Impact of an educational program on the Surviving Sepsis Campaign implementation for sepsis management

Background

Severe sepsis and septic shock represent around 10% of the ICU admissions with a mortality rate near 50%. The Surviving Sepsis Campaign (SSC) is an international quality improvement program heading to standardize sepsis management.

Objective

To evaluate an educational program to implement the SSC strategies in our fourth-level hospital.

Methods

We implemented an educational program for physicians and healthcare professionals to apply the SSC strategies in the Emergency Department and the ICU. The program was evaluated from May to October 2007 (Period 1) in terms of the compliance of the SSC initial resuscitation bundle goals (lactate, blood cultures, antibiotic administration, fluid administration, achieving central venous pressure (CVP) >8 mmHg and central venous oxygen saturation (ScvO₂) >70%) and management bundle goals (adhering to policy on corticosteroids and activated C protein administration, glucose control <150 mg/dl, plateau pressure ≤30 cmH₂O). The results were evaluated. Six months later the program was repeated to reinforce the SSC concepts. The SSC strategies implementation continued for the next 6 months and the program was evaluated assessing the same indicators (Period 2). The results from the two periods were compared.

Results

Seventy-three consecutive subjects were included (36 in Period 1 and 37 in Period 2). The demographic characteristics were similar in both groups (Table 1). With the exception of blood cultures (86.1% vs. 57.75%, P = 0.01), the initial resuscitation bundle goals' compliance was better achieved during Period 2; lactate measured (66.66% vs. 89.18%, P = 0.02), antibiotics administered within indicator timeline (50% vs. 75.67%, P = 0.03), appropriate fluid administration (63.88% vs. 94.59%, P = 0.001), when indicated achievement of CVP >8 mmHg (52.77% vs. 78.37%, P = 0.02) and ScvO₂ >70% (58.33% vs. 67.57%, P = 0.47). With the exception of the activated C protein administration policy (91.66% vs. 86.48%, P = 0.1), the management bundle goals' compliance was also better achieved during Period 2; corticosteroids according to policy (94.44% vs. 97.29%, P = 0.61), glucose control <150 mg/dl (52.77% vs. 78.37%, P = 0.02), plateau pressure ≤30 cmH₂O (75% vs. 89.18%, P = 0.13). In general we found a trend to better compliance in resuscitation bundle goals (33.33% vs. 40.54%, P = 0.62) and management bundle goals (63.88% vs. 67.56%, P = 0.80) during Period 2 (Table 2).

Table 1 Demographic and clinical characteristics of patients

Table 2 Performance of sepsis bundle compliance

Conclusion

An educational program and a retraining process when linked with SSC implementation were effective in producing process change in the management of severe sepsis, achieving better compliance with currently accepted best practice.