Castellanos-Ortega et al. (2010) [32]

To describe the effectiveness of the SSC guidelines with regard to both implementation and outcome in patients with septic shock, and to determine the contribution of the various elements of the guidelines to the outcome.

A quasi-experimental study that included a post intervention group and a historical comparison group. In addition, educational program based on the SSC guidelines was implemented over a 3 months period.

3 medical-surgical ICUs in an

academic tertiary care center in Spain.

N = 384

Convenient

2005-2008

In-hospital mortality was reduced

from 57.3% in the historical group to 37.5% in the intervention group (p < 0.001). The same happened with ICU mortality.

The crude difference was (53.1% vs.

30.5%; p < 0.001) Improvements in survival were related to the number of interventions completed (p for trend <0.001).

Patel et al. (2010) [33]

To examine the effect of a collaborative 2-part sepsis guidelines on clinical outcomes and mortality at a community hospital.

Quasi-experimental. A multidisciplinary collaborative approach was adopted to conduct the study using retrospective and unblended data collection techniques.

An ICU in a non-academic community hospital 427-licensed bed for acute care

in the USA.

N = 112

Convenient

2006

Mortality was 61.1% in the non-guidelines group versus 20% with the guidelines (p < 0.001). Implementation of a 2-part sepsis guidelines based on the SSC can yield a positive impact on clinical outcome and mortality.

Shiramizo et al. (2011) [34]

To determine the rate of compliance with 6-hour and 24-hour sepsis bundles, and to determine the impact of compliance on hospital mortality of patients with severe sepsis and septic shock.

Prospective quasi-experimental, pre and post design. Bundle compliance and patient outcomes were compared before (July 2005-April 2006) and after (May 2006-December 2009) implementation of the interventions.

medical-surgical ICU in a tertiary care private

hospital in Sao Paulo, Brazil.

N = 564

Convenient

2006-2009

In-hospital mortality was 54.0% from July 2005 to April 2006, 41.1% from May to December 2006, 39.3% in 2007, 41.4% in

2008 and 16.2% in 2009. A statistically significant decreased OR for inpatients mortality was observed when