Sepsis is an under-recognised condition that causes very significant illness in Ireland,” says Dr Michael O’Dwyer, HSE clinical lead on the national clinical programme for sepsis.
“The best hope of overcoming sepsis is early recognition and seeking treatment as quickly as possible.”
The national clinical programme was set up by the HSE in 2014 after the tragic death of Savita Halappanaver, who died of sepsis in hospital.
“Sepsis is a complication of an infection,” Dr O’Dwyer says. “By and large, most people who get infections – chest infections or cuts or scrapes – heal pretty quickly on their own without treatment or they might need some antibiotics and then they’d get better.
“In a small percentage of cases, however, infection can continue unabated and the body responds with a whole body response, which results in organ failure and very severe illness.
“We treat between 13,000 and 15,000 patients for sepsis in Ireland each year, one in five of whom will die in hospital, so it’s a very significant cause of mortality in Ireland.”
COVID ticks all the boxes for sepsis. Sepsis can develop from viral infections too. A cough can progress to sepsis either because of the virus or because the person subsequently develops a bacterial infection on top of the virus
Public should be aware
After 2014, the HSE focused on educating all employees to recognise sepsis and treat it very early, but sepsis can be very difficult to diagnose.
“We know, from collated data,” says Dr O’Dwyer, “that about 80% of people who develop sepsis present first either through a hospital emergency department or through their GP.”
This puts the onus on the HSE to educate the public as well as hospital staff about the illness’s signs and symptoms.
“That’s so that they know what to look out for and get themselves to the hospital for treatment as quickly as possible,” he says.
To develop sepsis, you must first have some kind of infection.
“The problem is that sometimes you may not even know that you have an infection,” he adds, “but it’s more likely that you will have had one that’s been lingering for a while. It could also be that your child, or the person you’re looking after, has a cough that’s not getting better or a cut that’s not healing. Because sepsis is difficult to recognise and because the symptoms can be widespread, it’s important to know the symptoms in both children and adults.”
Symptoms in children
Symptoms in adults
Symptoms in adults can be slightly different. It can be useful to remember the mnemonic S-E-P-S-I-S with each letter standing for a symptom:
It is also important to remember that people may develop sepsis when they are already under treatment for an infection
Always Ask: ‘could this be sepsis?’
“It is also important to remember that people may develop sepsis when they are already under treatment for an infection, ie taking antibiotics,” says Dr O’Dwyer.
“Such treatment won’t always stop the progression from infection to sepsis. Even if you are on treatment, it’s really important, if you or your family member is not getting better over the following couple of days, that you seek reassurance that the infection is not getting out of control. You should get back to your GP or hospital and ask: ‘Could this be sepsis?’”
Difficulty in diagnosing the illness comes down to there not being a perfect blood test to detect it as of yet.
“Research is ongoing for decades seeking this diagnostic test, but in the meantime it is difficult for patients and for hospital staff.”
Treatment for sepsis
Strong antibiotic therapy is the treatment.
“Early administration of this is the key to survival,” Dr O’Dwyer says.
“When someone presents with suspected sepsis, a resuscitation stage starts in the emergency department and, if necessary, the patient then goes to an intensive care unit where treatment continues and hopefully the antibiotics start working and healing begins.”
Pneumonia, urinary tract infections (UTIs) and kidney infections are the most common sources of infection that lead to sepsis.
“We have just come through a worldwide pandemic of sepsis,” he states. “COVID ticks all the boxes for sepsis. Sepsis can develop from viral infections too. A cough can progress to sepsis either because of the virus or because the person subsequently develops a bacterial infection on top of the virus because of some of the damage that the virus has done. In the older cohort of patients, coughs and pneumonia leading to sepsis is very significant.”
Watch out for confusion
“New onset confusion is something that we see time and time again as the first symptoms of sepsis in older patients,” the national sepsis programme’s clinical lead says.
“It can be hard to be sure, as a person becoming confused can also be a sign of dehydration or stroke, but it can be a really common indicator of sepsis.”
Old, young, pregnant
Developing sepsis is related to immune function and dysfunction.
“People who are at risk of sepsis usually have immune systems that are not functioning very well. That might be because their immune system is declining with age or if they are young because their immune system hasn’t started up yet. A person might also be on treatment like chemo therapy, which dampens down the immune system.”
Pregnant women are also at risk.
“Pregnancy dampens down your immune system also so that it doesn’t attack the new baby, so pregnant women can develop it, but it is important to remember that sepsis can affect anybody.” CL
For additional information see
Up-and-coming rap artist Sean Hughes (Lil’Red) from Finglas in Dublin was only 15 years old when he died from sepsis on 12 January 2018.
He had no underlying health issues, but came home from school on Monday, 8 January with flu-like symptoms.
His condition worsened and his mum, Karen, took him to their GP on Wednesday, 10 January.
“She said that Sean had a high fever and a bad chest infection and prescribed antibiotics and painkillers, in case it progresses to pneumonia. Later that day and next he was coughing up a lot of phlegm and I thought the antibiotics were working. At that time there were ads on the telly saying not to go to A&E because there was an Aussie flu going around and that was in our heads too, but late on Thursday evening Sean became unresponsive.
“Joe [Sean’s dad] administered CPR while we waited for the ambulance and we then followed it to Temple Street Hospital. I’ll never forget when the ambulance doors opened and I could see that the paramedics were still trying to revive him. It’s a sight that’ll stay with me forever.”
Sadly, Sean passed away at 6.30 the next morning. His parents were officially informed at Sean’s inquest that the cause of his death was sepsis.
“We had never heard of sepsis,” his dad, Joe, says. “No one had mentioned it – this silent, global killer – neither GP, paramedics nor hospital doctors.”
Since Sean’s death, Joe, Karen and their daughter Zoe educated themselves about sepsis and began their Lil’Red’s Legacy Sepsis Awareness Campaign to increase awareness about the illness. (Sean was nicknamed Lil’Red because of his red hair and rosy cheeks).
Karen and Joe are now board members of the Irish Sepsis Foundation and give regular talks to schools, colleges and sports clubs. They have also presented to TDs and senators in Leinster House.
“What we’d love to see is the HSE running a national TV ad campaign (see HSE response on previous page) about sepsis so more people know about it. There are 11 million deaths per year from sepsis worldwide and 3,000 of them are in Ireland so that’s an average of seven deaths every day in Ireland from sepsis. Those figures are jaw-dropping.”
The hardest thing the couple find to accept is that sepsis deaths are preventable deaths.
“If we’d known about sepsis, maybe Sean would still be here,” Joe says. “We’re doing what we’re doing because we wouldn’t like to see any other family going through what we go through every day.”
“Huge work has been done in recent years since our sepsis programme was set up, focusing firstly on healthcare workers’ education and behaviour – leading to huge improvement in how we successfully identify sepsis and intervene to improve outcomes for many.
“Extensive public communications work has also been done to good effect. We haven’t used paid radio or TV advertising campaigns but use other communications channels to share our messages. This has involved using media relations to publicise sepsis risk, symptoms and what action people should take to respond to signs of this time-sensitive medical emergency.
“HSE clinicians and patients have taken part in media interviews on radio and TV. We have quality information on HSE.ie about sepsis, which is the primary route that the public take to learn about health topics.
“We also use social media to share videos and messaging, we have produced a range of printed information materials for the public, available through hospitals and health facilities.
“Further leaflets will be sent to GP surgeries and community pharmacies in the coming weeks.
“In the past, we have attended the National Ploughing Championships and used this large public event to share our materials and for our expert nursing teams to engage with and educate the public about sepsis.”
– Comment from HSE press office