National Sepsis Program

A wide range of signs and symptoms can be experienced in patients at various stages of sepsis development. While infections can potentially trigger sepsis development in everyone, a number of groups are at increased risk including:

• Newborns and young children
• Older people
• Aboriginal and Torres Strait Islander people
• People with complex health conditions
• People with COVID-19
• People with poor immune systems
• Women who are pregnant or have just given birth
• People being treated for cancer with chemotherapy
• People with burns, wounds or injuries
• Patients with indwelling devices such as a catheter
• People who have just had surgery or another procedure
• People who have previously been diagnosed with sepsis.

It should be noted that sepsis symptoms might present slightly different in children.

Signs of sepsis in adults

• Fast breathing or breathlessness
• Fever and chills
• Low body temperature
• Low or no urine output
• Fast heartbeat
• Nausea and vomiting
• Diarrhoea
• Fatigue, confusion or sleepiness
• A lot of pain or ‘feeling worse than ever’

Common sepsis signs in children

• Fast breathing or long pauses in breathing
• Blotchy or discoloured skin
• Skin that is abnormally cold to touch
• Rash that doesn’t fade when pressed
• Infrequent wet nappies
• Drowsiness – the child is difficult to wake up or confused
• Restlessness or floppy limbs
• Vomiting
• Fits or convulsions
• A lot of unexplained pain.

Sepsis contributes considerably to the burden of disease in the population¹. The global incidence of sepsis is conservatively estimated at over 30 million cases and 5.3 million deaths annually². It imposes significant economic burdens on healthcare systems³ and individuals. Sepsis is a significant cause of death and disability, particularly in children^{4, 5}. The World Health Organization (WHO) in 2017 adopted a resolution on sepsis urging action to reduce the burden of sepsis worldwide⁶.

The Commission is joining the efforts of the states and territories in light of increasing sepsis incidence¹, to improve early detection, recognition and treatment of sepsis.

National inpatient data shows that sepsis cases are increasing in Australia. The Australian Sepsis Network reports that almost 5,000, of an estimated 18,000, Australians treated in an intensive care unit die each year as a result of sepsis.

Hospital administrative data shows that 437,354 hospitalisations were recorded with a sepsis diagnosis in 739 public hospitals in Australia between 2013-14 and 2017-18. Indigenous people accounted for 5.4% (n=23,621) of all sepsis hospitalisations. However, age standardised incidence rate was 1.7 times higher among indigenous people than other Australians (1,878.4 compared with 1,119.5 per 100,000 population, respectively). Of 437,354 hospitalisations of patients with sepsis, 12.0% (n=52,297) died in hospital, which was 10.9 times higher than non-sepsis patients (1.1%). The median hospital length of stay for sepsis patients was seven times as long as the median LOS for non-sepsis patients (7.0 days vs 1.0 days respectively). About 22.3% of hospitalisations with sepsis had an ICU stay while only 2% of hospitalisations without sepsis were admitted to ICU during their stay. Nearly half of all sepsis patients had at least one comorbidity recorded with poor clinical prognosis¹.

For more information on sepsis please visit:

• Australian Sepsis Network
• World Health Organisation      
• Children’s Health Queensland Hospital and Health Service
• International Sepsis forum
• Global Sepsis Alliance
• Centers for Disease Control and Prevention

Contact the National Sepsis Program: sepsis@safetyandquality.gov.au

The Commission published a report on an epidemiological analysis of national inpatient sepsis data to ascertain its veracity.

This report presents the first national epidemiological snapshot of sepsis and its impact on Australians and was prepared by Centre for Health Systems and Safety Research - Australian Institute of Health Innovation (AIHI) at Macquarie University, Sydney, Australia.

Epidemiology of Sepsis in Australian Public Hospitals

2020

Publication, report or update

The Commission undertook a pilot study for a national retrospective medical record review examining clinical records of patients with sepsis and suspected sepsis to examine three questions:

• The relationship between sepsis ICD-10-AM coding practices, and potential under estimation of sepsis cases in Australia
• Instances of detection, recognition and clinical management of sepsis from the review that could be considered as ‘gold-standard’
• The factors that influence, or are most commonly associated with, deviation from local, district or jurisdictional sepsis clinical management guidelines, and the potential reasons for this deviation.

The project included examining data from a number of sites across different jurisdictions, including public hospitals, private hospitals, and ambulance and retrieval services.

The Commission engaged KPMG Australia to support the development of a review protocol, data collection tool, data repository solution and data analysis for the MRR project. 

A report has been prepared to provide useful background and key learnings and findings from the pilot study. The report will inform future studies in relation to the recognition and management of sepsis in acute health care settings.

Sepsis Medical Record Review: Pilot Study

2022

Publication, report or update

The Commission published a systematic review of the literature examining trigger tools that support the identification of sepsis in healthcare settings. The review was prepared by The George Institute for Global Health.


The primary focus of the review was to examine sepsis detection tools with the best supporting evidence in respect to diagnostic accuracy, and the potential for use within routine clinical practice across a variety of healthcare settings.

Further work may include communication with the states and territories based on recommendations in the report, including providing advice on routine serum lactate measurement in patients with severe infection or suspected sepsis.

Review of trigger tools to support the early identification of sepsis in healthcare settings

2021

Publication, report or update

The National Safety and Quality in Health Service (NSQHS) Standards were designed to protect the public from harm and to improve the quality of care for consumers. In implementing the NSQHS Standards, it is important that heath service organisations have processes in place to ensure consideration is given to the underlying cause of a patient’s deterioration. This allows response systems to be tailored to the specific circumstances of the patient.

The NSQHS Standards include actions that have relevance and applicability to patients experiencing sepsis. These include the requirements to have systems in place to:

• Preventing and Controlling Healthcare-Associated Infection Standard: prevent patients from acquiring preventable healthcare-associated infections, and to effectively manage these infections when they occur 
• Recognising and Responding to Acute Deterioration Standard: appropriate response system in place to manage the deterioration 

The Commission published the third edition of the National Consensus Statement: Essential elements for recognising and responding to acute physiological deterioration.

The Consensus Statement describes eight essential elements for prompt and reliable recognition of, and response to, physiological deterioration of patients in acute healthcare facilities in Australia, including sepsis patients.

National Consensus Statement: Essential elements for recognising and responding to acute physiological deterioration (third edition)

2021

Publication, report or update

The Commission has reviewed the Antimicrobial Stewardship Clinical Care Standard (AMS CCS) to further strengthen the emphasis on sepsis.

The AMS CCS was first released in 2014 and highlights the importance of prompt intravenous antibiotic treatment to prevent sepsis in people with severe infection.

The updated AMS Clinical Care Standard  (2020) is published on the Commission’s website.

Antimicrobial Stewardship Clinical Care Standard (2020)

2020

Publication, report or update

The Commission developed the Sepsis Clinical Care Standard (CCS) and supporting materials to address the need for national clinical guidance to support improvements in the delivery of sepsis care in healthcare services.

The Sepsis Clinical Care Standard will help to ensure sepsis is recognised early and patients receive coordinated, best-practice care so that the risk of death or ongoing morbidity is reduced. This includes timely recognition of sepsis, early and appropriate antimicrobial therapy and continuity of care from the acute setting through to discharge and survivorship.

The national Standard was launched via webcast on Thursday, 30 June 2022.

The Commission delivered the National Sepsis Awareness Campaign in partnership with The George Institute for Global Health. The campaign aimed to improve both general community awareness and clinician recognition of sepsis. The campaign included the development of new materials and leveraged off existing state and territory campaigns and programs.

National Sepsis Awareness Campaign was developed and delivered in three phases:

1. Phase I: scoping activities
2. Phase II: development of sepsis campaign toolkit and communications strategy
3. Phase III: campaign execution, including a commencement on World Sepsis Day 2021

Phase I

The Commission engaged The George Institute for Global Health to undertake initial scoping activities examining the evidence supporting appropriate messaging, audiences and communication channels.

Phase II

The Commission engaged Percept for conceptual design and delivery of the sepsis campaign toolkit resources. A staged rollout of toolkit resources occurred over the duration of the campaign, which commenced on World Sepsis Day 13 September 2021 and concluded on 26 November 2021.

Phase III

Utilising the findings and recommendations from the scoping review (Phase I), the draft Sepsis Clinical Care Standard quality statements, existing national and international campaigns and programs, and advice from the implementation support topic working group, the Commission considered a communication approach which focused on three key pillars:

• Awareness campaign toolkit and hosted campaign webpage
• Media / communications toolkit
• Activities and events.

Both the campaign toolkit and media toolkit are housed on a dedicated sepsis awareness campaign landing page. Print-ready resources are accessible at the campaign landing page for health service organisations and state and territory representatives conducting local campaign activities.

The Commission also developed Spotlight on Sepsis - Video Series to complement the sepsis campaign toolkit and to promote sepsis awareness among clinicians and the general community.

The Commission encourages health service organisations and state and territory representatives to support increased sepsis awareness through participation in the campaign.

Please visit the campaign landing page for more information and ways you can get involved.

Post-sepsis morbidity is a significant public health issue for Australians who survive the condition. People who survive sepsis are more likely to experience physical, cognitive and / or mental health problems after sepsis. According to the Australian Sepsis Network, 40% of sepsis survivors will re-present to hospital within thirty days, while 75% will re-present within 365 days. A recurrence of sepsis is expected in approximately 25% of total survivors.

In view of high rates of disease recurrence and associated morbidity and disability relating to survivors of sepsis in Australia, The Commission engaged KP Health to undertake a literature review (Phase I) to describe:

• The evidence regarding the burden of sepsis in the Australian population
• The impacts of sepsis on people who experience the illness
• The evidence for interventions to improve outcomes after sepsis.

Sepsis Survivorship Report

2021

Publication, report or update

In support of recommendations in the Sepsis Survivorship Report, the Commission engaged KP Health to undertake a qualitative study to investigate the lived experience of sepsis survivors, their families and carers, and bereaved families (Phase II). The Commission and KP Health have worked closely with The George Institute for Global Health to shape the project.

This qualitative research project expands the evidence base by describing the following:

• How sepsis affects people, their families and carers
• What supports people need from health services to address sepsis impacts
• What health system improvements are needed to improve sepsis outcomes.

Sepsis impacts and opportunities for health service improvement: a qualitative study

2022

Publication, report or update

Sepsis affects every person differently, and the care required depends on the severity of the illness. Some people may require a longer hospital stay. This could include time in an intensive care unit (ICU) or a paediatric intensive care unit (PICU).

Information and resources for patients, families and caregivers who have experienced an ICU or PICU journey can be found at My Life after LCU.

1. ^{Li L, Sunderland N, Rathnayake K, Westbrook JI. Epidemiology of Sepsis in Australian Public Hospitals. Sydney: ACSQHC; 2020.}
2. ^{Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. American journal of respiratory and critical care medicine. 2016;193(3):259-72.}
3. ^{Arefian H, Heublein S, Scherag A, Brunkhorst FM, Younis MZ, Moerer O, et al. Hospital-related cost of sepsis: A systematic review. The Journal of infection. 2017;74(2):107-17.}
4. ^{Kissoon N, Reinhart K, Daniels R, Machado MFR, Schachter RD, Finfer S. Sepsis in Children: Global Implications of the World Health Assembly Resolution on Sepsis. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2017;18(12):e625-e7.}
5. ^{Schlapbach LJ, Straney L, Alexander J, MacLaren G, Festa M, Schibler A, et al. Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002-13: a multicentre retrospective cohort study. Lancet Infect Dis. 2015;15(1):46-54.}
6. ^{Schlapbach LJ, Thompson K, Finfer SR. The WHO resolution on sepsis: what action is needed in Australia? The Medical journal of Australia. 2019.}