Zusammenfassung Ziel Darstellung von Studien zur psychischen Belastung von medizinischem Personal unter Bedingungen der COVID-19-Pandemie. Methodik PubMed-gestützte Suche mit den Stichworten COVID 19“, „stress“, „mental health“, „healthcare worker“, „staff“, „psychiatry“. Eingeschlossen wurden quantitative Studien, (inkl. „Letter to the editor“) zur Belastung des medizinischen Personals im Zeitraum von Januar bis März 2020. Ergebnisse Es wurden 14 Studien mit Klinikpersonal aus Infektionsabteilungen, Abteilungen für Fieberkranke, Abteilungen der Inneren Medizin inklusive Intensivstationen sowie der Chirurgie und Psychiatrie identifiziert. Am häufigsten wurden der Patient Health Questionnaire-9 (PHQ-9), die Self-rating-Anxiety Scale (SAS) und die Impact of Event Scale (IES-R) verwendet. Die Stichprobengröße schwankte zwischen 37 und 1257 Personen des überwiegend pflegerischen und ärztlichen Personals. Der Anteil an COVID-19-nahen Tätigkeiten schwankte zwischen 7,5 % und 100 %. Es wurde eine erhebliche Belastung durch Stresserleben, depressive und ängstliche Symptome berichtet. Schwere Ausprägungsgrade fanden sich bei 2,2–14,5 % der Befragten. Die Ausprägung der psychischen Symptomatik wurde beeinflusst durch Alter, Geschlecht, Berufsgruppe, Fachrichtung, Art der Tätigkeit und die Nähe zu COVID-19-Patienten. Als Mediatorvariablen wurden das Personalmanagement, die präventive Intervention, die Resilienz und vorhandene soziale Unterstützung angesehen. Schlussfolgerung Angesichts der Häufigkeit psychischer Symptome bei medizinischem Personal erscheinen begleitende psychiatrisch-psychotherapeutisch informierte Interventionen notwendig, um eine Bewältigung zu unterstützen. Eine schnell einsetzende Forschung ist in diesem Bereich wünschenswert.

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The purpose of this study was to assess the impact of the COVID-19 pandemic on orthopedic and trauma surgery in private practices and hospitals in Germany. Design In this cross-sectional study, an online-based anonymous survey was conducted from April 2th to April 16 th 2020. Setting The survey was conducted among 15.0000 of 18.000 orthopedic and trauma surgeons in Germany, both in private practices and hospitals. Participants All members of the German Society of Orthopedic and Trauma Surgery (DGOU) and the Professional Association for Orthopedic and Trauma Surgery (BVOU). were invited by email to participate in the survey. Main outcome measures Out of 50 questions 42 were designed to enquire a certain dimension of the pandemic impact and contribute to one of six indices, namely "Preparedness", "Resources", "Reduction", "Informedness", "Concern", and "Depletion". Data was analyzed in multiple stepwise regression, aiming to identify those factors that independently influenced the indices. Results 858 orthopedic and trauma surgeons participated in the survey throughout Germany. In the multiple regression analysis, being employed at a hospital was identified as an independent

Background In spine surgery, surgical site infection (SSI) is one of the main perioperative complications and is associated with a higher patient morbidity and longer patient hospitalization. Most factors associated with SSI are connected with asepsis during the surgical procedure and thus with contamination of implants and instruments used which can be caused by pre- and intraoperative factors. In this systematic review we evaluate the current literature on these causes and discuss possible solutions to avoid implant and instrument contamination. Methods A systematic literature search of PubMed addressing implant, instrument and tray contamination in orthopaedic and spinal surgery from 2001 to 2019 was conducted following the PRISMA guidelines. All studies regarding implant and instrument contamination in orthopaedic surgery published in English language were included. Results Thirty-five studies were eligible for inclusion and were divided into pre- and intraoperative causes for implant and instrument contamination. Multiple studies showed that reprocessing of medical devices for surgery may be insufficient and lead to surgical site contamination. Regarding intraoperative causes, contamination of gloves and gowns as well as contamination via air are the most striking factors contributing to microbial contamination. Conclusions Our systematic literature review shows that multiple factors can lead to instrument or implant contamination. Intraoperative causes of contamination can be avoided by implementing behavior such as changing gloves right before handling an implant and reducing the instruments’ intraoperative exposure to air. In avoidance of preoperative contamination, there still is a lack of convincing evidence for the use of single-use implants in orthopaedic surgery.

Zusammenfassung Ziel Bisher gibt es keine Studien zu den Erfahrungen und zum Belastungserleben bei Pandemien von ambulant tätigem medizinischem Personal. Es sollen die Auswirkungen der COVID-19-Pandemie im Frühjahr 2020 auf niedergelassene Neurologen und Psychiater untersucht werden. Methode Es erfolgte eine E-Mail- und Fax-gestützte Befragung von 2072 niedergelassenen Psychiatern und Neurologen mit Fragen zur subjektiven Belastung, dem Erleben von realer Gefährdung und besonderen Bedingungen der Praxisorganisation. Ergebnisse Der Rücklauf betrug n = 396 (19 %). Mehr als 60 % der Ärzte fühlen sich stark bis sehr stark eingeschränkt. Mehr als ein Drittel machen sich große und sehr große Sorgen und sehen zudem eine hohe oder sehr hohe Gefahr einer eigenen Infektion. Für ein weiteres Drittel trifft das eher nicht zu. 91 % hatte in der letzten Arbeitswoche März keinen wissentlichen Kontakt zu COVID-19-positiv Getesteten. Ein Drittel fühlt sich persönlich finanziell bedroht und Umsatzverluste der Praxis werden erwartet. 18 % der Befragten macht die Corona-Pandemie große bis sehr große Angst. Schlafstörungen, die nahezu jede Nacht auftreten, sind mit 9 % selten. Schlussfolgerung Ambulant tätige neuropsychiatrische Fachärzte berichten erhebliche Einschränkungen und Belastungen sowie eine Reihe von negativen Konsequenzen.