The challenges of compliance with sepsis management protocols in low and low-middle income countries − A cross-sectional study

Abstract

Aim: There is a need to understand the resources available to manage sepsis in Low & Low Middle-Income Countries (L&LMIC). We explored sepsis management in L&LMIC hospitals in the context of international sepsis guidelines. Methods: Cross-sectional study. A 17-question electronic survey was self-administered to a purposive sample of critical care nurses from L&LMIC. Primary questions included general demographics sepsis recognition tools, available resources and timing to respond. Findings: Our sample comprised of 93 respondents from 66 hospitals in 24 L&LMIC. Hospital in-patient and ICU bed capacity was an average (SD) of 685.14 (1157.34), and 21 (23.97), respectively. Hospitals early warning system for patient deterioration was identified by 38 % of respondents, while 72.3 % worked in hospitals equipped with a central oxygen supply. Pulse oximeters were available in 93.6 % of ICUs and 79.8 % of wards. Broad spectrum antibiotics were available in almost all hospitals; however, lactate tests, and culture testing were unavailable in 19 %, and 11 % of hospitals, respectively. Lack of resources resulted in staff asking families to seek these items externally at their own expense or simply doing without, resulting in a compromised level of care. Conclusion: Many L&LMIC hospitals can comply with sepsis guidelines, however this is not consistent nor sustained. We identify substantial delays for patients with sepsis receiving fundamental tests and treatments in L&LMIC and recognise the ongoing need to bridge the sepsis care gap between L&LMIC and High-Income Countries. Implications for Clinical Practice: Further efforts to identify, test, evaluate and refine effective responses to the prevention and management of sepsis in L&LMIC are urgently needed. We have identified in some L&LMIC that good practice can be achieved but timeliness and consistency of good practice is challenging. Finding common approaches, tools and protocols that enable consistent effective practice and outcomes in L&LMIC must be an ongoing ambition.