Aerosol-generating procedure
An aerosol-generating procedure (AGP) is a medical or health-care procedure that a public health agency such as the World Health Organization or the United States Centers for Disease Control and Prevention (CDC) has designated as creating an increased risk of transmission of an aerosol borne contagious disease,[1] such as COVID-19. The presumption is that the risk of transmission of the contagious disease from a patient having an AGP performed on them is higher than for a patient who is not having an AGP performed upon them. This then informs decisions on infection control, such as what personal protective equipment (PPE) is required by a healthcare worker performing the medical procedure, or what PPE healthcare workers are allowed to use.
Designation of a procedure as an AGP may indicate a presumption that such a procedure causes the emission of more aerosols than a patient not undergoing the procedure. Such a position is at increasing odds with the scientific understanding of bioaerosol production and airborne transmission of respiratory infections.
Medical procedures that have been designated as AGPs include positive-pressure
COVID-19 pandemic
The COVID-19 pandemic[9][1] has prompted research to measure the aerosols produced by patients during some AGPs including tracheal intubation and extubation,[10][11][12] gastroscopies, colonoscopies and trans-nasal endoscopies.[13] The AGPs studied generate less aerosols than a cough or even just breathing,[14][10][11][12] so some AGPs may not increase the risk from aerosol-borne diseases such as COVID-19 significantly above that of a patient breathing or coughing normally. In a study that looked for viral RNA in air samples taken near patients with COVID-19, no correlation was found between finding viral RNA and mechanical ventilation, high flow nasal cannula, nebuliser treatment or non-invasive ventilation.[15] However data are still lacking for many AGPs. Conversely, fine and ultrafine aerosols constitute the majority of all detectable viral RNA in COVID-19 positive symptomatic and asymptomatic individuals during breathing, talking, and singing.[16]
References
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Small size droplets (< 1 μm) predominated the total number of droplets expelled when coughing
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These observations confirm that there is a substantial probability that normal speaking causes airborne virus transmission in confined environments.
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Given the lack of evidence for droplet and fomite transmission and the increasingly strong evidence for aerosols in transmitting numerous respiratory viruses, we must acknowledge that airborne transmission is much more prevalent than previously recognized.
- ^ MacIntyre, C Raina; Veness, Benjamin; Ananda-Rajah, Michelle (June 16, 2021). ""At last, health, aged care and quarantine workers get the right masks to protect against airborne coronavirus"". The_Conversation_(website). Retrieved 21 March 2024.
The existing guidelines said health providers working around COVID-19 patients should wear a surgical mask. It restricted use of the more protective P2 or N95 masks, which stop airborne particles getting through, to very limited scenarios. These involved "aerosol-generating procedures", such as inserting a breathing tube.
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- PMID 22563403.
- from the original on 2020-08-21.
- ^ PMID 33022093.
- ^ PMID 33047327.
- ^ medRxiv 10.1101/2021.08.23.21262441v1.
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- PMID 34358292. Retrieved March 20, 2024.