Infection sources and residents at higher risk

Sepsis begins with infection, but not every infection becomes sepsis. The risk rises when an infection is uncontrolled, the person is vulnerable, or early signs of deterioration are missed.

Common infection sources in care settings

• Chest infections: cough, breathlessness, sputum changes, aspiration risk, low oxygen levels or new confusion.
• Urinary infections: pain, frequency, catheter issues, cloudy or offensive urine, new incontinence, fever, rigors or decline in condition.
• Skin and wounds: cellulitis, pressure ulcers, surgical wounds, leg ulcers, diabetic foot problems, redness, swelling, heat, discharge or pain.
• Abdominal or bowel infection: abdominal pain, diarrhoea, vomiting, dehydration or sudden deterioration.
• Device-related infection: urinary catheters, feeding tubes, lines, drains or recent invasive procedures.
• Recent healthcare contact: surgery, hospital discharge, dental or invasive procedures, or recent emergency attendance.

Residents who may be more vulnerable

NICE identifies factors that increase the risk of developing sepsis or of sepsis not being recognised promptly. In adult social care, these include age 75 or over, frailty, multiple conditions, severe chronic illness, impaired immune function, recent surgery or invasive procedures, indwelling catheters, repeated antibiotic use, broken skin integrity and communication difficulties.

Some residents face extra barriers to accurate assessment. This includes people with dementia, learning disabilities, autism, severe mental health conditions, brain injury, sensory impairment, limited speech, altered pain expression or English as a second language.

Look for infection plus a change from normal. Do not wait for a high temperature before taking deterioration seriously.