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Coronavirus staff guidance University Hospitals Birmingham NHS Foundation Trust

Aerosol generating procedures

Aerosol generating procedures (AGPs) are medical procedures that can result in the release of aerosols from the respiratory tract. The criteria for an AGP are a high risk of aerosol generation and increased risk of transmission (from patients with a known or suspected respiratory infection).

Medical procedures that are considered to be aerosol generating and associated with an increased risk of respiratory transmission are:

  • awake* bronchoscopy (including awake tracheal intubation)
  • awake* ear, nose, and throat (ENT) airway procedures that involve respiratory suctioning
  • awake* upper gastro-intestinal endoscopy
  • dental procedures (using high speed or high frequency devices, for example ultrasonic scalers/high speed drills)
  • induction of sputum
  • respiratory tract suctioning**
  • surgery or post-mortem procedures (like high speed cutting / drilling) likely to produce aerosol from the respiratory tract (upper or lower) or sinuses.
  • tracheostomy procedures (insertion or removal)

* Awake including "conscious" sedation (excluding anaesthetised patients with secured airway).

** The available evidence relating to respiratory tract suctioning is associated with ventilation. In line with a precautionary approach, open suctioning of the respiratory tract, regardless of association with ventilation, has been incorporated into the current (COVID-19) AGP list. It is the consensus view of the UK IPC cell that only open suctioning beyond the oro-pharynx is currently considered an AGP, and that oral/pharyngeal suctioning is not an AGP.

Source: "National infection prevention and control manual for England", 8 June 2022.

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