The guidance around Personal Protective Equipment continues to evolve as we learn more about the Covid -19 virus. An area of on-going focus is the PPE requirements for aerosol-generating procedures. On June 5, 2020, the CDC provided updated guidance within their Frequently Asked Questions. See below:
Which procedures are considered aerosol generating procedures in health care settings?
Some procedures performed on patients are more likely to generate higher concentrations of infectious respiratory aerosols than coughing, sneezing, talking, or breathing. These aerosol generating procedures (AGPs) potentially put healthcare personnel and others at an increased risk for pathogen exposure and infection.
Development of a comprehensive list of AGPs for healthcare settings has not been possible, due to limitations in available data on which procedures may generate potentially infectious aerosols and the challenges in determining if reported transmissions during AGPs are due to aerosols or other exposures.
There is neither expert consensus, nor sufficient supporting data, to create a definitive and comprehensive list of AGPs for healthcare settings.
Commonly performed medical procedures that are often considered AGPs, or that create uncontrolled respiratory secretions, include:
• open suctioning of airways
• sputum induction
• cardiopulmonary resuscitation
• endotracheal intubation and extubation
• non-invasive ventilation (e.g., BiPAP, CPAP)
• manual ventilation
Based on limited available data, it is uncertain whether aerosols generated from some procedures may be infectious, such as:
• nebulizer administration*
• high flow O2 delivery
*Aerosols generated by nebulizers are derived from medication in the nebulizer. It is uncertain whether potential associations between performing this common procedure and increased risk of infection might be due to aerosols generated by the procedure or due to increased contact between those administering the nebulized medication and infected patients.
References related to aerosol generating procedures:
Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J (2012) Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review. PLoS ONE 7(4); https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3338532/#!po=72.2222external iconexternal icon)
To see their most recent responses to Frequently Asked Questions, visit their website at https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-faq.html