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

{{ICD10 transition status
| OldDxArticle =Central Line Related Blood stream Infection (CLR-BSI)| 
CurrentStatus = reconciled
| InitialEditorAssigned = not assigned
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{{ICD10 dx
| MinimumCombinedCodes =2
| ICD10 Code=T82.70
| BugRequired= required
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{{ICD10 category|Infectious disease}}{{ICD10 category|Infection requiring pathogen}}{{ICD10 category|Iatrogenic}}{{ICD10 category|Iatrogenic infection}}{{ICD10 category|Misc}} 

== 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 (CLA[[BSI]]); 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]]'''.

'''Excludes:'''
* [[Iatrogenic, infection, related to vascular access other than central line]]
* [[Iatrogenic, infection, cardiac or vascular prosthetic device or implant or graft NOS]]

== 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'''
:*A [[#Common Skin Commensals]] (examples listed below) is cultured from '''TWO''' or more separate blood cultures (see [[#Blood Culture Counts]])

====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]] ====
*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 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====
*diphtheriods -- including but not limited to [[Corynebacterium spp]].
*Bacillus spp.
*Propionibacterium spp.
*coagulase-negative staphylococci (including: [[Staphylococcus epidermidis]])
*[[Strep viridans|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 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]]

== 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:[http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf  CDC_CLR_[[BSI]] criteria]

{{Template:ICD10 Guideline Iatrogenic}}

== 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]] ==
{{ICD10 Guideline Infection}}

== Related CCI Codes ==

{{Data Integrity Check List}}

== Related Articles ==
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