Compliance of medicine residents with 6-hour sepsis bundle at a tertiary care center

Objective: To determine the frequency of medicine residents’ compliance with 6-hour sepsis bundle in patients with severe sepsis at the Aga Khan University Hospital Methods: Cross-sectional study, conducted at the emergency room and medical wards of a tertiary care university hospital. The study was conducted from April to October, 2009. Sixty seven patients with severe sepsis and 67 medicine residents (postgraduate years 3 and 4) meeting the inclusion criteria were enrolled in the study after informed consent. A checklist was used to document whether all tasks of 6-hour sepsis bundle were undertaken and completed within 6 hours of making a diagnosis of severe sepsis. Results: Overall residents’ compliance with 6-hour sepsis bundle was 11.9%. Out of the 67 patients of severe sepsis, serum lactate was measured in 14 (20.9%) patient, blood culture before antibiotics was obtained in 38(56.7%) patients; 53(79.1%) patients received antibiotics within 3 hour of presentation to the emergency room and 1 hour of their diagnosis of severe sepsis in the ward. Initial fluid resuscitation was completed in 65(97%) patients. If the mean arterial pressure (MAP) remained less than 65mmHg despite adequate initial fluid resuscitation, vasopressors of choice were initiated in 55 (82.1%) cases. Central venous pressure of =8 mmHg was achieved in 53(79%) patients after adequate fluid resuscitation. Blood transfusion to target hemoglobin (Hb) of 7-9g/dl was given to 59(88.1%) patients. Conclusion: Hospital mortality from severe sepsis can be reduced by enhancing compliance with evidence-based interventions through adoption of simple strategies which are relevant to our local problems and needs