546100 editorial2014
BJI0010.1177/1757177414546100Journal of Infection PreventionJournal of Infection Prevention
Editorial: Sepsis and the impact of life-threatening infection – working together to make an impact
W
orld Sepsis Day, held every year on 13 September, marks the day when the world strives towards reducing the number of deaths from sepsis by 20%, by 2020. The Global Sepsis Alliance, which launched the day in 2012, have stated that every three seconds someone, somewhere, dies of sepsis. One major issue is that, contrary to global burden of disease reports, the problem isn’t confined to maternal and newborn sepsis. The true burden of sepsis, that it is one of the biggest causes of preventable deaths due to acute illness, is largely unknown to policymakers and the public. In recent years, the World Health Organization, Professor Dame Sally Davies (the Chief Medical Officer of England) and now the Prime Minister of the UK have highlighted the real threat posed to human health by antimicrobial resistance (AMR). The messaging has centred around the fact that our ability to perform planned surgery is likely to be compromised, but there is a bigger problem. We will be less able to prevent infection should the development of new antimicrobials not receive urgent attention, but we will also be unable to treat life-threatening infection. Even if the incidence of sepsis were to remain static at approximately 150–200 cases per 100,000 population per year, a lack of effective antibiotics would mean that 70,000 more people would lose their lives to sepsis each year in the United Kingdom alone. This equates to a Virgin Pendolino train crashing every week for two years, with no survivors. In September 2013, The UK Sepsis Trust led in the development of ‘The Trinity of Infection Management: United Kingdom Coalition Statement’. This statement advented a new, holistic approach to supporting the reduction of lives lost to infection. This work was only possible due to the commitment and energy of other organisations, including the Infection Prevention Society (IPS). IPS appreciated the necessity for joining a collaboration of professional groups to be part of this important step in raising the profile of sepsis, underpinned by infection prevention and antimicrobial stewardship actions, on the national agenda. Collaborative working is at the core of making an impact on patient safety and over the last couple of years the UK Sepsis Trust and IPS have worked together to understand each other’s visions in support of this. The creation of the coalition typifies this, with patients at the centre of collaborative statements now and into the future. Historically across many health and social care initiatives, interorganisational collaboration has been lacking, and this can result in a disconnect that hampers the effectiveness of important public messages. The coalition statement highlights that ‘To achieve sustainable reduction in harm from infection demands an unprecedented heightening of awareness among health workers, government,
commissioners and the general public, and for stakeholders to unite with one voice to disseminate a comprehensive and wide-ranging call to action. For the first time, leaders in all aspects of infection management have come together to state that the three key domains – urgent treatment of sepsis, prevention of infection, and preservation of antibiotics – are of equal and critical importance. This paves the way for reduced infection incidence, better outcomes, and ensuring that we have effective antibiotics into the future.’ The Prime Minister’s announcement on a new commission on AMR, based on recommendations from Dame Sally Davies, means that it is prudent that we work together to emphasise the components of the coalition statement even more. This gives us all the opportunity to highlight the importance of infection prevention, which is of course IPS vision, as key to reducing premature deaths. IPS’ alongside others will continue to raise the profile through the Clinical Advisory Group on Sepsis (reporting to the All Party Parliamentary Group on Sepsis), the British Society for Antimicrobial Chemotherapy (BSAC) round table discussions in September 2014, and representation on the national AMR working groups. The coalition statement aims to make real progress in managing sepsis, of which the ‘Sepsis 6’ is a key part, preventing infections and ensuring antimicrobial stewardship, as seen in the ambitions detailed in Table 1. Lest we forget, as quoted by the Royal College of Nursing when the coalition statement was issued, ‘Around 35 per cent of patients who develop severe sepsis will die. Early recognition and intervention to prevent it will significantly reduce mortality.’ Something the many survivors of sepsis continue to highlight and which should never be far from any of our minds. Collaborative working has brought us further than we could have imagined in these last couple of years, accelerating progress more rapidly than each individual organisation’s capabilities allow. Building on this is essential if we are to take the opportunity to address sepsis and the impact of life-threatening infections every day, especially on the back of a high profile AMR agenda; as this will mean that we save thousands more lives each year and improve the quality of life for survivors. The collaborative working approach described here makes sense on many fronts and describes a model that others may want to emulate at national, regional or local level. Read more on these topics at: http://sepsistrust.org/ http://sepsistrust.wp.substrakt.net/files/2013/09/The-trinity-ofinfection-management-final-0913b.pdf http://world-sepsis-day.org/ http://www.ips.uk.net/news-media/collaborations/
© The Author(s) 2014
Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav 10.1177/1757177414546100
VOL. 15 NO. 5 September 2014
Journal of Infection Prevention
161
Table 1. ‘The trinity of infection management: United Kingdom coalition statement’ – ambitions.
Coalition trinities
Ambition
Key stakeholders
Recognition of and rapid response to severe sepsis
By 2020, 90% of patients with symptoms of severe sepsis in the UK will receive assessment, appropriate antibiotics and fluids within one hour following presentation to the healthcare system (whether to general practice, Ambulance Service, NHS telephone advice or hospital) By 2020 there will be national standardised reduction and improvement programmes as described above, either initiated or embedded throughout the NHS, as well as recommendations for standardised application of evidence based infection prevention guidance issued at national level. By 2020, robust electronic prescribing should be available as the standard throughout the UK to support antimicrobial stewardship and infection prevention programmes across all sectors of healthcare. Medicines safety and management programmes should embrace strategies to ensure reliable and rapid delivery of life-saving medication as an equal priority to risk mitigation from drug errors. The use of antimicrobials in agriculture should be subject to regulatory supervision by 2020.
Global Sepsis Alliance, UK Sepsis Trust, Surviving Sepsis Campaign, Royal Colleges, specialist societies, NHS England, Scottish Antimicrobial Prescribing Group, Scottish Patient Safety Programme Public Health England, Infection Prevention Society, Healthcare Infection Society, British Infection Association, Royal Colleges, specialist societies, NHS England
Prevention of infection
Antimicrobial preservation
Disclaimer The opinions expressed in editorials are the author’s own and not those of their employers, the journal, or any other organisation. Ron Daniels Good Hope Hospital, Heart of England NHS Foundation Trust, Rectory Road, Sutton Coldfield B75 7RR Email: [email protected]
162 Journal of Infection Prevention
September 2014 VOL. 15 NO. 5
British Society for Antimicrobial Chemotherapy, Antibiotic Action, Soil Association, Scottish Antimicrobial Prescribing Group, UK Sepsis Trust, Veterinary Medicines Directorate, Royal Colleges, specialist societies, NHS England, Department for the Environment, Food and Rural Affairs, Academy of Medical Royal Colleges, Royal Pharmaceutical Society
Claire Kilpatrick Infection Prevention Society, UK Jules Storr Infection Prevention Society, UK
BJI0010.1177/1757177414546100Journal of Infection PreventionJournal of Infection Prevention
Editorial: Sepsis and the impact of life-threatening infection – working together to make an impact
W
orld Sepsis Day, held every year on 13 September, marks the day when the world strives towards reducing the number of deaths from sepsis by 20%, by 2020. The Global Sepsis Alliance, which launched the day in 2012, have stated that every three seconds someone, somewhere, dies of sepsis. One major issue is that, contrary to global burden of disease reports, the problem isn’t confined to maternal and newborn sepsis. The true burden of sepsis, that it is one of the biggest causes of preventable deaths due to acute illness, is largely unknown to policymakers and the public. In recent years, the World Health Organization, Professor Dame Sally Davies (the Chief Medical Officer of England) and now the Prime Minister of the UK have highlighted the real threat posed to human health by antimicrobial resistance (AMR). The messaging has centred around the fact that our ability to perform planned surgery is likely to be compromised, but there is a bigger problem. We will be less able to prevent infection should the development of new antimicrobials not receive urgent attention, but we will also be unable to treat life-threatening infection. Even if the incidence of sepsis were to remain static at approximately 150–200 cases per 100,000 population per year, a lack of effective antibiotics would mean that 70,000 more people would lose their lives to sepsis each year in the United Kingdom alone. This equates to a Virgin Pendolino train crashing every week for two years, with no survivors. In September 2013, The UK Sepsis Trust led in the development of ‘The Trinity of Infection Management: United Kingdom Coalition Statement’. This statement advented a new, holistic approach to supporting the reduction of lives lost to infection. This work was only possible due to the commitment and energy of other organisations, including the Infection Prevention Society (IPS). IPS appreciated the necessity for joining a collaboration of professional groups to be part of this important step in raising the profile of sepsis, underpinned by infection prevention and antimicrobial stewardship actions, on the national agenda. Collaborative working is at the core of making an impact on patient safety and over the last couple of years the UK Sepsis Trust and IPS have worked together to understand each other’s visions in support of this. The creation of the coalition typifies this, with patients at the centre of collaborative statements now and into the future. Historically across many health and social care initiatives, interorganisational collaboration has been lacking, and this can result in a disconnect that hampers the effectiveness of important public messages. The coalition statement highlights that ‘To achieve sustainable reduction in harm from infection demands an unprecedented heightening of awareness among health workers, government,
commissioners and the general public, and for stakeholders to unite with one voice to disseminate a comprehensive and wide-ranging call to action. For the first time, leaders in all aspects of infection management have come together to state that the three key domains – urgent treatment of sepsis, prevention of infection, and preservation of antibiotics – are of equal and critical importance. This paves the way for reduced infection incidence, better outcomes, and ensuring that we have effective antibiotics into the future.’ The Prime Minister’s announcement on a new commission on AMR, based on recommendations from Dame Sally Davies, means that it is prudent that we work together to emphasise the components of the coalition statement even more. This gives us all the opportunity to highlight the importance of infection prevention, which is of course IPS vision, as key to reducing premature deaths. IPS’ alongside others will continue to raise the profile through the Clinical Advisory Group on Sepsis (reporting to the All Party Parliamentary Group on Sepsis), the British Society for Antimicrobial Chemotherapy (BSAC) round table discussions in September 2014, and representation on the national AMR working groups. The coalition statement aims to make real progress in managing sepsis, of which the ‘Sepsis 6’ is a key part, preventing infections and ensuring antimicrobial stewardship, as seen in the ambitions detailed in Table 1. Lest we forget, as quoted by the Royal College of Nursing when the coalition statement was issued, ‘Around 35 per cent of patients who develop severe sepsis will die. Early recognition and intervention to prevent it will significantly reduce mortality.’ Something the many survivors of sepsis continue to highlight and which should never be far from any of our minds. Collaborative working has brought us further than we could have imagined in these last couple of years, accelerating progress more rapidly than each individual organisation’s capabilities allow. Building on this is essential if we are to take the opportunity to address sepsis and the impact of life-threatening infections every day, especially on the back of a high profile AMR agenda; as this will mean that we save thousands more lives each year and improve the quality of life for survivors. The collaborative working approach described here makes sense on many fronts and describes a model that others may want to emulate at national, regional or local level. Read more on these topics at: http://sepsistrust.org/ http://sepsistrust.wp.substrakt.net/files/2013/09/The-trinity-ofinfection-management-final-0913b.pdf http://world-sepsis-day.org/ http://www.ips.uk.net/news-media/collaborations/
© The Author(s) 2014
Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav 10.1177/1757177414546100
VOL. 15 NO. 5 September 2014
Journal of Infection Prevention
161
Table 1. ‘The trinity of infection management: United Kingdom coalition statement’ – ambitions.
Coalition trinities
Ambition
Key stakeholders
Recognition of and rapid response to severe sepsis
By 2020, 90% of patients with symptoms of severe sepsis in the UK will receive assessment, appropriate antibiotics and fluids within one hour following presentation to the healthcare system (whether to general practice, Ambulance Service, NHS telephone advice or hospital) By 2020 there will be national standardised reduction and improvement programmes as described above, either initiated or embedded throughout the NHS, as well as recommendations for standardised application of evidence based infection prevention guidance issued at national level. By 2020, robust electronic prescribing should be available as the standard throughout the UK to support antimicrobial stewardship and infection prevention programmes across all sectors of healthcare. Medicines safety and management programmes should embrace strategies to ensure reliable and rapid delivery of life-saving medication as an equal priority to risk mitigation from drug errors. The use of antimicrobials in agriculture should be subject to regulatory supervision by 2020.
Global Sepsis Alliance, UK Sepsis Trust, Surviving Sepsis Campaign, Royal Colleges, specialist societies, NHS England, Scottish Antimicrobial Prescribing Group, Scottish Patient Safety Programme Public Health England, Infection Prevention Society, Healthcare Infection Society, British Infection Association, Royal Colleges, specialist societies, NHS England
Prevention of infection
Antimicrobial preservation
Disclaimer The opinions expressed in editorials are the author’s own and not those of their employers, the journal, or any other organisation. Ron Daniels Good Hope Hospital, Heart of England NHS Foundation Trust, Rectory Road, Sutton Coldfield B75 7RR Email: [email protected]
162 Journal of Infection Prevention
September 2014 VOL. 15 NO. 5
British Society for Antimicrobial Chemotherapy, Antibiotic Action, Soil Association, Scottish Antimicrobial Prescribing Group, UK Sepsis Trust, Veterinary Medicines Directorate, Royal Colleges, specialist societies, NHS England, Department for the Environment, Food and Rural Affairs, Academy of Medical Royal Colleges, Royal Pharmaceutical Society
Claire Kilpatrick Infection Prevention Society, UK Jules Storr Infection Prevention Society, UK
