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

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=== TIMELINE to consider if [[BSI]] is Central Line Associated  ===
=== TIMELINE to consider if [[BSI]] is Central Line Associated  ===
To establish if CLI is central line associated, a [[blood culture]] must be taken and meet the following conditions:
To establish if CLI is central line associated, a [[blood culture]] must be taken and meet the following conditions:
* [[Central Line]] in place for more than 48 hours before the sample meeting [[#Criteria for BSI]] is taken
* [[Central Line]] in place for '''more than 48 hours''' before the sample meeting [[#Criteria for BSI]] is taken
* OR... the first sample meeting [[#Criteria for BSI)]] must be taken at most 48 hours after removal of the central line
* OR... the first sample meeting [[#Criteria for 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-associated unless there is evidence that is was related to the device.
** 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-associated unless there is evidence that is was related to the device.


=== ICU related CLA [[BSI]] or not? ===
=== ICU related CLA [[BSI]] or not? ===
CLA BSI onset was during ICU stay and a CL has been in place for more than 48 hrs.   
CLA BSI onset was during ICU stay and a CL has been in place for '''more than 48 hrs'''.   


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

Revision as of 17:33, 2017 October 2

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.

We are currently revisiting this article for clarity, please hold off on discussion Ttenbergen 20:08, 2017 September 12 (CDT)  some important info go cleaned out and has been added back.  Tina will help reconstruct this.  thanks.Trish Ostryzniuk 16:59, 2017 September 15 (CDT)
   *article name should be update to: CLA-BSI - central line associated blood stream infection. Trish Ostryzniuk 16:27, 2017 September 25 (CDT)
  *Trish has the CNISP (Public Health CLA-BSI Survelliance Protocol).  Our criteria are the same!  They have a good flowchart also.   Their layout can help us restructure our guidelines here.  They have relapse criteria that we will include.Trish Ostryzniuk 19:13, 2017 September 25 (CDT)


A Central Line Associated Infection (CLABSI) is blood steam infections that are caused by a Central Line

CLA (CLI) can be coded as:

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

Criteria when to code a Central Line Associated Blood stream Infection (CLA-BSI)

Blood stream infection BSI case definition

  • The BSI NOT related to an infection at another site and meets one of the following criteria:

Criteria for BSI

Criteria 1
  • Recognized pathogen cultured from one or more blood cultures, unrelated to infection at another site.
Criteria 2

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 (contaminant) is cultured from two or more blood cultures.

TIMELINE to consider if BSI is Central Line Associated

To establish if CLI is central line associated, a blood culture must be taken and meet the following conditions:

  • Central Line in place for more than 48 hours before the sample meeting #Criteria for BSI is taken
  • OR... the first sample meeting #Criteria for 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-associated unless there is evidence that is was related to the device.

ICU related CLA BSI or not?

CLA BSI onset was during ICU stay and a CL has been in place for more than 48 hrs.

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

In addition to #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 more than 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 include this in her admission diagnosis list 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 and would follow up on Contacting Quality Officer and Manager for VAPs and CLIs.

Blood Culture considerations

  • 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.
  • 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-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.

Review at task

Template:Discuss@task

See Also

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