Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)
|Dx:||Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)|
|Pre-ICD10 counterpart:||Central Line Related Blood stream Infection (CLR-BSI)|
|APACHE Como Component:||none|
|APACHE Acute Component:||none|
|External ICD10 Documentation|
- 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.
Follow these criteria explicitly. We are reporting this information externally and it needs to be comparable.
The BSI is NOT believed to be related to an infection at another site AND it meets the timeline indicated below AND it meets either Criterion 1 or Criterion 2:
- Recognized pathogen (ie not a #Common skin commensal) unrelated to infection at another site is cultured from one or more blood cultures.
2. Patient has at least one' of the following signs or symptoms without any other recognized cause:
- fever (>38 C)
Timeline to consider if the BSI is a CLI (ensuring correct timing of the infection is crucial for identification of a CLI)
- 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 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).)
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 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.
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.
- see also: Pneumonia,_ventilator-associated_(VAP)#Attribution_of_the_VAP_to_a_Hospital_Location
- 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).
- 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.
- Eliminate this preventable patient harm.
- Contacting Quality Officer and Manager for VAPs and CLIs for steps
- Centers for Disease Control and Prevention (CDC): January 2013:CDC_CLR_BSI criteria
- 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.
- 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.
- These are infections that are related to medical care
- Most (but not all) are directly related to a medical device that predisposes the patient to infection
- e.g: ETT, vascular catheters, Foley, suprapubic catheter, implanted ortho devices, implanted cardiac devices, etc, etc.
- For the following three we have specific diagnostic (and attributional) criteria:
- Also see Nosocomial infection, NOS
Regarding Attribution and Identification of Surgical Wound Infections
- Note that these iatrogenic infections are attributed to the perioperative care for 30 days --- and for ONE WHOLE YEAR if related to an implanted device left in place
- Our reference for this is this (specifically pages 9-10 to 9-14), and describes 4 entities:
- SUPERFICIAL INCISIONAL SURGICAL SITE INFECTION
- DEEP INCISIONAL SURGICAL SITE INFECTION
- ORGAN/SPACE SURGICAL SITE INFECTION -- without an implanted device left in place
- ORGAN/SPACE SURGICAL SITE INFECTION -- with an implanted device left in place
- For your purposes of whether such an infection is considered a Admit Diagnosis versus Acquired Diagnosis, use the timing rules as above
- Here is an unusual consequence of this rule for surgical wound infections: Patient has a hip prosthesis put in 8 months ago. Admitted 1 month ago with pneumonia, and today is recognized to have an infection of that hip prosthesis. Despite the fact that the hip infection "seems" to have occurred well after this hospital admission, by the CDC rule it is actually a ORGAN/SPACE SURGICAL SITE INFECTION, and therefore it is attributed to the surgery one year ago, and so you should code it as a Admit Diagnosis even though the recognition of it was delayed for a whole month while in hospital.
Alternate ICD10s to consider coding instead or in addition
- Iatrogenic, infection, related to vascular access other than central line
- Any of the other iatrogenic injury codes: see Iatrogenic codes in ICD10
Candidate Combined ICD10 codes
Infections in ICD10 have combined coding requirements for some of their pathogens. Any that have antibiotic resistances would store those as Combined ICD10 codes as well. If the infection is acquired in the hospital, see Nosocomial infection, NOS. See Lab and culture reports for confirmation and details about tests. See Infections in ICD10 for more general info.
Infection requiring pathogen
This diagnosis is an infection that requires a pathogen to be coded.
Attribution of infections
Related CCI Codes
Data Integrity Checks (SMW)
|Check Inf Pathogens must have Infection requiring pathogen or Potential Infection||CCMDB.accdb||implemented|
|Query check ICD10 Inf Infection req Pathogen must have one||CCMDB.accdb||implemented|
|Query NDC CLI vs DX but no TISS17 CentralLine||CCMDB.accdb||ready to implement|
|Query s tmp QAInf tmp no dx||CCMDB.accdb||retired|
|Query NDC CLI unacceptable date||Centralized data front end.accdb||retired|