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The timely administration of intrapartum antibiotic prophylaxis (IAP) to eligible pregnant mothers reduces the risk of early onset Group B Streptococcus (GBS) neonatal sepsis. The incidence of neonatal GBS sepsis is increasing, in spite of national guidelines for its prevention. This retrospective cohort study was undertaken to assess the incidence of culture-proven GBS sepsis before and after a change of practice on intrapartum management of GBS sepsis in babies born at Sunderland Royal Hospital between January 1 2008 and December 31 2017. The data regarding the risk factors, the intrapartum antibiotic prophylaxis and the outcomes of the babies were collected. Twenty-nine cases were identified and presented in two epochs-before and after changing guidelines for intrapartum management. There was a statistically significant reduction in early onset sepsis rates and no difference in late-onset sepsis rates. The prolonged rupture of membranes is a significant risk factor at any gestation. Impact statement What is already known on this subject? Appropriate intrapartum administration of antibiotics in mothers reduces 80% of early-onset GBS infections. In the United Kingdom, IAP is given based on risk factors, which fail to accurately identify and treat the woman who harbours GBS in the birth canal in labour and the incidence of GBS neonatal sepsis is increasing. The national guideline on the prevention of GBS sepsis is not consistent and is open to interpretation. What do the results of this study add? This study highlights prolonged rupture of membranes as a significant risk factor at any gestation and there were missed opportunities to prevent GBS sepsis in term babies with the prolonged rupture of membranes. This study also highlights that it is possible to reduce the neonatal GBS sepsis burden by adhering to guidelines and administering timely intrapartum antibiotics. What are the implications of these findings for clinical practice and/or further research? The timely administration of IAP to all eligible women is possible if the national guidelines are consistent and interpreted correctly. Our national guideline on the prolonged rupture of membranes at term is not clear and is interpreted differently. If IAP is provided in all those with risk factors irrespective of gestation, this would involve additional costs to the NHS; but in the long term, it will benefit as it reduces morbidity. [ABSTRACT FROM AUTHOR]

Background: Women are discharged home from hospital increasingly early, but there is little evidence examining the postnatal hospital discharge process and how this may impact on the health of women and babies. In particular, there is little on sepsis prevention advice, despite it being the biggest direct cause of maternal mortality. Aim: To explore the perceptions of women and senior student midwives related to the postnatal hospital discharge process and maternal sepsis prevention advice. Methods: Three focus group interviews were undertaken, involving 9 senior student midwives and 14 women attending paid or specialist classes for vulnerable migrant women. Findings: All participants believed that the postnatal hospital discharge process was inadequate, rushed and inconsistent. Sepsis advice was patchy and the condition underplayed. Conclusions: Cost effective, time-efficient and innovative ways to impart vital information are required to support the postnatal hospital discharge process. [ABSTRACT FROM AUTHOR]

The latest report from the UK and Ireland Confidential Enquiries into Maternal Deaths, the fourth in the new annual report format, and the first to repeat the 3‐yearly thematic cycle, was published in December,1 and includes surveillance and Confidential Enquiries covering the period 2013–15. Once again the report includes reviews into the care of women who died during or after pregnancy in the Republic of Ireland as well as the UK. Following the annual topic‐specific format, this report includes topic‐specific reviews into the care of women who died from neurological conditions, other medical and surgical conditions, sepsis, anaesthetic complications, haemorrhage and amniotic fluid embolism, as well as Confidential Enquiries into the care of women with morbidity due to uncontrolled epilepsy in pregnancy and those with severe postpartum mental illness. [ABSTRACT FROM AUTHOR]

Older people with frailty and urgent care needs are major uses of health and social care services. Comprehensive geriatric assessment (CGA) is an evidence-based approach to improving their outcomes, as well as improving service outcomes. Geriatricians form a small proportion of the overall workforce and cannot address the population need alone, so all clinicians (doctors, nurses, therapists and so on) need to engage in delivering CGA as a process of care, underpinned by specifi c competencies -- which can be developed. Delivery of this care pathway needs to be measured and improved as rigorously as campaigns like those for improving sepsis or eradicating methicillin-resistant Staphylococcus aureus [ABSTRACT FROM AUTHOR]

Background Maternal sepsis is the leading cause of direct maternal death in the UK. Cost-effective training for staff is essential in providing safe, high-quality maternity care. Aims This project aimed to examine the impact of a maternal sepsis training package, provided during the period 1 April – 30 September 2013 (quarters 2–3), on maternity staff ’s compliance with the Trust’s maternal sepsis guideline, as documented in maternity notes. Methods An audit was undertaken of the staff compliance rates for the Trust’s maternal sepsis guideline (on which the training package is based) recorded in maternal notes during the period 1 January – 31 December 2013 (quarters 1–4). Data were analysed to investigate significance. Findings There was no statistically significant increase in compliance with the guideline from quarter 1 through to quarter 4. Conclusions Despite its limitations, this audit suggests the training has not had a significant impact on practice. When an initiative starts to deliver results that are not providing value for money, reassessing services in the interest of quality care must be the priority. [ABSTRACT FROM AUTHOR]

The failure within the NHS to rapidly diagnose and treat sepsis has been highlighted by the Parliamentary Health Services Ombudsman. This article underlines why early recognition is key and that clinicians need to act promptly to prevent the progression of infections towards a potentially fatal endpoint. [ABSTRACT FROM AUTHOR]

Background: Skin organisms at the insertion site are frequently implicated in central venous catheter blood stream infections (CVC BSIs) yet few studies have compared the durability of CVC dressings in critically ill patients. Aims: To undertake an evaluation of the durability and associated costs of different CVC dressings. Methods: Dressing duration was captured prospectively using a pro forma on four different dressings on five critical care units over a 12-month period. Staff received training on CVC dressing evidence-based practices and a ‘how to guide’ was implemented. Findings: A total of 1229 CVC dressings were observed from 590 CVCs. One dressing had a median (IQR) duration of 68.5 h (range, 32–105 h) compared to a median duration of 43.5, 46.0 and 40.5 h for the other dressings (P <0.001). The mean time to change a CVC dressing was 13.5 min and the cost of a dressing change was in the range of £1.97–4.97. During the 12-month study period we observed a downward trend in CVC BSIs. Discussion: Despite few dressings remaining adherent for 7 days, the low rates of CVC BSI observed suggests good dressing practices. Conclusions: One dressing appeared more durable than the others, although it was still below the recommended standard and more expensive. [ABSTRACT FROM AUTHOR]

Group B streptococcus (GBS) is the most common cause of sepsis and meningitis in infants under the age of 3 months with a 10% mortality and significant morbidity for many survivors. In the UK, over 40 babies die each year of GBS-related sepsis. Early-onset infection can be prevented in the majority of cases by giving women known to be colonised with GBS intravenous antibiotics during labour, but this requires a screening process which is not currently recommended in the UK. In many countries, including the USA, Canada and much of Europe, screening for GBS colonisation is part of routine antenatal care. This article aims to review the issues surrounding antenatal screening for GBS and argues that we could be doing much more in the UK to prevent this potentially devastating infection in newborn babies. [ABSTRACT FROM AUTHOR]

Group B streptococcus (GBS) is the commonest cause of early onset sepsis in UK newborns. Several risk factors for early onset GBS sepsis (EOGBS) have been described. The presence of these risk factors provides an opportunity for intrapartum antibiotic prophylaxis (IAP) and forms the basis of current UK EOGBS prevention guidance. Having observed poor compliance with national guidelines in a review of EOGBS cases within the UK Neonatal Infection Surveillance Network (NeonIN), we reviewed 14 NeonIN unit guidelines. We found substantial variation in recommendations within and between units on indications for IAP and treatment of asymptomatic neonates, and discrepancies between obstetric and neonatal guidelines, potentially increasing infants’ risk of infection. The lack of high quality evidence in this area and related ambiguity in national guidance may have contributed to diverse local approaches. A common approach would permit prospective evaluation of an EOGBS prevention strategy, generating an evidence base to benefit future guidelines. [ABSTRACT FROM PUBLISHER]

In this article, Aseptic Non-Touch Technique clinical director Stephen Rowley and Simon Clare, who are both cancer nurses, explain the importance of aseptic technique, Alison Ruffell, a sister in critical care, describes a local initiative to reduce ventilator-associated pneumonia and, in conclusion, Jeanette Beer of the National Patient Safety Agency focuses on a national programme to reduce infections associated with central venous catheters. [ABSTRACT FROM AUTHOR]

This paper summarises the problem of the recognition and management of sepsis in in-patients. A case vignette describes a common scenario faced by trainees, in which timely and effective care is difficult to deliver. We offer suggestions for possible changes in hospital systems and care delivery that are likely to lead to better outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the urge by the National Institute for Health Care Excellence (NICE) for community nurses to look out for sepsis signs. Topics include a description of the NICE draft guidance, sepsis care as the highlighted priority in the draft guidance of NICE, and a discussion of the screening tool developed by NICE and the UK Sepsis Trust (UKST). Also mentioned are NICE deputy chief executive Gillian Leng and UKST executive lead nurse Georgina McNamara.

The article reports that Great Britain Sepsis Trust has launched a nationwide campaign 'Streets Against Sepsis' to raise awareness against conditions leading to sepsis and encourage people to advocate for each other. It includes a story of 15-year-old Oliver Leather, who wounded his knee during a rugby training, which was inflamed and was later diagnosed as severe sepsis.

The article offers nursing management news briefs in Great Britain as of October 2017 on topics including the call for healthcare providers to watch out for sepsis symptoms, International Council of Nurses (ICN) chief executive Frances Hughes's departure from the organization, and the National Health Service's use of more than one in ten of the world's pagers.

This section offers news briefs on pediatric nursing in Great Britain as of September 2015 including the Royal College of Pediatrics' warning about how the National Health Service children's hospital services will cope over the next six months, the launch of an online learning resource for new school nurses by the Queen's Nursing Institute, and a report from the Office for National Statistics that highlights the first rise in unexplained infant deaths in England and Wales since 2008.

The article discusses the Sepsistoolkit campaign launched on February 23, 2015 by National Health Services (NHS) Change Day together with the Great Britain Sepsis Trust to establish toolkits in every organisation in the NHS. Topics discussed include an audit of sepsis in primary care order by the Department of Health on general practitioners' practice, and the signs of sepsis including slurred speech, extreme shivering and severe breathlessness.

The author reflects on the new research and development projects, announced on April 10, 2012, that seek to enhance the diagnosis, detection, and management of sepsis. The author is critical on the suffering of the hope of sepsis-specific treatment when Eli Lilly & Co. withdrew drotrevogin alfa from the market in October 2011. Also investigated is the eight million pound British government funding to be received by the projects.