Central Line Related Blood stream Infection (CLR-BSI): Difference between revisions

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*I just wanted to clarify how many positive blood cultures are required in order to code a CVC-BSI. You noted up above that there must be at least two consistent findings, but my impression from the WIKI instructions is that if all other criteria are met, one positive culture is sufficient. Have I been wrong in this assumption?[[User:Mlagadi|Mlagadi]] 16:05, 2016 August 25 (CDT)
*I just wanted to clarify how many positive blood cultures are required in order to code a CVC-BSI. You noted up above that there must be at least two consistent findings, but my impression from the WIKI instructions is that if all other criteria are met, one positive culture is sufficient. Have I been wrong in this assumption?[[User:Mlagadi|Mlagadi]] 16:05, 2016 August 25 (CDT)
**One.  We are just clarifying definition of what is: ONE set of blood cultures vs what is TWO SEPARATE blood cultures.
**One.  We are just clarifying definition of what is: ONE set of blood cultures vs what is TWO SEPARATE blood cultures.
**It's one  blood culture for recognized pathogens (criterion #1) and 2 cultures or more for criterion #2 (common skin commensal)[[User:GHall|GHall]] 06:56, 2016 August 31 (CDT)


== Related temporary study collection instructions ==
== Related temporary study collection instructions ==

Revision as of 06:56, 2016 August 31

For the collection of CLI's in TMP in CCMDB.mdb go to: QA Infection Audit

For steps in notifying Basil Evan for CLI's go to: CLI Call Basil Evan if MICU/SICU/IICU


  • Centers for Disease Control and Prevention (CDC): January 2013:CDC_CLR_BSI criteria
  • A List of common comensals can be found on Regional Server: \\ad.wrha.mb.ca\WRHA\REGIONWRHA\SHARED\ICU_DATA_COLLECTION\documents\List of Common Comensals CDC Jan 2013


Legacy Content

This page is about the pre-ICD10 diagnosis coding schema. See the ICD10 Diagnosis List, or the following for similar diagnoses in ICD10:Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)

Click Expand to show legacy content.

Criteria for ICU associated Central Line Related Blood stream Infections (CLR-BSI)

NOTE: Central Line Infections can be coded in the diagnosis section if the pt already has a line sepsis on arrival to the ICU, or if the line sepsis was evident within the first 48 hrs of admission to the ICU. The criteria in this section relates to when a pt develops a central line sepsis while in the ICU, in this event the CLI code is put in the complications section and also the tmp study section under QA infection CLI must also be completed with the date. (Note: Basil Evan must be notified of all ICU related CLI's)

  • Laboratory confirmed bloodstream infection must meet at least one of the following criteria and have occurred in the ICU or within 48 hours of leaving an ICU: 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.
  • 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.
    • ONE OF THE FOLLOWING 2 CRITERIA MUST BE MET: (FOR BOTH CRITERIA,THE PATIENT MUST HAVE BEEN IN THE ICU WITH A CENTRAL LINE FOR AT LEAST 48 HOURS).
  • CRITERION 1:
  • 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. See: what is a Blood culture.
  • OR
  • CRITERION 2:
  • Patient has at least one of the following signs or symptoms:
    • fever (>38 C)
    • chills
    • hypotension
  • Note: These 3 symptoms should not have any other recognized cause.

and

  • Common skin commensal ( e.g. diphtheriods, Bacillus sp., Propionibacterium sp., coagulase-negative staphylococci, or micrococci) is cultured from two or more Blood cultures drawn on separate occasions.

Special considerations for the above criteria

Regarding how we define the number of blood cultures done: This issue is applicable not only in the case definition of CVC-BSI (where consistent findings from least 2 blood cultures are required), but more generally for counting how many blood cultures were done for a given patient.

And it’s simple: A single blood culture is any amount of blood that is obtained from a single site at a single time, and inoculated into any number of tubes/bottles. Examples:

  • If 40 mL of blood is obtained from a venipuncture site at noon and squirted into 12 different bottles, this is ONE blood culture. The # of bottles is completely irrelevant to how many cultures were done.
  • If at one point in time, 1 person obtains blood for culture from the L antecubital vein, while another person simultaneously obtains blood for culture from a R IJ triple lumen catheter, those are TWO blood cultures.
  • If a person obtains blood for culture from the L antecubital vein at noon, and then comes back 5 (or 15 or 1000) minutes or hours later, cleans off that site again, and obtains blood for culture from the same L antecubital vein, these are TWO blood cultures.

Thus, if EITHER the sites and/or the times were different when the blood was obtained, then you have separate cultures. This is easy when the sites are different. An easy way to think about what separates distinct blood cultures from the same site (which could be a line, or the same venipuncture site) is that the site was cleaned off separately for the 2 cultures.

Template:Discussion

  • I just wanted to clarify how many positive blood cultures are required in order to code a CVC-BSI. You noted up above that there must be at least two consistent findings, but my impression from the WIKI instructions is that if all other criteria are met, one positive culture is sufficient. Have I been wrong in this assumption?Mlagadi 16:05, 2016 August 25 (CDT)
    • One. We are just clarifying definition of what is: ONE set of blood cultures vs what is TWO SEPARATE blood cultures.
    • It's one blood culture for recognized pathogens (criterion #1) and 2 cultures or more for criterion #2 (common skin commensal)GHall 06:56, 2016 August 31 (CDT)

Related temporary study collection instructions

Definition of Terms

CL means Central Line

A CL is a vascular access catheter that passes through or has a tip ending at or close to the heart or in one of the great vessels.

Great vessels include:

  • aorta
  • pulmonary artery
  • superior vena cava
  • inferior vena cava
  • brachiocephalic veins
  • internal jugular veins
  • subclavian veins
  • external iliac veins
  • common iliac veins
  • femoral veins

Central Lines include:

  • subclavian vein catheter
  • internal jugular vein catheter
  • PICC (Peripherally Inserted Central Catheter)
  • Swan-Ganz (pulmonary artery) catheter
  • Brovic
  • Groshong
  • Hickman
  • Dialysis catheter
  • introducer for temporary pacing wire

Not counted as Central Lines:

  • arterial catheters inserted into an artery
  • ECMO
  • IABP
  • VAD
  • IMPELLA

Common skin commensal

  • 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 coagulase negative staphylococci, proprionbacterium species, corynebacterium species, diphtheroids, bacillus species and mirococcus species.
    • 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

Frequently asked questions

  1. If a patient in an ICU has a temporary or tunneled hemodialysis catheter, is that device counted as a central line in the central line days?
    • If a line meets the defintion of what is a central line, then it should be counted. The only exception to this would be an implanted device that is not used. In this situation, the line would only be counted beginning on the first day that it is accessed (e.g., physician orders that the port-a-cath be flushed). Then it would be counted every day there after.
  2. Do central lines include the following: implantable-ports, non tunneled TLC, Swan Ganz catheter, tunneld-Borviac, Groshong, Quinton, Hickman, ASHE catheter, PICC lines? If yes would they be counted in the central line days for that unit?
    • Yes to all of the above if they meet the definition. Central lines are not defined by the type of device.
  3. Is a dialysis catheter considered a central line since it isn't used for infusion?
    • A dialysis catheter is considered a central line if it meets the definition of a central line. It is used for infusion of the patient's own blood.
  4. If a patient is admitted to the ICU with a central line in place, is it counted in the central line days
    • Yes
  5. Clarify the last sentence of the definition for CLR-BSI that reads, "If the time interval was longer than 48 hours, there must be compelling evidence that the infection was related to the vascular acess device."
    • This means only that if the time interval between the removal of the line and the onset of bloodstream infection (BSI) is greater than 48 hours, the BSI should not be considered central line-associated unless there is evidence that is was related to this device.
  6. What if: a patient had a central line inserted in the ICU; 6 days later the patient has a positive blood culture; and the patient meets the definition for laboratory confirmed bloodstream infection. Would this patient be counted as a Central Line Related blood stream Infection (CLR-BSI)?
    • If the line was not discontinued, it would be counted as a CLR-BSI. If the line were to be discontinued on day 4 or earlier, it would not be counted as a CLR-BSI.
  7. How do you determine which unit to "credit with a bloodstream infection? E.G., on May 2nd the patient is in the medical ICU; on May 3 the patient is transferred to the coronary care unit; symptoms develop on May 4th. Which unit is "credited"?
    • The patient is followed for 48 hours AFTER TRANSFER to another ICU. If a BSI develps within that 48 hour period, the original ICU is "credited" with the infection.

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-related bloodstream infections (CR-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 Venous Line Related 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 occuring 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.