Sepsis Hour-One Bundle Compliance and Outcomes: A Twenty-Four Month Cohort and Quality Improvement Programme: Bundle Implementation, Compliance Trajectory, and Mortality Determinants in Four Hundred and Twelve Sepsis Presentations

Abstract

Sepsis remains a leading cause of in-hospital mortality globally with substantial burden in resource-limited settings where late presentation, atypical presentations, and infrastructure constraints compound the underlying high-mortality biology. The Surviving Sepsis Campaign Hour-One Bundle comprising lactate measurement, blood cultures before antibiotics, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension or lactate ≥4, and vasopressor initiation if needed represents the current standard for early sepsis management. We undertook a 24-month implementation cohort with embedded quality improvement programme involving 412 consecutive ED sepsis presentations. Pulmonary sources (33.5%), urinary (22.3%), intra-abdominal (16.5%), skin/soft tissue (9.2%), and bloodstream (7.8%) accounted for the majority of sepsis sources. Hour-1 bundle compliance rose from 22% at programme launch to 87% by month 24 through structured QI cycles. 28-day mortality differed substantially by compliance: 12% with full hour-1 bundle, 29% with partial compliance, and 46% with non-compliance. Strongest predictors of mortality included septic shock, bundle non-compliance, high lactate, inappropriate empirical antibiotic, elderly age, frailty, and uncontrolled source. Bundle compliance and rapid source control were strongly protective.

Keywords