TSS in children is rare, which actually makes it perfect for a focused QI/audit—you can audit recognition and management standards rather than incidence. Here are some practical UK-style audit/QI ideas that paediatric departments, PICUs, or EDs could realistically run.
1. Early recognition of Toxic Shock Syndrome
Audit question:
Are children with suspected TSS recognised and escalated promptly?
Standards you could audit against
Audit indicators
Time from presentation → sepsis screening
Time from presentation → senior review
Documentation of rash, hypotension, mucous membrane involvement
Documentation of possible source (burns, skin infection, tampon, wound)
QI angle
2. Compliance with recommended antibiotic therapy
Audit question:
Are children with suspected TSS receiving appropriate empiric antibiotics?
Standards
Typical recommended early regimen:
Clindamycin (toxin suppression)
Broad spectrum coverage (e.g. Ceftriaxone, Piperacillin–tazobactam, or Meropenem)
MRSA cover if risk (e.g. Vancomycin)
Audit indicators
Clindamycin given within 1 hour
Broad-spectrum antibiotic given within 1 hour
Blood cultures taken before antibiotics
Infectious diseases/microbiology consultation documented
QI idea
3. Use of antitoxin therapy
Audit question:
Are eligible children with severe TSS receiving IV immunoglobulin?
Standards
Use guidance from National Institute for Health and Care Excellence and microbiology consensus.
Audit indicators
Proportion receiving Intravenous Immunoglobulin
Time from PICU admission → IVIG
Documentation of decision if IVIG not given
Why this is good
The UK surveillance study found IVIG underused (~20%), so this is a strong QI topic.
4. Compliance with paediatric sepsis bundle in suspected TSS
Audit question:
Are children with TSS managed according to paediatric sepsis standards?
Standards
Guidelines from National Institute for Health and Care Excellence sepsis guidance.
Audit indicators
Lactate measured
Blood cultures obtained
Antibiotics within 1 hour
Fluid bolus within recommended timeframe
Escalation to PICU when needed
QI angle
5. Source control and microbiological investigation
Audit question:
Are appropriate investigations performed to identify the infection source?
Audit indicators
Wound swab taken
Throat swab for streptococcus
Skin/burn swabs
Imaging when deep infection suspected
Surgical review documented
QI intervention
6. Recognition of TSS in burns patients
Good if you work in a burns-associated paediatric unit.
Audit question:
Are children with burns screened for early TSS features?
Indicators
7. Follow-up and complication monitoring
Audit question:
Are complications of TSS appropriately monitored?
Indicators
💡 Easier QI project idea (very doable):
Title:
“Compliance with early antibiotic and toxin-suppressing therapy in suspected paediatric Toxic Shock Syndrome.”
Why it works:
✅ If you want, I can also show you:
Here is the full English text of “The Song of the Sannyasin” — a poem composed by Swami Vivekananda in July 1895 that expresses the ideals of renunciation and spiritual freedom:
The Song of the Sannyasin
(by Swami Vivekananda)
Wake up the note! the song that had its birth
Far off, where worldly taint could never reach,
In mountain caves and glades of forest deep,
Whose calm no sigh for lust or wealth or fame
Could ever dare to break; where rolled the stream
Of knowledge, truth, and bliss that follows both.
Sing high that note, Sannyâsin bold! Say —
“Om Tat Sat, Om!”
Strike off thy fetters! Bonds that bind thee down,
Of shining gold, or darker, baser ore;
Love, hate — good, bad — and all the dual throng,
Know, slave is slave, caressed or whipped, not free;
For fetters, though of gold, are not less strong to bind;
Then off with them, Sannyâsin bold! Say —
“Om Tat Sat, Om!”
Let darkness go; the will-o’-the-wisp that leads
With blinking light to pile more gloom on gloom.
This thirst for life, for ever quench; it drags
From birth to death, and death to birth, the soul.
He conquers all who conquers self. Know this
And never yield, Sannyâsin bold! Say —
“Om Tat Sat, Om!”
“Who sows must reap,” they say, “and cause must bring
The sure effect; good, good; bad, bad; and none
Escape the law. But whoso wears a form
Must wear the chain.” Too true; but far beyond
Both name and form is Âtman, ever free.
Know thou art That, Sannyâsin bold! Say —
“Om Tat Sat, Om!”
They know not truth who dream such vacant dreams
As father, mother, children, wife, and friend.
The sexless Self! whose father He? whose child?
Whose friend, whose foe is He who is but One?
The Self is all in all, none else exists;
And thou art That, Sannyâsin bold! Say —
“Om Tat Sat, Om!”
There is but One — The Free — The Knower — Self!
Without a name, without a form or stain.
In Him is Māyā dreaming all this dream.
The witness, He appears as nature, soul.
Know thou art That, Sannyâsin bold! Say —
“Om Tat Sat, Om!”
Where seekest thou? That freedom, friend, this world
Nor that can give. In books and temples vain
Thy search. Thine only is the hand that holds
The rope that drags thee on. Then cease lament,
Let go thy hold, Sannyâsin bold! Say —
“Om Tat Sat, Om!”
Say, “Peace to all: From me no danger be
To aught that lives. In those that dwell on high,
In those that lowly creep, I am the Self in all!
All life both here and there, do I renounce,
All heavens and earths and hells, all hopes and fears.”
Thus cut thy bonds, Sannyâsin bold! Say —
“Om Tat Sat, Om!”
Heed then no more how body lives or goes,
Its task is done. Let Karma float it down;
Let one put garlands on, another kick
This frame; say naught. No praise or blame can be
Where praiser praised, and blamer blamed are one.
Thus be thou calm, Sannyâsin bold! Say —
“Om Tat Sat, Om!”
Truth never comes where lust and fame and greed
Of gain reside. No man who thinks of woman
As his wife can ever perfect be;
Nor he who owns the least of things, nor he
Whom anger chains, can ever pass through Māyā’s gates.
So, give these up, Sannyâsin bold! Say —
“Om Tat Sat, Om!”
Have thou no home. What home can hold thee, friend?
The sky thy roof, the grass thy bed; and food
What chance may bring, well cooked or ill, judge not.
No food or drink can taint that noble Self
Which knows Itself. Like rolling river free
Thou ever be, Sannyâsin bold! Say —
“Om Tat Sat, Om!”
Few only know the truth. The rest will hate
And laugh at thee, great one; but pay no heed.
Go thou, the free, from place to place, and help
Them out of darkness, Māyā’s veil. Without
The fear of pain or search for pleasure, go
Beyond them both, Sannyâsin bold! Say —
“Om Tat Sat, Om!”
Thus, day by day, till Karma’s powers spent
Release the soul for ever. No more is birth,
Nor I, nor thou, nor God, nor man. The “I”
Has All become, the All is “I” and Bliss.
Know thou art That, Sannyâsin bold! Say —
“Om Tat Sat, Om!”
If you’d like, I can also break this poem down stanza by stanza with meanings and explanations — just let me know!
