• Sandra Christina Pereira Lima Shiramizo, Alexandre R Marra, Marcelino S Durão, Ângela T Paes, Michael B Edmond, and Oscar Fernando Pavão dos Santos.
• Critical Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
• Plos One. 2011 Jan 1;6(11):e26790.

BackgroundThe Surviving Sepsis Campaign (SSC) guidelines for the management of severe sepsis (SS) and septic shock (SSh) have been recommended to reduce morbidity and mortality.Materials And MethodsA 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.ResultsA 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.ConclusionThese results suggest reducing SS and SSh patient mortality is a complex process that involves multiple performance measures and interventions.

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