Surviving Sepsis Campaign Releases Hour-1 Bundle

A new Surviving Sepsis Campaign (SSC) Hour 1 Bundle was released after being updated to reflect the latest evidence from the International Guidelines for Management of Sepsis and Septic Shock 2016.

The most important change in the revision of the SSC bundles is that the 3-hour and 6-hour bundles have been combined into a single “Hour-1 Bundle” with the explicit intention of beginning resuscitation and management immediately.

This new sepsis “Hour-1 Bundle” should be introduced to staff in the emergency department (ED), wards, and intensive care unit as the next iteration of ever-improving tools in the care of patients with sepsis and septic shock as we all work to lessen the global burden of sepsis.

Reflecting the latest evidence, the Hour-1 Bundle highlights five steps that healthcare professionals should begin as soon as sepsis is recognized:

  • Measure the blood lactate level. A high lactate level indicates that the tissues are not getting enough oxygen from the blood.
  • Perform blood cultures to identify the cause of the infection. Blood samples should be taken before antibiotics are administered, if possible.
  • Administer broad-spectrum antibiotics that are active against the causative organism.
  • Start intravenous fluids. Fluid resuscitation is an essential step to stabilize the patient’s condition.
  • Administer vasopressors to raise blood pressure. This is a critical resuscitation step in patients with septic shock.

“There is no reason to delay treatment for patients with sepsis and septic shock,” comments lead author Mitchell Levy, MD, MCCM. “Recognizing the urgent need to treatment, clinicians must (and many already do) begin treatment immediately, rather than waiting for 3 or 6 hours in these critically ill patients.” The authors point out that the new revision is based on the 2016 SSC guidelines update, which provides further discussion and evidence related to each step and to comprehensive management of sepsis. They also note some important gaps in current knowledge, including the need for further studies in important subgroups such as patients with burns and compromised immune function.

Read the Statement from Surviving Sepsis Campaign Leadership on Time Zero in the Emergency Department.

Find the new SSC Hour-1 Bundle and related resources at