Can you introduce yourself and tell us more about the UK Sepsis Trust and its core mission?
my name is dr. Ron Daniels, and I am an intensive care consultant based in Birmingham in the West Midlands, and I am also the founder and chief executive of the UK Sepsis Trust. The charity is on a mission to reduce the unnecessary loss of life from sepsis and improve outcomes for survivors. We do this through three work flows. The first and perhaps the most important is by providing support to people affected by sepsis. We have support groups for people affected by the condition, support groups for survivors and their families, and we also provide financial and legal advice to people.
The second workflow is in the clinical space. We provide solutions such as the Sepsis Six Treatment Tool to healthcare professionals, which is now in use in the UK and many other countries around the world. We also provide education to support those tools.
The third stream is to increase public awareness, because it is not good to ensure that health professionals are properly trained if people wait at home with deterioration before presenting themselves to health professionals. We encourage citizens to go to healthcare at the right time.
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Sepsis affects nearly 50 million people worldwide every year. What exactly is sepsis, how is it diagnosed and why is it so important to spot it at an early stage?
Sepsis is the way the body responds to an infection. It is always caused by an infection and in sepsis the immune system goes into overdrive. If we don’t stop it, it starts to cause organ damage. The infections that give rise to sepsis are common. They are things like pneumonia, urinary tract infections, abdominal problems, or sometimes something as simple as a cut, a bite, or a sting.
In terms of how we recognize it, sepsis can be very difficult to spot. It can develop in an insidious manner in many people, with patients slowly deteriorating over a period of sometimes 72 to 96 hours. It can develop in people of any age and it can develop as a result of an infection. So there isn’t a single set of criteria to look for to help us identify sepsis. What we need is a high index of clinical suspicion.
During the first two hours we build up an image that the patient is with us. That photo includes data from blood tests, other lab data, as well as monitoring vital signs and the patient’s clinical history. When we take this picture, in the UK we are looking for red flags or a very high NEWS2 score, and internationally the academic criteria is a change in something called the SOFA score or SOFA score.
In terms of why it’s time-sensitive and why it’s time-critical is because sepsis is a medical emergency. In the most severe cases, just a few hours can make the difference between life and death. We know that it is better to treat the patient sooner than later. In the most severe cases, we have to start that treatment within the first hour; in the less severe cases, we can allow up to about three hours to treat the patient.
Sepsis can be difficult to recognize due to the range of symptoms it can cause. Do you have any advice on how to make it easier for individuals to recognize the symptoms of sepsis?
The key to sepsis is to be aware that infections can lead to sepsis in some cases, and to know where to look for the symptoms. The first piece of advice is to trust your instincts. If you or a loved one is getting worse with an infection, and especially if you have never seen this person feel so unwell, then if you are in the UK you should go to 111 or make an appointment to see the GP and just ask, would could it be sepsis?
If you think someone is seriously ill, if you are very concerned about them then they should go to the NHS website or any other source like yours and look for the symptoms of sepsis which will take them straight to the SEH should lead. Now, for adults, those symptoms spell the word sepsis:
- s for slurred speech or confusion
- E for extreme pain in the muscles or joints
- p to not pee one day
- s for severe shortness of breath
- l ‘Cause it feels like I’m going to die
- s for mottled or discolored skin, or very pale
Any of those six in the context of infection go straight to the ER.
Many people are not aware of the possible life-changing after-effects that sepsis can cause. Can you tell us more about the cognitive, psychological or physical consequences of sepsis?
We know that about 40% of people who survive sepsis after one year still have life-altering effects, and these can range from relatively mild, such as disturbed thoughts and sleep disturbances, to debilitating, which can be very debilitating fatigue. or PTSD for example.
A study in Scandinavia found that 43% of working-age adults were still out of work a year after their illness. So what we need to do is support and lobby for the allocation of resources for the rehabilitation of this very large and very needy population.
Can you tell us more about the relationship between sepsis and SARS-CoV-2?
So, because we agree that sepsis is the body’s way of responding to infection and causing organ damage, we can look at what happened to the people most seriously ill with SARS-CoV-2 infection. With COVID-19, it is very clear that in severe cases, especially those who need intensive care, this is sepsis.
It’s an overwhelming immune response to the virus that is sepsis. SARS-CoV-2 can thus directly cause sepsis. A small percentage of people infected with SARS-CoV-2 have gone on to develop a secondary bacterial infection, which can naturally cause sepsis. We expect that as people recover from severe illness with COVID-19, they will not have a huge, but slightly greater, risk of further infections and sepsis than the general population that has not been very ill with COVID-19.
One in five deaths worldwide is associated with sepsis. Why is sepsis prevention so important, and how do you think we can achieve a common goal to reduce the incidence of sepsis worldwide?
You mentioned sepsis prevention. Now we cannot prevent every case of sepsis, but it is important that people have equal access to appropriate vaccinations. It is also important that we examine individual countries’ needs for access to clean water, sanitation and hygiene, as well as access to resilient health care systems.
Step one is to prevent as many cases as possible. Step two involves raising awareness among the general public in all countries. This shouldn’t just be in high-income countries. Most of those deaths, almost half of those deaths in poorer countries, are children. So it is vital that governments educate their populations as set out in the World Sepsis Declaration and the WHO resolution on sepsis.
The third thing is building resilience within those health systems. It ensures supply chains ensure that health professionals have access to the right antimicrobials at the right time and in a responsible manner. It also involves training health professionals to quickly recognize sepsis and deliver the very best care to patients.
Both World Sepsis Month and World Sepsis Day are celebrated annually in September. Why do you think it is so important to raise awareness about sepsis and how do such events help to achieve this goal?
This is the 10th year of World Sepsis Day, which is a milestone. Now we have seen events for World Sepsis Day in 60 countries around the world. In some cases, these are joint events between hospitals and the public, which is of course a great way to involve local communities. In other countries, these are national events involving policy makers, business leaders, healthcare providers, health professionals and the general public. By events like these, and by really turning up the noise, including on traditional and social media, we can really engage those policymakers in this journey and start working towards the WHO resolution on sepsis. I think an example of what has happened is that health ministers made a commitment in their communiqué at the G7 summit in May this year to strengthen the WHO resolution.
What’s next for the UK Sepsis Trust? Are there exciting projects in the pipeline?
We are all aware that we are entering a challenging landscape for any small business or nonprofit. We must innovate. We need to modernize to deliver the care we desperately need for our patients.
The UK Sepsis Trust is also 10 years old and we have launched our Power of 10 campaign. It’s ambitious. We aim to train 10,000 newly qualified health professionals this year. We want to support 10,000 more people affected by sepsis, and we want to raise awareness about sepsis 10 million more people in our countries. There we are on a journey, but there is one specific example. What we are doing is we are building a platform where people who have survived sepsis can access robust resources and help guide their rehabilitation. By bringing our support services to that digital space, we are confident that we can very quickly scale the delivery of those services to massive numbers of patients.
Where can readers find more information?
About Dr. Ron Daniels
Ron Daniels is an NHS consultant in intensive care based at University Hospitals Birmingham, UK. He is also Chief Executive of the UK Sepsis Trust and Vice President of the Global Sepsis Alliance. In 2016 he was awarded the British Empire Medal for his services to patients.
Ron’s expertise lies in translational medicine and leadership. He leads the team driving the spread of the Sepsis 6 treatment pathway and is part of the team responsible for much of the policy and media engagement surrounding sepsis in the UK and elsewhere, including as a core member of the team that ensures the adoption of the 2017 resolution on Sepsis by the WHO.
At home, Ron has spent the past seven years working with the NHS to ensure that in the UK over 80% of patients with suspected sepsis are now getting the right antimicrobials quickly. He is always aware of the perceived conflict and synergies and the need to collaborate with the antimicrobial stewardship agenda.