Sepsis clinical pathways, guidelines and resources

Statewide sepsis pathways, guidelines and resources for the early recognition, assessment, treatment and referral of patients with sepsis and post sepsis syndrome, applicable for all healthcare settings.

SA Health hosts multiple sepsis pathways and guidelines for all patient age groups.

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

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

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:

Applicable for neonates presenting from the community:

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

Applicable for neonates within the first 72 hours of life:

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 life-threatening organ dysfunction caused by a dysregulated host response to infection

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.

  • 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.

In hospital consider sepsis in any patient with suspected infection who is acutely unwell or deteriorating.

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 - most sepsis cases develop outside of hospitals and can complicate any infection including pneumonia, urinary tract infection, or skin infection.

If sepsis is suspected:

  • arrange urgent transfer of the patient to hospital, and
  • take blood for culture if possible and send with the patient to hospital.

Refer to the Could it be sepsis? Primary Care Screening Tool (PDF 301KB), Sepsis Six – Primary Care Management Tool (PDF 823KB) and HealthPathways SA - Sepsis in Adults (Including Meningitis).

If Post Sepsis Syndrome is suspected – refer to Post Sepsis Syndrome Screening Tool (PDF 1MB).

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.

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.