Subtle signs, soft signs and red flags

Sepsis can be difficult to recognise because symptoms are often non-specific. A resident may not say "I feel septic" but may look or behave differently, breathe differently or cope less well than usual.

Soft signs that should prompt concern

• Behaviour change: new confusion, agitation, withdrawal, irritability, drowsiness or reduced responsiveness.
• Function change: sudden need for more help, new falls, inability to transfer, eating less, drinking less or staying in bed more.
• Breathing change: faster breathing, breathlessness, difficulty speaking, noisy breathing or new concerns about oxygen.
• Circulation change: cold, clammy, mottled, ashen, blue, grey or pale skin, lips or tongue.
• Urine change: passing less urine than usual, dry pads, catheter bag much emptier than normal or other signs of dehydration.
• Temperature or rigors: very hot or very cold, shivering, shaking or feeling unusually unwell.

Red flags for urgent help

Call 999 or follow local emergency procedures if a resident with suspected infection is acutely confused, has slurred speech or is not making sense; has severe breathlessness or very fast breathing; has blue, grey, pale or blotchy skin, lips or tongue; has a non-blanching rash; is difficult to wake; has very low blood pressure if measured; has a very fast heart rate if measured; or has not passed urine for a concerning length of time.

On brown or black skin, look for colour change on the palms, soles, lips, tongue, gums, nail beds or inside the eyelids. Do not rely on a single sign, and do not wait for every sign to appear.

In care homes, "not their usual self" can be clinically important when it is new, sudden or linked to possible infection.