Abstract

An aerosol generating procedure (AGP) is a medical procedure that can result in the release of airborne particles (aerosols) from the respiratory tract when treating someone who is suspected or known to be suffering from an infectious agent transmitted wholly or partly by the airborne or droplet route.

This is the list of medical procedures for COVID-19 that have been reported to be aerosol generating and are associated with an increased risk of respiratory transmission:

tracheal intubation and extubation
manual ventilation
tracheotomy or tracheostomy procedures (insertion or removal)
bronchoscopy
dental procedures (using high speed devices, for example ultrasonic scalers/high speed drills
non-invasive ventilation (NIV); Bi-level Positive Airway Pressure Ventilation (BiPAP) and Continuous Positive Airway Pressure Ventilation (CPAP)
high flow nasal oxygen (HFNO)
high frequency oscillatory ventilation (HFOV)
induction of sputum using nebulised saline
respiratory tract suctioning
upper ENT airway procedures that involve respiratory suctioning
upper gastro-intestinal endoscopy where open suction of the upper respiratory tract occurs
high speed cutting in surgery/post-mortem procedures if respiratory tract/paranasal sinuses involved
Certain other procedures or equipment may generate an aerosol from material other than patient secretions but are not considered to represent a significant infectious risk for COVID-19. Procedures in this category include administration of humidified oxygen, administration of Entonox or medication via nebulisation.

The New and Emerging Respiratory Viral Threat Assessment Group (NERVTAG) advised that during nebulisation, the aerosol derives from a non-patient source (the fluid in the nebuliser chamber) and does not carry patient-derived viral particles. If a particle in the aerosol coalesces with a contaminated mucous membrane, it will cease to be airborne and therefore will not be part of an aerosol. Staff should use appropriate hand hygiene when helping patients to remove nebulisers and oxygen masks. In addition, the current expert consensus from NERVTAG is that chest compressions are not considered to be procedures that pose a higher risk for respiratory infections including COVID-19.

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