Aerosol-Generating Medical Procedure Guidance Tool

Infection Prevention & Control

This list of Aerosol-Generating Medical Procedures (AGMPs) is based on current evidence. It is subject to an ongoing review process and will be updated accordingly.

This list of Aerosol-Generating Medical Procedures (AGMPs) is based on current evidence. It is subject to an ongoing review process and will be updated accordingly.

As always, a risk assessment is recommended.

1 Patients on contact and droplet precautions may or may not have symptoms and may have not had a positive laboratory test.

Process

Adults

Pediatrics

PPE and signage

Post the AGMP in progress sign on the patient's door/bedspace for the duration of the procedure.

For more information, refer to the following AHS IPC guidance:


Find a Procedure & Related N95 Use Requirement

To find a procedure and its related N95 use requirement, type a keyword into the filter bar or scan the full list.

view-all
Options
Procedure N95 Documentation
Aerosol Generating Dental Instruments Such As: 3-In-1 Water / Air Syringe; Polishing Rotary Equipment, Rotary Instruments/Handpieces (All Speeds), Trimming Handpieces Yes COVID-19 Scientific Advisory Group Rapid Response Report
Any Procedure Done with Regional Anesthesia No IPC Recommendations for Suspected or Confirmed COVID-19 Patients requiring Urgent or Emergent Surgery
Automated External Defibrillator (AED) No -
Autopsies Yes Aerosol Generation During Bone-Sawing Procedures in Veterinary Autopsies
Bag Valve Masks, Includes Where Performed with ECT Yes Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review
Bair Hugger No Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review
Bi-level Positive Airway Pressure (e.g. BiPAP/CPAP, neonatal CPAP in isolette) - Noninvasive ventilation (NIV) Yes
Blow by Oxygen Administration with Nebulizer / Aersolized Medication Yes
Breath Hydrogen Test No -
Bronchial Artery Embolization - Open Procedure, Not Bronchoscopy No -
Bronchial Challenge (Pulmonary Function Studies) - Provocation with Nebulized Methacholine Yes Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review
Bronchoscopy Yes Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review
Cardiac Stress Tests No -
Cardiopulmonary Resuscitation (CPR) with Respiratory (BVM, Intubation) Yes Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review
Cardiopulmonary Resuscitation (CPR), Chest Compressions Alone No Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review
Chest Physiotherapy No Respiratory Illness Algorithm
Chest Tube for Pneumothorax No -
Cough - Manual Cough Assist (Not Induced Sputum) No -
Cough - Mechanical Cough Assist, Mechanical Insufflation Exsufflation (MIE) Yes -
Cough from a Trach No -
Cutting / Shaving Frozen Sections (cryostat and/or use of propellant freezing spray) Yes
Directed Spray of Fluid into the Nasal/Oral Mucous Membranes (Includes Non-Aerosol Sprays Lidodan, Xylocaine) No -
Entonox - Administration of Nitrous Oxide No COVID-19 Scientific Advisory Group Rapid Response Report (Similar to Administration of Low Flow Oxygen)
Expiratory Muscle Strength Training No -
Extubation Yes Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review
Gastro-Jejunostomy Tube Placement No -
Gastrostomy No -
GI Endoscopy No -
High Frequency Oscillation to Loosen Mucous (Aerobika, Flutter Devices) No -
High Frequency Oscillatory Ventilation Yes Respiratory Illness Algorithm
Hyperbaric Therapy No -
Incentive Spirometry No -
Intranasal Narcan Administration (If No BVM) No -
Intubation & Related Procedures (e.g., Manual Ventilation) Yes
Jejunostomy No -
Labour & Delivery (All Stages) No -
Live Attenuated Influenza Vaccine No -
Lung Ablation - Open Procedure, not via Bronchoscopy No -
Lung Biopsy No -
Lung Testing (Pulmonary Function Studies) - with Filter (e.g. Spirometry, DLCO, Peak Flow Testing) No -
Lung Testing (Pulmonary Function Studies) - with NO Filter (e.g. Spirometry, DLCO, Peak Flow Testing) No -
Lung Volume Recruitment Maneuvers (LVRM) Yes -
Lung Volume Testing (Pulmonary Function Studies) - Body Box Door Closed, Filter in Place No -
Manual resuscitator (Includes Bag Valve Mask, T-piece, Flow Inflating) Yes -
Mechanical Ventilation Using Physical Proning - Closed System No -
Mechanical Ventiliation, Filtered Air and Cuffed Tube - closed system No Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19) - Alhazzani et al. (2020)
Mechanical ventiliation, unfiltered air, uncuffed tube - open system Yes -
Metered Dose Inhalers (MDI) With or Without Spacer (e.g. "Puffers") No Nebule to Metered Dose Inhaler Therapeutic Interchange – Respiratory Medications
Nasoendoscopic Procedures Including Fiberoptic Endoscopic Evaluation (FEE) of Swallowing No -
Nasopharyngeal (NP) Aspirates using Manual Technique or using Wall-mount Suction No Respiratory Illness Algorithm
Nasopharyngeal (NP) Swabs No Risk of dispersion or aerosol generation and infection transmission with nasopharyngeal and oropharyngeal swabs for detection of COVID-19: a systematic review
Nasopharyngoscopy or Flexible Laryngoscopy Procedures - with High Pressure Irrigation or Suction Yes Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review
Nasopharyngoscopy or Flexible Laryngoscopy Procedures - without High Pressure Irrigation or Suction No Aerosol Generating Procedures & Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review
NG & NJ Tube Placement No -
Suctioning of Open Respiratory or Airway; or Deep Tracheal Suctioning Yes Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review
Open Tracheostomy or Laryngectomy Tube, with procedure or manipulation performed; Tracheostomy care Yes COVID-19 Scientific Advisory Group Rapid Evidence Report
Open Tracheostomy or Laryngectomy Tube, without Procedure or Manipulation Performed No -
Opthalmology - Lacrimal Gland/Duct Manipulation Including Tear Films on Conjunctiva No -
Oral Suctioning or Suctioning of the Oropharynx No Respiratory Illness Algorithm
Orogastric Tube Placement No -
Oxygen, Bubble-Humidified, Flow Less Than & Including 6 LPM (e.g., Nasal Cannula) No -
Oxygen Devices with Total Delivered Flow Greater Than 30 LPM, Including Flush Flow (e.g. Venturi Devices, Or Combination of Interfaces) Yes Flush flow: when flow is not precisely known by a numerical value displayed on a flowmeter, flowrates must be assumed to be in excess of 30 LPM
Oxygen, Flush Flow, Regardless of Device Used Yes Flush flow: when flow is not precisely known by a numerical value displayed on a flowmeter, flowrates must be assumed to be in excess of 30 LPM
Oxygen, Heated Humidified High Flow (HHHFO) (e.g. AIRVO, Optiflow or Vapotherm) Yes Scientific Advisory Group Rapid Response Report: Oxygen Therapy
Oxygen, Less Than & Including 15 LPM, Filtered Mask (e.g. FLO2max) - with nebulizer/aerosolized medication administration Yes
Oxygen / Medical Gas, Nebulized, Producing Visible Mist (Aerosols) (e.g. Cold, Medication, Small Volume, or Vibrating Mesh Nebulizers, i.e., Aerogen) Yes Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review
Oxygen Dry or Bubble Humidified, Flow Less Than & Including 15 LPM, (e.g. nasal cannula, simple mask, blow by). Note: do not exceed the flow of the humidification device. No Pediatric Oxygen Therapy: A Review & Update
Oxygen, Non-Humidified (Dry), Less Than & Including 15 LPM, Filtered Mask (e.g. FLO2max) - Without Nebulizer No Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review
Oxygen / Oxygen Systems (dry) with Total Flow Greater Than 30 LPM including Flush Flow (e.g. venturi devices, mask over nasal cannula, dry cold nebulizer) Yes
Oxygen / Oxygen Systems (dry, non-humidified) Output Less Than & Including 30 LPM, any single (e.g. nasal cannula or non-rebreather mask) or combined devices (e.g. non-rebreather over nasal cannula) No -
Oxygen / Oxygen Systems (dry, non-humidified) Output Less Than & Including 30 LPM, any single (e.g. nasal cannula or non-rebreather mask) or combined devices (e.g. non-rebreather over nasal cannula) No -
Pediatric Chest Tube Placement No -
Phlebotomy No -
Pleural Drains No -
PleurX Catheter Insertions, Removals, & Drainage Procedures No -
Sawing Off Casts/Splints No -
Sputum Induction Yes Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review
Supraglottic Airways (i.e., LMA, King LT, iGel Used Pre-Hospital) Yes -
Throat Swab No -
Thoracentesis No -
Transesophageal Echocardiography (TEE) No -
Transsphenoidal Surgery Yes Safety Recommendations for Evaluation and Surgery of the Health & Neck During the COVID-19 Pandemic - Givi et al.
Use of Propellant (e.g. Compressed Gas Delivery Method) Anesthetic Freezing Sprays on Mucosal Surfaces, such as Oral Lidocaine Yes Tuberculous infection Associated with Tissue Processing - California
Video Flurographic Swallowing Study (VFSS) No -
Vocal Exercises, Increased Loudness No -
VQ Scan with Aerosol-Based Ventilation Agents Yes Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review
VQ Scan with Technegas No -
Gargle Liquid No -