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| | {{PreICD10 dx |
| | | NewDxArticle = Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI) |
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| {{DX tag |Infection | Medical Problem| Central Line Related Blood stream Infections | See: [[UPL]] (Universal Pathogen List) | 8600 - Central Line Related Blood stream Infections | No | 0 | '''''Critical Care and Medicine''''' |Currently Collected | Code added Jan 1996|}} | | {{DX tag |Infection | Medical Problem| Central Line Related Blood stream Infections | See: [[UPL]] (Universal Pathogen List) | 8600 - Central Line Related Blood stream Infections | No | 0 | '''''Critical Care and Medicine''''' |Currently Collected | Code added Jan 1996|}} |
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| '''''We are currently revisiting this article for clarity, please hold off on discussion Ttenbergen 20:08, 2017 September 12 (CDT) '''''
| | == Criteria == |
| Central Line Infections (CLIs) are infections of [[Central Line]]s (so see there what is included). CLIs can be coded as an [[Admit Diagnosis]] or [[Acquired Diagnosis / Complication]] based on the criteria below.
| | Have been moved to [[Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)]] in prep for ICD10, please see there. |
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| '''Follow these criteria explicitly. We are reporting this information externally and it needs to be comparable.'''
| | == Related Articles == |
| | {{Related Articles}} |
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| == Criteria when to code a Central Line Related Blood stream Infections (CLR-BSI) ==
| | [[Category: Central lines (old)]] |
| * {{discussion}} If these are not met, would it just be a [[Septicemia/Bacteremia/Fungemia]]? Might be good to link there if so, but it might also muddy the water. Ttenbergen 20:08, 2017 September 12 (CDT)
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| === Timeline to consider Central Line Related (CLR-BSI) ===
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| To establish a CLR-BSI, a [[blood culture]] must be taken and meet the following conditions:
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| * [[Central Line]] must have been established at least 48 hours before the sample meeting [[#Criteria for the Blood Stream Infection (BSI)]] is taken
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| * first sample meeting [[#Criteria for the Blood Stream Infection (BSI)]] must be taken at most 48 hours after removal of the central line
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| ** If the lab sample was taken more than 48 hours after removal of the [[Central Line]] there must be compelling evidence that the infection was related to the vascular access device, ie the BSI should not be considered central line-related unless there is evidence that is was related to the device.
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| ==== example ====
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| A patient had a central line inserted on day 1 in the ICU. The line is removed on day 4.
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| If a the patient has a positive blood culture and meets the definition for laboratory confirmed bloodstream infection:
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| * on day 5, it would be considered a CLR-BSI
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| * on day 7, it would not be considered a CLR-BSI
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| === Criteria for the Blood Stream Infection (BSI) ===
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| * '''At least one of''' the following two criteria must be met:
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| :'''criterion 1:'''
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| :*Patient has a '''recognized pathogen''' cultured from '''one or more''' blood cultures and the organism cultured from blood is '''not related''' to an '''infection at another site'''.
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| :'''criterion 2:'''
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| :*Patient has at least '''one''' of the following signs or symptoms '''without any other recognized cause'':
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| :**fever (>38 C)
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| :**chills
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| :**hypotension
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| ::'''and'''
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| :* [[#Common skin commensal|Common skin commensal]] is cultured from '''two or more''' blood cultures drawn on separate occasions.
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| ====Common skin commensal====
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| Common skin commensal means microorganisms that are commonly found on the skin and often indicate contamination of the blood culture media rather than identification of a pathogenic organism when identified in blood culture tests. These include
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| * diphtheriods
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| *Bacillus sp.
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| * Propionibacterium sp.
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| *coagulase-negative staphylococci
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| *or micrococci
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| *corynebacterium species
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| A List of common comensals can be found on [[Regional Server]] located: \\ad.wrha.mb.ca\WRHA\REGIONWRHA\SHARED\ICU_DATA_COLLECTION\'''List of Common Comensals CDC Jan 2013'''
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| == Criteria when to code CLI as [[Acquired Diagnosis / Complication]] vs [[Admit Diagnosis]] ==
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| In addition to [[#Timeline to consider Central Line Related (CLR-BSI)]], to code the CLI as as a [[Acquired Diagnosis / Complication]] one of the following must be true:
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| * the patient must have '''been on this unit for at least 48 hours'' before the lab sample was taken
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| * lab sample must have been taken ''''within 48 hours of patient leaving the unit'''
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| The ICU collectors do not follow patients once they leave the ICU so those who leave and subsequently develop a line infection may be captured by the medicine collectors if it is on a ward in our program.
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| {{discussion}}
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| Would the medicine collector then collect this as CLI [[Admit Diagnosis]], or just notify the ICU collector to collect it as [[Acquired Diagnosis / Complication]]? Ttenbergen 20:08, 2017 September 12 (CDT)
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| == this should really go into [[QA Infection CLI]] ==
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| ICU associated CLR-BSI is not present on admission to ICU. The patient must have been in the ICU for 48 hours for the CLR-BSI to be considered ICU associated, unless compelling evidence suggests the infection was ICU associated.
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| == Background==
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| ===The Case for Preventing Central Venous Catheter related Bloodstream Infections===
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| * Central Venous Catheters (CVCs) are being used increasingly in the inpatient and outpatient setting to provide long-term venous access. CVCs disrupt the integrity of the skin, making infection with bacteria and/or fungi possible. Infection may spread to the bloodstream and hemodynamic changes and organ dysfunction (severe sepsis) may ensue, possibly leading to death. Approximately 90% of the catheter-related bloodstream infections (CR-BSIs) occur with CVC.
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| * Forty-eight percent of intensive care unit (ICU) patients in the U.S. have central venous catheters, accounting for 15 million central-venous-catheter-days per year in U.S.-based ICUs. Studies of catheter-related bloodstream infections that control for the underlying severity of illness suggest that mortality attributable to these infections is between 4% and 20%. Thus, it is estimated that 500 to 4000 U.S. patients die annually due to bloodstream infections.
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| * In addition, nosocomial bloodstream infections prolong hospitalization by a mean of 7 days.Attributable cost per bloodstream infection is estimated to be between US $3,700 and $29,000. There are no equivalent Canadian figures for burden of illness. (as per literature).
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| ===Purpose===
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| *To identify the incidence of Central Venous Line Related Infections within the WRHA ICU's.
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| *The monitoring of the incidence over time will identify the magnitude of the problem within a specific area or unit and will enable comparisons between selected ICU's across Canada (Canadian Collaborative - Safer Health Care Now).
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| *This should lead to the review of practices occuring at the time of insertion as well as the care processes relating to the maintenance of the catheter dressings.
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| ===Goal===
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| *Eliminate this preventable patient harm.
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| == See Also ==
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| * [[QA Infection]] for info common to the [[QA Infection CLI]] and the [[QA Infection VAP]] project
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| * [[CLI Call Basil Evan if MICU/SICU/IICU]] for steps in notifying [[p:Basil Evan]]
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| * Centers for Disease Control and Prevention (CDC): January 2013:[http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf CDC_CLR_BSI criteria]
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| * A List of common commensals can be found on Regional Server: \\ad.wrha.mb.ca\WRHA\REGIONWRHA\SHARED\ICU_DATA_COLLECTION\documents\List of Common Comensals CDC Jan 2013
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| [[Category:QAInfection]]
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| [[Category: Central lines]]
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