SUMMARY:

• Routine sepsis screening, early detection, and standardized care approaches have been the driving force of sepsis care for decades.

• Although extensively studied within the United States, the rest of world’s adoption of these approaches leaves considerable room for improvement.

• New strategies are needed to drive improved recognition and care outcomes.

REVIEW:

• Current guidelines for sepsis recommend:

• • Routine screening

• • Implementation of Surviving Sepsis Campaign Guidelines

• • Quality Improvement Initiatives

• • Protocols for Standardized sepsis care

• • • Antibiotic stewardship

• • • Track prevalence and mortality rates

• • • Measure sepsis bundle compliance

• International Survey Scheer CS, et al. Am J Respir Crit Care Med Vol 211, Iss 4, pp 587–599, Apr 2025

• • August 2021 – June 2022

• • 5 regions – Northern; Eastern; Southern; Western Europe and rest of world

• • Evaluated by

• • • Bed size

• • • Type of hospital

• • • Location: ED; ICU; Ward

• • 1,023 hospitals, 388,000 acute care beds (23% of all acute care beds  in the European Union)

• Sepsis criteria used:

• • Sepsis-1 definitions 24.5% of hospitals

• • Sepsis-3 definitions 45.4% of hospitals

• Standardized sepsis screening

• • Daily screening:

• • • 51% of wards

• • • 75.8% of ICU

• • • Otherwise, screening occurred only on demand or not at all

• • SIRS Criteria:

• • • All 4 criteria used in only 56.3% of hospitals

• Hospitals with quality improvement initiatives used on a regular basis had greater implementation of sepsis screening than those that did not.

• • Only 31.4% of hospitals had a quality improvement initiative

• • 9.8% had implemented a regular quality improvement initiative within the hospital

• European rates of screening were lower than previously published U.S. rates.

• Standardized Sepsis Management

• • Wide variability occurred between European regions but not by hospital size.

• • Sepsis prevalence and mortality were only monitored in 54.3% and 45.0% respectively.

• • Sepsis bundle compliance was only measured in 18.1% of hospitals.

• • Similar to sepsis screening rates, those with a regular quality improvement initiative had better management rates than those without.

• Antibiotic stewardship and antibiotic hospital guideline use followed similar trends to sepsis screening and management.

• The findings demonstrate room for dramatic improvement in a large number of hospitals within Europe.

CONCLUSIONS:

• European hospitals lag in terms of sepsis screening and quality improvement initiatives.

• Increased efforts are necessary to improve education and clinical approaches to sepsis.

• Local factors and available resources should also be considered.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.