Assessing the effect of the Surviving Sepsis Campaign treatment guidelines on clinical outcomes in a community hospital

Ann Pharmacother. 2010 Nov;44(11):1733-8. doi: 10.1345/aph.1P251. Epub 2010 Oct 26.


Background: Bundles yield a reduction in mortality in patients with sepsis, but the majority of the data is from large academic centers. The ability of a community hospital to implement a sepsis bundle successfully, however, has not been investigated.

Objective: To examine the effect of a collaborative 2-part sepsis bundle on clinical outcomes and mortality at a community hospital.

Methods: The study included all patients with severe sepsis/septic shock over the age of 18 years admitted to the intensive care unit (ICU) from 2006 to 2007 who were not treated with a bundle (n = 53) and those who were treated with a bundle (n = 59). Data collected included demographics; initiation of vasopressors; days on vasopressors; blood glucose; use of drotrecogin alfa (activated), steroids, and ventilator; ICU/hospital lengths of stay; ventilator days; time to culture; time to first dose of antibiotics; time to transfer from emergency department to ICU; fluid resuscitation in the first 24 hours; percentage of patients started on dialysis; and mortality.

Results: Demographics; blood glucose; use of drotrecogin alfa (activated), steroids and ventilator; ICU/hospital lengths of stay; and ventilator days were statistically similar between groups. Median time to cultures, first dose of antibiotics, and transfer to ICU were all reduced with the bundle. Percentage of non-bundle patients on vasopressors was 87% versus 66.7% of bundle patients (p = 0.011) and number of median days on vasopressors was reduced. Fewer bundle patients were initiated on dialysis (0%) versus non-bundle patients (14.8%) (p = 0.02). Median fluid administered in the first 24 hours was 2200 mL (10-13,996 mL) for non-bundle patients and 7143 mL (1000-19,104 mL) for bundle patients (p < 0.001). Mortality was 61.1% in the non-bundle group versus 20% with the bundle (p < 0.001).

Conclusions: Implementation of a 2-part sepsis bundle based on the Surviving Sepsis Campaign Guidelines can yield a positive impact on clinical outcome and mortality in a nonacademic, community hospital setting.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Infective Agents / therapeutic use
  • Blood Glucose / analysis
  • Clinical Protocols*
  • Cooperative Behavior
  • Female
  • Hospital Mortality
  • Hospitals, Community / methods*
  • Hospitals, Community / organization & administration
  • Humans
  • Intensive Care Units
  • Length of Stay
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Protein C / therapeutic use
  • Recombinant Proteins / therapeutic use
  • Retrospective Studies
  • Sepsis / mortality
  • Sepsis / therapy*
  • Shock, Septic / mortality
  • Shock, Septic / therapy*
  • Treatment Outcome


  • Anti-Infective Agents
  • Blood Glucose
  • Protein C
  • Recombinant Proteins
  • drotrecogin alfa activated