- Assess opportunities to identify sepsis and to improve outcomes for those patients that acquire and are at risk for sepsis—emergency department, wards, ICU.
- Formalize a process/workflow to screen patients for signs of sepsis throughout the entire institution
- What is screening tool?
- Who does the screen?
- When is the screen done?
- What is done once screen is positive?
- Who responds to + screen?
- How is sepsis 3-hour bundle activated?
- Implement a sepsis response team or incorporate early detection of sepsis into existing medical emergency teams (e.g. rapid response teams, if available)
Treatment/Intervention:
- Adhere to the Surviving Sepsis Campaign 2016 and other international guidelines for LMIC (WHO ETAT, etc)
- Formalize a process/workflows for clinicians to adhere to after a patient sepsis screen is positive in order to activate bundles.
- Sepsis 3-hour bundle activation for sepsis leads to the following actions:
- Obtain IV access and obtain blood cultures (if possible)
- Give oxygen if SpO2 < 90% on room air or < 94% if patient is in shock. If pulse oximeter is not available, use clinical indicators to initiate oxygen therapy
- Administer appropriate broad spectrum antibiotics according to clinical suspicion and local antibiograms (when available) and preferably within the hour
- If patient has hypotension or other signs of hypoperfusion, give initial fluid bolus of 30 ml/kg over 30 minutes in adult
- Monitor clinical signs of perfusion after bolus: BP, skin exam, CR, urine output, AVPU in addition to vital signs If hypotension resolved, then resume maintenance fluid and monitoring every 1-2 hours.
- If hypotension resolved, then resume maintenance fluid and monitoring every 1-2 hours.
- If hypotension persists, then activate 6-hour sepsis bundle
- Sepsis 6-hour bundle for patients with septic shock leads to the following actions:
- Give 2nd bolus of crystalloid fluid and monitor markers of perfusion. Repeat as clinically indicated as long as volume responsive
- Start vasopressors (for hypotension that does not respond to initial fluid resuscitation to maintain a mean arterial pressure (MAP) ≥65 mm Hg)
- If vasopressors are needed, insert CVC under sterile conditions (when possible). Though vasopressors can be delivered via peripheral IV with caution
- Monitor in the ICU, preferably continuous monitoring of HR, SpO2 BP check at least every 30 minutes