Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)

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ICD10 Diagnosis
Dx: Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)
ICD10 code: T82.70
Pre-ICD10 counterpart: Central Line Related Blood stream Infection (CLR-BSI)
Charlson/ALERT Scale: none
APACHE Como Component: none
APACHE Acute Component: none
External ICD10 Documentation
This diagnosis is a part of ICD10 collection.

Additional Info

  • 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.

If it is coded as a Acquired Diagnosis / Complication, then it must also be coded in the the tmp study QA Infection CLI.

Excludes:

Criteria for a Central venous catheter-related bloodstream infection (CVC-BSI)

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:

CRITERION 1:

  • Recognized pathogen (ie not a #Common skin commensal) unrelated to infection at another site is cultured from one or more blood cultures.

or

CRITERION 2:

1. #Common skin commensal is cultured from TWO OR MORE separate blood cultures (see #Blood Culture considerations).

and

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

  • fever (>38 C)
  • chills
  • hypotension

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

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


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.
    • An important consequence of this is that if on admission to the current unit it was NOT recognized that the patient has a CLI, but by these rules it is then figured out to be so --> THEN the correct coding of this CLI is as an Admit Diagnosis, not an Acquired Diagnosis.
  • see also: Pneumonia,_ventilator-associated_(VAP)#Attribution_of_the_VAP_to_a_Hospital_Location

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.

See Also

Iatrogenic Infection

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: CDC Surgical Wound Infection Guidelines, and descrubed=s 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

Candidate Combined ICD10 codes

Infections

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 Infections in ICD10 for more info.

Infection requiring pathogen

This diagnosis is an infection that requires a pathogen to be coded.

Pathogens codes:

Related CCI Codes

Data Integrity Checks (SMW)

 AppStatus
Check Inf Pathogens must have Infection requiring pathogen or Potential InfectionCCMDB.mdbimplemented
Query check ICD10 Inf Infection req Pathogen must have oneCCMDB.mdbimplemented
Query s tmp QAInf tmp no dxCCMDB.mdbretired
Query NDC CLI vs DX but no TISS17 CentralLineCentralized data front end.accdbimplemented
Query NDC CLI AcqDX but NoCLI DateinTMPV2Centralized data front end.accdbimplemented
Query NDC CLI No AcqDX but CLI DateinTMPV2Centralized data front end.accdbimplemented
Query NDC CLI unacceptable dateCentralized data front end.accdbretired

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