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      Fighting hospital sepsis

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      1 , , 1 , 1 , 1 , 1 , 1
      Critical Care
      BioMed Central
      33rd International Symposium on Intensive Care and Emergency Medicine
      19-22 March 2013

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          Abstract

          Introduction Sepsis accounts for a very high mortality. The Surviving Sepsis Campaign recommends a first 6 hours resuscitative bundle to improve patient outcome. Despite this, the bundle is poorly performed because of several organizational and cultural barriers. In recognition of this, we guess that an Educational and Organizational Intervention out of the ICUs could impact on septic patient outcome. In order to test our hypothesis we carried out, in 12 hospitals, a pre-intervention survey of the human and organizational resources (HOR) available in the management of septic patients. The aim is to seek any barrier potentially affecting correct Guidelines implementation. Methods Thirty-nine medical wards (MW) and 12 emergency departments (ED) were enrolled. Every unit was asked to fill in a pre-agreed HOR Checklist focused on the main requirements suggested by the Guidelines. Results Analysing the human resources available, we see that the bed-to-doctor ratio significantly (P <0.01) increases from the day to the night shift: from 6 to 43 beds per doctor on the MW (median). Otherwise, the ED staff remains roughly the same: from 3.5 to 2.5 doctors on duty (median). The analysis of the organizational tools (Table 1) points out a low percentage of hospitals having: a Diagnostic and Therapeutic Protocol for sepsis management (8.3%), some Hospital Empirical Antibiotic Therapy Guidelines (0%) and an Infective Source Eradication Protocol (8.3%). Moreover, just 25% of hospitals involve an infectious diseases expert in every case of severe sepsis or septic shock. Table 1 Resource Availability (%) Diagnostic and therapeutic protocol for septic patient management 8.3 Use of early warning score for diagnosis and management 8.3 Sepsis team 25 Microbiology laboratory: open 7 days a week 66.6 Lactate dosage: 24 hours a day availability 83.3 Central venous catheter insertion (CVC) available 24 hours a day 91.6 Hospital empirical antibiotic therapy guidelines 0 Infectious diseases team advice in any case of severe sepsis septic shock 25 Infective source eradication  Infective source eradication protocols 8.3  Intervention radiology available 24 hours a day 50  Operating room available 24 hours a day 58.3 Specific infection management protocol (that is, CVC infection) 58.3 Imaging reporting service available 7 days a week 41.6 Conclusion We guess that the poor availability of HOR showed by the hospitals could have a role in the Guidelines implementation and in the patient's outcome. Only a comparison between these results and data collected from a Clinical Checklist, focused on sepsis bundle compliance, and from a patient's outcome summary could confirm our hypothesis. This is the aim for our next part of the study.

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          Author and article information

          Conference
          Crit Care
          Crit Care
          Critical Care
          BioMed Central
          1364-8535
          1466-609X
          2013
          19 March 2013
          : 17
          : Suppl 2
          : P55
          Affiliations
          [1 ]Ospedale Niguarda Ca' Granda, Milan, Italy
          Article
          cc11993
          10.1186/cc11993
          3642961
          50d78a0f-e291-4e72-8de0-41e5341bd72b
          Copyright ©2013 Calini et al.; licensee BioMed Central Ltd.

          This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

          33rd International Symposium on Intensive Care and Emergency Medicine
          Brussels, Belgium
          19-22 March 2013
          History
          Categories
          Poster Presentation

          Emergency medicine & Trauma
          Emergency medicine & Trauma

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