where sepsis is detected early, treated effectively, and its long-term consequences mitigated. The poignant stories shared at the event underscore the human cost of sepsis and the need to continue to invest in research, education, and advocacy.
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1 https://www.who.int/news-room/fact-sheets/detail/sepsis
3 Ibid.
4 Ibid.
5 Ibid
6 https://www.england.nhs.uk/2024/02/nhs-to-roll-out-marthas-rule/
7 https://www.imperial.nhs.uk/about-us/blog/more-effective-treatment-for-patients-with-sepsis
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