Dr. Colm Henry:

I wish the Chair and members of the committee a good morning. I thank them for their invitation to meet the Joint Committee on Health to discuss awareness, prevention and services for the treatment of sepsis. I thank and acknowledge the important contributions made not just this morning but by the Irish Sepsis Foundation, the End Sepsis campaign and Lil Red’s Legacy Sepsis Awareness Campaign, some of which we have had contact with in recent months. I commend the very impressive testimonies and stories from patients, which they were brave enough to share with us this morning. I am joined by my colleagues, Dr. Orla Healy, national clinical director for quality and patient safety, Dr. Michael O Dwyer, national clinical lead for the sepsis programme, and Dr. Ciara Martin, national clinical adviser and group lead for children and young people.

Today, I will present under the following headings around increasing awareness of signs and symptoms, prevention and appropriate management of sepsis through: implementation of national clinical guidelines; education and training of staff; audit, quality assurance and governance; increasing public awareness of sepsis; and the five-year strategic plan for the national clinical programme for sepsis, including its key priorities from 2024 to 2026.

The national clinical programme for sepsis, NSP, was established in 2014 and the first national clinical effectiveness committee national clinical guideline for sepsis was published. The focus of the programme is to promote the early recognition and evidence-based management of sepsis. Implementation of Sepsis Management for Adults (including maternity): National Clinical Guideline No. 26 is advanced through audit, education, quality improvement and raising awareness.

The national sepsis report for Ireland is published annually by the national clinical programme for sepsis. The report highlights the burden of sepsis in the acute settings and its associated mortality rates. The National Sepsis Report 2021 was published in March 2023. The key finding in that report was a 22.3% reduction in age-adjusted mortality from sepsis or septic shock since 2011 in Ireland. The overall reduction has been contributed to by development and implementation of the sepsis management for adults, including maternity, guideline of 2021 and implementing the national implementation plan for the International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children, which provides a standardised approach to the recognition and management of sepsis in Ireland. The increased knowledge and awareness and action of healthcare staff was the key driver behind these improvements in care.

Accurate reporting of sepsis epidemiology has been complicated since 2020 with the emergence of the Covid-19 pandemic. In addition, the mortality rates of patients with sepsis from SARS-CoV-2 were higher than in patients with sepsis from other causes, as we have outlined in our national report. Furthermore, as the pandemic has waned, there have been some poorly understood changes in sepsis epidemiology, including the global increase in invasive group A streptococcus infections, which we have also noted in Ireland. Notwithstanding these recent changes, mortality rates from sepsis have decreased since the inception of the programme in 2014 from 20.3% in 2020 to 19.0% in 2021, which are the published data available. It is expected those data will be published for 2022 before the year end.

Regarding education and training of staff, in 2015, a nationwide education campaign was commenced for relevant healthcare workers in acute hospitals as part of the implementation of the guideline, and in 2016, we noticed a 67% increase in documented cases of sepsis or septic shock.

E-learning modules are available on HSeLanD, the online learning and development platform, for all relevant staff on adult, maternity and paediatric sepsis. Regular education sessions on signs and symptoms of sepsis and the sepsis 6 bundle are conducted across all hospitals throughout the year with audits to assess adherence to recommendations. In June 2023, the programme conducted a qualitative survey on sepsis awareness and management in acute settings, which was completed anonymously by a large volume of clinical staff. The survey analysis and results indicate that there is a high uptake of the e-learning training module on HSeLanD.

The national clinical programme supported the establishment of a pilot project to introduce sepsis recognition and treatment for GPs. This project is progressing and is developing many resources for GPs across the country such as, for example, a quick reference guide for GPs on the recognition and treatment of sepsis in adults, which will be ready for implementation in quarter 2 of 2024. Other education and training opportunities have been provided to GPs, such as a recent webinar on recognising sepsis with more than 1,600 GP attendees. Other resources include supporting the integration of software to GP clinics to aid with sepsis awareness and management and education and awareness activities increase during Sepsis Awareness Month.

With regard to sharing expertise through events, the seventh sepsis summit took place in Dublin Castle on 19 September. This year’s summit had a global aspect with international experts and family advocates among those presenting. Some 500 health and social care professionals and almost 100 members of the public attended the event. The summit heard from a range of speakers on the latest scientific research and the impact of the Covid-19 pandemic on sepsis care. Topics covered included improving early recognition of paediatric sepsis, the role of technology in sepsis diagnosis, the importance of antimicrobial stewardship and many more. The NSP invited public awareness champions and groups such as the Irish Sepsis Foundation and Lil Red’s Legacy Sepsis Awareness Campaign to the event and afforded them the opportunity to promote awareness at the event.

With regard to increasing public awareness of sepsis, a variety of resources were developed and widely distributed to all hospital groups, community healthcare organisations, CHOs, primary care and the GP network via the HSE and Children's Health Ireland, CHI. Communication links including animated paediatric videos and social media cuts and are currently being played in waiting rooms and public areas in all CHI hospitals and other clinical areas. These can be accessed via the link in the witness statement. Posters and credit cards with signs and symptoms of sepsis for both adults and children are widely distributed at sepsis awareness days and events and displayed locally in each hospital.

In 2023, a new sepsis information leaflet was developed, and I acknowledgment again the Lil Red's campaign, which was central to its development, to raise awareness of the signs and symptoms of sepsis in the community for adults, maternity and children and to provide advice on how to reduce the risk of developing sepsis. The leaflets were distributed to 1,700 GP surgeries and more than 1,800 community pharmacies and are translated into ten languages. Currently, all emergency ambulances carry signage on the signs and symptoms of sepsis and in the future, all National Ambulance Service, NAS, vehicles will carry this signage.

September was Sepsis Awareness Month, with World Sepsis Day recognised on 13 September. Many events and initiatives took place across our health service to mark World Sepsis Day. These included public awareness stands, staff education sessions, the provision of sepsis leaflets and the lighting up of public buildings. As part of our engagement with the media, we worked closely with patient advocates to highlight the symptoms of sepsis. All hospitals had information stands with pull-up banners and provided education to staff and the programme liaises with universities and schools and relevant charities to provide education services.

Regarding the national public awareness campaign, the HSE and national sepsis team are currently scoping out the optimum approach to a public awareness campaign to raise awareness of the signs and symptoms of sepsis and what action people should take if they suspect sepsis. It is envisaged that by increasing awareness of sepsis, the public will seek treatment earlier and, therefore, there will be a reduction in mortality associated with sepsis.

This new campaign is currently in a data gathering and research phase and will undergo engagement with families affected by sepsis and healthcare practitioners in the coming weeks.

Turning to quality assurance on the recognition and management of sepsis, retrospective audits against the national clinical guideline have been undertaken annually since the inception of the guideline, with the exception of 2020 and 2021 due to staff redeployment. Concurrent medical and surgical audits have been completed in all acute hospitals in 2023. Key learnings from the audits are used to improve care in the early recognition and management of sepsis. Paediatric audits will be completed by the end of the year, while maternity audits are scheduled are 2024. More than 95% of hospitals have a deteriorating patient committee, which includes sepsis. The national report for 2022 will be published in the coming weeks.

Regarding the five-year strategic plan, the national quality patient safety directorate and the clinical programme for sepsis have identified the priority areas for inclusion in the five-year sepsis strategic plan for the HSE. The plan will build on and enhance the existing priorities and work of the programme. The sepsis programme plan with clear objectives and outcomes for 2024 to 2026 will be completed by the end of this year.

Key priorities for the years 2024 to 2026 include addressing women’s health through sepsis awareness in pregnancy and post pregnancy, including the development of a public awareness campaign; the development of a quick reference guide for GPs on sepsis in children; a scope project on developing a flag system to be incorporated in all GP systems; the introduction of new metrics regarding sepsis governance, audit and education in acute hospitals to streamline deteriorating patient and sepsis programme key performance indicators, KPIs, and governance structures; and the development of a proposal to engage with academic and research partners to develop a research strategy for sepsis.