10 Steps to Improve Sepsis Care in Low-Resource Settings

Abstract

OBJECTIVES: To develop a practical consensus-based framework for 10 steps to improve sepsis care in low-resource settings (LRSs), aligned with the sepsis chain of survival and informed by global expertise. DATA SOURCES: We reviewed peer-reviewed literature on sepsis epidemiology, prevention, recognition, and management in LRS; international guidelines, including the Surviving Sepsis Campaign; and prior "10-step" consensus frameworks for resuscitation and emergency care. STUDY SELECTION: A Task Force representing adult and pediatric sepsis care, emergency care, critical care, infectious diseases, public health, and implementation science identified key domains from the above data sources. DATA EXTRACTION: With guidance from methodologists and implementation science experts, we utilized an iterative, consensus-based process-literature review, Delphi survey, Utstein-style conference, stakeholder input, and public comment-to first define and then refine steps and implementation strategies. DATA SYNTHESIS: The process resulted in 10 nonsequential, actionable steps covering governance and commodities, provider and caregiver education, community and facility prevention, early recognition and rapid response, timely guideline-based interventions, structured post-sepsis care, data systems, quality improvement, a culture of excellence and respect, and holistic well-being of patients, caregivers, and providers. Each step includes a rationale and potential implementation strategies adaptable to local resources and needs. Collectively, the ten steps emphasize integration across the continuum of care, equitable access to essential interventions, and the role of emerging technologies to prevent, recognize, monitor, and follow-up sepsis. CONCLUSIONS: The 10 steps provide a consensus-driven roadmap for health leaders, clinicians, and policymakers to improve sepsis care, strengthen the sepsis chain of survival, reduce preventable morbidity and mortality, and address global inequities in sepsis outcomes.