The changes called for on these web pages mirror the individual elements of the Severe Sepsis Bundles. Taken together, these changes will substantially reduce mortality due to severe sepsis. The Severe Sepsis Bundles are a distillation of the evidence-based recommendations found in the 2008 practice guidelines promulgated by the Surviving Sepsis Campaign.

A "bundle" is a group of evidence-based care components for a given disease that, when executed together, may result in better outcomes than if implemented individually. In a bundle, the individual elements are built around best evidence-based practices. The science supporting the individual treatment strategies in a bundle is sufficiently mature such that  implementation of the approach should be considered either best practice or a reasonable and generally accepted practice.

The purpose of creating a bundle strategy is to clearly articulate a therapeutic framework that will function as a lever for change. We anticipate that making the Severe Sepsis Bundles standard practice will eliminate the piecemeal or chaotically applied standards for sepsis care that characterizes many clinical environments today. 

The Severe Sepsis Bundles have been designed to encourage teams to follow the timing, sequence, and goals in the bundles to achieve a 25 percent reduction in mortality due to severe sepsis or septic shock.

We hope hospitals will use the bundles to create customized protocols and pathways that will function well within their institutions. However, we encourage that each of the elements in the bundles be incorporated in those protocols. Optimally, the protocols should closely mirror the bundles, but allow flexibility for logistical and other needs specific to each hospital. The reason to include the therapies specified in the bundles in your protocol for care is that if you use our measurement strategies and database, you will be measured as compliant (or non-compliant) with those elements. Therefore, if not all of the elements of the bundles are incorporated into your customized protocol, your performance on the quality indicators we have designed will suffer. In addition, we believe that implementing all the elements together is the best strategy to improve care.

There are two different Severe Sepsis Bundles. Each bundle articulates objectives to be accomplished within specific timeframes. The bundles have been developed based on the 2008 Surviving Sepsis Campaign Guidelines for the Management of Severe Sepsis and Septic Shock. The Guidelines incorporate an evidence-based review of the literature and rank the strength of each recommendation. The grading of the evidence supporting each element is noted on the web page describing that element, and a separate document describes the evidence ranking process (see the Ranking the Evidence section below).

• The Sepsis Resuscitation Bundle describes seven tasks that should begin immediately, but must be accomplished within the first 6 hours of presentation for patients with severe sepsis or septic shock. Some items may not be completed if the clinical conditions described in the bundle do not prevail in a particular case, but clinicians should assess for them. The goal is to perform all indicated tasks 100 percent of the time within the first 6 hours of identification of severe sepsis. 

• The Sepsis Management Bundle lists four management goals. Efforts to accomplish these tasks should also begin immediately, but these items may be completed within 24 hours of presentation for patients with severe sepsis or septic shock.

Ranking the Evidence

Choosing therapies to treat patients with severe sepsis and septic shock requires an organized approach to evaluating the evidence. The Sepsis Resuscitation and Management Bundles were derived from the 2008 Surviving Sepsis Campaign Guidelines, which incorporate the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system approach to evaluating the literature. Download the Ranking the Evidence document to learn more.