A study¹ published yesterday in Critical Care by a team of researchers led by Dr Massimo Girardis of The University of Modena, Italy, showed that educating hospital staff about treatment guidelines for severe infections reduced deaths by nearly 40%. In addition, the availability of a dedicated team to deal with severe infections reduced deaths by a further 40%.

Sepsis is caused by severe infections, where bacteria enter the blood stream or invade tissues, and accounts for as many deaths per year as heart attacks. Sepsis also requires long stays in intensive care and is extremely costly to healthcare systems. The USA spends $16.7 billion per year treating sepsis; a figure that is predicted to rise as the number of susceptible elderly people increases.

To combat deaths from sepsis the Surviving Sepsis Campaign (SSC) was launched in 2002. The aim of the SSC is that doctors use standard guidelines to recognise and treat sepsis early. Early and effective treatment of sepsis is essential to prevent the damage to bodily systems that is associated with a dramatic decrease in survival.

Before the SSC guidelines were published there was no standard treatment for sepsis, but these guidelines, says Professor Mitchell Levy, President of the Society of Critical Care Medicine, “are founded on data that suggest that the era of individual practice variations really needs to come to an end.”

The guidelines recommend that as soon as sepsis is recognised the patient should receive packages or ‘bundles’ of treatments and investigations. The sepsis bundle that each patient should receive within the first six hours of diagnosis includes standard blood tests, regularly monitoring blood pressure and oxygen levels, and receiving antibiotics.

Unfortunately, despite the high profile of the SSC, widespread implementation of the guidelines in clinical practice has proven difficult. In 2005, three years after the SSC was set up, Fang Gao, a professor of critical care at Birmingham Heartlands Hospital, UK, reported that even though implementing the guidelines led to a halving in death rates, these were still only followed in 30 to 52% of patients.

Girardis found that a hospital staff education program led to increased implementation of the guidelines and a concomitant decrease in deaths due to sepsis. But even so, the guidelines were still only followed in 35-40% of sepsis patients in the study. 

There are many reasons for this poor compliance with the guidelines says Dr Ron Daniels, critical care consultant and leader of the UK’s SSC campaign. “A major reason”, he says “is that sepsis can present along with many other medical conditions, which means it can be difficult to spot. So, to increase recognition of sepsis more resources need to be provided to educate all members of the medical team, from nurses, to doctors, to physiotherapists”. In Daniels’s hospital, providing education to enable a wider range of hospital staff to recognise sepsis has increased use of SSC guidelines by 69%, with “reductions in mortality of over 80%”.

The other main issue comes with implementation of the guidelines once sepsis has been identified. Resources are also important here, Daniels says, “but it is important to make the guidelines simple enough to be followed by any member of staff.” He has found that only 25% of patients require the more complex interventions suggested by the SSC. The problem is that if these are included in staff guidelines many find them too confusing; by keeping the initial guidelines simple he finds they are followed by more members of staff. Then, if a sepsis team assesses the patient soon afterwards, more complex measures can be given at this stage.

Daniels concludes by saying that education of the public is as important as educating medical staff. Getting the public to recognize the importance of sepsis should hopefully be instrumental in channeling more resources to enable the implementation of these life saving guidelines.

© 2009 Justine Davies