Sepsis kills more people than lung cancer, and more people than bowel and breast cancer put together. The costs to the NHS are significant; it is estimated that in Europe, patients with severe sepsis cost healthcare funders around 7.6 billion euros per year (Daniels et al, 2007). Costs in the United States are estimated at $16 billion annually (Angus et al, 2001), and in the United Kingdom up to 46% of intensive care unit (ICU) bed days are used by patients with severe sepsis (Padkin et al, 2003), with each ICU bed costing around pounds sterling1700 per day. In 2002 an international campaign was launched: the Surviving Sepsis Campaign. The main aim of this campaign is to reduce mortality from sepsis by 25% by 2009. A lot of the early work has concentrated on improving sepsis care in intensive care units, but many patients on general wards develop sepsis, and the need to educate nurses throughout all areas of the hospital has been recognized. In September 2007 a new part of the campaign was launched called Survive Sepsis, which aims to deliver sepsis education to ward nurses and junior doctors. This article discusses how to recognize severe sepsis and explains how nurses can dramatically improve a patient's chance of survival by ensuring that six simple things (Sepsis Six) are done in the first hour.

Parastomal hernia continues to be a common and distressing problem for patients with stomas and research investigating prevention strategies is scant. In March 2005 Thompson and Trainor reported that the introduction of a prevention programme for 1 year following stoma formation surgery significantly reduced the incidence of parastomal hernia. This follow-up study strengthens the reliability and validity of the findings of the first study by confirming a statistically significant reduction in the incidence of parastomal hernias through the introduction of a simple non-invasive prevention programme. clinical 22 gastrointestinal nursing vol 5 no

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