Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)

ICD10 Diagnosis
Dx:	Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)
ICD10 code:	T82.70
Pre-ICD10 counterpart:	Central Line Related Blood stream Infection (CLR-BSI)
Charlson/ALERT Scale:	none
APACHE Como Component:	none
APACHE Acute Component:	none
Start Date:
Stop Date:
External ICD10 Documentation	ICD-10 CM Wikipedia ICD-10 Wikipedia WHO ICD10 documentation ICD10data.com

This diagnosis is a part of ICD10 collection.

Additional Info

This is one of a number of different types of iatrogenic injury codes. Here is information about all of them; Iatrogenic codes in ICD10
Here are equivalent names for this entity: Central line infection (CLI); Central line-associated bloodstream infection (CLABSI); Central venous catheter-related bloodstream infection (CVC-BSI)
It is a bloodstream infection caused by a Central Line. Do not confuse it with an iatrogenic, local catheter-related skin site infection, for which you use code Iatrogenic, infection, cardiac or vascular prosthetic device or implant or graft NOS.

Excludes:

Contacting...

If at STB, see STB Critical Care Collection Guide#CLI notification.

Criteria for a Central venous catheter-related bloodstream infection (CVC-BSI)

Follow these criteria explicitly. We are reporting this information externally and it needs to be comparable.

Criteria

The BSI is NOT believed to be related to an infection at another site
It meets the timeline indicated below #Timeline to Consider
The patient meets either criteria A or B

Criteria A:

A Recognized Pathogen (ie. not one of the #Common Skin Commensals) unrelated to an infection at another site is collected from one or more blood cultures.
(NO signs or symptoms are required)

OR

Criteria B:

A #Common Skin Commensals (examples listed below) is cultured from TWO or more separate blood cultures (see #Blood Culture Counts)

AND

Patient has at least one of the following signs or symptoms without any other recognized cause:

fever (>38)
chills
hypotension

Timeline to Consider

To establish if BSI is central line associated, a central line must have been in place FOR AT LEAST 48 hours preceding when the FIRST positive blood culture was drawn.
The line may or may not be in place at the time the sample is taken -- i.e. the central line may have been removed up to but not longer than 48 hours before that first positive blood culture was drawn, AND it must have been in place for >48 hours before the removal.
If the central line was removed >48 hours after the first positive blood culture was drawn, then the CDC does not consider the bloodstream infection to be attributable to the central line, and it is not a CLI.

Criteria for coding CLI as Acquired Diagnosis / Complication vs Admit Diagnosis

In addition to all the above criteria for a CLI, including #TIMELINE to consider if BSI is Central Line Associated, to code the CLI as as a Acquired Diagnosis / Complication one of the following must be true:
- the patient must have been on this unit for >48 hours before the first positive blood culture was drawn
- first positive blood culture was drawn <48 hours after the patient left the unit

Blood Culture Counts

Single blood culture:
- is a blood culture that is taken from a single site at a single time and inoculated into any number of bottles.
Separate blood cultures:
- If either the sites or times that the blood culture was taken are different, then this is considered to be separate blood cultures.
- Different ports of the same line are considered more than one site.

Tip of line culture doesn't count

If the tip of a removed line is cultured as positive, but the blood cultures are negative, this is not a central line infection. (see criteria above: must have positive blood culture(s).)

Common Skin Commensals

diphtheriods -- including but not limited to Corynebacterium spp.
Bacillus spp.
Propionibacterium spp.
coagulase-negative staphylococci (including: Staphylococcus epidermidis)
viridans group streptococci
Aerococcus spp.
Micrococcus spp.

Diagnosed AFTER Patient Left Unit

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.

The medicine collector would need to include this as an Admit Diagnosis and then email the ICU collector that the pt has a CLI. The ICU collector would need to confirm that the criteria for CLI are met, and if so notify main office to add CLI into the ICU profile as an Acquired Diagnosis. If at STB, see STB Critical Care Collection Guide#CLI notification.

Attribution of a CLI to a Hospital Location

The infection is attributed to the location where the patient was on the date the infection became clinically evident -- EXCEPT if all elements of the infection are present within the first 48 hours of arrival, the infection is attributed to the location from which they were transferred.
- An important consequence of this is that if on admission to the current unit it was NOT recognized that the patient has a CLI, but by these rules it is then figured out to be so --> THEN the correct coding of this CLI is as an Admit Diagnosis, not an Acquired Diagnosis.
see also: Pneumonia,_ventilator-associated_(VAP)#Attribution_of_the_VAP_to_a_Hospital_Location

Background

The Case for Preventing Central Venous Catheter related Bloodstream Infections

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-associated bloodstream infections (CA-BSIs) occur with CVC.
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.
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).

Purpose

To identify the incidence of Central Line Associated Blood stream Infections within the WRHA ICU's.
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).
This should lead to the review of practices occurring at the time of insertion as well as the care processes relating to the maintenance of the catheter dressings.

Goal

Eliminate this preventable patient harm.

Iatrogenic injuries

Some iatrogenic codes are self-explanatory for what occurred. For example Iatrogenic, air embolism, as complication of line/infusion/transfusion/injection. But for others, such as Iatrogenic, puncture or laceration, related to a procedure or surgery NOS it's not clear what happened, i.e. what was iatrogenically injured.
- In these latter cases, with just one exception, DO NOT also code a trauma code for what was iatrogenically injured. This is because iatrogenic injuries are technically not considered to be traumas.
  - that one exception is you should code Rib fracture(s) due to CPR in the context of CPR, cardiac resuscitation.
- Instead, combine the iatrogenic code with another ICD10 code indicating the body part involved.
  - e.g. for iatrogenic laceration of a pulmonary artery, combine: Iatrogenic, puncture or laceration, related to a procedure or surgery NOS with Disorder of pulmonary vessels, NOS. See list of NOS codes in ICD10.