Dealing with the COVID-19 pandemic in orthopaedics: experiences and procedure in Germany

Abstract

Aims The worldwide COVID-19 pandemic is directly impacting the field of orthopaedic surgery and traumatology with postponed operations, changed status of planned elective surgeries and acute emergencies in patients with unknown infection status. To this point, Germany's COVID-19 infection numbers and death rate have been lower than those of many other nations. Methods This article summarizes the current regimen used in the field of orthopaedics in Germany during the COVID-19 pandemic. Internal university clinic guidelines, latest research results, expert consensus, and clinical experiences were combined in this article guideline. Results Every patient, with and without symptoms, should be screened for COVID-19 before hospital admission. Patients should be assigned to three groups (infection status unknown, confirmed, or negative). Patients with unknown infection status should be considered as infectious. Dependent of the infection status and acuity of the symptoms, patients are assigned to a COVID-19-free or affected zone of the hospital. Isolation, hand hygiene, and personal protective equipment is essential. Hospital personnel directly involved in the care of COVID-19 patients should be tested on a weekly basis independently of the presence of clinical symptoms, staff in the COVID-19-free zone on a biweekly basis. Class 1a operation rooms with laminar air flow and negative pressure are preferred for surgery in COVID-19 patients. Electrocautery should only be utilized with a smoke suction system. In cases of unavoidable elective surgery, a self-imposed quarantine of 14 days is recommended prior to hospital admission. Conclusion During the current COVID-19 pandemic, orthopaedic patients admitted to the hospital should be treated based on an interdisciplinary algorithm, strictly separating infectious and non-infectious cases. Cite this article: Bone Joint Open 2020;1-6:309–315.

Surgical site infections: guidance for elective surgery during the SARS-CoV-2 pandemic – international recommendations and clinical experience

“…If oxygen saturation fell < 94%, supplemental oxygen therapy was started. Advanced monitoring was started if the patient’s general condition deteriorated, particularly if there was somnolence, delirium, dyspnoea or reduction in oxygen saturation, as recommended by Mueller et al [ 32 ].…”

“…SARS-CoV-2 positive patients need to be transferred to a black area. In case-positive hospitals which do not possess the potential of spatial separation into these three risk-categories, patients need to be assigned and transferred to a regional tertiary hospital which is able to provide spatial separation [ 32 , 33 ]. Diagnostic-based screening for potentially SARS-CoV-2 positive patients depends on the availability of appropriate testing.…”

“…In case-positive hospitals which do not possess the potential of spatial separation into these three risk-categories, patients need to be assigned and transferred to a regional tertiary hospital which is able to provide spatial separation [ 32 , 33 ].…”

COVID-19 consent and return to elective orthopaedic surgery

“…It is known that asymptomatic carriers have similar viral loads in their upper respiratory tract to those of symptomatic patients, and can therefore spread COVID-19 with similar virulence, so there is an argument for the regular testing of hospital medical staff working across such sites to confirm their negative status rather than rely just on presence of symptoms (fever, cough, anosmia) in order to maintain safety. 12 Nonetheless, the very low rate of COVID-19 contraction on the elective site with orthopaedic surgery (0.9%) and with soft-tissue surgery (0%) indicated that, practically, this risk may be very low. Thirdly, we acknowledge that only relying only on positive swabs postoperatively to count COVID-19-positive cases postoperatively is a methodological flaw.…”

The rate of patient deferral and barriers to going forward with elective orthopaedic surgery during the COVID-19 pandemic

“…COVID-19-free elective patient pathways and precautions continue to evolve with time. 20 , 22 Mueller et al 23 suggested a 14-day isolation period preoperatively with a COVD-19 test immediately prior to surgery, which has been shown to be associated with a low probability of death from COVID-19 postoperatively when the test was negative (i.e. the false negative rate was low).…”