Sepsis is a global health problem with high mortality rates. Recently, managed care protocols (sepsis bundles) have been developed to reduce sepsis-related morbidity and mortality.
Sepsis is a significant problem in the United States, with more than 1.7 million adults experiencing it annually and emerging as a leading cause of hospital death.
One out of every three people passing away in medical facilities succumb to sepsis. Thus, early recognition and proper treatment can improve patient outcomes.
The first goal-directed therapy for sepsis was introduced in 2001, followed by the Surviving Sepsis campaign a year later. Subsequently, various guidelines have continued to be established and enhanced for managing sepsis, collectively known as the “sepsis bundle.”
The overarching goal of these interventions revolves around early detection and aggressive patient care. It is essential to note that the effectiveness of such protocols is directly linked to prompt implementation.
Table of Contents
What is Sepsis?
Sepsis is a life-threatening condition in which the body’s immune system reacts inappropriately to an infection. This can cause organs to malfunction, and if left untreated, it may worsen into septic shock – a sudden decrease in blood pressure that severely damages the lungs, kidneys, liver, and other vital organs. With timely treatment, however, individuals can improve their chances of survival.
What is Sepsis Bundle?
The “Sepsis Bundle” is a set of evidence-based interventions that can reduce the risk and improve outcomes for patients with sepsis. Every hour counts when treating sepsis, so healthcare providers have developed the 1-hour sepsis bundle. This bundle is a set of evidence-based interventions that aim to improve patient outcomes by quickly identifying and treating sepsis.
The bundle consists of five core elements:
- Early recognition
- Rapid administration of antibiotics
- Hemodynamic support
- Source control
- Patient monitoring
This bundle was developed by the Surviving Sepsis Campaign (SSC), an international collaboration of experts in critical care which promotes awareness and implementation of best practices in sepsis management.
By utilizing the Sepsis Bundle, healthcare providers can better recognize signs and symptoms of sepsis earlier and provide the timely treatment necessary for improved outcomes.
Implementing this bundle is associated with decreased mortality rates in hospitalized patients with sepsis and increased compliance with international guidelines.
Methods
A total of 167 patients were retrospectively studied. The 3-hour bundle included the collection of lactate and cultures, initiating broad-spectrum antibiotics within one hour of sepsis diagnosis, and volume replacement with crystalloid if hypotension or lactate ≥2 mmol/L was present.
Mortality rates in those receiving the intervention were significantly lower when compared to those who did not receive the sepsis bundle (25.6% vs 45.7%; p=0.01). The 3-hour sepsis bundle was also independently associated with lower mortality (OR=0.175; CI=0.04–0.64; p=0.009). Moreover, fewer patients required ICU admission, and those who did had shorter lengths of stay.
Results
The 3-hour sepsis bundle was associated with lower mortality in this tertiary care hospital, fewer ICU admissions, and shorter lengths of stay in those admitted. Implementing a sepsis bundle may be beneficial in improving patient outcomes.
Early Recognition of Sepsis
The first element of the Sepsis Bundle is early recognition, which involves identifying sepsis before it progresses to severe sepsis or septic shock. This can be done by recognizing signs and symptoms such as fever, increased heart rate, decreased blood pressure, altered mental status, and elevated white blood cell count. The American College of Chest Physicians (ACCP) and SSC have developed Sepsis Care Pathways, which provide a systematic approach to sepsis management that can help healthcare providers quickly recognize the signs and symptoms of sepsis.
Rapid Administration of Antibiotics
The second element of the bundle is the rapid administration of antibiotics, which are used to target any bacteria causing the infection specifically. Prompt antibiotic administration is essential for treating sepsis to prevent further deterioration or death from the disease.
It is recommended that antibiotics be administered within one hour of diagnosis for patients with severe sepsis or septic shock; however, this recommendation may vary depending on clinical circumstances.
Hemodynamic Support
The third element of the Sepsis Bundle is hemodynamic support, which involves providing medications and fluids to restore adequate blood pressure. Vasopressors such as norepinephrine are often used to maintain good blood pressure. Additionally, intravenous fluids may increase the circulating fluid volume to improve tissue perfusion.
Source Control
The fourth element of the Sepsis Bundle is source control, which refers to identifying and treating any potential sources of infection. This can include draining an abscess or removing a catheter if it is thought to be a source of infection. Source control is essential for decreasing morbidity and mortality in sepsis patients by limiting the further spread of disease from the site where it originated.
Patient Monitoring
The fifth and final element of the Sepsis Bundle is patient monitoring, which involves assessing patients for signs and symptoms of sepsis, such as fever, increased heart rate, decreased blood pressure, altered mental status, and elevated white blood cell count. It is essential to monitor these vital signs to adjust treatments accordingly closely.
What’s the Most Essential Element in Surviving Sepsis?
The most crucial element in surviving sepsis is early recognition and timely interventions. By recognizing the signs and symptoms of sepsis and providing treatment promptly, healthcare providers can reduce the risk of mortality from this potentially life-threatening condition. The Sepsis Bundle provides an evidence-based approach to sepsis management that incorporates these key elements to improve outcomes for patients with sepsis.
Stages of Sepsis
The stages of sepsis are:
1. Suspicion of infection (symptoms may include fever, chills, and general malaise).
2. Sepsis (organ dysfunction is present due to the release of cytokines and other inflammatory mediators).
3. Severe sepsis (multiple organ systems are affected by the infection).
4. Septic shock (severe hypotension and tissue hypoperfusion are present).
5. Multiple organ dysfunction syndrome (MOSD; multiple organs have sustained damage due to the infection).
6. Death (in severe cases, death may occur due to sepsis-induced complications or overwhelming infections).
What are the Goals of the Sepsis Bundle?
The goals of the Sepsis Bundle are to reduce morbidity and mortality associated with sepsis, improve care, and increase the quality of life for those affected by sepsis. This is achieved by utilizing early recognition of signs and symptoms, prompt administration of antibiotics, hemodynamic support, source control, and patient monitoring.
By using this bundle, healthcare providers are better able to identify sepsis early on and provide timely treatment necessary for improved outcomes. Additionally, implementing the Sepsis Bundle is associated with increased compliance with international guidelines.
What Should Be Done if a Patient Exhibits Signs and Symptoms of Sepsis?
Suppose a patient exhibits signs and symptoms of sepsis. In that case, healthcare providers should immediately begin the Sepsis Bundle, which includes early recognition, rapid administration of antibiotics, hemodynamic support, source control, and patient monitoring. Additionally, healthcare providers should assess the vital signs of patients with sepsis hourly to adjust treatments accordingly.
It is also essential to ensure that any potential sources of infection are identified and treated. This can include draining an abscess or removing a catheter if it is thought to be a source of infection. Source control is essential for decreasing morbidity and mortality in sepsis patients by limiting the further spread of disease from the site where it originated.
Finally, healthcare providers should consult with the patient’s family members and caregivers to provide education about sepsis and its management. This includes informing them of any changes in the patient’s condition and discussing any concerns or questions they may have.
Ongoing Assessments and Interventions
Ongoing assessments and interventions for patients with sepsis should include the following:
- Periodic monitoring of vital signs, including temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation.
- Closely monitor laboratory values such as white blood cell count or C-reactive protein levels.
- Assess for any new signs or symptoms of infection and adjust treatments accordingly.
- Evaluate the patient for signs of multisystem organ failure, which can indicate a need for more aggressive therapies.
- Administer appropriate antibiotics if necessary to target any bacteria causing the infection.
- Provide hemodynamic support with vasopressors and intravenous fluids to maintain adequate blood pressure and tissue perfusion.
- Administer supplemental oxygen and mechanical ventilation if needed to maintain adequate oxygenation.
- Monitor for any potential sources of infection and take appropriate measures, such as draining an abscess or removing a catheter, to eliminate the source of infection.
- Provide patient and family education about sepsis, its management, and potential complications.
- Provide supportive care, such as pain control and nutrition, to improve patient comfort and quality of life.
- Assess for any adverse reactions to medications or treatments.
- Reassess the patient frequently to adjust treatments accordingly.
- Follow up with the patient post-discharge to ensure they have recovered from their sepsis and can return home safely.
Mrs. Marie Brown has been a registered nurse for over 25 years. She began her nursing career at a Level I Trauma Center in downtown Chicago, Illinois. There she worked in the Emergency Department and on the Surgical Intensive Care Unit. After several years, she moved to the Midwest and continued her nursing career in a critical care setting. For the last 10 years of her nursing career, Mrs. Brown worked as a flight nurse with an air ambulance service. During this time, she cared for patients throughout the United States.