The changes detailed here 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 2004 practice guidelines recommended by the Surviving Sepsis Campaign. 

A "bundle" is a group of interventions related to a disease process that, when executed together, result in better outcomes than when implemented individually. The individual bundle elements are built upon evidence-based practices.  The science behind the elements of a bundle is so well-established that their implementation should be considered a generally accepted practice.

The purpose of creating change bundles is to clearly articulate a framework that will function as levers for change.  In addition, following the Severe Sepsis Bundles will eliminate the piecemeal or inappropriate application of standards for sepsis care that characterizes the majority of clinical environments today. 

The Severe Sepsis Bundles have been designed to allow teams to follow the timing, sequence, and goals of the individual elements of care, in order to achieve the goal of a 25 percent reduction in mortality from severe sepsis.   

Hospitals should use the bundles to create customized protocols and pathways that will function well within their institutions.  However, all of the elements in the bundles must be incorporated in those protocols.  Addition of other strategies not found in the bundles is not recommended.  The protocols should very closely mirror the bundles, but allow flexibility for logistical and other needs specific to the local hospital.  The bundle will form the basis for the measurements your team will conduct.  Therefore, if not all of the elements of the bundles are incorporated into your customized protocol, your performance on the measures will suffer.

Hospitals should implement two different Severe Sepsis Bundles.  Each bundle articulates objectives to be accomplished within specific timeframes.

• The Severe 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 must 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 twenty-four hours of presentation for patients with severe sepsis or septic shock.