Applicable for people over the age of 16, who are not pregnant or within 6 weeks post pregnancy:

• Adult Sepsis Pathway (PDF 1093KB), SA Health
• FAQ – Adult Sepsis Pathway (PDF 387KB), SA Health.

Applicable for all pregnant women and up to 6 weeks post pregnancy:

• Perinatal Practice Guideline: sepsis in pregnancy (PDF 984KB)

Neonate is defined as a baby born at full term and under 28 days or a premature baby whose corrected age is ≤44 weeks.

Applicable for neonates before they are discharged home post birth:

• Paediatric Improvement Collaborative Guideline: Recognition of the seriously unwell neonate and young infant.

Applicable for neonates presenting from the community:

• Neonatal sepsis presenting from the community (PDF 303KB)

Applicable to all children from 28 days to 16 years old. (17 to 18 year-olds can use either paediatric or adult guidelines):

• Sepsis in children (PDF 339KB)
• Paediatric Improvement Collaborative Guideline: Sepsis assessment and management.

Applicable for any person who presents with a recorded temperature ≥ 38°C (or are not febrile but shows signs of shock – consider sepsis without fever) AND:

• have had a stem cell or bone marrow transplant within the last 3 months, OR
• have been prescribed long term steroids for Graft vs. Host Disease, OR
• present with a ‘Febrile Neutropenia Emergency Letter’ (see Appendix 6), OR
• have had recent chemotherapy, e.g., in the last 4 weeks, OR
• are known to be neutropenic: neutrophils < 1.0 x 109/L.

Febrile Neutropenia Management (Adults) Clinical Guideline.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection – and early recognition and rapid treatment of sepsis are critical to reducing mortality.

Sepsis can progress rapidly and lead to septic shock, organ failure, and death if not recognised and treated early.

Most sepsis cases develop outside of hospitals and can complicate any infection such as pneumonia, urinary tract infection or skin infection.

• Presenting to hospital: consider sepsis in any patient with suspected infection who is acutely unwell or deteriorating.
  
• Presenting to primary care: consider sepsis in all patients with signs or symptoms of infection and refer to the Medcast Could it be sepsis? Primary Care Screening Tool (PDF 301KB)

• Tachypnoea - Adults – RR >21/min *
• Tachycardia - Adults – HR > 99 bpm *
• Altered mental state – new confusion, fatigue, drowsiness – babies difficult to wake, adults -falls
• Hypotension - Adults – SBP<100 mmHg *
• Temperature - Adults - <35.6 or >38 *
• Raised lactate - >2 mmol/L
• Oliguria – Adults <0.5 mL/kg/hr – Paediatrics refer to relevant pathway
• Parent/carer concern – their child (or loved one) is getting worse.  

* babies/children – refer to relevant Rapid Detection and Response (RDR) Observation Chart.

• babies and children under 5 years, especially under 3 months
• malnourished, frail or aged over 65 years
• pregnant, recently pregnant or post-partum women
• Aboriginal and Torres Strait Islander people
• people with impaired immunity – chemotherapy, chronic illness, steroids, diabetes
• people who have had recent surgery, trauma (burns), or a medical procedure
• people with a medical device or line (or recently removed)
• people with a known infection not responding to treatment
• people who have had sepsis before
• people who are re-presenting, deteriorating, or showing no improvement with the same illness.

Presenting to hospital

Follow the relevant sepsis pathway of your hospital or health network. If sepsis is suspected, the patient should be promptly reviewed by an experienced clinician.

Follow the SA Health Rapid Detection and Response (RDR) Observation Charts and consider the site capability to care for a critically unwell patient.

Presenting to primary care

Refer to Could it be sepsis? Primary Care Screening Tool (PDF 301KB) and transfer the patient urgently to hospital by ambulance.

Take blood for culture if possible and send with the patient to hospital.

Immediately treat patients with possible sepsis – don’t wait for test confirmation.

Follow the relevant sepsis pathway/guideline including:

1. Oxygen: maintain SpO2 >94% (refer to relevant pathway)
2. Vascular access: intravenous or intraosseous
3. Blood cultures: x2 and serum lactate
4. IV Antibiotics: within 30-60 minutes and refer to the Therapeutic Guidelines and the SA Health Antimicrobial Guidelines and relevant sepsis pathway/guideline
5. IV fluids: Adults – 500ml bolus of crystalloid; Neonates/paediatrics – refer to relevant pathway
6. Vasopressors: consider commencing if no improvement in haemodynamic status.

Do not delay the commencement of antibiotics.  Identify sepsis source, if not already clear, by taking diagnostic samples (e.g. sputum, urine, pus).

• Monitor: Observations (Rapid Detection and Response (RDR) chart) vital signs, lactate levels and fluid balance.
• Refer: Escalate to a higher level of care or intensive care if transient or no response to treatment and consider referral to specialist physician.
  
  Follow local escalation pathways and, in non-tertiary healthcare settings consider early consultation with SAAS/MedSTAR.
  
  
• Reassess: Review microbiology results and appropriateness of antibiotics as soon as possible.
  
  Consider source control: draining abscesses, removing infected devices, surgical consult if required.
  
  Discuss plans, goals of care and treatment options with the patient and family.

• De-escalate: If following review, the Senior Medical Officer determines the patient does not have possible or probable sepsis, consider other causes of deterioration and continue to monitor closely with frequent RDR observations.

Reconsider sepsis and recommence the relevant pathway if the patient continues to deteriorate.

• Provide patient information:
  
  • Provide sepsis information to the patient or parent/carer on the signs to watch for and when to seek medical care or return to the hospital: SA Health Brochure – Let’s talk sepsis – Patient information for adults and children (PDF 201KB)
  • For adult patients discharged home with infection, provide: SA Health Flyer – Sepsis patient discharge information for adults (PDF 59KB).

Post sepsis syndrome (PSS) describes physical, cognitive, emotional and behavioural effects of sepsis that can be short-term or long-term and can affect up to 50% of people who survive sepsis. 

Survivors may suffer from:

• sleep disturbance including insomnia
• nightmares, hallucinations, flashbacks and panic attacks
• muscle and joint pain which can be severe and disabling
• extreme tiredness and fatigue
• inability to concentrate
• impaired mental (cognitive) functioning
• loss of confidence and self-belief.

People who have a long hospital stay and especially those treated in an intensive care unit are at greatest risk of suffering PSS.

Older people who survive sepsis are also at greater risk for long-term cognitive impairment.

• Sepsis patient discharge information for adults (PDF 59KB), SA Health flyer
• Let’s talk sepsis – Patient information for adults and children (PDF 201KB), SA Health brochure
• Sepsis in adults – Know the signs poster (PDF 66KB), SA Health poster
• Sepsis in children – Know the signs poster (PDF 67KB), SA Health poster
• Life after sepsis – What adult survivors need to know (PDF 63KB), SA Health fact sheet
• ACSQHC – Information for consumers – Bereavement support after sepsis (PDF 240KB)