Iatrogenic, infection, central venous catheter-related bloodstream infection (CVC-BSI, CLI)
| 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
A Central Line Associated Infection (CLABSI) is blood stream infection caused by a Central Line.
If it is coded as a Acquired Diagnosis / Complication, then it must also be coded in the the tmp study QA Infection CLI.
Criteria when to code a Central Line Associated Blood stream Infection (CLA-BSI)
Follow these criteria explicitly. We are reporting this information externally and it needs to be comparable.
The BSI NOT related to an infection at another site and meets one of the following criteria:
Criteria 1:
- Recognized pathogen (ie not a #Common skin commensal) cultured from one or more blood cultures, unrelated to infection at another site.
or
Criteria 2:
1. #Common skin commensal (contaminant) is cultured from two or more 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 BSI is Central Line Associated
To establish if CLI is central line associated, a central line must have been in place within the 48 hours preceding the blood culture. The line may or may not be in place at the time the sample is taken.
If the lab sample was taken more than 48 hours after removal of the Central Line there must be compelling evidence that the infection was related to the vascular access device, ie the BSI should not be considered central line-associated unless there is evidence that is was related to the device.
Criteria when to code CLI as Acquired Diagnosis / Complication vs Admit Diagnosis
In addition to #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 more than 48 hours before the lab sample was taken
- lab sample must have been taken 'within 48 hours of patient leaving 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 commensal
- diphtheriods
- Corynebacterium spp.
- Bacillus spp.
- Propionibacterium spp.
- coagulase-negative staphylococci (including: Staphylococcus epidermidis)
- viridans group streptococci
- Aerococcus spp.
- Micrococcus spp.
diagnosed after pt 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
- A List of common commensals can be found on Regional Server: \\ad.wrha.mb.ca\WRHA\REGIONWRHA\SHARED\ICU_DATA_COLLECTION\documents\List of Common Comensals CDC Jan 2013
- Template:Discussion let's check that list and make sure it is consistent with what we have in Common skin commensal; once it is, let's delete the file and if anything only add a link to the CDC version.
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
- Must also code the organism.
Related CCI Codes
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