title: Early detection strategy and mortality reduction in severe sepsis.
abstract: OBJECTIVE
  To evaluate the impact of implementing an institutional policy for detection of severe sepsis and septic shock.
  
  
  METHODS
  Study before (stage I), after (stage II) with prospective data collection in a 195 bed public hospital.. Stage I: Patients with severe sepsis or septic shock were included consecutively over 15 months and treated according to the Surviving Sepsis Campaign guidelines. Stage II: In the 10 subsequent months, patients with severe sepsis or septic shock were enrolled based on an active search for signs suggesting infection (SSI) in hospitalized patients. The two stages were compared for demographic variables, time needed for recognition of at least two signs suggesting infection (SSI-Δt), compliance to the bundles of 6 and 24 hours and mortality.
  
  
  RESULTS
  We identified 124 patients with severe sepsis or septic shock, 68 in stage I and 56 in stage II. The demographic variables were similar in both stages. The Δt-SSI was 34 ± 54 hours in stage I and 7 ± 8.4 hours in stage II (p <0.001). There was no difference in compliance to the bundles. In parallel there was significant reduction of mortality rates at 28 days (54.4% versus 30%, p <0.02) and hospital (67.6% versus 41%, p <0.003).
  
  
  CONCLUSIONS
  The strategy used helped to identify early risk of sepsis and resulted in decreased mortality associated with severe sepsis and septic shock.
authors.affiliation: Hospital Municipal São José, Joinville, SC, Brasil.
authors.forename: Glauco Adrieno
authors.initials: GA
authors.lastname: Westphal
authors.affiliation: Hospital Municipal São José, Joinville, SC, Brasil.
authors.forename: Janaína
authors.initials: J
authors.lastname: Feijó
authors.affiliation: Unidade de Terapia Intensiva Geral, Hospital Imperial de Caridade, Florianópolis, SC, Brasil.
authors.forename: Patrícia Silva de
authors.initials: PS
authors.lastname: Andrade
authors.affiliation: Unidade de Terapia Intensiva Geral, Hospital Imperial de Caridade, Florianópolis, SC, Brasil.
authors.forename: Louise
authors.initials: L
authors.lastname: Trindade
authors.affiliation: Universidade da Região de Joinville, Joinville, SC, Brasil.
authors.forename: Cezar
authors.initials: C
authors.lastname: Suchard
authors.affiliation: Centro de Controle de Infecção, Hospitalar do Hospital Municipal São José, Joinville, SC, Brasil.
authors.forename: Márcio Andrei Gil
authors.initials: MA
authors.lastname: Monteiro
authors.affiliation: Unidade de Terapia Intensiva Geral, Hospitalar do Hospital Municipal São José.
authors.forename: Sheila Fonseca
authors.initials: SF
authors.lastname: Martins
authors.affiliation: Centro de Controle de Infecção, Hospitalar do Hospital Municipal São José, Joinville, SC, Brasil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Nunes
authors.affiliation: Unidade de Terapia Intensiva Geral, Hospitalar do Hospital Municipal São José.
authors.forename: Milton
authors.initials: M
authors.lastname: Caldeira Filho