Orion Building Blocks
Introduction
This document compiles the responses of Clinique Saint-Jean (Brussels, Belgium) to the Epic/Bugsy Groundwork Building Blocks questionnaire, as part of the INSPIRE Epic implementation project. It covers infection prevention surveillance workflows, reporting obligations, isolation management, and system configuration requirements.
About Clinique Saint-Jean: Clinique Saint-Jean is a general acute care hospital operating across 3 physical sites in Brussels:
Jardin Botanique (main site)
Méridien/Saint-Josse (1 rehabilitation unit)
Résidence Magnolia/Jette (2 rehabilitation units)
The PCI Team (Infection Prevention and Control) currently consists of one infection preventionist nurse(Sona), as the second IP (Bruno) is temporarily assigned as Epic Analyst for 18 months. The PCI Team works under the supervision of Dr. Marckiewicz, infection control physician.
Belgian regulatory context: Clinique Saint-Jean operates under Belgian federal and Brussels regional healthcare regulations. Key differences from the US context include:
Mandatory disease reporting is a regional competence — handled by Vivalis for Brussels
HAI surveillance follows NSIH/ECDC protocols (not NHSN)
Nurse Practitioner and Physician Assistant roles do not exist in their US form
INAMI/RIZIV billing system governs prescribing rights and provider identification
| Document | Description | Link |
|---|---|---|
| NSIH-ISO 2023 Protocol | Belgian SSI surveillance protocol (Sciensano | Protocole de surveillance des SSI 2023 |
| NSIH-ISO 2023 Excel forms | Data collection template for SSI reporting | Data collection Template |
| ECDC HAI-Net ICU Protocol v2.2 | European ICU HAI surveillance criteria (VAP, BSI, UTI) | HAI-NET ICU |
| CDC/NHSN CAUTI Protocol | CAUTI surveillance criteria (target with Epic | CAUTI et UTI surveillance explainaition |
| Vivalis — Maladies infectieuses | List of notifiable infectious diseases for Brussels | Déclaration des maladies infectieuses |
| Document transfert MDRO | Inter-institutional MDRO patient transfer form | Document de transfert de patient MDRO |
| PAQS indicators | Surgical antibiotic prophylaxis quality indicators | Site internet paqs |
| Global PPS | Global antimicrobial consumption survey | Global PPS Site |
| NSIHwin V4.11c3 | ICU HAI Surveillance | Data collection Template |
How to read this document:
This document is structured around the Epic/Bugsy Groundwork Building Block questions. For each question:
Description — reproduces the original question description as provided by the Epic implementation team
Comment — contains the response formulated by the PCI Team (Bruno/Sona) based on current institutional practice and Belgian regulatory context
Data collection choice — indicates the option selected in the Groundwork Building Block form
Action required from collaborators: Please review the Comment sections and indicate whether you:
✅ Validate the response as accurate
✏️ Suggest corrections or additions directly in the document or via comments
1. Bugsy Administrative Tasks
1.1 Discuss common groups of units or hospitals that are surveilled together and decide which unit and hospital groupers are needed.
Description
Using dashboard parameters, you can modify which units or hospitals you are surveilling. To make it easier for IPs who cross-cover, you can build groups of hospitals or groups of departments that are commonly surveilled together to save time.
You do not need groupers if the IPs are fine with manually adding departments or hospitals to their dashboard parameters. Those settings stick to the next time they log in or access the dashboard.
Comment :
Clinique Saint-Jean operates across 3 physical sites: Jardin Botanique (main site), Méridien/Saint-Josse (1 rehabilitation unit), and Résidence Magnolia/Jette (2 rehabilitation units). All sites belong to the same institution and are surveilled by the same EOHH team.
Hospital grouper needed: A single grouper combining all 3 sites is required to enable a unified surveillance view across the entire institution.
Department/unit groupers needed:
Surgical units grouped together (CLABSI comparison vs medical units)
Medical units grouped together (CLABSI comparison vs surgical units)
Geriatric units grouped together (CAUTI comparison vs non-geriatric units)
Rehabilitation units grouped together (Méridien + Magnolia)
The goal is to enable both global institutional surveillance and targeted comparisons between unit types for nosocomial infection incidence monitoring
1.2 What infection control system do you use today?
Description
See the Bugsy Data Collection Workbook: 10.2Please select the system that you use to compete surveillance and reporting today.
Knowing the infection control system you use today helps us identify workflows or build needs that have helped other organizations transitioning from the similar system.
If your system is not available by default below, please add it on as an option.
Comment
Clinique Saint-Jean does not currently use a dedicated infection control surveillance software. Surveillance data is managed through Excel. This is one of the primary motivations for implementing Epic/Bugsy as a centralized surveillance platform.
Data Collection choice
Homegrown System
1.3 Outline IP Roles & Responsibilities
Description
See the Bugsy Data Collection Workbook: 3.06
There are many different surveillance structures across organizations. To best tailor our discussions and demo to fit the workflows of the organization, we need to understand how surveillance and reporting responsibility is split up amongst the infection prevention group. Please describe your ownership in the notes or link out to a document with the ownership outlined, if it’s too long to express in the comments.
Some examples of useful information:
- Centralize Surveillance, where infection preventionists monitor all hospitals at once
- Local Surveillance where IPs are assigned specific hospitals to monitor
- Workflow specific surveillance, where certain IPs surveil specific workflows. (Eg. Susan monitors CAUTI & CLABSI while Tom monitors SSIs)
- Floor specific monitoring, where IPs monitor all workflows for specific areas of the hospital
- Any of break-down of responsibilities that you have defined for your organization
Comment
The PCI Team at Clinique Saint-Jean currently consists of one infection preventionist (Sona), as the second IP (Bruno) is temporarily assigned as Epic Analyst for 18 months.
Previous workflow split (when 2 IPs):
Bruno:
CLABSI surveillance
C.difficile surveillance
Medical units and ICU monitoring
Sona:
SSI surveillance
Surgical units and operating theater monitoring
Staff education and training (new employees, etc.)
Current gaps: Clinique Saint-Jean does not currently have the capacity to perform CAUTI or VAP surveillance. These are identified as areas for development with the Epic/Bugsy implementation.
Current situation: Sona is managing all surveillance responsibilities alone during the transition period. The full two-IP workflow is expected to resume after the Epic go-live.
1.4 Determine which dashboard parameters and groupers should be available
Description
Report distribution can be done at the following levels, and it’s important to know what will be enabled on the dashboard to know how to build all of the reports.
Service Area
Hospital
Department
Each level has options for Authorized, Login, and entry of specific records. Hospital and Department also allow groupers.
We recommend enabling all parameters unless there is a need for a service area restriction due to data restrictions within the organization.
Comment
Clinique Saint-Jean requests the following dashboard parameter configuration:
Primary navigation level — Hospital: The PCI Team will primarily navigate by hospital/site (Botanique, Méridien, Magnolia), with a global grouper combining all 3 sites for institution-wide surveillance.
Secondary navigation level — Department: Unit-level navigation is required as a secondary filter for targeted surveillance.
Optional groupers by service type:
Medicine (internal medicine, oncology)
Geriatrics
Surgery
Rehabilitation (Méridien + Magnolia)
Day hospital (medical and surgical)
Psychiatry — to be configured as a standalone grouper due to its specific infection profile: ectoparasites (scabies, lice, bed bugs), tuberculosis, and MRSA with adapted isolation practices. Not comparable to other service types.
Palliative care — to be configured as a standalone grouper due to its specific patient population and care model. Not comparable to any other service type.
No data access restrictions are required. All parameter levels (Service Area, Hospital, Department) should be enabled.
Data collection choice
Hospital
2. Healthcare Associated Infection Prevention
2.1 Do you surveil for central line attributed blood stream infections (CLABSI) ?
Comment
Yes. Clinique Saint-Jean performs CLABSI surveillance. This was previously managed by Bruno (currently assigned as Epic Analyst), and is now handled by Sona during the transition period. CLABSI surveillance is performed across all inpatient units, with a particular focus on the ICU where central line use is highest. CLABSI bundle compliance checklists are currently completed at unit level in the ICU. Results are reported internally and externally as part of the NSIH surveillance program.
Note: ICU-level BSI surveillance is currently performed using NSIHwin V4.11c3 (Sciensano) during the mandatory 3-month annual surveillance period, managed by the ICU physician. This is distinct from the hospital-wide CLABSI surveillance described above.
2.2 Which patient populations do you monitor for CLABSI ?
Comment
Clinique Saint-Jean monitors all inpatient populations for CLABSI. Surveillance is performed indirectly through bloodstream infection (BSI) surveillance — when a bacteremia is detected, the source is investigated to determine whether it is central line-attributed. This approach covers all units where patients may have a central line, rather than being limited to specific high-risk populations such as ICU only.
Important: Clinique Saint-Jean currently uses NSIH/ECDC criteria for CLABSI definition, not NHSN criteria. Differences between these two definitions may impact case identification and reporting in Bugsy. Please advise on how to align or adapt the Epic/Bugsy configuration to accommodate NSIH criteria, or flag this as a discussion point for the workgroup sessions.
2.3 Do you collect device denominator data for CLABSI ?
Comment
Clinique Saint-Jean does not currently track central line device-days. In line with standard Belgian practice for NSIH reporting, patient-days (hospitalization days) are used as the denominator rather than central line-days, as most Belgian hospitals are currently unable to systematically collect device-day data.
Epic opportunity: Implementation of Epic is expected to enable automated tracking of central line insertion and removal dates, allowing central line device-days to be calculated for the first time. This is a priority for Clinique Saint-Jean, as international literature and benchmarking (ECDC, NHSN) universally use device-days as the standard denominator for CLABSI rate calculation. Moving from patient-days to device-days will significantly improve the comparability of our CLABSI rates with international benchmarks and published literature.
Data collection choice
Yes
2.4 How do you collect device denominator data for CLABSI ?
Comment
As stated above, Clinique Saint-Jean does not collect central line device-day data. Patient-days (hospitalization days) are currently used as the denominator for CLABSI rate calculation, in line with standard Belgian NSIH reporting practice. No formal device-day collection process exists at this time. Automated central line device-day tracking via Epic is a priority for the institution.
2.5 Who is responsible for collecting device denominator data for CLABSI?
Comment
The responsibility for collecting central line device-day denominator data should fall to the same person performing CLABSI/bloodstream infection surveillance — currently the PCI Team. Once Epic enables automated central line tracking, the PCI Team will extract device-day data as part of their routine CLABSI surveillance workflow.
2.6 Do you report CLABSI internally or externally ?
Comment
Clinique Saint-Jean reports CLABSI both internally and externally:
External reporting: CLABSI surveillance data is submitted to Sciensano via the healthdata.be platform, as part of the national NSIH (National Surveillance of Healthcare-Associated Infections) program.
Internal reporting: CLABSI data is reported internally to hospital leadership and relevant clinical teams.
Data collection choice
Internally & Externally
2.7 What body do you report CLABSI to?
Comment
Clinique Saint-Jean reports CLABSI data to Sciensano via the healthdata.be platform, as part of the national NSIH surveillance program.
2.8 Do you surveil for urethral catheter attributed infections (CAUTI) ?
Comment
Clinique Saint-Jean does not currently perform direct CAUTI surveillance. The diagnosis of CAUTI requires the combination of fever, bacteriuria >100,000 CFU/mL, clinical symptoms, and urinary catheter use within the past 48 hours. Crossing these data points is not currently possible with the existing information systems.
As with CLABSI, CAUTI surveillance is performed indirectly through bloodstream infection (BSI) surveillance — urinary tract-origin bacteremias are identified and investigated for catheter association.
Epic opportunity: Implementation of Epic is expected to enable direct CAUTI surveillance by integrating clinical, microbiological, and device-use data, allowing automated identification of cases meeting the full CAUTI definition. Automated tracking of urinary catheter insertion and removal dates (device-days) would also enable rate calculation per 1000 catheter-days, which is currently not possible. This is identified as a significant added value of the Epic implementation for Clinique Saint-Jean.
Note: ICU-level UTI surveillance is currently performed using NSIHwin V4.11c3 (Sciensano) during the mandatory 3-month annual surveillance period, managed by the ICU physician. This is distinct from the indirect hospital-wide CAUTI monitoring described above.
Data collection choice
Yes
2.10 Which patient populations do you monitor for CAUTI ?
Comment
Clinique Saint-Jean monitors all inpatient populations for CAUTI. As with CLABSI, surveillance is performed indirectly through bloodstream infection (BSI) surveillance — urinary tract-origin bacteremias are identified and investigated for catheter association. With Epic, direct CAUTI surveillance following CDC/NHSN criteria is planned for all inpatient locations where denominator data can be collected.
2.11 Do you collect device denominator data for CAUTI ?
Comment
Clinique Saint-Jean does not currently track urinary catheter device-days. In line with standard Belgian practice for NSIH reporting, patient-days (hospitalization days) are used as the denominator rather than catheter-days, as most Belgian hospitals are currently unable to systematically collect device-day data.
Epic opportunity: Implementation of Epic is expected to enable automated tracking of urinary catheter insertion and removal dates, allowing catheter device-days to be calculated for the first time. This is a priority for Clinique Saint-Jean, as international literature and benchmarking (CDC/NHSN) universally use device-days as the standard denominator for CAUTI rate calculation.
Data collection choice
Yes
2.12 How do you collect device denominator data for CAUTI ?
Comment
As stated above, Clinique Saint-Jean does not collect urinary catheter device-day data. Patient-days (hospitalization days) are currently used as the denominator, in line with standard Belgian NSIH reporting practice. Automated urinary catheter device-day tracking via Epic is a priority for the institution.
2.13 Who is responsible for collecting device denominator data for CAUTI ?
Comment
Ideally, device denominator data collection for CAUTI should be the responsibility of the PCI Team, as part of their broader hospital epidemiology role. Once Epic enables automated urinary catheter tracking, the PCI Team will extract catheter device-day data as part of their routine CAUTI surveillance workflow, alongside CLABSI device-day collection.
2.14 Do you report CAUTI internally or externally ?
Comment
CAUTI data is currently reported both internally and externally, but indirectly:
External reporting: CAUTI-origin bacteremias are captured within the NSIH-SEP (bloodstream infection) surveillance submitted to Sciensano via healthdata.be. When a urinary tract source is identified for a bacteremia, the NSIH-SEP form includes a field indicating whether the patient had an indwelling urinary catheter in the preceding 48 hours. This allows partial identification of catheter-associated urinary tract infections within the BSI dataset.
Internal reporting: BSI data including urinary tract-origin infections is reported internally to hospital leadership and relevant clinical teams.
With Epic: Full standalone CAUTI surveillance and reporting following CDC/NHSN criteria is planned, enabling direct CAUTI reporting separately from BSI surveillance.
Data collection choice
Internaly & Externaly
2.15 What body do you report CAUTI to?
Comment
CAUTI-related data is reported to Sciensano via the healthdata.be platform, as part of the NSIH-SEP (bloodstream infection surveillance) program. Dedicated standalone CAUTI reporting is not currently performed.
2.16 What are the required data elements for CAUTI reporting?
Comment
Based on the CDC/NHSN CAUTI protocol and the AHRQ CAUTI Data Collection Tool, the required data elements for CAUTI reporting at Clinique Saint-Jean will be:
Monthly rates to calculate:
CAUTI rate per 1,000 catheter days = (total CAUTIs / total catheter days) x 1,000
Catheter Utilization Ratio = (catheter days / patient days) x 100
Daily data collection (collected at the same time each day):
Number of new CAUTI events
Number of patients with an indwelling urinary catheter (catheter days)
Total number of inpatients (patient days)
Per CAUTI event:
Date of event
IUC present >2 consecutive days (yes/no)
Signs and symptoms met (fever >38°C, suprapubic tenderness, costovertebral angle pain)
Urine culture results (organism, CFU/mL)
Secondary BSI (yes/no)
Antimicrobial susceptibility results
Currently: no direct CAUTI data collection exists. With Epic, automated daily denominator tracking (catheter days and patient days) is a key implementation priority.
3. Infection Prevention Rounding
3.1 Do the Infection Preventionists have and use iPads at your organization?
Description
See the Bugsy Data Collection Workbook: 6.02
If your Infection Preventionists use iPads at their organization, you will need to complete the attached build task to give these users access to Canto so they can perform some of their day to day job responsibilities through their iPad.
Comment
The PCI Team at Clinique Saint-Jean does not currently use iPads or tablets for infection prevention surveillance activities. However, given that the PCI Team is constantly moving across all units and sites of the institution, mobile access via Canto would be highly beneficial for day-to-day surveillance work. Tablets/iPads for the PCI Team are requested as part of the Epic go-live, to enable mobile access to Bugsy and patient records during rounds without returning to the office. Canto access configuration will be required once devices are procured.
4. Internal Surveillance & Reporting
4.1 Which organisms & MDROs would you like to include in the High Priority section of the dashboard?
Description
See the Bugsy Data Collection Workbook: 6.04
Please choose the MDROs & organisms you would like to include in your High Priority Organisms section of the dashboard. This list is for daily surveillance.
If your organization has specific definitions for MDRO or policies, please link those in the notes.
Comment
The listed organisms cover bacterial MDROs only. Clinique Saint-Jean also requires surveillance capability for epidemic viral agents causing significant nosocomial outbreaks: Norovirus, Influenza A/B, RSV, and SARS-CoV-2. Please advise whether these can be incorporated into the High Priority dashboard or an alternative surveillance module within Epic.
Data collection choice
Acinetobacter, C diff, Candida auris, CephR-Klebsiella, CP-CRE, CRE, CRO, ESBL-All, KPC, MRSA, MSSA, VRE, XDR & PDR Organisms, Other (list in comments)
Note : The listed organisms cover bacterial MDROs only. Clinique Saint-Jean also requires surveillance capability for epidemic viral agents causing significant nosocomial outbreaks: Norovirus, Influenza A/B, RSV, and SARS-CoV-2. Please advise whether these can be incorporated into the High Priority dashboard or an alternative surveillance module within Epic.
5. State/Local Reportable Cases
5.1 Link the department of health website with state reportables and their definitions in the comments.
Description
See the Bugsy Data Collection Workbook: 7.05
We will use this website to determine our state reportables scope for the project. If you have multiple states, please link a reference for every state
Comment
In Belgium, disease reporting obligations are regulated at two levels:
Federal level — Sciensano (Institut Scientifique de Santé Publique): Responsible for national surveillance of communicable diseases and HAI. Website: https://www.sciensano.be
Regional level — Région de Bruxelles-Capitale: Mandatory disease reporting managed by: Observatoire de la Santé et du Social de Bruxelles-Capitale Website: https://www.observatbru.be
Key surveillance programs relevant to infection control:
NSIH (National Surveillance of Healthcare-Associated Infections): BSI, SSI, VAP, CAUTI — https://www.sciensano.be/fr/projects/surveillance-des-infections-associees-aux-soins-nsih
HD4DP2: digital reporting platform for mandatory disease notifications
MDRO surveillance: CPE, MRSA, C. difficile
Additional reporting obligations specific to Clinique Saint-Jean:
PAQS (Plateforme pour l’Amélioration continue de la Qualité des soins et de la Sécurité des patients): Mandatory reporting of nosocomial MRSA acquisition rates and surgical antibiotic prophylaxis compliance indicators — https://www.paqs.be
Global PPS (Global Point Prevalence Survey of Antimicrobial Consumption and Resistance): Clinique Saint-Jean participates regularly in this international antimicrobial consumption and resistance point prevalence survey — https://www.global-pps.com
5.2 Who does your state reportables workup and who does your state reportable submissions?
Description
See the Bugsy Data Collection Workbook: 7.01
Do all infection preventionists work up state reportables or are they worked up by specific people? Are there any state reportables that are submitted by the ED instead of the infection preventionists (like animal bites)?
This will help us update our training materials and target workflow discussions to the correct people.
Comment
In Belgium, mandatory disease reporting is a regional competence. For Clinique Saint-Jean (Brussels), declarations are submitted to Vivalis: https://www.vivalis.brussels
List of notifiable infectious diseases and reporting procedures: https://www.vivalis.brussels/sites/default/files/uploads/documents/Docs%20divers/Notification-Maladies%20infectieuses.pdf
Workflow at Clinique Saint-Jean:
The clinical laboratory identifies the notifiable pathogen and notifies the attending physician by email.
The attending physician submits the declaration to Vivalis.
The EOHH is not directly involved in the mandatory reporting workflow.
No specific ED-based reporting pathway exists — all declarations go through the attending physician.
5.3 How do you report your reportable cases to the department of health?
Description
See the Bugsy Data Collection Workbook: 7.02
Comment
Reportable cases are submitted by the attending physician through two possible methods, triggered by an email notification from the clinical laboratory:
Primary method: eForm “Déclaration des maladies infectieuses à Vivalis (GGC)” completed directly from within the Electronic Medical Record (DMI), via an integrated eForm.
Fallback method: PDF form sent to Vivalis either via:
e-Healthbox (UMM) — Vivalis is listed under INAMI number 1990007260 in the “Entité spéciale reconnue par la plateforme eHealth” category
Encrypted email: notif-hyg@vivalis.brussels
The EOHH is not directly involved in the submission. There is no automated lab interface or file export. The lab initiates the process by notifying the attending physician by email.
Data collection choice
Manually entering the reportable cases online
5.4 Who is the best person to determine the lab results that qualify for each reportable condition? This is frequently a microbiologist. Please add the answer in the comments.
Description
See the Bugsy Data Collection Workbook: 7.04
Some public health agencies require labs to send all reportable results, even if they were not the resulting lab.
Comment
In Belgium, many notifiable diseases are confirmed by designated national reference laboratories. The reporting workflow at Clinique Saint-Jean is as follows:
Specimens are collected by the appropriate clinician and processed by the CSJ laboratory, which sends them to the appropriate national reference laboratory for confirmation.
The reference laboratory obtains the confirmed positive result and may initiate a partial declaration via the e-Healthbox platform, which is designed to allow each stakeholder to complete their respective sections.
The CSJ clinical microbiologist notifies the attending physician by email, asking them to complete the declaration form with the clinical data that the reference laboratory cannot provide.
The attending physician finalizes the declaration to Vivalis as a safety net in case the reference laboratory has not completed it.
The PCI Team is not directly involved in this reporting workflow.
Comment
At Clinique Saint-Jean, the clinical microbiologist (médecin biologiste) of the laboratory is responsible for identifying lab results that qualify as reportable conditions. Upon identification, the microbiologist notifies the attending physician by email with instructions to submit the declaration to Vivalis. The PCI Team is not directly involved in this determination pro
Lab: Does the public health agency require you to report results performed by other organizations or reference labs?
Lab: Does the public health agency require you to report results performed by other organizations or reference labs?
Description
See the Bugsy Data Collection Workbook: 7.04
Some public health agencies require labs to send all reportable results, even if they were not the resulting lab.
Comment
In Belgium, many notifiable diseases are confirmed by designated national reference laboratories. The reporting workflow at Clinique Saint-Jean is as follows:
Specimens are collected by the appropriate clinician and processed by the CSJ laboratory, which sends them to the appropriate national reference laboratory for confirmation.
The reference laboratory obtains the confirmed positive result and may initiate a partial declaration via the e-Healthbox platform, which is designed to allow each stakeholder to complete their respective sections.
The CSJ clinical microbiologist notifies the attending physician by email, asking them to complete the declaration form with the clinical data that the reference laboratory cannot provide.
The attending physician finalizes the declaration to Vivalis as a safety net in case the reference laboratory has not completed it.
The PCI Team is not directly involved in this reporting workflow.
Data collection
6. Surgical Site Infection (SSI) Surveillance
6.1 Which procedures do you surveil for Surgical Site Infections (SSIs) and report externally on?
Description
Procedure denominator and SSI reporting allows for defining different behavior and required data elements for different procedure denominator types. To support this, work with your surgical site surveillance team to determine how you will categorize procedures that you will include in reporting. For example, you might choose to report hip replacement procedures, cardiac procedures, and cesarean section procedures. This might be defined by a regulatory body or local policy.
Please add any additional specific grouping you would like to surveil if they are not in the list.
The list below is the list of procedures referenced/started with for the NHSN. The codes likely will not correlate exactly to your locale but the grouping/categorization of procedures is globally accurate and helpful when collecting which procedures they surveil for SSIs.
Comment
SSI surveillance at Clinique Saint-Jean follows the PAQS (Plateforme pour l’Amélioration continue de la Qualité des soins et de la Sécurité des patients) mandatory quality indicator set, which covers the following procedures:
Coronary artery bypass graft (CABG — on-pump and off-pump)
Total hip prosthesis (PTH)
Colorectal surgery (cancer)
Transurethral resection of the prostate (TURP)
In addition, Clinique Saint-Jean also surveils total knee prosthesis (PTG/TKA) beyond PAQS requirements. Both PTH and PTG carry similar infection risk (~1-2%) and comparable clinical severity (prosthetic joint infection requiring surgical revision and prolonged antibiotherapy). Surveillance of both procedures is therefore considered equally justified from a clinical and quality improvement perspective.
These procedures are reported externally to PAQS. PTG surveillance is managed internally.
Data collection Choice
6.2 What format can they accept for an SSI report ?
comment
Clinique Saint-Jean currently submits SSI reports to PAQS via Excel file sent by email. There is no dedicated web application or automated reporting portal available at this time for SSI data submission.
Data collection choice
6.3 What are the required data elements for your procedure denominators and for your SSI cases
Description
If your organization reports SSIs externally, they will typically have to report denominators as well. Collect the required information both for procedure denominators and for confirmed SSI cases that needs to be collected and sent to your locales regulatory reporting body.
This information can typically be found on your regulatory reporting bodies website and on their protocols.
Be sure to understand if the required data elements is the same for all procedure denominator types or if it needs to be different. This impact questionnaire build.
Comment
Clinique Saint-Jean follows the NSIH-ISO 2023 protocol (Sciensano) for SSI surveillance and reporting, which is aligned with the ECDC HAI-Net SSI protocol.
Required data elements for procedure denominators:
Mandatory:
Date of intervention
Surgical procedure category (CABG-BE, HPRO-BE, KPRO-BE, COLO-BE, TURP)
Number of procedures performed
Optional but collected:
ASA score
Wound class
Duration of intervention
Elective vs. emergency procedure
Endoscopy (yes/no)
Presence of implant
Post-operative hospitalization days
Discharge date
Required data elements for confirmed SSI cases:
Mandatory:
Patient identifier (pseudonymized national registry number)
Date of intervention
Surgical procedure category
Date of SSI onset
Type of SSI (superficial incisional / deep incisional / organ-space)
Optional but relevant:
Microorganism identified (SNOMED CT code)
Antimicrobial susceptibility testing results (LOINC code, EUCAST criteria)
Secondary bacteremia
Re-intervention due to SSI
Readmission due to SSI
Post-discharge surveillance data
Additional module — Perioperative Antibiotic Prophylaxis (PAP) evaluation: Clinique Saint-Jean also participates in the PAP evaluation module, collecting data on antibiotic indication, product choice, dose, timing and duration per intervention.
Data submission: Via HD4DP platform to Sciensano (healthdata.be). Deadline: September of year X+1 for data from year X.
Full protocol available at: https://www.sciensano.be/fr/projets/surveillance-nationale-des-infections-du-site-operatoire
7. Who is responsible/involved in reporting VAEs?
Comment
Hospital level: Hospital-wide VAE/pneumonia surveillance is not currently performed at Clinique Saint-Jean. The diagnostic criteria for pneumonia rely heavily on radiological findings, which cannot be systematically tracked through microbiological data alone (endotracheal aspirates). As a result, post-operative pneumonias linked to intraoperative ventilation are likely underdetected at this time.
Epic/Bugsy opportunity: Implementation of Epic is expected to improve pneumonia detection capability by integrating radiological, microbiological, and clinical data, enabling hospital-wide VAE surveillance for the first time. This is identified as a significant added value of the Epic implementation for Clinique Saint-Jean.
8. Antimicrobial Stewardship
Determine if you will use Epic’s Antibiogram or continue to use an Antibiogram provided by your lab system
Description
If you will be using the antibiogram from Epic, you must have Bugsy or Beaker.
Comment
Clinique Saint-Jean will use Epic’s Antibiogram for institutional antimicrobial resistance monitoring.
Decision
9. Cutover - IP Infection Control
9.1 Determine the process for entering patient infection status during backload.
Description
his decision has been addressed at the Cross-Clinical Advisory Board (CCAB) level. The following approach has been agreed upon:
Patient colonization/infection flags will be imported as-is from CliniWeb into Epic, accepting potential false-positive alerts in preference over false negatives, to ensure patient safety.
Primary microbiology data will be migrated via the Jade laboratory management system interface.
A physician-facing validation alert is being explored — when a clinician opens a patient file, Epic would prompt them to manually validate or reject the legacy colonization data before it is saved to the record. This feature needs technical confirmation.
False-positive flags will be progressively removed after go-live by the PCI Team as part of routine infection status curation.
Key stakeholders involved: Infection Prevention Workgroup, Romuald Dumont, Marcel Van der Sluis, Ariana Zito-Wolf.
The final strategy will be confirmed by the Infection Prevention Workgroup.
Comment
This decision has been addressed at the Cross-Clinical Advisory Board (CCAB) level. The following approach has been agreed upon:
Patient colonization/infection flags will be imported as-is from CliniWeb into Epic, accepting potential false-positive alerts in preference over false negatives, to ensure patient safety.
Primary microbiology data will be migrated via the Jade laboratory management system interface.
A physician-facing validation alert is being explored — when a clinician opens a patient file, Epic would prompt them to manually validate or reject the legacy colonization data before it is saved to the record. This feature needs technical confirmation.
False-positive flags will be progressively removed after go-live by the PCI Team as part of routine infection status curation.
Key stakeholders involved: Infection Prevention Workgroup, Romuald Dumont, Marcel Van der Sluis, Ariana Zito-Wolf.
The final strategy will be confirmed by the Infection Prevention Workgroup.
Decicion
10. Infection Prevention Rounding
10.1 What documentation do you complete when you round on patients ?
Description
See the Bugsy Data Collection Workbook: 6.01
We would like to understand what documentation you do for rounding - notes, flowsheets, patient education or other documentation.
We will build out this content for you to review later on in our workgroups.
Education: If you complete patient education during your rounds, we will include this in Epic.
Flowsheets: For documenting assessments, screenings, etc. for the patient
Note templates: Documentation for IP to complete during or after rounding
Do you write any notes that should be stored as part of the patient’s Legal Medical Record? For example, you may write a note after rounds to document the discussion. Or you may write a note about why the patient is on certain isolation precautions. This is not asking about notes you can write within a specific infection case, which is not part of the legal medical record.
Other documentation: Could include other forms, questionnaires, or anything else the IPs document during rounding
Comment
The PCI Team at Clinique Saint-Jean does not routinely document directly in patient records. Infection prevention documentation is managed in a decentralized model, as close as possible to the point of care:
Isolation management: Isolation precautions are primarily entered by the bedside nursing staff. The PCI Team does not systematically track individual patient admissions and discharges across the institution.
Bundle checklists: Bundle compliance checklists are currently completed by nursing staff at unit level:
CLABSI bundle checklists exist in the ICU patient record
CAUTI catheter insertion and maintenance checklists exist in H++ (current nursing information system)
Isolation audits: Isolation compliance audits are performed exclusively by the PCI Team. These audits are conducted directly at the point of care, including at the bedside in the patient’s room. Audit findings are currently not documented in the patient’s legal medical record.
Epic configuration request: Clinique Saint-Jean requests that Epic enables both nursing staff and the PCI Team to complete bundle compliance checklists (CLABSI, CAUTI, and others) directly at the point of care. The PCI Team also requires a dedicated workflow in Epic/Bugsy to document isolation audit findings during rounds.
Data collection choice
11. Isolation and infection Management
11.1Update Isolation and Infection Statuses in the Bugsy Data Collection Workbook
Description
See the Bugsy Data Collection Workbook: 4.01
The Bugsy Data Collection Document lists the infections and required isolations that exist in the Foundation System. Please update this list to match the infections and required isolations for your organizations.
If you want to remove an infection, mark as “Delete”
If you update an infection or required isolation, mark as “Change - See Comments”
If you add a new infection, mark as “Add”
If you want to keep an infection as is, mark as “Keep”
Comment
Clinique Saint-Jean currently maintains MDRO colonization flags indefinitely in CliniWeb, including for patients with documented negative follow-up cultures, in order to preserve historical carrier information. This has resulted in alert fatigue, with flags losing clinical relevance over time.
With Epic/Bugsy, Clinique Saint-Jean requests a more structured approach:
Active infections generate isolation alerts with defined expiration periods
Resolved/historical infections are retained in the patient’s record as historical data without generating active isolation alerts
Suggested default expiration periods:
MRSA: 730 days (2 years) — based on published median carriage duration of ~88 weeks without active decolonization
CPE: 365 days
VRE: 180 days — based on published median carriage of ~26 weeks
ESBL: 90 days
Candida auris: 365 days
VRSA: 365 days
All expirations with automatic extension if patient remains admitted. This approach aims to reduce alert fatigue while preserving historical carrier traceability.
12. VAE, PedVAE, PNEU
12.1 Do you surveil for ventilator associated events (VAE) ?
Comment
Clinique Saint-Jean currently performs VAE surveillance only at the ICU level, managed by an ICU physician for a mandatory 3-month annual period, as required by Belgian regulations.
As with CLABSI and CAUTI, ventilator-associated infections are monitored indirectly through bloodstream infection (BSI) surveillance — bacteremias with a presumed pulmonary source in mechanically ventilated patients are tracked within the NSIH-SEP program submitted to Sciensano via healthdata.be.
VAE surveillance in the strict CDC/NHSN sense (mechanical ventilation ≥2 consecutive days) is limited to the ICU at Clinique Saint-Jean, as prolonged mechanical ventilation outside the ICU is uncommon. Early post-operative pneumonia linked to short intraoperative ventilation is a recognized gap but falls outside the scope of standard NHSN VAE criteria. Epic implementation may help improve detection of this specific complication through integration of clinical, microbiological, and radiological data.
Note: ICU-level VAP surveillance is currently performed using NSIHwin V4.11c3 (Sciensano) during the mandatory 3-month annual surveillance period, managed by the ICU physician. This structured ICU surveillance is distinct from the hospital-wide VAP surveillance planned with Epic/Bugsy following ECDC/HAI-Net criteria.
Data collection choice
12.2 What criteria do you use to qualify a Ventilator Associated Event ?
Comment
Clinique Saint-Jean will apply the ECDC/HAI-Net criteria for VAE/VAP surveillance, as these criteria are more specific and aligned with Belgian NSIH reporting obligations to Sciensano.
The ECDC criteria require a combination of:
Radiological criteria (new or progressive infiltrate, consolidation, cavitation on chest X-ray or CT scan)
Clinical criteria (at least 2 of: fever >38°C or hypothermia <36°C, leukocytosis >12,000 or leukopenia <4,000, purulent secretions)
Microbiological criteria (positive quantitative/semi-quantitative respiratory culture with identified organism)
Epic implementation strategy: Clinique Saint-Jean is interested in exploring Epic’s NLP (Natural Language Processing) capabilities for radiology report data mining to automate detection of radiological criteria (new infiltrates, consolidations) from radiology reports. Combined with automated capture of clinical and microbiological data already available in Epic, this would enable semi-automated VAP surveillance following ECDC criteria, without manual radiological interpretation for each case.
This approach would allow:
Compliance with Belgian NSIH/Sciensano reporting standards
Reduced manual workload for the PCI Team
Potential benchmarking with European ECDC/HAI-Net data
Please advise on the availability and configuration requirements of Epic NLP tools for radiology report mining in the current implementation scope.
12.3 What are the required data elements for VAE reporting?
Comment
With Epic, Clinique Saint-Jean intends to implement VAP surveillance following ECDC/HAI-Net criteria, aligned with Belgian NSIH reporting obligations to Sciensano. Required data elements are:
Denominator data (collected daily):
Ventilator days per location
Patient days per location
Numerator data per VAP event:
Radiological criteria (mandatory):
- New or progressive infiltrate, consolidation or cavitation on chest X-ray or CT scan
Clinical criteria (at least 2 required):
Fever >38°C or hypothermia <36°C
Leukocytosis >12,000 or leukopenia <4,000 cells/mm³
Purulent respiratory secretions
Microbiological criteria:
Positive quantitative/semi-quantitative respiratory culture (BAL, endotracheal aspirate, protected brush)
Organism identified + antimicrobial susceptibility results
Epic implementation: NLP data mining on radiology reports is being explored to automate radiological criteria detection, enabling semi-automated VAP surveillance without manual radiological review for each case.
13. Procedure Abstraction
What format can they accept for procedure denominator reports?
Comment
Clinique Saint-Jean currently submits SSI procedure denominator data to Sciensano via Excel file sent by email. There is no automated export or dedicated web portal for this submission at this time.
Data collection choice
