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Critical Care and Emergency Medicine - Infectious Diseases - Microbiology - Non-Clinical Medicine

Decreasing Mortality in Severe Sepsis and Septic Shock Patients by Implementing a Sepsis Bundle in a Hospital Setting
Published: Thursday, November 03, 2011
Author: Sandra Christina Pereira Lima Shiramizo et al.

by Sandra Christina Pereira Lima Shiramizo, Alexandre R. Marra, Marcelino S. Durão, Ângela T. Paes, Michael B. Edmond, Oscar Fernando Pavão dos Santos


The Surviving Sepsis Campaign (SSC) guidelines for the management of severe sepsis (SS) and septic shock (SSh) have been recommended to reduce morbidity and mortality.

Materials and Methods

A quasi-experimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize SS and SSh shock patients' clinical outcomes were performed by applying sepsis bundles (6- and 24-hour) in May 2006. We compared bundle compliance and patient outcomes before (July 2005-April 2006) and after (May 2006-December 2009) implementation of the interventions.


A total of 564 SS and SSh patients were identified. Prior to the intervention, compliance with the 6 hour-sepsis resuscitation bundle was only 6%. After the intervention, compliance was as follows: 8.2% from May to December 2006, 9.3% in 2007, 21.1% in 2008 and 13.7% in 2009. For the 24 hour-management bundle, baseline compliance was 15.0%. After the intervention, compliance was 15.1% from May to December 2006, 21.4% in 2007, 27.8% in 2008 and 44.4% in 2009. The in-hospital mortality was 54.0% from July 2005 to April 2006, 41.1% from May to December 2006, 39.3% in 2007, 41.4% in 2008 and 16.2% in 2009.


These results suggest reducing SS and SSh patient mortality is a complex process that involves multiple performance measures and interventions.