An aerosol-generating procedure (AGP) is a

medical Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...

or health-care procedure that a public health agency such as the

World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...

or the United States Centers for Disease Control and Prevention (CDC) has designated as creating an increased risk of transmission of an

aerosol An aerosol is a suspension (chemistry), suspension of fine solid particles or liquid Drop (liquid), droplets in air or another gas. Aerosols can be generated from natural or Human impact on the environment, human causes. The term ''aerosol'' co ...

borne

contagious disease A contagious disease is an infectious disease that can be spread rapidly in several ways, including direct contact, indirect contact, and droplet contact. These diseases are caused by organisms such as parasites, bacteria, fungi, and viruses. ...

, such as

COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the coronavirus SARS-CoV-2. In January 2020, the disease spread worldwide, resulting in the COVID-19 pandemic. The symptoms of COVID‑19 can vary but often include fever ...

. The presumption 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, or what PPE healthcare workers are allowed to use. Designation of a procedure as an AGP may indicate a presumption that such a procedure causes the emission of more aerosols than a patient not undergoing the procedure. Such a position is at increasing odds with the scientific understanding of bioaerosol production and airborne transmission of respiratory infections. At times, healthcare workers concerned about their own risk of contracting airborne infections have been denied access to

respirators A respirator is a device designed to protect the wearer from inhaling hazardous atmospheres including lead, lead fumes, vapors, gases and particulate matter such as dusts and airborne pathogens such as viruses. There are two main categories o ...

outside the employment of AGPs. Medical procedures that have been designated as AGPs include positive-pressure

mechanical ventilation Mechanical ventilation or assisted ventilation is the Medicine, medical term for using a ventilator, ventilator machine to fully or partially provide artificial ventilation. Mechanical ventilation helps move air into and out of the lungs, wit ...

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 a ...

(CPAP), high-frequency ventilation,

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

, airway suction,

tracheostomy Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision on the front of the neck to open a direct airway to the trachea. The resulting stoma (hole) can serve independently as an airway ...

, chest physiotherapy, 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 Cytopathology, cytological ...

induction, bronchoscopy and ultrasonic scaling and root planing. 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. Conversely, fine and ultrafine aerosols constitute the majority of all detectable viral RNA in

positive symptomatic and asymptomatic individuals during breathing, talking, and singing.

References

{{reflist Medical procedures