Central Line Related Blood stream Infection (CLR-BSI)

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)

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edit dx infobox
Category/Organ System:	Category:Infection (old)
Type:	Category: Medical Problem (old)
Main Diagnosis:	Central Line Related Blood stream Infections
Sub Diagnosis:	See: UPL (Universal Pathogen List)
Diagnosis Code:	8600 - Central Line Related Blood stream Infections
Comorbid Diagnosis:	No
Charlson Comorbid coding (pre ICD10):	0
Program:	Critical Care and Medicine
Status:	Currently Collected
Start Date:	Code added Jan 1996

We are currently revisiting this article for clarity, please hold off on discussion Ttenbergen 20:08, 2017 September 12 (CDT) 

Central Line Infections (CLIs) are infections of Central Lines (so see there what is included). CLIs can be coded as an Admit Diagnosis or Acquired Diagnosis / Complication based on the criteria below.

• If it is coded as a complication, then it is included in the tmp study QA infection CLI.

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

Criteria when to code a Central Line Related Blood stream Infections (CLR-BSI)

Timeline to consider Central Line Related (CLR-BSI)

To establish a CLR-BSI, a blood culture must be taken and meet the following conditions:

• Central Line must have been established at least 48 hours before the sample meeting #Criteria for the Blood Stream Infection (BSI) is taken
• OR... the first sample meeting #Criteria for the Blood Stream Infection (BSI) must be taken at most 48 hours after removal of the central line
  • 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.

example

A patient had a central line inserted on day 1 in the ICU. The line is removed on day 4. If a the patient has a positive blood culture and meets the definition for laboratory confirmed bloodstream infection:

• 48 hours after the insertion or within 48 hours of the removal, it would be considered a CLR-BSI
• on day 7, it would not be considered a CLR-BSI

Criteria for Central Line Related Blood Stream Infection (CLR-BSI)

• • If a blood culture shows a recognized pathogen: You only need one positive blood culture to meet the criteria as long as the patient meets the timeline descibed above and the organism is not related to an infection at any other site.
  • If a blood culture result is a common skin commensal (not a recognized pathogen): You need to still meet the timeline criteria above, and you need to meet the following 2 criteria:

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

• • fever (>38 C)
  • chills
  • hypotension

and

2. * Common skin commensal is cultured from two or more blood cultures.

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

• diphtheriods
• Bacillus sp.
• Propionibacterium sp.
• coagulase-negative staphylococci
• or micrococci
• corynebacterium species

A List of common commensals can be found on Regional Server located: \\ad.wrha.mb.ca\WRHA\REGIONWRHA\SHARED\ICU_DATA_COLLECTION\List of Common Commensals CDC Jan 2013

Criteria when to code CLI as Acquired Diagnosis / Complication vs Admit Diagnosis

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:

• the patient must have 'been on this unit for at least 48 hours before the lab sample was taken
• lab sample must have been taken 'within 48 hours of patient leaving the 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 notify the ICU collector that the pt has a CLI and the medicine collector could include this in her admission diagnosis list. The ICU collector would need to notify main office to add CLI into the ICU profile as an acquired diagnosis and Basil Evan would need to be notified. QA Infection CLI.

Blood Culture considerations

• Different ports of the same line are considered more than one site.
• One blood culture is defined as one site (may be 2 bottles taken from one site).
• 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).)

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.

See Also

• QA Infection for info common to the QA Infection CLI and the QA Infection VAP project
• CLI Call Basil Evan if MICU/SICU/IICU for steps in notifying p:Basil Evan
• Centers for Disease Control and Prevention (CDC): January 2013:CDC_CLR_BSI criteria
• 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