Hambatan Implementasi Surviving Sepsis Campaign Guidelines 2012 pada Pasien Anak di Rumah Sakit Rujukan Tersier The Barrier of Surviving Sepsis Campaign Guideline 2012 Implementation for Children at Tertiary Hospital

The adequate sepsis management are likely improve patient's outcome. Surviving sepsis campaign (SSC) 2012 is an international guideline for management of severe sepsis and septic shock, however its implementation is depend on health facilities and resources. This study evaluates implementation of the guideline in hospital. Prospective study was conducted in February-June 2013, included pediatric patient 1 month-18 years old fulfilled sepsis criteria at Saiful Anwar General Hospital. The management of fluid resuscitation and vasoactice drug, time to perform antibiotics and blood culture examination, nutrition, mechanical ventilation, and mortality rate were observed. Of 40 patients, 34 were septic shock. All septic shock patients got fluid resuscitation and vasoactive drugs. In 21 patients, vasoactive drugs were given at the first 6hours. Only 14 patients were given antibiotics at the first 1-hour, and only 6 were performed blood culture examination. Twenty-eight patients need mechanical ventilation, yet 13 could not receive it, which increased the mortality risk 2,1 times (95% CI 1,2; 3,7). In PICU, 27 patients received nutritional support at the 6-24 hours, however most (32 patients) received calories less than 80% at the first 48 hours, with mortality risk 3 times higher (95% CI 1,1; 8,2). Mortality occurred in 24 patients. This study showed the obstacles in implementing SSC guideline 2012 for antibiotics administraton, blood culture examination, mechanical ventilation, and adequate nutrition in severe sepsis and septic shock. Inavailability of mechanical ventilation and inadequate nutrition increased the mortality risk.