Implementation of a multifaceted sepsis education program in an emerging country setting: clinical outcomes and cost-effectiveness in a long-term follow-up study

Noritomi, Danilo Teixeira; Ranzani, Otávio T.; Monteiro, Mariana B; Ferreira, Elaine Maria; Santos, Sérgio Ricardo; Leibel, Fernando; Machado, Flávia Ribeiro

doi:10.1007/s00134-013-3131-5

Cited by 108 publications

(99 citation statements)

References 41 publications

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“…Developing countries therefore need educational programs to train healthcare providers on the prevention, early recognition and diagnosis, and management of sepsis. [4][5]16]. This would lead to a higher compliance with the early goal-directed therapy and the Surviving Sepsis Campaign guidelines, which has been demonstrated in a recent interventional study where a network of ten private hospitals in Brazil used a multifaceted, centrally coordinated quality improvement program involving multiple multidisciplinary educational sessions, case managements, and continuous performance assessment [16].…”

Section: Create Training Programs For Healthcare Professionalsmentioning

confidence: 97%

“…While prompt recognition and management of sepsis are likely to be the most cost-effective interventions for the patients with sepsis in developing countries with limited resources, educational efforts targeted at sepsis in developing countries are necessary and crucial to improve clinical outcomes [4][5]16]. The diverse signs and symptoms of sepsis frequently disguised the disease process, and lack of targeted sepsis education in developing countries makes it difficult for the healthcare professionals to make accurate diagnoses and provide care for the patients [4].…”

Section: Create Training Programs For Healthcare Professionalsmentioning

confidence: 99%

“…[4][5]16]. This would lead to a higher compliance with the early goal-directed therapy and the Surviving Sepsis Campaign guidelines, which has been demonstrated in a recent interventional study where a network of ten private hospitals in Brazil used a multifaceted, centrally coordinated quality improvement program involving multiple multidisciplinary educational sessions, case managements, and continuous performance assessment [16]. As a result, the healthcare professionals had high compliance with the resuscitation protocol, increasing the proportion of patients who received adequate treatment from 13% to 62% and hence decreasing the overall mortality from 55% to 26% [16].…”

Section: Create Training Programs For Healthcare Professionalsmentioning

confidence: 99%

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Optimizing Quality of Care for Septic Patients in Developing Countries

Saleh¹

2015

SOJAPM

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Open Access Opiniondeveloping countries. Although data on the burden of sepsis in developing countries is lacking in the published literature, the incidence and mortality are likely to be disproportionally high in developing countries compared to developed countries [4][5][6][7][8][9][10]. The Brazilian Sepsis Epidemiological Study has confirmed this conclusion by evaluating 1383 patients who were admitted to five different intensive care units. The investigators discovered that the incidence of sepsis, severe sepsis, and septic shock were 61.4, 35.6, and 30.0 per 1000 days, respectively [6]. The mortality of patients with sepsis, severe sepsis, and septic shock were 34.7%, 47.3%, and 52.2%, respectively [6]. These high incidences and mortalities of sepsis in developing countries may be caused by their quality of healthcare, lack of access to healthcare and educational efforts targeting sepsis, and shortage of resources.It is also important to note that severe sepsis is likely to complicate malnutrition, malaria, maternal conditions, and chronic illnesses, including HIV/AIDS, diabetes, and cancer in developing countries [4][5]8]. For instance, Bane et al. [7] Evaluated HIV-positive patients who were admitted to an Ethiopian hospital and noticed that sepsis and septic shock were among the most common causes of mortality due to their immunosuppressant [4,7]. Sani et al. [4,8]. Reviewed the causes of death among patients with AIDS over 4 years in a Nigerian hospital As a result of their calculations, 455 of 4574 patients (9.9%) were admitted due to their HIV/AIDS-related diagnoses, which caused 176 deaths (38.7%) over the period [4,8]. The most common causes of these deaths were tuberculosis (33.4%) and sepsis (23.8%). This indicates that immunosuppressant secondary to acute illnesses and chronic conditions in developing countries may thus potentially significantly increase the incidence and mortality of sepsis in developing countries [4].similarly, a large prospective study evaluating 1,235 Brazilian patients admitted to 90 Brazilian icus demonstrated that there was a clear association between infection and mortality [10]. Furthermore, the overall ICU mortality rate was 28.4% with the higher rate in the infected patients than in non-infected patients (37.6% vs 13.2%) [10]. Likewise, the in-hospital mortality rate was 34.2%, with 44.2% in the infected patients and 17.7% in non-infected patients. The authors performed a multivariate analysis and concluded that the significant factors associated with the incidence of infection were emergency surgery (OR 2.89), mechanical ventilation (OR AbstractSepsis is a major cause of morbidity and mortality in intensive care units. It affects millions of people worldwide annually, causing hundreds of thousands deaths and health-care expenditure of at least $16.7 billion per year. This highlights the significance of diagnosing and treating septic patients emergently. Unfortunately, developing countries are struggling with limited resources, lack of educational efforts targeting se...

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Section: Create Training Programs For Healthcare Professionalsmentioning

confidence: 97%

Section: Create Training Programs For Healthcare Professionalsmentioning

confidence: 99%

Section: Create Training Programs For Healthcare Professionalsmentioning

confidence: 99%

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Optimizing Quality of Care for Septic Patients in Developing Countries

Saleh¹

2015

SOJAPM

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“…Unlike the negative results from recently published RCTs, most observational studies demonstrated that SSC bundle adherence was associated with a reduced mortality rate (9,(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74), but without significantly increasing medical cost (75). Over a 7.5-year period running from 2005 till 2012, Levy et al found that compliance to the SSC bundle resulted in a 25% relative mortality risk reduction (76).…”

Section: Compliance With Surviving Sepsis Campaign (Ssc) Bundlementioning

confidence: 99%

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

et al. 2017

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Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials. Focus was laid on the setting (emergency department versus ICU) where EGDT was carried out. Early recognition of sepsis, through clinical or automated systems for early alert, together with well-timed initiation of the recommended therapy bundles may improve patients' outcome. However, the original "EGDT" protocol by Rivers and coworkers has been largely modified in subsequent trials. Currently, many investigators opt for an "expanded" EGDT (as suggested by the Surviving Sepsis Campaign). Evidence is also presented on the effectiveness of automated systems for early sepsis alert. Early recognition of sepsis and well-timed initiation of the SSC bundle may improve patient outcome.

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“…In addition, compliance with resuscitation measures in the 3-and 6-hour SSC bundles is highly variable across studies [8][9][10][11], suggesting they are not standards of care across all settings or that the guidelines are in fact difficult to follow and comply with even in excellent centres. A multinational one-day prevalence study also showed low compliance rates with all resuscitation items, including lactate sampling (56%), repeat lactate sampling (64%), administering 30 mL/kg of crystalloids for fluid resuscitation (57%), and vasopressors for hypotension (66%) [12].…”

Section: Introductionmentioning

confidence: 99%