Sepsis protocols to reduce mortality in resource-restricted settings: A systematic review

Elsevier

Available online 7 June 2022, 103255

Intensive and Critical Care NursingHighlights•

Standardised sepsis protocols were associated with a significant decrease in the overall sepsis-related mortality rate by 22.6%, even when not fully executed.

Standardised sepsis protocols can be used in resource-restricted settings but may benefit from simplification to overcome challenges associated with lack of resources.

Rates of compliance with standardised sepsis protocols improved with the proper education of nursing assistants, nurses, and physicians.

Facilitators include adequate education, presence of dedicated nurse champions, and cost-effective measures.

Barriers include lack of resources, including intravenous fluids, antibiotics, manpower, intensive care unit beds, and ventilators.

AbstractObjectives

The management of sepsis in critically ill patients varies globally based on the availability of resources resulting in increased sepsis-related mortality rates in resource-restricted countries. We aimed to summarise evidence regarding components of sepsis protocols, compliance with implementing sepsis protocol, effects on lengths of stay and sepsis-related mortality, and facilitators and barriers to implementing sepsis protocols.

Research Methodology

A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The quality was appraised using the Johns Hopkins Nursing Evidence-Based Practise model.

Results

Six eligible studies reported using modified-sepsis protocols to recognise early warning signs of sepsis and manage sepsis in resource-restricted settings. Interventions comprised educational components and modified sepsis protocols (early sepsis screening tool and sepsis intervention bundle). Studies reported increased protocol compliance with education on and standardised sepsis protocols. While there was no significant impact on hospital lengths of stay, the sepsis-related mortality rates decreased by 22.6% even with partial implementation of the protocol. The primary challenge in implementing sepsis protocols in resource-restricted settings is the lack of resources necessary to complete every component of the protocol successfully.

Conclusion

Simplified sepsis protocols are essential to improving sepsis-related mortality rates in resource-restricted settings, but adequate training of clinicians and modified protocols are necessary for successful implementation.

Keywords

Compliance

Mortality

Protocol

Resource-restricted

Sepsis

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