The Surviving Sepsis Campaign (SSC) is a global initiative to bring together professional organizations in reducing mortality from sepsis

Sepsis

Sepsis is a potentially deadly medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues...

. The purpose of the SSC is to create an international collaborative effort to improve the treatment of sepsis and reduce the high mortality rate

Mortality rate

Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...

 associated with the condition. The Surviving Sepsis Campaign and the Institute for Healthcare Improvement have teamed up to achieve a 25 percent reduction in sepsis mortality by 2009.

Relevance

Mortality associated with severe sepsis remains high at 30-50%. When shock

Septic shock

Septic shock is a medical emergency caused by decreased tissue perfusion and oxygen delivery as a result of severe infection and sepsis, though the microbe may be systemic or localized to a particular site. It can cause multiple organ dysfunction syndrome and death...

 is present, mortality is reported to be even higher at around 50-60%. Approximately 1400 people die from sepsis each day throughout the world.

In the U.S. there are approximately 750,000 new sepsis cases each year, with at least 210,000 fatalities and this is reported to be same throughout Europe. As medicine becomes more advanced, with invasive procedure

Invasiveness of surgical procedures

There are three main categories which describe the invasiveness of surgical procedures. These are: non-invasive procedures, minimally invasive procedures, and invasive procedures ....

s and immunosuppression

Immunosuppression

Immunosuppression involves an act that reduces the activation or efficacy of the immune system. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other...

, the incidence of sepsis is likely to increase even more.

Approach

This is done using a six-pronged approach:

• Building awareness of sepsis
• Improving diagnosis
• Increasing the use of appropriate treatment
• Educating healthcare professionals
• Improving post-intensive care unit
  Intensive Care Unit
  thumb|220px|ICU roomAn intensive-care unit , critical-care unit , intensive-therapy unit/intensive-treatment unit is a specialized department in a hospital that provides intensive-care medicine...
  
   (ICU) care
• Developing guidelines of care
• Facilitating data collection for the purposes of audit and feedback (SSC Guidelines 2008)

Using bundles in health care

Using bundles in health care simplifies the complex processes of the care of patients with severe sepsis. A bundle is a selected set of elements of care distilled from evidence-based

Evidence-based medicine

Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...

 practice guidelines that, when implemented as a group, have an effect on outcomes beyond implementing the individual elements alone. Each hospital's sepsis protocol may be customized, but it must meet the standards created by the bundle.

The first 6 hour SSC Resuscitation Bundle includes:

• Blood culture
  Blood culture
  Blood culture is a microbiological culture of blood. It is employed to detect infections that are spreading through the bloodstream...
  
  s obtained prior to antibiotic
  Antibiotic
  An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
  
   administration.
• serum lactate
  Lactate dehydrogenase
  Lactate dehydrogenase is an enzyme present in a wide variety of organisms, including plants and animals.Lactate dehydrogenases exist in four distinct enzyme classes. Two of them are cytochrome c-dependent enzymes, each acting on either D-lactate or L-lactate...
  
   measured
• Broad-spectrum antibiotics administered within two hours of admission/diagnosis. For every hour a patient is denied AB therapy after the onset of septic shock, the patients chance of survival is reduced by 7.9% (Survivesepsis.org 2005)

Further management is centered around Early Goal Directed Therapy (EGDT).

• In the event of hypotension
  Hypotension
  In physiology and medicine, hypotension is abnormally low blood pressure, especially in the arteries of the systemic circulation. It is best understood as a physiologic state, rather than a disease. It is often associated with shock, though not necessarily indicative of it. Hypotension is the...
  
    and/or lactate > 4 mmol/L, delivering an initial minimum of 20 ml/kg of crystalloid or 5mls/kg of colloid
  Colloid
  A colloid is a substance microscopically dispersed evenly throughout another substance.A colloidal system consists of two separate phases: a dispersed phase and a continuous phase . A colloidal system may be solid, liquid, or gaseous.Many familiar substances are colloids, as shown in the chart below...
  
  
• Apply vasopressors, usually noradrenaline for hypotension not responding to initial fluid resuscitation to maintain mean arterial pressure
  Mean arterial pressure
  The mean arterial pressure is a term used in medicine to describe an average blood pressure in an individual. It is defined as the average arterial pressure during a single cardiac cycle.-Calculation:...
  
   (MAP) > 65 mm Hg, in the event of persistent hypotension despite fluid resuscitation (septic shock) and/or lactate > 4 mmol/L (36 mg/dl):

Resuscitation Goals are:

• To achieve central venous pressure
  Central venous pressure
  Central venous pressure describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart...
  
   (CVP) of > 8 mm Hg
• To achieve central venous oxygen saturation (ScvO2) of > 70%
• To achieve MAP > 65mmHg and a urine output of >0.5mls/kg/hr

The 24 hour SSC Management Bundle includes:

• Low-dose steroids administered for septic shock in accordance with a standardized ICU policy
• activated protein C administered in certain conditions, this however is controversial with concerns regarding the guidelines being funded by the manufacturer Eli Lilly and Company
  Eli Lilly and Company
  Eli Lilly and Company is a global pharmaceutical company. Eli Lilly's global headquarters is located in Indianapolis, Indiana, in the United States...
  
   and a 2011 Cochrane review finding that its use cannot be recommended as it does not imporve survival but does increase bleeding risk. On October 25, 2011, this controversy has been resolved. Lilly has taken the drug off the market worldwide because of clear evidence that it has no beneficial effect. The Surviving Sepsis Campaign was an industry-sponsored public relations campaign that was quite successful despite the ineffectiveness of the marketed intervention, Xigris.
• Glucose control
  Blood sugar
  The blood sugar concentration or blood glucose level is the amount of glucose present in the blood of a human or animal. Normally in mammals, the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM , or 64.8 and 104.4 mg/dL...
  
   maintained below upper limit of normal (8.3 mmol/L) with an insulin sliding scale regime (usually short-acting insulin such as Human Actrapid)
• Lung Protective Ventilator Strategy utilising 5-8 mls/kg tidal volumes for mechanically ventilated
  Mechanical ventilation
  In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
  
  patients to avoid volutrauma and barotrauma.