Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. 1 Outside of sepsis, steroid use is generally advocated for maternal benefit, such as in severe asthma and connective tissue disease, 59, 60 but repeated steroid use may have a negative impact on the developing fetus; concerns include a reduction in birthweight … [5] Critical care means an intensivist or intensive care outreach team, or specialist in intensive care or paediatric intensive care. any indications of clinical concern, such as new onset abnormalities of behaviour, circulation or respiration. Do not perform a lumbar puncture without consultant instruction if any of the following contraindications are present: signs suggesting raised intracranial pressure or reduced or fluctuating level of consciousness (Glasgow Coma Scale score less than 9 or a drop of 3 points or more), unequal, dilated or poorly responsive pupils, coagulation abnormalities or coagulation results outside the normal range or platelet count below 100x109/litre or receiving anticoagulant therapy, local superficial infection at the lumbar puncture site, respiratory insufficiency in children. Ensure a care team member is nominated to give information to families and carers, particularly in emergency situations such as in the emergency department. N2 - Sepsis is a leading cause of maternal morbidity and mortality in developed and developing nations. 1.4.2 Recognise that adults, children and young people aged 12 years and over with suspected sepsis and any of the symptoms or signs below are at high risk of severe illness or death from sepsis: objective evidence of new altered mental state, respiratory rate of 25 breaths per minute or above, or new need for 40% oxygen or more to maintain oxygen saturation more than 92% (or more than 88% in known chronic obstructive pulmonary disease), heart rate of more than 130 beats per minute, systolic blood pressure of 90 mmHg or less, or systolic blood pressure more than 40 mmHg below normal, not passed urine in previous 18 hours (for catheterised patients, passed less than 0.5 ml/kg/hour). These reports led to a renewed focus on maternal sepsis with the publication of national clinical guidelines, the development of obstetric early warning scores (EWS) to detect critical illness, the application of care bundles, and a growing awareness of the need to treat maternal infection early and appropriately. Neutropenic sepsis: prevention and management in people with cancer (2012) NICE guideline CG151. Y1 - 2018/2/1. The guideline includes recommendations on: We updated this guideline in April 2019 to include the national early warning score (NEWS2) endorsed by NHS England. Also healthcare providers need to follow certain guidelines, which are strict and evidence-based providing a reference when dealing with patients with maternal sepsis, such as NICE [26] guideline on recognition, diagnosis and management of sepsis, RCOG [27] guideline on bacterial sepsis in pregnancy and their own local hospital policies. Sepsis: Management of Maternal Sepsis Clinical Guideline V2.3 Page 2 of 14 1. 1.11.4 Give people with sepsis and their families and carers information about national charities and support groups that provide information about sepsis and the causes of sepsis. 1.6.37 1.6.23 For children aged 5–11 years with suspected sepsis and 2 or more moderate to high risk criteria: arrange for a clinician to review the person's condition and venous lactate results within 1 hour of meeting criteria in an acute hospital setting. The guideline committee identified that the key issues to be included were: recognition and early assessment, diagnostic and prognostic value of blood markers for sepsis, initial treatment, escalating care, identifying the source of infection, early monitoring, information and support for patients and carers, and training and education. The Improving Diagnosis and Treatment of Maternal Sepsis toolkit was developed by the Maternal Sepsis Task Force as a resource for obstetricians, rapid response teams, and intensive care units who interact with women during pregnancy and in the postpartum period. Alert a consultant to attend in person if a child aged under 5 years with suspected sepsis and any high risk criteria fails to respond within 1 hour of initial antibiotic and/or intravenous fluid resuscitation. [8] Clinical assessment should be carried out by a medically qualified practitioner or equivalent who has antibiotic prescribing responsibilities.
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