Impact of Surviving Sepsis Campaign implementation in Brazil

Introduction

Sepsis mortality rates in Brazil are high [1, 2]. Many studies have already shown that implementation of education programs based on Surviving Sepsis Campaign 6-hour (6 h SSC) and 24-hour bundles successfully reduces sepsis mortality. The objective of this study was to evaluate the impact of the SSC-based program on patient outcome in Brazil.

Methods

Severe sepsis and septic shock patients were included in voluntary participating hospitals that have sent data for at least 2 years. The intervention was based on strategies aimed at improving compliance with the bundles. Regular reports containing compliance and mortality data were sent to the hospital in order to base local strategies of improving care. Results are presented by the semester of hospital inclusion in the campaign through 2 years, regardless of when those months occurred in the time frame of the study. Results were considered significant if P < 0.05.

Results

From February 2005 and August 2009, 19 hospitals included 2,135 patients in a nonconcomitant fashion. Demographic data are restricted as in the SSC database. Septic shock patients comprised 52% of the patients with a mean number of organ dysfunctions of 2.34 ± 1.33, and 38.6% were admitted from the ER and 24.9% developed sepsis during their ICU stay. Compliance to 6 h SSC increased from the first to the fourth semester as follows: lactate: 65.0% to 71.5%, P = 0.01, blood culture: 42.5% to 50.3%, P = 0.08, antibiotics: 38.9% to 45.3%, P = 0.02, achieving mean arterial pressure >65 mmHg: 43.7% to 75.4%, P < 0.000, CVP achievement: 14.6% to 36.6%, P < 0.000, SvO₂ achievement: 10.4 to 22.7, P = 0.000 and completion of the whole bundle: 8.3 to 9.0, P = 0.34. A 7% absolute reduction (relative reduction of 11.6%) in hospital mortality was found in the third semester of the campaign (OR 1.33 (1.04 to 1.69), P = 0.01). However, in the fourth semester mortality has increased again to 60.6%.

Conclusions

Implementation of the SSC in Brazil has been associated with increased bundle adherence. However, the impact on the mortality rate seems not to be sustained, probably due to the difficulty associated with keeping an education program. It is important to develop strategies aiming to increase motivation in Brazilian hospitals.