Evidence-based guide helps detect and treat sepsis

Severe sepsis is surprisingly common, with an estimated 750,000 cases occurring annually in the United States. It begins as a localized infection that triggers a systemic response, called systemic inflammatory response syndrome (SIRS). Severe sepsis is defined as acute organ system dysfunction associated with infection, which differs from sepsis, which is an infection with at least two SIRS signs. Evidence-based guidelines and tools are available and can help achieve reductions in mortality and reduce length of stay. However, one of the major hurdles to conquering severe sepsis is having these tools readily available in a critical care setting.

"The timeliness of providing appropriate care and the ability to implement the sepsis bundles with a multidisciplinary team approach using the expertise of physicians, pharmacists, and nurses are imperative for reaching full success of the Surviving Sepsis Campaign," said Luka. In the Sepsis Resuscitation Bundle, the primary goal is to take immediate action in identifying and treating severe sepsis. This includes obtaining blood cultures prior to administering antibiotics and beginning broad-spectrum antibiotics within three hours for emergency department patients admitted to the ICU and within one hour for non-emergency department patients admitted to the ICU. There are also precise directions in the event of hypotension and for septic shock. IHI found that one of several factors leading to suboptimal care for sepsis patients was the frequent failure to support the cardiac output when depressed.

The second bundle, Sepsis Management Bundle, contains four items that should also be addressed as soon as possible, but at the very most within 24 hours. Items in this bundle include the administration of low-dose steroids for septic shock, drotrecogin alfa activated (Xigris, Lilly) administered in accordance with a standardized intensive care unit policy, and glucose control maintained at <150 mg/dl but above the lower limit of normal.

The IHI sepsis Web site, http://www.ihi.org/IHI/Topics/CriticalCare/Sepsis (see box above), contains the complete bundles and provides tools to screen patients for severe sepsis, as well as tools to measure success with adherence to implementing the bundles.