Could you please introduce yourself and tell us more about the UK Sepsis Trust and its core mission statement?
My name is Dr. Ron Daniels and I are an intensive care consultant 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, as well as improving outcomes for survivors. We do this through three lines of work. First, and perhaps most important, is to support people affected by sepsis. We have support groups for people grieving the illness, support groups for survivors as well as their families, and we also offer financial and legal advice to people.
The second workflow is in the clinical space. We offer solutions such as the Sepsis Six Treatment Tool to healthcare professionals, which is now used in the UK and many other countries around the world. We also provide education in support of these tools.
The third line is to raise public awareness because it is no good to ensure that health professionals are well trained if people wait at home getting worse before presenting themselves to health professionals. We encourage citizens to access health care and access it at the right time.
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Sepsis affects nearly 50 million people worldwide each year. What exactly is sepsis, how is it diagnosed and why is it so important to identify it at an early stage?
Sepsis is how the body responds to an infection. It’s always triggered by an infection, and in sepsis, the immune system goes into overdrive. If we don’t stop it, it starts to cause organ damage. Infections leading to sepsis are common. These are things like pneumonia, urinary tract infections, abdominal problems, or sometimes something as simple as a cut, bite, or sting.
In terms of how we recognize it, sepsis can be very difficult to recognize. It can develop in many people insidiously, with patients slowly deteriorating over a period of sometimes 72 to 96 hours. It can develop in people of any age and can arise as a result of any infection. Therefore, there is no single set of criteria to look for that will help us identify sepsis. What we need is a high index of clinical suspicion.
We build a picture during the first hour or two that the patient is with us. This image will include data from blood tests, other laboratory data, as well as vital sign monitoring and the patient’s medical history. When we build this picture, in the UK we look for red flags or a very high NEWS2 score, and internationally the academic criteria is a change in something called a SOFA score or SOFA score.
As for why it’s time-sensitive and why it’s time-critical, it’s because sepsis is a medical emergency. In the most severe cases, just a few hours can mean the difference between life and death. We know that getting treatment for the patient sooner is better than getting treatment later. In the most serious cases, we must start this treatment within the first hour; in less serious cases, we can allow up to three hours to treat the patient.
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Sepsis can be difficult to detect because of the variety of symptoms it can cause. Do you have any tips on how people can more easily recognize the symptoms of sepsis?
The key to sepsis is being aware that infections can, in some cases, lead to sepsis, and knowing where to look for symptoms. The first tip is to trust your gut. If you or a loved one is deteriorating with an infection, and especially if you’ve never seen that person this bad before, then if you’re in the UK you should call 111 or make an appointment to see your GP and ask for it , could it be sepsis?
If you think someone is seriously ill, if you’re really worried, then they should go to the NHS website or another source like yours and look up the symptoms of sepsis, which should take them straight to A&E. Now, for adults, these symptoms spell the word sepsis:
- S for confusion or confusion
- And for extreme pain in the muscles or joints
- P for not urinating in a day
- S for severe respiratory distress
- That’s why I feel like I should die
- S for stained or discolored skin, or very pale
Any of these six in the context of infection means going straight to A&E.
Many people are still unaware of the potentially life-changing side effects that sepsis can cause. Can you tell us more about the cognitive, psychological or physical sequelae of sepsis?
We know that around 40% of people who survive sepsis still have life-changing consequences after a year, and they can range from the relatively mild, such as disordered thinking and sleep disturbances, to the disability, which can be extremely disabling fatigue. or PTSD, for example.
There was a study in Scandinavia that showed that among working-age adults, 43% were still not returning to work a year after their illness. So what we need to do is support and push for the allocation of resources to the rehabilitation of this very large and much needed population.
Can you tell us more about the relationship between sepsis and SARS-CoV-2?
So, since we’ve agreed that sepsis is the body’s way of responding to infection, causing organ damage, we can look at what has happened to those people who are most seriously ill with SARS-CoV-2 infection. . With COVID-19, it is very clear that in severe cases, especially those who have needed intensive care, it is sepsis.
It is an overwhelming immune reaction to the virus that is sepsis. Therefore, SARS-CoV-2 can directly cause sepsis. A small percentage of people infected with SARS-CoV-2 have gone on to develop a secondary bacterial infection and, of course, that can precipitate sepsis. We expect that as people recover from severe illness with COVID-19, they will have a not enormous but slightly higher risk of new infections and sepsis than the general population who have not been very ill with COVID-19.
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One in five deaths worldwide is associated with sepsis. So why is sepsis prevention so critical and how do you think we can move towards a shared goal of reducing the incidence of sepsis worldwide?
You mentioned sepsis prevention. Now we can’t prevent every case of sepsis, but it’s important that people have equitable access to the right vaccines. It is also important that we look at the needs of individual countries in terms of access to clean water, sanitation and hygiene, as well as access to resilient health systems.
The first step is to prevent as many cases as we can. The second step is to raise awareness among the general public in all countries. This should not be only in high-income countries. Most of these deaths, almost half of the deaths in the poorest countries, are children. It is therefore vital that governments educate their populations as set out in the World Sepsis Declaration and the WHO Sepsis Resolution.
The third thing is to build resilience within these health systems. It is ensuring that supply chains mean that healthcare professionals can access the right antimicrobials at the right time and do so responsibly. It is also about training health professionals to detect sepsis quickly and provide the best care to patients.
Both World Sepsis Month and World Sepsis Day are held annually in September. Why do you think it’s so important to raise awareness about sepsis and how do events like these help achieve that goal?
This is the 10th anniversary of World Sepsis Day, which is a milestone. We have now seen World Sepsis Day events in 60 countries around the world. In some cases, these are joint events between hospitals and members of the public, which of course is a great way to involve local communities. In other countries, these are national events involving policy makers, business leaders, health provider organizations, health professionals and the general public. Through events like this, and by really raising the noise, even on social and traditional media, we can get these policy makers involved in this journey and start working towards the delivery of the WHO Resolution on the sepsis I think that an example of what has happened is that in May this year, at the G7 Summit, the Ministers of Health undertook to strengthen the WHO Resolution in their statement.
What’s next for the UK Sepsis Trust? Do you have an exciting project?
We are all aware that we are entering a challenging landscape for any small business or non-profit organization. We must innovate. We must modernize to provide the care our patients so desperately need.
The UK Sepsis Trust is also in its 10th year and we’ve launched our Power of 10 campaign. It’s ambitious. We want to train 10,000 newly qualified health professionals this year. We want to support 10,000 more people affected by sepsis and we want 10 million more people in our countries to know about sepsis. We are on a path towards this, but there is a concrete example. What we’re doing is building a platform where sepsis survivors can access robust resources and help guide their rehabilitation. By bringing our support services into this digital space, we are very confident that we can scale up the delivery of these services to a large number of patients very quickly.
Where can readers find more information?
About Dr. Ron Daniels
Ron Daniels is an NHS consultant in critical care, based at University Hospitals Birmingham, UK. He is also Chief Executive of the UK Sepsis Trust and Vice-Chair of the Global Sepsis Alliance. In 2016 he was awarded the British Empire Medal for services to patients.
Ron’s expertise lies in translating…