Conformity to the Surviving Sepsis Campaign International Guidelines among Physicians in a general Inensive care unit in Nairobi

Abstract

Background: There are emerging therapies for managing septic critically-ill patients. There is little data from the developing world on their usage. Objectives: To determine the conformity rate for resuscitation and management bundles for septic patients amongst physicians in a general intensive care unit. Design: Cross sectional observational study. Setting: The general intensive care unit, Aga Khan University Hospital, Nairobi. Subjects: Admitting physicians from all specialties in the general intensive care unit. Results: The physicians had high conformity rates of 92% and 96% for the fluid resuscitation and use of va so pressors respectively for the initial resuscitation bundle. They had moderate conformity rates for blood cultures prior to administering antibiotics (57%) and administration of antibiotics within first hour of recognition of septic shock (54%). There was high conformity rate to the glucose control policy (81%), use of protective lung strategy in acute lung injury/Acute respiratory distress syndrome, venous thromboembolism prophylaxis (100%) and stress ulcer prophylaxis (100%) in the management bundle. Conformity was moderate for use of sedation, analgesia and muscle relaxant policy (69%), continuous renal replacement therapies (54%) and low for steroid policy (35%), administration ofdrotrecogin alfa (0%) and selective digestive decontamination (15%). Conclusion: There is varying conformity to the international sepsis guidelines among physicians caring for patients in our general ICU. Since increased conformity would improve survival and reduce morbidity, there is need for sustained education and guideline based performance improvement.

East African Medical Journal Vol. 87 No. 8 August 2010