Guidance
Update information
March 2024: We have replaced a recommendation on contraindications to lumbar puncture with a link to the section on lumbar puncture in the updated NICE guideline on bacterial meningitis and meningococcal disease. This recommendation is marked [2024].
January 2024: We have reviewed the evidence and made new recommendations on risk evaluation and management of suspected sepsis for people aged 16 or over who are not and have not recently been pregnant, in mental health, ambulance and acute hospital settings. This covers the population and settings in which the national early warning score (NEWS2) applies. These recommendations are marked [2024].
We have also made some changes without an evidence review. These are marked [2016, amended 2024].
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Recommendations have been updated on when to use an early warning score to assess people with suspected sepsis.
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Some recommendations have been updated and one recommendation was added to ensure better communication and inclusivity (for example, for people with learning disabilities and autism).
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Recommendations on when to suspect neutropenic sepsis were updated and the reference to NICE's guideline on neutropenic sepsis was broadened to cover immunosuppression unrelated to cancer.
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The recommendations on when GPs and ambulance services should consider having mechanisms in place to give antibiotics to people at high risk of severe illness or death from sepsis were updated to ensure due consideration is given to both patient safety and antimicrobial stewardship.
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The recommendations on identifying the source of infection and involving surgical teams were broadened to cover risk of sepsis in all parts of the body and a wider range of interventions.
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For safety reasons, people with spinal cord injury were added to the list of people whose temperature may not rise when they have sepsis.
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Recommendations for people under 16 and pregnant or recently pregnant were amended to align them with changes made for people aged 16 or over for consistency.
We have also made some presentational changes without changing the meaning of the recommendations. These recommendations are marked [2016].
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The population covered by the guideline has been divided into different subgroups, as part of the changes to incorporate the NEWS2. We have done this without changing the meaning of the recommendations for people under 16 or pregnant people.
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Duplication between the tables and recommendations was removed.
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The recommendations have been aligned with other guidelines that have been updated.
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Changes have been made to the wording to bring the language and style up to date.
October 2022: We added text to indicate that pulse oximetry may be less reliable in people with dark skin. We also added a link to the NHS patient safety alert on the risk of harm from inappropriate placement of pulse oximeter probes.
In recommendation 1.15.2 we updated the volume of fluid bolus used for intravenous fluid resuscitation from 20 ml/kg to 10 ml/kg in children and young people up to 16 years. See the surveillance report for more information.
September 2017: Table 1 was corrected to give oxygen saturation as less than 92% in air. Table 2 was amended to include tympanic temperature as a moderate risk factor. Table 1 was amended to add pallor of skin, lips or tongue as an intermediate to high risk factor.
Minor changes since publication
July 2024: We amended the wording of recommendation 1.1.4 for better inclusivity (for example, for people with learning disabilities and autism).
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