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Aerosol-Generating Medical Procedure Guidance Tool

novel coronavirus (COVID-19)

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.

Use this tool to determine which procedures are considered to be aerosol-generating. 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.

Find a Procedure & Related N95

To find a procedure and its related N95 select a procedure from the dropdown or use the search bar.

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 Respiratory Illness Algorithm
Bi-level Positive Airway Pressure (e.g. BiPAP, CPAP) - Noninvasive Ventilation (NIV) Yes Respiratory Illness Algorithm
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
Bubble Humidified Oxygen - e.g. Nasal Cannula No  
Cardiac Stress Tests No  
Cardiopulmonary Resuscitation (CPR) with Respiratory (BVM, Intubation) Yes Respiratory Illness Algorithm
Cardiopulmonary Resuscitation (CPR), Chest Compressions Alone Unresolved  
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  
Dry Oxygen via Non-rebreather Mask with Reservoir No  
Entonox - Administration of Nitrous Oxide No COVID-19 Scientific Advisory Group Rapid Response Report (Similar to Administration of Low Flow Oxygen)
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
Humidified Blow by Oxygen Administration No Pediatric Oxygen Therapy: A Review & Update
Humidified High Flow Oxygen Systems e.g. ARVO, Optiflow or Vapotherm (typically >30 LPM) 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 No  
Live Attenuated Influenza Vaccine No  
Low Flow Dry Oxygen Systems (e.g., Nasal Prongs or Masks) No COVID-19 Scientific Advisory Group Rapid Response Report

Essential COVID-19 Information for Physicians, Respiratory Therapy, & Nurses on the Use of Oxygen Therapy
Lung Ablation - Open Procedure, not via Bronchoscopy No  
Lung Biopsy No  
Lung Testing (Pulmonary Function Studies) - with Filter (e.g. Spirometry, DLCO) No  
Lung Testing (Pulmonary Function Studies) - with NO Filter (e.g. Spirometry, DLCO) No  
Lung Volume Recruitment Maneuvers (LVRM) Yes  
Lung Volume Testing (Pulmonary Function Studies) - Body Box Door Closed, Filter in Place No  
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  
Nasoendoscopic Procedures Including Fiberoptic Endoscopic Evaluation (FEE) of Swallowing No  
Nasopharyngeal (NP) Aspirates No 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
Nebulized Therapy or Aerosolized Medication Administration Yes Respiratory Illness Algorithm
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 (Dry) Delivered by a Venturi Device Yes

Essential COVID-19 Information for Physicians, Respiratory Therapy, & Nurses on the Use of Oxygen Therapy

Although The Risk Is Low, Venturi Devices Deliver High Gas Flows (>15L) When Considering Entrained Air

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  
Xylocaine Gargle No