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Aerosol Generating Medical Procedures

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Aerosol Generating Medical Procedures

Medical procedures and Aerosol Generating Medical Procedures (AGMPs) used for patients with confirmed or suspected COVID-19.

About AGMPs and decision making

AGMPs performed on patients with confirmed or suspected COVID-19 may generate aerosols in high concentrations, which could contain infectious SARS CoV-2 particles. This presents a risk for possible inhalation of the virus by individuals in the room where the AGMP is performed.

The B.C. AGMP expert group assesses medical procedures to determine which ones are considered AGMPs based on reviews of current information and evidence. Medical procedures are assessed using the COVID-19 AGMP Decision Framework.

COVID-19 AGMP decision framework

The COVID-19 AGMP Decision Framework provides a transparent and consistent framework to guide the B.C. AGMP expert group in making decisions on whether medical procedures are considered to be AGMPs in the context of the COVID-19 pandemic.

Procedures are assessed as:

  • Probable AGMP
  • Possible AGMP
  • Non-AGMP

These three categories were developed to describe the varying amount and quality of evidence currently available for each procedure. New evidence may continue to emerge and the list will be updated accordingly.

Health-care workers are encouraged to review the AGMP status and accompanying documents to guide their point-of-care risk assessment for determining what Personal Protective Equipment (PPE) is required and if other organizational measures need to be implemented to minimize risk.

For more information about aerosols, refer to COVID-19: Risk of SARS-CoV-2 Aerosol Transmission in Health-Care Settings.

AGMPs may be referred to as “aerosol-generating procedures” by some organizations. For consistency, B.C. provincial guidelines use the term AGMPs.

Guidance for health-care workers

Health-care workers are encouraged to review the AGMP status of the above medical procedures below and accompanying documents. Additionally, health care workers should:

  • Conduct a point-of-care risk assessment prior to performing any AGMPs to determine the appropriate personal protective equipment (PPE) required; and
  • Implement additional measures outlined in their local health authority or organizational AGMP guidelines; and
  • Refer to provincial, health authority or organizational guidance on PPE use and other measures to minimize risk.
Learn about PPE use

Review of medical procedures

Supplementary materials are available for procedures reviewed by the B.C. AGMP expert group. Procedures without supplementary material were previously considered as AGMPs and remain on the provincial list as probable AGMPs – they will be re-evaluated as needed.

The dates below indicate when the procedure’s AGMP status was last reviewed.

Medical Procedures and AGMP status
Medical Procedure Description/Status
Airway suctioning (deep suction and open tracheal suctioning): The B.C. AGMP Expert Group concludes there is no evidence that airway suctioning is, by itself, an AGMP, but it is often associated with procedures that are more likely to be AGMPs. It is those other procedures that would warrant the use of high levels of PPE (January 28, 2022)
Arterial blood gas: Non-AGMP (May 21, 2021)
Autopsy: Probable AGMP
Bronchoscopy and bronchoalveolar lavage: Probable AGMP (January 17, 2022)
Cardiopulmonary exercise testing: Non-AGMP (May 21, 2021)
Chest compressions alone: Non-AGMP
Clinical (bedside) swallow assessment: Non-AGMP (June 2, 2021)
CPR with bag valve mask ventilation: Possible AGMP (June 18, 2021)
Continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP): Probable AGMP (January 17, 2022)
Cough reflex testing: Possible AGMP (June 2, 2021)
Direct laryngoscopy: Probable AGMP
Flexible/fiber optic endoscopic evaluation of voice and swallowing: Possible AGMP (June 2, 2021)
Heated high flow nasal oxygen (e.g., AIRVO, Optiflow, Vapotderm: Non-AGMP): Non-AGMP (September 10, 2021)
Intra nasal naloxone: Non-AGMP (March 15, 2021): Intra nasal naloxone decision summary
Intubation and extubation procedures: Probable. Examples include: Hyperoxygenation using nasal prongs before intubation, manual ventilation before intubation, disconnecting the patient from the ventilator, breaking closed ventilation systems (intentionally or un-intentionally).
“Physical proning of patient” was removed based on AGMP Expert Group Discussion: Probable AGMP
Mastoidectomy: Possible AGMP (July 9, 2021)
Methacholine challenge (i.e., bronchoprovocation test): Possible Possible AGMP (May 21, 2021)
Nasopharyngeal aspirates: Possible AGMP (September 10, 2021)
Nasopharyngeal washes: Possible AGMP (September 10, 2021)
Nasopharyngeal scoping: Non-AGMP (June 17, 2021)
Nebulized therapy: Possible AGMP (January 17, 2022)
Non-heated nebulizer style of high flow oxygen (single or double flow): Possible AGMP (September 10, 2021)
Overnight oximetry: Non-AGMP (May 21, 2021)
Spirometry: Non-AGMP (September 10, 2021)
Sputum induction: Probable AGMP
Tracheotomy: Possible AGMP (March 4, 2022)
Tracheostomy care: Non-AGMP (April 1, 2022)
Transesophageal echocardiogram (TEE): Non-AGMP (June 4, 2021): TEE decision summary
Upper gastrointestinal endoscopy: Possible AGMP (May 10, 2021): Upper Gastrointestinal (GI) decision summary
Videofluoroscopic swallow study: Non-AGMP (June 2, 2021)

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Requests for Review

If you have a request for specific procedures for review by the B.C. AGMP expert group, contact picnet@phsa.ca

About the B.C. AGMP Expert Group

In B.C., the AGMP expert group reports to the Provincial Infection Control Network of B.C (PICNet). Its purpose is to:

  1. Review medical procedures requested by clinicians that are performed on patients with suspected (i.e., with COVID-19 risks) or confirmed COVID-19 in health-care settings to determine if the procedures are AGMPs; and,
  2. Maintain and update the provincial list of AGMPs as needed

Members of the B.C. AGMP expert group have diverse expertise, which includes but is not limited to medical microbiology, IPC, infectious diseases, aerosol mechanics research, workplace health and safety, respiratory therapy, critical care, emergency medicine, pediatrics, obstetrics, gynecology and BC Emergency Health Services.

The B.C. AGMP expert group developed and uses a decision framework to guide its decisions.  The group does not provide guidance on PPE use. Visit the PPE webpage for more information.