title: Nursing considerations to complement the Surviving Sepsis Campaign guidelines.
abstract: OBJECTIVE
  To provide a series of recommendations based on the best available evidence to guide clinicians providing nursing care to patients with severe sepsis.
  
  
  METHODS
  Modified Delphi method involving international experts and key individuals in subgroup work and electronic-based discussion among the entire group to achieve consensus.
  
  
  METHODS
  We used the Surviving Sepsis Campaign guidelines as a framework to inform the structure and content of these guidelines. We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system to rate the quality of evidence from high (A) to very low (D) and to determine the strength of recommendations, with grade 1 indicating clear benefit in the septic population and grade 2 indicating less confidence in the benefits in the septic population. In areas without complete agreement between all authors, a process of electronic discussion of all evidence was undertaken until consensus was reached. This process was conducted independently of any funding.
  
  
  RESULTS
  Sixty-three recommendations relating to the nursing care of severe sepsis patients are made. Prevention recommendations relate to education, accountability, surveillance of nosocomial infections, hand hygiene, and prevention of respiratory, central line-related, surgical site, and urinary tract infections, whereas infection management recommendations related to both control of the infection source and transmission-based precautions. Recommendations related to initial resuscitation include improved recognition of the deteriorating patient, diagnosis of severe sepsis, seeking further assistance, and initiating early resuscitation measures. Important elements of hemodynamic support relate to improving both tissue oxygenation and macrocirculation. Recommendations related to supportive nursing care incorporate aspects of nutrition, mouth and eye care, and pressure ulcer prevention and management. Pediatric recommendations relate to the use of antibiotics, steroids, vasopressors and inotropes, fluid resuscitation, sedation and analgesia, and the role of therapeutic end points.
  
  
  CONCLUSIONS
  Consensus was reached regarding many aspects of nursing care of the severe sepsis patient. Despite this, there is an urgent need for further evidence to better inform this area of critical care.
authors.affiliation: Research Centre for Clinical and Community Practice Innovation, Griffith University, Nathan, Queensland, Australia. l.aitken@griffith.edu.au
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Aitken
authors.forename: Ged
authors.initials: G
authors.lastname: Williams
authors.forename: Maurene
authors.initials: M
authors.lastname: Harvey
authors.forename: Stijn
authors.initials: S
authors.lastname: Blot
authors.forename: Ruth
authors.initials: R
authors.lastname: Kleinpell
authors.forename: Sonia
authors.initials: S
authors.lastname: Labeau
authors.forename: Andrea
authors.initials: A
authors.lastname: Marshall
authors.forename: Gillian
authors.initials: G
authors.lastname: Ray-Barruel
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Moloney-Harmon
authors.forename: Wayne
authors.initials: W
authors.lastname: Robson
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Johnson
authors.forename: Pang Nguk
authors.initials: PN
authors.lastname: Lan
authors.forename: Tom
authors.initials: T
authors.lastname: Ahrens
mesh_terms: D006439:Hemodynamics; D006801:Humans; D017053:Infection Control; D008991:Monitoring, Physiologic / Q000451:nursing; D044623:Nutrition Therapy / Q000451:nursing; D010371:Pediatric Nursing; D017410:Practice Guidelines as Topic; D003668:Pressure Ulcer / Q000451:nursing; D012151:Resuscitation / Q000451:nursing; D018805:Sepsis / Q000175:diagnosis / Q000451:nursing* / Q000517:prevention & control