CMScript 7 of 2025: Focus on Sepsis

Sepsis is a serious and potentially life-threatening condition that happens when your immune system overreacts to an infection in the blood in its attempt to fight it off. This overreaction can damage tissues and organs, leading to septic shock or organ failure. The latest edition of CMScript provides all the information you need to understand sepsis, how to recognise it, and how your medical scheme supports treatment and care.

Causes and risk factors

Sepsis can start from any infection, such as pneumonia, urinary tract or kidney infections, meningitis, stomach infections, or infected wounds and catheter sites.

Although anyone with an infection can develop sepsis, the risk is higher in certain groups, such as:

• Babies up to one month of age.
• People older than 65 years of age.
• Pregnant women or women who were recently pregnant.
• People with weakened immune systems, like those with HIV or those undergoing chemotherapy.
• People with medical devices or long hospital stays.

Signs and Symptoms

Sepsis can look different as it develops, but common warning signs include:

• Fever, shivering, or very low temperature
• Fast heartbeat or rapid breathing
• Confusion or difficulty staying awake
• Cold, clammy skin
• Severe pain or discomfort

In children, sepsis may show as fast breathing, convulsions, pale or cold skin, unusual sleepiness, trouble feeding, vomiting, or not urinating.

Preventing Sepsis

You can lower your risk of sepsis by:

• Practising good hygiene, including regular handwashing
• Keeping up to date with vaccines
• Managing chronic health conditions properly
• Cleaning and covering wounds until they heal
• Seeking medical care quickly if you suspect an infection

In hospitals, careful infection control and correct use of antibiotics are also key to preventing sepsis.

Diagnosis and Treatment

Doctors diagnose sepsis by checking vital signs such as heart rate, breathing, temperature and blood pressure. They may also use blood or urine tests to find the infection and assess how organs are coping. In some cases, scans like X-rays or ultrasounds are used to identify where the infection started. Sepsis needs urgent care and treatment may include:

• Antibiotics that are given as soon as possible to fight the infection.
• Fluids through a drip to keep blood pressure stable.
• Medicines to relieve pain and manage blood pressure if fluids alone are not enough
• Supportive care such as oxygen, a ventilator to help with breathing, or kidney dialysis if the kidneys are affected.
• Surgery, such as incision and drainage of infected sites to remove the source of infection, such as pus or damaged tissue.

Understanding PMB level of care

Sepsis is covered under the Prescribed Minimum Benefits (PMBs) as both a diagnosed condition (DTP 904S: septicaemia) and a medical emergency.

This means your medical scheme must:

• Pay in full for diagnosis, treatment, and care – in and out of hospital – if you use a Designated Service Provider (DSP).
• Cover emergency care in full, even if a non-DSP is used involuntarily.
• Fund PMB claims from your risk benefit, not your Medical Savings Account.

Your healthcare provider can help with the necessary forms and motivation letters to ensure your treatment is correctly covered under PMBs.

 

Download the full CMScript here.