A Retrospective Study on the Compliance with Surviving Sepsis Campaign Guideline in Patients with Sepsis Admitted to Intensive Care Unit in Hong Kong

Abstract

The global incidence of sepsis is increasing due to earlier recognition, but mortality from sepsis still remains high. Local data on the management according to the Surviving Sepsis Campaign Care Bundle is still lacking. Hence, this study looks at the epidemiology, patient characteristics and management of septic patients admitted to intensive care unit (ICU) in a regional hospital in Hong Kong. Clinical records of all patients admitted to ICU of Tseung Kwan O Hospital from 1st January to 30th June, 2014 were screened. There were 108 patients who fulfilled the inclusion criteria, corresponding to incidence of 32%. There were 62% males with a mean age of 63.6 years. Most patients (34.3%) were diagnosed in emergency department and the majority (46%) were transferred to ICU within 3 h of diagnosis, whereas 44% were transferred >6 h after diagnosis and 10% were transferred between 3-6 h. Most common source of infection was respiratory (26%), followed by blood (15.7%) and urinary tract (7%). Three-hour bundle compliance: measurement of lactate (0%), blood culture before antibiotics (56%), administration of antibiotics (100%) and administration of intravenous fluids volume to 30 ml/kg (21%). Six-hour bundle compliance: Vasopressor use (89%), central venous pressure monitoring (68%), central venous oxygen saturation measurement (0%). The hospital mortality rate was 26.8%. In conclusion, mortality of sepsis is high. Relentless effort is needed to boost the adherence to Sepsis Care Bundle, especially the measurement of serum lactate. Protocols, checklists, education and simulation training are possible means to improve the quality of care and clinical outcome of septic patients.