What are the signs of sepsis? There is no single sign, and a high temperature is not one you can rely on. The NHS lists the common symptoms in adults as confusion or slurred speech, uncontrollable shivering, muscle pain, difficulty breathing, blue, pale, grey or blotchy skin, lips or tongue, a high or low temperature, and passing very little or no urine — and it notes that a high temperature is less common in older adults. NICE goes further and tells clinicians not to rely on fever or a low temperature alone to rule sepsis in or out. In a care setting, the earliest warning is often simply that the person is not their usual self.
At a glance: Nexis CPD’s £9 Sepsis Awareness course covers what sepsis is and why it matters, recognising it in adults, sepsis in children and higher-risk groups, and how to respond and help prevent it. It is CPD accredited and 100% online with a verifiable e-certificate, and any three courses cost £18. It is awareness training for care and support staff — it does not replace clinical training in taking and scoring observations, and it is not a regulated qualification.
What is sepsis?
The NHS describes sepsis as “a serious reaction to an infection that can be life-threatening”. It is not an infection in itself. It is the body’s response to an infection going wrong: the NHS explains that the exact cause is not known, but “it’s thought your immune system overreacts to an infection and starts to damage your body’s organs.”
Three facts from the NHS sepsis page shape everything a care worker needs to know:
- It moves fast. Sepsis “usually develops quickly over a few hours”. If it is not treated it can turn into septic shock, which can be fatal.
- It needs hospital treatment. Sepsis is treated in hospital, typically with antibiotics, oxygen and fluids into a vein. It is not something that can be managed in a care home or at home.
- Any infection can lead to it. Bacterial infections are the most common cause, including chest infections (pneumonia), urinary tract infections (UTIs), abdominal infections such as appendicitis, and skin infections such as cellulitis or infected wounds.
Chest infections, UTIs and infected wounds are everyday events in care. Most do not become sepsis; the skill is spotting the one that is starting to.
Treat dramatic death-toll figures with care: the NHS says only that “many people die from sepsis in the UK each year”, and NICE’s guideline notes a lack of robust UK studies on how often sepsis occurs. What is not in doubt is that it is time-critical and often missed early.
What are the signs of sepsis in adults?
The NHS lists these as common symptoms of sepsis in adults:
- confusion or slurred speech
- uncontrollable shivering
- muscle pain
- difficulty breathing
- blue, pale, grey or blotchy skin, lips or tongue — on black or brown skin this may be easier to see on the palms of the hands or soles of the feet
- a high or low temperature — “a high temperature is less common in older adults”
- not peeing all day, or peeing very little in the past 18 hours
Several of these signs are easy to explain away in an older or frail person — confusion put down to dementia, shivering to a cold room, low urine output to not drinking enough. And the temperature sign runs both ways: a person with sepsis may feel cold and have a low temperature.
The NHS also warns that a person with sepsis “might not have every symptom listed”, and gives a plain instruction: get immediate medical help if someone is unwell and you think there is something seriously wrong. Its short version is “trust your instincts”.
Why is a high temperature not a reliable sign of sepsis?
Because many of the people most at risk do not develop one. The national guideline for adults — NICE NG253, Suspected sepsis in people aged 16 or over, published on 19 November 2025 and last updated on 23 September 2026, which partially updates and replaces the older NG51 — is explicit. It tells clinicians to “take into account that people with sepsis may have non-specific, non-localised presentations, for example feeling very unwell, and may not have a high temperature”, and to “not rely on fever or hypothermia alone to rule sepsis either in or out.”
NICE lists groups who may not develop a raised temperature at all:
- people who are older or very frail
- people having treatment for cancer
- people severely ill with sepsis
- people with a spinal cord injury.
It adds that older people with an infection “may not develop an increased heart rate”. The lesson for a care team: “temperature normal” is not the same as “no sepsis”, and a normal reading should never close down a conversation about a resident who looks or behaves differently.
What are the early signs of sepsis in older people and people with dementia?
In older people, and in anyone who struggles to describe how they feel, sepsis often shows up first as a change in behaviour or ability rather than a clear physical symptom. NICE tells clinicians to:
- “interpret a person’s mental state in the context of their normal function and treat changes as being significant”
- be aware that changes in cognitive function “may be subtle”, and that assessment should include history from the person’s family or carers
- take into account that changes in cognitive function “may present as changes in behaviour or irritability in adults with a learning disability or dementia”
- take into account that in older people, changes in cognitive function may present as “acute changes in functional abilities”.
In care, that might be a resident who usually walks with a frame suddenly needing two staff to stand, or someone who normally chats becoming withdrawn and sleepy. Care-home deterioration tools call these “soft signs” — changes staff notice before any measurement changes.
NICE also says clinicians should “pay particular attention to concerns expressed by the person and their family or carers, for example changes from usual behaviour.” That puts care workers in a strong position. You often know the person’s normal far better than a GP or paramedic meeting them for the first time. The NHS makes the same point from the other side: sepsis symptoms can be more difficult to notice in people with dementia, people with a learning disability and people who have difficulty communicating.
Who is most at risk of sepsis?
Anyone can get sepsis, but the NHS says the chance is higher if a person:
- is a baby under 12 months, or is over 75
- is pregnant, or has given birth, had an abortion or a miscarriage in the past 6 weeks
- has a weakened immune system — for example because of HIV or sickle cell disease, chemotherapy, or taking corticosteroids or immunosuppressants
- has a burn, cut or wound, or a skin infection like cellulitis
- has a urinary catheter
- injects illegal drugs or misuses alcohol.
NICE’s 2025 list of factors that increase the risk of sepsis, or of it not being identified promptly, reads like a description of many people who use care services: being 75 or over, frailty, multiple long-term conditions, impaired immunity, recent surgery, indwelling catheters, repeated antibiotic use, breaks in the skin, and communication challenges such as learning disabilities or cognitive impairment.
NICE also says that anyone who becomes unwell within 30 days of anticancer treatment should be suspected of neutropenic sepsis and referred immediately for hospital assessment.
What should a care worker do if they suspect sepsis?
A care worker’s job is not to diagnose sepsis. It is to notice, check, act quickly and pass on clear information. A practical sequence looks like this.
1. Think “could this be sepsis?”
NICE’s very first recommendation is to think “could this be sepsis?” when someone has signs of a possible infection. If a person with a cough, urine infection or hot, red wound is now more unwell, ask the question out loud and tell the senior on shift.
2. Call 999 for red-flag signs
The NHS says to call 999 or go to A&E if an adult or child aged 5 or over:
- is breathing very fast
- is confused, has slurred speech, or is not making sense
- has blue, pale or blotchy skin (on black or brown skin, check the palms of the hands or soles of the feet)
- has a very high or very low temperature, feels hot or cold to the touch, or is shivery
- has a rash that does not fade when you press it
- has symptoms you are worried might be sepsis.
Notice the last bullet. You do not need to be sure. The NHS also advises that a person should not drive themselves to A&E and should bring their medicines with them — useful to remember for supported living and domiciliary settings.
3. Take observations if you are trained to
NICE says people with suspected sepsis should have their temperature, heart rate, breathing rate, blood pressure, level of consciousness and oxygen saturation assessed. In community settings, NICE says to measure oxygen saturation if equipment is available and doing so does not delay assessment or treatment. It also recommends asking how often the person has passed urine in the past 18 hours, and about any recent fever or shivering episodes (rigors).
Only take observations if you are trained and assessed as competent, and never let them delay a 999 call.
4. Hand over clearly
When you phone a GP, NHS 111 or the ambulance service, structured handovers help. Many care homes use SBARD — Situation, Background, Assessment, Recommendation, Decision — so that the call covers: who the person is and what has changed; their relevant history and medicines; the observations and soft signs you have seen; and what you are asking for. Tell them plainly that you are worried about sepsis. Record the call, the advice given and the decision.
5. Keep watching and re-escalate
Sepsis can change over hours. If the person gets worse after you have been told to wait and monitor, call again. NICE now asks clinicians whether the person has recently been seen with symptoms that could indicate sepsis, so include any earlier GP or hospital contacts in your handover.
What is NEWS2, and what is RESTORE2?
NEWS2 is the National Early Warning Score developed by the Royal College of Physicians. It turns routine observations — breathing rate, oxygen saturation, blood pressure, pulse, level of consciousness or new confusion, and temperature — into a single score that shows how unwell someone is. NICE NG253 recommends using NEWS2 to assess suspected sepsis in adults in acute hospitals, acute mental health settings and ambulances. For community settings, NICE says to “consider using an early warning score”.
NICE’s committee stressed that NEWS2 supports clinical judgement rather than replacing it, and that a score of 0 does not mean a person with an infection is not at risk of sepsis.
RESTORE2 — Recognise Early Soft Signs, Take Observations, Respond and Escalate — is a deterioration and escalation tool designed for care and nursing homes. It is owned by NHS Hampshire and Isle of Wight Integrated Care Board, which says it makes NEWS2 accessible to care homes “through the use of soft signs of deterioration”, combined with an escalation protocol and the SBARD communication tool. The ICB says RESTORE2 is free for all health and care settings to use provided no alterations are made, and there is a shorter “RESTORE2 mini” for homes that are not yet able to measure vital signs.
Whatever tool your service uses, every member of staff — including night, agency and new staff — should know where it is and who to call.
Can a UTI turn into sepsis, and should care homes dipstick urine?
Yes, a UTI can lead to sepsis — the NHS lists urinary tract infections among the most common causes, and people with urinary catheters are at higher risk. But the traditional care-home habit of dipping a urine sample every time a resident seems confused is now actively discouraged for older people.
The UK Health Security Agency’s quick reference tools for diagnosing UTIs say for adults over 65: “Do not perform urine dipsticks.” The reason given is that dipsticks become less reliable with age because of bacteria in the urine that are not causing an infection: “By 80 years, about half of older adults living in care homes can have bacteria present in the urine without infection.” A positive dipstick can therefore lead to the wrong diagnosis — and, just as importantly, to the real cause of someone’s decline being missed.
The same tool tells clinicians to “think sepsis” in anyone with urinary symptoms. For a care worker, that means reporting what you see — new confusion, fever or shivering, pain passing urine, a change in output — and escalating urgently for any red-flag sign.
How can care workers help prevent sepsis?
You cannot prevent every case, but good everyday care reduces the infections that lead to sepsis and gets them treated earlier:
- Infection prevention and control. Hand hygiene at the right moments, correct use of gloves and aprons, and clean equipment all cut the spread of infection. See our guide to infection prevention and control.
- Skin and wound care. Breaks in skin integrity are on NICE’s risk list. Preventing pressure ulcers, checking wounds and reporting redness, heat, swelling, discharge or new pain early all matter.
- Catheter care. Follow the person’s catheter care plan and your service’s procedures, and report cloudy or offensive urine, pain, fever or reduced drainage promptly.
- Knowing the person’s baseline. Record what “normal” looks like for each person — mobility, appetite, alertness, communication — so that changes are easy to spot and describe.
- Following up antibiotics. If someone has been prescribed antibiotics for an infection and is not improving, or is getting worse, raise it rather than waiting for the course to finish.
After sepsis the risk does not disappear. The NHS advises calling NHS 111 if someone who has had sepsis in the past 12 months develops symptoms of an infection, and describes post-sepsis syndrome — tiredness, weakness, memory problems, anxiety and low mood — which “often lasts 6 to 18 months”.
What are the signs of sepsis in children?
Sepsis looks different in young children. The NHS lists signs including breathing very fast or with difficulty, a fit, a high or low temperature, blue, grey, pale or blotchy skin, a rash that does not fade when pressed, being unusually sleepy or hard to wake, and not passing urine for 12 hours in under-5s. NICE has separate guidelines for suspected sepsis in people under 16 and in pregnant or recently pregnant people.
Is sepsis training mandatory for care workers?
No law names sepsis training specifically. But the duty to train is real. In England, regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires registered providers to provide care and treatment “in a safe way”, including “assessing the risks to the health and safety of service users”, “doing all that is reasonably practicable to mitigate any such risks”, ensuring staff have the “qualifications, competence, skills and experience” to provide care safely, and “assessing the risk of, and preventing, detecting and controlling the spread of, infections”.
NICE NG253 makes the expectation explicit. It recommends that all healthcare staff and students involved in assessing people’s clinical condition are given “regular, appropriate training in identifying people who might have sepsis”, and says this includes “primary, community care and hospital staff including those working in care homes.” NICE guidelines are not law, but services are expected to take them fully into account, and CQC looks at whether staff recognise and respond to deterioration.
In practice: awareness training on signs, risk and escalation, plus hands-on competency checks in the service’s own observation tool. See our guide to mandatory training for healthcare workers for how this fits alongside the rest of a care team’s training.
What is Martha’s Rule?
Martha’s Rule is an NHS England patient safety initiative for hospitals. NHS England explains that it followed the death of Martha Mills, who died in 2021 after developing sepsis in hospital when her family’s concerns about her worsening condition were not responded to. It gives patients, families and carers the right to request a rapid review from a different team if they are worried a patient is deteriorating and are not being listened to. NHS England says implementation in adult and children’s inpatient settings is expected to be complete during 2026/27. It does not apply in care homes, but if someone you support is admitted, you can pass on what their normal looks like and their family can ask whether Martha’s Rule is available on the ward.
Does a DNACPR decision mean sepsis should not be treated?
No. A DNACPR decision is about whether CPR will be attempted if the heart stops; it is not a decision to withhold other treatment. Follow any advance care plan or ReSPECT form, but still escalate to the GP, community team or NHS 111 so a clinician can decide with that information. Our guides to end of life care and the Mental Capacity Act explain how these decisions work.
Which training helps care teams recognise sepsis?
These three £9 courses work well together for care workers and senior carers, each with a verifiable certificate:
- Sepsis Awareness — what sepsis is, recognising it in adults, children and higher-risk groups, and how to respond.
- Infection Prevention and Control Awareness — stopping the infections that lead to sepsis from spreading.
- Dementia Awareness — understanding the person and their normal, so that changes in behaviour are noticed.
Risk Assessments in Care is a useful alternative for senior staff. Any three courses cost £18 with the pay-for-2-get-3 offer — add them to the cart and the discount applies automatically. These are awareness courses: they do not train you to take or score clinical observations, which must be taught and assessed in your workplace, and they are not regulated qualifications.
Frequently asked questions
What are the first signs of sepsis in adults?
The NHS lists confusion or slurred speech, uncontrollable shivering, muscle pain, difficulty breathing, blue, pale, grey or blotchy skin, lips or tongue, a high or low temperature, and passing little or no urine. In older people the first sign is often a change from their usual behaviour or abilities.
Can you have sepsis without a high temperature?
Yes. NICE says people with sepsis may not have a high temperature and that fever or a low temperature should not be relied on to rule sepsis in or out. Older or very frail people, people having cancer treatment and people who are severely ill may not develop a raised temperature.
When should you call 999 for suspected sepsis?
The NHS says call 999 or go to A&E if an adult is breathing very fast, is confused or not making sense, has blue, pale or blotchy skin, has a very high or low temperature or is shivery, has a rash that does not fade when pressed, or has symptoms you are worried might be sepsis.
How quickly does sepsis develop?
The NHS says sepsis usually develops quickly over a few hours. If it is not treated it can turn into septic shock, which can be fatal, so suspected sepsis needs urgent assessment rather than waiting to see how the person is the next day.
Is sepsis training mandatory in care homes?
No law names sepsis training specifically, but CQC regulation 12 requires providers to assess and reduce risks and to make sure staff are competent. NICE recommends regular sepsis recognition training for staff assessing people’s condition, including those working in care homes.
Should care homes use urine dipsticks to check for infection?
Not for adults over 65. UKHSA guidance says do not perform urine dipsticks in this group, because by 80 years about half of older adults in care homes can have bacteria in the urine without infection. Report symptoms and think sepsis instead.
Help your team spot sepsis sooner
£9 per course. CPD accredited, 100% online, verifiable e-certificate. Pay for 2, get 3 — any 3 courses for £18.
This article is general information for care and support staff, not medical advice, and it is not a substitute for clinical assessment or your service’s own policies. If you think someone might have sepsis, call 999 or go to A&E. Guidance is drawn from the NHS, NICE (NG253), UKHSA, NHS England, NHS Hampshire and Isle of Wight ICB and legislation.gov.uk at the time of writing; regulation 12 applies to CQC-registered services in England, and Scotland, Wales and Northern Ireland have their own care regulators. A Nexis CPD awareness course is CPD accredited but is not a regulated qualification and does not certify competence in clinical observations.