Prognostic outcomes of adherence to guideline of bundle therapy by key points of control strategies in septic shock patients

Objective To evaluate the improvement of clinical septic shock guideline of bundle therapy by key points of control strategies and its impact on the outcomes of septic shock patients. Methods The quality control team and sepsis steering committee were established to apply key points of control strategies to improve the clinical septic shock guideline of bundle therapy. The time to resuscitation, antibiotics and cultures, the implementation rate of 6-hour resuscitation goals, glucose control and lung protective ventilation strategies were recorded during the plan-do-check-act (PDCA) steps. And the changes of length of ICU stay and hospital mortality were analyzed. Results Between July 2009 and December 2012, a total of 563 sequential septic shock patients were admitted. Demographics included median age, gender ratio, initial Acute Physiology and Chronic Health Evaluation Ⅱ (Apache Ⅱ) score and sources of infection showed no significant differences during this period. Compared with 2009, the time to resuscitation(65.1±10.3 vs 99.7±10.5 min, P<0.01), the time to cultures (55.9±5.2 vs 71.5±7.9 min, P<0.01) and the time to antibiotics (58.1±5.8 vs 152.8±16.1 min, P<0.01) significantly decreased in 2012. The implementation rate of 6-hour resuscitation goals (68.7% vs 28.7%, P<0.01), the implementation rate of glucose control (79.6% vs 40.0%, P<0.01) and the implementation rate of lung protective ventilation strategies (74.1% vs 51.4%, P=0.004) improved significantly form 2009 to 2012. The length of ICU stay (7.2±1.5 vs 9.8±2.7 d, P<0.01) decreased. And hospital mortality decreased from 40.0% in 2009 to 23.1% in 2012 (P=0.015). Conclusion The key points of control strategies can improve the clinical septic shock guideline of bundle therapy performance so that there are significant decreases of length of ICU stay and hospital mortality of septic shock patients. Key words: Infection control; Shock, septic; Guidebooks; Bundle