Tool that predicts infection risk is a HSJ winner
A tool to identify patients most at risk of infection after receiving a cardiac device has won a major industry award.
The rate of infection for patients with implantable electronic devices that regulate heart rate and rhythm - such as pacemakers and defibrillators - is on the rise globally. As technology becomes more complex, and people live longer with chronic health conditions, the risk of device infection following implantation or replacement increases significantly.
Clinicians from the Barts Heart Centre at St Bartholomew’s Hospital developed the BLISTER score to determine which patients stand to benefit most from an antimicrobial envelope, a surgical mesh lined with antibiotics that is proven to reduce the risk of infection in the 12 months following a procedure.
Working alongside colleagues from the Royal Papworth and Guy's and St Thomas' hospitals, the team studied data from over 12,000 patients to determine the factors that increase the risk of infection. The acronym ‘BLISTER’ represents different clinical factors that contribute to the overall score.
Since adopting the BLISTER system, infection rates have reduced to below 1 per cent, and the tool has delivered annual savings of more than £100,000.
Their work has been recognised with a Health Service Journal award in the Patient Safety category.
Specialist cardiology registrar Dr Edd Maclean who lead the project said: "Device infection is a devastating complication with significant ramifications for patient mortality, quality of life, and also healthcare expenditure.
"The TYRX antimicrobial envelope is highly effective, but it is too expensive to use in every case. With this in mind, we recognised the need for a tool that could identify high-risk patients who may benefit most from additional technology."
Edd added: “Whilst the economic modelling behind the BLISTER score was complex, the score itself is very easy to use. An online calculator allows colleagues to generate a score at the bedside and posters in the cath labs prompt the team to risk assess every patient.
"BLISTER has therefore enabled all members of the multidisciplinary team to recognise and quantify the likelihood of infection risk.
"Device infection is at an all-time low.”
The system has been endorsed by the British Heart Rhythm Society and trusts who demonstrate they are using the score can get the cost of the TYRX envelope reimbursed by NHS England.
Edd said: "We know that BLISTER is being implemented in many different centres across the country, but for the score to become the gold standard it would need to be incorporated in international guidelines.
"The electrophysiology team are delighted to be recognised by the HSJ, and we hope this will further spread our Barts model to device patients across the NHS and beyond."
A number of Barts Health teams were shortlisted including the East London Cardiovascular Prevention Group, who were up for the NHS Race Equality award.
A nurse-led service between the Barts Heart Centre and the Essex Cardiothoracic Centre to provide the sedative Remimazolam for patients requiring treatment for an abnormal heart rhythm made the final in the Medicines, Pharmacy and Prescribing Initiative of the Year category.
Meanwhile, a collaboration between researchers from The Royal London Hospital and Queen Mary University of London to prevent users of nitrous oxide from experiencing nerve damage through a new emergency pathway, was highly commended in the Acute Sector Innovation of the Year category.
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