MEETING WITH PROFESSOR KEVIN ROONEY
I went to the Intensive Care Unit of the Royal Alexandra Hospital in Paisley to meet with Professor Kevin Rooney, National Clinical Lead on Sepsis to Healthcare Improvement Scotland, National Clinical Lead for Knowledge into Action for Healthcare Improvement Scotland and Professor of Care Improvement at the University of the West of Scotland. I discussed with him current treatment of sepsis in Scotland, and future challenges.
EB: What are the biggest challenges facing successful treatment of sepsis in Scottish Healthcare today?
KR: Don’t need bacteraemia to have sepsis – there is a new definition of sepsis which will be coming out in March next year. Incorrect to call sepsis septicaemia now, because it implies the requirement for bacterial invasion. Three classifications of sepsis – goes from sepsis -> severe sepsis -> septic shock, and causes 37000 deaths per year in the UK. Lack of recognition is major problem. Sepsis kills more people than lung, bowel and prostate cancer combined. RECOGNITION is extremely important. KR involved in national campaign to screen patients with a national early warning score. The sepsis 6 bundle should be implemented within an hour of diagnosis, as the mortality rate increases by 7.6% every hour after sepsis begins. Every hospital in Scotland is screening patients, and scoring them, and the scheme is now being rolled out across Ireland and England. Reduced mortality by 21% in Scotland, and compliance with sepsis 6 bundle administration is at 90% across Scotland. There have been lots of trials looking at complex interventions to sepsis, but they don’t work. Early recognition and intervention is essential. Do the simple things i.e. the sepsis 6 well. Can’t expect healthcare professionals to do 15 or 16 things – much better to condense the protocol into 6 simple steps that are proven to be effective life-savers. New definition will most likely be ‘Q-SOFA’ which will be a sepsis associated organ failure score. Patients are also graded on the national early warning score in which seven signs are assessed, and the scores accumulated. If a patient’s score >5 then the patient should be screened for sepsis.
EB: With antibiotics being a key component of sepsis treatment, how are you combatting the rise of antibiotic resistance?
KR: With good antimicrobial stewardship and de-escalation of antibiotics once you know the source. Switching from IV antibiotics to pill antibiotics as soon as possible. The hospital has been monitoring levels of S. aureus, C.diff and MRSA for the last three years, and have returned the lowest rates in the last quarter, so are reducing levels of bacteria within hospital itself too.
EB: Do you think that lack of awareness of sepsis is still a problem?
KR: Yes, there is still a lack of awareness within the medical profession and within the public. But, we are working with the Fiona Elizabeth Agnew Trust to raise awareness that sepsis is the leading cause of maternity associated death in the UK. Also lots of work being done by the Global Sepsis Alliance.
EB: How have sepsis care practices evolved in recent years?
KR: The sepsis 6 bundle was pioneered by Ron Daniels in England. Initially it was a six hour bundle, and a 24 hour bundle. Now it is a 4 hour bundle. In Scotland we have a simplified system. My academic interest is in liability science – we need to make treatment the bare minimum which will still be effective. Sepsis six has been on the go for around 5 years. The surviving sepsis campaign started in 2007. Also need to make sure we are treating patients according to their overall condition. Let’s say you have terminal cancer and sepsis, there is no point in treating you to the point where you are going to be on a life support machine when your illness is terminal. Good antimicrobial stewardship is key to sepsis care, and is improving all the time.
EB: Are the patients you see with sepsis more likely to have gone through the trauma of major surgery, or have developed sepsis because of other co-morbidities?
KR: All of the above. Sepsis is an indiscriminate killer. Chronic patients have an increased risk, and sepsis is the commonest post-operative complication and the most common cause of post-operative death. As co-morbidity increases so does your risk of sepsis. Equally, a 21 year old student can easily get sepsis from meningococcal infection in dorm rooms – totally indiscriminate.
EB: What preventative measures can be taken against sepsis, and do you think they will ever be truly effective, since sepsis can be a result of many different infections?
KR: Vaccination would be the best method of prevention – then could prevent huge reaction against invasion. Also hand hygiene and infection control precautions – reducing exposure to infectious agents. Antimicrobial stewardship is key again, to maintain our ability to treat sepsis.
EB: What are your biggest challenges going forward in the effective treatment of sepsis?
KR: Maintaining awareness in the medical profession. Creating a greater focus on recognition of sepsis, and implementation of appropriate management plans. We need to continually adapt treatment plans. Also need to continue good antimicrobial stewardship. In addition, doing a lot of work with the Scottish Patient Safety Programme for Healthcare Improvement Scotland. There is also an ongoing need for education of the public and medical profession about sepsis.
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