Aerosol Generating Procedures in Adult Social Care

We would like to audit the use of AGPs (aerosol generating procedures) in Adult Social Care services and find out whether staff have been fit tested for FFP3 masks. Whilst wider use of FFP3s in ASC is not currently recommended, there is a possibility that FFP3s may be recommended in the future (if there is a new variant of concern of COVID-19 which is particularly transmissible, or if there is a  new virus spread through the airborne route).

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What is an Aerosol Generating Procedure (AGP)?

“An AGP is a medical procedure that can result in the release of airborne particles (aerosols) from the respiratory tract when treating someone who is suspected or confirmed to be suffering from an infectious agent transmitted by the airborne or droplet route. Only staff who are needed to undertake the procedure should be present, wearing airborne PPE/RPE precautions.

Filtering face piece class 3 (FFP3) respirators are required when you are undertaking AGPs on a person with suspected or confirmed COVID-19 infection, or another infection spread by the airborne or droplet route. FFP3 respirators should be removed outside of the room where the AGP was carried out and disposed of. They should then be replaced with a type I, II or IIR mask depending on what is most appropriate for the next task. If undertaking an AGP in someone’s own home, FFP3 respirators and face masks should be removed and disposed of when leaving the house.”

The list of medical procedures that are considered to be aerosol generating or associated with an increased risk of respiratory transmission is:

– tracheal intubation and extubation

– manual ventilation

– tracheotomy or tracheostomy procedures (insertion or removal)

– bronchoscopy

– dental procedures (using high speed devices, for example ultrasonic scalers/high speed drills)

– non-invasive ventilation (NIV); bi-level positive airway pressure ventilation (BiPAP) and continuous positive airway pressure ventilation (CPAP)

– high flow nasal oxygen (HFNO)

– high frequency oscillatory ventilation (HFOV)

– induction of sputum using nebulised saline

– respiratory tract suctioning*

– upper ear, nose, and throat (ENT) airway procedures that involve respiratory suctioning*

– upper gastro-intestinal endoscopy where open suction of the upper respiratory tract* occurs beyond the oro-pharynx

– high speed cutting in surgery/post-mortem procedures if respiratory tract/paranasal sinuses involved

“The available evidence relating to respiratory tract suctioning is associated with ventilation. In line with a precautionary approach, open suctioning of the respiratory tract regardless of association with ventilation has been incorporated into the current (COVID-19) AGP list. It is the consensus view of the UK IPC cell that only open suctioning beyond the oro-pharynx is currently considered an AGP, that is oral/pharyngeal suctioning is not an AGP.”

Link to the form: https://docs.google.com/forms/d/e/1FAIpQLSeg9GC6EBpE2clccA8B9b9iu-NjUQfbsh8BTxU_roJfcuUS0A/viewform?usp=sf_link