Compliance with the Surviving Sepsis Campaign guideline 1-hour bundle for septic shock in China in 2018

BACKGROUND: Effective implementation of the Surviving Sepsis Campaign (SSC) guidelines has effectively reduced sepsis mortality. The effects of hospital level and ownership on compliance with the SSC guideline 1-hour bundle (C(ssc-1h)) are unclear. We designed this study to identify the differences in C(ssc-1h) between secondary and tertiary hospitals, public hospitals, and private hospitals. METHODS: In this survey, 1,420 hospitals were enrolled, including 864 public tertiary hospitals, 482 public secondary hospitals, 34 private tertiary hospitals, 40 private secondary hospitals. The data were collected between January 1, 2018, and December 31, 2018. The outcomes were adherence to the SSC guidelines (2018 update). Monitoring indicators include 1-hour bundle and its sub-indicators (measure lactate level and remeasure lactate level if initial lactate is >2 mmol/L, obtain blood cultures before administering antibiotics, administer broad-spectrum antibiotics, begin rapid administration of 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L, apply vasopressor if hypotension is present during or after fluid resuscitation to maintain a mean arterial pressure ≥65 mmHg). Every monitoring indicator was stratified by the median, which is defined as 1 if greater than or equal to the median, and 0 if not. RESULTS: C(ssc-1h) in tertiary hospitals was significantly higher than in secondary hospitals (P<0.05). However, there were no statistical differences in C(ssc-1h) in public hospitals and private hospitals. CONCLUSIONS: C(ssc-1h) in tertiary hospitals was significantly better than that in secondary hospitals. There is an urgent need to improve C(ssc-1h) in secondary hospitals. The increase in private hospitals will not reduce C(ssc-1h).