The Surviving Sepsis Campaign Bundle: 2018 Update

Abstract

INTRODUCTION The “sepsis bundle” has been central to the implementation of the Surviving Sepsis Campaign (SSC) from the first publication of its evidence-based guidelines in 2004 through subsequent editions (1–6). Developed separately from the guidelines publication by the SSC, the bundles have been the cornerstone of sepsis quality improvement since 2005 (7–11). As noted when they were introduced, the bundle elements were designed to be updated as indicated by new evidence and have evolved accordingly. In response to the publication of “Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016” (12,13), a revised “hour-1 bundle” has been developed and is presented below (Fig. 1).Figure 1.: Hour-1 Surviving Sepsis Campaign Bundle of Care.*The compelling nature of the evidence in the literature, which has demonstrated an association between compliance with bundles and improved survival in patients with sepsis and septic shock, led to the adoption of the SSC measures by the National Quality Forum (NQF) and subsequently both by the New York State (NYS) Department of Health (14) and the Centers for Medicare and Medicaid Services (CMS) (15) in the USA for mandated public reporting. The important relationship between the bundles and survival was confirmed in a publication from this NYS initiative (16). Paramount in the management of patients with sepsis is the concept that sepsis is a medical emergency. As with polytrauma, acute myocardial…