An aerosol-generating procedure (AGP) is a

medical Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practic ...

health-care Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health pr ...

procedure that a public health agency such as the

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...

or the United States

Centers for Disease Control and Prevention (CDC) The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georg ...

has designated as creating an increased risk of transmission of an

aerosol An aerosol is a suspension of fine solid particles or liquid droplets in air or another gas. Aerosols can be natural or anthropogenic. Examples of natural aerosols are fog or mist, dust, forest exudates, and geyser steam. Examples of anthropogen ...

borne

contagious disease A contagious disease is an infectious disease that is readily spread (that is, communicated) by transmission of a pathogen through contact (direct or indirect) with an infected person. A disease is often known to be contagious before medical ...

, such as

COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease quick ...

. The implication 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. Medical procedures that have been designated as AGPs include positive-pressure

mechanical ventilation Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move a ...

including BiPAP and

continuous positive airway pressure Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The ...

(CPAP),

high-frequency ventilation High-frequency ventilation is a type of mechanical ventilation which utilizes a respiratory rate greater than four times the normal value. (>150 (Vf) breaths per minute) and very small tidal volumes. High frequency ventilation is thought to reduce ...

tracheal intubation Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequentl ...

, airway suction,

tracheostomy Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision (cut) on the anterior aspect (front) of the neck and opening a direct airway through an incision in the trachea (windpipe). The r ...

chest physiotherapy Chest physiotherapy (CPT) are treatments generally performed by physical therapists and respiratory therapists, whereby breathing is improved by the indirect removal of mucus from the breathing passages of a patient. Other terms include respir ...

, nebuliser treatment,

sputum Sputum is mucus that is coughed up from the lower airways (the trachea and bronchi). In medicine, sputum samples are usually used for a naked eye examination, microbiological investigation of respiratory infections and cytological investigatio ...

induction,

bronchoscopy Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a trac ...

and ultrasonic

scaling and root planing Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus (scaling or debridement) and then smoothing, or planing, o ...

. Different public health agencies have different lists of AGPs. The term AGP became popular during the 2003 SARS epidemic, where small retrospective studies showed a higher rate of infection amongst healthcare workers in which the AGPs were performed.

COVID-19 pandemic

The COVID-19 pandemic has prompted research to measure the aerosols produced by patients during some AGPs including tracheal intubation and extubation, gastroscopies, colonoscopies and trans-nasal endoscopies. The AGPs studied generate less aerosols than a cough or even just breathing, so some AGPs may not increase the risk from aerosol-borne diseases such as

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

, high flow nasal cannula, nebuliser treatment or non-invasive ventilation. However data are still lacking for many AGPs.

References

Medical procedures {{med-stub