Please, can you introduce yourself and tell us more about the UK Sepsis Trust and its primary mission statement?
My name is Dr. Ron Daniels, I am an Intensive Care Consultant in Birmingham in the West Midlands, and I am also the founder and CEO of the Sepsis Trust in the UK. The charity has a mission to reduce unnecessary loss of life from sepsis, as well as improve outcomes for survivors. We do this through three courses of action. The first and perhaps most important is providing support to people with sepsis. We have support groups for people with this condition, support groups for survivors, as well as their families, and we also provide financial and legal advice to people.
A second course of action in the clinical space. We offer solutions such as the Sepsis VI Tool for Health Professionals, which is now used across the UK and in many other countries around the world. We also provide education to support these tools.
The third track is to raise public awareness because it is not a good idea to ensure that health professionals are well trained if people wait at home as they deteriorate before applying to healthcare professionals. We encourage members of the public to obtain and access health care in a timely manner.
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Sepsis affects approximately 50 million people worldwide each year. What exactly is sepsis, how is it diagnosed, and why is it important to identify it at an early stage?
Sepsis is the way the body responds to infection. It is always triggered by infection, and in the case of sepsis, the immune system goes to an excessive level. If we don’t stop it, it will start causing organ damage. Infections that lead to sepsis are common. It’s things like pneumonia, urinary tract infections, tummy problems, or sometimes something as simple as a cut, bite or sting.
In terms of how to identify it, it can be very difficult to recognize sepsis. In many people it can develop insidiously, with the disease slowly deteriorating, sometimes over 72 to 96 hours. It can develop in people of any age, and it can arise as a result of any infection. Therefore, there is no single set of criteria to look for to help us identify sepsis. What is needed is a high index of clinical suspicion.
We build a picture for the first hour or two of the patient being with us. This image will include data from blood tests, other lab data, as well as monitoring of the patient’s vital signs and clinical history. When we build this picture, in the UK we’re looking for red flags or a very high NEWS2 score, and internationally, the academic standards are a change in something called a SOFA score, or SOFA score.
In terms of why time is sensitive and why it is time critical, it is because sepsis is a medical emergency. In severe cases, just a few hours can make the difference between life and death. We know that getting a patient treated early is better than getting treatment later. In severe cases, we should start treatment within the first hour; In less severe cases, we can allow up to three hours to deliver treatment to the patient.
Sepsis can be difficult to detect due to the range of symptoms it can cause. Do you have any advice on how people can easily recognize the symptoms of sepsis?
The key to sepsis is realizing that infection can, in some cases, lead to sepsis, and knowing where to look for symptoms. The first tip is to trust your instinct. If you or a loved one is deteriorating due to infection, and especially if you have not seen this person well before, then if you are in the UK you need to go to 111 or make an appointment to see a GP and just ask, can you Have sepsis?
If you think someone is seriously ill, and if you are very concerned about it, they should go to the NHS website or another source like you and look for symptoms of sepsis, which should direct them to A&E. Now, for adults, these symptoms spell the word sepsis:
- s to cause confusion or confusion
- e For severe muscle or joint pain
- s For not urinating a day
- s For severe shortness of breath
- I Because it looks like I’m going to die
- s For mottled, discolored or very pale skin
Any one of these six in the course of infection means going straight to A&E.
Many people remain unaware of the life-altering 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 still experience life-altering effects one year later, and they can range from relatively mild symptoms, such as restless thoughts and disturbed sleep, to disability, which can be very tiring. Or post-traumatic stress disorder, for example.
There was a study in Scandinavia that showed that 43% of adults of working age did not return to work one year after their illness. So, what we have to do is provide support and pressure to allocate resources to rehabilitate this very large and very needy population.
Can you tell us more about the relationship between sepsis and the SARS virus 2?
So, since we agreed that sepsis is the way the body responds to infection, causing organ damage, we can look at what happened to those people who became very ill with SARS-CoV-2 infection. With COVID-19, it’s very clear that in severe cases, especially those who needed intensive care, this 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 develop a secondary bacterial infection, and of course this can lead to sepsis. We anticipate that as people recover from severe illness with COVID-19, they will not be as severely ill, but are at greater risk of infection and sepsis than the general population who has not been very ill with COVID-19.
One in five deaths worldwide is related to sepsis. So, why is sepsis prevention so important, and how do you think we can move toward a common 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 equal opportunities to get the right vaccinations. It is also important that we examine the needs of individual countries in terms of access to clean water, sanitation and hygiene, as well as access to flexible healthcare systems.
The first step is to prevent as many cases as possible. The second step is to raise awareness among the general public in all countries. This should not only be in high-income countries. Most of these deaths, almost half of those deaths in poor countries, are children. Therefore, it is imperative that governments educate their populations as stipulated in the World Sepsis Declaration and the WHO Resolution on Sepsis.
The third thing is to build resilience within those healthcare systems. It ensures that supply chains mean that health professionals can access the right antimicrobials at the right time and do so in a responsible manner. It’s also about training health professionals to detect sepsis quickly and provide the best patient care.
World Sepsis Month and World Sepsis Day are celebrated annually in September. Why do you think it is so important to raise awareness of sepsis and how events like this help achieve this goal?
This is the tenth year of World Sepsis Day, which is an important event. We have now witnessed World Sepsis Day activities in 60 countries around the world. In some cases, these are joint events between hospitals and members of the public, which is of course a great way to engage local communities. In other countries, these are national events with the participation of policy makers, business leaders, organizations of health care providers, health professionals, and the general public. Through events like this, and really creating hype, including traditional and social media, we can really engage policy makers on this journey and start working towards the delivery of the WHO resolution on sepsis. I think one example of what happened is that in May of this year, at the G7 summit, health ministers committed to upholding the decision of the World Health Organization in their communiqué.
What’s next for the UK Sepsis Trust? Do you have any exciting projects coming up?
We all know that we are entering a challenging landscape for any small business or non-profit organization. We have to innovate. We need to modernize in order to provide much-needed care to our patients.
The Sepsis Trust UK is also in its 10th year and we have launched our own Power of 10 campaign. He is ambitious. We want to educate 10,000 newly qualified health professionals this year. We want to support an additional 10,000 people with sepsis, and we want to make an additional 10 million people in our country aware of sepsis. We’re on a journey to make this happen, but there is one specific example. What we’re doing is building a platform where people who have survived sepsis can access powerful resources and help guide their rehabilitation. By moving our support services into that digital space, we are very confident that we can scale up the provision of these services to a large number of patients very quickly.
Where can readers get more information?
About Dr. Ron Daniels
Ron Daniels is an NHS Consultant in Intensive Care, based at University Hospitals Birmingham, UK, and is also CEO of the Sepsis Trust UK and Vice-President of the Global Sepsis Alliance. In 2016 he was awarded the Order of the British Empire for his services to patients.
Ron’s expertise lies in transformational medicine and leadership. He leads the team leading the rollout of Sepsis Treatment Pathway 6 and is part of the team responsible for much of the policy and media engagement around sepsis in the UK and elsewhere, including as a core member of the team that ensures the 2017 resolution on sepsis is approved by the World Health Organization.
At home, Ron has worked with the NHS over the past seven years to ensure that more than 80% of patients with suspected sepsis are now rapidly receiving appropriate antimicrobials in England. He is always aware of the perceived conflict, synergies and need to collaborate with the antimicrobial stewardship agenda.