Who is at risk of sepsis?

Sepsis can affect anyone with an infection at any time but particular groups of people are at greater risk. Those include:

• Anyone with an infection that is not getting better
• Older people, newborns and young children
• Aboriginal and Torres Strait Islander people
• People with complex health conditions, chronic disease such as diabetes, kidney, liver or heart disease
• People with a weak immune system including those being treated for cancer with chemotherapy
• People with COVID-19 or pneumonia
• People who are pregnant or have just given birth
• People who have had sepsis before
• People with burns, wounds and injuries
• People with medical devices in their body such as a pacemaker, stent, catheter, or prosthetic valve
• People who have had recent surgery.

 

Signs and symptoms of sepsis

Recognising sepsis early is crucial to ensuring time-critical management and better outcomes. Sepsis can be difficult to recognise because its symptoms are often similar to those of other illnesses. However, there are warning signs that could indicate sepsis, including:

• Fever, chills, shivering or feeling cold: A person could develop a high temperature or a low temperature
• Confusion, disorientation or slurred speech: Sepsis can affect brain function leading to confusion, difficulty thinking clearly or unresponsiveness
• Fast heart rate: This could indicate that the body is struggling to fight the infection
• Rapid breathing or feeling short of breath: Breathing fast, struggling to breath, irregular breathing
• Extreme pain or discomfort: Some people have described pain related to sepsis as overwhelming and severe, particularly around the site of infection
• Clammy, sweaty, discoloured skin or a rash: A rash or discolouration of the skin that doesn't fade when pressed
• Reduced or no urine output: Sepsis can affect kidney function, resulting in little or no urine
• Nausea, vomiting and diarrhoea: Digestive issues can be seen in all people with sepsis, but particularly if the infection is in the gastrointestinal tract
• Fatigue or extreme tiredness: Feeling weak, unusually tired or exhausted is common
• Low blood pressure or dizziness: A drop in blood pressure can cause light-headedness, dizziness or fainting.

Sepsis is hard to recognise. Trust your gut, seek urgent medical attention, don't be afraid to call an ambulance and ask the question 'could it be sepsis?'.

Diagnosing sepsis

Diagnosing sepsis is challenging because its symptoms can mimic many other conditions. There is no singular diagnostic test to confirm sepsis. Rather, doctors and nurses will use a combination of clinical assessments, tests and monitoring to identify sepsis.

This process usually involves:

1. Physical examination: This might include the doctors and nurses taking a medical history during which they will ask about your symptoms, listen to your lungs, heart and bowels and check for signs of confusion.
   
   
2. Vital sign monitoring: This will include your temperature, heart rate and rhythm, which may involve putting a heart monitor on, as well as checking your blood pressure, respiratory rate and oxygen levels. These will be monitored closely for any changes.
   
   
3. Blood tests: These are essential for diagnosing sepsis. Some tests may include:
   • Infection markers: High white cell count, lactate and other inflammatory markers can suggest infection or sepsis
   • Blood cultures: These will help identify the specific pathogen causing the infection and help guide antibiotic choice
   • Organ function tests: These can show if you kidneys, liver and heart have had any damage.
     
     
4. Other tests
   • Urine tests
   • Sputum tests
   • Wound swabs
   • Respiratory swabs
   • Imaging such as X-rays, CT scans, MRI, ultrasounds
     
     
5. Sepsis pathway: Sir Charles Gairdner Osborne Park Health Care Group (SCGOPHCG) has an adult sepsis pathway to help identify those at risk of sepsis and for the treatment of sepsis.

 

How is sepsis treated?

The sooner sepsis is treated, the better the chances of recovery. If identified and treated early most patients will make a full recovery. You will be reviewed by a senior doctor who will diagnose sepsis. Treatment usually involves a combination of interventions:

1. Intravenous (IV) antibiotics: Early administration of broad-spectrum antibiotics to target a wide range of potential pathogens while waiting for test results to identify the specific bug. Once identified, the antibiotics may change to target it more effectively.
   
   
2. IV fluids: Sepsis often causes very low blood pressure, which can lead to organ dysfunction. Fluids may be given to maintain blood pressure and improve circulation.
   
   
3. Oxygen: Sepsis can reduce the oxygen supply to tissues and organs. In some cases, oxygen may be required through a nasal canula or mask.
   
   
4. Source control: If the source of infection can be identified, you may require surgery to remove the source of infection.
   
   
5. Specialist care: In some cases, sepsis requires specialist care in the Intensive Care Unit (ICU) for organ and blood pressure support.
   
   
6. Coordinated care: Sir Charles Gairdner Hospital is the first hospital in Western Australia to have an adult sepsis clinical nurse consultant. The Sepsis Service is under development but aims to provide coordinated sepsis care to patients, their families and staff through each person's sepsis journey.

Dealing with complex health conditions such as sepsis can be overwhelming. Let your healthcare team know if you need more information or support.

If you are worried at any time, please use Aishwarya’s CARE Call for guidance on what to do next.

 

Intensive Care Unit

Sepsis can develop rapidly, and patients may become critically ill. In some cases, specialist treatment in the Intensive Care Unit (ICU) will be required to manage the condition and support the body's organs.

If you or a loved one requires specialist care in the ICU for sepsis and sepsis shock this may include:

• Continuous monitoring: Our team will monitor your vital signs closely by placing you on a continuous monitor. Monitoring your vital signs closely is crucial for assessing and managing your sepsis care. It allows us to respond quickly to any changes in condition.
  
  
• Blood pressure support: Sepsis can cause dangerously low blood pressure, which can lead to your vital organs not getting enough blood flow and oxygen. The use of strong medications called vasopressors may be required to stabilise and support your blood pressure. A large drip called a central line may be placed into your neck or groin to deliver this medication.
  
  
• Dialysis: Sepsis can damage your kidneys, preventing them from working properly. Usually, the kidneys work to filter out waste products produced by the body and remove excess fluid. Dialysis may be required to take over this function until kidney function improves. A large drip will be placed in the neck or groin and blood will be pumped through the dialysis machine to be filtered and then returned to circulation.
  
  
• Non-invasive ventilation: To assist with breathing we may place a mask over your face that is connected to a breathing machine (ventilator). This will provide support as you breathe in and out. It can feel uncomfortable at first but will make breathing much easier.
  
  
• Invasive ventilation: For patients requiring more intensive support, we may use a ventilator connected to a breathing tube that would be placed down your throat. You will be put to sleep with sedatives and painkillers, and we would control your breathing while your body focuses on beating the infection.

 

Patient diary

Patients who have stayed in the ICU may experience lost time, gaps in their memory, nightmares and confusion. A recent innovation to help fill these memory gaps and help patients have a better understanding of what happened to them in ICU is the use of a patient diary.

The diary can be written in by friends, family and healthcare providers and detail your progress each day and what happened while you were asleep. You may not feel ready to look at your diary straight away. It can be an emotional process, so take it slowly and have your family there to support you.

 

Life after sepsis and post-sepsis syndrome

Sepsis does not always end when the infection is treated. Many patients who have survived sepsis will experience long term physical, emotional and psychological effects, a condition known as post-sepsis syndrome (PSS). These effects can last weeks, months or even years, impacting your quality of life. It's a condition that affects up to 50 percent of sepsis survivors.

The risk of developing PSS is higher among people admitted to the ICU or those who have had a prolonged hospital admission. While PSS is not fully understood, it's believed to occur because the body's inflammatory process causes widespread damage to tissues and organs, which can take time to heal. The psychological toll of being critically ill and possibly having an admission to the ICU can also contribute to long-term emotional and mental health challenges.

 

Signs and symptoms can include:

Emotional and psychological symptoms

• Post-traumatic stress symptoms
• Nightmares
• Anxiety
• Depression
• Sadness
• Mood swings
• Clouded thinking
• Difficulty concentrating
• Fatigue and tiredness
• Poor memory
• Reduced attention span
• Difficulty sleeping
• Panic attacks
• Hallucinations

 

Physical symptoms

• Difficulty swallowing
• Muscle weakness
• Weight loss, lack of appetite, food tasting different
• Brittle nails & hair loss
• Body aches or pains
• Headaches
• Visual and speech disorders
• Chronic nerve pain such as tingling and intensified pain in extremities
• Joint and muscle pain, including paralysis

Sepsis survivors have an increased risk of experiencing sepsis again, particularly in the first few months after recovery. One in every 4 sepsis survivors will be readmitted to hospital within 30 days, most commonly due to infection. This is thought to be due to a weakened immune system, pre-existing health conditions and organ damage. Sepsis survivors should take steps to prevent infection, including:

• Practise good hygiene - keep your body and hands clean.
• Avoid being around anyone who is sick.
• Monitor wounds, inspect bites and cuts closely. If they are not healing or become red or hot, make sure you visit your GP.
• If you develop an infection, make sure you see your GP and take antibiotics as prescribed.
• If you go to hospital or visit a doctor, make sure you inform them of your past diagnosis of sepsis.
• Stay up-to-date with your vaccinations, including your annual flu shot.
• Look after your chronic diseases.
• Maintain a healthy lifestyle by eating a healthy, balanced diet and getting enough physical exercise to rebuild your strength.
• Know the signs and symptoms of sepsis, act fast and seek medical care immediately.

 

For families, carers and loved ones

How can you help?

1. Be patient: Recovery takes time, and sepsis survivors may experience setbacks or slow improvement. Patience and understanding go a long way in supporting them through the process.
   
   
2. Provide emotional support: Sepsis survivors often struggle with anxiety, depression or feelings of frustration. Offer a listening ear, provide encouragement and remind them that it's okay to take things one day at a time.
   
   
3. Assist with daily activities: Simple tasks that may have once been easy, such as walking, cooking, or even dressing, can feel overwhelming after sepsis. Helping with these activities can alleviate stress and promote a smoother recovery.
   
   
4. Encourage physical and cognitive rehabilitation: Many sepsis survivors benefit from physical therapy, occupational therapy, or cognitive exercises to regain strength and focus. Encouraging consistent participation in these programs can aid in their recovery.
   
   
5. Stay informed and involved: Understanding PSS and how it affects the person can help you recognise when they may need more help or when to celebrate small victories. Attending medical appointments with them or learning about sepsis recovery together can deepen your understanding and strengthen your support.

 

Helpful websites

Sepsis Australia (external site)

Sepsis Awareness Resources (external site)

Sepsis Clinical Care Standard (external site)

Maternal sepsis (external site)

Pregnancy and childbirth (external site)

Global Sepsis Alliance (external site)

The UK Sepsis Trust (external site)

Is it sepsis? (external site)

Post-Sepsis Syndrome (external site)

My Life After ICU (external site)

The Australian & New Zealand Intensive Care Foundation (external site)

 

Support groups and sepsis stories

Australia & NZ Sepsis Support Group - Facebook (external site)

Maddy Jones Foundation for Sepsis Prevention (external site)

Matthew's Story (external site)

Mandy and Rod McCracken (external site)

Sepsis Awareness Tasmania - Facebook (external site)

Coma to confidence (external site)

 

Bereavement support

Bereavement booklet (PDF)

Life After Sepsis (PDF)

Bereavement support after sepsis (PDF)

Beyond Blue (external site)

Carers WA (external site)

Relationships Australia (external site)

Centrecare (external site)

Anglicare (external site)

Yorgum Healing Services (external site)

Metropolitan Migrant Resource Centre (external site)

Centre for Grief and Bereavement (external site)

Compassionate Friends WA
Peer support group after the death of a child (any age, any cause); for parents, siblings or grandparents
Tel: 1300 064 068 or (08) 6107 6257

Solace Grief Support WA
Peer support group and phone support for those grieving the death of a partner
Tel: 0488 991 084
Email: info@solacegriefsupportwa.org.au

 

Amputee support

Limbs 4 life (external site)

Amputee Support Services in Western Australia (external site)

Amputee Clinic Osborne Park Hospital
Tel: (08) 6457 8135
Email: OPH.amputee@health.wa.gov.au

National Disability Insurance Scheme (NDIS)
Tel: 1800 800 110
Web: www.ndis.gov.au (external site)

Western Australian Limb Service for Amputees (WALSA)
Tel: 1300 884 903
Email: WALSA@health.wa.gov.au

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