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
Start Date:
Stop Date:
External ICD10 Documentation

This diagnosis is a part of ICD10 collection.

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    • 2019-01-01
    • 2999-12-31
    • T82.70
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Additional Info

Excludes:

Contacting...

If at STB, see STB Critical Care Collection Guide#CLI notification.

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.

Criteria

  • The BSI is NOT believed to be related to an infection at another site
  • It meets the timeline indicated below #Timeline to Consider
  • Patient has at least one of the following signs or symptoms without any other recognized cause:
    • Fever (>38)
    • chills
    • hypotension
  • One of:
    • A Recognized Pathogen (ie. not one of the #Common Skin Commensals) unrelated to an infection at another site is collected from one or more blood cultures.
OR

Timeline to Consider

  • 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 Counts

  • 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.

Tip of line culture doesn't count

  • 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 as an Admit Diagnosis 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. If at STB, see STB Critical Care Collection Guide#CLI notification.

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
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_wiki housekeeping

  • we have a page about attribution somewhere, make sure that this is consistent.
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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

  • Centers for Disease Control and Prevention (CDC): January 2013:CDC_CLR_BSI criteria

Iatrogenic injuries

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 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

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 Lab and culture reports for confirmation and details about tests. See Infections in ICD10 for more general info.

Attribution of infections

See Attribution of infections

Related CCI Codes

Data Integrity Checks (automatic list)

 AppStatus
Query check ICD10 Inf Infection req Pathogen must have oneCCMDB.accdbimplemented
Query Check Inf Pathogens must have Infection requiring pathogen or Potential InfectionCCMDB.accdbimplemented
Query check ICD10 CLI vs CCI CentralLineCCMDB.accdbready to implement
Query s tmp QAInf tmp no dxCCMDB.accdbretired
Query NDC CLI unacceptable dateCentralized data front end.accdbretired

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