This Signal discusses the importance of considering the presence of necrotising fasciitis in any patient who presents with severe infection and has been produced after concerns about delays in diagnosis of this condition were raised with the NPSA.
A report received by the NPSA reads:
"Patient was discharged home following surgery. At home the patient developed diarrhoea, abdominal distension and abdominal and perineal pain. On readmission four days later it was noted that the patient had been seen by the out of hours service on 3 consecutive days but no examination of the perineum was undertaken. The patient was found to have necrotising fasciitis of the perineum."
Necrotising fasciitis is a devastating, albeit relatively rare, condition and a search of the National Reporting and Learning System (NRLS) over three years to September 2011 found 75 reports concerning this condition; 14 related specifically to a delay in diagnosis, two from the specialty of obstetrics and gynaecology. Nine of these resulted in death or severe harm to the patient.
Healthcare organsiations should remind staff of the following cardinal signs:
• evidence of skin infection, erythema or vesicles;
• a woody feel to tissues and crepitus that often appears late in the progression of the disease;
• fever, rigors, nausea, vomiting or septic shock in a patient with an obvious skin infection;
• severe pain and systemic features of infection in a patient with an infection in an extremity; and,
• complaints of pain out of proportion to the clinical findings.
Patients who are at high risk of this condition include those who use drugs of abuse, have diabetes mellitus or atherosclerotic vascular disease and patients with reduced immunity. In post natal patients there should be a high index of suspicion if the woman presents with a wound infection or an abnormal appearance of the wound during the early phases of healing.
If necrotising fasciitis is suspected the patient must be referred for immediate review by a senior clinician.
We would like to hear from you - please contact us with your initiatives to reduce risks in this area.
Signals are notifications of key risks emerging from review of serious incidents reported to the NRLS and shared by the NPSA.