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.
Last Updated: December 22, 2022
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.
As always, a risk assessment is recommended.
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. There are a number of procedures where there is no evidence base to guide decisions. In these situations, we have extrapolated from similar procedures where there is evidence and used the expert opinion of the working group. Where possible, applicable literature has been cited.
In adults, all 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 recommendation for adults is currently under review.
In pediatrics, there is a paucity of data and therefore N95 respirators are only used with suspected or confirmed influenza (all strains), COVID-19 and emerging viral infections when an AGMP is anticipated or underway.
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 on Modified Respiratory precautions for COVID-19 or on Contact and Droplet precautions for other respiratory pathogens. 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 the 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.
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 | |
|---|---|---|---|
| 0010, view-all | 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 |
| 0012, view-all | Aerosolized Medication Administration | Yes | Respiratory Illness Algorithm |
| 0020, view-all | Any Procedure Done with Regional Anesthesia | No | IPC Recommendations for Suspected or Confirmed COVID-19 Patients requiring Urgent or Emergent Surgery |
| 0030, view-all | Automated External Defibrillator (AED) | No | - |
| 0040, view-all | Autopsies | Yes | Aerosol Generation During Bone-Sawing Procedures in Veterinary Autopsies |
| 0050, view-all | Bag Valve Masks, Includes Where Performed with ECT | Yes | Respiratory Illness Algorithm |
| 0060, view-all | Bi-level Positive Airway Pressure (e.g. BiPAP, CPAP) - Noninvasive Ventilation (NIV) | Yes | |
| 0062, view-all | Blow by Oxygen Administration with Nebulizer | Yes | - |
| 0064, view-all | Breath Hydrogen Test | No | - |
| 0070, view-all | Bronchial Artery Embolization - Open Procedure, Not Bronchoscopy | No | - |
| 0080, view-all | Bronchial Challenge (Pulmonary Function Studies) - Provocation with Nebulized Methacholine | Yes | - |
| 0090, view-all | Bronchoscopy | Yes | Respiratory Illness Algorithm |
| 0110, view-all | Cardiac Stress Tests | No | - |
| 0120, view-all | Cardiopulmonary Resuscitation (CPR) with Respiratory (BVM, Intubation) | Yes | Respiratory Illness Algorithm |
| 0130, view-all | Cardiopulmonary Resuscitation (CPR), Chest Compressions Alone | No | - |
| 0140, view-all | Chest Physiotherapy | No | Respiratory Illness Algorithm |
| 0150, view-all | Chest Tube for Pneumothorax | No | - |
| 0160, view-all | Cough - Manual Cough Assist (Not Induced Sputum) | No | - |
| 0170, view-all | Cough - Mechanical Cough Assist, Mechanical Insufflation Exsufflation (MIE) | Yes | - |
| 0180, view-all | Cough from a Trach | No | - |
| 0190, view-all | Cutting/Shaving Frozen Sections (Cryostat) | Yes | WHS - Cryostat Aerosolization Report |
| 0200, view-all | Deep Tracheal Suctioning | Yes | - |
| 0210, view-all | Directed Spray of Fluid into the Nasal/Oral Mucous Membranes (Includes Non-Aerosol Sprays Lidodan, Xylocaine) | No | - |
| 0230, view-all | Entonox - Administration of Nitrous Oxide | No | COVID-19 Scientific Advisory Group Rapid Response Report (Similar to Administration of Low Flow Oxygen) |
| 0232, view-all | Expiratory Muscle Strength Training | No | - |
| 0240, view-all | Gastro-Jejunostomy Tube Placement | No | - |
| 0250, view-all | Gastrostomy | No | - |
| 0260, view-all | GI Endoscopy | No | - |
| 0270, view-all | High Frequency Oscillation to Loosen Mucous (Aerobika, Flutter Devices) | No | - |
| 0280, view-all | High Frequency Oscillatory Ventilation | Yes | Respiratory Illness Algorithm |
| 0310, view-all | Hyperbaric Therapy | No | - |
| 0320, view-all | Incentive Spirometry | No | - |
| 0330, view-all | Infants/Young Children - Heated Humidified High Flow Oxygen (HHHFO) | Yes | The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach |
| 0340, view-all | Intranasal Narcan Administration (If No BVM) | No | - |
| 0350, view-all | Intubation & Related Procedures (e.g., Manual Ventilation, Open Endotracheal Suctioning, Extubation) | Yes | Respiratory Illness Algorithm |
| 0360, view-all | Intubation with Neonates | Yes | - |
| 0370, view-all | Jejunostomy | No | - |
| 0380, view-all | Labour & Delivery (All Stages) | No | - |
| 0390, view-all | Live Attenuated Influenza Vaccine | No | - |
| 0410, view-all | Lung Ablation - Open Procedure, not via Bronchoscopy | No | - |
| 0420, view-all | Lung Biopsy | No | - |
| 0430, view-all | Lung Testing (Pulmonary Function Studies) - with Filter (e.g. Spirometry, DLCO, Peak Flow Testing) | No | - |
| 0440, view-all | Lung Testing (Pulmonary Function Studies) - with NO Filter (e.g. Spirometry, DLCO, Peak Flow Testing) | No | - |
| 0450, view-all | Lung Volume Recruitment Maneuvers (LVRM) | Yes | - |
| 0460, view-all | Lung Volume Testing (Pulmonary Function Studies) - Body Box Door Closed, Filter in Place | No | - |
| 0462, view-all | Manual resuscitator (Includes Bag Valve Mask, T-piece, Flow Inflating) | Yes | - |
| 0470, view-all | Mechanical Ventilation Using Physical Proning - Closed System | No | - |
| 0480, view-all | 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) |
| 0490, view-all | Mechanical Ventiliation, Unfiltered Air - Open System | Yes | - |
| 0492, view-all | Metered Dose Inhalers (MDI) With or Without Spacer (e.g. "Puffers") | No | Nebule to Metered Dose Inhaler Therapeutic Interchange – Respiratory Medications |
| 0500, view-all | Nasoendoscopic Procedures Including Fiberoptic Endoscopic Evaluation (FEE) of Swallowing | No | - |
| 0510, view-all | Nasopharyngeal (NP) Aspirates Using Manual Technique | No | Respiratory Illness Algorithm |
| 0511, view-all | Nasopharyngeal (NP) Aspirates Using Wall-Mount Suction | Under Review | Respiratory Illness Algorithm |
| 0520, view-all | Nasopharyngeal (NP) Swabs | No | Respiratory Illness Algorithm |
| 0530, view-all | Nasopharyngoscopy or Flexible Laryngoscopy Procedures - with High Pressure Irrigation or Suction | Yes | - |
| 0540, view-all | 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 |
| 0560, view-all | Neonatal: CPAP in Isolette | Yes | - |
| 0570, view-all | NG & NJ Tube Placement | No | - |
| 0580, view-all | Open Respiratory or Airway Suctioning | Yes | Respiratory Illness Algorithm |
| 0590, view-all | Open Tracheostomy or Laryngectomy Tube, with Procedure or Manipulation Performed | Yes | COVID-19 Scientific Advisory Group Rapid Evidence Report |
| 0600, view-all | Open Tracheostomy or Laryngectomy Tube, without Procedure or Manipulation Performed | No | - |
| 0610, view-all | Opthalmology - Lacrimal Gland/Duct Manipulation Including Tear Films on Conjunctiva | No | - |
| 0620, view-all | Oral Suctioning or Suctioning of the Oropharynx | No | Respiratory Illness Algorithm |
| 0630, view-all | Orogastric Tube Placement | No | - |
| 0634, view-all | Oxygen, Bubble-Humidified, Flow Less Than & Including 6 LPM (E.G., Nasal Cannula) | No | - |
| 0632, view-all | 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 |
| 0640, view-all | 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 |
| 0642, view-all | Oxygen, Heated Humidified High Flow (HHHFO) (E.G. AIRVO, Optiflow or Vapotherm) | Yes | Respiratory Illness Algorithm |
| 0644, view-all | Oxygen, Less Than & Including 15 LPM, Filtered Mask (E.G. FLO2max) - With Nebulizer | Yes | FLO2max Filtered Oxygen Mask |
| 0646, view-all | Oxygen / Medical Gas, Nebulized, Producing Visible Mist (Aerosols) (E.G. Cold, Medication, Small Volume, or Vibrating Mesh Nebulizers, I.E., Aerogen) | Yes | - |
| 0648, view-all | 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 |
| 0649, view-all | Oxygen, Non-Humidified (Dry), Less Than & Including 15 LPM, Filtered Mask (E.G. FLO2max) - Without Nebulizer | No | FLO2max Filtered Oxygen Mask |
| 0650, view-all | 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 |
| 0652, view-all | 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 | - |
| 0654, view-all | 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 | - |
| 0656, view-all | Pediatric Chest Tube Placement | No | - |
| 0658, view-all | Phlebotomy | No | - |
| 0660, view-all | Pleural Drains | No | - |
| 0670, view-all | Pleurex Insertions, Removals, & Drainage Procedures | No | - |
| 0680, view-all | Sawing Off Casts/Splints | No | - |
| 0690, view-all | Sputum Induction | Yes | Respiratory Illness Algorithm |
| 0700, view-all | Supraglottic Airways (i.e., LMA, King LT, iGel Used Pre-Hospital) | Yes | - |
| 0710, view-all | Throat Swab | No | - |
| 0720, view-all | Thoracentesis | No | - |
| 0730, view-all | Tracheostomy Care | Yes | Respiratory Illness Algorithm |
| 0740, view-all | Transesophageal Echocardiography (TEE) | No | - |
| 0750, view-all | Transsphenoidal Surgery | Yes | Safety Recommendations for Evaluation and Surgery of the Health & Neck During the COVID-19 Pandemic - Givi et al. |
| 0760, view-all | 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 |
| 0770, view-all | Use of Propellant Freezing Sprays (Lab Use) | Yes | Tuberculous infection Associated with Tissue Processing - California |
| 0780, view-all | Video Flurographic Swallowing Study (VFSS) | No | - |
| 0782, view-all | Vocal Exercises, Increased Loudness | No | - |
| 0784, view-all | VQ Scan with Aerosol-Based Ventilation Agents | Yes | - |
| 0786, view-all | VQ Scan with Technegas | No | - |
| 0790, view-all | Xylocaine Gargle | No | - |
