Downplay Sepsis at Your Peril

The Surviving Sepsis Campaign (SSC) guidelines were developed as part of a plan to reduce severe sepsis mortality. For improving sepsis care, the SSC and the Institute for Healthcare Improvement recommend implementing two bundles of guidelines, similar to the bundles that have been successfully implemented to fight VAP.

Ricard Ferrer, MD, of the Universidad Autónoma de Barcelona in Spain, and colleagues conducted a study to determine whether a national educational program based on the SSC guidelines could improve compliance with recommended processes of care in severe sepsis at 59 Spanish ICUs. All ICU patients were screened daily and enrolled if they fulfilled severe sepsis or septic shock criteria. A total of 854 patients were enrolled in the pre-intervention period, 1,465 patients during the post-intervention period, and 247 patients during the long-term follow-up period one year later.

The educational program consisted of training physicians and nursing staff from the emergency department, wards, and ICU in the definition, recognition, and treatment of severe sepsis and septic shock as outlined in the guidelines. Treatment was organized in two bundles: a resuscitation bundle (six tasks to begin immediately and be accomplished within six hours) and a management bundle (four tasks to be completed within 24 hours).

Patients in the post-intervention group had a statistically significant lower risk of hospital mortality (44.0 percent vs. 39.7 percent) and 28-day mortality (36.4 percent vs. 31.1 percent) compared with the pre-intervention group. Compliance with the process-of-care variables improved after the intervention in the sepsis resuscitation bundle (5.3 percent vs. 10.0 percent) and in the sepsis management bundle (10.9 percent vs. 15.7 percent). The percentage of patients in whom care complied with all resuscitation and all management measures improved significantly after the educational program. However, evidence from the one-year follow-up indicated that compliance with the resuscitation bundle returned to baseline, but that compliance with the management bundle and mortality remained stable with respect to the post-intervention period.