New quality standard for bacterial meningitis and meningococcal septicaemia in children and young people
29 June 2012
NICE has today published a new quality standard for bacterial meningitis and meningococcal septicaemia in children and young people.
Bacterial meningitis occurs when bacteria found normally in the upper respiratory tract infect the lining of the brain (meninges) and the spinal cord. Invasive meningococcal disease is the term used to describe two major illnesses – meningococcal meningitis (one form of bacterial meningitis) and meningococcal septicaemia (blood poisoning), which is caused when the bacteria multiply rapidly in the bloodstream, leading to damage to blood vessels and, in some cases, multi-organ failure or damage. These illnesses can occur on their own or more commonly both together.
Although there has been a reduction in the incidence of meningococcal disease and bacterial meningitis over the last 20 years, primarily as a result of the introduction of the meningitis C vaccine, meningococcal disease is still the leading infectious cause of death in early childhood making its control and treatment a clinical priority. The majority of meningococcal disease occurs in infants aged under 5 years, with a peak incidence in those aged under 1 year. There is a smaller, secondary peak in incidence in young adults aged between 15 and 19 years.
Long-term complications of bacterial meningitis include neurological damage, loss of hearing, blindness, or epilepsy. Children with meningococcal disease, as well as suffering from the complications of bacterial meningitis, may lose areas of skin, fingers/toes or even limbs, or, rarely, develop kidney failure.
The NICE quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for children and young people aged under 16 years with bacterial meningitis and meningococcal septicaemia. An important aspect of the standard is the associated measures that enable trusts to demonstrate to commissioners and patients the achievement of high quality care. The standard will also help trusts to meet the outcome goals set out in the NHS Outcomes Framework, which sets out the aims and objectives towards improving outcomes in the NHS, and what this will mean for patients and healthcare professionals.
Included among 14 quality statements and associated quality measures, the new quality standard states that children and young people with suspected or confirmed bacterial meningitis or meningococcal septicaemia have their temperature, respiratory rate, pulse, blood pressure, urine output, oxygen saturation and neurological condition monitored at least hourly until stable. In addition, children and young people with suspected bacterial meningitis have a lumbar puncture and their cerebrospinal fluid microscopy result available within 4 hours of the procedure. It also states that children and young people with suspected or confirmed bacterial meningitis or meningococcal septicaemia being transferred within or between hospitals are escorted by a healthcare professional trained in advanced paediatric life support.
Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “Fortunately, bacterial meningitis and meningococcal septicaemia are very rare. But because of the speed with which they can strike, often with little warning that anything serious is amiss, and their life-threatening potential, they are perhaps the diseases most feared by parents with young children. Because the symptoms of these diseases are often hard to distinguish from those that are less serious, this new quality standard includes an important statement on giving ‘safety netting’ information on bacterial meningitis and meningococcal septicaemia to the parents and carers of children and young people presenting with non-specific symptoms and signs. We are confident that the quality standard will help all those involved in delivering services to monitor and improve the care given to children and young people affected by these potentially devastating conditions.”
Linda Glennie, Head of Research and Medical Information at Meningitis Research Foundation (MRF), and member of the topic expert group for the new quality standard said: “Both NICE and MRF share a commitment to driving up the quality of care for children and young people who get bacterial meningitis or meningococcal septicaemia. These infections can be rapidly fatal and meningococcal disease is the leading cause of death from infection in early childhood in the UK, so identification and treatment are time critical. The new NICE quality standard will ensure that service providers, commissioners and health professionals have the information they need to deliver the best care for these children, from early symptoms assessment through to specialist treatment and universal follow-up. An integrated approach to the bacterial meningitis and meningococcal septicaemia care pathway is crucial in achieving this.”
Sue Davie, Chief Executive at Meningitis Trust said: “The prompt diagnosis and treatment of meningitis and meningococcal disease is critical to save lives and much progress has been made with the introduction of the NICE guidelines and now this new quality standard. However, as many as 40% of children who survive the most common cause of bacterial meningitis, meningococcal B, are left with after-effects so we are delighted to see that follow up and the need for appropriate information to be given to families before discharge are included in the quality standard. Too many people are left to suffer alone and at the Meningitis Trust, our goal is to ensure everyone knows where they can turn to get the support they need, when they need it and for as long as it is needed.”
Kate Rowland, Chief Executive at Meningitis UK said: “The fourteen points outlined in NICE’s new quality standard concisely highlight some of the most important areas of NICE’s clinical guidelines for the care of young people with bacterial meningitis and meningococcal septicaemia. They will help everyone monitor and improve the care given to children and young people affected by the disease.
“As meningitis can strike with incredible speed and can be difficult to diagnose, with specific symptoms often showing late, we are particularly pleased to see that the standard stresses the importance of prompt treatment, regular monitoring, appropriate care by experienced paediatric professionals and effective aftercare. As the disease can progress rapidly, we also welcome the focus on providing parents and carers with information about meningitis when children with non-specific symptoms are discharged.”
The quality standard is available on the NICE website at: www.nice.org.uk/guidance/qualitystandards/meningitis/home.jsp
For more information, please call the NICE press office on 0845 003 7782, or out of hours on 07775 583 813, or email email@example.com