This is an update for surgeons and surgical PAs:

1. When to Order a Fungal Culture?
2. Using ORs 3 and 4 for "Not-Detected" Patients – Is it safe?

When to Order a Fungal Culture?

Great news! The Surgery Team is thrilled to have a new culture order set when ordering intra-op cultures in Surgery. However, it has created some confusion regarding when to order fungal cultures, especially when ordering aerobic and anaerobic cultures, are fungal cultures necessary? It turns out this may be duplicative and an unnecessary charge. Aerobic cultures already contain a fungal element. Please see the explanation from Dr. Hori:

Unlike anaerobic bacterial cultures that must be ordered and processed in a special way to find these types of organisms, fungal cultures are not absolutely necessary to find yeasts or molds in a clinical specimen. Aerobic bacterial cultures typically pick up yeasts that are in clinical culture specimen and most molds as well. Probably the biggest difference is that if a bacterial culture picks up a yeast or mold and it is not Candida albicans (that can be differentiated by a simple test), a request must be placed to have the yeast or mold further identified. A simple call to the microbiology lab (x5962) can make this happen. Fungal cultures are costly, time consuming, and not overly helpful most of the time. Please think twice before ordering one.

Using ORs 3 and 4 for ‘Not-Detected’ Patients – Is it safe?

Here’s the scenario: You have an add-on or elective case, your patient has been tested for COVID-19, and is "not detected."

The Surgery Charge RN has scheduled your case in OR 3, but there is a COVID patient having surgery next door in OR 4.

--> Is it SAFE for you and your patient to use OR 3?

You might be considering airflow, proper cleaning between cases, and the shared substerile.

Airflow:

• Each OR has its own inflow and outflow pathways for air to enter and exit the OR Suite.
• Air between operating rooms is not shared, nor is it exchanged.
• Each operating room is under positive pressure per regulations, and for infection prevention of the surgical site.

Cleaning Between Cases:

• After the PUI / COVID-19+ patient leaves the OR, we start the clock for 45 minutes to allow sufficient air exchange before cleaning begins.
• The staff who clean the OR wear appropriate PPE to protect themselves and prevent cross-contamination of the department.
• All horizontal and high touch areas are cleaned in the OR and in the sub-sterile room.

A normal between-case cleaning can take around 10 minutes. However, we are very meticulous with the between-case cleaning after a PUI/COVID-19+ procedure, so the between case cleaning takes about 45 minutes.

Here is the Covid-19 Care in the OR workflow and training information for the Perioperative Team. OR cleaning instructions are located on page 17.

The Shared Substerile:

• The substerile room is shared between OR 3 & OR 4, and is where we keep warmed fluids and blankets.
• In order to prevent cross-contamination, the substerile should be used when caring for PUI/Covid-19+ patients.
• If your patient is "not detected" then you have the luxury of leaving the OR to collect warm blankets and fluids from a different warmer without having to worry about cross contamination.
• In order to keep it straight, we have posted this Do Not Enter sign on our sub-sterile doors.

Bottom Line: Yes, you can safely use OR 3 & OR 4 for ‘not detected’ patients, even if there is an ongoing PUI/COVID-19+ procedure next door.

Please don’t hesitate to reach out with any further questions or concerns, contact Stephanie_Lilje@Valleymed.org or 425.228.3440 x5756