• Reference Number: HEY1043/2019
• Departments: Trustwide - Adult
• Last Updated: 4 April 2019

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet but it is not intended to replace the discussion between you and the healthcare team. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is sepsis?

Sepsis is another term for severe infection. Sepsis is a relatively new term but severe infections have always been a problem. They used to sometimes be called septicaemia or blood poisoning.

Infections are common and most people recover from them without too many problems. Sepsis is less common but can be very serious.

Sepsis can move from a mild illness to a serious one very quickly, which can be very frightening for patients and their relatives.

This abnormal reaction of the immune system can happen to anyone in response to any infection but it is most common with bacterial infections such as pneumonia (chest infection), meningitis or urinary tract infections (water infection). 

How does sepsis start?

Sepsis always starts with an infection. In the UK this is usually a bacterial infection but it can also sometimes be a viral infection such as ‘Flu’. The commonest types of infection that can lead to sepsis include:

• Pneumonia (infection in the lungs often also called chest infection)
• Urinary tract infection (cystitis/ water infection)
• Meningitis (infection in the fluid around the brain)
• Cellulitis (skin infection often in the legs)
• Wound infection after surgery

Often these infections start with very general symptoms such as fevers and muscle aches and lots of people think they are just starting to get ‘Flu’.

Who is at risk of getting sepsis?

Bacterial infections are common and can affect anyone from very young babies to the very old. Very few people that get an infection will go on to develop sepsis but it could happen to anyone that gets a severe infection. However, there are some groups of people that are more at risk of developing sepsis and these include:

• Very young babies
• Very old people
• Women who are pregnant or have just given birth
• People on medication which decreases the immune system such

as steroids (Prednisolone), Azathioprine or Methotrexate

• People with cancer especially if they are on chemotherapy
• People who have recently had surgery
• People who have had an organ transplant
• People with liver disease

How do you feel when you get sepsis?

At the beginning of the infection you will probably feel generally unwell. You may have muscle aches and pains and fevers and feel as if you were starting to get ‘Flu’. You may then develop symptoms associated with the underlying infection. For example, in pneumonia you are likely to develop a cough and perhaps some pain in your chest. In a urinary infection you will start to get pain when passing urine.

As the infection gets worse and sepsis starts to develop you may have some or all of the following:

• Feel cold and shivery
• Feel hot and sweaty and looked flushed
• Feel very tired and unable to do even simple tasks
• Feel short of breath as if you can’t breathe properly
• Feel sick, vomited and or had diarrhoea
• Go off your food and not felt like eating
• Not passing much urine
• Start to struggle to get your words out or be confused
• Your skin may become cold, blue or mottled
• You may feel very scared and as if you were going to die

What happens to your body when you get sepsis?

Sepsis affects everyone differently but there are some things that happen to most people and these include:

• As part of the body’s response to fighting the infection the body temperature goes high and creates a fever. In some people the body temperature goes low instead of high.
• The blood vessels get bigger. This means that the blood has a larger space to fill and this causes the pressure in the blood vessels (the blood pressure) to drop. A low blood pressure can make you feel dizzy and light headed.
• To try and get the blood pressure up again the heart beats faster. You may feel this as an awareness of your heart racing or palpitations.
• The blood vessels also get leaky. As a result, the water part of the blood leaks out of the blood vessels in to the tissues. This means that some areas of the body such as the arms and legs become swollen and heavy.
• The blood vessels also leak fluid in to the lungs and this means that the lungs don’t work as well-meaning less oxygen gets in to the blood. This makes you feel short of breath and is if you can’t breathe properly.

What happens to you when you get to hospital?

Once sepsis starts to develop it is important that you get treatment as soon as possible. This treatment needs to be in hospital so anyone showing signs of sepsis should be taken to hospital quickly.

• Once sepsis has been diagnosed the following things should happen quickly:
• Oxygen will be given to try and increase the amount of oxygen in the blood and make your breathing feel easier.
• Blood samples will be taken. Some of these are to try and identify the bacteria that is causing the infection
•  Antibiotics to kill the bacteria causing the infection will be given straight in to the vein. Initially these antibiotics may be very broad but once the bacteria have been identified the antibiotics can be narrowed to target the bacteria specifically. Antibiotics, especially broad-spectrum antibiotics, can make you feel nauseous and can give you diarrhoea.
• Fluid will be given straight in to the vein. This is to increase the blood volume and try and increase the blood pressure.

Some people will respond quickly to this treatment and start to feel better within a few hours. These people will be sent to normal ward within the hospital. Which ward they go to will depend to a large extent on what the underlying infection is.

Unfortunately, a few people will not respond to this immediate treatment and they may need to be taken to the Critical Care Unit (this can be either Intensive Care or High Dependency).

What can I do to help my relative or friend?

It can be very frightening to watch your relative or friend get ill so quickly and need so much medical help. Often, especially at the beginning of their treatment, the doctors and nurses will be so busy treating your relative or friend that they may not have time to stop and explain to you what is happening. Hopefully this leaflet will help to explain some of the things that may have happened. If there is something you don’t understand or are worried about ask a member of staff at the next opportunity. If you are worried about forgetting things before you get a chance to ask, then write down your questions to help you remember when you do get to speak to someone.

The support that you give your relative or friend as they are being treated is very important. You are their link to the outside world and having you around is very important to them. Some of the ways that you can help are:

• Tell the doctors and nurses about how your relative or friend was before they became unwell. This is very important information and helps the doctors to understand how fit they were. This in turn helps them to make decisions about how much treatment their body can cope with.
• Talk to your friend or relative even if they are drowsy/ sleepy and not talkative. Patients can often hear what is being said to them even if they are unconscious. Hearing a familiar voice helps to calm them down and make sense of what is happening. It doesn’t really matter what you talk to them about. People often feel embarrassed or a bit silly talking to someone who can’t talk back. Try and put these feelings aside and talk to your friend or relative just as you would if they were awake and listening to you. You can talk to them about anything from what has happened to you at work that day or what your children have been doing, to explaining what has happened to them during the day. You may also want to tell them how you feel about them. If you find all these things difficult you can read to them from a book or a newspaper instead.
• You might want to help by doing some small things that will help your relative or friend to feel more comfortable. You can brush their hair (you will be in a better position to know how they like it to be done) or keeping their mouth moist by using a special damp sponge. Ask the nurse looking after them if you are unsure.
• You can massage your relative or friend’s hands and feet. This can be very comforting to them and it can also help to reduce some of the swelling that they may have. If you do want to do this, please check with the nurse looking after your relative or friend first to make sure that you don’t disturb any drips or monitors.

This can be a very distressing and tiring time for you as well and it is important that you make sure you look after yourself. You do not have to be in the hospital 24 hours a day. Make sure you get sleep when you can and continue to eat regularly. Accept any offers of help from your friends. You are going to be much more use to your friend or relative if you are well rested.

For further information: Email   hyp-tr.sepsis@nhs.net UK Sepsis Trust at www.sepsistrust.org Facebook Group: Simply Sepsis

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and well-being and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.