Sepsis protocols to reduce mortality in resource-restricted settings: A systematic review

Abstract

Objectives: The management of sepsis in critically ill patients varies globally based on the availability of resources resulting in increased sepsis-related mortality rates in resource-restricted countries. We aimed to summarise evidence regarding components of sepsis protocols, compliance with implementing sepsis protocol, effects on lengths of stay and sepsis-related mortality, and facilitators and barriers to implementing sepsis protocols.

Research methodology: A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The quality was appraised using the Johns Hopkins Nursing Evidence-Based Practise model.

Results: Six eligible studies reported using modified-sepsis protocols to recognise early warning signs of sepsis and manage sepsis in resource-restricted settings. Interventions comprised educational components and modified sepsis protocols (early sepsis screening tool and sepsis intervention bundle). Studies reported increased protocol compliance with education on and standardised sepsis protocols. While there was no significant impact on hospital lengths of stay, the sepsis-related mortality rates decreased by 22.6% even with partial implementation of the protocol. The primary challenge in implementing sepsis protocols in resource-restricted settings is the lack of resources necessary to complete every component of the protocol successfully.

Conclusion: Simplified sepsis protocols are essential to improving sepsis-related mortality rates in resource-restricted settings, but adequate training of clinicians and modified protocols are necessary for successful implementation.

Keywords: Compliance; Mortality; Protocol; Resource-restricted; Sepsis.