Attribution of infections

There will always be a delay between an actual infection and the time at which the infection is confirmed by the lab, or manifests so it can be determined without lab clarification (for diagnoses where we allow that). Some of our reports "attribute" infections to units on which they happen if they are an Acquired Diagnosis.

I finally figured out how to ask this at task: I was worried that we might apply the delay at the data entry end and also at the reporting end (i.e. the delay might be included twice or not at all, so we need to phrase and then link this correctly so it's clear whether the delay is considered at collection or at reporting. Ttenbergen 21:37, 2020 August 27 (CDT)

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Is the following correct, then: This means that an infection discovered shortly after admission should not generally be coded as an Acquired Diagnosis, since it likely happened before the patient arrived on the current ward, and should instead be coded as an Admit Diagnosis. To be consistent, we have rules on how long after admission to a unit an infection needs to be discovered before we would call it an Acquired Diagnosis instead of an Admit Diagnosis.

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Diagnoses with specific attribution rules

We have specific attribution rules as documented in their pages for the following diagnoses:

• Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)
• Pneumonia, ventilator-associated (VAP)
• Iatrogenic, infection, urinary catheter
• Template:ICD10 Guideline Iatrogenic deals with attribution of surgical infections
• Nosocomial infection, NOS
• Template:ICD10 Guideline Como vs Admit - also deals with this

Attribution for all other infections

• A chronic-type infection (e.g. TB) which is first discovered in hospital BUT presumably was actually present on admission is governed by the rules of Template:ICD10 Guideline Como vs Admit -- i.e. coded as an admit dx.
  • But rarely, a person can acquire such a chronic-type infection in hospital, and if THAT is thought to have happened, then code it as an acquired dx.
• For an acute-type infection (e.g. bacterial cellulitis) first identified after admission (the start of the current database record) to choose admit vs. comorbid dx, you should try to figure out whether it was actually present at admission or actually began after admission.
  • Typically there will be at least a guess by the team about this. If not, then you can default to the guideline that if it was firstdiscovered within the first 48 hrs after admission to code it as an Admit Diagnosis, and if discovered >48 hrs after admission to code it as as an Acquired Diagnosis.

Attribution doesn't apply to colonization

See Colonized with organism (not infected)#Colonizations are not attributed to any units

Cleanup

When this is all settled, the details need to be integrated into Template: ICD10 Guideline Infection, Lab and culture reports, Infections in ICD10

added: no added date action: no action date

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