Be-SNAP: the Belgian Sepsis National Action Plan

Annelies Mondelaers^1,2Febe Van de Voorde³Harlinde Peperstraete⁴Ken Dewitte⁵Jan De Waele⁴Ilse Malfait⁶Patrick Van de Voorde^7*Erika Vlieghe^1,2

• ¹Department of Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, Antwerp, Belgium
• ²Global Health Institute, University of Antwerp, Antwerp, Antwerp, Belgium
• ³Department of Emergency Medicine, AZ Maria, Halle, Belgium
• ⁴Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
• ⁵Emergency department, AZ Voorkempen, Malle, Belgium
• ⁶Patient organisation Sepsibel vzw, Oostkamp, Belgium
• ⁷Department of Emergency Medicine, Ghent University Hospital, Ghent, East Flanders, Belgium

Sepsis represents a significant healthcare challenge in Belgium with an estimated 40,952 cases annually (95% CI 31,451). This life-threatening condition leads to approximately 7,675 premature deaths per year (95% CI 6,421-9,089) and a loss of 38,106 quality-adjusted life years. The economic impact is substantial with annual costs ranging from €277 million to €4.3 billion. Despite this impact, Belgium lacks a national sepsis plan until present date. Following requests from diverse professional and patient organizations yielding public and political attention, the federal minister of Health requested a scientific advice to be written (November 2023-May 2024), as a basis for a national sepsis plan. This article describes Belgium's approach to developing a National Sepsis Action Plan, highlighting evidence-based and contextualized key recommendations aimed at reducing the sepsis burden by building on existing initiatives. A multidisciplinary working group was established, including representatives of healthcare workers and professional societies representing relevant disciplines in first, second and tertiary health care settings, home care and long-term care facilities. In addition, input was sought from public health actors and experts (e.g. surveillance, vaccination programs) and patient organizations. A Haddon matrix was made and seven key topics were specified:(1) awareness, (2) prevention, (3) early warning, (4) patient management, (5) post-sepsis rehabilitation, (6) advanced care planning and ( 7) surveillance and research. For each item, core group members were defined. Each group conducted literature reviews and developed recommendations tailored to the Belgian healthcare system, with consensus achieved during plenary sessions. The final document was externally reviewed by national and international experts. This is the first document addressing comprehensively sepsis prevention and care in Belgium, in its diverse presentations across the community and healthcare system. The next critical steps will involve the establishment of an implementation team and design of a detailed implementation plan.