Improving the Recognition and Management of Severe Infection and Sepsis

Sepsis is one of the leading causes of death in hospital patients worldwide. It causes more deaths than prostate cancer, breast cancer and HIV/AIDS combined [1]. There are approximately 15,000 episodes of severe sepsis and septic shock in Australian and New Zealand intensive care units per year [2].

Sepsis is a life-threatening condition that arises when the body's response to infection injures its own tissues and organs [3]. Sepsis can present in any patient, in any clinical setting and is a medical emergency. Despite this, awareness of sepsis and the need for prompt and targeted treatment is limited.


Appropriate recognition and timely management of patients with severe infection and sepsis is a significant problem in NSW hospitals and in health care facilities around the world. Delayed treatment is associated with high mortality rates, significant morbidity and high costs to the health care system. In paediatric patients, sepsis is one of the leading causes of death, with mortality rates as high as 10 per cent. Many of these deaths are preventable [4].

The mortality rate for adult patients with septic shock is around 25 per cent [5]. It has been shown to increase by 7.6 per cent for every hour of delay after the onset of hypotension, in starting antibiotic therapy [6]. In the complex hospital ward environment, there are frequently long delays between medical review and antibiotic prescription, particularly when decision making is by junior medical officers [7].

The SEPSIS KILLS program aims to reduce preventable harm to patients through improved recognition and management of severe infection and sepsis in emergency departments and inpatient wards throughout NSW.

The Clinical Focus Report on Recognition and Management of Sepsis[8] found deficits in a range of clinical settings in NSW health care facilities in 2009. The lack of timely recognition and appropriate management was further demonstrated in the findings from the CEC Quality Systems Assessment.

The focus of the program is:

  • RECOGNISE risk factors, signs and symptoms of sepsis
  • RESUSCITATE with rapid intravenous fluids and antibiotics within the first hour of recognition of sepsis
  • REFER to senior clinicians and specialty teams, including retrieval as required

The SEPSIS KILLS program is a quality improvement initiative that has been developed from international evidence-based practice. The goal is to reduce preventable harm to patients with sepsis through early recognition and prompt management.

The program is founded on international evidence-based practice and brings significant benefits to NSW hospitals at both the clinical and system levels including:

  • Enhanced clinician skills in sepsis recognition and management
  • More timely, standardised and effective detection and management of sepsis
  • Reduced mortality, morbidity and bed-stays from sepsis-related conditions
  • Improved quality and safety of care and a better and safer patient experience.


[1] World Sepsis Day Organisation [internet] 2014. [cited 2014,March 31] Available from:
[2] Finfer S, Bellomo R, Lipman J. Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Medicine 2004; 30:589-596.
[3] Czura CJ Merinoff Symposium 2010: sepsis - speaking with one voice. Molecular Medicine; 2011; 17:1-2, 2-3.
[4] Han Y, Carcillo J, Dragotta M, Bills D, Watson S, Westerman M, Orr R. Early Reversal of Pediatric-Neonatal Septic Shock by Community Physicians Is Associated With Improved Outcome. Pediatrics 2003; 112(4) 793-799The
[5] Australasian Resuscitation in Sepsis Evaluation (ARISE) Investigators and the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD) Management Committee. The outcome of patients with sepsis and septic shock presenting to emergency departments in Australia and New Zealand. Critical Care and Resuscitation 2007; 9:8-18.
[6] Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine 2006; 34:1589-1596.
[7] Marwick CA, Guthrie B, Pringle JE, et al. A Multifaceted intervention to improve sepsis management in general hospital wards with evaluation using segmented regression of interrupted time series. British Medical Journal 2013;0:1-8
[8] Clinical Excellence Commission. Clinical Focus Report from review of root cause analysis and/or incident information management system (IIMS) data recognition and management of sepsis. Clinical Excellence Commission 2009; Sydney.