Aerosol-Generating Medical Procedure Guidance Tool


This list of Aerosol-Generating Medical Procedures (AGMPs) is based on current evidence. This list is subject to an ongoing review process, and will be updated accordingly. Please continue to revisit this list, as guidance may evolve.

All Aerosol-Generating Medical Procedures (AGMP) require an N95 respirator if the patient has a suspected or confirmed acute viral respiratory infection. This includes viral respiratory pathogens such as influenza A or B or other common seasonal respiratory viruses including respiratory syncytial virus, rhinovirus, enterovirus, adenovirus, human metapneumovirus, coronavirus, and parainfluenza virus; novel pathogens such as COVID-19, SARS, MERS-CoV, avian influenza; and for suspected or confirmed viral hemorrhagic fever. Guidance is linked within the tool.

This list of procedures was reviewed by an expert working group made up of infection prevention and control physicians, workplace health and safety physicians, infection prevention and control practitioners, epidemiologists and respiratory therapists.

Whenever possible post the AGMP in progress sign on the patient's door for the duration of the procedure. This sign is only to be used for AGMP when the patient is also on Contact and Droplet precautions. If a patient is on a continuous AGMP this poster may be up for the duration of admission. In addition to an N95 respirator when performing an AGMP, gown, gloves and eye protection are also required. For more information about the PPE required, please see the AHS IPC guidance for Contact and Droplet Precautions, COVID-19 Interim Guidelines and Modified Respiratory Precautions and Alberta Health Services (AHS), Alberta Union of Provincial Employees (AUPE), Covenant Health, the Health Sciences Association of Alberta (HSAA), and United Nurses of Alberta (UNA), joint statement on the safe and effective use of personal protection equipment (PPE) during the COVID-19 pandemic.

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.

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
Aerosolized Medication Administration Yes Respiratory Illness Algorithm
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 Respiratory Illness Algorithm
Bi-level Positive Airway Pressure (e.g. BiPAP, CPAP) - Noninvasive Ventilation (NIV) Yes
Blow by Oxygen Administration with Nebulizer Yes -
Breath Hydrogen Test No -
Bronchial Artery Embolization - Open Procedure, Not Bronchoscopy No -
Bronchial Challenge (Pulmonary Function Studies) - Provocation with Nebulized Methacholine Yes -
Bronchoscopy Yes Respiratory Illness Algorithm
Cardiac Stress Tests No -
Cardiopulmonary Resuscitation (CPR) with Respiratory (BVM, Intubation) Yes Respiratory Illness Algorithm
Cardiopulmonary Resuscitation (CPR), Chest Compressions Alone No -
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) Yes WHS - Cryostat Aerosolization Report
Deep Tracheal Suctioning 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 -
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 -
Infants/Young Children - Heated Humidified High Flow Oxygen (HHHFO) Yes The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach
Intranasal Narcan Administration (If No BVM) No -
Intubation & Related Procedures (e.g., Manual Ventilation, Open Endotracheal Suctioning, Extubation) Yes Respiratory Illness Algorithm
Intubation with Neonates 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 - 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 - 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 No Respiratory Illness Algorithm
Nasopharyngeal (NP) Aspirates Using Wall-Mount Suction Under Review Respiratory Illness Algorithm
Nasopharyngeal (NP) Swabs No Respiratory Illness Algorithm
Nasopharyngoscopy or Flexible Laryngoscopy Procedures - with High Pressure Irrigation or Suction Yes -
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
Neonatal: CPAP in Isolette Yes -
NG & NJ Tube Placement No -
Open Respiratory or Airway Suctioning Yes Respiratory Illness Algorithm
Open Tracheostomy or Laryngectomy Tube, with Procedure or Manipulation Performed 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 Respiratory Illness Algorithm
Oxygen, Less Than & Including 15 LPM, Filtered Mask (E.G. FLO2max) - With Nebulizer Yes FLO2max Filtered Oxygen Mask
Oxygen / Medical Gas, Nebulized, Producing Visible Mist (Aerosols) (E.G. Cold, Medication, Small Volume, or Vibrating Mesh Nebulizers, I.E., Aerogen) Yes -
Oxygen, Non- Or Bubble Humidified, Less Than & Including 15 LPM, or Flow Limit of Humidification Device, Blow-By No Pediatric Oxygen Therapy: A Review & Update
Oxygen, Non-Humidified (Dry), Less Than & Including 15 LPM, Filtered Mask (E.G. FLO2max) - Without Nebulizer No FLO2max Filtered Oxygen Mask
Oxygen, Non-Humidified (Dry), Total Flow Greater Than 30 LPM (Or Flush Flow), Any Single or Combination of Devices (E.G., Non-Rebreather Mask Over Nasal Cannula, Venturi Devices, Dry Cold Nebulizer) 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, Non-Humidified (Dry), Total Flow Less Than & Including 30 LPM, Any Single (E.G., High Flow Nasal Cannula - HFNC, Masks With or Without Reservoir) or Combination of Devices (E.G., Non-Rebreathe Mask Over Nasal Cannula) No -
Oxygen Systems, Dry, With Flow Output Less Than & Including 30 LPM, Via Single or Combined Interface/Delivery Device (E.G. Nasal Cannula or Masks) No -
Pediatric Chest Tube Placement No -
Phlebotomy No -
Pleural Drains No -
Pleurex Insertions, Removals, & Drainage Procedures No -
Sawing Off Casts/Splints No -
Sputum Induction Yes Respiratory Illness Algorithm
Supraglottic Airways (i.e., LMA, King LT, iGel Used Pre-Hospital) Yes -
Throat Swab No -
Thoracentesis No -
Tracheostomy Care Yes Respiratory Illness Algorithm
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
Use of Propellant Freezing Sprays (Lab Use) 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 -
VQ Scan with Technegas No -
Xylocaine Gargle No -