Hospital Pharmacist
2008;15:78
March 2008

News summary

Study calls for better sepsis management

Implementing hospital-wide guidelines to help recognise and treat bloodstream infections can raise the standard of care for this condition, a British study has shown (BMJ 2008;336:440-3).

A six-week observational study was undertaken at a 1,400- bed teaching hospital in Leeds. The case notes for all 157 episodes of bloodstream infection were reviewed to identify the occurrence any major errors. These errors were defined as:

• A delay of 48 hours or more in diagnosis, despite the presence of two or more signs of bloodstream infection (eg, hypotension, tachycardia, fever)

• A delay of six hours or more in giving appropriate antibiotics to critically ill patients (detected from an early warning score or from the patient showing signs of shock)

• Failure to prescribe effective antibiotics despite a positive microbiology result

Results showed that major errors occurred in 46 (30 per cent) of cases — 44 of which occurred in areas of the hospital that did not have a protocol in place to manage bloodstream infections. On 10 occasions, the appropriate drug could not be administered because it was not available on the ward or there was a lack of intravenous access.

A subsequent prospective study was conducted on medical wards at the hospital, both before and after a strategy for improvement had been introduced. The strategy included:

• Introducing guidelines for recognising and managing bloodstream infection

• A team of infection control staff reviewing all patients with confirmed bloodstream infection for appropriate antibiotic treatment and offering advice if necessary

Before the intervention, 11 out of 37 episodes of bloodstream infection were associated with a major error (30 per cent). This dropped to six out of 79 episodes (8 per cent) after the intervention. The authors suggest that all hospital managers should assess (and, if necessary, improve) protocols for managing bloodstream infections.