Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI): Difference between revisions
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| OldDxArticle =Central Line Related Blood stream Infection (CLR-BSI)| CurrentStatus = | | OldDxArticle =Central Line Related Blood stream Infection (CLR-BSI)| | ||
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| InitialEditorAssigned = Julie Mojica | | InitialEditorAssigned = Julie Mojica | ||
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Revision as of 13:57, 2018 August 7
| 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.
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.
Template:Discussion Is this still part of Critical Care Vital Signs Monitoring? Ttenbergen 17:22, 2018 May 31 (CDT)
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 can have been removed up to but not longer than 48 hours before that first positive blood culture was drawn, IF it had been in place already 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.
Background
- 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
- QA Infection for info common to the QA Infection CLI and the QA Infection VAP project
- Contacting Quality Officer and Manager for VAPs and CLIs for steps
- Centers for Disease Control and Prevention (CDC): January 2013:CDC_CLR_BSI criteria
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
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.
Possible Simultaneous Presence of Multiple Different Types of Infection in a Single Site
- This refers to the situation where there may be simultaneous infection with multiple types of organisms -- e.g. 2 of bacteria, virus, fungus. While a classic example is a proven viral pneumonia (e.g. influenza) with a suspected/possible bacterial pneumonia superimposed, this kind of thing can occur in places other than the lungs, e.g. meningitis.
- The "signature" of this is typically the patient being treated simultaneously with antimicrobial agents for multiple types of organisms. BUT don't confuse this with there being infections at DIFFERENT body sites.
- As per our usual practice, we will consider a diagnosis as present if the clinical team thinks it's present and are treating it, with the exception that the team initially treated for the possible 2nd type of infection but then decided it likely was NOT present and stopped those agents.
- And remember that Infectious organism, unknown is used when the the specific organism is unknown (this could be not knowing the TYPE of organism, or suspecting the type but not having identified the specific organism of that type), while when the organism has been identified but it's not in our bug list, THEN use Bacteria, NOS, Virus, NOS or Fungus or yeast, NOS.
Attribution of infections
Related CCI Codes
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