NEW hospital sepsis strategies broaden improvement beyond early recognition, targeting diagnosis, antibiotics, surveillance, and infection prevention.
A multidisciplinary panel has developed a practical framework to strengthen infection related sepsis care across U.S. hospitals. The recommendations cover six domains: diagnostic testing and pathogen detection, antibiotic management and delivery, surveillance and performance measurement, adjunctive therapy, organizational infrastructure, and infection prevention.
The consensus paper complements existing bedside guidelines and quality measures by focusing on operational changes hospitals can implement across the care continuum. Recommendations were classified as high or moderate priority according to their potential impact, supporting evidence, feasibility, costs, and possible unintended consequences.
Among the high priority recommendations, hospitals should introduce rapid molecular testing for positive blood cultures alongside active antimicrobial stewardship. This combination is intended to accelerate pathogen identification while supporting timely interpretation, treatment optimization, and follow up.
For patients with septic shock, hospitals should optimize workflows to deliver the first antibiotic within 1 hour of recognition and begin infusion within 30 minutes of the order. The panel also recommends prolonged infusion of antipseudomonal beta lactam antibiotics after a loading dose in critically ill patients. When beta lactams and vancomycin are ordered together for suspected sepsis, clinical decision support should generally prioritize the beta lactam.
Moderate priority strategies include preventing delayed second doses, improving antibiotic selection for patients with reported beta lactam allergies, and using electronic tools to estimate infection specific multidrug resistant organism likelihood. Hospitals should monitor both inadequate treatment and unnecessarily broad empiric therapy, alongside antibiotic de-escalation and the timeliness of source control.
The framework calls for multidisciplinary sepsis governance involving infectious diseases, clinical microbiology, infection prevention, pharmacy, nursing, and antimicrobial stewardship expertise. Electronic health record surveillance could help hospitals track incidence, outcomes, and differences between community onset and hospital onset sepsis.
Infection prevention recommendations include chlorhexidine bathing with appropriate methicillin resistant Staphylococcus aureus decolonization for selected hospitalized populations. Structured daily toothbrushing programs may also reduce hospital-acquired pneumonia, a major cause of hospital onset sepsis.
Automated prediction tools, host response diagnostics, culture independent bloodstream infection testing, respiratory molecular panels, and procalcitonin guided antibiotic duration were considered promising but not ready for routine adoption. The panel emphasized that implementation should reflect local resources, infrastructure, and patient populations.
Reference
Rhee C et al. IDSA/ACEP/ASM/PIDS/SCCM/SHEA/SHM/SIDP multisociety position paper: Hospital strategies to improve sepsis outcomes. Clin Infect Dis. 2026;doi:10.1093/cid/ciag438.
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