Has the implementation of sepsis prevention protocol

reduced the mortality rate in critical care patients?

Sophie Bateson, Sara Davis, Breanna Hughes, Ashley Redinger, Lauren Samuels

Background
Sepsis has proven to be a major health issue and healthcare burden for several decades that has only just recently been placed at the top of the
healthcare reform agenda. As sepsis gained more attention, it proved to be a deadly opponent for the healthcare system; causing not only high
rates of mortality but multisystem morbidity. In light of these findings, it became clear that further knowledge related to this deadly infection
was needed in order to improve prevention and treatment interventions against sepsis. Increasingly, more studies have began to appear within
the healthcare profession, all reiterating the importance of further research and acknowledgement of evidence based practice related to sepsis.
In response, literature such as the Surviving Sepsis Campaign have been created and instituted in healthcare settings that support need for
placing more attention on early recognition and the importance of protocol implementation. Our study builds upon this new movement and
works to gain further insight into the factors that reduce sepsis mortality in a specific patient population.

Methods
•Key words used: sepsis, sepsis mortality, sepsis
protocol, Surviving Sepsis Campaign, critical care
•Databases used: CINAHL, JMU Nursing Library,
PubMed, and Cochrane Library
•All articles date no earlier than 2012.
•All articles were written in English.
•The articles included worldwide studies, from other
countries in addition to the United States.
•All articles used were peer-reviewed journals.
•There were no opinion based articles used.

Results Diagnostic Criteria for Sepsis

Levels of Evidence:
• Six studies in Level IV: Evidence from well-designed case-control and
cohort studies.
• Two studies in Level III: Evidence obtained from well-designed
controlled trial without randomization (quasi-experimental design).
• Two studies in Level VI: Evidence from a single descriptive or
qualitative study.
Population and Sample Sizes Studied:
• Population: critical care patients diagnosed with sepsis
• Sample sizes range from 29 patients to 49,331 patients
Findings related to mortality rates and time to treatments:
• In the study, Benchmarking the incidence and mortality of severe
sepsis in the United States (2013), the sepsis protocols from multiple
hospitals and their associated mortality rates were compared. It was
found that there was a significant variation in the treatment times
and mortality rates for each of the different protocols. From this, the
research concluded that the establishment of a universal and
uniform sepsis protocol across all hospitals was imperative in
decreasing sepsis mortality rates.
• Based on various studies, the average time it took for a patient to
receive antibiotics upon arrival to the hospital decreased by between
27-99 minutes after the initiation of sepsis protocols.
• The time it took for patients to receive fluids decreased by an
average of 31 minutes after establishing sepsis protocols.
• Multiple studies concluded that rapid identification of patients with
sepsis and timely treatment reduced the overall mortality rate.
• With each hour of time used to complete the sepsis bundle, the
mortality rate of patients increased.
• In one study, the impact of the emergency department length of stay
on hospital mortality, compliance with sepsis protocol, and
resuscitation was assessed. It was found that the length of stay in the
emergency department did not impact compliance with the sepsis
protocol with the exception of repeat lactate draw. It took less than
six hours to admit 47% of the patients in study.
Two or more of the following and suspected or confirmed infection:
•Temperature less than 96.8°F or greater than 100.4°F
•Heart rate greater than 90 bpm
•Respiration rate greater than 20 breaths per minute or PaCO2 less
than 32 mmHg
•WBC count greater than 12,000,less than 4,000, or greater than
10% bands
Surviving Sepsis Campaign established four key elements
to be completed within 3 hours of admission to the ER as
part of sepsis protocol:
• measure serum lactate level
• obtain blood cultures
• administer broad spectrum antibiotics
• infuse 30 ml/kg of IV crystalloid fluids
Nursing Implications
• A lack of knowledge about the Surviving Sepsis Campaign was a
major barrier found in the research. It is important to ensure that all
health professionals and staff involved in patient care are aware of
the current hospital sepsis protocols.
•Keep a surveillance record on the unit (similar to VAP records) so
that nurses are able to observe the effectiveness of the protocols on
their units, and understand the importance of the Surviving sepsis
campaign.