Sepsis for health professionals
Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs and is a major cause of morbidity and mortality worldwide.
Causes of sepsis
Sepsis can occur with any infection, most commonly respiratory, abdominal, urinary, skin and soft tissue infections. Many different organisms can cause sepsis, including bacteria, fungi and viruses, but bacteria are the most common. Sepsis can occur in widespread or localised infection.
Sepsis may occur in patients both in the community and those already being treated in hospital. In hospitalised patients, Rapidly Deteriorating Patient Observation Charts may provide early indicators of possible sepsis. Refer to local policy and procedures.
Early diagnosis and prompt treatment of sepsis is essential, including the administration of antibiotics and supportive therapy.
Risk factors for sepsis also include vulnerable people who:
- are immunocompromised
- have indwelling medical device(s)
- are 3 months or younger and aged >65years
- have had recent surgeries or wounds
A SA Health Sepsis patient discharge information flyer for adults (PDF 61KB) is available for healthcare professionals to provide to patients considered at risk of sepsis.
Signs and Symptoms of sepsis
People with sepsis can deteriorate quickly and the early signs and symptoms can be hard to recognise. It is important for everyone (clinicians, patients and carers) to ask, ‘Could it be sepsis?’
In addition to signs of infection, symptoms can be different for adults and children.
Suggested signs of sepsis in adults. A person may experience one or more of these:
- fast breathing or breathlessness
- rigor and chills
- low body temperature
- low or no urine output
- tachycardia or bradycardia
- nausea and vomiting
- fatigue, confusion or sleepiness
- a lot of pain or ‘feeling worse than ever’
- a new rash, discoloured or clammy sweaty skin
Children and infant signs
Children and infants may deteriorate rapidly.
Suggested signs of sepsis in children and infants. A child or infant may experience one or more of these:
- fast breathing or long pauses in breathing
- blotchy or discoloured skin
- skin abnormally cold to touch
- rash that doesn’t fade when pressed
- infrequent wet nappies or low urine output
- drowsiness, difficulty waking up or confusion
- restlessness or floppy limbs
- fits or convulsions
- a lot of unexplained pain
- neonate with bulging anterior fontanelle and high-pitched cry
- fast or slow heart rate
- fever or very low temperature
- persistent vomiting and not feeding or eating
Signs suggestive of septic shock or worsening of sepsis
- fever or hypothermia
- tachycardia or tachypnoea
- mottled or cold peripheries
- capillary refill time > 3 seconds
- systolic BP < 90 mmHg or mean arterial pressure (MAP) < 60 mmHg
- purpuric rash
- arterial or venous lactate ≥ 2 mmol/L
- oliguria (urine output less than 0.5 mL/kg/hour)
Treatment of sepsis
Sepsis is a medical emergency
Treatment of sepsis includes the prompt administration of antibiotics (aim to administer within one hour of suspecting sepsis), source control, intravenous fluid therapy and organ system support with vasopressor drugs, mechanical ventilation, and renal replacement therapy, as required.
Immediate management of sepsis
- assess for airway patency and administer oxygen
- immediately obtain IV access, blood cultures and baseline blood tests (including lactate) prior to taking diagnostic samples
- prescribe and administer antibiotics within 60 minutes; Refer to the SA Health Antimicrobial Guidelines
- IV fluid bolus if patient showing signs of shock/hypoperfusion; repeated as required
- if sepsis is suspected, the patient is promptly reviewed by an experience clinician; the patient is escalated to a higher level of care or intensive care if transient or no response to treatment
- identify source of sepsis if not already clear by taking other diagnostic samples (sputum, urine, pus)
- monitor fluid balance and urine output
People and families affected by sepsis
Listen to Fiona who is a sepsis survivor and advocate and shares her personal journey which includes why it is important to spread the word about sepsis.
The Australian Commission on Safety and Quality in Heath Care (ACSQHC) has developed resources to support the Sepsis Clinical Care Standard and to provide information for people affected by sepsis and their families and are available on the Information for consumers – Sepsis Clinical Care Standard webpage.
Also, support services such as the Sepsis Australia provide information and assistance to people with sepsis and their families at all stages of treatment and recovery.
National Sepsis Clinical Care Standard
The Australian Commission on Safety and Quality in Health Care (ACSQHC) in partnership with The George Institute for Global Health Australian Sepsis Network has developed a Sepsis Clinical Care Standard to provide guidance to clinicians and health service organisations when investigating and managing sepsis, and information to consumers about the care they can expect to receive.
The standard was launched by the ACSQHC June 2022 and will support doctors, nurses and other frontline healthcare workers to recognise the signs of sepsis and to identify patients who need urgent assessment and treatment.
The Sepsis Clinical Care Standard contains seven quality statements to ensure sepsis is recognised early and patients receive coordinated, best-practice care to reduce the risk of death or ongoing morbidity.
- Quality statement 1 – Could it be sepsis?
- Quality statement 2 – Time-critical management
- Quality statement 3 – Management of antimicrobial therapy
- Quality statement 4 – Multidisciplinary coordination of care in hospital
- Quality statement 5 – Patient and carer education and information
- Quality statement 6 – Transitions of care and clinical communication
- Quality statement 7 – Care after hospital and survivorship
Additionally, there are 11 local monitoring indicators (that support the seven quality statements). The indicators support healthcare services to monitor how well they are implementing the Sepsis Clinical Care Standard.
To help healthcare services implement the Sepsis Clinical Care Standard, the Australian Commission on Safety and Quality in Health Care (ACSQHC) has released to improvement tools:
- Self-Assessment tool to allow services to assess their progress in implementing key elements of the standard.
- Indicator Monitoring tool is a data repository, analysis and reporting tool for the standard indicators.
For further information on Sepsis for health professionals, contact SA Health's Communicable Disease Control Branch on 1300 252 272.