The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study
Open accessAbstract
Introduction: Compliance with the ventilator care bundle affects the rate of ventilator-associated pneumonia. It was not known, however, whether compliance with sepsis care bundles has an impact on outcome. The aims of the present study were to determine the rate of compliance with 6-hour and 24-hour sepsis bundles and to determine the impact of the compliance on hospital mortality in patients with severe sepsis or septic shock. Methods: We conducted a prospective observational study on 101 consecutive adult patients with severe sepsis or septic shock on medical or surgical wards, or in accident and emergency areas at two acute National Health Service Trust Teaching hospitals in England. The main outcome measures were: the rate of compliance with 6-hour and 24-hour sepsis care bundles adapted from the Surviving Sepsis Campaign guidelines on patients' clinical care; and the difference in hospital mortality between the compliant and the non-compliant groups. Results: The median age of the patients was 69 years (interquartile range 51 to 78), and 53% were male. The sources of infection were sought and confirmed in 87 of 101 patients. The chest was the most common source (50%), followed by the abdomen (22%). The rate of compliance with the 6-hour sepsis bundle was 52%. Compared with the compliant group, the non-compliant group had a more than twofold increase in hospital mortality (49% versus 23%, relative risk (RR) 2.12 (95% confidence interval (CI) 1.20 to 3.76), P = 0.01) despite similar age and severity of sepsis. Compliance with the 24-hour sepsis bundle was achieved in only 30% of eligible candidates (21/69). Hospital mortality was increased in the non-compliant group from 29% to 50%, with a 76% increase in risk for death, although the difference did not reach statistical significance (RR 1.76 (95% CI 0.84 to 3.64), P = 0.16). Conclusion: Non-compliance with the 6-hour sepsis bundle was associated with a more than twofold increase in hospital mortality. Non-compliance with the 24-hour sepsis bundle resulted in a 76% increase in risk for hospital death. All medical staff should practise these relatively simple, easy and cheap bundles within a strict timeframe to improve survival rates in patients with severe sepsis and septic shock.
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Early detection and appropriate treatment of sepsis are associated with a significant mortality benefit in hospitalized patients.
“Early detection and appropriate treatment of sepsis have been associated with a significant mortality benefit in hospitalized patients.1,2,3”
From External validation of a widely implemented proprietary sepsis prediction model in hospitalized patients (2021) · cites this paper as [3]
The Key messages report significantly lower hospital mortality among patients with severe sepsis who received the complete 6-hour treatment bundle (23% versus 49%). The study supports an association with timely bundled care, but it does not establish a separate benefit from early detection or extend the finding to all hospitalized patients with sepsis. (LLM, conf=0.84)
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- Authors
- Gao, F., Melody, T., Daniels, D. F., Giles, S., & Fox, S.
- Affiliations
- Heart of England NHS Foundation Trust (GB)
- Good Hope Hospital (GB)
- Corresponding author
- Gao, Fang
- Venue
- Critical Care
- Published
- 2005-11-11
- Volume
- 9
- Issue
- 6
- Pages
- R764-70
- ISSN
- 1364-8535 (ISSN-L)
- PMC
- PMC1414020
- OpenAlex
- W2169285498
- Cited by
- 461
- References
- 1
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 10 · 2020: 8 · 2019: 12 · 2018: 12 · 2017: 78 · 2016: 28 · 2015: 20 · 2014: 24 · 2013: 27 · 2012: 23
- FWCI
- 19.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Critical Care (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Funders
- Eli Lilly and Company
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Keywords
- sepsis care bundle, sepsis bundle compliance, severe sepsis, septic shock, in-hospital mortality, Surviving Sepsis Campaign guidelines, guideline adherence, sepsis care quality, infection source, chest infection, intra-abdominal infection, emergency department, medical and surgical wards
- MeSH terms
- Aged, Clinical Protocols, Critical Care, England, Female, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Prospective Studies, Time Factors, Survival Analysis, Hospital Mortality, Sepsis, Guideline Adherence
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