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The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study

Fang Gao1*, Teresa Melody2, Darren F Daniels3, Simon Giles4 and Samantha Fox5

Author Affiliations

1 Consultant, Critical Care Unit, Heart of England NHS Foundation Trust (Teaching), Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK

2 Research co-ordinator, Critical Care Unit, Heart of England NHS Foundation Trust (Teaching), Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK

3 Consultant, Critical Care Unit, Good Hope NHS Trust (Teaching), Rectory Road, Sutton Coldfield B75 7RR, UK

4 Nursing consultant, Critical Care Unit, Heart of England NHS Foundation Trust (Teaching), Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK

5 Clinical nurse specialist, Critical Care Unit, Good Hope NHS Trust (Teaching), Rectory Road, Sutton Coldfield B75 7RR, UK

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Critical Care 2005, 9:R764-R770  doi:10.1186/cc3909


See related commentary http://ccforum.com/content/9/6/653

Published: 11 November 2005

Abstract

Introduction

Compliance with the ventilator care bundle affects the rate of ventilator-associated pneumonia. It was not known, however, whether compliance with sepsis care bundles has an impact on outcome. The aims of the present study were to determine the rate of compliance with 6-hour and 24-hour sepsis bundles and to determine the impact of the compliance on hospital mortality in patients with severe sepsis or septic shock.

Methods

We conducted a prospective observational study on 101 consecutive adult patients with severe sepsis or septic shock on medical or surgical wards, or in accident and emergency areas at two acute National Health Service Trust Teaching hospitals in England. The main outcome measures were: the rate of compliance with 6-hour and 24-hour sepsis care bundles adapted from the Surviving Sepsis Campaign guidelines on patients' clinical care; and the difference in hospital mortality between the compliant and the non-compliant groups.

Results

The median age of the patients was 69 years (interquartile range 51 to 78), and 53% were male. The sources of infection were sought and confirmed in 87 of 101 patients. The chest was the most common source (50%), followed by the abdomen (22%). The rate of compliance with the 6-hour sepsis bundle was 52%. Compared with the compliant group, the non-compliant group had a more than twofold increase in hospital mortality (49% versus 23%, relative risk (RR) 2.12 (95% confidence interval (CI) 1.20 to 3.76), P = 0.01) despite similar age and severity of sepsis. Compliance with the 24-hour sepsis bundle was achieved in only 30% of eligible candidates (21/69). Hospital mortality was increased in the non-compliant group from 29% to 50%, with a 76% increase in risk for death, although the difference did not reach statistical significance (RR 1.76 (95% CI 0.84 to 3.64), P = 0.16).

Conclusion

Non-compliance with the 6-hour sepsis bundle was associated with a more than twofold increase in hospital mortality. Non-compliance with the 24-hour sepsis bundle resulted in a 76% increase in risk for hospital death. All medical staff should practise these relatively simple, easy and cheap bundles within a strict timeframe to improve survival rates in patients with severe sepsis and septic shock.