Every three seconds, someone in the world dies of sepsis.
Sepsis is a life-threatening condition that can arise from any infection. It remains one of the most common but least recognised illnesses in both the developed and developing world.
Every hour, five people in the UK lose their lives to sepsis, and it kills more than breast, bowel and prostate cancer combined.
In late 2019, the Fifth Senedd’s Health, Social Care and Sport Committee started an inquiry into Sepsis. One of the Committee Members, Angela Burns AM, was a sepsis survivor herself. The Committee begun hearing oral evidence in early 2020, but the inquiry was halted when COVID-19 hit.
On World Sepsis Day (13 September), this article looks at the current state of play with sepsis and highlights the ongoing relevance of the issues raised during the inquiry.
What is sepsis?
Sepsis is a medical emergency, arising when a person’s immune system overreacts to an infection and starts to damage their body’s own organs and tissues. It can result in multiple organ failure and death if not treated urgently. Yet with early diagnosis it is often treatable.
Every year, 245,000 people in the UK are affected by sepsis, and there are 48,000 sepsis related deaths.
Even for those who survive, it can be a long road to recovery. Around 40% of sepsis survivors experience physical, cognitive, and/or psychological after effects. Some are adjusting to life with limb amputations or Post Traumatic Stress Disorder (PTSD), and some experience a variety of physical, cognitive and psychological difficulties longer term - this is known as Post Sepsis Syndrome.
Causes and symptoms
Anyone with an infection can get sepsis. For example it could start with a chest infection, a Unitary Tract Infection (UTI), or even an infection after a minor wound, as the Chief Executive of Healthcare Inspectorate Wales recently experienced (after nicking his finger while cooking). It is not known why some people develop sepsis in response to common infections and others do not.
Symptoms present differently in adults and children:
What are the symptoms?
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Symptoms in children under 5 A child under 5 may have sepsis if they:
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Symptoms in children A child may have sepsis if he or she:
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Symptoms in adults An adult may have sepsis if they show any of these signs: Slurred speech or confusion Extreme shivering or muscle pain Passing no urine (in a day) Severe breathlessness It feels like you're going to die Skin mottled or discoloured |
Source: The UK Sepsis Trust
See the UK Sepsis Trust’s ‘Get Sepsis Savvy’ resources for more information.
NHS 111 Wales advises “if you think you or someone you look after has symptoms of sepsis, call 999 or go to A&E. Trust your instincts”. Sepsis needs treatment in hospital straight away because it can get worse quickly.
The need to improve community awareness
There have been repeated calls for a public awareness campaign on sepsis, to improve recognition in the community and expedite referrals.
During the inquiry, Terence Canning from the UK Sepsis Trust emphasised the importance of equipping the public with information on the signs of sepsis, so they can use this knowledge when presenting to health professionals. He also noted that healthcare staff, like GP receptionists, can play a vital role in escalating patients quickly if they are aware of the signs of sepsis.
The Royal College of Nursing (RCN) Wales and the UK Sepsis Trust pointed to the success of the ‘Act FAST’ campaign for stroke. The UK Sepsis Trust noted that like stroke, sepsis is a time critical illness, with the risk of mortality increasing by 8% for every hour that a patient with sepsis does not receive antibiotics.
Public Health Wales said at the time it was keen to collaborate with the UK Sepsis Trust to explore the possibility of an awareness campaign.
During the inquiry there was general agreement that while progress had been made in acute settings, further work and training are needed to raise professional awareness of sepsis in other settings, particularly in primary care and communities.
Members of the previous Committee heard that the role of the GP must include ‘safety netting’, for example if a patient has an infection, giving them information and advice on symptoms to look out for, and what to do if they deteriorate.
According to the Royal Pharmaceutical Society Wales, treatment failure for Urinary Tract Infections (UTIs) in the primary care setting is a significant contributory factor for the rise in sepsis hospital admissions.
Latest findings about public awareness
A new YouGov survey (2024) commissioned by the UK Sepsis Trust found record general awareness levels of the condition: 94% of the public are aware of sepsis, and 91% recognise it as a medical emergency.
Despite this progress, the survey also found a limited understanding of the symptoms; with only 31% of people confident they would recognise if they or someone else might have sepsis.
The UK Sepsis Trust is calling on governments to raise awareness of the signs and symptoms of sepsis, as “empowering the public to ‘Just ask, “Could it be sepsis?” can help save lives”.
Support for sepsis survivors
Evidence to the inquiry showed a clear lack of support available for those who survive sepsis, and that many are unprepared for the difficulties they face during their recovery. Dr Paul Morgan from Cardiff and Vale University Health Board said:
Primary and community care services are ill-equipped to provide - and often largely ignorant of - the needs of sepsis survivors. The only secondary care services are those provided to amputees. This is a wholly-inadequate service provision.
Stakeholders like the UK Sepsis Trust want to see information provided to sepsis patients on discharge from hospital to prepare them for what may lie ahead and signpost to support, as well as increased provision of specific support services to help survivors in their recovery.
Recently the UK Sepsis Trust found (2024) that 83% of survivors in the UK were not told about Post Sepsis Syndrome by healthcare professionals, and 68% of survivors and 64% of caregivers of survivors were not given information about support resources and services after sepsis.
During the inquiry, Public Health Wales was enthusiastic about improving post sepsis support, saying there's a real opportunity for some great work in Wales to develop what person-centred care would look like for sepsis survivors. When asked about timescales, Dr John Boulton said he’d hope this would be up and running within 12 months.
Unfortunately the COVID-19 pandemic hit soon after, diverting focus elsewhere (and plans for work to improve public awareness and post sepsis support did not progress). The UK Sepsis Trust believes that decline in sepsis outcomes is related to a de-prioritisation of sepsis in the wake of the pandemic. Dr Ron Daniels said:
During the Covid-19 pandemic, attention to sepsis care understandably diminished, leading to gaps in timely and effective treatment. As we emerge from the pandemic, it’s crucial to refocus our efforts on this life-threatening but often treatable condition.
The UK Sepsis Trust (UKST) is urging governments to reprioritise sepsis, ensuring it is treated with the same urgency and resources as strokes and heart attacks.
On World Sepsis Day, the Global Sepsis Alliance is issuing a call for worldwide action, in the 2030 World Sepsis Declaration.
The Alliance calls on all relevant stakeholders to commit to its 6 key targets, and calls on each country to formalise a national action plan to deliver these targets by 2030 (less than 6 years away). It says this is required “to ensure the necessary multi-agency, global response to address the burden of the huge numbers of episodes and deaths from sepsis”.
Article by Amy Clifton, Senedd Research, Welsh Parliament
