Sepsis protocol: how changes in its management can directly impact the reduction of sepsis mortality

Abstract

Introduction: Sepsis has high prevalence and mortality rates worldwide, and early recognition combined with therapeutic measures within the first hour is essential to reduce mortality. However, sepsis protocol management remains challenging, especially due to the difficulty in retrospectively identifying cases not recognized by the healthcare team. Objective: To present changes in the management of the sepsis protocol in a secondary public hospital and their impact on first-hour antimicrobial adherence and sepsis mortality. Methods: A standardized paper form was implemented containing suspected case criteria, time of case identification, laboratory collection, and administration of first-hour measures. In addition, retrospective case searches began to be performed using different markers: sepsis kit collection, ICD codes for infection/sepsis at admission, and deaths with sepsis-related ICD codes. Cases with suspected infection associated with SIRS criteria and/or organ dysfunction were included. Adherence to antimicrobial administration within the first hour and sepsis mortality rates were evaluated between May 2024 and June 2025. Results: A total of 205 suspected sepsis cases were analyzed, including 100 identified through the paper form, 69 through the sepsis kit, 12 through ICD codes for sepsis/septic shock, and 24 through sepsis-related deaths. First-hour antimicrobial adherence was 72% among cases identified through the paper form, higher than that observed among cases identified through the sepsis kit (58%) and retrospective reports (50%). Case analysis revealed failures related to delayed identification and delays between antimicrobial prescription and administration. In response, institutional measures were implemented, including antibiotic loading doses in the electronic medical record, a physical antimicrobial kit, standardized antibiotic therapy recommendations, multidisciplinary training, and mortality review meetings. After these interventions, first-hour antimicrobial adherence increased from 29 to 75%, with a positive impact on sepsis mortality. Conclusion: Expanded and systematic management of the sepsis protocol, associated with careful medical record review and targeted interventions, contributed to improved adherence to first-hour measures and reduced institutional sepsis mortality.