The implementation of the sepsis resuscitation bundle recommended by the SSC guidelines has been shown to increase compliance and reduce mortality in several settings. Different implementation strategies have been utilized, including education, posters, reminders, audit and feedback, paper-based and electronic sepsis screening tools, clinical pathway and sepsis response teams. Different studies showed a considerable variation effect on compliance and mortality.It has been suggested that implantation strategies vary in there effect from low impact for human-based interventions such as education and training, rules and policies, reminders, checklists and double checks, however, reaching high effect for system based interventions like automation and computerization and forcing function. However, this has not been studied in relation to the implementation of SSC bundle. As such, many projects continue to invest on low-impact interventions with modest change in compliance and mortality. Multiple interventions were adopted by different centers worldwide to implement SSC guidelines. These interventions vary on their level of compliance and outcomes. The effectiveness of intervention if system oriented is more effective than human oriented. The hierarchy of effectiveness assigning forcing function intervention on the top of the pyramid and the training and education on the bottom.~The investigators hypothesize that interventions system based interventions are more likely to be more effective in improving the compliance with sepsis resuscitation bundle and in improving mortality.~The aim of this study is to assess the effectiveness of different interventions for implementation of Surviving Sepsis Campaign guidelines and their impact on compliance and mortality reduction.
This is a systematic review and Meta-Analysis of interventions for implementation of Surviving Sepsis Campaign guidelines and their impact on compliance and mortality reduction