Hour-1 Bundle

The Surviving Sepsis Campaign (SSC) bundle is the core of the Campaign's quality improvement efforts. Applying the sepsis bundle simplifies the complex processes of the care of patients with sepsis. The bundle is based on the 2016 guidelines recommendations integrating identified decision points and courses of action that when combined with clinical judgment, can make a difference in patient outcomes.

*Hour-1 Bundle

The Hour-1 bundle should be viewed as a quality improvement opportunity moving toward an ideal state. For critically ill patients with sepsis or septic shock, time is of the essence. Although the starting time for the Hour-1 bundle is recognition of sepsis, both sepsis and septic shock should be viewed as medical emergencies requiring rapid diagnosis and immediate intervention.

The Hour-1 bundle encourages clinicians to act as quickly as possible to obtain blood cultures, administer broad spectrum antibiotics, start appropriate fluid resuscitation, measure lactate, and begin vasopressors if clinically indicated.  Ideally these interventions would all begin in the first hour from sepsis recognition but may not necessarily be completed in the first hour. Minimizing the time to treatment acknowledges the urgency that exists for patients with sepsis and septic shock. 

*Note the description of the Hour-1 Bundle (not 1-Hour Bundle) above is the most current having passed all approval points effective 1/10/19.

​Hour-1 Bundle Pocket Card and Infographic​​ (see more resources below)

Surviving Sepsis Campaign Hour-1 Bundle of Care Elements:

  • Measure lactate level* 
  • Obtain blood cultures before administering antibiotics.
  • Administer broad-spectrum antibiotics.
  • Begin rapid administration of 30mL/kg crystalloid for hypotension or lactate level ≥ 4 ​mmol/L.
  • Apply vasopressors if hypotensive during or after fluid resuscitation to maintain MAP ≥ 65 mm Hg.

* Remeasure lactate if initial lactate is elevated (> 2 mmol/L).

Early Identify of the Sepsis on the Hospital Floors: Insights for Implementation of the Hour-1 Bundle

The Surviving Sepsis Campaign's Sepsis on the Wards Collaborative was instrumental in identifying factors that contribute to improving care of patients with sepsis on the hospital floors and providing resources for implementation.

Based on lessons learned from the Sepsis on the Wards Collaborative, this guide offers clinicians on hospital wards tools and resources to successfully implement the hour-1 bundle and sustain its success.

This guide addresses:

  • Best practices for early identification of sepsis on hospital floors
  • Implementing and sustaining a quality improvement program
  • Defining the roles of team members
  • Overcoming barriers
  • Screening strategies

Download this guide today to be part of the SSC's mission to reduce mortality and morbidity rates of sepsis.

Surviving Sepsis Campaign: Guidance on the Guidelines and Bundle
Surviving Sepsis Campaign:
Guidance on the Guidelines
and Bundle
The Surviving Sepsis Campaign Bundle: 2018 update
Surviving Sepsis Campaign
Bundle: 2018 update

Teaching Slides
Hour-1 Bundle Teaching Slides  

Hour-1 Bundle Pocket Card and Infographic​​

The Surviving Sepsis Campaign Bundle: 2018 Update Journal Publication

Critical Care Medicine
Intensive Care Medicine

Bundle Implementation

A bundle is a selected set of elements of care that, when implemented as a group, have an effect on outcomes beyond implementing the individual elements alone.

Find more bundle implementation​​ resources.​​​​​​​​​​​​​​​