Mohana Rajmokan - Academia.edu (original) (raw)
Address: Brisbane, Queensland, Australia
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Papers by Mohana Rajmokan
Journal of Hospital Infection, 2011
Reporting of hospital adverse event data is becoming increasingly mandated and this has motivated... more Reporting of hospital adverse event data is becoming increasingly mandated and this has motivated work on methods for the analysis and display of these data for groups of institutions. Currently, the method preferred by many workers is the funnel plot. Often, indirect standardisation is employed to produce these plots. It appears that, when used to display binary data such as surgical site infection or mortality data, the method is satisfactory. Increasingly, these data are risk-adjusted. However, risk adjustment of these data usually involves individual patients undergoing the same or similar procedures and the method does not appear to mislead. However, when dealing with count data such as bacteraemias it appears that this method can mislead, particularly where methods for risk adjustment of these data are used. Information about the hospitals or units of interest rather than individual patients is employed. For example, one hospital may have plastic and cardiac surgery units in w...
Background: Surgical site infections following coronary artery bypass graft (CABG) procedures pos... more Background: Surgical site infections following coronary artery bypass graft (CABG) procedures pose substantial burden on patients and healthcare systems. This study aims to describe the incidence of surgical site infections and causative pathogens following CABG surgery over the period 2003-2012, and to identify risk factors for complex sternal site infections. Methods: Routine computerised surveillance data were collected from three public hospitals in Queensland, Australia in which CABG surgery was performed between 2003 and 2012. Surgical site infection rates were calculated by types of infection (superficial/complex) and incision sites (sternal/harvest sites). Patient and procedural characteristics were evaluated as risk factors for complex sternal site infections using a logistic regression model. Results: There were 1,702 surgical site infections (518 at sternal sites and 1,184 at harvest sites) following 14,546 CABG procedures performed. Among 732 pathogens isolated, Methicillin-sensitive Staphylococcus aureus accounted for 28.3% of the isolates, Pseudomonas aeruginosa 18.3%, methicillin-resistant Staphylococcus aureus 14.6%, and Enterobacter species 6.7%. Proportions of Gram-negative bacteria elevated from 37.8% in 2003 to 61.8% in 2009, followed by a reduction to 42.4% in 2012. Crude rates of complex sternal site infections increased over the reporting period, ranging from 0.7% in 2004 to 2.6% in 2011. Two factors associated with increased risk of complex sternal site infections were identified: patients with an ASA (American Society of Anaesthesiologists) score of 4 or 5 (reference score of 3, OR 1.83, 95% CI 1.36-2.47) and absence of documentation of antibiotic prophylaxis (OR 2.03, 95% CI 1.12-3.69). Conclusions: Compared with previous studies, our data indicate the importance of Gram-negative organisms as causative agents for surgical site infections following CABG surgery. An increase in complex sternal site infection rates can be partially explained by the increasing proportion of patients with more severe underlying disease.
Journal of Hospital Infection, 2011
Reporting of hospital adverse event data is becoming increasingly mandated and this has motivated... more Reporting of hospital adverse event data is becoming increasingly mandated and this has motivated work on methods for the analysis and display of these data for groups of institutions. Currently, the method preferred by many workers is the funnel plot. Often, indirect standardisation is employed to produce these plots. It appears that, when used to display binary data such as surgical site infection or mortality data, the method is satisfactory. Increasingly, these data are risk-adjusted. However, risk adjustment of these data usually involves individual patients undergoing the same or similar procedures and the method does not appear to mislead. However, when dealing with count data such as bacteraemias it appears that this method can mislead, particularly where methods for risk adjustment of these data are used. Information about the hospitals or units of interest rather than individual patients is employed. For example, one hospital may have plastic and cardiac surgery units in w...
Background: Surgical site infections following coronary artery bypass graft (CABG) procedures pos... more Background: Surgical site infections following coronary artery bypass graft (CABG) procedures pose substantial burden on patients and healthcare systems. This study aims to describe the incidence of surgical site infections and causative pathogens following CABG surgery over the period 2003-2012, and to identify risk factors for complex sternal site infections. Methods: Routine computerised surveillance data were collected from three public hospitals in Queensland, Australia in which CABG surgery was performed between 2003 and 2012. Surgical site infection rates were calculated by types of infection (superficial/complex) and incision sites (sternal/harvest sites). Patient and procedural characteristics were evaluated as risk factors for complex sternal site infections using a logistic regression model. Results: There were 1,702 surgical site infections (518 at sternal sites and 1,184 at harvest sites) following 14,546 CABG procedures performed. Among 732 pathogens isolated, Methicillin-sensitive Staphylococcus aureus accounted for 28.3% of the isolates, Pseudomonas aeruginosa 18.3%, methicillin-resistant Staphylococcus aureus 14.6%, and Enterobacter species 6.7%. Proportions of Gram-negative bacteria elevated from 37.8% in 2003 to 61.8% in 2009, followed by a reduction to 42.4% in 2012. Crude rates of complex sternal site infections increased over the reporting period, ranging from 0.7% in 2004 to 2.6% in 2011. Two factors associated with increased risk of complex sternal site infections were identified: patients with an ASA (American Society of Anaesthesiologists) score of 4 or 5 (reference score of 3, OR 1.83, 95% CI 1.36-2.47) and absence of documentation of antibiotic prophylaxis (OR 2.03, 95% CI 1.12-3.69). Conclusions: Compared with previous studies, our data indicate the importance of Gram-negative organisms as causative agents for surgical site infections following CABG surgery. An increase in complex sternal site infection rates can be partially explained by the increasing proportion of patients with more severe underlying disease.