Meningitis and Meningococcal Septicaemia: A Care Staff Guide

Meningitis and meningococcal septicaemia can look like flu at first and become life-threatening within hours. UK Health Security Agency (UKHSA) guidance for clinicians says that patients may start with flu-like symptoms but often deteriorate rapidly. For care staff, who may be the first to notice that someone is unwell, speed of recognition and escalation matters more than certainty about the diagnosis.

What are meningitis and septicaemia?

Meningitis is inflammation of the protective membranes around the brain and spinal cord. Meningococcal disease, caused by meningococcal bacteria, can also cause septicaemia, a bloodstream infection. The two can occur together or separately, and either needs emergency treatment. Our guide to sepsis recognition and management covers the wider picture of serious infection, and this guide focuses on the specific features of meningitis and meningococcal disease.

Signs of meningitis

The GOV.UK signs and symptoms poster lists the main features of meningitis as fever, a very bad headache, vomiting, a stiff neck, sensitivity to bright light, a rash, confusion or delirium, severe sleepiness or loss of consciousness, and seizures. Not everyone has all of these, and they can appear in any order. A headache on its own is not a reason to seek emergency help, but a headache together with other signs should raise concern.

Signs of septicaemia

The same poster lists fever with shivering, severe pain in the limbs and joints, vomiting, very cold hands and feet, pale or blotchy skin, rapid breathing, diarrhoea and stomach cramps, a red or purple bruise-like rash that does not fade under pressure, difficulty walking or standing, and severe sleepiness or loss of consciousness. Cold hands and feet, severe limb pain and pale or blotchy skin tend to appear early. A rash that does not fade, confusion, or being too sleepy to wake are later and very serious signs. Do not wait for a rash before acting.

The glass test

Press the side of a clear drinking glass firmly against the rash. If the rash does not fade or lose colour under pressure, contact a doctor immediately. On darker skin, the poster advises checking inside the eyelids and the roof of the mouth, where spots may be easier to see. The glass test is a useful extra check, but a person who is seriously unwell with no rash still needs urgent help.

What to do

• Call 999 if the person is getting worse. GOV.UK advises urgent help from an emergency department or 999 when symptoms are worsening, and NHS 111 or the GP for advice when you are concerned but the person is stable.
• Keep checking. The poster stresses that people can deteriorate within hours and that early treatment can save lives. Repeat observations and keep the person under watch rather than assuming they are sleeping.
• Record what you see. Note the time symptoms started, any rash and its appearance, temperature, level of alertness, and what you told the ambulance service.
• Tell the right people. Inform the manager, the GP and the family, following your own escalation policy.

Use a structured way to describe how drowsy or confused someone is. Our guide to the 4AT delirium screening tool explains how to spot sudden changes in alertness, which can be an early warning in older residents.

Protecting others

UKHSA guidance explains that invasive meningococcal disease is under national enhanced surveillance in England, and that close contacts may need advice about antibiotics. It also links to a patient group direction for supplying ciprofloxacin to clusters of two or more cases in a congregate setting. If a resident, staff member or visitor is diagnosed, contact your local UKHSA health protection team promptly for advice and follow their instructions about contacts. Good everyday hygiene helps too, and our guide to infection prevention and control in care homes sets out the basics.

Supporting families and colleagues

A suspected case is frightening for everyone. Keep relatives informed with calm, factual updates, avoid speculation about the cause, and make sure other residents and staff know who to ask for information. Debrief the team afterwards, since staff who were involved in an emergency may need time to talk it through. Use the incident to review what worked and whether any step, such as how quickly observations were repeated or how the call was made, could be improved.

Vaccination

UKHSA states that the routine UK schedule includes the MenB vaccine at 2, 4 and 12 months, Hib/MenC at 12 months and MenACWY at 14 years, and that quadrivalent MenACWY vaccination is required for Hajj and Umrah and recommended for travel to parts of Africa and other high-incidence countries. Vaccination does not protect against every cause of meningitis, so staff should keep recognising the signs regardless of vaccination status. The Green Book chapter on meningococcal disease has full details.

Supporting staff learning

Short, regular scenario-based practice helps staff to act quickly. Team talks that cover the signs, the glass test and who to call give confidence to people working nights or alone. You can find learning options in Learnsignal's CPD library.

Frequently asked questions

Does a rash always appear? No. UKHSA describes a non-blanching rash as often a late sign, so staff must not wait for it.

What if the glass test is negative? If the person is seriously unwell, still seek urgent help. The test is a tool, not a reason to wait.

Who should I call? Call 999 if symptoms are worsening or serious. Use NHS 111 or the GP for advice when you are concerned and the person is stable.