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Compliance with the surviving sepsis guidelines: a review of South African intensive care units


Despite the availability of guidelines for practice in many clinical domains, it is common for clinicians to practice outwith these guidelines. As part of a 1-day sepsis prevalence study in ICUs in South Africa, a review was undertaken to determine the extent to which units comply with the surviving sepsis guidelines as promulgated by the International Sepsis Forum [1].


Following appropriate institutional approval, 43 ICUs were selected using the proportional probability sampling technique. This was applied to a national database of ICUs. Every seventh bed was selected from all the serially placed units. Data collected included the presence of an infection control policy (including guidelines for performance of blood cultures), recording of culture results, microbiological support structures, glucose control protocols and protocols for sedation analgesia and muscle relaxation.


Forty-three out of a total of 458 units were sampled. The mean age of patients was 55 years with a male:female ratio of 60:40. Sixty-eight per cent of patients were admitted post surgery. An infection control policy was present in 77% of units. A practice procedure for blood culture sampling was used in 51% of units, with records of culture results being documented in 56% of units. Microbiologists were available in 65% of units and they were involved in ward rounds in 26% of units. Physical consultation by a microbiologist in 47% of units and telephone consultations in 54% of units were possible. Sixty-one per cent of units had a glucose control policy. Sedation, analgesia and neuromuscular blockade protocols were present in 33%, 26% and 21% of units, respectively. See Table 1.

Table 1 Percentage of units utilizing protocols


The majority of units have an infection control policy, utilize glucose control regimens and have access to a microbiologist. Sedation, analgesia and neuromuscular blockade are infrequently utilized. Despite the availability of guidelines, it is common for many recommendations not to be implemented. Further work is required to determine the reasons for noncompliance with attention to educational programs and other strategies to improve practice.


  1. Dellinger RP, Carlet JM, Masur H, for the Surviving Sepsis Campaign Management Guidelines Committee, et al.: Guidelines for the management of severe sepsis and septic shock. Crit Care Med 2004, 32: 858-873. 10.1097/01.CCM.0000117317.18092.E4

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Bhagwanjee, S., Paruk, F., Scribante, J. et al. Compliance with the surviving sepsis guidelines: a review of South African intensive care units. Crit Care 11 (Suppl 2), P72 (2007).

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