People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
Healthcare professionals should follow our general guidelines for people delivering care:
NICE has also produced visual summaries on:
If they meet any high-risk criteria, refer people aged 16 or over with suspected sepsis in the community and in custodial settings for emergency medical care (see table 1).
Use the most appropriate means of transport (usually 999 ambulance).
Emergency care requires facilities for resuscitation to be available and, depending on local services, may be an emergency department or medical admissions unit. [2016, amended 2024]
Pre-alert secondary care (through GP or ambulance service) when any high-risk criteria are met in a person aged 16 or over with suspected sepsis in the community or in a custodial setting and transfer them immediately. [2016, amended 2024]
For people in an acute mental health setting who are aged 16 or over and are at high risk of severe illness or death from sepsis, refer for emergency medical care. [2024, amended 2025]
For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on when to transfer immediately: people in mental health settings.
Full details of the evidence and the committee's discussion are in evidence review C: early management of suspected sepsis (except antibiotic therapy) in the NEWS2 population, in acute hospital settings.
Ambulance crews should consider a time-critical transfer and pre-alerting the hospital for people aged 16 or over with suspected or confirmed infection who either have consecutive NEWS2 scores of 5 or above or show cause for significant clinical concern. [2024]
When deciding whether a time-critical transfer and pre-alerting the hospital is needed for someone aged 16 or over with consecutive NEWS2 scores of 5 or above and suspected or confirmed infection, take into account:
local guidelines and protocols in relation to clinician scope of practice
agreements on transfer to hospital
advance care planning
end of life care planning. [2024]
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on transfer by ambulance for people with consecutive NEWS2 scores of 5 or above.
Full details of the evidence and the committee's discussion are in evidence review B: managing and treating suspected sepsis in acute hospital settings; antibiotic treatment in people with suspected sepsis.
In ambulances and acute hospital settings, on taking over care for someone whose risk of severe illness or death from sepsis has originally been evaluated in the community or in a custodial setting, evaluate their risk of severe illness or death from sepsis using NEWS2. [2024]
In remote and rural locations where transfer time to emergency department is routinely more than 1 hour, ensure GPs have mechanisms in place to give antibiotics to people with high-risk criteria in pre-hospital settings. For high-risk criteria, see table 1. [2016, amended 2024]
In remote and rural locations where combined transfer and handover times to emergency department are greater than 1 hour:
ambulance services should consider whether they need to put mechanisms in place to be able to give antibiotics to people at high risk of severe illness or death from sepsis if antibiotics have not been given before by a GP (see recommendation 1.6.1 on evaluating risk of severe illness or death from sepsis).
paramedics who are thinking about giving antibiotics should follow local guidelines. [2016, amended 2024]
See also the recommendations on choice of antibiotic therapy.
For a short explanation of why the committee made the 2024 recommendations and how they might affect practice, see the rationale and impact section on managing suspected sepsis while awaiting transfer to an acute hospital setting.
Full details of the evidence and the committee's discussion are in evidence review B: managing and treating suspected sepsis in acute hospital settings; antibiotic treatment in people with suspected sepsis.
In the community and in custodial settings, assess people aged 16 or over with suspected sepsis who meet any moderate- to high-risk criteria (as per table 1) to:
make a definitive diagnosis of their condition
decide whether their condition can be treated safely outside hospital.
If a definitive diagnosis is not reached or the person's condition cannot be treated safely outside an acute hospital setting, refer them urgently for emergency care. [2016, amended 2024]
In the community and in custodial settings, provide information about the following to people aged 16 or over with suspected sepsis who do not meet any high-risk or moderate- to high-risk criteria:
symptoms to monitor and
how to access medical care if they are concerned.
Also see information at discharge for people assessed for suspected sepsis, but not diagnosed with sepsis. [2016, amended 2024]
For people in acute mental health settings who are aged 16 or over and are at moderate risk of severe illness and death from sepsis (see recommendation 1.6.1 on evaluating risk of severe illness or death from sepsis):
get medical advice and
decide whether their condition can be treated without transfer. [2016, amended 2025]
If the person's condition cannot be treated in an acute mental health setting, refer for emergency medical care. [2016, amended 2025]
In acute mental health settings, provide information about the following to people aged 16 or over who are at low or very low risk of sepsis:
symptoms to monitor and
how to access medical care if they are concerned.
Also see information at discharge for people assessed for suspected sepsis, but not diagnosed with sepsis. [2016, amended 2024]
For a short explanation of why the committee made the 2025 recommendations and how they might affect practice, see the rationale and impact section on managing suspected sepsis when immediate transfer is not required for people in mental health settings.
Full details of the evidence and the committee's discussion are in evidence review C: early management of suspected sepsis (except antibiotic therapy) in the NEWS2 population, in acute hospital settings.
NICE has also produced a visual summary on managing risk of severe illness or death in acute hospital settings with NEWS2.
For people in hospital who have suspected infections:
start looking for the source of infection (see the section on finding and controlling the source of infection)
take microbiological and blood samples before giving an antimicrobial.
See the UK standards for microbiology investigations. [2016, amended 2024]
For a short explanation of why the committee amended this recommendation and how it might affect practice, see the rationale and impact section on finding and controlling the source of infection.
Full details of the evidence and the committee's discussion are in evidence review C: early management of suspected sepsis (except antibiotic therapy) in the NEWS2 population, in acute hospital settings.
A person is at high risk of severe illness or death from sepsis if they have suspected or confirmed infection and a NEWS2 score of 7 or above.
A person is also at high risk of severe illness or death from sepsis if they have suspected or confirmed infection, a NEWS2 score below 7, and:
a single parameter contributes 3 points to their NEWS2 score and a medical review has confirmed that they are at high risk (see recommendation 1.6.2 on evaluating risk of severe illness or death from sepsis) or
there are any other clinical reasons for concern (see recommendations 1.6.3 and 1.6.4 on taking causes for clinical concern into account when evaluating risk of severe illness or death from sepsis).
For people aged 16 or over who are at high risk of severe illness or death from sepsis:
arrange for a clinician with core competencies in the care of acutely ill patients (FY2 level or above) to urgently assess the person's condition and think about alternative diagnoses to sepsis
carry out a venous blood test, including for:
blood gas, including glucose and lactate measurement
blood culture
full blood count
C-reactive protein
urea and electrolytes
creatinine
liver function tests
a clotting screen
give antibiotics in line with recommendation 1.8.3 and the recommendations on choice of antibiotic therapy
refer to the senior clinical decision maker as soon as possible
use clinical judgement to decide whether to discuss with a consultant. [2024]
For a short explanation of why the committee made the 2024 recommendation and how it might affect practice, see the rationale and impact section on managing suspected sepsis in acute hospital settings: high and moderate risk of severe illness or death from sepsis.
Full details of the evidence and the committee's discussion are in evidence review C: early management of suspected sepsis (except antibiotic therapy) in the NEWS2 population, in acute hospital settings.
Give people aged 16 or over who are at high risk of severe illness or death from sepsis broad-spectrum intravenous antibiotic treatment, within 1 hour of calculating the person's NEWS2 score on initial assessment in the emergency department or on ward deterioration. Only give antibiotics if they have not been given before for this episode of sepsis (see recommendations 1.7.7 and 1.7.8 on managing the condition while awaiting transfer).
Also see the recommendations on finding and controlling the source of infection and choice of antibiotic therapy. [2024]
For a short explanation of why the committee made the 2024 recommendation and how it might affect practice, see the rationale and impact section on managing suspected sepsis: type and timing of antibiotics.
Full details of the evidence and the committee's discussion are in evidence review B: managing and treating suspected sepsis in acute hospital settings; antibiotic treatment in people with suspected sepsis.
Give an intravenous fluid bolus without delay (within 1 hour of identifying that they are at high risk) to people aged 16 or over with a high risk of severe illness or death from sepsis, unless contraindicated. [2025]
If people aged 16 or over need intravenous fluid resuscitation, use an isotonic electrolyte crystalloid solution (a balanced solution such as Hartmann's, or 0.9% saline if a balanced solution is not available). [2025]
Give an initial bolus of 250 ml. Ideally, give this over 10 to 15 minutes. [2025]
Give further 250 ml boluses if needed, up to 1,000 ml total (including any fluids previously given). [2025]
Reassess after each fluid bolus. [2025]
If the person has not improved enough (for example, increased blood pressure, improved consciousness level) after 1,000 ml has been given, get advice from a senior clinical decision maker. [2025]
If using a pump or flow controller to deliver intravenous fluids for resuscitation to people over 16 years with suspected sepsis who need fluids in bolus form ensure the device is capable of delivering fluid at the required rate for example at least 2,000 ml/hour in adults. [2016]
For a short explanation of why the committee made the 2025 recommendations and how they might affect practice, see the rationale and impact section on fluids.
Full details of the evidence and the committee's discussion are in:
Discuss with the critical care team or, if not available, with the senior clinical decision maker:
whether vasopressors should be given and, if so
whether they should be started peripherally, if central access is not available. [2025]
Before starting vasopressors, make a shared decision with the person and, if appropriate, their family and carers (and, if possible, their specialist or critical care team) about whether escalation is appropriate. Take into account:
their overall condition
any advance care or treatment escalation plans (also see the NICE guidelines on end of life care services and care of dying adults in the last days of life)
how urgently they need critical care – some of these discussions may not be possible in the time available. [2025]
If starting vasopressors peripherally:
follow local policies on choice of vasopressor, dose, concentration, and monitoring
ensure the peripheral line and cannula are visible and
monitor them for any signs of adverse events (in particular extravasation). [2025]
Note: not all vasopressors are licensed for this indication, so use would be off-label. See NICE's information on prescribing medicines.
For a short explanation of why the committee made the 2025 recommendations and how they might affect practice, see the rationale and impact section on vasopressors.
Full details of the evidence and the committee's discussion are in:
Recalculate the NEWS2 score periodically, in line with the recommendations on when to recalculate a NEWS2 score. [2024]
If a person aged 16 years or over who is at high risk of severe illness or death from sepsis does not respond within 1 hour of any intervention:
ensure the senior clinical decision maker attends in person and
refer to or discuss with a critical care specialist or team and
inform the responsible consultant. [2024]
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on managing suspected sepsis in acute hospital settings: high and moderate risk of severe illness or death from sepsis.
Full details of the evidence and the committee's discussion are in evidence review C: early management of suspected sepsis (except antibiotic therapy) in the NEWS2 population, in acute hospital settings.
A person is at moderate risk of severe illness or death from sepsis if they have suspected or confirmed infection and a NEWS2 score of 5 or 6.
A person is also at moderate risk of severe illness or death from sepsis if they have suspected or confirmed infection, a NEWS2 score below 5, and:
a single parameter contributes 3 points to their NEWS2 score, and a medical review has confirmed that they are at moderate risk (see recommendation 1.6.2 on evaluating risk of severe illness or death from sepsis) or
there are any other clinical reasons for concern (see recommendations 1.6.3 and 1.6.4 on taking causes for clinical concern into account when evaluating risk of severe illness or death from sepsis).
For people aged 16 or over with a moderate risk of severe illness or death from sepsis:
carry out a venous blood test, including for:
blood gas, including glucose and lactate measurement
blood culture
full blood count
C-reactive protein
urea and electrolytes
creatinine
liver function tests
a clotting screen
arrange for a clinician with core competencies in the care of acutely ill patients (FY2 level or above) to review the person's condition and venous lactate results within 1 hour of the person being assessed as at moderate risk. [2024]
For a short explanation of why the committee made the 2024 recommendation and how it might affect practice, see the rationale and impact section on managing suspected sepsis in acute hospital settings: high and moderate risk of severe illness or death from sepsis.
Full details of the evidence and the committee's discussion are in evidence review C: early management of suspected sepsis (except antibiotic therapy) in the NEWS2 population, in acute hospital settings.
For people at moderate risk of severe illness or death from sepsis, a clinician with core competencies in the care of acutely ill patients (FY2 level or above) should consider:
deferring administration of a broad-spectrum antibiotic treatment for up to 3 hours after calculating the person's first NEWS2 score on initial assessment in the emergency department or on ward deterioration and
using this time to gather information for a more specific diagnosis (see recommendations on finding and controlling the source of infection and choice of antibiotic therapy)
discussing with a senior clinical decision maker.
Once a decision is made to give antibiotics, do not delay administration any further. [2024]
For someone with a NEWS2 score of 5 or 6 and a single parameter contributing 3 points to their total NEWS2 score, use clinical judgement to determine the likely cause of the 3 points in one parameter. If the likely cause is:
the current infection, manage as high risk and give broad-spectrum antibiotic treatment in line with recommendation 1.8.3
something else (such as a pre-existing condition), manage as moderate risk and follow recommendation 1.8.17. [2024]
For a short explanation of why the committee made the 2024 recommendations and how they might affect practice, see the rationale and impact section on managing suspected sepsis: type and timing of antibiotics.
Full details of the evidence and the committee's discussion are in evidence review B: managing and treating suspected sepsis in acute hospital settings; antibiotic treatment in people with suspected sepsis.
For people aged 16 or over at moderate risk of severe illness or death from sepsis:
recalculate the NEWS2 score periodically, in line with the recommendations on when to recalculate a NEWS2 score
if there is further cause for concern (such as deterioration or no improvement), escalate care to a clinician with core competencies in the care of acutely ill patients (FY2 level or above). [2024]
For a short explanation of why the committee made the 2024 recommendation and how it might affect practice, see the rationale and impact section on managing suspected sepsis in acute hospital settings: high and moderate risk of severe illness or death from sepsis.
Full details of the evidence and the committee's discussion are in evidence review C: early management of suspected sepsis (except antibiotic therapy) in the NEWS2 population, in acute hospital settings.
For people aged 16 or over with a moderate risk of severe illness or death from sepsis and evidence of hypoperfusion (for example, lactate over 2 mmol/litre or evidence of acute kidney injury), treat their condition as if they were at high risk of severe illness or death from sepsis. [2025]
Consider giving intravenous fluids, after clinical assessment, to people aged 16 or over with a moderate risk of severe illness or death from sepsis and no evidence of hypoperfusion. See the recommendations on type and volume of fluid. [2025]
For a short explanation of why the committee made the 2025 recommendations and how they might affect practice, see the rationale and impact section on fluids.
Full details of the evidence and the committee's discussion are in evidence review F: indicators of organ hypoperfusion in people with suspected sepsis.
A person is at low risk of severe illness or death from sepsis if they have suspected or confirmed infection and a NEWS2 score of 1 to 4 (see recommendation 1.6.2 on evaluating risk of severe illness or death from sepsis), or a NEWS2 score of 0 and cause for clinical concern (see recommendations 1.6.3 and 1.6.4 on taking causes for clinical concern into account when evaluating risk of severe illness or death from sepsis).
For people aged 16 or over at low risk of severe illness or death from sepsis:
arrange for registered health practitioner review within 1 hour of the person being assessed as at low risk
perform blood tests if indicated. [2024]
For a short explanation of why the committee made the 2024 recommendation and how it might affect practice, see the rationale and impact section on low or very low risk of severe illness or death from sepsis.
Full details of the evidence and the committee's discussion are in evidence review C: early management of suspected sepsis (except antibiotic therapy) in the NEWS2 population, in acute hospital settings.
For people at low risk of severe illness or death from sepsis, request assessment by a clinician with core competencies in the care of acutely ill patients (FY2 level or above) for them to consider:
deferring administration of a broad-spectrum antibiotic treatment for up to 6 hours after calculating the person's first NEWS2 score on initial assessment in the emergency department or on ward deterioration and
using this time to gather information for a more specific diagnosis (see recommendations on finding and controlling the source of infection and choice of antibiotic therapy).
Once a decision is made to give antibiotics, do not delay administration any further. [2024]
For someone with a NEWS2 score of 3 or 4 and a single parameter contributing 3 points to their total NEWS2 score, use clinical judgement to determine the likely cause of the 3 points in one parameter. If the likely cause is:
the current infection, manage as moderate or high risk and:
for moderate risk, give broad-spectrum antibiotic treatment in line with recommendation 1.8.17
for high risk, give broad-spectrum antibiotic treatment in line with recommendation 1.8.3
something else (such as a pre-existing condition), manage as low risk and follow recommendation 1.8.23. [2024]
For a short explanation of why the committee made the 2024 recommendations and how they might affect practice, see the rationale and impact section on managing suspected sepsis: type and timing of antibiotics.
Full details of the evidence and the committee's discussion are in evidence review B: managing and treating suspected sepsis in acute hospital settings; antibiotic treatment in people with suspected sepsis.
For people aged 16 or over at low risk of severe illness or death from sepsis:
recalculate the NEWS2 score periodically, in line with the recommendations on when to recalculate a NEWS2 score
if there is deterioration or no improvement, escalate care to a clinician with core competencies in the care of acutely ill patients (FY2 level or above). [2024]
For a short explanation of why the committee made the 2024 recommendation and how it might affect practice, see the rationale and impact section on low or very low risk of severe illness or death from sepsis.
Full details of the evidence and the committee's discussion are in evidence review C: early management of suspected sepsis (except antibiotic therapy) in the NEWS2 population, in acute hospital settings.
A person is at very low risk of severe illness or death from sepsis if they have suspected or confirmed infection and a NEWS2 score of 0 (see recommendation 1.6.2 on evaluating risk of severe illness or death from sepsis).
For people who are at very low risk of severe illness or death from sepsis:
arrange for review by a registered health practitioner
use clinical judgement to manage their condition and escalate if appropriate
recalculate the NEWS2 score periodically, in line with the recommendations on when to recalculate a NEWS2 score. [2024]
For a short explanation of why the committee made the 2024 recommendation and how it might affect practice, see the rationale and impact section on low or very low risk of severe illness or death from sepsis.
Full details of the evidence and the committee's discussion are in evidence review C: early management of suspected sepsis (except antibiotic therapy) in the NEWS2 population, in acute hospital settings.
Before discharging people who have been assessed for suspected sepsis, provide information on:
the management of their definitive condition (if identified) and
warning signs for sepsis (see information at discharge for people assessed for suspected sepsis). [2024]
For a short explanation of why the committee made the 2024 recommendation and how it might affect practice, see the rationale and impact section on managing suspected sepsis in acute hospital settings: discharge.
Full details of the evidence and the committee's discussion are in evidence review C: early management of suspected sepsis (except antibiotic therapy) in the NEWS2 population, in acute hospital settings.