Ten Steps to Improve Sepsis Care in Low-Resource Settings

Teresa B. Kortz; Jorge L. Hidalgo; Samuel O. Akech; Sheila N. Myatra; Ryan C. Maves; Javier Perez-Fernandez; Subhash P. Acharya; Craig M. Coopersmith; Shevin T. Jacob; Cintia Johnston; Niranjan Kissoon; Flávia R. Machado; Elizabeth Molyneux; Brenda M. Morrow; Martha Susana Pérez Cornejo; Chairat Permpikul; Kunchit Piyavechviratana; Andrew Rhodes; Mpoki M. Ulisubisya; Vishakha K. Kumar; Hariyali Patel; Daniel Woznica; Vinay M. Nadkarni

doi:10.1097/CCM.0000000000007090

Ten Steps to Improve Sepsis Care in Low-Resource Settings

Teresa B. Kortz
, Jorge L. Hidalgo
, Samuel O. Akech
, Sheila N. Myatra
, Ryan C. Maves
, Javier Perez-Fernandez
, Subhash P. Acharya
, Craig M. Coopersmith
, Shevin T. Jacob
, Cintia Johnston
, Niranjan Kissoon
, Flávia R. Machado
, Elizabeth Molyneux
, Brenda M. Morrow
, Martha Susana Pérez Cornejo
, Chairat Permpikul
, Kunchit Piyavechviratana
, Andrew Rhodes
, Mpoki M. Ulisubisya
, Vishakha K. Kumar

Hariyali Patel, Daniel Woznica, Vinay M. Nadkarni

Clinical Sciences

University of California at San Francisco
Belize Healthcare Partners
Kenya Medical Research Institute
Tata Memorial Hospital
Wake Forest University
Baptist Hospital Miami
Tribhuvan University
Emory University
Walimu
Universidade de São Paulo
Provincial Health Services Authority
Universidade Federal de São Paulo
Kamuzu University of Health Sciences
University of Cape Town
State General Hospital
Mahidol University
Phramongkutklao College of Medicine
St George's University Hospitals NHS Foundation Trust
Muhimbili Orthopaedic Institute
Society of Critical Care Medicine
University of Pennsylvania

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: – To develop a practical consensus-based framework for ten 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 “ten-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 employed 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 ten 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 ten 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.

Original language	English
Journal	Critical Care Medicine
DOIs	https://doi.org/10.1097/CCM.0000000000007090
Publication status	Published - 1 Apr 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

emergency care frameworks
international collaboration
low-income countries
low-resource settings
public health policy
sepsis management

Access to Document

10.1097/CCM.0000000000007090

25-01668Licence: CC BY

Cite this

Kortz, T. B., Hidalgo, J. L., Akech, S. O., Myatra, S. N., Maves, R. C., Perez-Fernandez, J., Acharya, S. P., Coopersmith, C. M., Jacob, S. T., Johnston, C., Kissoon, N., Machado, F. R., Molyneux, E., Morrow, B. M., Pérez Cornejo, M. S., Permpikul, C., Piyavechviratana, K., Rhodes, A., Ulisubisya, M. M., ... Nadkarni, V. M. (2026). Ten Steps to Improve Sepsis Care in Low-Resource Settings. Critical Care Medicine. https://doi.org/10.1097/CCM.0000000000007090

@article{29ecb9288dab437b87b7bceac33cde73,

title = "Ten Steps to Improve Sepsis Care in Low-Resource Settings",

abstract = "Objectives: – To develop a practical consensus-based framework for ten 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 “ten-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 employed 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 ten 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 ten 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.",

keywords = "emergency care frameworks, international collaboration, low-income countries, low-resource settings, public health policy, sepsis management",

author = "Kortz, \{Teresa B.\} and Hidalgo, \{Jorge L.\} and Akech, \{Samuel O.\} and Myatra, \{Sheila N.\} and Maves, \{Ryan C.\} and Javier Perez-Fernandez and Acharya, \{Subhash P.\} and Coopersmith, \{Craig M.\} and Jacob, \{Shevin T.\} and Cintia Johnston and Niranjan Kissoon and Machado, \{Fl{\'a}via R.\} and Elizabeth Molyneux and Morrow, \{Brenda M.\} and \{P{\'e}rez Cornejo\}, \{Martha Susana\} and Chairat Permpikul and Kunchit Piyavechviratana and Andrew Rhodes and Ulisubisya, \{Mpoki M.\} and Kumar, \{Vishakha K.\} and Hariyali Patel and Daniel Woznica and Nadkarni, \{Vinay M.\}",

year = "2026",

month = apr,

day = "1",

doi = "10.1097/CCM.0000000000007090",

language = "English",

journal = "Critical Care Medicine",

issn = "0090-3493",

publisher = "Lippincott Williams and Wilkins",

}

Kortz, TB, Hidalgo, JL, Akech, SO, Myatra, SN, Maves, RC, Perez-Fernandez, J, Acharya, SP, Coopersmith, CM, Jacob, ST, Johnston, C, Kissoon, N, Machado, FR, Molyneux, E, Morrow, BM, Pérez Cornejo, MS, Permpikul, C, Piyavechviratana, K, Rhodes, A, Ulisubisya, MM, Kumar, VK, Patel, H, Woznica, D & Nadkarni, VM 2026, 'Ten Steps to Improve Sepsis Care in Low-Resource Settings', Critical Care Medicine. https://doi.org/10.1097/CCM.0000000000007090

TY - JOUR

T1 - Ten Steps to Improve Sepsis Care in Low-Resource Settings

AU - Kortz, Teresa B.

AU - Hidalgo, Jorge L.

AU - Akech, Samuel O.

AU - Myatra, Sheila N.

AU - Maves, Ryan C.

AU - Perez-Fernandez, Javier

AU - Acharya, Subhash P.

AU - Coopersmith, Craig M.

AU - Jacob, Shevin T.

AU - Johnston, Cintia

AU - Kissoon, Niranjan

AU - Machado, Flávia R.

AU - Molyneux, Elizabeth

AU - Morrow, Brenda M.

AU - Pérez Cornejo, Martha Susana

AU - Permpikul, Chairat

AU - Piyavechviratana, Kunchit

AU - Rhodes, Andrew

AU - Ulisubisya, Mpoki M.

AU - Kumar, Vishakha K.

AU - Patel, Hariyali

AU - Woznica, Daniel

AU - Nadkarni, Vinay M.

PY - 2026/4/1

Y1 - 2026/4/1

N2 - Objectives: – To develop a practical consensus-based framework for ten 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 “ten-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 employed 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 ten 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 ten 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.

AB - Objectives: – To develop a practical consensus-based framework for ten 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 “ten-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 employed 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 ten 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 ten 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.

KW - emergency care frameworks

KW - international collaboration

KW - low-income countries

KW - low-resource settings

KW - public health policy

KW - sepsis management

U2 - 10.1097/CCM.0000000000007090

DO - 10.1097/CCM.0000000000007090

M3 - Article

C2 - 41860319

AN - SCOPUS:105035119383

SN - 0090-3493

JO - Critical Care Medicine

JF - Critical Care Medicine

ER -

Ten Steps to Improve Sepsis Care in Low-Resource Settings

Abstract

UN SDGs

Keywords

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