A report by NHS England has called for standardised, improved and faster processes for taking and testing blood to identify and treat infections, such as sepsis. As with many recent reports which highlight current failings within the NHS, the full findings of NHS England and NHS Improvement’s review into improving blood culture practices are not available to the public. However, the published summary of the report, Improving the blood culture pathway – A national review of blood culture pathway processes to support better antimicrobial stewardship and improved patient safety, says that NHS trusts must now take action to bring ‘the blood culture pathway’ for taking, testing and acting on blood samples up to recognised and consistent standards. The aim is to ensure that blood culture pathways are actively managed ‘from board to ward’ to improve the effective use of antibiotics for individual patients, manage antimicrobial resistance, and improve outcomes for patients with sepsis. How common is bacterial infection? Bacterial infections are a leading cause of serious disease. Large amounts of NHS resources are dedicated to the diagnosis and treatment of patients with these infections. Delays in the diagnosis and treatment of conditions such as meningitis and sepsis can lead to death or life-changing disability. According to the report, 100,000 blood stream infections are detected every year in the UK. Bacterial infections are the cause of : approximately 40% of emergency admissions to hospital; 33% of inpatients (patients staying overnight in hospital) being treated with antibiotics at any one time; 66% of all hospital deaths; 50% of all hospital bed use. Blood tests are vital in the treatment of infection and sepsis The report emphasises that optimising the blood culture pathway is essential to provide the best outcomes for patients with sepsis. It is also needed for effective antimicrobial stewardship (AMS) which ensures that these important medicines are properly selected, given at correct dosage and duration to treat the patient’s infection with minimal side effects and with minimal impact on personal and general antibiotic/antimicrobial resistance. NHS England believes that each positive blood culture (test result) provides an opportunity to improve patient care for the individual patient and the population, but this requires NHS trusts consistently to comply with the necessary standards. Improved speed of detection of positive blood cultures could lead to: improved rates of detection of patients with blood stream infections; improved outcomes from sepsis and infections; quicker and more accurate infection diagnosis, with identification of specific organisms ( to allow more effective targeted antibiotic treatment); guidance towards other specific investigations (tests) and management of the patient’s condition; reduced length of hospital stays; public health benefits, such as from earlier infection control; reduction in use of unnecessary antibiotics; shorter use of antibiotics/antimicrobials for newborn babies; improved antimicrobial stewardship (AMS). Blood tests for sepsis: The Sepsis Six Quick and accurate blood tests are an essential stage in the diagnosis and effective treatment of sepsis. They are one of the steps that are set out in the Sepsis Six. This is a tool that was developed by the UK Sepsis Trust to help doctors identify and deliver basic but essential care for sepsis patients. In 2011, UK Sepsis Trust research showed that using the Sepsis Six in the first hour of treatment of patients with suspected sepsis led to a 50% reduction in mortality (death rates). The Sepsis Six is now used in almost all NHS hospitals and more than 30 countries worldwide. The Sepsis Six steps are: Ensure that a senior clinician (doctor or nurse) attends. Experienced care is essential for this dangerous condition. Give oxygen if required. Correcting low oxygen saturation helps avoid the risk of tissue damage from hypoxia. Obtain IV (intravenous) access and take bloods This allows the healthcare team to assess the patient’s risk, identify the pathogen that is causing the infection and give targeted antibiotic treatment. Give IV antibiotics, to control the source of the infection. Give IV fluids. Low blood volume contributes to shock in sepsis. Monitor the patient’s condition, which can deteriorate or change rapidly. Recommendations from the NHS blood culture pathway review The review found that despite significant progress in NHS England’s management of sepsis, the vital role of blood cultures has often been overlooked. The report suggested that once the blood culture is collected little attention is given to how the blood sample can be used to benefit patient management. The report identified an urgent need to co-ordinate all the elements of the blood culture pathway to effectively manage patients with a severe infection in the rapidly changing healthcare environment. Blood cultures are the primary diagnostic test available to detect blood stream infection and identify the organism that is causing the infection, so that the most suitable antimicrobial can be selected to treat the infection. Where the blood culture pathway is working well, the most significant positive cultures should be detected within 12 hours of the blood sample being taken. However, a national survey by NHS England and NHS Improvement into blood culture practises within the NHS has shown that there is room for substantial improvement in the use of existing microbiology standards. The report of the review emphasised the importance of taking sufficient blood samples to guarantee a clear result and set minimum standards for the volume of blood that should be taken from patients with suspected sepsis. It also calls for a reduction in delays between the blood sample being taken and received in the laboratory, recommending that blood culture samples should be incubated in a blood culture analyser (to carry out the test) within a maximum of four hours. Blood culture pathways should be designed by multidisciplinary teams, including but not limited to microbiology staff, to ensure compliance with existing standards. They should be seen as a core part of NHS trust leadership and governance, and be managed ‘board to ward’ through NHS trust management and every stage. NHS trust performance in relation to blood culture processes should be checked against key performance indicators (KPIs). Compensation for injury caused by delayed diagnosis and treatment of sepsis Sepsis is a serious condition which can quickly lead to death, severe disability from limb loss and amputation, and lasting effects from organ failure and psychological injury. With early diagnosis and correct treatment, sepsis can be cured and patients can avoid permanent injury. Any delays in diagnosis, investigations such as blood tests, and treatment can have devastating and lifelong effects. Boyes Turner’s medical negligence specialists help patients and their families recover compensation and rebuild their lives after negligent delays and treatment for sepsis. We welcome NHS England’s recommendations in the hope that improved blood culture pathways will help reduce delays in diagnosis and treatment, and the resulting harm that is suffered by patients with sepsis. If you have suffered severe injury or have lost a loved one as a result of medical negligence, and would like to find out more about making a claim, you can talk to one of our experienced solicitors, free and confidentially, by contacting us here.
