Institute for Healthcare Improvement: Sepsis

	Commentary
	Mortality associated with severe sepsis remains unacceptably high: 30 to 50 percent. When shock is present, mortality is reported to be even higher: 50 to 60 percent. There are approximately 750,000 new sepsis cases each year, with at least 210,000 fatalities. As medicine becomes more aggressive, with invasive procedures and immunosuppression, the incidence of sepsis is likely to increase even more. The Surviving Sepsis Campaign — a partnership of the Society of Critical Care Medicine, the European Society of Intensive Care Medicine, and the International Sepsis Forum — has teamed up with the Institute for Healthcare Improvement to wage war on sepsis and achieve a 25 percent reduction in sepsis mortality within five years (by 2009). A member of the Surviving Sepsis Campaign's Executive Committee, Mitchell M. Levy, MD, talks about the international collaborative effort to improve the treatment of sepsis and reduce the high mortality rate associated with the condition. (See Commentary.)

	Severe Sepsis Bundles
		A "bundle" is a group of interventions related to a disease process that, when executed together, result in better outcomes than when implemented individually. Sepsis Resuscitation Bundle: Serum lactate measured Blood cultures obtained prior to antibiotic administration From the time of presentation, broad-spectrum antibiotics administered within 3 hours for ED admissions and 1 hour for non-ED ICU admissions In the event of hypotension and/or lactate > 4 mmol/L (36 mg/dl): Deliver an initial minimum of 20 ml/kg of crystalloid (or colloid equivalent) Apply vasopressors for hypotension not responding to initial fluid resuscitation to maintain mean arterial pressure (MAP) > 65 mm Hg In the event of persistent hypotension despite fluid resuscitation (septic shock) and/or lactate > 4 mmol/L (36 mg/dl): Achieve central venous pressure (CVP) of > 8 mm Hg Achieve central venous oxygen saturation (ScvO2) of > 70% Sepsis Management Bundle: Low-dose steroids administered for septic shock in accordance with a standardized ICU policy Drotrecogin alfa (activated) administered in accordance with a standardized ICU policy Glucose control maintained > lower limit of normal, but < 150 mg/dl (8.3 mmol/L) Inspiratory plateau pressures maintained < 30 cm H2O for mechanically ventilated patients

	How to Use This Website
		The Surviving Sepsis Campaign and the Institute for Healthcare Improvement have teamed up to achieve a 25 percent reduction in sepsis mortality by 2009. IHI.org is a dynamic resource that will guide you as you learn how to change clinical processes in your hospital, implement a core set of changes, and measure the results of those changes.