Adapting the Sepsis 1-Hour Bundle for Resource-Limited Settings: Lessons from Turkana, Kenya

The Surviving Sepsis Campaign (SSC) 1-hour bundle has transformed sepsis care in high-income countries. This bundle comprises rapid lactate measurements, blood cultures, broad-spectrum antibiotics, intravenous fluids, and vasopressors. However, in fragile systems such as Turkana County, Kenya, this protocol is largely impractical. This review synthesises current global and regional literature to contextualise the bundle’s limitations and propose evidence-based adaptations. Long travel distances, shortage of essential diagnostics and medicine, limited human resources, and inadequate critical care capacity remain significant systemic barriers. This review advocates for reframing the bundle from a fixed 1-hour metric to an “as soon as possible” (ASAP) framework, emphasising early recognition, timely empirical antibiotics, and pragmatic hemodynamic stabilisation using available resources. Key recommendations include replacing lactate measurements with clinical surrogates (such as capillary refill time), creating locally informed empirical antibiotic protocols, strengthening supply chains, investing in task-sharing and simulation-based training, and embedding community awareness initiatives. These adaptations can achieve meaningful mortality reduction and mitigate antimicrobial resistance.