Guidance on the SSC Bundle

The Surviving Sepsis Campaign (SSC) Bundle is the core of the sepsis improvement efforts. Applying the sepsis bundle simplifies the complex processes of the care of patients with sepsis. The Surviving Sepsis Campaign Steering Committee and members of the Executive Committee collaborated to revise the bundle based on the International Guidelines for Management of Sepsis and Septic Shock 2016. More information on the members of these committees can be found on the SSC website. Currently, there is a discussion underway amongst a number of experts with regards to this bundle. Should there be any further progress on this initiative, ESICM will provide updates as necessitated.

The guidelines and the bundle integrate identified decision points and courses of action that when combined with clinical judgment, can make a difference in patient outcomes. Note that the updated bundle is not mandated, but rather serves as a guide and should be implemented within the first hour of sepsis recognition.

As explained in the related article, more than one hour may be required for resuscitation to be completed, but the Campaign encourages the prompt initiation of resuscitation and treatment, such as obtaining blood for measuring lactate and blood cultures, administration of fluids and antibiotics, and in the case of life-threatening hypotension, initiation of vasopressor therapy – treating sepsis as a medical emergency.

Surviving Sepsis Campaign Bundle of Care

• Measure lactate level. Remeasure if initial lactate level > 2 mmol/L.
• Obtain blood cultures before administering antibiotics.
• Administer broad-spectrum antibiotics.
• Begin rapid administration of 30mL/kg crystalloid for hypotension or lactate level ≥ 4 mmol/L.
• Apply vasopressors if patient is hypotensive during or after fluid resuscitation to maintain MAP ≥ 65 mm Hg.

Bundle Implementation

A bundle is a selected set of elements of care that, when implemented as a group, have an effect on outcomes beyond implementing the individual elements alone. ​Each hospital’s sepsis protocol may be customised with the bundle serving as guidance when acknowledging that sepsis is a medical emergency. ​​Each hospital’s sepsis protocol may be customised with the bundle serving as guidance when acknowledging that sepsis is a medical emergency. ​

The Surviving Sepsis Campaign Bundle: 2018 update (Free Access) has been published in Intensive Care Medicine and Critical Care Medicine. Here is a short video to illustrate the SSC activities:

Do you want to know more about the SSC and the updated bundle? 

You can find the new SSC Hour-1 Bundle (including free printable infograph and pocket card) and related resources on the Campaign at survivingsepsis.org/Bundle.