For internal use in GHNHSFT only
- This site contains guidelines registered with Gloucestershire Hospitals NHS Foundation Trust and is intended solely for use by healthcare professionals to aid the treatment of patients currently within the Trust's care (see full disclaimer).
- The guidelines reflect local sensitivities and infection control issues and, unless otherwise stated, are intended for the treatment of immunocompetent adult patients.
- The guidelines are intended for initial treatment and may be modified when microbiology results are available.
- For clinical advice or if the patient fails to respond, discuss with senior member of the clinical team and if necessary, the Consultant Microbiologist.
- Mon-Fri 09.00-17.00 ext. 4430 CGH and 5050 GRH
- For urgent advice out of hours, contact the "On-Call Consultant Microbiologist" via switchboard.
HAVE YOU CONSIDERED SEPSIS?
The 'Sepsis Six' are six tasks which, when delivered to patients within one hour of recognition of sepsis, can half the risk of death for patients (Surviving Sepsis Campaign).
1. 100% Oxygen
2. IV fluid bolus
3. Blood cultures
4. IV antibiotics
5. Lactate & bloods
6. Monitor urine output
Please see the Sepsis Six Pathway for more information.
For neutropenic sepsis also see additional guidance Click here
The Flow Chart for Infected Patients
Do any 2 apply?
- Temperature less than 36ºC or more than 38.3ºC
- Respiratory Rate more than 20/minute
- Heart Rate more than 90/minute
- Acutely altered mental state
- WBC >12x109/L or <4x109/L
- CRP >100
Treat as schedule A
? need for Admission
(Minor to Moderate Infection)
Do any apply?
- Systolic Blood Pressure less than 90 mm Hg
- Mean Arterial Pressure less than 65 mm Hg
- Lactate greater than 2
- Urine output < 0.5ml/kg/hr OR creatinine >177
- SpO2 < 90%
- Platelets < 100
- INR > 1.5
- Bilirubin >34
Treat as schedule B
(Moderate to Severe Infection)
Treat as schedule C
Serious Life Threatening Infection – mortality ≈ 35%
COMPLETE SEPSIS SIX PATHWAY
C. difficile WARNING
The incidence of C.difficile diarrhoea is strongly associated with the use of Cephalosporins, Ciprofloxacin and Levofloxacin. Gentamicin is the preferred option to cover Gram Negative organisms. An initial single dose is unlikely to cause oto/nephro toxicity.
- Blood cultures: 2 sets from 2 sites
- Obtain appropriate samples BEFORE treatment
- When prescribing on inpatient chart include indication & 48 hours review box (click here for policy)
- Dosing is based on an average weight of 70kg
- Adjustment may be required for renal or hepatic disease, consult pharmacy for dosing advice
- Pregnancy - See BNF for initial advice or consult pharmacy
- Pharmacy Medicines Information: CGH 3030, GRH 6108. Out of hours via switchboard.