Rationale and impact
These sections briefly explain why the committee made the updated recommendations and how they might affect practice.
People with neutropenia or immunosuppression
Recommendations 1.1.9 and 1.1.11
Why the committee made the recommendations
The committee carefully thought about care for people with neutropenia or immunosuppression, such as those on anticancer treatment and immunosuppressant therapies, because sepsis shares many of the same signs and symptoms as neutropenic sepsis. The committee agreed that people with suspected neutropenic sepsis are at very high risk and should be treated in line with NICE's guideline on neutropenic sepsis in people with cancer.
Initial assessment and examination
Why the committee made the recommendation
The committee agreed that the initial assessment is an important opportunity to identify people who are most at risk of sepsis. They noted that sepsis is hard to recognise (particularly in the initial stages), because the signs and symptoms are not specific. So when people who are unwell present multiple times to a GP or hospital with non-specific signs and symptoms, they may not initially be identified as at risk of sepsis. However, the committee agreed that this group is more likely to have sepsis, and they highlighted the need to ask people if they have presented before.
How the recommendation might affect practice
Asking people about multiple presentations can be done as part of the existing initial assessment, so should not require additional resources to implement. This information could allow sepsis to be diagnosed and treatment started earlier. This could reduce costs, because fewer critical care interventions would be needed at a later point.
Discharge
Why the committee made the recommendation
By consensus, the committee removed recommendations on discharge for people at moderate and low risk of severe illness or death from sepsis. The committee did not think that the initial management period was the right time to consider discharge for people at these risk levels. The section of the 2016 recommendations on providing information and safety netting was retained, as this is applicable to everyone with suspected sepsis when they are eventually ready for discharge.
How the recommendation might affect practice
This change to the recommendations is not expected to have a significant impact on practice, because safety netting information should already be provided to people who have had suspected sepsis.
Finding and controlling the source of infection
Why the committee made the recommendations
The 2016 recommendation on involving surgical teams only covered intra-abdominal and pelvic infections. Infections at other sites can be treated surgically or radiologically, and the committee expanded the recommendation by consensus to address this.
The committee discussed the timing of interventions and agreed that this would vary depending on:
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the patient
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where the source of infection was
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if the intervention would be surgical or radiological
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if an interventional radiologist was available.
Because of this, the committee could not recommend a specific timeframe for interventions. However, they agreed that interventions should be carried out as soon as possible.
How the recommendations might affect practice
Prompt source control could mean fewer critical care interventions are needed at a later point, which would reduce costs.