title: Decreasing mortality in severe sepsis and septic shock patients by implementing a sepsis bundle in a hospital setting.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  These results suggest reducing SS and SSh patient mortality is a complex process that involves multiple performance measures and interventions.
authors.affiliation: Critical Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Sandra Christina Pereira Lima
authors.initials: SC
authors.lastname: Shiramizo
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Marcelino S
authors.initials: MS
authors.lastname: Durão
authors.forename: Ângela T
authors.initials: ÂT
authors.lastname: Paes
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
authors.forename: Oscar Fernando
authors.initials: OF
authors.lastname: Pavão dos Santos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000401:mortality* / Q000628:therapy; D012772:Shock, Septic / Q000401:mortality* / Q000628:therapy
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