Aerosol generating procedures (AGPs) are procedures performed on patients that are more likely to generate higher concentrations of infectious respiratory aerosols than coughing, sneezing, talking or breathing. These AGPs may put healthcare workers (HCW) at an increased risk for exposure and infection. AGPs can induce the production of aerosols of various sizes including droplet nuclei. Medical procedures that generate aerosols or droplet nuclei in high concentration present a risk for opportunistic airborne transmission of pathogens not otherwise spread by airborne route (eg. TB).
Procedures with potential to generate respiratory aerosols:
- Non-invasive ventilation e.g. Bi-level, CPAP/Autopap/ASV/home ventilators
- Sputum induction
- Nasopharyngeal washing, aspirate, scoping and testing
- Pulmonary function testing
- Spirometry
- High-flow oxygen
- Breaking closed ventilation system, intentional (e.g. open suctioning)
- Cardio-pulmonary resuscitation (CPR)
- Tracheostomy care
- Chest physiotherapy (manual and mechanical cough assist device)
- Administration of aerosolizing or nebulizing medications
- Abscess/wound irrigation (non-respiratory TB)
- High flow oxygen Nebulizer
- Bronchoscopy and bronchoalveolar lavage
- Laryngoscopy
- Airway suctioning
- Bag mask ventilation
- High frequency oscillatory ventilation
- Tracheostomy Speech language pathologists’ procedures (instrumental and non-instrumental) that trigger cough reflex
- E.N.T. procedures that trigger cough reflex
- Surgery
Definitions:
AA- Administrative Assistant
CRC- Clinical Research Center
CRM- Clinical Research Manager
CTRB- Clinical Translational Research Building
CTSI – Clinical and Translational Science Institute
UF- University of Florida
PROCEDURES
- Only essential AGPs should be performed as part of an approved protocol in the CRC.
- AGPs may need to be put on hold or suspended temporarily based on factors related to staffing, environmental conditions and/or availability of other resources.
- The CRC may limit the number of AGPs to be performed in a single day. For the CRC exercise physiology area, only one AGP procedure may be scheduled in the morning between 8 a.m. – 12 p.m.; and only one AGP procedure may be scheduled in the afternoons between 1 p.m. – 5 p.m.
- Patient/participant should be carefully assessed prior to arrival by research team. Patient/participant will be carefully screened and assessed prior to entry to CRC for signs and symptoms of known or suspected airborne infection, influenza-like illness, and acute respiratory infection. COVID-19 testing must be done within 3 days prior to scheduled visit and results must be negative and documented.
- For all AGPs performed in the CRC, the highest level of appropriate personal protective equipment (PPE) and environmental controls will be required. All clinical, medical and research personal will use an N95 respirator mask with additional eye protection (e.g. goggles, face shield), gloves and gown when performing or assisting with AGPs.
- All AGPs should be pre-scheduled and assigned to be conducted in an enclosed private room with the door closed. Patient door signs will be posted.
- The number of healthcare workers and staff in the room will be limited to only those necessary for the procedure. Anyone at the bedside or in the room should wear the same level of PPE as the person performing the procedure. Staff that are considered to be at high risk should not participate in AGPs.
- All healthcare workers should perform hand hygiene before donning and after removing PPE and upon leaving the room/area.
- The door should remain closed for 60 minutes following the procedure. Clinicians may exit the room during this time, but if the clinician stays in the room during this period, they should stay in the same PPE as what they wore during the procedure.
- Eye and face protection should be removed only after leaving the room/area and then disposed of in either a hands-free waste receptacle (if disposable) or in a separate receptacle to go for reprocessing (if reusable).
- After the appropriate amount of time has passed and the patient/participant has been discharged, then Environmental Services (Housekeeping) may enter and complete the terminal clean. Housekeeping personnel must enter the room with an ear loop mask, face shield, gown and gloves.
- Cleaning and disinfection: After each AGP, all horizontal surfaces and high-touch surfaces shall be cleaned per institutional cleaning and disinfection procedures using hospital-grade disinfectants for healthcare settings.