Ainan Arshad  ( Department of Medicine, Aga khan University, Karachi, Pakistan )
Abdul Aziz  ( Department of Medicine, Aga Khan University, Karachi, Pakistan )
Ahmed Ayaz  ( Aga Khan University, Karachi, Pakistan )
Syed Maaz Salahuddin  ( Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan )
Bushra Jamil  ( Department of Medicine, Aga Khan University Hospital, Karachi. )

This study was conducted to determine the compliance and knowledge of sepsis guidelines among resident physicians in a tertiary care hospital of a developing country. A self-structured validated questionnaire was prepared to evaluate compliance and knowledge of the Surviving Sepsis Campaign (SSC) guidelines. A total of 76 resident physicians completed the questionnaire; out of these, 51 (67%) were from Internal Medicine department and 25 (33%) were from Emergency Medicine department of the Aga Khan University Hospital, Karachi. A total of 71 (93%) participants claimed to be aware of the SSC guidelines but only 20 (26%) considered themselves very knowledgeable on the subject. Thirty-five (46%) physicians claimed that they were using the guidelines regularly. We concluded that the overall knowledge and compliance of sepsis guidelines was suboptimal. This emphasises the need for increased awareness and teaching of sepsis and SSC guidelines to improve patient outcomes in developing countries.

Keywords: Sepsis knowledge; health education; critical care.

DOI: https://doi.org/10.47391/JPMA.926

 

Introduction

 

Sepsis is a serious healthcare concern around the world, affecting more than 30 million people each year and causing more than six million deaths.¹ The main barriers in sepsis bundle implementation are low accessibility of resources, lack of intensive care unit (ICU) beds, and shortage of healthcare professionals; however, one of the main problems to be addressed  is the low awareness of sepsis.² Several studies have proven that the management of sepsis is very time sensitive.^3,4 Although there is limited data about mortality rates due to sepsis in South East Asia, the rates range between 30% and 40%.⁵ This pilot study was conducted to evaluate the knowledge and compliance of SSC guidelines among resident doctors of Internal Medicine and Emergency Medicine departments who deal with sepsis patients on a daily basis.

 

Methods and Results

 

This evaluation study was conducted from July 1 to July 31, 2019, at the Aga Khan University Hospital (AKUH) Karachi, Pakistan, after approval by the Institutional Review Board (2019-1586-3925). To evaluate the knowledge and attitudes of resident physicians about sepsis, a self-structured questionnaire was prepared which was pilot-tested and revised by the same panel of experts. The questionnaire was composed of four parts. The first part included demographic data, the second part assessed the participant’s attitude towards sepsis management guidelines, the third part assessed the knowledge regarding diagnostic criteria of sepsis and organ dysfunction, and the last part tested the knowledge regarding immediate management of sepsis as per the updated 1-hour bundle. The questionnaire was analysed on the basis of scalar-scoring method. All participants were handed out the pre-approved questionnaire in an exam-like setting, consisting of three shifts each of 20 minutes, at three different dates for the convenience of the resident physicians to attend. IBM SPSS 22 was used for data analysis which is presented as mean with standard deviation for numerical data and number with percentage for categorical data.

A total of 76 resident physicians completed the questionnaire; 51 (67%) were Internal Medicine residents and 25 (33%) were Emergency Medicine residents. Seventy-one (93%) participants claimed to be aware of the SSC guidelines but only 20 (26%) considered themselves very knowledgeable on the subject. A total of 35 (46%) physicians claimed that they were using the guidelines regularly (Table 1).

Seventy-three (96%) chose the correct definition of sepsis. whereas 51 (67%) participants correctly identified sepsis in the two fictitious cases (Table 2).

On the basis of scalar scoring method, 42 (55%) resident physicians had excellent knowledge and attitude towards sepsis bundle, 19 (25%) had good and 15 (20%) had poor attitude and knowledge towards the sepsis bundle. It is interesting to note that our results were comparable to other studies conducted around the world. A multi-centre study conducted in eight centres from all over Turkey showed similar results.⁶

The main limitation of our study is the relatively small sample size. Secondly, although knowledge of the basic concepts is an important step in recognising and treating sepsis, the performance of the participants could be different in a real clinical setting. Sample size was not calculated.

 

Conclusion

 

The overall knowledge and compliance of sepsis guidelines was suboptimal in our study. We found that 46% of the resident physicians used the guidelines regularly. Furthermore, only 55% of them had excellent knowledge and attitudes towards the bundle. These results emphasise on the need for increased awareness and teaching of sepsis and SSC guidelines to improve patient outcomes in developing countries.

 

Disclaimer: None.

Conflict of interest: None.

Funding Sources: None.

 

References

 

1.      De Backer D, Dorman T. Surviving Sepsis Guidelines: A Continuous Move Toward Better Care of Patients With Sepsis. JAMA 2017;317:807-8. doi: 10.1001/jama.2017.0059.

2.      Assunção M, Akamine N, Cardoso GS, Mello PV, Teles JM, Nunes AL, et al. Survey on physicians' knowledge of sepsis: do they recognize it promptly? J Crit Care 2010;25:545-52. doi: 10.1016/ j.jcrc.2010.03.012.

3.      Micek ST, Roubinian N, Heuring T, Bode M, Williams J, Harrison C, et al. Before-after study of a standardized hospital order set for the management of septic shock. Crit Care Med 2006;34:2707-13. doi: 10.1097/01. CCM.0000241151. 25426.D7.

4.      Rivers EP, McIntyre L, Morro DC, Rivers KK. Early and innovative interventions for severe sepsis and septic shock: taking advantage of a window of opportunity. CMAJ 2005;173:1054-65. doi: 10.1503/cmaj.050632.

5.      Ullah AR, Hussain A, Ali I, Samad A, Ali Shah ST, Yousef M, et al. A prospective observational study assessing the  outcome of Sepsis in intensive care unit of a tertiary care hospital, Peshawar. Pak J Med Sci 2016;32:688-93. doi: 10.12669/pjms.323.9978.

6.      Tufan ZK, Eser FC, Vudali E, Batirel A, Kayaaslan B, Bastug AT, et al. The Knowledge of the Physicians about Sepsis Bundles is Suboptimal: A Multicenter Survey. J Clin Diagn Res 2015;9:13-6. doi: 10.7860/JCDR/2015/12954.6220.