Central Line Related Blood stream Infection (CLR-BSI)

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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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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.

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:

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:

  • on day 5, it would be considered a CLR-BSI
  • on day 7, it would not be considered a CLR-BSI

Criteria for the Blood Stream Infection (BSI)

  • At least one of the following two criteria must be met:
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.
criterion 2:
  • Patient has at least one' of the following signs or symptoms without any other recognized cause:
    • fever (>38 C)
    • chills
    • hypotension
and

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 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

number of cultures required to be positive

  • 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)

Template:Discussion that should really live inside the definition above, not in a separate discussion, not here. Ttenbergen 20:08, 2017 September 12 (CDT)

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

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 lab sample was taken
  • lab sample was 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. Template:Discussion Would the medicine collector then collect this as CLI Admit Diagnosis, or just notify the ICU collector to collect it as Acquired Diagnosis / Complication? Ttenbergen 20:08, 2017 September 12 (CDT)

this should really go into QA Infection CLI

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.

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