Knowledge of sepsis risk and management among dental professionals in Wales: a service evaluation

Abstract

Aims Sepsis is a significant medical condition. This service evaluation aimed to investigate the current level of knowledge, confidence and educational requirements regarding sepsis among dental professionals in Wales.

Design A convenience-sampled, self-administered electronic questionnaire.

Setting All chairside dental professionals registered with Health Education and Improvement Wales, all Local Dental Committees, district general hospitals, Cardiff University Dental Hospital and Community Dental Services throughout Wales.

Materials and methods A questionnaire was distributed electronically to an estimated 3,716 dental professionals working in Wales in late 2019. Responses were descriptively and statistically analysed.

Results In total, 357 responses were received (9.6%), which achieves a 95% confidence interval (CI) with a 5% margin of error. The majority of respondents reported lack of knowledge or confidence in sepsis recognition and management. Approximately two-fifths of respondents did not access equipment to measure oximetry, temperature or blood pressure. More than three-quarters of respondents had not been trained in sepsis recognition and management. The majority of respondents requested online/distance training (42%), local/national conferences (27%) and local study days (16%) as postgraduate educational format.

Conclusion There is a clear need for postgraduate education for dental teams regarding the identification and management of individuals with potential sepsis in Wales.

Introduction

Key points

  • Dental professionals report low levels of knowledge and confidence in sepsis recognition and management.

  • Relevant investigations pertinent to sepsis identification are not frequently undertaken in individuals presenting with infection.

  • There is a high requirement and demand for face-to-face and e-learning regarding sepsis.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig 6
Fig. 7

References

  1. 1.

    Singer M, Deutschman C S, Seymour C W et al. The third international consensus definitions for Sepsis and septic shock (Sepsis-3). JAMA 2016; 315: 801-810.

  2. 2.

    Rudd K E, Johnson S C, Agesa K M et al. Global, regional, and national Sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet 2020; 395: 200-211.

  3. 3.

    The UK Sepsis Trust. About. 2020. Available at https://sepsistrust.org/about/ (accessed February 2020).

  4. 4.

    Singer M, Inada-Kim M, Shankar-Hari M. Sepsis hysteria: excess hype and unrealistic expectations. Lancet 2019; 394: 1513-1514.

  5. 5.

    NHS England. Improving outcomes for patients with sepsis: A cross-system action plan. 2015. Available at https://www.england.nhs.uk/wp-content/uploads/2015/08/Sepsis-Action-Plan-23.12.15-v1.pdf (accessed February 2020).

  6. 6.

    NHS England. Second Sepsis action plan. 2017. Available at https://www.england.nhs.uk/wp-content/uploads/2017/09/second-sepsis-action-plan.pdf (accessed February 2020).

  7. 7.

    Royal College of General Practitioners. Sepsis Toolkit. 2018. Available online at https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/sepsis-toolkit.aspx (accessed February 2020).

  8. 8.

    National Institute for Health and Care Excellence. Sepsis: recognition, diagnosis and early management: NICE Guideline NG51 - Tools and resources. 2017. Available online at https://www.nice.org.uk/guidance/ng51/resources (accessed October 2019).

  9. 9.

    Nutbeam T, Daniels R on behalf of the UK Sepsis Trust. Clinical Tools. 2015. Available online at https://sepsistrust.org/professional-resources/clinical-tools/ (accessed February 2020).

  10. 10.

    Care Quality Commission. Dental mythbuster 25: Sepsis. 2019. Available at http://www.cqc.org.uk/guidance-providers/dentists/dental-mythbuster-25-Sepsis (accessed February 2020).

  11. 11.

    National Institute of Health and Clinical Excellence. Sepsis: recognition, diagnosis and early management: NICE Guideline NG51 - Guidance. 2017. Available online at https://www.nice.org.uk/guidance/ng51 (accessed October 2019).

  12. 12.

    Currie W J, Ho V. An unexpected death associated with an acute dentoalveolar abscess - report of a case. Br J Oral Maxillofac Surg 1993; 31: 296-298.

  13. 13.

    Green A W, Flower E A, New N E. Mortality associated with odontogenic infection! Br Dent J 2001; 190: 529-530.

  14. 14.

    Carter L, Lowis E. Death from overwelling odontogenic Sepsis: a case report. Br Dent J 2007; 203: 241-242.

  15. 15.

    Omura Y, Kitamoto M, Hyogo H et al. Morbidly obese patient with non-alcoholic steatohepatitis-related cirrhosis who died from Sepsis caused by dental infection of Porphyromonas gingivalis: A case report. Hepatol Res 2016; DOI: 10.1111/hepr.12528.

  16. 16.

    Holmberg P, Hellmich T, Homme J. Paediatric Sepsis Secondary to an Occult Dental Abscess: A Case Report. J Emerg Med 2017; 52: 744-748.

  17. 17.

    Gilway D, Brown S J. Medical emergencies: Sepsis in primary dental care. Br Dent J 2016; 220: 278.

  18. 18.

    Coelho C, Mead M. Sepsis: the applicability to dental care professionals. Br Dent J 2018; 225: 1078-1081.

  19. 19.

    Robson W, Beavis S, Spittle N. An audit of ward nurses' knowledge of Sepsis. Nurs Crit Care 2007; 12: 86-92.

  20. 20.

    Assunção M, Akamine N, Cardoso G S et al. Survey on physicians' knowledge of Sepsis: do they recognise it promptly? J Crit Care 2010; 25: 545-552.

  21. 21.

    Jeffery A D, Mutsch K S, Knapp L. Knowledge and recognition of SIRS and Sepsis among paediatric nurses. Paediatr Nurs 2014; 40: 271-278.

  22. 22.

    Cowan S L, Holland J A A, Frost I, Kane A. Recognition and management of Sepsis by junior doctors. Fut Hosp J 2016; 3: 99-102.

  23. 23.

    Park J, Hwang S Y, Shin T G et al. Emergency medical service personnel need to improve knowledge and attitude regarding prehospital Sepsis care. Clin Exp Emerg Med 2017; 4: 48-55.

  24. 24.

    Storozuk S A, MacLeod M L P, Freeman S, Banner D. A survey of Sepsis knowledge among Canadian emergency department registered nurses. Australas Emerg Care 2019; 22: 119-125.

  25. 25.

    Royal College of General Practitioners. RCGP Sepsis Clinical Spotlight and Clinical Priority: Overview and Impact Report 2016-17. 2018. Available at https://www.rcgp.org.uk/-/media/Files/CIRC/Sepsis/RCGP-Sepsis-Clinical-Spotlight-and-Clinical-Priority-2016-17.ashx (accessed October 2019).

  26. 26.

    Welsh Government. Well-being of Future Generations (Wales) Act 2015. 2015. Available at http://www.futuregenerations.wales/about-us/future-generations-act/ (accessed April 2020).

  27. 27.

    Centres for Disease Control and Prevention. Epi Info™ for Windows. Available online at https://www.cdc.gov/epiinfo/pc.html (accessed April 2020).

  28. 28.

    Loots F J, Smits M, van Steensel C, Giesen P, Hopstaken R M, van Zanten A R H. Management of Sepsis in outofhours primary care: a retrospective study of patients admitted to the intensive care unit. BMJ Open 2018; DOI: 10.1136/bmjopen-2018-022832.

  29. 29.

    Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. 2017. Available online at https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2 (accessed August 2020).

  30. 30.

    NHS England and NHS Improvement. Resources to support the safe adoption of the revised National Early Warning Score (NEWS2). 2018. Available at https://www.england.nhs.uk/wp-content/uploads/2019/12/Patient_Safety_Alert_-_adoption_of_NEWS2.pdf (accessed February 2020).

  31. 31.

    1000 Lives Plus. Acute deterioration: Sepsis & AKI. 2018. Available at http://www.1000livesplus.wales.nhs.uk/acute-deterioration-Sepsis-aki (accessed February 2020).

  32. 32.

    National Confidential Enquiry into Patient Outcome and Death. Just Say Sepsis! A review of the process of care received by patients with sepsis. 2015. Available at https://www.ncepod.org.uk/2015report2/downloads/JustSaySepsis_FullReport.pdf (accessed February 2020).

  33. 33.

    Fee N, Hartigan L, McAuliffe F M, Higgins M F. Education in Sepsis: A Review for the Clinician of What Works, for Whom, and in What Circumstances. J Obstet Gynaecol Can 2017; 39: 772-780.

  34. 34.

    Thomas S, Atkinson C, Hughes C, Revington P, Ness A. Is there an epidemic of admissions for surgical treatment of dental abscesses in the UK? Br Med J 2008; 336: 1219-1220.

  35. 35.

    NHS Digital. Hospital Admitted Patient Care Activity 2018-19. 2019. Available online at https://digital.nhs.uk/data-and-information/publications/statistical/hospital-admitted-patient-care-activity/2018-19 (accessed April 2020).

  36. 36.

    NHS Wales Informatics Service. Annual PEDW Data Tables. 2020. Available online at http://www.infoandstats.wales.nhs.uk/page.cfm?orgid=869&pid=41010&subjectlist=Primary+Diagnosis+%284+character+detail%29&patientcoverlist=0&period=0&keyword=&action=Search h (accessed April 2020).

  37. 37.

    Porter S R, Whitcomb, M E, Weitzer W H. Multiple Surveys of Students and Survey fatigue. New Direct Institut Res 2004; 121: 63-73.

  38. 38.

    Porter S R. Raising response rates: What works? New Direct Institut Res 2004; 121: 5-21.

Download references

Acknowledgements

The authors would like to thank HEIW, the CDS and HDS CDS, Dental Clinical Leads and Local Dental Committee chairs who acted as gatekeepers to disseminate the questionnaire. They would also like to thank Mrs Maria Morgan for advice in preparing this paper and for the map in Figure 1. The authors are grateful to the UKST for permission to use Figure 6 and the Royal College of Physicians for permission to use Figure 7.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Stephen Woolley.

Ethics declarations

The authors do not have any conflict of interests. No funding was received for this project.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Woolley, S., Allen, M. & Medeiros Mirra, R. Knowledge of sepsis risk and management among dental professionals in Wales: a service evaluation. Br Dent J (2020). https://doi.org/10.1038/s41415-020-2022-8

Download citation

Search