Environmental Impact of a Direct Laryngoscopy: Opportunities for Pollution Mitigation.

OBJECTIVE: To quantify the environmental impact of standard direct laryngoscopy surgery and model the environmental benefit of three feasible alternative scenarios that meet safe decontamination reprocessing requirements. STUDY DESIGN: This is a life cycle assessment (LCA) modeling study. SETTING: Yale-New Haven Hospital (YNHH), a 1541-bed tertiary medical center in New Haven, Connecticut, USA. METHODS: We performed cradle-to-grave LCA of DLS at Yale New Haven Hospital in 2022, including global warming potential (GWP), water consumption, and fine particulate matter formation. Three alternative scenarios were modeled: disinfecting surgical tools using high-level disinfection rather than steam sterilization, substituting non-sterile for sterile gloves and gowns; and reducing surgical towel and drape sizes by 30%. RESULTS: Changes in disinfection practices would decrease procedure GWP by 11% in each environmental impact category. Substituting non-sterile gowns and gloves reduced GWP by 15%, with nominal changes to water consumption. Linen size reduction resulted in 28% less procedure-related water consumption. Together, a nearly 30% reduction across all environmental impact categories could be achieved. CONCLUSIONS: Not exceeding minimum Center for Disease Control (CDC) decontamination standards for reusable devices and optimizing non-sterile consumable materials could dramatically reduce healthcare-associated emissions without compromising safety, thereby minimizing the negative consequences of hospital operations to environmental and human health. Findings extend to other non-sterile surgical procedures. LEVEL OF EVIDENCE: NA Laryngoscope, 134:3206-3214, 2024.

Hand Hygiene among Anesthesiologists and Microorganisms Contamination in Anesthesia Environments: A Single-Center Observational Study.

Objective: To investigate the baseline levels of microorganisms' growth on the hands of anesthesiologists and in the anesthesia environment at a cancer hospital. Methods: This study performed in nine operating rooms and among 25 anesthesiologists at a cancer hospital. Sampling of the hands of anesthesiologists and the anesthesia environment was performed at a ready-to-use operating room before patient contact began and after decontamination. Results: Microorganisms' growth results showed that 20% (5/25) of anesthesiologists' hands carried microorganisms (> 10 CFU/cm 2) before patient contact began. Female anesthesiologists performed hand hygiene better than did their male counterparts, with fewer CFUs ( P = 0.0069) and fewer species ( P = 0.0202). Our study also found that 55.6% (5/9) of ready-to-use operating rooms carried microorganisms (> 5 CFU/cm 2). Microorganisms regrowth began quickly (1 hour) after disinfection, and increased gradually over time, reaching the threshold at 4 hours after disinfection. Staphylococcus aureus was isolated from the hands of 20% (5/25) of anesthesiologists and 33.3% (3/9) of operating rooms. Conclusion: Our study indicates that male anesthesiologists need to pay more attention to the standard operating procedures and effect evaluation of hand hygiene, daily cleaning rate of the operating room may be insufficient, and we would suggest that there should be a repeat cleaning every four hours.

Lavagem, preparo e esterilização de materiais / Lavado, preparación y esterilización de materiales / Washing, preparation and sterilization of materials

Esta Norma Técnica tem por objetivo estabelecer os critérios para lavagem, preparo e esterilização de vidrarias e materiais utilizados nos processos de manipulação e controle da qualidade do leite humano ordenhado, visando a garantia da qualidade em Bancos de Leite Humano e Postos de Coleta de Leite Humano e sua certificação.

Esta Norma Técnica tiene por objetivo establecer los criterios de lavado, preparación y esterilización de la vidriería y materiales utilizados en los procesos de manipulación y control de calidad de la leche humana extraída, con el fin de asegurar la calidad en los Bancos de Leche Humana y Centros de Recolección de Leche Humana y su certificación.

Higiene e conduta: acompanhantes e visitantes / Hygiene and conduct: companions and visitors

Esta Norma Técnica tem por objetivo estabelecer as condições de higiene e conduta de acompanhantes das usuárias e visitantes em Bancos de Leite Humano e em Postos de Coleta de Leite Humano, visando a garantia da qualidade nestes serviços e sua certificação.

Strategies to ensure efficient laboratory functioning while navigating through the COVID-19 crisis in developing countries: An early experience from a tertiary care centre in India.

BACKGROUND: The coronavirus disease 2019 (COVID 19) is a zoonotic viral infection that originated in Wuhan, China, in December 2019. It was declared a pandemic by the World Health Organization shortly thereafter. This pandemic is going to have a lasting impact on the functioning of pathology laboratories due to the frequent handling of potentially infectious samples by the laboratory personnel. To deal with this unprecedented situation, various national and international guidelines have been put forward outlining the precautions to be taken during sample processing from a potentially infectious patient. PURPOSE: Most of these guidelines are centered around laboratories that are a part of designated COVID 19 hospitals. However, proper protocols need to be in place in all laboratories, irrespective of whether they are a part of COVID 19 hospital or not as this would greatly reduce the risk of exposure of laboratory/hospital personnel. As part of a laboratory associated with a rural cancer hospital which is not a dedicated COVID 19 hospital, we aim to present our institute's experience in handling pathology specimens during the COVID 19 era. CONCLUSION: We hope this will address the concerns of small to medium sized laboratories and help them build an effective strategy required for protecting the laboratory personnel from risk of exposure and also ensure smooth and optimum functioning of the laboratory services.

The need for participation in the development and critical review of recommendations for infection control policies involving vascular ultrasound.

Recently reported guidelines from the Society of Diagnostic Medical Sonography regarding disinfection of ultrasound probes and infection control policies for ultrasound procedures conflict with accepted clinical norms in vein practices and recommendations from the American Institute for Ultrasound in Medicine. We have provided a review of these conflicting policy recommendations and new proposed practice recommendations and a call for physicians who perform ultrasound-guided procedures to be involved in the process of development and critical review of societal recommendations.

An evaluation of cleaning practices at a teaching hospital.

BACKGROUND: The COVID-19 outbreak has highlighted the role of hospital-acquired infections in spreading epidemics. Adequately cleaning surfaces in patient rooms is an essential part of this fight to reduce the spread. Traditional audits, however, are insufficient. This study assesses surface cleaning practices using ultravoilet (UV) marker technology and the extent to which this technology can help improve cleaning audits and practices. METHODS: One hundred and forty-four audits (1,235 surfaces) were retrieved. UV-marker cleaning audits conducted at a major teaching hospital in 2018 after implementing a new cleaning protocol. In addition, semi-structured interviews were conducted with cleaning staff and supervisors. RESULTS: On average, 63% of surfaces were appropriately cleaned. Toilet handles (80%) and toilet seats underside (83%) scored highest while main room sink fixtures (54%), light switch (55%), and bedrails (56%) scored lowest. Training, staffing and time constraints may play a role in low cleaning rates. DISCUSSION: The high-touch patient surfaces in the bedroom remain neglected and a potential source of infections. UV marker audits provided an objective measure of cleaning practices that managers and staff were unaware of. CONCLUSIONS: UV-markers audits can play a key role in revealing deficiencies in cleaning practices and help in raising awareness of these deficiencies and improving cleaning practices.

Locally produced personal protective equipment can offer hospital staff protection against Covid-19 if combined with surgical masks and rigorous personal protective equipment cleaning routine.

Locally made, washable and reusable personal protective equipment (PPE), used in combination with N95 masks that were reused safely, has proven to be a viable alternative to disposable gowns and caps for hospital staff in low- and middle-income countries. Muhimbili University Hospital's children's cancer ward in Dar es Salaam, Tanzania, developed locally made PPE and created rigorous cleaning and disinfecting protocols, when the daily use of imported, disposable materials were not an option. These items continue to protect staff, children and parents. The novel PPE approach was able to prevent staff from becoming infected during the pandemic despite the fact that several parents, and subsequently their children, became infected with Covid-19 during cancer treatment at the facility.

Construction and validation of checklist for disinfecting ambulances to transport Covid-19 patients / Construcción y validación de checklist para la desinfección de ambulancias para el transporte de pacientes Covid-19 / Construção e validação de checklist para desinfecção de ambulâncias para transporte de pacientes Covid-19

ABSTRACT Objective To build and validate a checklist for disinfecting ambulances transporting patients with Covid-19. Method Methodological study composed by the construction of a checklist and validation by 42 professionals, of which 35 professionals had expertise in patient transport/transfer and seven in hospital infection control. The item with a minimum agreement of 80% was considered valid, based on the Content Validation Index and binomial test. Results The checklist had the steps performed for terminal disinfection of ambulances. It had 54 items, which included the personal protective equipment and used materials, disinfection of the driver's cabin, equipment, and the patient care cabin. The minimum agreement obtained was 85% and the mean of the Content Validation Index was 0.96. Conclusion The checklist was considered valid in terms of content and can be used to disinfect ambulances transporting patients with Covid-19.

RESUMEN Objetivo Construir y validar checklist para desinfectar ambulancias que transportan pacientes con Covid-19. Método Un estudio metodológico compuesto por la construcción de un checklist y validación por 42 profesionales, de los cuales 35 profesionales tenían experiencia en transporte/transferencia de pacientes y siete en control de infecciones hospitalarias. El ítem con un acuerdo mínimo del 80% se consideró válido, según el índice de validación de contenido y la prueba binomial. Resultados El checklist tenía los pasos a seguir para la desinfección terminal de ambulancias. Tenía 54 artículos, que incluían el equipo de protección individual y los materiales utilizados, la desinfección de la cabina del conductor, el equipo y la cabina de atención al paciente. El acuerdo mínimo obtenido fue del 85% y el promedio del Índice de Validación de Contenido fue de 0,96. Conclusión El checklist se consideró válido en términos de contenido y puede usarse para desinfectar ambulancias que transportan pacientes con Covid-19.

RESUMO Objetivo Construir e validar checklist para desinfecção de ambulâncias que transportam pacientes com Covid-19. Método Estudo metodológico composto pela construção de checklist e validação por 42 profissionais, dos quais 35 profissionais possuíam expertise em transporte/transferência de pacientes e sete em controle de infecção hospitalar. Foi considerado válido o item com concordância mínima de 80%, a partir do Índice de Validação de Conteúdo e teste binomial. Resultados O checklist possuiu as etapas que devem ser realizadas para desinfecção terminal das ambulâncias. Possuiu 54 itens, que contemplaram os equipamentos de proteção individual e materiais utilizados, desinfecção da cabine do condutor, dos equipamentos e da cabine de atendimento ao paciente. A concordância mínima obtida foi de 85% e a média do Índice de Validação de Conteúdo foi de 0,96. Conclusão O checklist foi considerado válido quanto ao conteúdo e pode ser utilizado para desinfecção das ambulâncias que transportam pacientes com Covid-19.

Tecnologia Educacional sobre limpeza e desinfecção de brinquedos para ambientes escolares frente à pandemia da COVID-19 / Educational technology on cleaning and disinfecting toys for school environments in the face of the COVID-19 pandemic / Tecnología educativa en limpieza y desinfección de juguetes para ambientes escolares ante la pandemia COVID-19

Objetivo: descrever a construção e validação do conteúdo e aparência de tecnologia educacional sobre limpeza e desinfecção de brinquedos para ambientes escolares e creches, no contexto de pandemia do coronavírus. Método: Pesquisa metodológica de validação, orientada pela teoria da Psicometria. Realizada em três fases: (1) revisão bibliográfica (2) elaboração da tecnologia educacional (3) avaliação, aperfeiçoamento e validação do conteúdo e aparência da cartilha. Participaram 20 juízes e 16 profissionais da educação infantil. Para garantir a validação, consideramos o índice de validade de conteúdo de, no mínimo, 0,8. Os dados foram tratados no software Statistical Package for Social Science e submetidos à análise descritiva de distribuição de frequências. Resultados: O índice de validade de conteúdo global foi de 0,99 para juízes e 0,96 para o público-alvo. Os domínios da cartilha apresentaram índice de validade de conteúdo superior a 0,8 sugerindo que é um material representativo, quanto à aparência e conteúdo. Conclusão e implicações para prática: A cartilha digital pode ser considerada, no contexto das atividades educativas em enfermagem, instrumento capaz de favorecer orientações claras e confiáveis sobre a limpeza e desinfecção de brinquedos, para ambientes escolares, no cenário de pandemia do novo coronavírus.

Objective: to describe the construction and validation, of content and appearance, of an educational technology on cleaning and disinfecting toys for school environments and daycare centers in the context of the coronavirus pandemic. Method: Validation methodological research, guided by the Psychometry theory. Three phases were carried out, namely: (1) bibliographic review, (2) elaboration of the educational technology, and (3) evaluation, improvement and validation of the content and appearance of the booklet. The participants were 20 evaluators and 16 professionals specialized in early childhood education. To ensure validation, we consider a Content Validity Index of at least 0.8. The data were treated using the Statistical Package for Social Science software and submitted to descriptive analysis of frequency distribution. Results: The global improvement and validation of the content was 0.99 for the evaluators and 0.96 for the target audience. The domains of the booklet showed improvement and content validation above 0.8, suggesting that this is a representative material, in terms of appearance and content. Conclusion and implications for the practice: In the context of educational activities in Nursing, the digital booklet can be considered as an instrument capable of favoring clear and reliable guidance on cleaning and disinfecting toys for school environments in the coronavirus pandemic scenario

Objetivo: describir la construcción y validación, en términos de contenido y apariencia, de tecnología educativa sobre la limpieza y desinfección de juguetes para ambientes escolares y guarderías en el contexto de la pandemia por coronavirus. Método: investigación metodológica de validación, guiada por la teoría de la Psicometría. Se realizó en tres etapas, a saber: (1) revisión bibliográfica, (2) elaboración de la tecnología educativa, y (3) evaluación, mejora y validación del contenido y la apariencia del folleto. Participaron 20 jueces y 16 profesionales de educación infantil. Para garantizar la validación, consideramos un Índice de Validez de Contenido mínimo de 0,8. Los datos se trataron en el software Statistical Package for Social Science y fueron sometidos a análisis descriptivo de distribución de frecuencias. Resultados: El Índice de Calidez de Contenido global fue de 0,99 para los jueces y de 0,96 para el público objetivo. Los dominios del cuadernillo presentaron un Índice de Validez de Contenido superior a 0.8, lo que sugiere que se trata de un material representativo, en términos de apariencia y contenido. Conclusión e implicaciones para la práctica: En el contexto de las actividades educativas en enfermería, el folleto digital puede considerarse como instrumento capaz de favorecer una orientación clara y confiable sobre la limpieza y desinfección de juguetes para ambientes escolares en el escenario pandémico del coronavirus

Predicting airborne coronavirus inactivation by far-UVC in populated rooms using a high-fidelity coupled radiation-CFD model.

There are increased risks of contracting COVID-19 in hospitals and long-term care facilities, particularly for vulnerable groups. In these environments aerosolised coronavirus released through breathing increases the chance of spreading the disease. To reduce aerosol transmissions, the use of low dose far-UVC lighting to disinfect in-room air has been proposed. Unlike typical UVC, which has been used to kill microorganisms for decades but is carcinogenic and cataractogenic, recent evidence has shown that far-UVC is safe to use around humans. A high-fidelity, fully-coupled radiation transport and fluid dynamics model has been developed to quantify disinfection rates within a typical ventilated room. The model shows that disinfection rates are increased by a further 50-85% when using far-UVC within currently recommended exposure levels compared to the room's  ventilation alone. With these magnitudes of reduction, far-UVC lighting could be employed to mitigate SARS-CoV-2 transmission before the onset of future waves, or the start of winter when risks of infection are higher. This is particularly significant in poorly-ventilated spaces where other means of reduction are not practical, in addition social distancing can be reduced without increasing the risk.

Environmental Disinfection of a Dental Clinic during the Covid-19 Pandemic: A Narrative Insight.

BACKGROUND: The control of biological hazard risk in health care and dental clinic environments represents a critical point in relation to the Covid-19 infection outbreak and international public health emergency. The purpose of the present review was to evaluate the scientific literature on the no-touch disinfection procedures in dental clinics aiming to limit transmission via airborne particles or fomites using no-touch procedures for environmental decontamination of dental clinics. METHODS: An electronic database literature search was performed to retrieve research papers about Covid-19 and no-touch disinfection topics including full-length articles, editorials, commentaries, and outbreak studies. A total of 86 papers were retrieved by the electronic research. RESULTS: No clinical article about the decontamination of a dental clinic during the Covid-19 pandemic was detected. About the topic of hospital decontamination, we found different no-touch disinfection procedures used in hospital against highly resistant organisms, but no data were found in the search for such procedures with respect to SARS-CoV-2: (1) aerosolized hydrogen peroxide, (2) H2O2 vapor, (3) ultraviolet C light, (4) pulsed xenon, and (5) gaseous ozone. One paper was retrieved concerning SARS-CoV-2; 32 documents focused on SARS and MERS. The cleaning and disinfection protocol of health care and dental clinic environment surfaces are essential elements of infection prevention programs, especially during the SARS-CoV-2 pandemic. CONCLUSION: The decontamination technique that best suits the needs of the dental clinic is peroxide and hypochlorous which can be sprayed via a device at high turbine speed with the ability of producing small aerosol particles, recommendable also for their low cost.

Particle removal from air by face masks made from Sterilization Wraps: Effectiveness and Reusability.

Wearing face masks is highly recommended to prevent SARS-CoV-2 transmission in health care workers and for the general public. The demand for high quality face masks has seen an upsurge in the recent times, leading to exploration of alternative economic and easily available options, without compromising on the quality. Particle removal from air in terms of capture efficiency of the filter media or the face mask is a crucial parameter for testing and quality assurance. Short-term reusability of the face masks is also an important aspect as the demand for masks will potentially outstrip the supply in future. Sterilization Wraps, which are used to wrap sterile surgical instruments, have shown a promising performance in terms of removal of particles from air. In this study, we evaluate the particle filtration characteristics of face masks made of 2 different metric weights [45 and 60 gram per square metre (GSM)] respectively, using locally available Sterilization Wraps. The aerosol filtration characteristics were also studied after sterilisation by different techniques such as heat with 50% humidity (thermal treatment), ethylene oxide (ETO), steam and radiation dose of 30kGy. We found that 60 GSM face mask had particle capture efficiency of 94% for total particles greater than 0.3 microns and this capture efficiency was maintained even after sterilisation with ETO and thermal treatment. The cost of producing these masks was 30 US cents/mask at our institute. Our study suggests that sterilization wrap material made of non-woven polypropylene spunbond-meltblown-spunbond (SMS) fibres could be an appropriate readily available inexpensive material for making face masks or N95 respirators.

[Reducing Abnormal Culture Rates of Digestive Endoscopy in a Health Management Center].

BACKGROUND: Endoscopic evaluation plays an indispensable role in medical treatments designed to prevent, diagnose, and cure gastrointestinal disease. Surveillance culture monitoring may be useful in monitoring the outcome of reprocessing. PURPOSE: In this project, microbiologic surveillance cultures were employed to improve the quality of flexible endoscope disinfection. RESOLUTION: This project, implemented from February 1st, 2018 to February 28th, 2019, used several approaches to improve the positive culture rate. We redesigned and implemented the standard operating procedures for endoscope reprocessing, established an in-service training course, provided education materials on reprocessing, and installed a storage cabinet that custom-built to accommodate the endoscope. RESULTS: The positive culture rate was reduced from 5.8% to 0%. CONCLUSIONS: Endoscopy culturing is a useful method to assess the effectiveness of standard reprocessing procedures. The development of guidelines and skill practices should follow current, evidence-based practice and infection prevention principles, and related documents should be organized. We suggest regularly deploying quality-improvement techniques to improve performance and service delivery.

A review of studies on the COVID-19 epidemic crisis disease with a preventive approach.

BACKGROUND: COVID-19 is a highly contagious acute respiratory syndrome and has been declared a pandemic in more than 209 countries worldwide. At the time of writing, no preventive vaccine has been developed and tested in the community. This study was conducted to review studies aimed at preventing the spread of the coronavirus worldwide. METHODS: This study was a review of the evidence-based literature and was conducted by searching databases, including Google Scholar, PubMed, and ScienceDirect, until April 2020. The search was performed based on keywords including "coronavirus", "COVID-19", and "prevention". The list of references in the final studies has also been re-reviewed to find articles that might not have been obtained through the search. The guidelines published by trustworthy organizations such as the World Health Organization and Center for Disease Control have been used in this study. CONCLUSION: So far, no vaccine or definitive treatment for COVID-19 has been invented, and the disease has become a pandemic. Therefore, observation of hand hygiene, disinfection of high-touch surfaces, observation of social distance, and lack of presence in public places are recommended as preventive measures. Moreover, to control the situation and to reduce the incidence of the virus, some of the measures taken by the decision-making bodies and the guidelines of the deterrent institutions to strengthen telecommuting of employees and reduce the presence of people in the community and prevent unnecessary activities, are very important.

Duodenoscope as a Vector for Transmission.

Elevator-based endoscope-related infections from patient cross-contamination is a multifactorial problem related to device design, maintenance, and function, with additional risk incurred from a high-level disinfection process that lacks quality controls. This article reviews the historical context for these outbreaks, technical aspects of scope design contributing to this risk, and innovations in endoscope technology that have the potential to overcome these shortcomings. Also reviewed are interim solutions and the data that support use of some of these interventions. Still needed are a validated manufacturer-recommended schedule for routine duodenoscope and echoendoscope maintenance with reprocessing protocols that can be implemented in endoscopy units.

Quality Systems Approach for Endoscope Reprocessing: You Don't Know What You Don't Know!

Several factors affect the efficacy of endoscope reprocessing, including human factors, inadequate cleaning, simethicone residuals, moisture in channels during storage, and biofilm or buildup biofilm formation. These factors all contribute to contamination of patient-ready endoscopes that may contribute to transmission of microorganisms resulting in infection and/or colonization. This article reviews monitoring as part of a quality management system that includes manual cleaning, dry storage, and culture to detect endoscope contamination. The published data for rapid tests that detect organic residuals and adenosine triphosphate to monitor manual cleaning are reviewed.

Recent Actions by the US Food and Drug Administration: Reducing the Risk of Infection from Reprocessed Duodenoscopes.

In addition to technological advancements, engagement and collaboration among the wider community of stakeholders will be beneficial toward reducing the risk of infection from reprocessed duodenoscopes. Such a community can raise awareness of the importance of duodenoscope cleaning, work to improve reprocessing training, identify the most pressing unanswered questions that merit further research, and develop tools that can be used by health care facilities to improve the quality of reprocessing at their sites. The Food and Drug Administration looks forward to working with the community to further reduce the risk of infections from reprocessed duodenoscopes.

Failure to eradicate non-tuberculous mycobacteria upon disinfection of heater-cooler units: results of a microbiological investigation in northwestern Italy.

BACKGROUND: Heater-cooler units (HCUs) used during cardiopulmonary bypass may become colonized with non-tuberculous mycobacteria (NTM), including Mycobacterium chimaera. Recently, a worldwide investigation conducted in hospitalized infected patients has detected M. chimaera in several Stockert 3T HCUs manufactured by LivaNova. AIM: Microbiological surveillance on Stockert 3T (LivaNova) and Maquet HCU40 (Getinge) devices as well as an evaluation of the efficacy of their recommended decontamination protocols. METHODS: A total of 308 water samples were collected from 29 HCUs: 264 samples were collected from 17 Stockert 3T HCUs and 44 samples from 12 Maquet HCU40 devices. Samples were tested for total viable counts (TVCs) at both 22 and 36°C, Pseudomonas aeruginosa, coliform bacteria, and NTM. The microbiological surveillance began in June 2017 and ran until October 2019. FINDINGS: A total of 308 HCU water samples were analysed, 65.5% of which yielded NTM. The most frequently colonized device with NTM was the Stockert 3T (88.2%), with a frequency of positive samples of 59.5% (157/264). The Maquet HCU40 devices less frequently yielded NTM (33.3%), with a frequency of positive water samples of 13.6% (6/44). Disinfection procedures were effective in reducing TVCs of bacteria with the exception of NTM species. NTM were detected in both pre-disinfection (50.1%) and post-disinfection (55.7%) samples, and no significant association was found between disinfection and NTM results both in Stockert 3T and Maquet HCU40 devices. CONCLUSION: This study suggests that manufacturers' procedures for disinfection are ineffective and/or inadequate. Until effective disinfection protocols become available, the only way to minimize the risk of NTM contamination is to closely monitor the water quality in the HCU, keep it as clean as possible, and treat it like any other biohazardous material.

Resuming elective hip and knee arthroplasty after the first phase of the SARS-CoV-2 pandemic: the European Hip Society and European Knee Associates recommendations.

PURPOSE: The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. METHODS: A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. RESULTS: The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. CONCLUSION: Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe return.